1921 Census Report: Influenza Epidemic in India, 12-13 m dead

1921 Census Report: Influenza Epidemic in India, 12-13 m dead
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The Content for this article is directly from the Census Report of 1921. India was under British Rule at that time

In considering the factors which determined the movement of the population in the decade between 1911-21 may conveniently be divided into two periods

a.  A fairly normal period from 1911 to 1917 and

b.  The disastrous epidemic year 1918, accompanied by scarcity and followed by a second crop failure in 1920.

As will be seen the war hardly began to affect the ordinary life of the people till about the third year after its outbreak.

The influenza epidemic, starting in the latter part of 1918, visited almost every portion of the country and wiped out in a few months practically the whole natural increase in the population for the previous seven years. Emergency measures were taken. Transport, the export of foodstuffs and the distribution of the necessities of life were all placed under Government control, and it was only the wonderful resisting power of the people, acquired from years of steady economic improvement, that enabled the country to tide without absolute disaster over a year of unprecedented difficulty and strain.

The influenza epidemic of 1918 invaded the continent of India in two distinct waves.

First Wave June to September 1918, The first infection apparently radiated from Bombay and progressed eastward from their, but its origin and foci are uncertain. It may have been introduced from shipping in Bombay district, Delhi, and Meerut in the spring; but the existence of the disease in epidemic form cannot be established without doubt before June. The diseases became general in India in both the military and civil population during August and infection spread rapidly from place to place by rail, road and water.

The first epidemic was most prevalent in

– Urban areas

– Affected young children and old people most severely.

The morality curve went to a peak in July and then dropped and there is evidence of a distinct interval between the first and second waves but not of any real break of continuity, as sporadic cases were reported throughout the intervening period.

Second Wave September 1918 to whole of 1919 It is impossible to say where the more virulent virus of the second invasion came from. There are certain facts, which suggest that the disease began in the Poona district in September. It spread from province to province, lasting in a virulent form generally from eight to ten weeks, when mortality, usually due to respiratory disease, reached its highest point.

The rural areas were most severely infected, the reason probably being that while villages have little advantage over towns in the matter of overcrowding, sanitation and ventilation the urban areas have the benefit of qualified medical aid and organized effort.

Mortality was especially high among

– Adults (20-40)

– Particularly among adult females

– The diseases being generally fatal to women in pregnancy.

It is suggested that the high mortality was specially high among women may have been due to the fact that, in addition to the ordinary tasks of the house, on them fell the duty of nursing the others even when themselves ill. The figures show that the excess mortality between the ages 20 to 40 amounted in some cases to nearly four times the mean. It is no exaggeration to say that at the worst period whole villages were put out of action by the epidemic.

To add to the distress the disease came at a period of widespread failure and reached its climax in November when the cold weather had set in; and, as the price of cloth happened at the time to be at its highest, many were unable to provide themselves with the warm clothing that was essential in the case of an illness that so readily attacked the lungs. The disease lasted in most provinces well into 1919 and gave a high mortality in that year in Bengal and the united Provinces even after it had subsided there were in the year, while local outbreaks continued over the country during the next two years. 

The comparative severity of the epidemic in the different parts of India is shown in the table below. It is not possible to explain the peculiar variations in the local prevalence of the diseases, which seems to have been entirely capricious in its incidence. The coastline escaped with a low mortality while in the hilly country the disease was usually special fatal, though this was apparently not always the case in the Punjab. The Eastern Provinces escaped lightly and Calcutta was not attacked as severely as other cities. It has been suggested that the mortality was determined by the comparative liability of the people to respiratory complications or, in other words, their susceptibility to pneumonia, and it looks as if the epidemic was more virulent in a cold dry climate than where there was comparative warmth or humidity.  

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There is no direct means of ascertaining the mortality from the epidemic. Influenza was unknown to the registration staff as a specific form of illness and the deaths were entered under the heads fever or respiratory disease. Various estimates have been made based on the excess mortality over some suitable mean. The average of these calculations gives a total number of deaths in the areas under registration of about 7,100,000 in 1918, as shown in the migration table ; to which must be added, as the results of similar calculation, another 1-1/3 million deaths in 1919, giving a total recorded mortality of nearly 8.5 millions in the two years.

 Even this, however, must be a substantial underestimate since, owing to the complete breakdown of the reporting staff. In any case the figure given above applies only to the areas under registration, which contain little more than three quarters of the population of India. The epidemic was especially virulent in the Rajputana and Central India Agencies and in the States of the Punjab, Central Provinces and Bihar and Orissa, while the attack was severe in Kashmir and Mysore and acute in Hyderabad and parts of Baroda. We have no statistics for these areas, at any rate none that are trustworthy, but a rough estimate would put the direct mortality in them, from the disease in 1918 and 1919, at least in the same proportion as in British territory. We thus arrive at a total mortality of between 12 and 13 millions for India. It is interesting to note that even this conservative estimate of a mortality, the large part of which occurred in the space of three or four months, exceeds by nearly two millions the total estimated deaths from plague extending over 20 years  (1898-1918), and is a good deal more than double the death rate directly attributable to the famines, of the period 1897-1901. The number of deaths, however, is not, of course, the measure of the loss of life from the epidemic. The case mortality has been put roughly at about 10 percent and on this basis the total number of persons affected by the disease was about 125 millions or two fifths of the total population of India. The effect on the general health of the people is shown by the reaction on the birth rate, which dropped below the death rate in 1918 and 1919 and only gave a slight excess in India in 1920.

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