Spanish ‘Flu of 1918-19 led to high mortality in Mayo Asylum

Many parallels with present day Covid pandemic

DURING this current Covid-19 pandemic, it is not unexpected that we hear frequent reference to the Spanish or Great ‘Flu of 1918-19, given the many parallels that exist between the two outbreaks.

The Spanish ‘Flu occurred towards the end of WWI and it is estimated to have been responsible for 50 million or more deaths worldwide, which was far more than resulted from the war itself.

Ireland, like the rest of the world at that time, did not go untouched by that pandemic where it is estimated to have claimed over 20,000 lives.

Review of contemporaneous records for that period show that the effects of the Spanish ‘Flu were keenly felt within the walls of the local Castlebar District Lunatic Asylum (DLA), later known as St. Mary’s Hospital and now home to the Headquarters of the Mayo Mental Health Service and the Galway Mayo Institute of Technology.

By 1918, when influenza hit Co. Mayo, the Castlebar District Lunatic Asylum, which opened 155 years ago in April 1866, had been in existence for just over 50 years.

Prior to then, people from Mayo who required treatment for a mental illness had been sent to the Ballinasloe Asylum.

When it opened in 1866, it had accommodation for 260 patients. Over the years the numbers gradually increased and the building was expanded, initially by putting on a third storey and in 1902, after the opening of the asylum church, the original chapel was converted into accommodation for patients.

Prior to 1918, there had been plans to convert part of the nearby prison into asylum accommodation but this plan never actually materialised.

So, by 1918, when the ‘flu hit, there was accommodation for about 600 patients in a building which was clearly overcrowded and housed 800 patients.

In recent times we have learned about the importance of social distancing, good hygiene, frequent hand washing, wearing of masks and good ventilation in combating the spread of Covid-19.

We also know how it spreads more easily and had a devastating effect on some nursing homes, particularly where patients did not have access to single rooms.

So, 100 years ago, when the ‘flu arrived in the Castlebar Asylum, where there was gross overcrowding, it is not difficult to understand how it easily spread.

At that time, patients were accommodated in very large wards, with maybe up to 50 beds, in a facility designed for far less, not to mention the absence of single rooms, en-suites and with only limited bathing facilities.

Besides the overcrowding, another factor, which although may not have directly led to the spread of the ‘flu but would certainly not have helped, were the unhygienic conditions that prevailed due to the unsatisfactory sewage disposal.

This problem had existed for the previous three decades. Apparently, the sewage from Spencer Street flowed into the back of the asylum grounds and despite several representations made by the Board of Governors to the local Urban Council, requesting that this be corrected, the problem continued to exist well beyond 1918.

However, despite these problems, it is worth noting that when the asylum was inspected only a few months earlier before the arrival of influenza, it was found to function well and the Report of the Inspectors mentioned “the general condition of the wards and dormitories throughout the asylum was most satisfactory” and “the health of the institution was excellent”.

Yet, within a few months, the health of the patients had changed drastically.

By mid-October 1918, just before the outbreak of the ‘flu, management had to resort to using turf as the fuel for the asylum as there was a serious shortage of coal.

However, given that there was great difficulty sourcing a supply of turf locally, consideration was given to cutting back the heating, cooking and washing facilities which perhaps possibly contributed further to the misery of life in the asylum during the influenza outbreak.

The devastating impact that the ‘flu had on both the patients and staff is well documented in the reports of Dr. Ellison, the doctor in charge, for the latter two months of 1918, to the Board of Governors, sometimes referred to as the Committee.

In November, 1918, when reporting on the state of the asylum, he wrote, “This institution is at this moment, passing through a crisis without parallel in its history.

“For the past ten days, Influenza in a most virulent and intensified form has stricken down the staff and patients. Up to this moment, close on one hundred male patients and about forty female patients have contracted the disease, while more than three fourths of staff are laid up and totally incapacitated from duty.

“Fourteen male patients have so far lost their lives chiefly from the results of septic pneumonia and many others are dangerously ill.

“With nearly one hundred and fifty persons ill and with less than one fourth of the staff available to look after them, not to mention the supervision of 800 inmates, the Committee will recognise the tremendous difficulties and dangers that have to be faced by the few who are left to do duty.

“The working of the asylum has necessarily been completely disorganised, while the remaining members of the staff are exhausted and worn out.”

Dr. Ellison’s account of staff shortages echoes what occurred during the current (Covid) pandemic when, in 2020, some nursing homes experienced staff shortages.

Dr. Ellison attempted to employ temporary staff but reported “nurses are nowhere to be had… it is therefore quite impossible to give that care and attention to the sick that their condition so urgently calls for.

“Those of the staff who have so far resisted the disease are making extraordinary and highly commendable efforts to carry out the impossible.” This is again somewhat similar to what happened a century later during this Covid-19 pandemic.

By mid-December, 1918, Dr. Ellison reported on how matters had deteriorated even further.

“Altogether over 200 patients were ill, of whom about forty died chiefly from pneumonia. Three female attendants died from this disease contracted in the asylum services. At one period, there were out of a total staff of 78 only 12 persons on duty….at one time only four members of the female staff out of a total of 27 were available for duty…these had to work by day and night to maintain even a semblance of supervision.”

Similar to the proposals today to acknowledge and reward the efforts and hard work of frontline staff who worked tirelessly and at times risked their own life during this Covid-19, back in 1918 there was a proposal “to give each of the attendants a week’s holidays and also commend their services for special consideration”.

The Board of Governors subsequently acknowledged their efforts and reference was made to “the real heroism on the part of staff” and they were rewarded with time off and monetary reward.

It is interesting to note that by mid-January 1919, three months after the outbreak began, it was reported “the epidemic has now abated but has left its mark on many of those who survived”.

Several members of the staff were still unable to return to duty, in consequence of the physical prostration which resulted from the illness.

One wonders was this inability to return to work caused by the equivalent of Long Covid, the debilitating condition that we are learning more about today.

Forty-seven patients, along with three members of staff, died from ‘flu during the last two weeks of November and early December 1918.

Unlike this current pandemic, which has been harder on the elderly, those most adversely affected by Spanish ‘Flu worldwide were young and likewise those who died as a result of it in the Castlebar DLA during 1918 also tended to be young, the majority being in their 20s and 30s.

Some had been in hospital for several years but others had only been admitted in the previous few months. It was particularly moving to find that two young brothers, both of whom had only been admitted earlier that year, died from the ‘flu within days of each other. One cannot begin to imagine what it was like for their devastated mother to get such news.

Reports about the influenza were widely covered in newspapers of the time. One such report, in The Connaught Telegraph, on Saturday, December 7, 1918, mentioned how “in Castlebar it was very severe and as was to be expected the mortality in the asylum was great, but it has practically died out there”.

Meanwhile, it is curious to note, “in the Castlebar Workhouse there is a large number of patients but the deaths have been comparatively small”.

One wonders why there should have been more deaths in the asylum when compared with the equally overcrowded workhouse?

It is also reported that “it (epidemic) is abating” even though at that time, patients in the asylum were still dying. One could question if this reflected a disconnect between what was happening in the asylum and the wider society.

Three female staff in the asylum, referred to as Attendants, also lost their lives to influenza.

At the December meeting of the Board of Governors, the three attendants who died were commended and as a gesture to show their work in the service was appreciated, it was mentioned that the cost of the coffins supplied in connection with the funerals of the three attendants be defrayed by the committee.

The deaths of the three nurses, Ms. Katie Gavin, Ms. O’Beirne and Ms. Rainey, were reported in that same edition of The Connaught Telegraph while sadly there is no mention of any of the large number of patients who died.

Neither do we have any records of their funerals nor where they were buried. We are aware that many patients, as was the custom at the time, were buried in unmarked graves in the asylum graveyard in Aglish.

That same edition of The Connaught Telegraph showed the global impact of the influenza outbreak as it reported how it had sadly resulted in the death of three brothers from Castlebar who had emigrated to Philadelphia.

Influenza was not mentioned in the minutes of the Board of Governors for February, 1919. However, it had raised its head again by March and on 21st, March, 1919, when a third wave occurred, it was reported “a few cases of influenza have occurred amongst the patients…the disease is of a milder type than was present during the November epidemic”.

There were no deaths from influenza recorded during March. It is mentioned again three months later, in June 1919, when 15 patients as opposed to the usual 10 or so had died during the previous month.

While there were no deaths directly recorded from Influenza, Dr. Ellison, referring to the previous month, remarked “the death rate was unusually high. Many of these were cases that failed to shake off the effects of the Influenza epidemic”.

After June 1919, there was no further mention of that epidemic.

So, in the same way as this current Covid-19 pandemic has had a devastating effect on our elderly population, particularly those in residential care, so too the Spanish ‘Flu similarly took its toll but on a younger group of patients in the Castlebar Asylum during the latter months of 1918.

Yet, it is encouraging to note that after a few months, there is no further reference to the influenza epidemic in the asylum records. So, in terms of parallels, would that in the next few months, Covid-19 might mirror this pattern.

(Article written and researched by the members of the St. Mary's Heritage Committee, June 2021).