Folk medicine during the Spanish flu pandemic in Iceland in 1918
We decided long ago to launch the “Resources” section of this website on folk beliefs in Iceland with a short post on popular remedies during the Spanish flu pandemic in 1918 – simply because we felt it was both on-brand and relevant for our times. The writing was delayed, however, as my own story of coronavirus contagion unfolded, and upended all my plans and those of my family for the entire month of October. While the disease hit us relatively mildly, the whole experience of the mandatory two-week isolation and its aftermath, turned out to be a lively lesson in some of the things that folklorist Andrea Kitta discusses in her 2018 book The Kiss of Death: Contagion, Contamination, and Folklore. We found, for example, that people were very much concerned about how we contracted the disease; and because we didn’t know it, or were unsure, it was as if our story was missing an expected beginning. By contrast, the virus tracing team of the Surgeon General were not at all interested in a contagion that had already happened, and just wanted to know who we had been in contact with afterwards. A number of people had to endure the 7-day quarantine and testing required by the Icelandic authorities because of our contagion. While, luckily, none of them had contracted the disease, this was a situation that easily triggers feelings of shame. We discussed what we could have done differently and whether we had been careless in some way. Our own anxiety caused us to be on our guard against signs of Covid-shaming from others. Social control phenomena, like Covid-shaming and travel-shaming, mirror the patterns described by Dr. Kitta and other researchers. We have also seen that some people we meet express fear of coming too close, as if we were still carrying the disease weeks later. We are in a way branded by the disease, with certain practical and social consequences.
The Kiss of Death was published in 2018. As the pandemic progressed in 2020 it became so relevant to current affairs that the publisher decided to issue an electronic copy for free download on their website. In her book Dr. Kitta uses examples of virus epidemics like the Spanish flu, HIV, the Ebola virus and the recent scares around avian flu and swine flu, to illustrate and explain how anxieties, rationalizations, forms of social control and remedies connected with contagious disease, are expressed through folklore. The avian flu scare of 2004-2005 forms the context of an article about the Spanish flu in Iceland by Icelandic historian Viggó Ásgeirsson, published in the history journal Saga in 2008. Entitled “Engill dauðans” (“The Angel of Death”), the article describes the influenza pandemic in Iceland during the winter of 1918-1919, based on personal accounts, such as interviews conducted by Ásgeirsson himself, published memoirs and the folklife collection (questionnaires) of the National Museum of Iceland, among other sources. The following short account is mostly based on his article, the questionnaires themselves, and the digital newspaper archive of the National and University Library of Iceland.
Camphor drops and Cuban cigars
The influenza pandemic of 1918 first made landfall in Iceland during the summer, after the coldest winter in living memory had passed. Two ships were believed to have carried the disease to the island; one from England and one from Denmark. This “first wave” was characterized by relatively mild symptoms and no recorded deaths. This put the health authorities in Iceland off their guard so that when the more deadly “second wave” hit in late October, their response was indecisive and slow. Once the virus started spreading in the fall the effects were devastating and swift. Of 15.000 inhabitants then living in the town of Reykjavík, an estimated ⅔ are believed to have contracted the disease, with the greatest number of people falling sick in the second and third week after the first cases were reported. Most companies and services shut down because of lack of manpower. The newspapers had to stop publication when the printing presses closed, and the telephone service was reduced to an hour each day. The single pharmacy in town was barely able to keep going with inexperienced temporary staff as most of the regulars had fallen ill. Doctors worked overtime making an incredible number of house calls each day. In many cases patients died without getting any medical help. The bed-ridden were called on by volunteers organized by a health committee created by the medical authorities, and they often had to collect and prepare the bodies of the deceased. Almost 500 are believed to have perished from the disease, most of them in Reykjavík.
Doctors and volunteers resorted to a variety of remedies to avoid contracting the virus themselves, as they tended to the sick and the dead. Many believed in the antiviral properties of camphor and turpentine. Rubbing turpentine on the chest was believed to be effective against deep coughs and there were even accounts of people drinking it to cure the flu. People believed that the smell of turpentine lessened the chances of contracting the virus by breathing it in. Camphor drops, a solution of camphor concentrate in neutral spirit, were sold without prescription by the pharmacy. As the mixture had to be fresh, the pharmacy resorted to mixing the solution in a big pot every day, and yet struggled to meet demand. A general shortage of medicines was recorded before the “second wave” was over in early December.
Another popular remedy was smoking. Puffing on a cigar, while tending to the sick, was believed to protect the smoker from contracting the virus. Belief in the medicinal properties of tobacco has long been widespread, and records from the folklife collection of the National Museum of Iceland show that using tobacco to cure wounds and relieve toothache was common well into the 20th century. In 1918 a variety of cigars was available in stores in Reykjavík. Import figures show that there was a marked increase in the sale of cigars and cigarettes in 1918 compared to previous years, while there was a similar decrease in the sale of pipe and chewing tobacco. It is possible that the influenza precipitated a change in the mainstream method of tobacco consumption.
While the miasma theory of disease spreading with “bad air” from rotting matter in the ground had long been replaced by germ theory in 1918, the influenza pandemic led people to speculate on the risk of contagion by inhaling the virus. It also brought into focus the often deplorable conditions of the poor in a fast growing town; overcrowded, stuffy and humid apartments in cellars and sheds. We see similar concerns in today’s debates on the risks of airborne contagion; the effectiveness of masks or the 2-metre rule, and the role of air-conditioning systems in spreading the disease. It is no wonder, then, that people should resort to strong-smelling substances, like terpenes and tobacco, to protect themselves.
Prescription liquor and Hoffman’s drops
While the medical community was divided on the usefulness of alcohol as medicine, many doctors prescribed it for a variety of common illnesses. Under the influence of a strong temperance movement, Icelandic voters had supported prohibition which came into effect in 1915. Doctors lobbied hard for exemptions that allowed pharmacies to import certain kinds of alcohol as medicine. The permitted types were neutral or concentrated spirit, brandy, red wine, port, sherry, and Malaga wine. Soon after, a public debate about the “læknabrennivín” (“doctors’ booze”) or prescription liquor ensued. Looking at import figures, it seems clear that at least some doctors prescribed excessive amounts of alcohol to patients during prohibition, which ended in 1936.
No known medicines were proven to work against the influenza, so both doctors and laypeople resorted to a variety of remedies to fight the most obvious symptoms: coughs, chest pains, and burning fever. The pharmacy had recently had a delivery of aspirin pills from the US, and these were used to quell fever, along with quinine. No tablet presses were available in Iceland at the time. Alcohol, especially brandy, was used to “ease the suffering” of patients. It was also widely used as a preventive, both by doctors and the public. Anecdotes about drunkards that never got sick circulated widely, and some doctors were known to drink before making house calls. One doctor always carried with him a thermos flask with toddy that he would drink one cup of every time he visited a patient during the pandemic. Volunteers tending to the dead held brandy in their mouths, believing this would prevent contracting the flu. Fortunately, the pharmacy had just acquired a large barrel of brandy that was sold with prescriptions under the pharmaceutical name spiritus vini gallici.
Another remedy that was widely used for relieving cold symptoms was the famous aetheris spiritus compositus, or Hoffmann’s drops. Named after the German 18th century doctor and chemist Friedrich Hoffmann, these were a mixture of alcohol and diethyl ether, which is also used as an anaesthetic. While not as pleasant as brandy, they were reportedly abused as a “household booze” during the prohibition era. In 1918, they could be acquired from the pharmacy without prescription in limited amounts. In Iceland Hoffmann’s drops were for a very long time the go-to medicine for a variety of ailments from the second half of the 19th century to the middle of the 20th. Their use (and abuse) is mentioned in a number of folktales, anecdotes and rhymes. Along with a few other such “drops” they were part of the standard medicine kit of midwives.
Just like elsewhere in the world, the pandemic had the immediate effect of relaxing the prohibition zeal. While opinion within the medical community was divided, doctors and medical authorities, who believed in the effectiveness of alcohol cures, were instrumental in this. In Norway, for example, authorities distributed half a bottle of brandy to every household because of the influenza. This directly contradicted an earlier ban on hard liquor introduced in 1916. This did not, however, lead to a wholesale abandonment of prohibition in these countries, although its effectiveness, in practice, eroded over time. When prohibition was lifted many years later, both Iceland and Norway passed very strict alcohol laws, influenced by the temperance movement.
Demand for dilutions
The influenza pandemic put immense pressure on the limited health services in Iceland at the time. Doctors worked overtime, and the single pharmacy in town was open 12 hours a day, with the pharmacist himself, Aksel Christensen, the only qualified staff member who didn’t get sick. It is therefore not surprising that people tried to procure medicine by alternative means. Homeopathy had been gaining ground in Iceland since the middle of the 19th century, despite opposition from physicians. In 1918 several homeopaths worked in Reykjavik and also in some parts of the country where doctors were few and far between. While in the questionnaires respondents often express doubts as to the effectiveness of the dilutions they provided for the Spanish flu, it emerges that many people sought their help, believing that it would not harm to try their remedies for an illness nobody really knew how to cure. Some testified that the dilutions had worked as promised, and the patients got better.
People seem to have classed homeopaths as self-made or amateur doctors. Some of them also used other alternative treatments, like warm and cold poultices, for the influenza. It is remarkable that although there was a living tradition for herbal remedies in Iceland in 1918, these are hardly mentioned in the context of the Spanish flu. Perhaps in people’s minds such a novel disease called for new remedies with new chemicals, like pills, drops, turpentine, and mineral oil. Perhaps it also reflects the urban-rural divide that marked the spread of the disease. At the time, many doctors commented on “excessive belief” in medicine among laypeople, and expressed doubts as to whether any of the remedies used, whether homeopathic or pharmaceutical, were really any good against the influenza.
It is clear that during those times, many people sought both comfort and hope in prayer. Some believed that certain persons had particular powers to “pray for” sick people, and in particular priests were known to mention bed-ridden congregation members during prayer in church, if that could help the person get better. From accounts and photographs it is clear that people tried the best they could to maintain form and traditions surrounding the dead, with vigils, burial services and processions with horse-drawn carts, although during the crisis these were difficult in practice. It is significant that the Icelandic Spiritualist Society was founded on December 19, 1918, and spiritualism gained considerable traction in the wake of the pandemic.
Just like in the current coronavirus pandemic, some form of isolation was considered to be the safest way to avoid contracting the Spanish flu. Handshakes were outlawed and guests barred from entering houses and farms. Sometimes this caused difficulties because in the rural countryside the laws of hospitality were still strictly observed in 1918. One account tells of a traveller who arrived at a farm with his 15 year old son, who showed every sign of having the influenza. The people of the farm chose to risk contagion, rather than eternal damnation, and let them inside where the boy was nursed. Several people in that area subsequently caught the disease from the pair. In most cases, however, travel was limited to the extreme. Mail bags were left and later picked up, to avoid contact, and guests arriving at farms were received outdoors. These measures proved effective so that large parts of Iceland avoided the pandemic altogether. Some of these areas were affected by influenza later, and there was probably a “third wave” of Spanish flu in the spring of 1919. These later epidemics were much less lethal than the “second wave” of the Spanish flu.
In Dr. Andrea Kitta’s book, The Kiss of Death, she talks about contagion narratives and how these reflect people’s “desire to be active participants in their well-being and indicates they are knowledgeable and capable of observing trends”. Far from being irrational or uninformed, the popular remedies used during the Spanish flu were based on many solid foundations, scientific and religious, that were accepted at the time. In addition, the official remedies proposed by the medical establishment at the time, were often based on what seems in hindsight to be somewhat shaky grounds or outdated science. There is no need to condemn one or the other, as both were attempts to formulate an effective answer to an unknown and incurable deadly disease. Many of the preventive and curative measures used by lay and learned alike in 1918 were probably largely ineffective, but they demonstrate an aptitude for self-preservation and a belief in rational responses to danger. If the current pandemic has taught us anything, it is to tread lightly when we evaluate people’s responses to an uncertain situation, based as they are on a flood of contradictory evidence, anecdotes, rationalisations, and narratives; in other words, folklore.
The Library of Congress Folklife Center
Stories from the 1918-1919 influenza pandemic from the ethnographic collections