Although the USA once claimed the dubious honour of being the seat of the ‘Spanish ‘Flu’ pandemic, with an outbreak in March 1918 at Camp Funston, Fort Riley, Kansas, new research supports the theory that the disease originated at the British army bases of Etaples and Aldershot. In fact, the official report on the pandemic, published in October 1920 by the Ministry of Health, noted that as early as 1889 that there had been a marked increase in the number of deaths due to influenza-type symptoms.
Soon after the outbreak of war over 20 Infantry Base Depots were operating in France for the reception and training of newly arrive soldiers, but, as the war continued, it was decided to concentrate most of these at Etaples, 20 miles south of Boulogne. With around 100,000 British and Imperial troops in residence at any one time, over one million men passed through the notorious ‘Bull Ring’ training ground during the war. Although there were 24 hospitals on site, there were few permanent buildings.
As early as December 1916, dozens of soldiers at the camp had fallen ill, complaining of aches, pains, cough and shortness of breath. Mortality amongst the sick was as high as 40 per cent, with some displaying what would later became known as a key diagnostic symptom of the killer flu: their faces were tinged a peculiar lavender colour. This condition, known as heliotrope cyanosis, was observed extensively in the ensuing 1918 outbreak. Undoubtedly, the overcrowded and unsanitary conditions of the camp, with most soldiers housed in tents or temporary wooden barracks, were ideal for the spreading of a respiratory virus.
A second outbreak occurred in March 1917 at the brick-built barracks of Aldershot, ‘The Home of the British Army’. Similar symptoms and mortality rates were experienced. This outbreak was the first to be studied in depth, the team of Adolphe Abrahams concluding that the unique clinical symptoms and high mortality rate suggested a hitherto unrecognised disease. At this point, the sickness was known to the British medical authorities as ‘Purulent Bronchitis’ (i.e. with pus brought up from the lungs).
Following the 1918-1919 outbreak, Dr Abraham’s team noted that the presenting symptoms of the two were markedly similar. In 1918, pathologist at Etaples conducted experiments into the transmission of the disease on monkeys; they were probably the first to isolate the agent of the pandemic as a virus.
It was not only the main base camps of the army that were affected. In the Spring of 1918, 10,313 sailors of the Royal Navy were taken ill; in France, at the relatively small 6th Stationary Hospital at Fillievres, an outbreak of the flu among the patients and staff required special isolation procedures, and eventually the evacuation of uninfected patients. In October 1918, 10 Other Ranks died from the disease, but by 11th November this total had already reached 27.
The unprecedented circumstances of 1916-18 – in particular the war on the Western Front, a landscape contaminated with respiratory irritants such as chlorine and phosgene gas, characterised by unsanitary living conditions, stress, overcrowding, and the partial starvation of civilians – provided the perfect opportunity for rapid transmission of influenza between young servicemen and women. The coming and going of people from all over the world provided the opportunity for the disease to spread beyond the base camps and hospitals of the troops, and become a pandemic of global proportions by the Winter. Raging unabated through 1919, the disease ultimately claimed more lives than the Great War itself.
 J.S. Oxford et al., ‘A Hypothesis: the conjunction of soldiers, gas, pigs, ducks, geese and horses in Northern France during the Great War provided the conditions for the emergence of the “Spanish” influenza pandemic of 1918-1919’, Vaccine 23.7 (2005), pp. 940-945.
 G. Newman, Report on the pandemic of influenza, 1918-19. (1920). Accessed 17th July 2012, from: http://influenza.sph.unimelb.edu.au/data/S0001/chapters/preface.pdf
 D. Gill and J. Putkowski, Le Camp Britannique d’Etaples. The British Base Camp at Etaples, 1914-1918 (Etaples, 1997).
 A. Abrahams et al., ‘Purulent bronchitis: Its influenzal and pneumococcal bacteriology’, Lancet 2 (1917), pp. 377-382.
 J.S. Oxford et al., ‘World War I may have allowed the emergence of “Spanish” influenza’ The Lancet infectious diseases 2.2 (2002), pp. 111-114. Accessed 17th July 2012, from: http://download.thelancet.com/flatcontentassets/H1N1-flu/epidemiology/epidemiology-36.pdf
 R. Hill, ‘Influenza in the Grand Fleet’, Journal of the Royal Naval Medical Service 5 (1919), pp. 142-149.
 R. Side & D. Purnell, ‘Sapper Percy Molland’ in Winkleigh Heroes (3rd January 2011). Accessed 17th July 2012 from: http://www.winkleighheroes.co.uk/soldiers/mollandp.htm. Quoting extracts from the War Diary of 6 Stationary Hospital, National Archives WO 95/4100.
 N.P.A.S Johnson and J. Mueller, ‘Updating the accounts: global mortality of the 1918–1920 “Spanish” influenza pandemic’, Bulletin of the History of Medicine 76 (2002), pp. 105–15.