Med Hx: The ‘Spanish’ influenza pandemic: New evidence for influenza outbreaks in England and France prior to 1918

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For the past 20 years the most widely accept theory has been that the 1918 pandemic likely began in Kansas (United States) and was carried to Europe by troops off to WWI.  But much of the data was anecdotal, and not everyone concurred.

Among the early contrarians was Professor John Oxford, who in 2001 published The so-called Great Spanish Influenza Pandemic of 1918 may have originated in France in 1916. 

In 2006, PBS published Origins of the 1918 Pandemic: The Case for France by Vikki Valentine, which would help send me down a rabbit hole in 2007 when I penned a long blog - citing U.S. Navy records, and old (1917) Lancet articles - that were highly suggestive of a highly virulent flu-like illness spreading in Europe as early as 2015. 

A brief excerpt from my blog Beginnings and Ends:

The files of The Lancet indicate that a more or less widespread epidemic occurred in England in the spring of 1915. The disease does not appear to have been as prevalent in 1916 as in 1915, but in 1917, among the military forces, cases of so-called "purulent bronchitis" occurred which were fundamentally the same as the rapidly fatal cases of influenzal pneumonia so frequently seen at the height of the pandemic.

An epidemic of purulent bronchitis was reported from a British Army base in northern France in January, 1917, whilst an epidemic of influenza was in progress. This outbreak began in December, 1916. Later, in the spring of 1917, similar cases of purulent bronchitis were treated at Aldershot, England.

These cases are noteworthy because they seem to have been similar in all respects to the fatal types of influenzal pneumonia so commonly seen in all parts of the world during the autumn of 1918. 

In 1918, influenza was still believed due to a bacterial infection (Influenza A was only isolated as a virus in 1933), and so - despite the clinical similarities - no virological confirmation that the wave of illnesses reported in 2015-2017 was due to the same virus as the 1918 pandemic exists.

 

Today we revisit this historical conundrum, with a new paper by Douglas Gill and John Oxford, that provides an updated - and far more detailed - historical hypothesis on the possible pre-1918 emergence of the `Spanish flu'. 

While we are left with something less than a `smoking gun', this 20-page narrative is a fascinating read, and very much worth your time. And with a little luck, it may serve to reopen the debate on the still murky origins of the worst influenza pandemic on record.  

 

The ‘Spanish’ influenza pandemic: new evidence for influenza outbreaks in England and France prior to 1918 

Douglas Gill1 and John Oxford
Published online by Cambridge University Press: 22 April 2026

Abstract 

The Spanish influenza pandemic of 1918 caused well over fifty million deaths. The epicentre undoubtedly was China, where gene mixing of different virus strains occurred amongst aquatic, migrant birds. But where and when did the virus first infect (or spill over to) a human being?

We take, as our starting point, a paper demonstrating that an infection causing the same symptoms as the influenza virus was widespread in New York during the winter of 1917–1918. The authors of that paper went on to suggest that the virus had probably reached North America from Europe, in the context of troop movement during World War I. Our own researches have focussed on this point.

We show that outbreaks of serious respiratory disease, local in nature but causing unusual patterns of mortality, were indeed reported by scientists and doctors in army hospitals in England and in France, well before the first wave of the pandemic had arrived. We use the records of these hospitals, now held in the National Archives, to trace the progress of this disease amongst the individuals who fell ill. We examine contemporary reactions to this minor epidemic – an epidemic, we suggest, which acted as a herald wave of the pandemic yet to come.

The latter part of our paper addresses the second question, as to how troop movement across the North Atlantic, once the United States had entered into war, may well have enabled the virus to spread from Europe to North America.

        (SNIP)

And it has enabled us to demonstrate that if indeed, as we suspect, the spillover of the H1N1 influenza virus, from a bird to a human being, took place in northern France in 1916, then a pathway certainly existed whereby that virus could cross the North Atlantic to New York. Once landed at that port, it could spread in a slow but certain fashion through the crowded cities and the burgeoning encampments of a great nation, now girding up for war. It might mutate, it might change the way it spread, but once it had adapted, it was then ready to take up the role of driving the subsequent pandemic.

        (Continue . . . )