Friday, April 2, 2021

The 1918 ‘flu: India’s worst pandemic


17 September 2020, Gateway House

The 1918 ‘flu: India’s worst pandemic

The 20th century’s worst pandemic – Spanish Flu – erupted in March 1918 in Camp Funston (Kansas, U.S.) during the Great War. Much like Covid-19 it spread globally at an astonishing pace. Its Second Autumnal Wave took about 30 million lives in four months, half of those in India. It’s sheer virulence and high mortality makes this virus the correct analogy for Covid-19

Bombay History Fellow

- Wikimedia Commons
American Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp FunstonAmerican Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp Funston

It was when the virus underwent a sudden mutation in its antigenic nature[7] that the Pandemic left its mark on global and Indian demographics – this time among the most productive age group of 20-40 year olds. In India, the mortality among young women in the reproductive age group was particularly high, resulting in a 30% drop in the birth rate for the year 1919.[8]

Most documented epidemics have tended to originate in the Eurasian landmass and moved from east to west. Unusually, the Spanish Flu originated in the West. Paul Kupperberg in The Influenza Pandemic of 1918-1919 (2008),[9] says a country physician in rural Kansas (U.S.) first raised a warning about “an influenza of a violent nature” in late January 1918, with the then U.S. Public Health Department. But to no avail. With the war on-going and American soldiers criss-crossing their country through military training camps and then embarking for the war front in Europe, it was inevitable that the violent flu spread in the US before it made landfall in France in April. From France, it travelled outwards through land and sea routes across Europe, Asia, Africa, Australia, New Zealand and the Pacific islands. The tiny island nation of Samoa lost half its population to this pandemic.

The moniker ‘Spanish Flu” was given to this virus through a far-fetched, specious connection. Neutral Spain wasn’t the country of origin for this H1N1 virus subtype. But it devastated the Spanish population and its wide reportage by the Spanish press gave it the name.

The extensive coverage in Spain was in stark contrast to the censored reportage among the warring nations which didn’t want a public panic. European newspaper headlines of the time took advantage of this fact and went a step further with the tongue-in-cheek name “Spanish Lady”. Flu victims were deemed to have had a visitation by the Spanish Lady.

But the first wave that had spread across the world by June 1918, was only the aperitif.

A poster issued by Alberta's Provincial Board of Health alerting the public to the 1918 influenza epidemic. It also gives instructions on how to make a face mask.
The similarities between instructions issued during the Influenza of 1918 regarding protective protocols and how to make a face mask, and those issued today are startlingly similar…100 years later!

It was the second or Autumnal Wave, a mutated virus, that was the main course and killed millions in just four months, starting in September 1918. Most medical historians[10] agree that there were three Atlantic ports thousands of miles apart from each other – Freetown (Sierra Leone), Brest (France) and Boston (U.S.), which became the foci for the Spanish Flu’s explosive second wave. All three ports were active hubs for military transport ships[11], from where it was carried into British India’s Bombay Presidency (Bombay and Karachi ports) and from there inland by the railways to its Central and United Provinces, Punjab, Rajputana and Bengal Presidency.[12]

The trigger for the mutation of the virus is unclear. But such virus’ do mutate – often in the span of a few months – making them intractable enemies.

This is particularly relevant in today’s Covid-19 pandemic, as a vaccine created for a first wave virus may be ineffective against its mutated version. This is an historical warning that countries should not lower their guard even in the event of a vaccine coming out by early 2021.

The deadly second wave, from September to December 1918, was marked by a lack of effective, strong interventions by city governments across British India, in sharp contrast to the stringent protocols enforced by them during the Plague Epidemic 1896. This time it was the NGOs – both secular and community-based – which took the lead to help the afflicted poor. NGOs like the Social Service League,[13] raised money for nutritious food, clothing (pneumonia jackets), nursing and isolation in makeshift hospitals. Mobile fever clinics were also set up, very much like the ones set up by the Brihan Mumbai Municipal Corporation for Covid-19 in the city today.

Many reasons were given for this official inaction. One, was the scarcity of doctors because of their recruitment for war duty. The ones that remained themselves became incapacitated by the flu whilst working on the frontlines in city hospitals.[14] Villages on the other hand, did not even possess the luxury of a visiting medical doctor then.

The second wave also coincided with famine in provinces devasted by the flu — Bombay, Bengal, United and Central Provinces, Punjab, Rajputana — which resulted in a vicious cycle of starvation (due to high food inflation) and illness. This was worsened by exports of food grains for the War and supply chain impediments for imports.[15] It made the poor even more susceptible to the flu and led to a high inflow of famine migrants into cities, which in turn increased the death tolls in urban centers. Says Historian Dr. Mridula Ramanna, “For every 1,000 persons living between the ages of 20 and 40, 62 men and 79 women died. Mortality was estimated at 1,086,758 for the months of June to December 1918, taking excess of total mortality over the mean of the previous five years. The peak was reached in October.” And these over 1 million deaths were just for Bombay Presidency!

In the case of the 1918 Influenza pandemic, western medicine did not have a prophylactic (vaccine) or treatment for a viral infection, because medical breakthroughs at the turn of the 20th century were for bacterial infections.[16] The suddenness of death from high fever in influenza patients – often within four days—with a feeling of drowning in lung fluids, resulted in the first and only ever drop in India’s 20th century population growth in the 1921 Decennial Census. A conservative estimate placed influenza deaths at 12-13 million from September to December 1918. More recent studies give a higher bandwidth of up to 18.5 million persons.[17]

This is the highest and fastest death rate ever for any epidemic in India’s history. It far exceeds the 10 million deaths from the 1896 Plague which ran over two decades. Given this fact, the dearth of photographic and literary output on this most devastating of fevers is mystifying. Maybe it was the swiftness of death, the flu’s lack of physical aberrations like buboes in the Plague, its short spell – it had spent itself by December – and the dismal response by the colonial administration, which together made it just another blip in Colonial India’s cup of woes.

Sifra Lentin is Bombay History Fellow, Gateway House.

This article was exclusively written for Gateway House: Indian Council on Global Relations. You can read more exclusive content here.

For interview requests with the author, or for permission to republish, please contact

© Copyright 2020 Gateway House: Indian Council on Global Relations. All rights reserved. Any unauthorized copying or reproduction is strictly prohibited.


[1] The Miasma Theory of disease originated in the Middle Ages and persisted till the late 19th century. After this the current Germ Theory of disease took precedence. Miasmas or poisonous vapours or mists made up of particles from decomposing organic matter giving out a foul smell were deemed the cause of numerous diseases particularly fevers. This theory led to wide-ranging sanitary reforms from the mid-19th century, which actually did go a long way in improving the lives of people.

[2] Arnold David, Death And The Modern Empire; The Influenza Epidemic of 1918-1919 (London, Transactions of the RHS Society 29, 2019) p.191.

[3] Historians studying the Influenza epidemic in India agree that unlike the plague, small-pox, cholera epidemics the Influenza of 1918 has hardly generated much documentation or literary works. Maybe a study of literary works in Indian languages such as Punjabi, Bengali and Hindi, would throw up more examples.

[4] Phillips Howard and David Killingray, Edited, The Spanish Influenza Epidemic of 1918–19: New Perspectives (London, Routledge, 2003). The introduction in this book sets out reasons why unlike other global pandemics the Influenza of 1918 was the least documented of epidemics globally. It is from the late 1970s that studies on this Pandemic gained momentum.

[5] Mills, I.D., The 1918-1919 Influenza Pandemic – The Indian Experience, Indian Economic and Social History Review, 23 (1986), p.5.

[6] The two worst hit cities were Bombay and Karachi both global transshipment ports, underscoring how hyper-connectivity through shipping routes carried this pandemic to every continent. In the case of SARS-Cov-19 it was air connectivity that led to outbreaks, for example in Milan (Italy), which had hosted Chinese buyers and investors for its Fashion Week just days before its epidemic began.

[7] Viral fevers are identified by a combination of the proteins H (Hemagglutinin) and N (Neuraminidase) on the surface of the virus. There are 16(H1 to H16) known types of hemagglutinin and 9 (N1 to N9) known types of neuraminidase, which gives 144 different possible combinations of these proteins. Studies by medical researchers and archaeo-serolists on tissues of those who died in the Influenza Pandemic of 1918, have revealed that the virus is similar to the swine flu virus. The current SARS-Cov-19 Pandemic’s zoonotic source is believed to be either the Pangolin or the bat.

[8] Mills, I.D., The 1918-1919 Influenza Pandemic – The Indian Experience, Indian Economic and Social History Review, 23 (1986), p. 32. The drop in births was not simply attributable to higher death rates among women but also to the fact of widespread widowhood.

[9] Kupperberg, Paul, The Influenza pandemic of 1918-1919 (New York, Chelsea House Publishers, 2008). This was part of a series Great Historic Disasters.

[10] Patterson K. David, and Gerald F. Pyle, The Geography And Mortality Of The 1918 Influenza Pandemic, Bulletin of the History of Medicine, Vol. 65, No. 1 (1991), published by John Hopkins University.

[11] Fevers were not ‘notifiable’ diseases in British India, the Bombay Port Trust Health officer in spite of an earlier wave released overseas passengers into the city without due diligence. This lacuna was only addressed in 1919.

[12] Most historical studies only cover British India and not the Indian Princely States because of a lack of data in these kingdoms. This means that only 75% of the Indian Subcontinent’s population was covered by researchers

[13] In Bombay there were numerous social, political, business and community organizations that came forward to help the Bombay Municipal Corporation (BMC) after the Health Officer J.A. Turner appealed to the public for their help. Almost every community and caste organization came forward to help their people because of sensitivities regarding dietary strictures, concepts of pollution etc. that was prevalent then. Among political parties, the Home Rule League, played a significant role. Protocols regarding the working conditions in textile mills were recommended by the BMC’s medical sub-committee made up of Rahimtulla Currimbhoy, Dr. Kavasji Dadachanji, Sir Cowasji Jehangir and Dr. M.C. Javle. This was because mill-workers were found to be most susceptible. This model was replicated in Poona, Sholapur, Surat, Ahmedabad and Karachi, all in Bombay Presidency. Karachi city took this a step further by closing all theatres for 3 months.

[14] Arnold, David, Death and the Modern Empire: The 1918 Influenza Epidemic in India, Transactions of the Royal Historical Society (2018), p.192.  According to Arnold, the 700 doctors of the Indian Medical Service had been inducted into active military service, and by 1918 many had died and others had not reverted to their civilian posts yet. As a result, the doctors from the Royal Medical Armed Services, who attended to British officers and soldiers were pressed into service in local hospitals but they did not possess the language skills to help them deal with patients.

[15] Ramanna, Mridula, Coping with the influenza pandemic: The Bombay experience, in Phillips Howard and David Killingray, Edited, The Spanish Influenza Epidemic of 1918–19: New Perspectives (London, Routledge, 2003), p. 84. The scarcity of foodgrains was a contentious issue between the government and Indian leaders, and it was only as late as October 1918 that export of wheat was stopped.

[16] Numerous medical breakthroughs in the field of epidemic illnesses both in terms of vaccines, treatment protocols and sanitation had been made in India from the late 19th century. Some notable ones were Dr. Waldemar Haffkine discovery of the plague and cholera vaccines. Haffkine introduced a Cholera vaccine first in Calcutta after Dr. Alexander Yersin first identified its cause, also in Calcutta. By the time of the Influenza pandemic of 1918, almost six to seven international sanitation conferences had been held since the 1860s. However, all these discoveries and sanitation improvements were for bacterial infections.

[17] Mills, I.D., The 1918-1919 Influenza Pandemic – The Indian Experience, Indian Economic and Social History Review, 23 (1986), p.2. Mills’ study looks closely at registered deaths — however, imperfect the records – and places mortalities from Influenza at anywhere between 15-18.5 million.



Related posts:
Lessons from the Bombay Pl

Lessons from the Bombay Plague EPIDEMIC


7 May 2020, Gateway House

Lessons from the Bombay Plague

To tackle Covid19 the Indian government has invoked the colonial-era Epidemics Act of 1897, originally enacted to tackle the Bombay Plague of 1896. The plague wreaked havoc across Bombay and presented some of the same challenges the government faces today, including a migrant labour exodus. History teaches by examples - here is a glance in to the past

Bombay History Fellow

The Bubonic Plague epidemic of 1896 lasted 20 years, it brought the city of Mumbai (then Bombay) to a grinding halt and decimated its population. By October 1896, 20,000 people had fled the city, and by February 1897, the population had halved to 450,000 people from 846,000 3 months back.[1] At its peak, from 1897 to 1901, the number of plague related deaths averaged a staggering 2624 per week.[2] Never had ‘Bombay the beautiful’, as one newspaper at the time commented, looked so deserted.[3] Today, over a century later, Mumbai, with its empty roads and absence of commerce (except for essential services) wears the same pallor of gloom and anxiety that it once did, during what will now always be remembered as the ‘Bombay Plague’.

The name ‘Bombay’ was attributed to this epidemic not because the city was its geographical origin, but because its devastation in terms of human life, health, property and livelihood were the greatest at its entry point of Bombay and its Presidency (which included other hotspots such as Poona and Karachi). In the 20 years that the epidemic ravaged the Indian subcontinent, it is believed that over 8 million people lost their lives to it.

A prospering city

Unlike Covid19, which is a virus, the plague  was caused by a zoonotic bacterium, carried by a rat flea, which is suspected to have entered Bombay sometime in August-September 1896, on board the ship Mandarin that arrived from British Hong Kong. Hong Kong was then in the throes of an outbreak.[4] At the time of onset, Bombay was not just the financial capital of British India but also a thriving international port and a major manufacturing center for cotton yarn and textiles. The revenue that the city and its Presidency generated was a sizeable chunk of the annual home payments sent to Great Britain. Not much has changed today in terms of the city’s importance in governance revenues. It remains an integral financial capital of India and a major contributor to the center’s tax coffers. It is also one of the most impacted by Covid19.

By 1896, there was already a use of stringent sanitary measures by colonial civic officials in Bombay, because of the recurring small-pox, cholera, diphtheria[5] and fever outbreaks. All of these were blamed on the unsanitary lifestyles of the local population. The death of Lady Fergusson (wife of Bombay Governor, James Fergusson) from cholera in Parel House (present day Haffkine Institute) in 1883, had a profound psychological effect on the resident British population[6] as it drove home the fact that they and their families could also get infected. The increasing xenophobia, peaked with the plague outbreak, and determined the manner in which anti-plague protocols, later enacted by the Epidemics Act of 1897, were implemented.

A postcard by Clifton & Co., c. 1903, showing a ward with patients and two medical personnel taken in a Plague Hospital in Bombay.
A postcard by Clifton & Co., c. 1903, showing a ward with patients and two medical personnel taken in a Plague Hospital in Bombay.

It wasn’t necessarily the stringency of the measures, which by all accounts seemed to have been warranted just as the all-India lockdown is today, but the tenor in which they were enforced that led to either acceptance or outright revolt. From the very beginning, it was clear that tracking the infected and those who had come in contact with them was the first step to breaking the cycle of infection particularly for the more virulent pneumonic variety where the plague bacillus was carried in droplets of air, much like the Covid19 virus is today. Though killing rats (carriers of the flea) was a major part of the city’s clean-up, contact tracing and quarantining people in Plague Camps were active measures (just as they are today) to check the spread of infection.

Tracking down cases

The first plague case in Bombay was diagnosed by Dr. Acacio G. Viegas[7], when he visited a patient in Mandvi on 23 September 1896. It is significant that the outbreak began in Mandvi, an area close to the docks and home (even today) to warehouses, grain merchants and dense, crowded dwellings. This first case was a bubonic plague case, however, its variant the more infectious pneumonic plague,[8] also appeared simultaneously in the city. It was the population density of the Mandvi area, very much like the slums of Dharavi (a Covid19 hotspot today), which encouraged contamination and spread.

Initially, the tracking, detection and sequestering, was implemented by the Bombay municipality and its locally elected officials who were naturally sympathetic, and attuned to local sensitivities. However, a death toll of 33,161 people from September 1896 to March 1897 called into question their competence,[9] and even whether Indians were really fit for self-governance to begin with.

Bombay's first Plague Committee under the Epidemics Control Act of 1897. Chairman, Brig-General W.F. Gatacre, center.
Bombay’s first Plague Committee under the Epidemics Control Act of 1897. Chairman, Brig-General W.F. Gatacre, center.

In March 1897, the British Indian government formed all-European Plague Committees to enforce control and sanitation[10]. The extreme measures taken by these committees against the local population led to a strong backlash in the local press, especially regional language newspapers such as Bal Gangadhar Tilak’s Maratha. Teams of soldiers and local volunteers forcibly entered homes of victims, burned beddings and personal belongings, broke the roofs and sanitised the confines. The house was then marked UHH (unfit for human habitation). The victim, often in a moribund condition, was forcibly carried away to a plague hospital with low survival rates.[11]

The measures were culture and gender insensitive and sacrilegious at a time when strict social distancing was observed between castes and communities. A flashpoint was reached when Walter Rand, chairman of the plague committee in Poona and his military escort were shot dead in June 1897 as an act of protest.[12]

The unpopularity of plague controls (in the first wave of the outbreak) combined with the panic created, was a stimulus to an unprecedented flight of migrant labour out of the city to their villages. They carried the infection unwittingly through carrier fleas on their clothes and beddings. It wasn’t just the mill workers but the freight trains carrying goods out of the city that were also culpable in the spread of plague across India.

A 'flushing engine' used to wash down plague infected buildings, much like the disinfectant spraying carried out in Mumbai's Covid19 containment zones.
A ‘flushing engine’ used to wash down plague infected buildings, much like the disinfectant spraying carried out in Mumbai’s Covid19 containment zones.

In 1896, Bombay and its Presidency had 133 cotton mills and the large-scale exit of its mill operatives and dock workers severely impacted the city’s economy. In order to keep the mills humming, there was an open and cut-throat bidding by mill agents for labour on street corners. Not only were wages unreasonably high but the system of daily wages was introduced, with no guarantee of workers reporting the next day for duty.

It was only in 1905-06 that the city’s textile industry became solvent once again, with the return of its migrant work force, many of who by now preferred to risk the plague than face starvation in their villages. [13]This return migration is likely in the Covid19 situation we face now and may happen simultaneous to the staggered starting-up of the economy.

In the past, what finally helped control the Plague epidemic was the discovery of a vaccine in 1897, by Dr. Waldemar Haffkine, who single-mindedly worked on it and was the first to test it on himself on 10 January 1897. A dogged pursuit of a vaccine and widespread inoculation might be the best possible solution to curtail the spread of Covid19 as well, as long as the virus doesn’t keep mutating.

A new urban vision

By 1900, there was a shift in thinking by the British on how to tackle the epidemic, resulting in a relaxation of controls. First, the violent backlash to plague protocols, which peaked with Rand’s assassination and the fact that the death rates were still high led to a policy of “co-opting” rather than “subjecting” people to controls. This was undertaken by reaching out to community and political leaders.

A positive and direct fallout of the Bombay Plague was the creation of a Bombay City Improvement Trust in November 1898 to decongest the city. It was the work of this trust that created the north-south Mohammed ali Road, and the east-west Princess Street and Sandhurst Road corridors with the aim of cross-ventilating the old city areas. It also created expansive garden housing estates, such as the Hindu and Parsi colonies in Dadar, in order to decongest south Bombay. Even today, in the times of Covid19, accelerating the redevelopment of slums, in particular Dharavi, has acquired a renewed urgency.

It is no doubt that Mumbai and India post Covid19 are going to be indelibly changed now as they were after the Plague over a century ago. Today, as the country grapples with curtailing a new pathogen, its government and citizens should learn from the mistakes and successes of the past to plan for the future.

Sifra Lentin is Bombay History Fellow, Gateway House.

This article was exclusively written for Gateway House: Indian Council on Global Relations. You can read more exclusive content here.

For interview requests with the author, or for permission to republish, please contact

© Copyright 2020 Gateway House: Indian Council on Global Relations. All rights reserved. Any unauthorized copying or reproduction is strictly prohibited.


[1] Ramanna, Mridula, Health Care in Bombay Presidency 1896-1930 (New Delhi, Primus Books, 2012), p. 13.

[2] Edwardes, S.M., The Gazetteer of Bombay City and Island Volume III (Pune, The Government Photozinco Press, Reprint 1978), p. 175.

[3] The regional newspaper Kaiser-i-Hindmade this observation in its issue dated 17 January 1897. Ibid (i), p.13.

[4] Catanach, I.J., The Globalization of Disease? India and the Plague, Journal of World History (University of Hawaii Press), Volume 12, No. 1, pp. 135. This journal article states that the plague was present in British Hong Kong in 1894, a few cases were reported in 1895, and many more in 1896. Also, Kalpish Ratna, Room 000: Narratives of the Bombay Plague (New Delhi, Pan Macmillan, 2015), p25.

[5] Ramanna, Mridula,Coping with Epidemics: Indian Responses, Bombay Presidency, 1900-1919, in Bandyopadhyay, Arun, ed, Science & Society1750-2000(New Delhi, Manohar, 2010), pp. 145-167.

[6] Parel House, the Bombay governor’s residence since 1829,ceased to be Governor’s Houseafter Fergusson’s tenure ended in 1885. Subsequent governors shifted to the breezier Governor’s House (today’s Raj Bhavan) at Malabar Point. By a twist of fate, Parel House became the city’s first Plague Hospital during the years 1897-98, before the Plague Research Laboratory headed by Dr. Waldemar Haffkine shifted there in 1899.

[7] Dr. Acacio Gabriel Viegas was a Goan doctor, who first alerted the city’s municipal corporation to the outbreak of plague. He was later president of the Bombay Municipal Corporation and a municipal councilor for many years. His statue stands in Dhobi Talao facing Metro Theatre.

[8] The pneumonic plagueaffected the lungs and was more virulent as it was transmitted through droplets in the air, while the bubonic variety, identified by a bubo near the groin, was less infectious.

[9] Ramanna, Mridula,Health Care in Bombay Presidency 1896-1930 (New Delhi, Primus Books, 2012), p. 11.

[10] The Epidemics Act (1897) resulted in financial control over plague expenditure being taken out of the hands of the Bombay Municipal Corporation and being vested first in a Plague Commissioner. A few years later, when the Plague Committees were disbanded the Municipal Commissioner was appointed as the plague administrator.

[11] Often the victims were dying by the time they were taken to the hospital as a result the death toll in the hospitals were very high, which led to misinformation that the hospitals killed the patients. This in fact led to an attack on the Arthur Road Hospital on 29 October 1896 by 800 to a 1000 people. It was an attack on medical personnel. See, Ramanna, Mridula, Health Care in Bombay Presidency 1896-1930 (New Delhi, Primus Books, 2012), p. 20.

[12] Bombay too, witnessed its share of hostility towards anti-plague measures.On 9 March 1898, riots occurred in Madanpura when a medical team and plague officer of the ward, were refused admission into a house to examine a suspected plague case.The crowds attacked them and in the subsequent police firing five persons were killed

[13] Many mill operatives began returning to the city after just a few months. The outbreak of plague in 1896 coincided with famine, which saw large numbers of returnees afflicted with diseases likecholera re-entering the city.


Related posts:
  1. The 1918 ‘flu: India’s worst pandemic