The last major epidemic during the British Raj in India was influenza in 1918. Called the ‘Spanish Flu’ (though it had no connection to Spain itself), India was adversely hit during this world-wide pandemic with an estimated ten to twelve million deaths.

In Indian historiography, the influenza pandemic has often been called the ‘forgotten’ epidemic. Despite being the deadliest, there was very little literature produced on the epidemic and there are hardly any pictures, manuals, or official reports, on influenza and its effect on India. Besides the usual central and provincial sanitary reports, the only other government report was a ‘preliminary report’ penned by Norman White, the Government of India’s Sanitary Commissioner in 1919. A detailed report never followed.

The 1918 influenza pandemic in India generated very little local response, and one can hardly find a reference to it in political speeches or private papers. Even the usually exciting vernacular press did not cover it in great detail. As noted by Professor David Arnold, there are only two references to influenza in even the voluminous writings of Gandhi, where once in November 1918, he notes that his son Harilal’s family had been hard hit by it, and then again in January 1919, when writing to his friend CF Andrews, Gandhi noted that Andrews had previously suffered from the flu. In an India where protests over the Jallianwala Bagh massacre in April 1919 led to a whole movement, the death of nearly twelve million people hardly became a political issue.

The reasons for the influenza pandemic remaining on the margins of Indian historiography are many. Some scholars, like Ira Klein, have posited that since India was very prone to epidemics, the flu was seen as just one of the several deadly diseases which had descended on the country. But this theory seems implausible since not only was the flu the deadliest, almost every epidemic, regardless of its spread or mortality had elicited government and public response.

Among the post-colonial scholars, the argument is that the British simply did not care how many Indians died of disease; as long as their interests were secured, the British cared for little. But even this argument fails as great strides were made in medicine and cure on several diseases during the Raj, and volumes of research exist on other epidemics. It also fails because the flu in fact affected British soldiers in large numbers, unlike the plague, for example.

In trying to find plausible explanations for the lack of literature on the influenza pandemic in India one must realise that it hit India hard for only a few months. Therefore, not only was the country ill-prepared for the disease, its quick on set and end did not give enough time for a measured government or public response.

Since the flu was so severe, the people who were usually the report writers from the government side — the Indian Medical Service officers, were themselves infected. The same was the case with a large number of journalists and newspaper editors. Hence, there just wasn’t enough time or people around to create a voluminous history.

By all accounts, influenza hit India in 1918 while no one was looking. Influenza had earlier infected people in India in 1890 and continued to prevail for a few years, but it was of a mild nature. The Punjab Sanitary Commissioner noted: “Prior to the present epidemic Influenza was regarded with apathy and scepticism by the vast majority of the profession.” Thus, when it suddenly appeared in a virulent form, everyone was ill-prepared.

Most likely the 1918 influenza virus was introduced to India via soldiers returning from the World War I. Where the Indian Sanitary Report notes the incidence of the flu in British soldiers as early as 1917, it was only in the first week of June 1918 that the flu was systematically diagnosed among soldiers, now both British and Indian, in Bombay where it was called ‘nai sardi ka bukhar,’ (the new cold weather fever).

By the third week of June 1918, the flu was diagnosed among soldiers returning from Basra in Karachi and a ‘batch of 110 patients’ was admitted to hospital. However, as noted in the report, it could not be conclusively said that the 1918 pandemic was spread through troops, as “the possibility of influenza having been endemic in India… must be remembered.” It was also noted that a weaker strain of the disease was already found in several parts of India as early as March, 1918.

Despite its unclear origins, it was clear that the disease spread throughout India via three main vectors: the military, the post office and the railways. The return of nearly a million men to all parts of India, the presence of post offices in even remote parts of the country, and the ease with which people could travel on the railways, meant that a disease like influenza could spread easily and speedily. The sanitary report clearly noted that “the railway played a prominent part…[and] the post office also was an important agency in disseminating infection…” Thus, more than other epidemics it seems that influenza spread more through elements of modernity than anything else.

The first wave of the pandemic hit India between June and August 1918. During this time the infection spread throughout the country, but it was acute only in coastal areas. In Bombay, the mortality rate rose sharply by June 29, peaked a week later, and was back to pre-epidemic rates by July 27.

In Madras and Calcutta, the mortality rates began to increase a fortnight after Bombay, and by the middle of August the rates had begun to decline in Calcutta, while it took Madras till the end of August to achieve pre-epidemic rates of mortality. Despite affecting all of India, the mortality rate was not high in the first wave, and since it disproportionately affected the very young and the elderly—groups with already high mortality rates—the first wave did not cause much alarm.

It was only the onset of the second wave of the pandemic from late August/early September 1918 onwards throughout India which took everyone by surprise. In this wave young people — between 20 and 40 were the worst affected and very soon whole provinces were overwhelmed with deaths.

The Punjab, while affected during the first wave, managed to escape any significant mortality rates during it. Even the start of the second wave was relatively mild in September 1918. It was only in October 1918 that the disease began to wreak havoc in the province. The report of the sanitary commissioner vividly describes the terrible conditions and merits a fuller quotation:

“A peculiarly fatal type of pneumonia appeared as a concomitant of the disease and from October 15^th to November 8^th. The state of the province was such as to render adequate description impossible. The hospitals were choked so that it was impossible to remove the dead quickly enough to make room for the dying: the streets and lanes of the cities were littered with dead and dying people: the postal and telegraph services were completely disorganised: the train service continued, but at all the principal stations dead and dying people were being removed from the trains; the burning ghats and burial ground were literally swamped with corpses, whilst an even greater number awaited removal; the depleted medical service, itself sorely stricken by the epidemic was incapable of dealing with more than a minute fraction of the sickness requiring attention; nearly every household was lamenting a death, and everywhere terror and confusion reigned.”

The stark description of the ravages of the influenza was similarly echoed in several other provinces and regions. In Delhi, where the mortality rates were very high, it was noted that “influenza overshadowed all the other diseases in it effect,” and that about 50 percent of the population was infected.

The report noted that ‘special street dispensaries were opened in the city, and nine temporary dispensaries worked in the rural areas.” In the most populous province in India, the United Provinces, it was estimated that over two million people had perished from the disease. Since the diagnosis of influenza was not always easy, it was usually noted under ‘fevers.’

The mortality rate in the Central Provinces and Berar was also very high and, in some divisions, it was exceptional. The death rate reached a shocking 66.4 per thousand, in the Central Provinces and Berar, making it the worst affected province in the country. The epidemic was so virulent that the government seemed to be helpless in controlling it, and the report noted that in the Central Provinces, “every available organisation, government, Local Board and Municipal, was used for the distribution of medicine, food and clothing.” Conditions were such that medical students were also utilised and even “tonga dispensaries” were formed to get medicine to far-flung areas.

Among the presidencies, Madras and Bengal fared better than the Punjab, United Provinces, Delhi and Central Provinces, where the mortality rate was 45.4, 43.4, 56.6 and 66.4 per thousand, respectively. In Madras, the mortality rate per thousand was 16.7, while Bengal noted a low rate of 8.3. Only the Bombay Presidency was hard struck by the epidemic noting a high of 54.9. The uneven destruction of the mortality throughout the country remained an unexplained enigma of the 1918 influenza pandemic.

(To be continued)

The writer teaches at the IT University in Lahore. He is the author of ‘A Princely Affair: The Accession and Integration of the Princely States of Pakistan, 1947-55.’ He tweets at @BangashYK