The Spanish Influenza of 1919: Lessons to Learn
Epidemic mortality was very high suggesting that short-term measures needed to be supplemented by a more fundamental and long-term approach to public health policy in the island
By Sada Reddi
Epidemics are never mere physiological phenomena – they are invariably shaped by social, economic and political processes they collide with. The epidemic influenza of 1919 was the worst epidemic that the world had faced. In Mauritius too, the epidemic caused brought about 12,000 deaths, but the worst happened in 1867 when the malaria epidemic killed about 40,000 people. In 1919, it was the political, economic and social factors that significantly affected the course of the epidemic and impacted the population.
Breakout of the Spanish epidemic
The Spanish epidemic itself broke out in northern France in the military camps in April 1918. On their way back to their homelands, the soldiers carried the epidemic into their respective countries. It initially spread in two waves and was followed by a third one; it reached North Africa in May, China and India in June. Global deaths were estimated to be between 50 to 100 million.
The epidemic influenza of 1919 was the worst epidemic that the world had faced. Photo – sciencemag.org
Before the epidemic reached our island, the people as well as the authorities were well aware of the threat, through information in local newspapers and articles they carried about how to combat the disease, although there was then no remedy. For example, there was an article by Dr A. Chauffard, professor of Clinical Medicine at the University of Paris in the journal de Maurice on 7 January 1919 about the history of the epidemic and measures to contain it. Another article in the same newspaper by Dr Pratt Johnson, Director of Clinical Research Laboratories gave favourable views about preventive inoculation. With the authorities and the public well informed of the evolution of the epidemic, the colonial government must have thought that it could contain the disease reasonably well.
Mauritius at the end of World War I
Moreover, the country had gone through unprecedented prosperity as a result of high sugar prices during the First World War, and there was no shortage of resources to face the epidemic. But war conditions, despite increased wealth, had considerably affected the health of the population. There was a general food shortage during the war: there was not enough rice in the country and prices of foodstuffs and other goods had increased considerably. The poor deprived of adequate food were suffering from malnutrition and other diseases. On the other hand, sanitary conditions in Port Louis had deteriorated considerably; malaria was rife in the island and particularly so in the capital. Even before the epidemic reached the island, the people had been debilitated by wartime conditions and were suffering from malaria, ankylostomiasis and beriberi. District and other hospitals were overcrowded.
Clayton Apparatus disinfecting a street in Port Louis during the epidemic
In January 1919, although there was officially no case of Spanish influenza in the colony, cases of fever were on the rise and the municipal doctor had to do up to 60 consultations per day. Dr Edgar Laurent devoted two days of consultation in the dispensary in the Eastern Suburb, Port Louis, his constituency. There was ‘an epidemic of diarrhoea developing into dysentery which affected thousands of adults and children’. The Municipal Council had to provide food for the poor in their respective wards and Rs 5 were recommended for the deserving poor.
Appointment of Committee
Before the government officially notified the outbreak of the epidemic in May, a committee was appointed in December 1918 and carefully considered a scheme for providing treatment to the sick, distribution of food, registration of deaths and burial. It secured the cooperation of the elected members of the Council, Municipal Corporations and the Boards of Commissioners of the different towns. According to J. Middleton, the officer responsible for the administration of the colony, a committee to prepare for the epidemic had been set up and he had given the green light to his advisers to set up hospitals, to spend liberally on food for the poor and to provide them with medical help.
The committee anticipated that the epidemic would strike with the greatest severity the town of Port Louis. Temporary hospitals were set up to accommodate 1000 patients with provision for soups, milk and medicines. In Plaines Wilhems, temporary accommodation was provided for 300 patients at Rose Hill and Beau Bassin, 200 in Quatre Bornes, 100 in Phoenix and 400 in Curepipe. A private hospital of 75 beds was equipped and opened in Curepipe. The Royal College provided accommodation for 500 patients. It voted liberally to spend money to deal with the epidemic and Rs 50,000 were disbursed initially; Rs 22,000 worth of vaccines were imported from Durban.
Though the colonial government took a number of measures, these were not made public. Arrangements were made to get all doctors to put their services at the disposal of the government for the treatment of the sick. Mass vaccination was advocated by the authorities; 70,000 doses of vaccine with two inoculations per person were made available, but not everybody was willing to get vaccinated. Vaccinations also took place in villages and were carried out in Chinese shops.
Private doctors were assigned to public dispensaries: H. Sakir at Taher Bagh, Dr Piarrouxar at Rue la Paix and the two dispensaries in Ward IV, Dr Louis at Triple Esperance, Dr Laurent at Grand River North West. Dr Acham was put in charge of a Chinese hospital demanded by the Chinese community. It was opened 15 days after the outbreak. Dr Laurent provided free consultations; other doctors came to Port Louis in the morning and left at night. At Bois Savon, a Chinese hospital, no cases of death were reported amongst those who had been vaccinated. Dr Acham vaccinated himself to inspire confidence. There were some deaths among those vaccinated but they were fewer compared with the unvaccinated. At the beginning of the campaign, there was no provision for immediate relief in many of the temporary hospitals, and a great number of people died on the first day of admission without proper care.
The epidemic broke out in May 1919 and that might have been due to the negligence of the authorities in waiving off quarantine for a ship from France. Two cases of the disease were identified on Flat Island and in the eastern suburb, Port Louis. Earlier a few cases of influenza were noted in Port Louis and Curepipe, but there were doubts whether they were really Spanish influenza; in Curepipe, they were attributed to vaccination and were considered benign.
Once cases of influenza were identified in May 1919, the colonial government swung into action. A government proclamation, issued on 5 May 1919, declared that the port of Seychelles was an infected port. On the same day the government issued another proclamation notifying the public that influenza was a contagious disease and the period of observation for quarantine was fixed for 8 days. On 14 May, another proclamation informed the public that the island was threatened by the Spanish influenza and all schools, colleges and places of public entertainment were closed. On the following day, Port Louis looked like a desolate place on that cold winter morning. Anxiety could be read on all the faces, the coaches were empty, and a few people attending to their businesses were wearing masks.
There were posters informing the public that those who spit in certain places would be fined. The sanitary authorities were invested with powers ‘to remove to hospital any person affected by the Spanish influenza which cannot be treated at his home to the satisfaction of the sanitary authority and shall be detained until complete recovery and discharged by the medical officer of the hospital’. Posters were erected along the roads about measures that the public should take. Food was a major concern of the authorities but they resisted pressure to fix food prices and to compel landowners to grow food crops. Chocolate, condensed milk and blankets were requisitioned for hospitals and lazarettos. The price of sugar was deregulated and the use of eggs in cakes and the manufacture of butter were prohibited by order of the Food Controller.
The epidemic spreads
In spite of all these measures, once the epidemic spread in the island in May 1919, there were 906 deaths including 55 prisoners over a period of 5 days in Port Louis. Out of 7197 deaths that occurred in that same month, 5367 were attributed to influenza. Between 1 May and 13 July, 3662 deaths were registered in Port Louis alone, and in the whole island registered deaths from influenza numbered 12,860. The number of indigents at the asylum and convents was on the increase. About one tonne of medicine was used in May and by 6 June, Rs 131,000 had been spent and another Rs 500,000 were released to combat the epidemic.
The response of the public to the epidemic was marked by growing solidarity. Many individuals, companies and organizations helped to alleviate poverty and to provide support for the sick and the poor — the Union Catholique, the Loge de La Triple Espérance, Hindu and Muslim organisations. GM Issac asked those who had stocks of rice to sell them to government at reasonable prices to feed the poor. He collected Rs 20,000 among his friends to help the poor and for burials. Mr Pezzani helped the whole town and not only his ward. A Tamil organisation had been visiting suburbs of the capital distributing money coupons of Rs 3 to the sick irrespective of race and religion.
Managers of schools put their buildings at the disposal of the authorities to be used as hospitals. Religious orders such as the Couvent des Lorettes, Notre dame de Bon Secours and the Filles de Marie put their disciples and administrative organisations at the disposal of government. Dr Momple took charge of the hospital of L’Union Catholique. The Chamber of Commerce provided food for the sick, up to 12 eggs per day. One third of the fund raised by L’oeuvre Anglo-Franco Mauricienne was diverted to helping the poor.
Many of the rich ‘in near view of death’ and the more charitable people subscribed large sums of money to help the poor to buy medicine. Others visited and nursed dying inmates and many poor were saved in this way. The Poor law administrator provided food for 10 days to the poor, and those unable to work food for 6 weeks depending on their health. After the epidemic, those seriously affected received 3 months’ assistance. Blyth Brothers reduced the price of siam rice form Rs 60 to Rs 48.
There were some protests too. There was again riot at Rivière du Rempart at ‘la boutique Martin’; a crowd comprising Creoles, Indians, women and children entered the shop to ask for rice. The police had to be called and there was a skirmish as the crowd moved to the shops of Ay You and Fok Sam. At Nouvelle France, Indians asked for more retailers to sell Burmese rice. Some profiteering also took place. Milkmen sold milk of which 60% was water at 30-40 cents a bottle. A shopkeeper sold camphor at 10 cents apiece. Indian rice which cost 22 cents was sold at 40 cents, Siam rice at 36 cents and peanut oil at 5 cents, manioc at 18-20 cents and sweet potatoes at 20 cents. Workers, butchers and bakers asked for higher wages and food vouchers were exchanged for rum. Rice shortage continued during the epidemic and shopkeepers forced people to shift from rice to maize. Coach drivers asked for 3 to 4 rupees for a trip from Rue Brabant to GRNW that was 3 to 4 times the usual price.
In the end, despite financial and medical assistance and the mobilizing efforts of the government and the public, epidemic mortality was very high suggesting that short-term measures needed to be supplemented by a more fundamental and long-term approach to public health policy in the island. The British colonial administration was considered to have failed in its public health policy not so much for lack of organization and assistance during the epidemic but for long-term neglect of sanitation in the island, particularly in the town of Port Louis and the lack of purified water.
Le petit Journal of 10 November 1919 wrote there would have been fewer victims if the population could have better resisted the epidemic had they not suffered from food shortage particularly rice. In the 1920s, the Balfour Report would advocate a more comprehensive approach to public health. It brought about a reorganization of the Medical Department. Sanitary matters were transferred from the Municipality to the Medical Department. There was greater support for sanitary reforms and Governor Bell’s sanitary reforms including better housing received wide support for ‘better housing would reduce the incidence of disease, enable people to work better and reduce pauperism’.
* Published in print edition on 23 March 2021
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