Ada Darwin will never forget the last time she saw her mother alive. It was November 19 1918 and the Spanish Lady - as the strain of pandemic flu sweeping Europe that winter was known - had just arrived in Greenheys, the district of Manchester where Ada, then seven, lived with her parents and five siblings.
"I remember my mother watching me as I got dressed to go with Auntie Annie," recalls Ada, now 94. "She looked so sad. I thought it was because I was leaving but in retrospect I realise she probably knew wouldn't be seeing me again."
Her mother, Jane Berry, died the following day, her face covered in the telltale blue-black marks of cyanosis, the usual end effect of the virus caused by fluids flooding the lungs. Three days later her four-year-old brother, Noel, also succumbed, followed on November 25 by her father, Frederick.
Today, Ada is one of the last survivors of the great influenza pandemic of 1918-19. The week before her parents' deaths the virus claimed more than 150 lives in greater Manchester. In the other 95 great towns of England and Wales there were similar fatality levels, with more than 7,740 people dying in the first week of November alone, according to the then returns of the registrar general.
Now, as Britain prepares for the possibility of another flu pandemic, sparked most likely by a sudden mutation in the avian flu virus H5N1, Ada's memories of that dreadful week 87 years ago could prove invaluable. For she is convinced that had it not been for a quick-thinking doctor she might also have perished.
"It was Sunday, November 17, that I was put to bed," she recalls, sitting in her living room in Chester, surrounded by pictures of her parents and grandchildren. "I remember this great big headache and telling my mother to stop the others crying, it's making my head hurt." Ada usually slept with her older sister Norah, then 12, while her brothers, Frederick, nine, and Austin, two, slept in a separate bed. But when she fell ill, her mother moved her into a cot in her room with Edith, her two-month-old sister, followed by Noel and Austin.
"It was my job to give Noel his medicine. But the doctor said myself and Austin would stand a better chance of survival if we were taken to be nursed separately." Ada believes her mother contracted the infection from a neighbour who she nursed and that if she had remained with her mother, as Noel did, she might also have died. "If it attacked the chest there was no hope. Austin and I must have been on the fringe."
But neither Edith nor Frederick and Norah, all of whom remained in the house with her mother, died, so it may be that her parents were simply more susceptible. Most flu viruses are dangerous to the very young and the very old, but the 1918 virus disproportionately affected adults between the ages of 20 and 40. In the case of Ada's mother, who was 34, it would not have helped that she had recently given birth to Edith. In the case of her father, aged 38, a member of the Royal Army Medical Corps, four years of war may have similarly compromised his immune system. An infrequent visitor to the family home, he probably caught the virus at a military hospital near Manchester where he had stayed on after the Armistice to nurse wounded soldiers. Ada remembers his military funeral on November 29 at Manchester Southern Cemetery.
"It's like a film in my head. There were the black horses with the plumes made from ostrich feathers, then the gun carriage with my dad's coffin covered with the union flag. My mother's coffin was in a big glass hearse with Noel's coffin under the driver's seat."
Ada's grandmother survived the flu and was able to take in Ada and her siblings. But according to Mary Moore, a local flu researcher who helped Ada locate her parents' grave, most families were not so lucky. "Many children had to be farmed out and ended up in workhouses."
Unlike today, when reports of bird flu infections are broadcast round the world in minutes, in 1918 there was no early warning system, no vaccine and no way of telling who might be next. Medical advice included boiling handkerchiefs, disinfecting infected areas and gargling with salt water. The principal advice was to stay in bed until the fever had gone and, as one leaflet put it, "keep children away from sick patients."
Because of the paucity of public information, by March 1919 many people assumed the pandemic was over. They were wrong. One of the last victims was Ms Moore's mother's first husband, Thomas Bithell. On March 8 1919, a few days after he had invited a sick young nephew into his home in Hawarden, Mr Bithell also contracted the virus and died.
He and Ms Moore's mother had only been married for six months. As in Ada's case, Ms Moore believes the only reason her mother did not fall ill is that a nurse locked her out of her husband's sickroom. "It was the most sensible and merciful course. She later learned he'd suffered terrible convulsions."
What does Ada make of the talk of a new pandemic? "I'm not worried, not at my age, but it is a concern for my grandchildren. Now there's a lot more kissing which could spread the virus. I've even seen men hugging each other. There was none of that in 1918."
Backstory: The 1918-19 pandemic
No one knows precisely where, when or how the 1918 pandemic began. The virus was dubbed the Spanish Lady because Spain, not being involved in the war, had a free press and did not censor reports of the pandemic. In fact, the first recorded case came on March 8 1918 at Camp Fuston, in Kansas.
However, British army medical reports suggest the virus could have been circulating in hospital camps in northern France as early as the winter of 1917, infecting soldiers weakened by three years of fighting and exposure to mustard gas. The first wave coincided with the arrival in Britain of American soldiers. But it was the second wave, between September and December 1918, and the third wave, between February and April 1919, which were to prove devastating. Britain - where the pandemic claimed 250,000 lives - ground to a halt as mail services were cancelled and fires went unattended.
France, Germany and America suffered similar mortality levels (about 2.5% of the population). But in India the toll is thought to have been far higher, taking the death toll to 40 million to 100 million worldwide, making it the most devastating disease in human history.
