An occasional series on eminent Scots unjustly forgotten or ignored
We are suffering one of humankind’s many pandemics, killing over two million souls, as I write, and as with those killed in past times, the majority the poorest in our society, the ones least protected. Depressing to add, it is liable to linger for a decade or more, despite multiple vaccines on the market.
In contrast, the Black Death plague killed an estimated 25 million people, almost a third of Europe’s population. It hung about for centuries, particularly in cities, reappearing in London in 1665 to kill an estimated 70,000 more.
More recently in western history, we had a pandemic called the Spanish Flu, an influenza virus. It lasted from 1918 to 1920. It infected over 500 million people and killed 50 million. Pretty well every family lost at least one member to it. The invisible death was most prevalent where people congregate in large numbers, cities. Like today, with virologists finding vaccines, a Scot, was central to its suppression. He set the pattern of how to beat an invisible enemy.
The man and the doctor
James Niven was not an easy man to get to know. A conversation with him was hard going. Solitary, introspective, terse in reply, appear to be the qualities most associated with his general demeanour. Colleagues describe him as a ‘straight-talker’, meaning no waffle or flim-flam, straight to the point.
Like a lot of serious professionals we have all met at one time or another, Niven didn’t suffer fools gladly. Looking for a a guide to the man and his presenece entering a room, there are shades of Niven in the role of James Robertson Justice’s fearsome chief hospital surgeon, Sir Lancelott Spratt, in the ‘Carry On‘ film comedies.
Today, English would describe him as dour, or if they see their racism as a natural facility, they might say a dour Scot, as if dourness is a malady afflicting only Scottish people. Niven had good, solid qualities. He actually cared about folk more than himself or his career reputation.
If he is remembered at all, he is venerated for stemming the Great Spanish Flu epidemic of 1893. And in that regard, it’s Manchunians who remember him most of all because Manchester was where he made his name as Chief Medical Officer. Niven is barely known in Scotland outside medical circles. Scots should know his story too.
Niven was born in Peterhead in 1851. He was educated at the University of Aberdeen, graduating with an MA, and finally Queens’ College, Cambridge University, elected as a fellow at Queens. His intention was to study engineering but being more interested in people that things that get grease and oil on your hands and clothes, he switched to the study of medicine after gaining his Cambridge MA in 1877.
He got his medical training at St Thomas’ Hospital in London. He qualified in 1880, as Batcheolor of Medicine, and worked first for the Metropolitan Asylums Board, being appointed an Assistant Medical Officer at the Deptford fever and smallpox hospital. It was not long before he left that post to take up a private practice in Manchester. It is worth noting that all his English medical qualification were of a lower status than the equivalent Scottish ones of the day, though that seems not to have dented his ambitions.
Very little is known about his domestic life. He appears to have married, partnerships almost unknown in his Victorian day, for his wife may have died early (this requires research beyond this brief biography), he was survived only by two daughters.
Pandemic versus pandemic
A month ago, we had never heard of “social distancing“, let alone been instructed to self-isolate in our own homes. But now social distancing is the top priority for limiting the spread of Covid-19 among the population. So how did people cope with these measures in previous pandemics, particularly in the Spanish Flu pandemic just over a century ago, which killed up to 100m people?
When Spanish flu first hit the UK in spring 1918, there was no obvious cause for alarm. Although the virus poured into the country via the ports, from Glasgow shipyards to the naval dockyards at Southampton, the authorities were focused on the war effort. London’s West End theatres were dominated by a sea of khaki as thousands of servicemen sought distraction from the war. Live entertainment and the distinct lack of social distancing made the theatres a breeding ground for the virus.
Unlike now, politicians felt certain of beating the huns in a week, a war, said in jest, could be quickened by sending our boys infected with the flu virus to the frontline to sneeze on the enemy.
The so-called Spanish flu – always Johnny Foreigner causing the problem – was just another annoyance while we got on with our glorious war to end all wars. Killer flu was commonplace in those days, attacking the old and infirm. It was just a fact of life.
When the pandemic spread to America the medical experts there were quicker off the mark than us to close it down. They spotted flue was not just a winter afflication. Coughs and sneezes spread diseases any time of the year. Masks, as now, were the symbol of the fight against flu. The Red Cross distributed gauze masks. For a slogan, instead of our functional ‘mask, space, hands’, Americans got the poetic that didn’t treat them as slow to learn. They were enjoined to:
Obey the laws and wear the gauze! Protect your jaws from septic paws!
When England sneezes, Scotland gets the flu
Employed today as an economic reference, in the original form the adage related to a Union that left ‘Jock’ to get on with survival alone. Here is an extract from an official report sent to AR Butler, Bute Medical School, in St Andrews:
“The impact of the pandemic on those at home was exacerbated by the poor wartime diet and scarce medical resources. The pandemic came at a time when most doctors were enlisted in military service. As a result, many areas were left without proper medical car or were left in a situation where one doctor had thousands of patients assigned to him. In part of Fife, there were 5,731 people to one doctor,19 and in one area of Glasgow, normally looked after by 17 GPs, ten were on military duty and three were ill. This meant there were only four doctors for a population of 55,000 people.”
In Scotland we got on tackling the pandemic ourselves. Though the UK Treasury took all we earned, as they do now, no refunds for boosting health and defeating the pandemic were offered. There was no shortage of interesting suggestions in the papers about how best to deal with influenza. Exacrbated by war shortages, meant tens of thousands of Scots died.
In good Scots tradition, we thought it a nutritional matter. Some recommended a diet based on porridge, jam and sugar; others urged people to drink more whisky and smoke tobacco, this last idea self-serving advise from heavy drinkers and smokers, fumes the best screen against infection.
Come the hour, come the hero
Niven took a different view. When schoolchildren started dying at their desks in Manchester, Niven knew he was dealing with an emergency. He understood proximity, one child to another, spread the virus. This new flu targeted the young and the healthy.
As it spread like, well, a flue epidemic, among shops, factories and offices, Niven instructed the council to close the schools and issued 36,000 handbills informing people with symptoms to self-quarantine for a fortnight. At first he met with resistance but using capitalist psychology, soon convinced the councillors it was better to save lives than lose workers and taxes. Thanks to him, mortality was only 322 people out of the 100,000 Mancunians who contracted Spanish flu during the spring and summer of 1918.
The press began mentioning his name. Niven became known beyond Manchester. As the deadly strain of influenza spread across Europe and the rest of the world, it was Niven who pushed a simple – though unpopular – health message that kept many more Mancunians alive than inhabitants of other UK cities: close down society as much as possible to stop the spread of the disease.
Like the mayor in the seaside tourist venue of Amity Island in the movie Jaws, Manchester was a thriving city. It prided itself on the productivity of its mills. They were not going to stop production, or isolate workers at home, not for anyone, neither Scottish doctor, not police officer. But Niven was resolute, publishing a leaflet early on in the crisis saying the sick should “at once” be separated from the healthy for treatment “and they should bear in mind that the risk of a relapse”.
The Manchester Guardian took up his cause wiith vigour. (Now known as the Guardian newspaper.) The editor gave him the space he needed to warn people and to give them a checklist of symptoms to watch out for: a sudden severe headache, pains in the back and limbs, and fever.
He warned that “discharge from nose and mouth should not be allowed to get dry on pocket handkerchiefs”. He ordered infected articles and rooms disinfected. Anyone who caught the flu must “on no account join assemblages of people for at least 10 days” – that stricture familiar to us now – after the beginning of the attack, and in severe cases “remain away from work for at least three weeks”.
Through his tenure met with bureacratic obduracy, ignorance spouted as expert knowledge, and officials protecting their careers and interests, he confronted them all. He moved from one meeting with the city fathers to the next, advising hospital consultants how to deal with mounting numbers and yet keep beds apart, and generally be the pain in the butt only a Scot can be when he knows he is right. Those battles must have been challenges for a man known to be shy and reserved.
In time, having saved thousands of lives of soldiers coming back from the war, the pandemic subsided, and Niven’s strictures of isolation and cleanliness received the applause he was due. Never one to advertise his past achievements, it was then people began to discover he had a long distinguished history beating diseases in his previous post in Oldham.
According to medical historian William Povey, whilst at Oldham Niven was “instrumental in improving the standard of housing, of sewage and refuse disposal, of the milk and water supply, in reducing smoke pollution, and containing the spread of infectious diseases.”
In addition, a term in Berlin studying with German physician and microbiologist Robert Koch (discoverer of the TB bacillus), helped Niven to use Koch’s treatment at Oldham General Infirmary on his return to deal with smallpox, typhus, measles, scarlet fever and whooping cough.
Paying the penalty of the pioneer
The pressures of the job eventually took their toll on Niven. He resigned his post early, and settled in Douglas, Isle of Man, writing medical papers and growing vegetables. Mind and body activities were not enough to stem growing depression. One day he went missing. He was found drowned in the sea off Douglas on 30 September 1925. An inquest recorded he had taken poison and drowned himself while temporarily insane.
His obituary in the Guardian is respectful, paying tribute to a dedicated doctor who carried his achievements lightly and put his patients’ health before all else: “He was not a great talker and had the merit of never ‘advertising’ – in fact, in later years especially he seemed to keep somewhat aloof from his colleagues. He had the reserve of the north-eastern Scotsman, and strangers sometimes fancied his manner to be somewhat chilling. But those who knew him best were able to attribute this to a kind of shyness, and no member of his profession who required help from his great experience and sound knowledge ever asked for advice and assistance in vain.”
As our English colleagues keep reminding us, wherever you go in this world, you will find a Scotsman or woman in charge doing something for the common good.
Information researched from various medical reports, the Manchester Guardian and the Scotsman, plus the 2012 dramatised documentary on Dr James Niven and Manchester, starring Bill Paterson. Ernest Dunks, Mark Gatiss. Paul Freeman. MJ O’Donnell, Kenneth Cranham.