2. Care and Community: York and the Second Wave
The Second Wave
By the end of July 1918, the influenza virus which had spread throughout York appeared to have subsided. The military authorities gradually lifted restrictions for soldiers in the city, who were allowed to return to theatres, music halls and other places of entertainment. The number of influenza-related deaths fell throughout August and September. But by mid-October, the virus had returned. This was the beginning of the second wave, which would hit the city and the country with redoubled force.
Across York and the towns of the West Riding of Yorkshire – the administrative county which included Sheffield, Wakefield, Bradford, Leeds, Huddersfield among others – 8% of overall deaths from the pandemic had taken place in the first wave, but 65% would occur in the second wave. In York, all schools were gradually closed once again. Cinemas and theatres mostly remained open as they had done during the first wave, but with additional sanitary measures in place. Managers were required to ventilate auditoriums before and after performances and during intervals, supervised by local police and by staff from the Health Department.
Despite these precautions, the city struggled to cope. The month of November 1918 saw the highest number of burials across a prolonged period on record at York Cemetery. 264 people were buried, including 164 whose cause of death was recorded as either influenza or pneumonia, and the local authorities had to seek assistance from the military to help with the digging of graves.
The numbers of medical staff on the home front were severely depleted by the deployment of doctors and nurses for the war effort, and during the second wave, the city’s health providers were overwhelmed. At York County Hospital on Monkgate, so many nurses were off sick with influenza at the same time that the hospital had to close for two months. The Infirmary at York Workhouse admitted an overflow of patients from the city’s hospitals, and all beds there were full by early November. York Explore holds various records relating to the workhouse and its inhabitants and staff, including for the period of the pandemic. We know that twenty-six patients died there and that some of them were very young.
With bed capacity at maximum and growing numbers of staff becoming infected and incapacitated, York’s Health Committee and hospitals mounted a huge coordinated effort. In late October, The Retreat and York City Asylum both sent nurses to Clifton Hospital, which had 139 patients with influenza and 51 staff who were sick. At the York Fever Hospital near Yearsley Bridge – established in 1880 to manage regular epidemics of infectious diseases in the city – existing patients were transferred elsewhere to make space for an influx of influenza cases. The experiences of one nurse here – Mary Wilson – were captured in an interview conducted with survivors of the pandemic by the journalist Richard Collier. Mary’s memories – preserved at the Imperial War Museum archives in London – would make for fascinating reading when archive visits are possible again.
Rear view of an open-air ward at the York Fever Hospital in the 1910s. The Rowntree Cocoa Works factory on Haxby Road can be seen in the distance. Rowntree & Co. donated three wooden shelters for patients in the hospital grounds. Source: City of York Council/Explore York Libraries and Archives Mutual Ltd.
District Nurses and Volunteers
With many of the city’s doctors away on military service and hospitals overrun, residents who fell sick had to seek care in their own homes. In the early twentieth century, those with financial means could pay for a full-time nurse – referred to as a private duty nurse – to live with them until they recovered. A separate system of “district nursing” existed to offer care of the sick poor.
The sociologist Elaine Denny, who has researched the history of nursing in the 19th and 20th centuries, argues that domiciliary nursing – nursing carried out in peoples’ homes – has been “hidden from history”. Various types of archival documents could help to reconstruct this history, but with local records and historic newspapers for York for 1918 and 1919 currently unavailable during the COVID-19 lockdown, we can only wonder what information they might hold about the experiences of ordinary district nurses in York during the outbreak. However, there is one major indication of the scale of their workload during the second wave: the Medical Officer for Health Edmund Smith had to recruit a group of untrained women – including “disengaged midwives and other handy substitutes”  – as volunteer domiciliary nurses.
Poverty and Infectious Disease: Influenza in York’s Slums
The majority of influenza deaths during the pandemic in York took place in the home. District and volunteer nurses caring for the poor in the city throughout the second wave would likely have encountered some incredibly difficult scenes. In Leeds, their counterparts reported that in some of the most deprived areas they visited, families were living in cramped conditions, sometimes with only a single bed. One nurse was called to a house where multiple family members were seriously ill and had to take the decision to remove a sick infant from the family’s solitary bed so that the child’s father could die in it.
York too had serious problems with poverty and housing at the time of the outbreak. Throughout the late nineteenth and early twentieth centuries, the Rowntree family had been involved in voluntary welfare activity in the city. This included campaigning for better housing, improved maternity services, and measures against infectious diseases. At the turn of the century, Seebohm Rowntree’s pioneering social study of living conditions in York revealed that almost 28% of the city’s population – over 20,000 people – lived below what he referred to as the “poverty line”.
Seebohm’s report, titled Poverty: A Study of Town Life, identified Walmgate and Hungate as areas of the city where poverty levels were particularly high. Some of the poorest residents were living in tenements, sharing a single water tap in the street and one toilet with multiple other households. Many were unable to afford enough food to meet their nutritional needs. Such insanitary conditions made people vulnerable to outbreaks of infectious disease, and during the second wave of the Spanish flu, seven members of one household in Hungate were recorded as being sick at the same time. Resident Lydia Brown died in October: her two daughters, aged eleven and sixteen, followed her a few days later. In Walmgate, 160 deaths from influenza or pneumonia were officially recorded in the aftermath of the pandemic – a notably high portion of the city’s overall death toll.
Buildings of Bradley and Co. carriage builders in Hungate, York, 1911. A water pump is visible to the left of the middle door. The row of doors under the gallery were probably outdoor lavatories and coal stores. Source: City of York Council/Explore York Libraries and Archives Mutual Ltd.
Lessons for Today
The medical, civic and philanthropic histories we have explored here feel newly relevant in the context of the COVID-19 pandemic, as national and local authorities draw up responses to the outbreak and health and social care staff work to protect the vulnerable.
The tireless work of medical staff in the 1918 flu pandemic adds additional weight to our renewed sense of the value and risks of care work amidst COVID-19. NHS staff redeployed to COVID care wards at York Hospital echo the journeys taken by midwives and other “hardy” women who volunteered when district nurses were overwhelmed in the Autumn of 1918.
We might note the importance of a strong infrastructure for public health both then and now, at national and local levels. The historian Fred R. Van Hartesveldt has described England’s public health system at national level as being “in disarray” in 1918, and not solely due to the war. He notes that although public health in some areas was well-served, nationally it was “inefficient and uncoordinated.” Therefore, responsibility for public health often lay in the hands of local authorities. Historians have previously identified Manchester as an example of good local practice during the pandemic. Its Medical Officer James Niven is renowned for having saved many lives by adopting social distancing measures and other precautions which went beyond those recommended by the London-based government. Having studied reports from the time, Van Hartesveldt names York as another positive example of a local authority response, citing the rigorous collection of data by the city’s Health Committee and a coordinated effort by medical staff to provide care and comfort to influenza patients.
Another striking parallel between 1918 and the present day is the enduring connection between socio-economic disadvantage and poor health. In the conclusion to his 1901 report, Seebohm Rowntree had recommended that the government introduce measures to protect the very young, the old and the unemployed, who were the groups most likely to fall into poverty. Between 1906 and 1912, Seebohm drew on his expertise and social influence to work with David Lloyd George’s Liberal Government on a number of reforms which laid the foundation for Britain’s welfare state. They included free school meals, sickness and unemployment insurance for working men, and the introduction of state pensions: an unprecedented body of legislation at the time. These were important steps in addressing the stubborn problems of social inequalities in Britain, but they remain pervasive today. For example, recent research from the Office for National Statistics has shown that people in deprived areas are dying from COVID-19 at double the rate of affluent areas.
Nurses and patients on the open-air ward of the York Fever Hospital in the 1910s. During the second wave of the influenza outbreak, the hospital moved all existing patients to other facilities and became an influenza hospital. Source: City of York Council/Explore Library and Archives Mutual Ltd.
Finally, we can also appreciate the strength and compassion of those living York 100 years ago, including within the most deprived communities. In Poverty: A Study of Town Life, Seebohm Rowntree observed the way that those facing hardship in York pulled together. In the slum districts, he noted, “life is lived more in common”:
Families which are, from any cause, in particularly hard straights, are often helped by those in circumstances but little better than their own. There is very much of this mutual helpfulness among the very poor. In cases of illness neighbours will almost always come in and render assistance, by cleaning the house, nursing, and often bringing some little delicacy which they think the patient would ‘fancy.’”
Seventeen years later, the Yorkshire Evening Post noted the same dynamic of care in the community at the height of the second wave of the Spanish flu:
The district nurses can, of course, only pay what may be termed flying visits, and any continuous nursing has to be left to neighbours and friends. Generally speaking, report the nurses, the residents in the poorer neighbourhoods have been real Samaritans to their stricken friends. No thought of a risk of infection has deterred the neighbours from lending a helping hand, and in this way many a silent, unnoticed act of devoted self-sacrifice has been performed.
Over a century later, hundreds of volunteers are working with the City of York Council’s Community Hubs to assist those who are older, who are sick, or who are shielding for medical reasons. The Supper Collective – an award-winning volunteer initiative set up by chefs, independent cafe owners and local residents in York – is cooking nutritious meals and delivering these for free to isolated and vulnerable people and to NHS staff during the COVID-19 outbreak. And the Joseph Rowntree Housing Trust has been working with the Joseph Rowntree Foundation to support older and vulnerable residents in their homes and communities across in York and across the North East. This includes a major staff redeployment programme from across the organisation to support essential services.
As we navigate the challenges of this contemporary pandemic and its consequences, care work and community remain some of our most deeply valuable practices.
 Knight, p. 8 Martin Knight, The Influenza Pandemic of 1918-1919 in the Towns of the West Riding and York, PLACE, 2015, p.8
 Knight, p. 8
 Knight, p.23
 York MOH, City of York: Annual Report of the Medical Officer of Health for 1918 (1919), cited in Knight, p. 24
 David Poole, “Busy Days in the Cemetery”, Friends of York Cemetery Newsletter, November 1995.
 Katherine A. Webb, From County Hospital to NHS Trust: The History and Archives of NHS Hospitals, Services, and Management in York, 1740-2000, Vol 1, Borthwick Publications, 2002, p.165
 Gary Brannan, “When the guns fell silent: York and the 1918 flu”, Borthwick Institute Blog, 19 November 2018, http://borthwickinstitute.blogspot.com/2018/11/when-guns-fell-silent-york-and-1918-flu.html; Chloe Adams, Caption from “York and the 1918 ‘Spanish’ Influenza Epidemic” exhibition at York Explore Library and Archive, 18 March 2018.
 Knight, p.19
 See Richard Collier, The Plague of the Spanish Lady, Macmillan, 1974, p. 375
 Webb, p. 142
 Elaine Denny, “The emergence of the occupation of district nursing in nineteenth century England”, D.Phil, University of Nottingham, 1999, p.4, http://eprints.nottingham.ac.uk/11094/1/297754.pdf
 York MOH, City of York: Annual Report, cited in Knight, p.14
 Brannan, “When the guns fell silent”
 “Splendid Work of the District Nurses”, Yorkshire Evening Post, Thursday 7 November 1918, p.3
 Webb, From County Hospital to NHS Trust, p. 3.
 Seebohm Rowntree, Poverty: A Study of Town Life, Macmillan and Co. 1901, pp.199-201 https://archive.org/details/povertyastudyto00rowngoog/page/n8/mode/2up
 Karyn Burnham, York in the Great War, Pen and Sword Books, 2014, p. 94
 Brannan, “When the Guns Fell Silent”
 Fred R. Van Hartesveldt, “The Doctors and the ’Flu’: The British Medical Profession’s Response to the Influenza Pandemic of 1918-1919”, International Social Science Review, 85. 1-2, 2010, p.35
 Van Hartesveldt, p.35
 Poverty and Social Exclusion (PSE), “The coronavirus (COVID-19) has had a disproportionally higher impact on the most deprived areas”, 1 May 2020, https://www.poverty.ac.uk/editorial/coronavirus-covid-19-has-had-proportionally-higher-impact-most-deprived-areas
 pp. 77, 43
 “Splendid Work of the District Nurses”