The 1918 influenza pandemic struck India at a time when it was believed that the tide had turned on major epidemics in India. After devastating India for centuries, cholera was under control, the plague, which had until recently been a menace had been largely contained, and the large-scale vaccination for small pox was rapidly bringing down the incidence of that disease.

Many issues, of course, remained but as David Arnold notes, “…in the principal cities, it was as if a corner had been turned. India, it seemed, was beginning to win its public health war.” The Calcutta’s health officer in 1917 noted that the year had been the heathiest on record, and to again quote Arnold “Indian’s great eastern metropolis could, it seemed, now anticipate a new age of public health.”

Great strides had also been made in terms of medical treatment and research in India. The Indian Medical Service, initially focused on military needs, was rapidly expanding, and Indian philanthropy had set up numerous hospitals, dispensaries and health units throughout the country. The setting up of a bacteriology department further enhanced research on diseases, their spread and cure. Therefore, amidst all this progress, the ferocity with which the influenza pandemic struck India took everyone by surprise and created a new and peculiar situation.

As compared to the government response towards the plague, the official reaction to the influenza was certainly muted. This was largely because the government was aware that any extreme measures would only alienate the people and coming just on the heels of the Great War, it would be very hard, if not impossible, to control large-scale disturbances.

Several plague measures, while patently critical in its prevention were simply flouted by the population at large earlier and so it was deemed futile to try and impose such large-scale measures in this case. As Arnold notes: “If the government did not intervene more actively in the 1918-19 epidemic it was in part because it had been chastened by its previous experience of plague.”

Another important reason for the lack of action on influenza was that in 1918 no one knew what caused it. The Punjab sanitary commissioner noted in 1918: “…we are not yet certain as to the true cause of the disease.” While medical strides had been made in deciphering the bacteria which caused the plague and cholera, the influenza virus was only fully identified in 1933.

Therefore, there was little medical knowledge or understanding of the disease. Furthermore, as the Punjab commissioner noted, in is initial stages the disease was like sandfly fever, while in its acute form it resembled pneumonic plague. Also, since the disease spread from Europe and America to India, rather than the other way round, and so not only was it seen as a ‘Western problem,’ there was also some complacency in India in that since the West had not been able to contain it, it would be impossible for India to do so either.

Influenza also did not experience the extreme public reaction, rumours, and panic which characterised the plague epidemic in India a couple of decades earlier. This was mainly because unlike plague and cholera, influenza was a new disease with no mention in either Hindu Ayurveda or Muslim Unani medicine. It also did not have any deity associated with it. Hence, there was little local opposition to its treatments. Furthermore, the speed of infection usually meant that there was no time to flee either. As Arnold exclaims: “Many people simply died where they were.”

The rapid onset and end of the disease also prevented the spread of rumours. Arnold notes only a small number of rumours circulating about influenza, and most related it to either “extensive use of poison gas on the Western front,” or “the evil machinations of our unscrupulous enemy,” i.e., Germany.

One important development which did emerge during the epidemic were the volunteer organisations which had been formed all over India. While these were evident during the plague operations, they took the lead in several instances during the influenza epidemic, so much so that the official government of India report mentioned several of them by name. The Indian sanitary commissioner noted that their existence made a critical difference in several towns where ‘volunteer agencies were both more numerous and better organised,’ leading to a lower mortality rate in the towns as compared to the villages which were already at a disadvantage due to scarce resources and unfavourable hygienic conditions.

While there is some dispute over the actual number of deaths caused by influenza in India, it is clear that it was the deadliest of all epidemics suffered by the region. Estimates have varied between seven million (official) to twenty million (as claimed by some scholars like K Davis). What is clear, however, is that even if the lower numbers are taken, it was still a very high mortality rate in just a few months.

In terms of the Punjab the 1918 Sanitary Report noted that about 4.58 percent of the population of the province had died due to influenza within a space of a few months. Within the province the mortality ranged quite widely. Among the worst affected districts was Gurgaon where it was 123 people per thousand, followed by Rohtak at 96, and Ludhiana at 77.

It seemed that the epidemic had badly hit the south-eastern districts. The lowest tally of districts was led by Kangra at 23, Simla at 24, Rawalpindi at 26, Hoshiarpur at 26 and Sialkot at 29. Two of the aforementioned districts were in the hills, while the latter three were in the plains. Rural areas were the worst hit with an average mortality of 51.21 per thousand, as compared to the urban areas which reported a death rate of 35.71. One interesting statistic was the fact that the town of Murree in the Punjab seemed to have retuned no deaths from influenza in 1918, a remarkable feat indeed.

The 1918 Punjab Sanitary Report also gives a very interesting case study of the spread of influenza. In September 1918, Major Mackenzie, the deputy sanitary commissioner, visited the Hindustan-Tibet road, and reported on how the epidemic spread in that region. According to him:

“A recruit suffering from symptoms of influenza had arrived in Narkanda and stayed the night with the khansamah [cook] of the hotel there. Three days later the khansamah and his wife went down with influenza. Within a few yards of the khansamah’s house lived a blacksmith and the two used to inter-visit. A few days after the khansamah was attacked all the members of the blacksmith’s house were down with the disease. The postal peons used to come and sit in the khansamah’s house, with the result that they all contracted the disease and two of them died from it.”

Thus, the disease introduced by a military recruit, found a home in the local areas, and then disseminated through postal workers, inflecting the whole areas within a very short amount of time.

Since there was no cure for influenza, only preventive measures could be taken to contain it. Foremost among them was the recommendation that people live in well ventilated houses. In the Punjab, it was noted that people living in the upper stories of a house were less infected than those living closer to the ground. The Punjab sanitary commissioner also noted that the lack of medical professionals was certainly a serious problem since Indian Medical Service was still a very small service, and it was only after 1920 that it was rapidly Indianised and expanded. The government also recommended that “…schools, colleges, etc, can be closed early; the people can be advised to eschew railway travelling, places of amusement and fairs; fairs can be prohibited…” But with the second wave of the epidemic lasting only three months, there just was not enough time to put any of these large-scale measures in place and these recommendations were seldom adhered to.

Preventive measures were further complicated because the country was just emerging from the Great War and food prices were up and fodder was scarce, resulting in increased suffering for the rural poor. The Punjab Report noted: “In the present epidemic the poor and the rural classes were adversely affected by the economic conditions resulting from the war and the failure of the monsoon. Food prices were high, a sufficiency of blankets and warm clothing almost impossible to obtain, and milk was scarce…”

By the start of 1919, influenza had begun to recede, and by the middle of the year, it was almost gone in most of India. 1919 noted a larger number of deaths in Bengal, amounting to about 200,000, whereas the Punjab only noted a few thousand cases and deaths. In Bihar and Orissa, over 10,000 people died, whereas Assam recorded just under 5,000 deaths from influenza.

In Bombay and Madras the disease only appeared sporadically, and even in the Central Provinces, where the highest percentage of the population had died among the provinces of India, the mortality rate was fairly low. The Indian sanitary commissioner estimated that less than half a million people had died from influenza in 1919, as compared to the over seven million in just four months in 1918. Thus, within less than a year, influenza had receded dramatically and, with the rise of mass Indian nationalism, was soon forgotten as the killer disease of the twentieth century.

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