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| Journal of the New Zealand Medical Association,
11-September-2009, Vol 122 No 1302
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We present a historical case of a New Zealand soldier on a
troop ship in 1918 who contracted pandemic influenza, became delirious,
“jumped overboard”, and drowned. Some lessons from this case of
current relevance are discussed.
Case report and outbreak contextThe case was that of a private in the New Zealand
Expeditionary Force whose records are publicly available, as are all World War
One participants from New Zealand (http://muse.aucklandmuseum.com/databases/Cenotaph/RecordDetail.aspx?OriginalID=2351&SearchID=7638822&Ordinal=1).
He was travelling aboard the troop ship Tahiti (Figure 1) which was off
the coast of West Africa en route from Wellington to Plymouth, England.
Figure 1. The HMNZT 107 Tahiti in
Wellington Harbour ca 1914–1919 (National Library of New Zealand
Reference number: 1/2-014597-G)
 In an archival report1 it
was noted that during an outbreak of pandemic influenza, a soldier with
influenza became delirious, “jumped overboard”, and was lost at sea
(presumed drowned) on 4 September 1918. Another archival document stated that
this particular individual was “missing at sea” on this
date.2
There was no doubt amongst the medical staff onboard the
vessel and in the subsequent Official Enquiry, that the outbreak on the
Tahiti was that of influenza.1 Indeed,
an outbreak of “fever” was reported to be circulating in Freetown,
Sierra Leone (where the Tahiti stopped to take on coal and to meet
other ships to form a convoy). Also other ships in the convoy reported influenza
outbreaks around this time with significant
mortality.1
Furthermore, the first cases of the more virulent second
wave of the 1918 influenza pandemic in West Africa occurred in Freetown, Sierra
Leone (on 22 August 1918)3 and this site was
one of the three major distribution points for this second
wave.4
DiscussionFrom a clinical perspective, altered mental state and other
neurological complications are known features of influenza infection. Indeed,
for the current (2009) pandemic of a novel Influenza A(H1N1) such features have
already been described in the literature (e.g. confusion, disorientation, and
even seizures).5
In terms of this being a potentially preventable death,
there are two aspects which suggest this possibility:
Another aspect of this case highlights a problem
with researching past pandemics. That is in the Official Roll-of-Honour records
for World War One, the online Cenotaph record (as per the URL above), and the
archival casualty records2 state that this
individual either “drowned” or was “missing at sea”,
with no mention of influenza. Only when an archival source was
consulted,1 was it possible to identify this
case as being an influenza-related fatality.
Additionally, the outbreak of pandemic influenza on this
ship highlights a research deficit in that no modern epidemiological analysis to
describe this outbreak (and identify risk factors) has been published to date.
This is despite very high levels of morbidity and 77 deaths resulting. Indeed,
it appears to have been the worst maritime disaster in New Zealand’s
history since the 1881 shipwreck of the Tararua (n=131
deaths).7
The inadequate research around past influenza pandemics has
been raised as a concern previously.8,9
Nevertheless, we are currently investigating this outbreak and other (previously
unstudied) pandemic-related deaths of many other New Zealand soldiers in 1918.
Author information: Nick Wilson, Senior
Lecturer; Jennifer Summers, Masters Student; Michael Baker, Associate
Professor—all at Department of Public Health, University of Otago,
Wellington; Geoff Rice, Professor, School of Humanities, University of
Canterbury, Christchurch
Correspondence: Dr Nick Wilson. Email: nick.wilson@otago.ac.nz
References:
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