An exhausted, flu stricken couple were admitted to Christchurch Hospital in November 1918.

Dr Charles Little and his registered nurse wife Hephzibah Little had been tending flu victims across rural North Canterbury when they too succumbed to the flu.

Charles died on November 26 and Hephzibar four days later.

They were far from alone. With an estimated third of New Zealand’s doctors and almost a quarter of its nurses overseas serving in the First World War the country was ill-prepared for when the second and most lethal wave of the ‘Black Flu’ of 1918 reached New Zealand’s shores in October – peaking in mid-November.

In total 14 doctors and about 37 registered nurses and nursing students died after succumbing to the flu caught from the patients they were tending. Along with VAD (voluntary aid detachment) nurses and other volunteers caring for flu victims in homes, city and cottage hospitals and makeshift hospitals set up across the country in schools, ships, and racecourses. While thousands died there were also tens of thousands of Kiwis who were infected and survived but were severely ill for days and took weeks to recover – stretching the already exhausted health workforce.

So it is not surprising that the thinly stretched nursing and medical workforce died in much greater proportions than the general public in the Black Flu, which worldwide on average on average killed about 20 per cent of those who contracted it. This is compared to a more typical flu mortality rate of one per cent. The Black Flu was also unique that in most of the victims were healthy young adults aged between 20 and 45 – with a peak death rate at age 28 – with the exceptionally infectious, severe new virus triggering secondary bacterial infections like pneumonia which is what most of the victims died of.

Overall across the country an estimated 9000 people died of the country’s then population of 1.1 million. That was a national death rate of about nine per 1000 residents (about 6 per 1000 residents for Europeans and a much higher rate of 49 per 1000 for Māori). The death rate of health professionals was about 20.2 per 1000 for doctors and 21.8 for nurses – similar to the death rate amongst the soldiers in military camps across the country.

First health professional death

There is debate about whether ill passengers on the ship Niagara – carrying home the Prime Minister Bill Massey and finance minister Sir Joseph Ward from a conference in London – that reached New Zealand on October 12 were the source of the lethal second wave of the flu or whether two troopships that arrived at the same time with ill soldiers on board were the more likely source.

But it was the Niagara flu that appears to be the cause of the death of the first health professional to die in the 1918 pandemic on New Zealand soil. Australian nurse Sister Irvine Crossing had been nursing in Auckland and had booked her homeward journey to Sydney on the Niagara.

Hester MacLean, chief nurse and founding editor of Kai Tiaki, wrote – in one of many nursing and medical obituaries she published in Kaitiaki in January 1919 – that the young nurse hearing of the sickness on board the Niagara had volunteered to nurse patients while it was berthed in Auckland but Crossing succumbed herself and was transferred to Auckland Hospital where she died on October 26.

“A pretty, bright girl only twenty-four years of age, she was beloved by her patients and much sorrow has been expressed at the sudden termination of her short life,” wrote MacLean.

Whatever the source the pandemic hit Auckland first and hard so by October 26 1918 there were reports of 28 nurses sick with the flu at Auckland Hospital –with eventually 140 of the hospital’s 180 nurses reported to have become ill with the flu, filling three of the hospital’s wards.

Though fortunately very few of the ill nurses died with a nursing ‘roll of honour’ of flu victims indicating only one nurse on the Auckland Hospital payroll died,  though two registered nurses from elsewhere in the country – who responded to Auckland’s desperate plea for volunteers to staff the hospital – also died after nursing flu patients at Auckland Hospital. Two other Auckland nurses died while private nursing in the city’s epidemic as well as a Paeroa mission nurse, Isabella Manning, who volunteered to nurse ill soldiers at Auckland’s Narrow Neck military camp.

MacLean also reports the death of Auckland’s assistant district health officer Dr O’Sullivan who died in November after returning “to duty too early” after a mild attack of influenza and contracting pneumonia. “He was a promising young doctor and (his death) much regretted by the Public Health Department,” wrote MacLean who also noted the death of ‘another medical man’ Dr P.McNabb during the Auckland pandemic.

Auckland’s lone district health officer Dr Hughes had urgently called for help from Wellington’s Health Department in late October and the Chief Health Officer Dr Frengley arrived by train on November 3.  But by then the flu had already made its way to Wellington where it went on to also kill nurses and doctors including newly married nurse Mollie Beagley, Port Health Officer Dr Henry Pollen, Greytown’s Dr William Bey and GP Dr Matthew Holmes who had been invalided back to Wellington in 1917 after serving in both Gallipolli and the Western Front.

Alfred Hollows, an army medical orderly assigned to a temporary hospital in Wellington’s Abel Smith Street said at the height of the epidemic it had 60 men being cared for only by four orderlies and 30 women with three VADs under the ‘steadying effect’ of a retired nurse.

“We ran a half-hourly chart for high fevers, temperature, pulse and so on taken and noted but it was mostly just sponge, sponge, sponge to get the temperatures down.”  With the only drugs aspirin, digitalis and morphia he said those who responded were discharged within a week while those who didn’t gradually went into a coma – or heavily haemorrhaged – and died within five to ten days.

The flu kept rolling through the country during November until its force wore out in mid-December.

The nursing roll of honour shows deaths from the Far North – district nurse Maude Mataira a ‘bright, pretty Māori girl’ who had served Hokianga Māori for several years and mental health nurse Julia Tweltridge of Dargaville’s Te Kopuru  Hospital – all the way to the deep South where the deaths included two VADs working at the Caitlin’s Owaka Hospital and four registered nurses and four VADs at Dunedin Hospital.

First woman GP lost to the flu

One of the most famous and poignant of the flu victims is Dr Margaret Cruikshank.

Soon after graduating in 1897 she had become the country’s first woman GP by taking up a position assisting Waimate’s GP and when he went to serve overseas at the start of World War One she became the district’s only GP.

By the time the influenza epidemic hit in November 1918, she was already strained by overwork but kept pushing on to care for flu-struck patients around the district – including stepping beyond medical care to at times feed babies and milk cows.

One Waimate resident at the time shared a tale with flu researcher Geoffrey Rice of their ‘wonderful doctor’ that illustrated just how hard she worked:

“She went to one place and found she’d left her stethoscope in her buggy, so she put her ear to this man’s chest and told him to count out loud while she listened to his lungs. So he started off, ‘One, Two, Three, Four’ and so on.  And she fell sound asleep! She woke up to hear him still going, ‘Nine hundred and ninety-seven, nine hundred and ninety-eight…’ I think he was one of the survivors. There weren’t very many funny stories like this one. That was a terrible time.”

The exhausted, selfless doctor caught the flu herself and succumbed to pneumonia on November 28, 1918. A statue was erected of her in the town carved with the words: “The beloved physician, faithful unto death”.

It was one of the few memorials to those lost in the flu epidemic – there is a plaque in Dunedin Hospital to the four nurses it lost and Christchurch’s Nurses Memorial Chapel (recently re-opened) commemorates not only Christchurch nurses lost in the war but also two Christchurch Hospital nurses who died nursing during the epidemic.

There are also memorials in Canterbury to honour two doctors who died after working during the pandemic. Dr Aubrey Short had graduated in 1914 and soon after joined-up to the army so landed as a surgeon-captain with the first contingent on Gallipolli (where his brother died in August 1915). He served also in France raising to the role of Major and deputy-assistant director of medical services and received the Military Cross before returning in early 1918 to join the staff at Christchurch Hospital. The popular house-surgeon was the fateful age of 28 when he too died from the flu on November 15 1918.

The second doctor commemorated was the beloved country doctor, the 52-year-old Dr Charles Little who has both a statue in front of Waikari Hospital – a facility built in response to public demand after the pandemic – and a monument in Culverden honouring his dedication to the district.  Sadly neither mention his second wife of two years, registered nurse Hephzibah Little (nee Kennedy), who had poignantly died just days later, aged 35, after also nursing local flu victims.

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