The Alumni Network Blog

When thinking about viruses in a university context, we perhaps mainly associate them with medical or scientific research. Or possibly, in a more everyday context, with how raging seasonal influenza strains and suchlike can lead to temporary increases in sick leave and leave to care for a sick child among university staff. However, certain viruses can affect a university more fundamentally, something that the Covid-19 pandemic of recent years – with staff working from home, the rapid transition to online teaching and cancelled doctoral conferment ceremonies – has taught us. But the coronavirus Sars-cov-2 was certainly not the first of its kind. Just over one hundred years ago one of its older relations, the influenza A(H1N1) virus, struck Lund University – and not least its students – hard.

From the history books we know the influenza A(H1N1) virus as Spanish flu. This is actually a misnomer, stemming from the fact that the first cases reported in the press were in Spain – where, among others, the King and members of the government were taken ill – in May 1918. However, by that time the virus had probably begun to spread in several other countries in continental Europe, but the ongoing press censorship during World War I had kept a lid on the news. The morale-sapping effect of a pandemic potentially threatening both troops and the civilian population was too much of a risk for it to be reported on openly. Spain on the other hand was neutral and still had a free press. The exact origin of the virus – which science only succeeded in identifying long afterwards – is still unclear however, but one theory is that it was taken to Europe by the American troops who began arriving after the USA entered the war. Once on these shores, it would prove to be a considerably more lethal weapon than all the human weapons with which the Central and Allied Powers had waged war against each other since 1914. And during the summer of 1918 it spread like wildfire, not just across war-torn Europe, but also to Africa. South America and Japan were also affected, but it is thought probable that the virus spread there from the USA.

A strange characteristic of Spanish flu was that – in contract to most other influenza strains – it did not primarily strike the traditionally “weak” groups such as young children, the elderly and the infirm. Rather, Spanish flu struck hardest against seemingly healthy young adults, mainly those aged between 20 and 40. The reason for this is still unknown, but one theory is that the virus caused the sufferer’s immune system to turn on itself. In other words, the stronger your immune system, the higher the risk of becoming seriously ill.

Professor Thunberg changes his mind

In Sweden, the first case of Spanish flu was noted in Skåne, namely in Hyllinge, in the summer of 1918. Ironically, this was not due to Skåne’s proximity to continental Europe. Hyllinge’s “patient zero” was a local man who had returned home at midsummer after a spell working in Norway, where he had contracted the disease (which in turn is thought to have come to Norway by ship from Scotland). Soon, some 50 local people had been taken ill. The district medical officer in Bjuv, Carl Dilot, was somewhat bemused by the rapid spread of infection, but even so made the assessment that it was just a matter of common influenza. There was consequently no cause to be overly concerned.

A similar assessment was also made initially by another medical expert, Torsten Thunberg, professor of physiology at Lund University. For several years he had been publishing a popular science journal called Hygienisk Revy, and its changing position on Spanish flu is indicative of how views on the virus would gradually alter. When Thunberg first wrote about the flu – one paragraph in the journal’s July edition – it was still under a slightly joshing headline “If the Spanish runny nose was life-threatening …”, and even though he noted that the infection “seems to be irresistible in its trajectory” he suspected that some of the reported cases were probably only “common mucous membrane catarrhs with a bout of fever”. But Thunberg did note that the “the Spanish runny nose does not seem to be a serious illness”, even though it could possibly “take a more serious turn” regarding “the elderly, infants and the infirm” so that “there could even be one or two deaths as a result”. However, even with “such an innocuous illness” Thunberg stated

[…] those who are ill have an obligation to keep away from healthy people. They should not without a valid reason be out in their neighbourhood and should not shake hands. They should preferably stay at home in isolation. And, above all, they should keep away from infants and the elderly.

This was in July and, as we saw above, Thunberg’s assumption about the primary at-risk groups was incorrect. The August edition of Hygienisk Revy did not mention Spanish flu at all. At the same time, the number of those taken ill nationwide was rising, particularly in Norrland and Skåne, and when the September issue of Hygienisk Revy came out, its first four pages were devoted to Spanish flu.

Thunberg now noted that they were dealing with a “a very infectious disease, spreading through airborne and direct contact”, in which one problem was that “many of those who are sick have such mild symptoms that they are not confined to bed”. Bedrest and self-isolation were what the professor primarily prescribed: “the person who is ill shall take to their bed and stay there until they are completely free from fever and any cough has gone”. He also realised that this was difficult achieve, as ordinary people’s impatience and the financial implications of being away from work presented obstacles. In addition, there was the fact that “life in modern society” in itself tended to mix “people with each other”:

The crowds of people in modern big cities and communication systems within and between communities, mean that such a disease that is now raging has the most favourable conditions for transmission to almost every home in our country.

One person who utilised this modern communication system during the summer was an alumnus of Lund University, Per Håkansson. He completed his doctoral degree in organic chemistry in Lund in 1873 and later became known as a manufacturer of vinegar and his own patented disinfectant, Salubrin. His company was based in Eslöv, but in early July 1918 he was compelled to travel to Stockholm on business, even though he felt somewhat unwell. Shortly after arriving, he felt considerably worse and died at his hotel after just a few days. The former Lund student Håkansson had thus not only become Sweden’s very first death caused by Spanish flu – he may very well have been the one who spread the disease to the capital.

Jubilee in the shadow of a food shortage and pandemic

Just over two months later, the traffic was going in the other direction. Now there was a large number of well-known people and dignitaries heading for Lund. The reason for this was that on 27 and 28 September, Lund University was to celebrate its 250th anniversary with great pomp. The original intention had been, as with previous jubilees, to schedule the celebrations at the end of the spring semester, but, as Vice-Chancellor Johan C. W. Thyrén stated in his review of the academic year 1918/19, “certain considerations, particularly the difficult conditions for supplying provisions” has meant the event had to be rescheduled for a later date. The conditions were a result of the war, which was now in its fifth year, bringing rising costs and shortages of most things – including the white velvet used in the student caps that was imported from England. The latter, however, was a minor concern for the students compared with the food shortage. Browsing through the Lund newspapers from 1918, the headlines about, and prior to, the jubilee are almost overshadowed by headlines about “the students’ food issue”. And, on top of this, Spanish flu now struck forcefully just weeks before the jubilee – and this against a student population already partially weakened because of the food shortage.

One of those afflicted was Thorild Dahlgren, a student of many years with multifarious involvements in student life (among other things, he was one of those who worked to resolve the above-mentioned “food issue”). In that autumn semester of 1918, he had got to the stage where he was ready to submit his doctoral thesis in mathematics Sur le théorème de condensation de Cauchy. The thesis defence was scheduled for 21 September, the very last date to be in time for the doctoral degree conferment ceremony during the jubilee celebrations the following week. With four days to go, Dahlgren fell ill with Spanish flu. When there was just one day to go and he was still ill, he was offered a further three-day deferral, something that he, however, declined. He later justified this in an article about his memories of student life:

I was sufficiently clear of mind to make the following argument: “either I am worse on Tuesday than I will be tomorrow, Saturday, and then I have completely missed the chance of achieving the objective, or I am better on Tuesday than I will be tomorrow, Saturday, in which case I might as well defend the thesis tomorrow”. [ – – – ] On Saturday, I got up immediately before the thesis defence, dressed myself in the compulsory tailcoat, got a cab for the short distance from Vinstrupsgatan 9, where I was living, to the University, performed a feeble defence of my thesis and after a three-hour break was back in bed.

Dahlgren was one of the lucky ones. Not only did he recover, but he did it in time to receive his laurel wreath at the Faculty of Philosophy’s jubilee doctoral degree conferment ceremony on 27 September. The Swedish royal family was not so lucky. King Gustaf V’s youngest son, Prince Erik, died of Spanish flu the day before Dahlgren’s thesis defence. Due to this, the royal couple cancelled their planned participation in the University’s jubilee. However, the event was not completely without royal lustre, as the King’s brother Eugen and the crown prince couple Gustaf Adolf and Margareta – the Duke and Duchess of Skåne – attended, although Margareta marked the recent death in the family by wearing mourning dress.

Despite the unfavourable circumstances, the festivities seem to have gone well and according to plan. The press referred to “an outstanding celebration”, “an impressive festive occasion” and “a resounding day of rejoicing in a celebratory atmosphere and sunshine” and thought that “those visiting the city have certainly taken only good memories home with them”. The question is how many of them – after two days of festivities, ceremonies, formal speeches and the general mingling of hundreds of local and visiting celebrators – took the virus home as well?

Certain parts of the jubilee programme had been under threat from the raging infection. For example, the students, through the Academic Society, were to contribute with a special production of the student cabaret Gerda – written in 1886 and subsequently considered to be one of the major classics in the spex genre – but were then suddenly faced with a drastically decimated ensemble. The Society’s then archivist Tusse Sjögren wrote:

[…] suddenly Prince Axel, the White Knight, the conductor, the prompter and a couple of small roles were replaced with others. But it worked. Einar Ralf, who was called in to sing in Father Berg’s jubilee cantata, took over Axel’s velvet cap and the always willing Otto Groothoff at LD [Lunds Dagblad] was surprised on the morning of the performance, taken to the Society and played the White Knight excellently after only one day of song and script rehearsals.

Some explanation of the above may be in order. Einar Ralf was at that time a student at the Royal Conservatory of Music in Stockholm and conductor of the Stockholm Academic Male Chorus but had studied law and been involved in student life in Lund in the early 1910s. He became known subsequently as a concert singer, choirmaster and choral teacher. “Father Berg” refers to Alfred Berg, the University’s then director of music, who became an honorary doctor at the jubilee in 1918. Finally, Otto Groothoff was a journalist, theatre critic and playwright. After hastily filling in, he seemed to have acquired a taste for performing in student cabaret, as he could be seen in the role of the Pharoah in Uarda in 1919 and 1923.

Despite everything, the student cabaret went ahead. As a finale to the jubilee celebrations, the students also planned to organise two balls, an official event at the Academic Society and a more unofficial one at the Grand Hotel. The city’s Healthcare Committee appealed at the last moment for these to be cancelled. However, the plea went unheard, at least regarding the official ball at the Academic Society, which was attended by 500 guests. They had promised that the dancing itself would be “restricted to a minimum”, but there is perhaps reason to question the extent this was adhered to. In any case, the city decided to put its foot down more emphatically only a few days later rather than just make a request. In a situation where the press was reporting around 50,000 people infected and one thousand deaths nationwide, the Healthcare Committee in Lund decided to ban theatre performances, concerts, dance events (including dance schools) and “other similar entertainment conducive to creating crowds” from 30 September until further notice. A similar ban on showing films at cinemas had been previously introduced. When asked by the press whether the jubilee festivities had contributed to the spread of infection, Lund’s chief medical officer, Rydberg, diplomatically replied that “it’s too early as yet – and altogether difficult – to make a statement about this”.

Handwashing and toothbrushing – but no cancelled lectures

Despite the local measures in Lund and other places, October was the worst month yet. The epidemic reached its peak with almost 10,000 deaths in Sweden in one month. In these circumstances, the Healthcare Committee in Lund made a plea on a matter in which they clearly did not consider they had the remit to issue a ban. The Committee wondered “if it wasn’t the case due to the epidemic that lectures and exercises at the University should be restricted to the greatest possible extent”? The matter was discussed at the University’s then next-highest governing body, the Lower Consistorium, on 15 October. To get an idea of the epidemic’s spread, the Lower Consistorium had before the meeting requested information from the student nations on the current number of sick students. The highest number was reported by Lund Nation (18) followed by Kristianstad (6) and Småland (5). The figures were considerably lower at the other student nations in terms of both numbers and percentages, and at some there were no current cases of illness at all to report. It can be mentioned as an interesting detail that Malmö Nation stated it could not provide any reliable figures at all “as a large number of the nation’s members live at their homes in Malmö and, if they fall ill, they are cared for there”. Malmö Nation was at that time virtually the only student nation whose members were not mainly living at their place of study but commuted to lectures. On the other hand, Malmö was the student nation that reported most deaths, five, among its members “from complications of influenza”. Otherwise, only Gothenburg Nation reported a single death.

In the following discussion, a range of views were expressed by those present. Astronomer Charlier deemed that “a difference must, of course, be made between lectures where there is a large audience and those where only a few students have registered”. Anatomist Broman’s view was that “numerous lecture halls are far too small and cramped for the number of students who were now attending lectures” and recommended that in these cases “a request should be made to those students who do not need to take part in courses and exercises now, to defer these until the epidemic in question was over in the city”. Lawyer Björling stated that it should “be sufficient if the University authorities ensured that lecture halls were disinfected after the end of each day’s lectures”.

Ultimately, the Lower Consistorium, despite the Healthcare Committee’s plea, decided not to cancel any teaching sessions, but to follow Björling’s proposal about disinfection plus “lecturers with large audiences would be assigned the large lecture halls (I and VI), and possibly the auditorium”. Lastly, information notices were to be put up with the following wording, of which at least the first two points feel very familiar from a modern Covid-19 perspective:

Due to Spanish flu, students are advised to

1) stay at home in cases of feeling unwell, a cold or fever, and not to go to lectures, courses or exercises due to the risk of exacerbation and the spread of infection;
2) wash hands often and always before meals and when returning home after being outdoors;
3) brush teeth carefully and use mouthwash before and after every meal and in the evenings.

The notice was signed by John Forssman, at that time deputy vice-chancellor and professor of general pathology, bacteriology and public healthcare. Contemporary events suggest Forssman was perhaps responsible for the third point, concerning mouth hygiene. A few weeks earlier the press had reported a discovery made by Forssman in his parallel capacity as a physician at Lund Hospital.

At the department for sexually transmitted diseases, patients were on two wards. On one of them almost all the patients had contracted Spanish flu, while on the other there was only one. The difference between the patients on the two wards was that the one with least infections was for patients suffering from syphilis, who had therefore “to avoid complications from the mouth” been prescribed “to […] use mouthwash and carefully brush teeth after every meal and in the evenings with a 1% solution of hydrogen peroxide”. Forssman therefore found that “in all probability, it is this care of the mouth and teeth that has given the syphilis patients protection against the infection, which can hardly be thought to penetrate in any other way than via the mouth or nose”. Whether Forssman’s conclusion stands up in terms of more recent research findings is beyond the author of this article’s capacity to judge, but perhaps a reader with medical expertise can answer this?

The student death toll

Regardless of toothbrushing, disinfected lecture halls and handwashing, Spanish flu claimed more lives in Lund’s academic world, and not least among the students. At that time, deaths among the teaching staff and students as well as others with University connections were reported regularly in both the university directories published each semester and the University’s academic year reports. A look at the University directory for the autumn semester of 1918 (which obviously came out quite a while after the semester started) reveals that the list of deaths since the previous issue began with elderly people – honorary members of student nations and similar – during the late autumn, but from the beginning of September, the names of ordinary young students begin to appear. By the time the directory was printed in mid-October, no less than ten such names had been added to the list, i.e. a somewhat higher figure than that reported at the Lower Consistorium’s meeting around the same time. And there would be more. In the academic year report for 1918/19, the total number of student deaths during the entire academic year had risen to 20, of whom 15 had died during the autumn semester. Admittedly, the exact cause of death is not stated, but Spanish flu can be ascertained as the main culprit from a comparison with the number of deaths in the academic year immediately before and after: five in 1917/18 and four in 1919/20. The number of deaths among students was thus at least four times as many during the worst year of the pandemic. And as the number of students in the last years of the war was around 1,300 to 1,400, 20 deaths represent a mortality rate of around 1.5%.

The figure for deaths among Lund students was of course small compared with the number of dead nationally and internationally. The Swedish central bureau of statistics, Statistiska centralbyrån (SCB), reported 28,922 proven deaths due to Spanish flu in the years 1918 och 1919, but also added a further 6,000 “probable” cases. Based on the Medical Board’s figures, which show a total of 516,013 confirmed cases of infection, this means that almost 7% of those infected died. Calculated according to Sweden’s population at the time, this represents a mortality rate of around 0.6%. Even with the proviso that we do not know the exact cause of death for all of the 20 deceased Lund students in 1918/19, there is much to suggest that the percentage of deaths within this group was considerably higher than the national average – an assertion that is reasonable considering that the infection struck the young harder than the population as a whole.

Globally, the figures were almost inconceivably high, especially as research in more recent times has revised the previous calculations – of just over 21 million deaths between 1918 and 1920 – to between as many as 50 and 100 million worldwide. So from this perspective, perhaps 20 deaths among Lund students can be seen as a small part of a global tragedy.

Fredrik Tersmeden
Archivist at the University Archive

Selected sources
Thorild Dahlgren: “Anteckningar från studentår 1907–1918” in Gerhard Bendz (ed): Under Lundagårds kronor – Tredje samlingen (Lund 1955).

“En intressant iakttagelse om sjukans spridning” in Svenska Dagbladet 26 September 1918.

Nils-Olof Franzén: Undan stormen – Sverige under första världskriget (Stockholm 1986)

Lunds Dagblad, various issues September 1918

Lunds Kungl. universitets katalog, höstterminen 1918 (Lund 1918)

Lund University Archive: Kansliets arkiv 1666–1930/31, volume A 2 B:47 (Minutes of the Upper and Lower Consistorium 1918).

Per T Ohlsson: 1918 – Året då Sverige blev Sverige (Stockholm 2017).

Ture Sjögren: 10-tals student (Academic Society Yearbook 1993; Lund 1994).

Wikipedia (Swedish version), the articles “Spanska sjukan” and “Spanska sjukan i Sverige”.

Fredrik Tersmeden: “Post festum jubilæum – Något om eftermälen och konkreta lämningar från Lunds universitets tidigare jubileer” in Årshögtiden. Lund University 26 January 2018 (Lund 1918)

Torsten Thunberg: “Om spanska snuvan vore livsfarlig…” and “I ’Spanska sjukans’ tecken” as well as “Skolorna och spanska sjukan” in Hygienisk Revy no 7 and no 9 1918 respectively.

Johan C W Thyrén: Lunds universitets årsberättelse 1918–1919 (Lund 1919)

Torbjörn Wester: “När mannen från Oslo tog sin tids pandemi till Skåne” in Sydsvenska Dagbladet 26 April 2020.

Women in Sweden still take more time off work to look after a sick child (VAB) than men do. In 2007, women took 64 per cent of all such leave, while men took 36 per cent. The equivalent figure for 2021 was 60 per cent for women and 40 per cent for men, according to statistics from the Swedish Social Insurance Agency (Försäkringskassan). It seems that not much has changed.

A little more than a decade ago, researcher Frida Eek (then at the Division of Occupational and Environmental Medicine, now working at the Department of Health Sciences) conducted a study. The study aimed to examine the significance of various work environment factors that the employer can influence, with regard to stress and mental wellbeing among parents of young children.  Just over 1,500 working parents took part in the study.

Women felt more stress when taking care of a sick child

The research study examined several different parameters around the parental role as combined with working life. Something that clearly emerged in a report from the study was that not only did women stay at home more with sick children, they also felt more stress than men from having to do so, since they were more likely to feel that they were letting down colleagues, their boss, customers or patients when they stayed at home with sick children. Men felt this way less, which, in combination with them taking fewer days than their partner, might be a possible explanation as to why they experienced fewer negative effects. According to the statistics, not an awful lot has changed since then. Women are more likely to be on sick leave for mental health reasons and men take fewer days of leave to take care of sick children.

Combining work and looking after sick children can create stress

One solution that many parents of young children turn to during February, when children are so often ill, is to try to combine working from home with taking care of a sick child. This is referred to in Swedish as ‘vobba’ – a portmanteau of the Swedish verbs ‘jobba’ and ‘vabba’. That means that the parents work from home (if their job allows it) while simultaneously wiping noses and comforting children with high fever.

The study shows, however, that some measures intended to make things easier – allowing children to come into the workplace, part-time working or working from home may actually cause stress. As Frida Eek points out, it is important to be aware of, and to respect, the fact that there are differing views on which solutions work for each individual. To ‘vobba’ might feel like a relief to some, while others would find it stressful. For that reason, there should be no explicit demand or expectation of working from home when taking care of a sick child, but the option can be provided for those who can and wish to do so.

Most efficient measures in the workplace

_{The most highly valued factors in the workplace were understanding and a parent-friendly attitude from both colleagues and managers, and a generally parent-friendly policy in the workplace.}

A published study also showed that parents who experienced a positive attitude to parenthood from managers and colleagues also experienced less stress and better mental health than parents who worked in workplaces where it was felt that the company or manager was negative or indifferent to parenthood. Frida Eek believes that this is probably still the case in 2023. An understanding of the combination of parenthood and work increases the likelihood of finding individually tailored, functioning solutions and work environment arrangements. This is probably of great significance to the wellbeing of parents of young children, since the report makes clear that the same arrangements may be considered a help by some, but a source of stress for others.

Two-year olds ill the most

If you have a two-year-old at home, you can probably expect to do a lot of ‘VAB’ this year. According to Försäkringskassan’s statistics, two-year-olds are ill more than any other age group.
An increase in the number of ‘VAB’ days has been noted across all ages, but never before have so many days been paid out as in April 2020. In both November and December 2021, more than one million ‘VAB’ days were paid out in each month. In early 2022, levels continued to rise compared with the same month in previous years, but then fell somewhat. The parents of young children in Sweden will have to see what 2023 has in store! Seasonal flu, winter vomiting bug and chickenpox have been joined by a new wave of COVID 19 and RSV. Are you ready?

Frida Eek’s ‘VAB’ tips for employees from a work environment perspective

Frida Eek’s ‘VAB’ tips for managers from a work environment perspective

Read the whole report here (in Swedish)

Frida Eek is an associate professor of epidemiology and senior lecturer at the Department of Health Sciences, within the Faculty of Medicine. Read more about her research in the areas of stress, epidemiology and public health here.

Frida Eek — Lund University

Text: Helga Heun & Frida Eek

Throw up, spew, vomit, hurl, drop a pavement pizza – just a few of the countless synonyms for this “favourite” (well…or not) activity. The winter vomiting bug season has arrived!🤮

A confusing number of names for the virus

If you google ‘winter vomiting bug’, you will find a lot of articles that give three different names for the virus: calicivirus, norovirus and sapovirus. Can you straighten this out – is it the same virus? Why are there different names if it is the same disease?

I think we should say ‘norovirus’ since that is what is used internationally and scientifically. But by way of explanation, you can look at the diagnosis. At first, these viruses were only seen via electron microscopes, and were given the wonderfully descriptive name, “small, round virus.” Later, when we learned about the genetics behind it, we realised that these viruses belong to the calicivirus group, and at first they were called calicivirus. Now we know that norovirus, sapovirus and others are part of the calicivirus group. Sapovirus results in similar symptoms to norovirus but is rarer. If you search for ‘calicivirus’, most of your results will concern feline calicivirus, which causes colds in cats. So use norovirus – that is the virus responsible for the winter vomiting bug.

Would we avoid getting sick if we moved south?

The winter vomiting bug arrives right on cue during the winter months, especially for young families – and as the name suggests, it is a winter germ – but does that mean that people do not have to worry about the winter vomiting bug at warmer latitudes?

The winter vomiting bug got its name in northern climes, since the virus seems to spread more effectively during the winter, but the virus is present around the world and is the most common cause of gastroenteritis (gastric flu) on the planet. It has been calculated that the virus affects 700 million people each year. There is a clear seasonal variation that has not been possible to fully explain. In Australia, the virus spreads mostly during their winter, but the seasonal variation is not as apparent in a tropical climate.

One for all, all for one?

It is said that someone vomiting with the bug will expel millions of virus particles, and that it only takes around ten particles to make you ill – is it even worth trying to protect yourself if someone in the family starts vomiting?

Good question – but I think it probably is. Infection is partly about the quantity of virus particles you take in, how it enters the body, but also how receptive you are. If you are partially immune, you can still become sick, but it takes a significantly higher dose of infection. So it is worth trying!

What is the best weapon?

What should you do to protect yourself?

Washing hands is the only thing that we know works. Cleaning is probably good, too. Someone who is ill should not prepare any food. The research we have done also indicates that the virus can spread in the air, in particles that are formed during vomiting, for example. It may be that face masks could help, but that is yet to be investigated.

A virus with wicked superpowers

We are told that hand sanitiser does not affect this virus – why is that? Apart from soap and water, what else should we be using?

Hand sanitiser works through the alcohol dissolving the fatty casing that surrounds all bacteria and certain viruses like an outer membrane – but the winter vomiting bug has no fat casing, so that is why it does not work. When cleaning, it is most important to simply scrub away as much virus as possible – manually. In hospitals, we use substances that have virus-killing properties. One such substance is chlorine. But you do not have to use such strong substances. Often a thorough ordinary clean is enough.

Trypanophobes can relax

Why is there no vaccine against this virus?

Great research efforts have been made to find a vaccine that works, but so far none have been found. There have been lots of difficulties along the way. Amongst other things, growing the virus in a laboratory has proved very difficult. The first successful attempt was in 2016, but the method involved is a complicated one. It has also been difficult to find an antibody that protects against infection and there are many different variants of the virus so a vaccine might need many different components in order to provide good protection. Hopefully, the progress made within vaccine development during the COVID-19 pandemic can help against the winter vomiting bug in the future.

Some parts of the population are not good at hand hygiene

How long is sensible to isolate after having an infection? Pre-schools usually say 48 hours while schools say 24 hours. What does the epidemiology say?

You are mostly contagious while you have symptoms, such as vomiting or diarrhoea. That is when there is a risk of a lot of virus particles being spread to your surroundings. The time is partly set to make sure that the stomach has recovered – you might feel fairly well but still have loose stools later. The fact that the times are different reflects the fact that pre-school children cannot take care of their hand hygiene as reliably as older children and adults. In addition, the virus remains in the gut for a long time in young children after the diarrhoea has passed, so it is sensible for pre-school children to be at home for a little longer.

Is this really true?

There are rumours that the winter vomiting bug didn’t exist in Sweden in the 1980s and 1990s. Is that true, or a myth?

It is a myth with a certain element of truth. The virus was first discovered in 1968 but has probably been around for a long time. Until the late 1990s, setting the correct diagnosis was very complicated – stool samples had to be sent to Stockholm for examination under electron microscope, and that was not something that was done as a matter of course. It is true, however, that the winter vomiting bug became much more commonplace in the early 2000s, not only because diagnosis improved but because of virological factors, too. A new kind of virus had developed that spread much more easily – norovirus type G2:4 Since then, new variants of G2:4 have emerged and spread at two or three-year intervals. When a new variant arrives in Sweden, we experience a winter with a lot of winter vomiting. It has now been several years since we were hit by a completely new variant though, which is why the last few years have been calmer.

High heel shoes are a fashion phenomenon that inspire wonder. Why is it that these shoes, in particular, have come to be synonymous with femininity and seduction? A look back in history reveals that they have not always been gender-coded in this way. High heels were once associated with masculinity and power at the highest level.

Heels affect both how you feel and how you are perceived by those around you. Just like many other objects of fashion, this creates a paradox. High heels give you confidence, signal power and sexuality. They radiate luxury. Anyone who can move freely in them must live a rarefied life far removed from humdrum everyday tasks; unsuitable for walking long distances, they signal a lifestyle of elegance. At the same time, women in high heels can be seen as unsteady, helpless and voluntarily constrained.

Yes, it did start with functionality

Although high-heeled shoes may seem impractical, it was for their functionality that shoes were first fitted with heels. Life became simpler for Asian horsemen once heels provided a firm grip on the stirrups.

High heels became an important part of Western male fashion in the late 16th century. The inspiration may have come from the Persian embassies that came to Europe to forge political alliances. The short, puffy trousers of Spanish fashion placed particular emphasis on men’s legs as they were displayed in tight-fitting silk stockings and elegant high-heeled latchet shoes with large rosettes known as shoe roses. 

Long, strong, slender legs, which were often portrayed in portraits with one from the front and one from the side, emphasised prowess in activities such as fencing and dancing, yet without any suggestion of the toil of real labour.

The high heels were regulated by sumptuary laws

During the Thirty Years’ War (1618-1648), military influences made themselves felt in portraiture. Even the bucket-topped Cavalier boots turned down below the knee and lace-adorned boothose had high heels.

Lace, embroidery, plumes, patterned silk fabrics, jewels that to a modern observer might appear far removed from ingrained ideals of masculinity, were perceived by contemporaries as symbols of power and bravery in dress comparable to bravery on the battlefield. High-heeled shoes were part of the power dressing designed for princes and aristocrats. The fact that the French King Louis XIV was short in stature probably contributed to his fondness for tall, curly wigs and high heels. Red heels became a special privilege that distinguished the King’s courtiers, the height of which were regulated by sumptuary laws.

Exposed legs were a male attribute. Women’s legs were always covered by long skirts, yet 17th century female fashion was influenced by what men wore in the form of masculine hats and high heels.

Impractical and exorbitant garments were an important part of how early modern elites manifested their elevated status.

The social order demanded visible differences between people of different estates – erasure of these differences would have been socially destabilising.

Platform shoes and chopines in the 17th century

The platform shoes worn by women in Spain and Italy in the 15th to 17th centuries proved to be another important influence. Perhaps the most famous example is the Venetian chopines, which could tower as high as 35 cm. This was originally a type of wooden shoe with a high sole that was worn on top of ordinary shoes to raise the wearer above the dirty, waterlogged streets. In the 17th century, they became a luxuriously designed piece of fashion.

The 18th century and female irrationality

During the 18th century, interest in men’s shoes waned while other aspects of dress came into focus. Shoes with high heels that were narrower and more difficult to manoeuvre in became more common for women. Ideals changed and heels became more associated with female irrationality than male prowess. Under the influence of Enlightenment thought, political capacity came to be seen in direct conflict with ostentatious dress, while women’s fashionable attire rather came to manifest their lack of political power. This is despite the fact that the 18th century continued to be strongly influenced by notions of the clear links between social status and clothing.

Heels named after the French King’s mistress

High-heeled shoes were worn to accompany the bulky fashions of the 18th century, which shaped the female body with laced-up corsets made with whalebone and enlarged hips with the help of skirt-supports. Shoes, covered in patterned silks or heavy metallic embroidery, matched the dresses. Mules with no backs or latchet tie shoes dominated footwear fashion.

The heel breast– the forward-facing side of the heel – was often curved under the foot, a shape later known as pompadour heels after the French King’s official mistress Madame de Pompadour.

Heels were higher during the first half of the 18th century, only to go lower during the second half. Together with the rest of a person’s attire, shoes provided a particular balance and posture to the body central to the complex pattern of movement that distinguished the upper classes from the hunched backs of the working class of the 18th century.

The body was supposed to sway lightly and movements be fluid, neither too quick nor too slow. Everything was carefully rehearsed but was supposed to be carried out effortlessly and naturally. The swaying gait of the French queen Marie Antoinette, even in her heavy court dresses with metre-long trains, became the ideal. During the 18th century, consumer culture grew stronger and fashionable clothing became more available in the cities.

Taking lessons from a dancing master to practise the correct movements, including the art of walking, was a less easily bought skill and therefore the ultimate aristocratic status symbol.

The erotic undertone of the high-heeled shoe was strengthened during the 19th century

After a long period of flat shoes, inspired by more bourgeois ideals in the first decades of the 19th century, by the mid-19th century high-heeled shoes were once more in fashion, both on everyday ankle boots and evening shoes. Long, heavy skirts with bustles at the back hid women’s legs, but their gait was still supposed to be delicate, their posture upright and the protruding foot small. High heels were a visual trick that gave the feet a daintier appearance. Women’s feet became alluring, and the erotic charge of the high-heeled shoe was reinforced by its role in the pornographic photographs of the time.

High-heeled shoes, an unattainable luxury

Specially designed sewing machines with several technical inventions transformed shoemaking, making shoes cheaper and more accessible to a wider market by the mid-19th century. In the countryside, however, shoes remained a rare commodity. Well into the 20th century, children in Skåne still went to school in rough, straw-filled wooden clogs and in the summer they went barefoot. It is easy to understand why high heels were an unattainable luxury. Sweden’s path to becoming a modern society was, in part, through industrially produced footwear. In the 1930s, there were over 300 factories providing the Swedish people with shoes.

Renewal in the shape of the heel

With shorter skirts in the 1920s, women’ legs came into focus in a whole new way. Fashionable attire was completed with elegant, shapely legs clad in silk stockings and high-heeled shoes, often with a t-shaped latchet or double straps across the ankle. Stocking seams extended the line from the heel and drew the eye up the legs. Interest in shoe design grew with renowned designers such as André Perugia, responsible for the shoes for fashion designer Paul Poiret’s garments. Imaginative, innovative and inspired by the fashion and art of the time, the shoes became sculptures. Experimenting with the shape of the heel became a way to renew designs, such as the wedge heel of the 1930s by Salvatore Ferragamo.

Christian Dior and ”the New Look”

After the Second World War, Christian Dior launched the “New Look”. Shoes with stiletto heels were worn with the provocatively full skirts of the 1950s. High, narrow heels became possible with a metal rod embedded in the plastic heel. The fashionable shoe designer Rogier Vivier collaborated closely with Dior.

Through stills, the film industry with its sexy, busty movie stars, spread the new fashion ideal effectively. On the silver screen, everyone could see their idols up close, what clothes they wore and how they should be worn. Department stores shortened the path to consumers. Narrow stiletto heels and pointed toes were now the order of the day, even though they could leave unsightly marks on parquet flooring or easily get stuck between paving stones. Marilyn Monroe’s favourite shoe was a Ferragamo model with 11 cm high heels.

The fast way to a man’s heart

For the “everyday film star” promoted by the corset industry, stiletto heels were another must. The high heel was thus more widely worn than before, and now tottering on high heels was now added to the general expectations placed on women.

No woman could consider herself properly dressed without a corset, hat, handbag, gloves and high-heeled shoes – shoes that were also marketed as the way to a man’s heart. The 1950s style of shoe set a standard that is still very much relevant today.

Pop stars challenged the traditional gender norms

With the 1960s and 70s focus on more youthful, natural fashion and women’s equality, fashion ideals for women were seen as oppressive and archaic. Like shaping underwear, high-heeled shoes lost popularity. At the same time, heels came into focus in new ways, with artists such as the Beatles, David Bowie and ABBA performing in high stack heels and challenging traditional gender norm.

Carrie Bradshaw and Sex and the City turned “Manolos” into a turn of phrase

To the power dressing of the 1980s, with wide shoulder pads and a new vision of financial success and luxury, high-heeled shoes and boots also brought added sex and potency to fashion. The high heels that had been part of the housewife ideal were now proving successful in the world of work.

In the 1990s and 2000s, a new generation of shoe designers such as Manolo Blahnik, Jimmy Choo and Christian Louboutin became well known for their glamorous high-heeled shoes. The TV series Sex and the City turned “Manolos” into a turn of phrase. At Louboutin, the heels towered ever higher and their red soles made the shoes easily recognisable.

Even established fashion designers like Vivienne Westwood have include pioneering shoe designs in their collections. Naomi Campbell’s fall during on the catwalk of Westwood’s show in 1993 is legendary.

Today, when overconsumption, luxury, stereotypical representations of gender and bodies and the existence of fashion itself are under discussion, our relationship with high-heeled shoes is multifaceted. This autumn’s fashion weeks showed that shoe design is a vital part of fashion. Models striding in high heels at Valentino swayed, wobbled and fell most involuntarily, revealing glamour as sullied and detached from the world.

Swedish Beate Karlsson of AVAVAV, known for her boundary-pushing, animal-like shoes, parodically let all the models fall like ninepins during her show instead.

When wearing high heels is a matter of choice, the joy of fashion also increases

Old conventions linked to shoes, status and luxury are being challenged. For women, sneakers can now be worn in the most formal of settings. When wearing high heels is a matter of choice, the joy of fashion also increases. At the same time, traditional cultural conventions persist. Men in heels, balancing on their toes, are mostly only seen on the dance floor.

Probably not that many men in heels at the Christmas party

Height and power are still linked, which, in their time, both Prince Charles and France’s then-President Nicolas Sarkozy handled in a conspicuous way. Fashion is about renewal and is said to reflect its time, but nevertheless is also impervious to change and conservative. As long as high heels themselves are not imbued with new cultural significance, we seem a long way off seeing men in high heels in Swedish urban environments or at the annual Christmas party.

Text: Pernilla Rasmussen, Fashion Science

Author’s Christmas gift tip:

Shoes – an illustrated History by Rebecca Shawcross.

More about Fashion science at Lund University

Fashion science is a theoretical and humanistic subject with social science elements. The subject is aimed at those who are interested in gaining a deeper understanding of the situation in both the past and present.

Read more at the Department of Cultural Sciences