How Gibraltar Prevailed Against The Spanish Flu


The Gibraltar Chronicle look at the Spanish Flu

by Andrew Sene former Surgeon General at St Bernard’s Hospital Gibraltar with contributions by Anthony Pitaluga Head of the Gibraltar National Archives

The following is a four-part account of how the Spanish flu impacted Gibraltar in the early 20th century.

There were apparently four waves and altogether it is estimated that approximately 500 million cases occurred with 25-50 million deaths.

At the time infectious organisms smaller than bacteria were suspected as some diseases could be transmitted by filtering out bacteria but viruses were not seen until much later with the advent of the electron microscope.

The first wave, of which there is less documentation than the second, appears to have started in Gibraltar in late May 1918 i.e. two months after the Kansas cases. It is reported in Gibraltar to have resulted in 600 cases but it is probable that 800 occurred with 29 deaths. Of these 19 were civilians, 1 naval and 1 military. The other 8 deaths were shipping or ‘bay’ cases. The MOH reports this wave as ‘benign’ with low mortality lasting 7-8 weeks and subsiding by the end of July 1918.

The second wave impacted Gibraltar much more forcefully, as it did worldwide. It started in September 1918, reached a maximum in October and died away in early December 1918.


Absent from this article is -

REVELATION: Only the “vaccinated” died during the 1918 Spanish Flu

Although the infectious nature of this illness was widely assumed, MASKS, QUARANTINES, AND ISOLATION WERE ALL WITHOUT EFFECT. What does 1918 Spanish Flu and the 2020 Corona Virus have in common? Both have a next generation wireless communications technology being rolled out.- Isn't it time to unmask this criminal conspiracy? - #7 by A_Freeman

The unmasked buried the masked in the "Spanish Flu." What did people in masks die from? Bacterial pneumonia. Who knew this and wrote about it in 2008? Dr. Anthony Fauci' - Blaylock: Face Masks Pose Serious Risks To The Healthy - #7 by be1

This is consistent not with any respiratory virus, but with what has been known about electricity ever since Gerhard did the first experiment on human blood in 1779. - Further information from The Invisible Rainbow - Discussion on the World Situation in Biblical Terms - #11 by A_Freeman

Study Shows Direct Correlation Between 5G Networks and “Coronavirus” Outbreaks

Withdrawn report from NIH website linking 5G and corona virus

The Connection Between 5G and the Corona Virus

The Final Refutation of Virology

Gibraltar Encampments and Health Passes During the Yellow Fever Outbreak – Gibraltar History Lesson


by Andrew Sene

The Medical Officer of Health (MOH) made further interesting recommendations:

  1. Funerals- he suggested that the danger was not from the body in the coffin but from contact with persons who had been in the sick room. He conferred with the heads of religious communities with a view to abolishing funeral services in churches making the grave-side service short and confining attendance at the cemetery to relatives only. Coffins and funeral parties were not permitted to enter the church. Undertakers were requested not to carry coffins on shoulders and to place sawdust or other absorbent within them in cases of haemorrhage.
  2. Religious Services – he did not think it desirable to close places of worship.
  3. Schools – he did not recommend closing schools as this would have tended to drive children into crowded and unventilated homes.
  4. Washing – he prepared a scheme for steam or chemical disinfection of washing from merchant shipping and warships to be carried out on the wharf or before being brought ashore. The Captain of the Port would direct the mode and place of disinfection as instructed by the Sanitary Commissioners. The Surgeon Rear-Admiral made arrangements for all naval washing to be disinfected before being brought ashore. The MOH asked if laundresses could use the sea-bathing establishments at Chatham Counterguard or Bayside as washhouses.
  5. The Fever Hospital or Lazaretto – One of the Sanitary Commissioners suggested that cases from the bay (shipping cases) should not be brought into the town’s Colonial Hospital but should be treated at the Fever Hospital. The MOH was quite forceful replying that this was impossible owing to staff shortage with many civilian doctors working 18 hours a day .The Fever Hospital at the time was located next to the Inundation (which is now the Laguna Estate) abutting right onto the Rock. The MOH was also very concerned with the appearance of other infectious diseases such as tuberculosis, typhoid (enteric fever), plague, smallpox, cerebral meningitis and yellow fever and recommended sending flu patients to the Colonial Hospital and any overflow there were to be sent to buildings in the vicinity. Indeed cases of tuberculosis, typhoid, measles and mumps were occurring concomitantly and at least two cases of smallpox (imported) appeared and were sent to the Fever Hospital.

Further recommendations included isolation of the sick, free ventilation, disinfection of clothing and bedding, provision of more biers (used by undertakers for transporting coffins), prohibition of indoor public assemblies (details of this are incomplete) and wakes and placing influenza on the list of infectious diseases. On the 1st November 1918 His Excellency the Governor H.L. Smith-Dorrien declared influenza an infectious disease as recommended by the Sanitary Commissioners and influenza was added to the list of infectious diseases contained in the Public Health Ordinance. He further ruled that the body of a person dying from infection should not be moved except for the purpose of burial unless the MOH deemed otherwise, designed to try to contain infection.

In the second wave there were approximately 3000 cases reported, but the MOH estimates probably there were a total of 6000 cases as many did not receive medical attention. Influenza was said to have been more prevalent in the ‘crowded’ districts of Willis’s Road, Castle Street, Flat Bastion Road, Devil’s Gap, tenements in the vicinity of Rosia and Irish Town. Some doctors including Drs Triay and Dotto were required to make home visits, ‘maybe 100 visits/week’; the former fell ill himself and gave up work and the latter, newly returned from England, was engaged to serve as an extra district doctor. Dr Durante was released by the military authorities to assist. Spanish doctors were unavailable as they were in demand in Spain. Treatment of patients probably included bed rest, isolation as far as possible, hydration, change of bedding and clothing and aspirin, the latter probably in large doses. Possible cases of aspirin overdosing might have occurred. Aspirin was well known to lower temperatures in patients and to relieve pain but in large doses can be fatal and can cause bleeding (nose-bleeds were reported!). Antibiotics, of course, were not widely available until approximately 1942. Gibraltar, with its very hectic and busy port not just militarily but also commercially and particularly during World War I, suffered from the flu pandemic in terms of cases landed from shipping and this overtaxed the health system. The Colonial Hospital was said to have been ‘full’ with patients though at no time did it ‘overflow’. Some of the nurses were Les Souers de Bon Secours (an international Roman Catholic women’s religious congregation for nursing) and were overworked and reduced as they were in demand in France.

The MOH stated that over 30% of the total civilian population suffered from influenza in some form or other. Between June and November he recorded deaths from influenza as separate from pneumonia but assuming that the pneumonias to have been secondary to influenza we can estimate death rates. During this time there were a total of 220 deaths of which 100 were civilian, 10 naval, 23 military and 87 were shipping cases. The MOH estimated the total deaths from flu and pneumonia in the civilian population at 100, which, for the estimated civilian population of 16549, gave a death rate of approximately 6 per 1000 or 0.6%.

The following two photos show tables submitted by the MOH to the Sanitary Commissioners and show the demographics of influenza (plus pneumonia) fatalities in both waves. Comparison of the tables immediately confirms that the second wave was much more lethal. Interestingly if the age columns are looked at, it is obvious that a significant proportion of fatalities occurred in the younger age groups. In the second wave, 81% of deaths occurred in those under the age of 40. If it is argued that the military and naval comprise a younger age group then, if the civilian group alone is looked at, 76% of deaths occurred in those under 40 and 84% in those under 50. This observation concurs with the unusually high mortality for young adults reported around the world.

Andrew Sene is a former Surgeon General at St Bernard’s Hospital Gibraltar and this series was produced with contributions by Anthony Pitaluga Head of the Gibraltar National Archives.

1 Like

El Calpense was a newspaper in the Spanish language established in Gibraltar in 1868. It reported on issues regarding the Spanish flu pandemic locally and was more critical of the Sanitary Commission. On the 16th October 1918 they stated that out of 38 deaths recorded in a week, 12 were foreigners who had died in the bay. They questioned the transfer of shipping cases to the Colonial Hospital rather than to the Lazaretto at “La Laguna”. They followed this up with more criticisms and here is an excerpt taken from El Calpense newspaper on 21st October 1918 translated from the Spanish:

“The Lazaretto continues to remain unused as a hospital for cases of Spanish flu and our observations have been well received by everyone except those who could have put this into practice. Even the mule attached to the Sanitary Commissioners’ cart agrees as it refuses to mount Hospital Hill and other means are needed to convey a patient. Anyhow the cases may be diminishing but the deaths are not.

On Saturday evening a patient from the bay was conveyed to hospital in a cab. It was thought that a patient was being conveyed but on arrival a corpse was found. He died in the cab on the way. We are not aware whether the cab was disinfected but it should be. No one can make us believe that the bringing of patients from the bay is not a danger to public health. We appear to be preaching alone, for some time, to deaf ears”.

El Calpense highlighted not only the non-usage of the Lazaretto at the Inundation (“La Laguna”) but also the use of a cab or public hackney carriage for the transfer of infected patients. It is obvious there were issues regarding the landing of sick patients and the transfer to the Colonial Hospital and the need for disinfection of the carriage used to transfer.

There were serious concerns regarding possible transmission of disease to others from such sick patients. El Calpense suggested that the removal of infected cases from the shipping to the Colonial Hospital was the principal cause of the outbreak in Gibraltar.

The Public Health Ordinance of 1907 stated it was an offence for any person suffering from any infectious disease to wilfully expose himself without proper precautions against the spread of the said disease in any street, public place, shop, inn or public conveyance or enters any public conveyance without previously notifying the driver who in turn would be obliged to refer the cab to the MOH for disinfection.

The case referred to by El Calpense came to the attention of the Colonial Secretary who asked for particulars about the case. This patient was a boatswain from the S.S. Maindy Court who apparently died in a public hackney carriage on the way to hospital.

The Secretary of the Colonial Hospital answered that when the man arrived in a hackney carriage, accompanied by a clerk from the shipping agent, at the gate of the hospital he was already dead, and the Surgeon found him dead on examination. The body was taken to the mortuary and he was buried the following day. The Captain of the Port reported that a dockyard launch was sent out to the S.S. Maindy Court which had arrived 19th October to land the sick man suffering from pneumonia.

The Sanitary Commissioners, after consulting the MOH, wrote to the shipping agents asking why they had allowed an infectious case to be exposed, without proper precautions against the spread of the disease, in a public conveyance contrary to the provisions of the Public Health Ordinance 1907 and for not advising the driver to report to the MOH so that the vehicle might be disinfected.

There was at all times a Sanitary Commissioners’ ambulance in readiness at Waterport Wharf for conveyance of patients to hospital and public hackney carriages should not have been used for transfer of shipping cases with probable influenza. Another similar case was reported later from the S.S. War Rose. This issue regarding the transfer of flu patients to hospital in public ‘cabs’ came to the attention of the Sanitary Commissioners towards the end of the second wave and it is possible other cases occurred earlier.
El Calpense explained the steps taken by the Spanish Home Office to prevent the flu. Madrid apparently stated that the ‘germs’ entered via the mouth and nose when breathing so thus disinfection of these cavities was advised. They recommended self-treatment with ‘biclorol’, which was a mixture of sodium chloride, bicarbonate and borate. The mouth was treated by gargling and the nose by wiping the nasal cavity with cotton wool balls soaked in ‘biclorol’.

There were problems with the supply of fresh milk, which was limited. Spain temporarily prohibited its importation into Gibraltar. Arrangements were made to pool the milk available and this was prioritised for the sick, young children and those issued with medical certificates. There were difficulties dealing with the disposal of manure from stables and cowsheds owing to the prohibition of its exportation to Spain. The Sanitary Commissioners overcame this problem by compressing it and burying it at Catalan Bay Quarry covering it with layers of earth soaked in creosote to ‘prevent house flies breeding therein’.

The Theatre Royal had been rebuilt and inaugurated in 1914 and was thus extremely popular. However, on the 21st October 1918 an order was sent from the Colonial Secretary to the Director of the Theatre Royal to close down on one day’s notice, resulting in disruption of existing contracts and difficulties. The Theatre Royal had been in regular operation holding events such as a cinematographic display, variety entertainment, La Bailarina Luna Benamor, Troupe Hermanas Gomez and film exhibitions.

The Gibraltar Public Assembly Rooms and Masonic Hall Ltd. and the Salon Ideal were also closed down on 22nd October. The Assembly Rooms regularly hosted dance clubs such as the Amoureuse, United Service, Victoria Quadrille and Travesties clubs and these events were cancelled. Most clubs, coffee houses, tavern schools and churches remained open it seems and it was argued by the Theatre Royal that the public were being diverted from a well-ventilated theatre to crowded taverns etc.

Andrew Sene is a former Surgeon General at St Bernard’s Hospital and this series was produced with contributions by Anthony Pitaluga, Head of the Gibraltar National Archives.