It happened 100 years ago
By Raj Boodhoo
Influenza is a highly infectious viral disease. One hundred years ago, an influenza pandemic known as Spanish Influenza swept the world in a matter of months. The 1918-19 pandemic is held to be the deadliest scourge in modern history, killing over 50 million people, if not the double according to recent estimates1. About 20 million people died only in India. According to A. Crosby ‘a fifth of the human race endured the fever.’ In the course of the 20th century, there were several pandemics, yet none of them as lethal as the Spanish Flu. Influenza is not a new phenomenon. It seems to be one of those infections together with measles and smallpox that were introduced by the Spaniards into the New World in the 15th century. McNeil believes that the infection raging on both sides of the Atlantic in the years 1556-59 could be an early influenza pandemic2.
Clayton Apparatus disinfecting a street in Port Louis
The Spanish Flu was so named as most of the information about the outbreak came from Spain, a neutral country during the Great War. Its real geographic origin may not be known. In spite of the development of bacteriology from the time of Louis Pasteur during the last quarter of the 19th century, little was known of the infection; treatment was therefore uncertain. Uncontrolled, its spread from Europe to the rest of the world was rapid.
By the end of 1918, the Government of Mauritius received cables about outbreaks in India and South Africa. After the disease appeared in England in November 1918, the Colonial Office recommended some cautions to be taken in the colonies. New quarantine regulations were passed in Mauritius to control ships arriving with influenza cases on board. The press actively announced news of influenza outbreaks in Bombay and Durban. According to M. Tomkins, the pandemic was introduced in Sierra Leone by a vessel from England and it spread to other parts of Africa through commercial routes, reaching the east coast facing the Indian Ocean3. The Indian Ocean islands were affected about the same time the following year.
Infectious Disease and Public Health
The first flu cases in Mauritius occurred in May 1918 in the eastern suburb of Port-Louis. It was believed that a ship from East Africa could have introduced the disease. By mid-May, nearly one hundred deaths were reported in Port Louis. Notices appeared on the walls of the town, cautioning the public to avoid crowds, fancy fairs and other gatherings. During 1919, the total number of vessels arriving at Port Louis was 177 (128 steamers and 49 sailing ships). Six of them having flu cases on board were directed to Flat Island quarantine station; the cargo of fifty of them were fumigated and disinfected.
The local medical authorities could not explain the cause of the infection, different views circulated and the same prescription given to malaria patients was issued to those suffering from flu-like disease: quinine products, aspirin, application of poultice, mustard-plaster on the chest and body massage with liniment. Such prescriptions were published in the press. Open air and sunshine were also recommended to all. Some Chinese shopkeepers in the capital wore flu masks, which cost 25 cents each. Schools were closed and some of the buildings were converted into makeshift wards. Shops, banks and some railway stations were closed due to shortage of staff.
The outbreak in Mauritius, stretching from May to July, was relatively short, it can also be said that it was the third wave of the pandemic. During the month of May, the number of deaths registered for the whole island rose to 4,680 and 4,442 for June, then the number dropped to 347 in July4. Figures were not reliable, the Poor Law Commission recorded over 12,000 deaths for 1919 while the Health Department classified the mortality figures as follows: the total number of deaths attributed to flu was 11,063, including 1,158 deaths caused by complications such as pneumonia and bronchitis. The medical services recorded 103,406 cases in hospitals and dispensaries that is about one third of the whole population. However, compared to several countries in the Indian Ocean, it can be said that Mauritius was less hard-hit by the pandemic.
When the number of patients in public hospitals and dispensaries rose abruptly in May and June, charitable institutions run by the ‘Soeurs de Lorette’ opened temporary wards on the site of the future Candos Hospital and at Quatre Bornes La Louise primary school, to provide nursing assistance. In Curepipe, the ‘Freres de la Doctrine Chrétienne’ provided care at the Royal College that was also temporarily closed. It should be noted that there was no public hospital in the Plaines Wilhems until Victoria Hospital opened in 1922. A few benevolent Hindu, Muslim and Chinese groups organized some relief for the needy in Port Louis.
Before the end of 1919, the epidemic having died down and its woes forgotten, the health department returned to its major preoccupation: malaria. By the time World War I ended, the government had reactivated its agricultural activities; the sugar boom and a short period of affluence provided the government sufficient funding to start sanitation works. Governor Hesketh-Bell firmly believed that the unsanitary conditions producing considerable miasma could be the cause of various diseases. In1921, a short plague epidemic broke out drawing the attention of the public. Moreover, the press concentrated on the agitation and excitement aroused by politicians during the Retrocession Movement and the elections that followed.
After the catastrophic global Spanish Flu, laboratory research intensified in Europe and America; by the early 1930s the causative viruses were identified. There are three types of influenza viruses: A, B, and C, each having more subtypes or strains. Type A is the most virulent and it constantly mutates. Moreover, it has reservoirs in pigs and birds, the virus can cross into human beings, making its control extremely difficult. An epidemic is caused when the virus spreads from human to human, through sneezes and coughs releasing droplets containing hundreds of pathogens.
After the 1918-19 pandemic, there have been sporadic pandemics related to Type A: the 1957 Asian Flu (H2N2) and the 1968 Hong Kong Flu (H3N2). Compared to the Spanish flu, they have been far less severe. The Asian Flu caused between one to two million deaths worldwide, but it was hardly felt in Mauritius. In June 1957, the press showing great concern about the pandemic which had reached the Indian Ocean argued that the Mauritius was a stop-over for Qantas and Air France planes coming from East Africa where flu epidemics had occurred. However, that pandemic causing undue panic hardly affected Mauritius, and Dr R. Lavoipierre, the Director of health services summarized the situation in one line, reporting that there was only ‘a slight increase in mortality’5. In 1997, a new strain of Avian flu H5N1 recorded in Hong Kong spread in South East Asia and re-appeared in 2003. Again, a new strain of A virus emerged in 2009, a combination of swine and avian viruses, A (H1N1) 2009 became pandemic. In Mauritius many cases were recorded in hospitals and dispensaries. Since 2009, A (H1N1) is circulating together with other seasonal viruses, such as A(H3N2).
However, the Spanish Flu lingered in the memory of the Mauritian community for a long time. A few decades ago, one could come across people who had heard of ‘la fievre espagnole’ referring to it as a terrible catastrophe that killed many. That story, however, has not appeared in any school book. Only recently a few local historians have tried to uncover some aspects of the pandemic. Anand Moheeputh, has provided interesting details on general aspects6. Sada Reddi presented a paper at the first international conference on the Spanish Influenza held at the University of Cape Town in September 1998, discussing the role of non-governmental organizations, especially the Indian merchant class, in organizing relief to help the sick poor in the capital7.Howard Phillips, from the Department of Historical Studies of the University of Cape Town, in a comprehensive historiography of the Spanish Flu argues that the Cape Town conference of 1998 triggered more historical research, and there has since been an upsurge of scientific works on the subject, as well as documentary films and books8. However, the most important catalyst has been the work of Jeffery Taubenberger who deciphered the virus that caused the disease in 1918-19, by means of tissues recovered from people having died of Spanish flu. It was observed that the 2009 pandemic and the 1918-19 pandemics had similar HINI strains. It was a landmark discovery that conjured up the hitherto ‘forgotten pandemic’. Scientists believe that past flu pandemics could provide information to understand future outbreaks.
Flu, it has to be noted, is entirely different from common cold, although their early symptoms may be similar. Common cold is caused by another set of viruses. Flu causes higher fever that can be followed by more serious complications, such as pneumonia. The human immune system starts to develop from childhood and stands as a barrier against infections. However, old people, pregnant women, infants, and those with damaged immune system can be particularly vulnerable. The best recommendation, however, for vulnerable groups is to have a vaccine as soon as it is available for each season. It is also highly recommended to develop basic hygiene habits: washing hands frequently, avoid touching the eyes and nose, or using a tissue to prevent virus-laden droplets spreading in the home, workplaces, classrooms and other public spaces.
The World Health Organisation constantly monitors the disease worldwide. Each year the vaccine is redesigned, depending on the viruses that are circulating. Tests are carried out in laboratories in different countries in the northern and southern hemispheres, and from data collected, WHO recommends the types of vaccine to be produced each year by pharmaceutical companies. The Central Health Laboratory at Candos, which plays the main role in this preparedness programme, performs the surveillance on the prevalence of particular strains circulating in Mauritius before submitting its findings to WHO.
As the flu virus continues to defy medical science and cause deaths, extensive research in the evolution of viruses and the preparation of vaccines are being carried out. International organizations, WHO and CDC, and institutions such as the Bill and Melinda Gates Foundation have invested considerable resources in research in influenza (and other infectious diseases) and the development of vaccines. When will a new virus evolve and cause a pandemic is still difficult to predict.
1 Johnson N et al – Updating the Accounts: Global Mortality of the 1918-1920 ‘Spanish’ Influenza Pandemic Bull. Hist.Med.2002, 76
2 McNeil W.H. 1976 – Plagues and Peoples, USA
3 Tomkins, S. – The Failure of Expertise, – Social History of Medicine.Vol 5,1992
4 Health Department, Annual Report 1919
5 Health Department, Annual Report 1957
6 Moheeputh, A. – The flu that killed thousands in Mauritius and tens of thousands in Mauritius and tens of millions worldwide, Week End 12 August 2018
7 Reddi, S. Conference Paper, Cape Town September 1998
8 Phillips, H. – Second Opinion, The Recent Wave of Spanish flu historiography, Social History of Medecine. 2014, Vol 27
* Published in print edition on 6 September 2019