University of Colorado, Boulder
CU Scholar
History Graduate Theses & Dissertations
History
Spring 1-1-2015
Death and Disorder: The 1918-1919 Influenza
Pandemic in British India
Maura Elizabeth Chhun
University of Colorado Boulder, [email protected]
Follow this and additional works at: http://scholar.colorado.edu/hist_gradetds
Part of the Asian History Commons, and the South and Southeast Asian Languages and Societies
Commons
Recommended Citation
Chhun, Maura Elizabeth, "Death and Disorder: The 1918-1919 Influenza Pandemic in British India" (2015). History Graduate Theses
& Dissertations. 27.
http://scholar.colorado.edu/hist_gradetds/27
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Death&and&Disorder:&&
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This thesis entitled:
Death and Disorder: The 1918-1919 Influenza Pandemic in British India
written by Maura Chhun
has been approved for the Department of History
Dr. Susan Kent
Dr. Mithi Mukherjee
Dr. Carol Byerly
Dr. David Ciarlo
Dr. Loriliai Biernacki
Date
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The final copy of this thesis has been examined by the signatories, and we
find that both the content and the form meet acceptable presentation standards
of scholarly work in the above mentioned discipline.
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Abstract&
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Chhun,!Maura!(Ph.D,!Department!of!History)!
Death&and&Disorder:&The&191821919&Influenza&Pandemic&in&British&India&
Dissertation!directed!by!Professor!Susan!Kent!
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The!1918B1919!influenza!pandemic!claimed!millions!of!lives!around!the!
world,!including!some!12B14!million!in!India.!!The!British!colonial!government!
found!itself!facing!a!previously!unimaginable!public!health!crisis!while!also!fighting!
the!First!World!War!and!staring!down!an!approaching!famine.!!!Without!an!effective!
cure!for!the!flu!and!with!only!an!overstretched!and!understaffed!bureaucracy!to!
fight!it,!the!British!government!managed!only!small,!largely!ineffectual!steps!to!
mitigate!the!flu’s!immense!death!toll.!!Issues!of!power,!racism,!and!colonial!control!
intersected!with!structural!deficiencies!and!a!wellBfounded,!deepBseated!distrust!of!
government!intervention!on!the!part!of!the!Indian!people!during!the!pandemic.!!In!
the!aftermath!many!people!questioned!the!government’s!response,!and!the!flu!
began!to!appear!in!anticolonialist!rhetoric!as!an!indictment!of!the!British!presence.!!
However,!the!atrocities!at!Amritsar!soon!overshadowed!the!neglect!of!the!pandemic!
in!nationalist!literature.!!The!British!government!did!briefly!consider!reforms!to!the!
Indian!Medical!Service!in!response!to!the!pandemic,!but!internal!bureaucratic!
wrangling!and!a!lack!of!a!recrudescence!put!an!end!to!those!discussions.!!By!the!late!
1920s,!the!flu!pandemic!in!British!India!had!faded!to!a!distant!memory.!
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Acknowledgements&
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This!dissertation!would!not!have!been!possible!without!the!support!and!
encouragement!of!Susan!Kent,!advisor!extraordinaire.!!It!also!owes!an!enormous!
debt!of!gratitude!to!Mithi!Mukherjee,!Carol!Byerly,!David!Ciarlo,!and!Loriliai!
Biernacki!for!their!questions,!critiques,!and!insights!that!continually!pushed!me!to!
question!my!conclusions!and!investigate!my!sources!more!thoroughly.!!I!would!not!
have!been!able!to!do!this!research!without!the!support!of!Thea!Lindquist!at!the!
University!of!Colorado,!James!Nye!and!Laura!Ring!at!the!University!of!Chicago,!and!
Cate!Booth!at!the!University!of!WisconsinBBaraboo,!as!well!as!the!librarians!and!
archivists!at!the!British!Library,!Wellcome!Library,!and!National!Archives.!The!
University!of!Colorado’s!Hazel!Barnes!Flat!and!Schwalbe!Travel!Grant!allowed!me!to!
undertake!extensive!research!in!England,!and!the!University!of!Colorado!History!
department!provided!additional!support!for!both!international!and!domestic!
research!trips.!
I!would!also!like!to!thank!my!parents,!Paul!and!Sue!DeChant,!for!always!
believing!in!me!(and!a!special!thanks!to!Mom!for!proofreading!countless!drafts),!and!
my!brother!and!sisterBinBlaw,!Tim!and!Shirley!DeChant,!for!lending!me!a!listening!
ear!when!I!needed!them.!!Matthew!Moynihan!was!there!whenever!I!had!to!talk!
through!a!snag,!as!was!the!Dissertation!Writing!Group!at!the!University!of!Colorado.!!
Patricia!DeChant!gave!me!housing!and!invaluable!life!advice!while!I!was!researching!
in!Chicago,!and!countless!friends!acted!as!my!personal!cheerleading!squad!while!I!
undertook!this!daunting!endeavor.!!I!owe!all!of!them!more!thanks!than!I!can!
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possibly!express.!!Lastly,!I!would!like!to!thank!my!husband,!Bunkhuon!Chhun,!for!all!
the!sacrifices!he!made!so!I!could!write!this!dissertation.!!It!would!not!be!the!work!it!
is!today!without!his!love!and!support.!
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Table&of&Contents&
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Acknowledgements………………………………………………………………………&&&&iv&
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Introduction…………………………………………………………………………………&&&1&
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Chapter&One&
Death&Pays&a&Visit:&Influenza&in&India………………………………………………….&&18&
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Chapter&Two&
Fiddling&while&Bombay&Burns:&The&Official&Government&Response…………&&&56&
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Chapter&Three&
Footsteps&of&Famine:&The&Situation&Worsens………………………………………&&&96&
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Chapter&Four&
Doctors&and&the&Government:&The&Front&Line&Defense&Against&the&Flu……&130&
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Chapter&Five&
Post2Mortem:&The&Flu&in&Retrospect……………………………………………………&183&
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Conclusion…………………………………………………………………………………….&&217&
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Bibliography………………………………………………………………………………….&&227&
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1!
Introduction*
The!1918!influenza!pandemic!affected!nearly!every!continent!and!mounted!a!
staggering!death!toll.1!!Much!like!the!First!World!War,!the!1918!pandemic!was!a!
worldwide!event!with!longAranging!influence!but!despite!its!enormous!impact,!the!
flu!has!been!largely!overshadowed!in!world!history.!!In!particular,!the!flu!pandemic!
in!India!has!been!relegated!to!mere!footnotes,!despite!a!death!toll!of!somewhere!
between!12!and!14!million.2!!This!dissertation!tracks!the!1918!influenza!outbreak!in!
India!and!how!this!disease!was!exacerbated!by!a!famine,!further!complicating!both!
the!British!reaction!and!the!Indian!experience.!!The!British!response!to!these!
catastrophes—or!more!accurately,!the!inadequate!British!response—led!to!anger!
among!some!Indian!people,!who!connected!the!flu!to!a!larger!critique!of!empire!in!
the!waning!days!of!the!First!World!War.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
1!Contemporaries!erroneously!named!the!1918!pandemic!the!Spanish!Flu!Pandemic,!
because!Spain!did!not!participate!in!World!War!I!and!thus!did!not!censor!its!news!
reports!on!the!flu.!!Therefore,!the!first!worldwide!knowledge!of!the!flu!came!from!
Spain!and!most!assumed!it!originated!there.!!!However,!for!the!purposes!of!my!
project!I!will!dispense!with!the!term!Spanish!Flu!and!instead!refer!to!it!as!the!1918!
Influenza!Pandemic.!
!
2!David!Killingray!and!Howard!Phillips,!The$Spanish$Influenza$Pandemic$of$1918819:$
New$Perspectives,!Routledge!Studies!in!the!Social!History!of!Medicine!12!(London ;!
New!York:!Routledge,!2003),!10.!The!official!British!records!list!the!death!toll!at!
roughly!6!million:!5!million!in!British!India!and!an!additional!1!million!in!the!Native!
States.!!I.D.!Mills!counters!with!an!upper!bound!of!18!million,!although!that!not!all!
scholars!accept!that!number.!!Chandra,!et.!al’s!“Mortality!from!the!Influenza!
Pandemic!of!1918A1919:!The!Case!of!India”!in!Demography,!2012,!Vol!49,!issue!3,!
gives!an!estimate!of!just!under!14!million.!!However,!all!researchers!concur!that!the!
official!number!of!6!million!is!too!low,!as!even!contemporary!British!officials!
acknowledged!that!reporting!of!deaths!was!extremely!irregular!in!many!areas,!due!
both!to!Indian!reluctance!to!register!deaths!with!the!British!and!the!absenteeism!of!
British!officials!who!were!also!dealing!with!the!flu.!
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The!historiography!currently!lacks!an!inAdepth!exploration!of!the!1918!
pandemic!in!India,!even!one!from!the!British!perspective.!!By!examining!the!various!
failures!and!successes!of!the!colonial!government!and!of!the!British!medical!
establishment,!this!dissertation!brings!a!new!perspective!to!the!role!of!government!
in!a!public!health!crisis.!!More!specifically,!previous!missteps!in!public!health!made!
any!attempt!by!the!British!to!control!the!pandemic!doomed!from!the!start.!!Although!
the!flu!pandemic!was!beyond!the!medical!capabilities!at!the!time,!the!perception!of!
British!failure!nonetheless!colored!Indian!reactions!to!the!flu!epidemic!itself.!!And!
with!the!major!upheavals!of!spring!of!1919,!as!many!Indians!began!to!reject!the!
British!presence!on!a!larger!scale,!!this!perception!of!British!failure!in!handling!the!
flue!was!a!small!but!contributing!factor!to!growing!discontent!and!open!protest.!
The!pandemic!revealed!weaknesses!within!the!British!government.!!Lack!of!
access!to!health!care!influenced!death!rates,!as!urban!areas!may!have!had!higher!
rates!of!infection!but!rural!areas!saw!higher!death!tolls.!!The!Indian!Medical!Service,!
already!overstretched!thanks!to!the!war,!had!far!too!few!men!to!mount!an!effective!
response!of!any!kind.!!The!British!government!also!prioritized!the!interests!of!the!
empire!above!those!of!the!Indian!people,!and!as!a!result!provided!a!bare!minimum!
of!support!for!the!famine!and!little!support!for!the!pandemic.!!With!an!ideology!that!
advocated!leaving!local!problems!to!the!locals!and!instead!focusing!their!efforts!on!
maintaining!stability!within!the!empire,!the!flu!and!famine!fell!by!the!wayside.!!
Although!the!British!felt!they!had!dealt!with!the!crises!to!the!best!of!their!ability!
considering!the!circumstances,!not!all!Indian!people!felt!the!same.!
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More!deadly!than!the!First!World!War,!the!pandemic!touched!nearly!every!
continent,!affecting!both!metropoles!and!colonies!alike.!!Few!works!on!the!1918!
pandemic!focus!on!the!nonAwestern!world!in!comparison!with!the!relatively!deep!
historiography!of!the!experiences!of!Western!Europe!and!the!United!States.!!!Given!
the!global!impact!of!the!epidemic!and!the!relative!dearth!of!research!into!the!flu!
pandemic!in!India,!this!dissertation!adds!a!comprehensive!overview!of!the!Indian!flu!
experience!that!examines!the!role!of!medicine!within!empire!as!well!as!the!
connections!between!environmental!catastrophe!and!imperial!power.!!!This!
dissertation!maps!the!spread!of!the!flu!in!India.!!It!further!explores!how!the!
government!responded!to!the!epidemic!while!balancing!other!demands,!namely!
fighting!a!war.!!It!looks!at!how!the!British!medical!community!responded!to!the!flu,!
and!measures!the!impact!the!flu!had!on!both!medical!and!governmental!policy.!!It!
investigates!how!responses!to!the!famine!complicated!relief!for!the!influenza!
pandemic,!as!well!as!how!famineAinstigated!price!spikes!compounded!the!influenza!
pandemic.!Finally,!it!argues!that!many!Indian!people!interpreted!the!flu!as!an!
indictment!of!the!British!presence!and!focused!their!anger!toward!the!British!
government’s!response.!
!
Very!few!historians!have!looked!at!the!intersection!of!the!British!Empire!and!
colonial!medicine!through!the!lens!of!the!1918!pandemic.!!!By!exploring!the!
interaction!of!government!and!public!health!catastrophes,!this!work!opens!a!new!
dimension!in!the!historiography!of!the!British!Empire.!!This!research!lies!at!the!
nexus!of!several!different!fields,!blending!the!history!of!the!1918!flu!with!the!
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4!
histories!of!colonial!medicine!and!empire.!!Each!of!these!broad!fields!provides!
necessary!background!for!this!project.!!!
The!majority!of!works!on!the!influenza!pandemic!itself!examine!the!United!
States!or!Europe,!with!a!few!focusing!on!Africa.3!Books!ranging!from!Crosby’s!
excellent!Forgotten$Pandemic!to!Byerly’s!Fever$of$War!emphasize!the!death!toll!of!
the!flu!in!the!United!States!and!the!accompanying!effect!on!the!First!World!War.4!!
India!has!been!largely!ignored.!Nonetheless,!while!the!influenza!pandemic!is!closely!
tied!to!First!World!War,!its!impact!should!not!be!viewed!solely!through!a!European!
lens;!an!examination!of!the!Indian!case!lets!us!see!more!clearly!the!ways!in!which!
the!influenza!pandemic!was!a!worldwide!phenomenon.!!
!
Research!into!the!1918!flu!generally!!start!with!the!flu’s!emergence!in!Kansas!
before!tracing!its!trajectory!across!the!United!States!and!to!Europe!via!troop!
transports,!often!highlighting!the!grim!spectacle!of!the!Leviathan,!the!fluAridden!ship!
that!arrived!in!France!in!the!fall!of!1918.5!!Here!the!approaches!generally!diverge,!
with!some!!focusing!on!the!military!impact!of!the!flu!on!the!United!States!Army,!and!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
3!Sandra!M.!Tomkins,!“Colonial!Administration!in!British!Africa!during!the!Influenza!
Epidemic!of!1918A19,”!Canadian$Journal$of$African$Studies$/$Revue$Canadienne$Des$
Études$Africaines!28,!no.!1!(1994):!60,!doi:10.2307/485825.!And!David!Simmons,!
“Religion!and!Medicine!at!the!Crossroads:!A!ReAExamination!of!the!Southern!
Rhodesian!Influenza!Epidemic!of!1918,”!Journal$of$Southern$African$Studies!35,!no.!1!
(2009):!29–44,!doi:10.1080/03057070802685536.!!Both!look!at!the!flu!pandemic!in!
Africa!and!its!accompanying!political!and!cultural!impacts.!
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4!Alfred!W.!Crosby,!America’s$Forgotten$Pandemic:$The$Influenza$of$1918,!2nd!ed!
(Cambridge ;!New!York:!Cambridge!University!Press,!2003).,!and!Carol!R.!Byerly,!
Fever$of$War:$The$Influenza$Epidemic$in$the$U.S.$Army$during$World$War$I!(New!York:!
New!York!University!Press,!2005).!
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5!Crosby,!125.!
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5!
others!looking!at!the!flu’s!effect!on!either!domestic!America!or!on!Europe.!!The!flu!
struck!Britain!as!well,!with!250,000!dying!during!the!course!of!the!pandemic.!6!!A!
few!take!a!more!journalistic!approach,!such!as!Kolata!and!Duncan,!who!focus!more!
closely!on!the!spread!of!the!flu!and!the!late!twentieth!century!attempts!to!track!
down!the!virus.7!!However,!in!all!of!these!different!narratives,!the!flu!in!India!is!
usually!relegated!two!a!few!sentences,!or!a!paragraph!at!most.!!!
The!emergence!of!this!particular!strain!of!flu!is!inextricably!linked!with!
World!War!I,!as!deftly!argued!by!both!Carol!Byerly!and!Susan!Kent.8!!Generally,!a!
strain!with!that!level!of!virulence!would!burn!itself!out!by!exhausting!all!possible!
hosts!too!quickly,!but!the!rotation!of!troops!on!the!front!and!close!proximity!of!new!
hosts!led!this!strain!to!mutate!in!a!previously!unseen!way.!!This!led!to!the!“terrible!
W”,!where!the!flu’s!mortality!rate!was!high!for!the!young!and!old—following!the!
typical!trends!for!fluAA!but!then!spikes!in!the!middle,!claiming!an!usually!high!
number!of!victims!between!the!ages!of!15A45.9!!Thus,!as!Byerly!has!argued,!the!flu!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
6!Susan!Kingsley!Kent,!The$Influenza$Pandemic$of$191881919:$A$Brief$History$with$
Documents!(Boston:!Bedford/St.!Martin’s,!2013).!11.!!While!not!as!staggering!as!the!
millions!lost!in!India,!this!number!was!still!unusually!high!for!the!island!nation.!
!
7!Gina!Bari!Kolata,!Flu:$The$Story$of$the$Great$Influenza$Pandemic$of$1918$and$the$
Search$for$the$Virus$That$Caused$It,!1st!ed!(New!York:!Farrar,!Straus!and!Giroux,!
1999).!!Kirsty!Duncan,!Hunting$the$1918$Flu:$One$Scientist’s$Search$for$a$Killer$Virus!
(Toronto ;!Buffalo:!University!of!Toronto!Press,!2003).!!These!books!take!a!more!
journalistic!approach!to!the!flu!and!the!search!for!its!official!cause,!but!their!work!in!
mapping!the!flu’s!trajectory!is!vital!to!the!project.!!They!also!provide!a!helpful!
exploration!of!the!scientific!aspect!of!the!flu!without!going!over!this!historian’s!head.!
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8!Byerly,!Fever$of$War,!7,!and!Kent,!5A6.!
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9!Kent,!2A3.!
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must!be!explored!in!conjunction!with!its!relationship!to!war.10!!While!the!Western!
Front!of!the!First!World!War!was!quite!far!from!India,!the!spread!of!the!pandemic!
links!them!together.!!The!flu!arrived!in!Bombay!in!June!along!with!returning!troops,!
bringing!India!into!even!closer!contact!with!the!war.11!!Given!that!the!discovery!of!
the!virus!was!impossible!until!the!creation!of!the!electron!microscope!over!a!decade!
after!the!pandemic!had!burned!out,!the!most!advanced!medical!researchers!of!the!
early!twentieth!century!found!themselves!at!a!complete!loss.!!There!was!very!little!
that!they!could!do,!and!the!bacillus!they!erroneously!identified!as!a!possible!causeAA
Pfeiffer’s!bacillusAA!did!little!to!aid!their!efforts!at!finding!a!cure.12!!Thus,!the!1918!
pandemic!proved!a!huge!challenge!for!modern!medicine.!
!
Very!few!historians,!however,!have!grappled!with!the!course!of!the!epidemic!
through!the!Indian!continent.!!Ramanna’s!article!“Coping!with!the!Influenza!
Pandemic:!The!Bombay!Experience”!in!Killingray!and!Phillips’!collection!of!influenza!
articles,!and!Mills’!attempt!to!construct!a!more!accurate!accounting!of!the!flu’s!
mortality!are!some!of!the!more!substantive!works!available.13!!Kohei!Wakimura!ties!
the!flu!to!famine!and!other!endemic!diseases,!but!Wakimura!and!Ramanna!only!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
10!Byerly,!7.!
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11!The!Sanitary!Commissioner!with!the!Government!of!India,!A$Preliminary$Report$
on$the$Influenza$Pandemic$of$1918$in$India,!(Simla,!Government!Monotype!Press,!
1919),!3.!
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12!Kent,!13.!
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13!Mridula!Ramanna,!“Coping!with!the!Influenza!Pandemic:!The!Bombay!Experience”!
in!The$Spanish$Influenza$Pandemic$of$1918819:$New$Perspectives,!Killingray!and!
Phillips,!eds.,!Routledge!Studies!in!the!Social!History!of!Medicine!12!(London ;!New!
York:!Routledge,!2003).!
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focus!on!specific!regions!of!India!affected!by!the!flu—Wakimura!on!Northern!India,!
Ramanna!on!Bombay.14!!While!Ramanna!does!excellent!work!on!Bombay,!the!
article’s!scope!is!limited.!!Bombay’s!place!in!the!narrative!is!important,!as!the!flu!
arrived!there!and!then!slowly!spread!across!the!country.!!However,!the!Bombay!
Presidency!alone!does!not!tell!the!whole!story.!!Ramanna!also!acknowledges!Indian!
discouragement!and!discontent!with!the!British!response,!as!several!Indian!
newspapers!commented!on!the!lack!of!engagement!by!the!British!government.!I.D!
Mills!examines!census!records!to!create!a!detailed!picture!of!the!demographic!
impact!of!the!flu.15!!!
Unlike!other!parts!of!the!world,!India!experienced!a!famine!in!1918!that!
complicated!the!flu’s!death!toll.!!Famine!has!a!long!history!with!the!British!presence!
in!India,!of!course,!and!the!historiography!of!famine!therefore!provides!a!critical!
element!to!our!understanding!of!how!the!British!government!understood!and!
reacted!to!the!events!of!1918.!!Recently,!Davis’!Late$Victorian$Holocausts$examines!
famine!in!the!late!nineteenth!century!and!his!deft!exploration!of!El!Niño,!worldwide!
weather!patterns,!and!political!ideology!demonstrates!just!how!vulnerable!the!
colonized!states!were!to!the!vagaries!of!weather!and!politics.!16!!The!famines!in!India!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
14!Kohei!Wakimura,!“Famines,!Epidemics!and!Mortality!in!Northern!India,!1870A
1921”!in!Local$Agrarian$Societies$in$Colonial$India:$Japanese$Perspectives,!Collected!
Papers!on!South!Asia,!no.!11!(Richmond,!Surrey![England]:!Curzon!Press,!1996).!
!
15!I.D.!Mills,!“The!1918A1919!Influenza!Pandemic:!The!Indian!Experience”!!in$Indian$
Economic$and$Social$History$Review,!March!1986!(23:1A40)!
!
16!Mike!Davis,!Late$Victorian$Holocausts:$El$Niño$Famines$and$the$Making$of$the$Third$
World!(London ;!New!York:!Verso,!2001).!!Davis’!work!focuses!on!the!late!nineteenth!
century,!but!his!work!on!famines!in!particular!explains!the!processes!of!the!British!
empire!when!faced!with!these!sorts!of!crises.!!!
!
8!
raise!vital!questions!about!the!lack!of!preparedness—or!general!unwillingnessAA!of!
the!British!Empire!to!handle!environmental!catastrophes.!!In!addition,!Davis’!work!
provides!a!blueprint!for!exploring!the!political!consequences!of!these!actions.!!The!
uncontrollable!elements!of!nature,!such!as!El!Niño!and!inadequate!rainfall,!met!with!
ideological!resistance!to!famine!relief!by!the!British!to!create!an!even!more!dire!
situation.17!!The!famine!that!hit!India!in!1918,!although!smaller!than!the!famines!
Davis!examines,!still!added!to!the!crisis!situation!within!India.!!The!British!were!
prepared!to!handle!the!famine!once!the!monsoons!failed,!but!the!famine!and!
pandemic!on!top!of!the!First!World!War!proved!too!much!for!the!British!
bureaucracy!to!handle!in!a!competent!manner.!!!
More!famously,!Amartya!Sen!studies!the!various!causes!and!exacerbating!
factors!of!famine!in!Poverty$and$Famines:$an$essay$on$entitlement$and$deprivation,!
and!explores!the!power!dynamics!that!cause!shortages!to!bloom!into!famines.18!!In!
Poverty$and$Famines,!Sen!examines!the!1943!Bengal!famine!and!the!1974!
Bangladeshi!famine,!and!while!these!are!outside!the!purview!of!this!project!they!do!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
17!Davis,!31.!
!
18!Amartya!Kumar!Sen,!Poverty$and$Famines:$An$Essay$on$Entitlement$and$
Deprivation!(Oxford;!New!York:!Clarendon!Press ;!Oxford!University!Press,!1982),!
49.!!Sen!uses!the!term!“entitlement”!to!parse!how!access!to!food!is!determined,!and!
notes!that!“In!the!Bengal!famine!of!1943!the!people!who!died!in!front!of!wellA
stocked!food!shops!protected!by!the!state!were!denied!food!because!of!lack!of!legal!
entitlement!and!not!because!their!entitlements!were!violated.”!49.!In!the!same!vein,!
Thomas!Keneally,!Three$Famines:$Starvation$and$Politics!(New!York:!PublicAffairs,!
2011),!compares!the!famines!of!Ireland!in!1845,!Bengal!in!1943,!and!the!Ethiopian!
famines!of!the!1970s!and!1980s.!!While!these!famines!have!different!causes!and!
conditions,!his!discussion!of!famines!and!state!power—particularly!a!government!at!
war!in!1943—!furnish!a!solid!methodology!for!the!study!of!famines.!
!
!
9!
provide!an!excellent!explanation!of!the!mechanisms!of!power!and!famine,!and!how!
state!actions!can!create!or!exacerbate!an!unnecessary!crisis.19!!The!British!created!a!
series!of!Famine!Codes!intended!to!address!the!issue!in!the!nineteenth!century,!but!
Sen!notes!their!presence!did!not!necessarily!mean!they!were!followed.20!!This!
reliance!on!a!minimal!amount!of!work!to!alleviate!famine!characterized!the!British!
response!in!1918!as!well.!!!
B.M.!Bhatia!also!tackles!the!issues!of!nineteenth!!and!twentieth!century!
famines!in!India!in!Famines$In$India,!arguing!that!famines!increased!in!intensity!
following!British!rule.21!!Bhatia!supplies!a!detailed!discussion!of!how!the!British!
contributed!to!these!conditions,!the!relief!projects!the!British!created,!and!the!
overall!conditions!for!the!Indian!people!during!these!famines.!!Bhatia!does!not!
directly!address!the!situation!in!1918,!but!does!deal!with!the!economic!and!
administrative!conditions!during!times!of!famine!and!scarcity!from!1896A1914.!!
These!would!be!the!conditions!freshest!in!the!minds!of!both!officials!attempting!to!
control!the!situation!in!1918!and!the!people!hit!hardest!by!price!surges.!!India’s!
famine!experiences!while!under!British!control!and!the!attendant!historiography!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
19!Sen,!Poverty$and$Famines,$52A83!and!131A153.!!Similarly,!Hunger$and$Public$Action$
found!in!Amartya!Kumar!Sen!et!al.,!The$Amartya$Sen$and$Jean$Drèze$Omnibus.!
(Oxford:!Oxford!University!Press,!1999),!deals!with!issues!of!hunger,!nutrition,!and!
state!action!during!famines!but!focuses!primarily!on!the!second!half!of!the!twentieth!
century.!
!
20!Sen,!Hunger$and$Public$Action,!126.!
!
21!B.!M!Bhatia,!Famines$in$India:$A$Study$in$Some$Aspects$of$the$Economic$History$of$
India$with$Special$Reference$to$Food$Problem,$186081990!(Delhi:!Konark!Publishers,!
1991).!8.!
!
!
10!
frames!the!conditions!surrounding!the!flu.!!The!British!prioritized!feeding!their!
armed!forces!above!the!Indian!people!in!1918,!further!coloring!their!response.!
!
The!history!of!colonial!medicine!likewise!informs!this!project,!although!this!
literature,!focused!on!“tropical”!diseases,!largely!neglects!influenza.!!Most!major!
works!look!at!cholera,!malaria,!and!smallpox—in!addition!to!British!attempts!to!
vaccinate!Indian!people—as!a!way!of!exploring!British!health!initiatives!in!India.22!!
Curiously,!most!of!the!relevant!works!to!this!project!conclude!their!studies!at!the!
advent!of!the!First!World!War.!!While!the!early!twentieth!century!did!lead!to!new!
breakthroughs!in!medicine!and!public!health,!!the!1918!pandemic!was!the!greatest!
public!health!crisis!the!British!Empire!had!ever!seen.!!The!influenza!outbreak!does!
not!fit!into!the!usual!category!of!“tropical!medicine”!on!which!many!historians!of!
colonial!medicine!focus,!but!it!does!represent!a!new!and!fruitful!avenue!of!study.!!!
The!emphasis!on!diseases!that!could!prevented!by!vaccines,!both!at!the!time!and!in!
the!current!historiography,!is!understandable.!!Most!British!researchers!at!the!turn!
of!the!century!fixated!on!either!vaccines!or!tropical!diseases,!so!it!follows!that!much!
of!the!historiography!would!cover!these!topics!as!well.!!British!researchers!generally!
centered!their!efforts!around!making!India!safe!for!white!Europeans!and!were!less!
interested!in!treating!Indian!people,!and!thus!their!plight!stayed!out!of!the!British!
purview.!Douglas!Haynes’!article!“The!Persistence!of!Privilege:!British!Medical!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
22!Douglas!Melvin!Haynes,!Imperial$Medicine:$Patrick$Manson$and$the$Conquest$of$
Tropical$Disease!(Philadelphia:!University!of!Pennsylvania!Press,!2001).!!Roy!M.!
MacLeod,!Disease,$Medicine,$and$Empire:$Perspectives$on$Western$Medicine$and$the$
Experience$of$European$Expansion!(London ;!New!York:!Routledge,!1988).!David!
Arnold,!Imperial$Medicine$and$Indigenous$Societies,!Studies!in!Imperialism!
(Manchester ;!New!York :!New!York,!NY,!USA:!Manchester!University!Press ;!
Distributed!exclusively!in!the!USA!and!Canada!by!St.!Martin’s!Press,!1988).!
!
!
11!
Qualifications!and!the!Practice!of!Medicine!in!the!Empire”!in!Beyond$Sovereignty!
provides!a!useful!overview!of!British!medical!qualification!procedures,!and!the!
onerous!burden!placed!upon!colonial!subjects!when!it!came!to!qualifying!in!British!
medicine.23!!Combined,!these!factors!created!a!fault!line!between!British!medicine!
and!the!Indian!people.!
In!Science,$Technology,$and$Medicine$in$Colonial$India$David!Arnold!argues!
that!the!years!following!World!War!I!saw!India!slowly!rejecting!British!science!as!an!
avenue!of!progress.24!!While!his!work!focuses!more!heavily!on!science!and!
technology!and!not!on!medicine,!the!growing!affinity!for!traditional!Indian!medicine!
proceeded!hand!in!hand!with!this!rejection!of!EuropeanAdirected!sciences.!!This!
dynamic!serves!as!a!useful!comparison,!as!the!British!failure!to!control!the!
pandemic!undermined!British!authority.!!However,!during!the!flu!pandemic!itself!
Indian!medical!practitioners—both!western!trained!and!vaidyas—worked!
alongside!British!doctors!to!try!and!alleviate!the!catastrophe!of!the!flu.!!!
Colonial!medicine,!of!course,!was!also!about!colonial!control.!!Colonial!desire!
for!classification!and!control!of!the!Indian!environment!was!similarly!manifested!
through!scientists!and!doctors,!as!Arnold!argues,!“This!investigation!establishes!
tropicality!as!one!of!the!central!paradigms!of!colonial!science!in!India…At!the!same!
time!it!gave!emphasis!to!the!external,!judgmental!nature!of!colonial!science!and!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
23!Beyond$Sovereignty:$Britain,$Empire$and$Transnationalism,$c.$188081950!edited!by!
Kevin!Grant,!Philippa!Levine,!and!Frank!Trentmann,!(Basingstoke![England] ;!New!
York:!Palgrave!Macmillan,!2007).!
!
24!David!Arnold,!Science,$Technology,$and$Medicine$in$Colonial$India,!The!New!
Cambridge!History!of!India,!III,!5!(Cambridge ;!New!York:!Cambridge!University!
Press,!2000).!
!
!
12!
manner!in!which!science!informed!colonial!attitudes!to!Indian!society!and!
culture.”25!!The!British!desire!to!classify!and!control!India!expressed!itself!through!
scientific!language,!as!doctors!and!scientists!acted!as!agents!of!imperial!power.!!This!
connection!between!European!understandings!of!science,!knowledge,!and!India—as!
well!as!the!Indian!environment—provides!a!useful!tool!when!examining!the!British!
reaction!to!the!influenza!pandemic.!
!
The!practice!of!medicine!in!colonial!possessions!was!consistently!fraught!
with!tension,!as!imperial!powers!attempted!to!exercise!their!power!over!often!
unwilling!subjects.!!They!often!flexed!this!power!in!the!form!of!quarantines,!such!as!
during!the!plague!outbreak!in!Bombay!in!the!late!1890s.!!However,!as!Harrison!
notes!in!Contagion,!those!mandatory!quarantines!only!applied!to!Indians,!and!
Europeans!were!exempt!from!the!draconian!powers!of!the!plague!committees!
established!by!the!Epidemic!Diseases!Act!of!1897.26!!The!historiography!of!colonial!
medicine!deals!directly!with!issues!of!control,!as!colonial!agents!undertook!efforts!
to!curb!what!they!perceived!as!chaos!in!colonial!areas.!!!!This!exercise!of!power!
often!led!to!problems,!as!“British!medical!policy!originated!from!and!remained!
subservient!to!the!needs!and!expediencies!of!the!Empire,”!as!Kumar!notes!in!
Medicine$and$the$Raj.27!!Issues!of!race!surface!repeatedly!in!the!historiography,!both!
as!barriers!for!colonial!subjects!wishing!participate!in!medical!services!and!in!how!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
25!Arnold,!Science,$Technology$and$Medicine$in$Colonial$India,!50A51.!
!
26!Mark!Harrison,!Contagion:$How$Commerce$Has$Spread$Disease!(New!Haven:!Yale!
University!Press,!2013).!182A183.!
!
27!Anil!Kumar,!Medicine$and$the$Raj:$British$Medical$Policy$in$India,$183581911!
(Walnut!Creek,!CA:!AltaMira!Press,!1998).!216.!
!
!
13!
the!westernAeducated!doctors!viewed!their!patients;!Kumar!argues!that!doctors’!
preAexisting!biases!toward!colonial!bodies!led!them!to!see!the!colonized!as!
“hygienically!degenerate!types,!requiring!constant!surveillance,!instruction!and!
isolation!and!to!formulate!health!policies!accordingly.”28!!!This!historiography!also!
grapples!with!the!conflict!between!the!state!and!medical!officials,!as!medical!
officials!disagreed!with!governmental!policy!and!vice!versa.29!!!!
!
Finally,!the!flu!outbreak!of!1918!undermined!British!relations!with!the!
Indian!people.!!The!massive!death!toll,!coming!on!the!heels!of!a!famine!and!a!war,!
irreparably!damaged!the!perception!of!the!British!Empire.!!The!colonial!
government’s!perceived!failure!to!adequately!deal!with!these!catastrophes,!coupled!
with!the!disappointments!of!the!not!being!granted!Home!Rule,!Rowlatt!Acts,!and!the!
end!of!the!First!World!War,!!led!to!a!rise!in!resentment!towards!the!British!on!the!
part!of!the!Indian!people.!!Although!eventually!overshadowed!by!the!brutality!at!
Jallianwala!Bagh,!the!anger!precipitated!by!the!flu!cannot!be!overlooked.!!
!
This!project!brings!the!disparate!fields!of!medicine,!history,!and!empire!into!
one!analytical!frame!in!order!to!more!fully!understand!the!connections!between!
environmental!catastrophe,!government!policy,!medical!knowledge,!and!imperial!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
28!Kumar,!Medicine$and$the$Raj,!217.!
!
29!!David!Arnold’s!Colonizing$the$Body$explores$the!difficult!dynamic!between!the!
medical!professionals!of!the!Indian!Medical!Service!and!the!state!in!the!form!of!the!
Indian!Army!and!jails!in!the!chapter!titled!“Colonial!Enclaves,”!p.!61A115.!!Mark!
Harrison’s!Contagion!also!investigates!this!issue!in!the!broader!context!of!plague!
outbreaks!and!global!attempts!and!stemming!pandemics!in!the!chapter!“Plague!and!
the!Global!Economy,”!pg.!174A210.!
!
!
14!
power.!!The!1918!pandemic!affected!the!world!as!a!whole,!and!its!impact!on!India!is!
crucial!to!understanding!the!position!of!the!British!Empire!within!India.!!!
!
The!first!chapter!covers!the!narrative!of!the!influenza!pandemic!itself,!
starting!in!the!American!Midwest!and!culminating!with!the!end!of!the!fall!wave!
arriving!on!the!eastern!side!of!the!Indian!subcontinent!at!the!end!of!November.!!
Somewhere!between!twelve!and!thirteen!million!people!died!during!this!fall!wave,!
although!official!counts!came!in!far!lower!due!to!the!massive!disorganization!caused!
by!the!flu.30!!Mortality!ranged!from!merely!higher!than!average!in!places!like!Madras!
to!absolutely!devastating!in!areas!like!the!Punjab,!which!lost!nearly!5%!of!its!
population!to!the!flu.31!!The!flu!arrived!in!September!but!by!early!December!it!began!
receding,!and!the!subsequent!winter!wave!took!far!fewer!victims.!
!
The!second!chapter!examines!the!governmental!structures!in!place!before!
the!pandemic!and!the!way!in!which!those!structures!failed!to!operate!effectively.!!
The!Indian!Civil!Service!and!the!Indian!Medical!Service!intended!to!provide!the!civil!
and!medical!support!for!the!Government!of!India,!but!by!the!advent!of!the!flu!
pandemic!the!war!had!overstretched!both!organizations,!leaving!them!illAprepared!
to!handle!a!public!health!crisis.!!Resistance!to!increasing!Indian!recruitment!in!both!
services!led!to!a!lack!of!qualified!individuals!as!British!men!left!to!serve,!depriving!!
India!of!both!doctors!and!civil!servants.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
30!Mills,!2!and!JT!Marten,!Census$of$India,$1921,!(Calcutta:!Superintendent!
Government!Printing,!1924),!13.**!
!
31!Annual$Report$of$the$Sanitary$Commissioner$of$the$Government$of$India$for$1918,*
(Calcutta:!Superintendent!Government!Printing,!1920),*57.!*
!
!
15!
Famine!further!complicated!the!response!to!the!flu!pandemic,!as!explored!in!
chapter!three.!!With!a!long!history!of!devastating!famines!in!the!past,!the!
Government!of!India!sprang!into!action!when!the!monsoons!failed!in!1918.!!
Unfortunately,!their!actions!did!little!to!assuage!the!high!price!spikes!that!followed!
and!while!the!Government!felt!the!lack!of!mass!starvation!meant!the!famine!had!
been!conquered,!the!Indian!people!felt!differently.!!The!flu!weakened!laborers,!
which!in!turn!negatively!effected!summer!agricultural!work,!which!led!to!more!
problems!as!the!fall!wave!of!the!flu!pandemic!began!and!proper!nutrition!became!
critical!just!as!prices!for!basic!necessities!rose.!!The!institutional!blindness!of!the!
British!bureaucracy!also!contributed!to!this!myopic!focus,!as!the!structures!of!
government!were!prepared!for!famine!but!not!for!an!epidemic!of!influenza.!
!
Chapter!four!explores!the!response!of!the!British!trained!medical!community.!!
The!challenges!of!the!flu!stumped!many!of!the!best!minds!the!world!over,!and!men!
used!to!using!science!and!medicine!to!save!lives!found!themselves!reduced!to!
attempting!to!prevent!its!spread.!!Ineffective!attempts!to!create!a!vaccine!the!
internal!debates!wracked!the!Indian!Medical!Service!while!Indian!people!died!by!the!
thousands,!while!articles!in!the!Indian$Medical$Gazette$!and!British$Medical$Journal!
portrayed!the!medical!community!as!banding!together!to!fight!influenza.!
!
Chapter!five!investigates!the!fallout!from!the!flu,!both!short!and!long!term.!!
Beginning!with!the!immediate!problem!of!corpse!disposal!and!moving!into!the!early!
1920s,!it!analyzes!how!the!British!and!Indians!came!to!understand!the!flu!and!its!
impact.!!The!!meager!developments!and!changes!within!the!IMS!and!British!
medicine!in!the!years!following!the!pandemic!explains!how!an!event!of!that!
!
16!
magnitude!could!create!such!little!change.!!The!flu!also!took!a!role!in!the!growing!
Indian!nationalist!movement,!even!as!it!came!to!be!overshadowed!by!far!more!
direct!and!egregious!examples!of!British!cruelty.!
!
Threading!through!all!of!these!chapters!is!an!exploration!of!how!the!media!
portrayed!the!flu.!!While!the!flu!came!to!be!subsumed!by!far!greater!conflicts!
between!the!Indian!people!and!the!British,!it!still!appeared!in!imagery!as!an!
example!of!the!breach!of!contract!between!the!government!and!its!people.!!Media!
coverage!of!the!flu!pandemic!ranged!from!optimistic!to!extremely!critical!of!the!
government.!!Popular!newspapers!like!the!Behar$Herald!and!Times$of$India!reported!
on!flu!deaths!and!progress!made!in!stemming!the!tide!of!the!pandemic,!while!also!
publishing!articles!that!offered!advice!and!medical!information.!!Technical!presses!
like!the!Indian$Medical$Gazette!and!the!Lancet,!as!well!as!the!British$Medical$Journal!
debated!the!causes!of!the!disease!as!well!as!the!need!for!a!vaccine,!but!in!the!end!
most!felt!little!more!could!have!been!done!and!prescribed!very!limited!intervention!
in!the!event!of!a!future!pandemic.!!Other!outlets,!such!as!the!Amrita$Bazar$Patrika!
criticized!the!government’s!failure!to!act!effectively.!
!
By!examining!the!exercise!of!imperial!power!in!a!public!health!crisis,!this!
project!opens!a!new!avenue!of!discussion!about!the!1918!pandemic.!!It!reveals!the!
myriad!of!ways!the!British!government!failed,!due!to!both!negligence!and!
unconquerable!foe,!and!illuminates!the!pandemic’s!role!in!spurring!nationalist!
discussion.!!Research!on!the!flu!pandemic!tends!to!focus!on!western!areas!and!
regions!such!as!India!are!only!now!beginning!to!be!investigated.!!This!work!
reintegrates!India!into!our!understanding!of!the!1918!pandemic!and!broaden!the!
!
17!
scope!of!historical!research!on!influenza.!!Within!these!pages!I!bring!new!light!to!a!
previously!understudied!historical!event!that!deserves!to!take!its!place!the!narrative!
history!of!the!British!Empire.!
!
*
*
!
18!
Chapter*One*
Death$Pays$a$Visit:$Influenza$in$India$
!
$
The!hospitals!were!choked!so!that!it!was!impossible!to!move!the!dead!quickly!
enough!to!make!room!for!the!dying;!the!streets!and!lanes!of!cities!were!littered!with!
dead!and!dying!people;!the!postal!and!telegraph!services!were!completely!
disorganised,!the!train!service!continued,!but!at!all!principal!stations,!dead!and!dying!
people!were!being!removed!from!the!trains;!the!burning!ghats!and!burial!grounds!
were!literally!swamped!with!corpses;!whilst!an!even!greater!number!awaited!
removal;!the!depleted!medical!service,!itself!sorely!stricken!by!the!epidemic,!was!
incapable!of!dealing!with!more!than!a!minute!fraction!of!the!sickness!requiring!
attention;!nearly!every!household!was!lamenting!a!death,!and!everywhere!terror!and!
confusion!reigned.32!
!
*
The!Sanitary!Commissioner!of!the!Punjab!relayed!the!above!scenes!of!panic!
and!destruction!in!his!report!on!the!destruction!wrought!by!the!1918!Influenza!
Pandemic.!!This!pandemic!killed!between!30!and!100!million!world!wide!in!one!year,!
with!at!least!seven!million!dead!in!India.33!!The!unparalleled!devastation!of!the!flu,!
with!its!origins!in!Kansas,!spanned!the!globe!from!the!spring!of!1918!to!the!winter!of!
1919.!!With!a!population!of!roughly!240!million,!India!lost!between!six!and!eighteen!
million!people,!most!in!a!few!months!in!the!fall!of!1918.34!!!!This!massive!blow!came!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
32!Preliminary$Report,$$8A9.!Norman!White!does!not!include!the!Sanitary!
Commissioner’s!name!in!his!report,!but!other!reports!filed!by!the!Sanitary!
Commissioner!give!his!name!as!LieutAColonel!W.H.C!Forster.!
!
33!Annual$Report,!57.!However,!it!is!important!to!remember!that!exact!counts!were!
very!difficult,!and!the!numbers!collected!by!the!British!Empire!were!mere!
estimations.!!The!30!to!100!million!figure!comes!from!Kent,!1.!!The!lack!of!record!
keeping!and!general!disorganization!caused!by!the!pandemic!leaves!the!exact!toll!
difficult!to!calculate.!
!
34!Preliminary$Report,!4.!!F.!Norman!White!gives!the!population!from!the!1911!
census!as!238,026,240.!!The!best!data!so!far,!calculated!by!demographers!Chandra,!
!
19!
on!the!heels!of!a!famine,!and!while!the!British!government!was!preoccupied!with!the!
First!World!War,!creating!a!tempest!of!suffering!on!the!subcontinent.!
The!flu!did!not!hit!all!residents!of!India!equally,!however,!and!the!poorest!
Indians!often!had!the!highest!death!rates.!!India!also!had!a!stark!divide!between!
urban!and!rural!fatalities!in!many!areas,!as!farAflung!towns!struggled!with!a!lack!of!
infrastructure!and!adequate!medical!staff.!!As!the!flu!marched!eastward!across!India,!
the!Indian!Medical!Service!found!itself!defeated!by!the!virulence!of!the!disease.!!
British!officials!scrambled!to!collect!data!and!submit!reports!on!their!provinces,!but!
the!general!disarray!caused!by!influenza!made!accurate!data!collection!nearly!
impossible.!
!
Influenza’s*origins*
!
Kansas!reported!the!first!incidents!of!the!Spanish!Flu,!as!it!came!to!be!called,!
in!the!spring!of!1918.35!!The!misnomer!caught!hold!when!Spain!did!not!censor!its!
newspaper!reports;!with!the!rest!of!Western!Europe!preoccupied!with!the!First!
World!War!and!unwilling!to!let!potentially!damaging!information!out,!the!first!
worldwide!awareness!of!the!flu!pandemic!came!from!Spain.36!!The!pandemic!had!
three!distinct!worldwide!waves,!starting!with!the!spring!wave,!peaking!with!the!fall!
wave,!and!concluding!with!a!wave!in!the!winter!of!1918A19.!!The!spring!and!winter!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
et.!al!puts!the!death!toll!at!13.88!million,!meaning!India!lost!5.8%!of!its!population!in!
under!a!year.!!Chandra,!861.!
!
35!Kent,!7A8.!!
!
36!For!the!purposes!of!this!dissertation,!I!will!call!it!the!1918!Influenza!Pandemic,!or!
the!1918!Pandemic!in!an!attempt!to!correct!this!misinterpretation.!
!
!
20!
versions!were!relatively!mild!compared!to!the!deadly!wave!that!occurred!in!the!fall,!
and!it!was!the!fall!wave!that!took!most!of!India’s!victims!as!well.!!A!form!of!the!H1N1!
virus,!the!flu!incubated!throughout!the!American!Midwest!during!the!spring!of!1918!
until!it!traveled!across!the!Atlantic!Ocean!via!troop!transports.!!Introduced!into!the!
trenches,!the!virus!lurked!among!soldiers!on!the!Western!Front,!tearing!through!the!
trenches!and!adding!yet!another!challenge!for!the!nations!fighting!the!First!World!
War!before!going!global!that!summer.37!!
!
Spread!through!air!droplets!and!contact!with!infected!people!and!surfaces,!an!
influenza!virus!thrives!on!a!constant!supply!of!fresh!hosts!in!which!to!replicate!itself!
within!the!human!body.!!If!a!virus!becomes!too!virulent,!it!will!kill!the!host!before!it!
has!a!chance!to!reproduce!and!infect!a!new!host;!a!version!that!deadly!would!burn!
out!before!it!had!a!chance!to!wreak!global!destruction.!!The!nature!of!trench!warfare!
required!men!who!fell!too!ill!to!fight!to!be!sent!back!to!hospitals!away!from!the!front!
lines!and!fresh!replacements!would!take!their!place.!!Thus,!the!flu!virus!had!
continuous!access!to!new!hosts,!allowing!an!incredibly!deadly!mutation!to!occur!
without!burning!out.38!!The!spring!wave!spent!several!weeks!incubating!in!the!
trenches!before!spreading!to!other!continents,!and!the!version!that!exploded!across!
the!world!in!the!fall!of!1918!was!unrivaled!in!its!deadliness.!!This!wave,!which!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
37!Byerly,!6,!and!Kent,!8A11.!!For!more!on!the!flu’s!impact!on!the!American!military!
effort!and!the!unique!relationship!between!the!flu!and!the!war,!please!see!Byerly’s!
excellent!work!on!the!pandemic!and!the!First!World!War.!
!
38!Kent,!5.!!Taubenberger!also!notes!that!the!three!waves!of!influenza!within!one!
year!are!highly!unusual!for!one!virus,!and!muses!that!“perhaps!the!surface!proteins!
of!the!virus!drifted!more!rapidly!than!other!influenza!virus!strains,!or!perhaps!the!
virus!had!an!ususally!effective!mechanism!for!evading!the!human!immune!system.”!!
73.!
!
!
21!
stretched!from!September!to!December,!killed!untold!millions.!!The!following!winter!
wave!claimed!far!fewer!victims,!likely!because!most!people!had!already!been!
exposed!to!the!virus!and!retained!some!type!of!immunity,!and!the!pandemic!burned!
out!a!little!over!a!year!after!it!began.39!
!
At!its!most!basic,!a!virus!is!a!microscopic!parasite.!!The!influenza!virus!
contains!a!single!strand!of!RNA!rather!than!the!double!stranded!helix!of!DNA!of!most!
organisms,!and!relies!on!a!host!cell!to!replicate!and!survive.!!Using!haemagglutinin!as!
a!kind!of!protein!glue,!an!influenza!virus!attaches!itself!to!a!host!cell’s!membrane!and!
injects!its!own!RNA!into!the!cell.40!!The!virus!then!reproduces!itself!by!raiding!the!
host!cell’s!material!before!being!released!into!the!host’s!body!to!attack!more!cells.!!
The!virus!replicates!this!process!over!and!over,!essentially!turning!the!host!cells!into!
their!own!personal!factory.!!Influenza!uses!waterfowl!and!pigs!as!natural!reservoirs!
and!must!undergo!a!series!of!mutations!in!order!to!make!the!jump!to!infecting!
humans.41!
!
However,!viruses!in!general!and!the!influenza!virus!in!particular!have!a!
disadvantage!when!they!replicate.!!When!DNA!replicates,!it!“unzips”!itself!and!copies!
from!one!side.!!During!this!process!with!DNA!the!other!side!acts!as!a!mirror!so!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
39!Killingray!and!Phillips,!5.**
!
40!Pete!Davies,!The$Devil’s$Flu:$The$World’s$Deadliest$Influenza$Epidemic$and$the$
Scientific$Hunt$for$the$Virus$That$Caused$it,!1st!American!ed!(New!York:!Henry!Holt!
and!Co,!2000),!75.!
!
41!Jeffrey!Taubenberger,!Institute!of!Medicine!(US)!Forum!on!Microbial!Threats,!The$
Threat$of$Pandemic$Influenza:$Are$We$Ready?$Workshop$Summary,!ed.!Stacey!L.!
Knobler!et!al.,!The!National!Academies!Collection:!Reports!Funded!by!National!
Institutes!of!Health!(Washington!(DC):!National!Academies!Press!(US),!2005),!
http://www.ncbi.nlm.nih.gov/books/NBK22156/,!70A71.!
!
!
22!
proteins!making!the!copies!can!catch!mistakes.!!Since!viruses!like!influenza!only!
contain!oneAstranded!RNA,!they!lack!this!safety!mechanism!and!are!more!prone!to!
mutations!as!proteins!make!errors!in!the!copying!process.42!!The!errors!can!be!
reproduced!over!and!over!again,!either!killing!off!the!virus,!or!in!the!case!of!the!1918!
influenza!virus,!creating!an!incredibly!deadly!mutation.!
!
The!influenza!mutation!that!arose!in!1918!focused!its!power!on!young!adults.!!
Generally,!the!influenza!virus!kills!those!at!opposite!ends!of!the!age!spectrum,!
focusing!on!the!very!young!and!the!very!old!in!addition!to!the!immunoA
compromised.!!The!1918!flu!showed!an!unusual!spike!in!victims!ages!15A45,!as!the!
virus!overwhelmed!usually!healthy!immune!systems.43!!Called!the!dreaded!W,!this!
unusual!pattern!struck!down!adults!in!their!prime!and!seemed!particularly!deadly!in!
pregnant!women.44!!People!who!contracted!the!virus!could!be!contagious!for!up!to!24!
hours!before!showing!symptoms!and!could!continue!to!spread!the!virus!for!up!to!a!
week!after!symptoms!appeared.45!!The!contagious!period—particularly!the!first!day!
before!victims!knew!they!were!infected—helped!spread!the!disease!very!quickly.!!
Symptoms!included!the!normal!fever!and!chills,!but!also!some!terrifying!new!
additions,!such!as!coughing!up!blood.!!Many!of!the!most!severely!ill!also!showed!
signs!of!heliotrope!cyanosis,!which!happens!when!blood!does!not!receive!enough!
oxygen.!!This!deprivation!turns!the!blood!purplish!black,!which!can!give!a!sufferer’s!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
42!Davies,!78.!
!
43!Summary!and!Assessment,!The$Threat$of$Pandemic$Influenza,!9.!
!
44!Kent,!2.!
!
45!Kent,!2.!
!
!
23!
skin!a!disconcerting!blue!tint.!46!!!According!two!British!doctors!treating!British!
troops!in!Bombay,!only!5.6%!of!their!patients!developed!bronchoApnuemonia!but!
mortality!for!those!cases!was!34%.47!
Once!a!victim!had!been!exposed!to!the!virus,!the!body’s!natural!defenses!
would!start!attacking!it.!!The!immune!system!would!attempt!to!destroy!the!virus!by!
any!means!possible,!and!within!hours!the!sufferer’s!body!had!become!the!site!of!an!
allAout!war!between!virus!replication!and!the!immune!system.!!The!1918!flu!forced!a!
host’s!immune!system!to!initiate!a!major!response!to!fight!off!the!foreign!invader,!
releasing!cytokines!to!try!and!obliterate!the!invading!virus.48!!These!toxins!destroyed!
lung!tissue!and!function,!and!the!inability!to!breathe!led!to!heliotrope!cyanosis,!as!
blood!cells!became!deprived!of!oxygen!and!!influenza!victims!turned!blue!and!slowly!
suffocated.49!!Symptoms!began!incredibly!quickly,!leading!to!overwhelmed!hospitals!
and!medical!staff!the!world!over!as!victims!sought!treatment!and!died!in!record!time.!
!
Death!from!influenza!could!occur!in!as!little!as!12!hours!after!the!appearance!
of!symptoms,!and!possibly!sooner.50!!The!formidable!speed!of!the!deadly!virus!
created!a!sense!of!panic!as!otherwise!healthy!individuals!dropped!dead!with!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
46!Kent,!2.!
!
47!Captain!R.N.O.!Moynan!and!Assistant!Surgeon!L.D.!C.!Meneses,!“The!Influenza!
Pandemic,”!!Indian$Medical$Gazette,!Vol!LIV,!(January!1919),!16.!
!
48!Kent,!2.!!!
!
49!Kent,!2.!
!
50!Kent,!2,!and!Duncan,!10.!!Duncan!relates!several!terrifying!stories!from!around!the!
world,!from!a!train!in!South!Africa!that!had!to!keep!stopping!to!drop!off!the!dead!to!
a!woman!dying!in!45!minutes!on!the!New!York!subway.!
!
!
24!
seemingly!little!warning.!!The!flu’s!focus!on!adults!further!magnified!the!trauma!of!
the!pandemic,!as!those!who!normally!would!survive!the!flu!with!ease!fell!victim!in!
large!numbers.!!“A!study!of!the!figures…received!indicates!that!influenza!as!
experienced!in!India!was!especially!fatal!between!the!ages!of!10!and!40,”!noted!
White,!the!Sanitary!Commissioner.51!!Some!have!hypothesized!that!the!immune!
response!in!healthy!young!adults!triggered!by!the!influenza!virus!put!them!at!
significant!disadvantage.52!!Their!typically!stronger!immune!systems!seem!to!have!
responded!to!the!virus!by!destroying!their!own!lung!tissue!in!the!process.53!!
Survivors!also!reported!being!in!a!weakened!state!of!extreme!fatigue!for!weeks!
following!the!initial!bout!of!infection,!delaying!full!recovery!for!an!extended!period.54!!
The!virus’s!symptoms!appeared!with!striking!regularity!throughout!the!world,!and!
leading!virologist!Jeffrey!Taubenberger!estimates!that!as!much!as!oneAthird!of!the!
world’s!population!was!infected.55!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
51!Preliminary$Report,!5.!
!
52!Michael!Worobey,!GuanAZhu!Han,!and!Andrew!Rambaut,!“Genesis!and!
Pathogenesis!of!the!1918!Pandemic!H1N1!Influenza!A!Virus,”!Proceedings$of$the$
National$Academy$of$Sciences!111,!no.!22!(June!3,!2014):!8107–12,!
doi:10.1073/pnas.1324197111,!and!Carl!Zimmer,!“In!1918!Flu!Pandemic,!Timing!
Was!a!Killer,”!The$New$York$Times,!April!30,!2014,!
http://www.nytimes.com/2014/04/30/science/inA1918AfluApandemicAtimingAwasA
aAkiller.html.!!This!hypothesis!has!not!been!fully!embraced!by!the!scientific!
community,!however,!and!some!believe!that!adults!older!than!25!were!more!likely!
to!die!from!the!flu!because!they!had!not!been!exposed!to!a!similar!virus!at!an!early!
age,!which!the!generations!younger!than!25!had!experienced!in!the!early!1900s.!!!
!
53!Kent,!2A3.!
!
54!Kent,!7.!
!
55!Taubenberger,!72.!
!
!
25!
Reports!on!the!influenza!pandemic!describe!similar!cases!no!matter!the!
region,!from!Philadelphia!to!Bombay.!!A!member!of!the!Indian!Medical!Service!
stationed!in!the!NorthAWest!Frontier!Province,!after!noting!that!the!incubation!
period!could!be!as!short!as!“a!few!hours”!or!as!long!as!two!days,!described!the!
progression!of!influenza!thus,!!
!
The!disease!begins!suddenly!with!severe!frontal!headache,!pains!at!the!back!
of!the!eyes!and!muscular!aching!of!the!back,!bones!and!thighs.!!Rigors!are!not!
present.!!Tongue!is!tremulous,!furred!and!indented.!!Fauces!and!tonsils!are!
red!and!breath!is!offensive.!!Coryza!is!often!present.!!Pulse!is!rapid!and!weak.!!
The!patient!is!very!ill,!restless,!sleepless,!and!prostrated.!!The!temperature!
rises!rapidly!to!102!or!more!and!falls!to!normal!in!1A3!days.!!A!troublesome!
cough!is!often!present.!!Convalescence!is!delayed!by!depression!and!
prostration.56!
He!went!on!to!note!that!rest!and!nutritious!food!were!the!universal!treatments!for!
influenza,!and!that!no!drugs!were!found!to!be!efficacious!in!treating!the!disease.!!!!
Writing!in!The$Lancet,!William!Collier,!a!doctor!from!Oxford,!described!similar!
symptoms!in!his!patients,!focusing!on!the!high!temperature!and!bronchial!
complications!presented!by!an!influenza!patient.57!!The!similarity!of!the!virus’!
progression!in!England!and!the!Indian!subcontinent!indicated!to!doctors!that!the!
virus!had!reached!global!pandemic!status.!!
Rumors!ran!rampant!in!India!about!the!source!of!the!flu!as!well!around!the!
globe.!!On!October!24th,!at!the!height!of!the!pandemic,!The$Empire$posited!that!
Germany!created!the!flu!as!biological!warfare!and!wrote,!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
56!Major!H.!Crossle,!Northwest$Frontier$Influenza$Report,*1919,!British!Library!India!
Office!Records![hereafter!IOR],!P/10588,!10.!!British!Library,!London,!United!
Kingdom.!!
!
57!Kent,!34.!!
!!
!
26!
By!the!last!mail!I!received!a!letter!from!a!friend!who!is!a!doctor!in!which!
it!was!stated!that!German!efforts!were!responsible!for!the!new!form!of!
influenza!that!is!now!scouring!the!world.!!…!!They!were!also!working!on!
a!culture!to!be!used!as!an!antidote,!but!orders!from!Berlin!caused!the!
doctors!to!hurry!as!it!was!considered!necessary!to!infect!the!American!
seaports!and!thereby!hamper!the!shipment!of!troops!and!munitions!
from!the!United!States.!!By!some!mischance!due!to!quarrelling!among!
the!bacteriologists!the!disease!was!prematurely!conveyed!to!Madrid!and!
the!Spanish!authorities!deciphered!some!cabled!instructions!that!had!
come!from!Berlin!and!one!of!the!Huns!exposed!the!plot.58!
!
Whispers!that!the!Germans!created!influenza!in!order!to!weaken!their!opponents!
circled!the!globe!in!1918,!so!India!was!not!alone!in!this!rumor.59!!This!letter!
demonstrated!the!extent!to!which!the!flu!seemed!unknowable!and!uncontrollable,!
and!adds!to!the!sense!of!war!paranoia.!!The!flu!became!more!than!just!a!disease,!
transformed!into!a!weapon!by!the!war.!
!
The!virus!struck!such!fear!into!people!that!some!felt!it!must!could!not!
possibly!be!influenza.!!The!Behar$Herald!published!their!doubts!in!mid!November,!
writing,!!!
The!present!Influenza!pandemic!has!brought!forth!an!immense!amount!
of!literature!and!medical!men!all!over!the!world!are!coming!forward!
each!with!his!particular!theories,!preventives!(sic)!and!prescription.!!
Some!authorities!are!of!opinion!that!the!disease!is!not!influenza!but!is!
an!entirely!new!one,!and!attribute!it!to!some!bacilli!with!an!
unpronounceable!name.60!
!
The!dismissive!tone!of!“some!bacilli!with!an!unpronounceable!name”!indicated!not!
only!confusion,!but!exhaustion!as!well.!!The!nature!of!the!disease!had!become!so!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
58!“War!Fever:!Another!German!Atrocity”,!The$Empire,!October!24,!1918,!5.!!
!
59!Crosby,!216.!
!
60!“When!Doctor’s!Differ!What!is!the!layman!to!do?,”!Behard$Herald,$November!16,!
1918.!!!
!
!
27!
overwhelming!that!even!naming!it!properly!had!become!too!great!of!a!burden.!!!
After!citing!a!doctor!who!suspected!the!disease!may!have!been!related!to!malaria,!
the!Herald$observed,!“In!this!medley!of!experts,!one!is!apt!to!get!confused!and!
lost.”61!!The!flu’s!unknowable!nature!proved!difficult!to!comprehend!for!the!public!
as!well!as!the!medical!community.!
!
Influenza*in*India*
The!flu’s!onslaught!in!India!began!in!late!spring,!arriving!on!a!ship!that!docked!
in!Bombay!on!May!29th.!!Within!48!hours!the!ship!reported!the!first!cases!of!
influenza,!and!while!the!sailors!may!have!caught!the!infection!while!portside,!the!
similarity!of!the!virus!in!India!and!elsewhere!around!the!world!indicated!the!virus!
did!not!originate!in!India.62!!That!summer!wave!caused!its!fair!share!of!problems!but!
it!did!not!have!the!overwhelming!death!toll!of!the!fall!wave,!which!would!eventually!
claim!the!lives!of!at!least!2%!of!the!population!of!British!India.63!!The!virus!travelled!
through!both!shipping!routes!and!railways,!with!postal!workers!often!singled!out!as!
the!source!of!infection!when!the!flu!arrived!in!previously!untouched!locations.!!The!
infrastructure!of!the!colonial!state!became!a!symbol!of!spreading!infection!
throughout!India.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
61!“When!Doctor’s!Differ.”!!!
!
62!Bombay$Influenza$Report$1919,!IOR:P/10588,!5.!British!Library,!London,!United!
Kingdom.!*The!report!also!notes!that!a!second!ship!arriving!in!Karachi!on!June!20th!
may!have!introduced!this!strain,!but!as!Bombay!seems!to!be!the!locus!of!infection!
we!will!say!this!was!the!first!arrival.!
!
63!Preliminary$Report,!5.!!Again,!this!is!a!lower!bound.!!At!least!2%!of!the!population!
died,!and!in!several!areas!the!percentage!was!likely!higher.!
!
!
28!
The!second!wave!likewise!began!in!Bombay!in!September!before!spreading!
throughout!the!subcontinent,!with!the!highest!death!tolls!concentrated!in!the!
northern!and!western!regions,!and!Madras!and!Calcutta!escaping!relatively!lightly.!!
This!is!not!to!say!that!those!areas!did!not!suffer,!but!simply!that!compared!to!the!
massive!death!tolls!of!areas!like!the!Punjab,!they!fared!comparatively!better.!!This!
lethal!version!peaked!first!in!Bombay!on!October!6th,!and!reached!its!zenith!in!the!
Bengal!Presidency!in!December.64!
!
The!fall!wave!of!the!pandemic!moved!across!the!South!Asian!peninsula!from!
West!to!East!and!South!to!North!and!claimed!millions!of!lives.!!The!exact!number!of!
victims!will!never!be!known,!with!estimates!ranging!from!the!official!tally!of!seven!
million—acknowledged!as!most!likely!an!undercount!by!contemporaries—to!Davis’!
upper!bound!of!18.5!million.65!!More!recently,!a!group!of!demographers!examined!
Indian!census!data!from!1891A1941!and!determined!that!the!flu!pandemic!led!to!
13.88!million!in!“lost!population.”66!!However,!this!flu!had!a!propensity!for!killing!
pregnant!women,!and!therefore!13.88!may!be!a!slight!overestimation!as!it!accounts!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
64!White,!7,!11.!
!
65!Kingsley!Davis,!The$Population$of$India$and$Pakistan!(Russell!&!Russell,!1968),!
237.!
!
66!!862.*!Chandra,!et.!al!arrive!at!their!numbers!through!careful!calculations,!but!the!
uneven!reporting!within!India!leaves!much!open!to!interpretation.!!The!nearly!14!
million!in!lost!population,!they!argue,!may!not!represent!14!million!deaths!but!
rather!14!million!less!people!in!the!1921!census!than!would!be!expected!based!on!
the!numbers!present!in!the!1911!census.!!However,!given!the!flu’s!high!death!toll!
among!pregnant!women!and!young!adults—the!group!of!the!population!most!likely!
to!reproduce—some!of!the!“missing”!population!would!be!children!that!were!never!
born,!either!because!they!died!in!utero!along!with!their!pregnant!mother!or!their!
parents!died!before!reproducing.!
!
!
29!
for!those!who!died!as!well!as!fetuses!that!died!in!utero.!!The!flu!did!not!attack!
uniformly!throughout!India!either,!with!the!Punjab!and!United!Provinces!suffering!
very!high!death!tolls!while!places!like!Madras!and!Calcutta!escaped!with!
comparatively!smaller!death!tolls.!!I.D.!Mills’!1986!investigation!of!the!pandemic,!
based!largely!on!India’s!1921!census,!gives!an!estimate!of!12A13!million!dead!in!three!
to!four!months!for!India!as!a!whole,!and!declares!“India!thus!represents!possibly!the!
hardest!hit!country!by!the!most!virulent!outbreak!of!influenza!in!recorded!history.”67
!
The!official!death!toll,!as!reported!by!F.!Norman!White!in!the!Annual$Sanitary$
Report$for$1918,!was!7,089,694.!!The!report!qualified!that!these!numbers!are!given!
“without!any!claim!to!accuracy.”68!!!The!1921!Census!added!another!1.3!million!to!the!
death!toll,!and!then!noted,!“Even!this,!however,!must!be!a!substantial!underestimate!
since,!owing!to!the!complete!breakdown!of!the!reporting!staff,!the!registration!of!
vital!statistics!was!in!many!cases!suspended!during!the!progress!of!the!epidemic!in!
1918.”69!!In!a!preliminary!report!on!the!pandemic,!White!had!given!a!death!toll!of!
4,899,725,!but!had!little!confidence!in!those!numbers,!given!the!tight!turnaround!
time!in!reporting!on!the!pandemic.70!!!Despite!their!inaccuracy!these!numbers!must!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
67!Mills,!2.!
!
68!Annual$Report,*56A57.*!
!
69!Census$of$India,$1921,!13.!This!extra!1.3!million!comes!from!deaths!recorded!in!
1919,!many!of!which!were!not!counted!in!the!original!reports.!!Still,!even!8.5!million!
was!a!very!low!estimate.!
!
70!Preliminary$Report,!4.!!Indeed,!both!the!Preliminary$Report$on$the$Influenza$
Pandemic!and!the!Annual$Sanitary$Report!are!full!of!qualifications,!estimates,!and!
out!right!shoulder!shrugging,!as!reports!were!incomplete,!late,!or!never!filed!at!all.!
!
!
30!
be!considered,!as!they!provided!the!lens!through!which!the!British!official!mind!saw!
the!pandemic.!
!
The!recording!of!influenza!deaths!was!haphazard!throughout!the!British!
Indian!states.!!High!rates!of!illness!within!the!British!government,!coupled!with!
rapidly!rising!death!tolls!and!Indian!attitudes!towards!reporting!deaths!to!the!British!
government!led!to!a!severe!underestimation!of!deaths.!!White!detailed!scenes!of!
devastation!and!chaos!throughout!urban!areas,!while!also!noting!that!many!rural!
areas!suffered!more!than!urban!ones.71!!Given!that!collecting!death!statistics!was!
spotty!to!begin!with—the!1917!Annual$Sanitary!Report!for!Bihar!and!Orissa,!a!year!
that!did!not!have!the!added!stress!of!a!pandemic,!discussed!new!programs!created!to!
improve!a!“defective”!registration!process—the!official!flu!numbers!as!provided!to!
the!British!government!are!undoubtedly!far!too!low.72!!Additionally,!the!flu!did!not!
hit!all!provinces!equally,!with!the!west!and!north!bearing!the!brunt!of!the!disaster.!!
The!Annual$Sanitary$Report!describes!the!split!in!mortality!rates!thusly:!“SouthAeast!
and!NorthAeast!with!a!death!rate!under!20,!and!the!other!West,!Central!and!NorthA
west,!with!a!death!rate!of!40!or!over.!In!the!first!group!are!included!Madras,!Bengal,!
Bihar!and!Orissa,!Assam!and!Burma;!and!in!the!second!group!are!Bombay,!Central!
Provinces,!United!Provinces,!Delhi,!Punjab,!NorthAWest!Frontier!Province,!and!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
71!Preliminary$Report,!1.!
!
72!Bihar$and$Orissa$Annual$Report$of$1917,*IOR:V!24,!4A8.!!British!Library,!London,!
United!Kingdom.!!!
!
!
31!
AjmerAMerwara.”73!!!This!chapter!will!explore!all!provinces!that!filed!a!report!on!the!
flu,!consisting!of!the!above!twelve!provinces!and!presidencies,!as!well!as!Coorg.!!The!
provinces!did!not!experience!the!flu!uniformly,!and!factors!such!as!wealth,!
urbanization,!and!famine!all!acted!as!variables!contributing!the!death!toll.!
!
Contemporary!observers!of!the!pandemic!like!Major!White!acknowledged!
that!the!utter!chaos!of!the!pandemic!created!an!added!obstacle!to!gathering!accurate!
data!on!morbidity!and!mortality,!in!addition!to!an!element!of!uncertainty!over!
proper!procedure.!F.!Norman!White,!Sanitary!Commissioner,!compiled!statistics!from!
any!available!source!and!summarized!them!in!A$Preliminary$Report$on$the$Influenza$
Pandemic$of$1918$in$India!for!the!Government!of!India.74!!Later!a!more!detailed!
summary!of!the!health!of!the!entire!subcontinent!was!published!in!the!Annual$
Report.75!!The!Annual$Report!was!not!published!until!1920,!and!the!extra!time!
allowed!provinces!to!report!more!complete!data!than!White!had!in!his!Preliminary$
Report,!although!the!Annual$Report!was!less!concerned!with!the!pandemic!
specifically.!!The!British!government!in!1918!did!not!consider!the!flu!a!reportable!
disease,!and!as!a!result!doctors!categorized!deaths!under!a!number!of!different!
headings,!most!often!fever!but!also!respiratory!disease.76!!One!report!estimated!that!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
73!Annual$Report,*57.*The!numbers!given!here!are!out!of!1,000,!giving!the!regions!
that!escaped!relatively!lightly!death!rates!of!2%!or!under,!and!harder!hit!areas!death!
rates!of!over!4%.!!*
!
74!Preliminary$Report,$1.!*
*
75!The!Preliminary$Report!was!published!in!1919!and!only!contained!deaths!through!
the!end!of!November!while!the!Annual$Report!was!published!in!1920!and!as!such!
contained!data!through!the!entirety!of!the!pandemic.!!*
!
76!Ramanna,!89.!
!
32!
some!50A80%!of!India’s!population!suffered!from!the!flu!throughout!its!duration!in!
India.77!!With!a!population!of!roughly!240!million,!that!means!between!120!and!192!
million!people!fell!ill,!and!case!mortality!hovered!at!6%!to!10%,!far!higher!than!the!
flu’s!typical!.1%!mortality!rate.78!
!
Along!with!uncertain!record!keeping,!British!doctors!reported!being!
completed!overwhelmed.!!Scenes!of!mayhem!plagued!India,!as!hundreds!died!each!
day!and!doctors!found!themselves!with!little!ammunition!in!the!fight.!!As!we!will!see!
in!chapter!four,!western!medicine!was!almost!useless!against!influenza,!although!
nursing!care!did!help!some!survive.!!The!Punjab!saw!horrific!death!rates,!and!as!
quoted!earlier!in!the!chapter,!officials!found!themselves!faced!with!too!many!dead!to!
handle!effectively,!and!“nearly!every!household!was!lamenting!a!death,!and!
everywhere!terror!and!confusion!reigned.”79!!The!havoc!wrought!by!the!flu!
overwhelmed!medical!services!around!the!world.!!In!Britain,!“Nurses!and!doctors!
could!not!handle!the!unprecedented!numbers!of!cases;!undertakers!could!not!fill!the!
orders!for!caskets!that!came!streaming!in!nor!could!gravediggers!handle!the!volume!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
77!“Mr.!Kamini!Kumar!Chanda!to!the!Indian!Legislative!Council!on!the!Financial!
Statement!1919A1920,”!March!7,!1919,!Proceedings$of$the$Indian$Legislative$Council$
Assembled$for$the$Purpose$of$Making$Laws$and$Regulations,$from$April$1918$to$March$
1919,$Vol$LVII,!(Calcutta:!Superintendent!Government!Printing,!1919),![hereafter!
ILC]!728.!*The!figures!used!here!are!attributed!to!White’s!report.!
!
78!Kent,!11.!!European!death!rates!were!between!1A2%.!!The!numbers!above!for!
India!are!rough!estimates!based!on!population!and!morbidity!and!mortality!
percentages.!
!
79!Preliminary$Report,!9.!
!
!
33!
requesting!their!services.”80!!While!British!India!did!have!an!established!British!
medical!corps!in!the!form!of!the!Indian!Medical!Service!(IMS),!India!did!not!have!
anywhere!near!enough!medical!personnel—either!British!trained!or!Indian!
practitioners—to!withstand!the!onslaught!of!flu!patients.!
!
The*Death*Tolls*Themselves!
As!the!flu!tore!through!Bombay!from!midASeptember!and!throughout!the!
remainder!of!the!fall,!an!average!of!326!people!died!each!day!of!influenza!in!the!City!
of!Bombay!alone.81!!The!flu!hit!its!peak!in!Bombay!on!October!6,!1918,!when!a!
devastating!768!deaths!recorded!under!the!categories!influenza,!respiratory!
diseases,!and!ague!or!remittent!fever.82!!The!average!death!rate!for!the!Bombay!was!
54.9!per!thousand,!and!the!Annual!Sanitary!Report!recorded!1,!059,497!souls!snuffed!
out!by!the!pandemic,!with!most!districts!reporting!40%!or!more!of!those!deaths!
being!adults!15A40.83!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
80!Kent,!4.!
!
81!Preliminary$Report,!8.!First,!a!note!about!the!accuracy!of!these!numbers.!!All!the!
numbers!reproduced!in!this!section!(unless!otherwise!noted)!are!directly!from!
reports!filed!by!contemporaries.!!As!such,!they!can!only!be!used!as!a!lower!bound!on!
mortality!during!the!flu,!as!sanitary!commisioners!repeatedly!acknowledge!their!
difficulties!in!!tracking!accurate!death!tolls.!!I!am!using!these!numbers!because!my!
purpose!is!to!create!an!accurate!reproduction!of!how!contemporaries!understood!
the!flu,!and!also!because!I!was!told!there!would!be!no!math.!!(They!lied).!
!
82!Preliminary$Report,!!3!The!report!indicates!that!all!these!deaths!were!from!
influenza.!
!
83!Annual$Report,!57!and!Bombay$Report,!6.!!
!
!
34!
However,!not!every!resident!of!Bombay!was!at!equal!risk!of!death,!due!to!a!
variety!of!factors.!!The!death!rate!for!Europeans!in!Bombay!hovered!around!8.3!per!
thousand!while!low!caste!Hindus!died!at!the!astonishing!rate!of!61.6!per!thousand,!
nearly!seven!and!a!half!times!that!of!Europeans.!!This!means!while!fewer!than!1%!of!
Europeans!in!Bombay!died,!some!Indian!populations!saw!death!rates!of!over!6%.84!!
Europeans!fared!best!throughout!the!pandemic,!likely!because!they!could!afford!
rising!food!prices—driven!by!the!war!and!failed!monsoons—and!because!they!could!
afford!nursing!care,!which!could!be!the!only!difference!between!life!and!death.85!!In!
addition,!the!more!spacious!European!enclaves!could!control!their!exposure!to!the!
flu!and!had!access!to!better!medical!care!than!poor,!dense!urban!areas.!Bombay!
demonstrated!the!striking!difference!in!mortality!rates!between!the!poor!and!the!
wealthy,!as!well!as!the!large!gap!between!classes!and!castes,!as!Europeans!faced!far!
lower!death!tolls!than!low!caste!Hindus.!
The$Hindu!reported!that!293!people!died!in!Bombay!on!September!19th,!
1918,!but!reassured!readers!that!usually!epidemics!like!the!current!one!only!last!a!
little!more!than!a!week,!claiming,!“The!worst!is!now!reached.”86!!Even!in!the!first!few!
weeks!of!the!fall!wave!the!news!media!had!zeroed!in!on!the!class!differences!in!the!
flu’s!victims,!noting,!“The!victims!are!mostly!people!of!the!poorer!classes!and!the!
majority!are!children.!!Nakedness!and!neglect!lead!to!pneumonia!and!it!is!this!that!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
84!!Preliminary$Report,!8.!!
!
85!Please!see!chapters!two!and!three!for!more!on!the!war!and!famine!and!how!these!
events!complicated!the!Indian!experience!with!the!flu.!
!
86!!“Influenza!in!Bombay:!a!Further!Outbreak,”!The$Hindu,!September!20,!1918,!13.!!!
!
!
35!
kills.”87!!While!eventually!the!victims!would!be!mostly!young!adults!and!not!
children,!the!article!implied!that!with!proper!nutrition!and!care,!everyone!outside!
the!poorest!classes!could!survive!the!pandemic!easily.!!!
!
Due!to!the!sudden!nature!of!the!pandemic,!commissioners!varied!in!how!they!
answered!questions!required!on!the!forms.!!In!Bombay,!Lieutenant!Colonel!F.H.S.!
Hutchinson,!Sanitary!Commissioner,!chose!to!emphasize!excess!mortality!in!his!
tables.88!!In!the!Bombay!Presidency,!excess!mortality!in!the!nonpandemic!months!
ranges!from!a!high!of!9,952!in!April!of!1918!to!a!low!of!3,211!in!July!in!the!midst!of!
the!first!wave!of!influenza.!!That!number!spiked!to!an!astonishing!53,065!in!
September.!!This!thirteenAfold!increase!merely!shows!the!start!of!the!deadly!wave,!
however,!as!in!October!excess!mortality!in!the!Bombay!Presidency!reached!
486,637.89!!A!nineAfold!increase!from!September,!October!saw!over!150!times!as!
many!deaths!as!July.90!!Even!these!numbers!are!incomplete,!as!several!areas!did!not!
return!numbers!to!Hutchinson—either!because!they!had!not!compiled!the!numbers!
yet,!or!more!likely,!because!the!level!of!devastation!was!so!immense!and!illness!rates!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
87!Influenza!in!Bombay.”!!
!
88!For!the!non!demographers!among!us!(yours!truly!included):!Excess!mortality!
involved!calculating!the!average!number!of!deaths!for!the!previous!five!years,!then!
subtracting!that!average!from!the!actual!mortality!inflicted!by!the!flu.!!The!resulting!
number!of!“excess!deaths”!could!then!be!attributed!to!the!influenza!pandemic.!!Since!
India!did!not!have!any!other!major!outbreaks!of!diseases!during!these!months,!these!
numbers!are!relatively!reliable!for!the!purposes!of!this!section.!
!
89!Bombay$Report,!21.!!
!
90!Bombay$Report,!21.!!
!
!
36!
among!British!officers!so!high!they!simply!had!no!idea!where!to!start.91!!In!“The!
Bombay!Experience,”!Mridula!Ramanna!provides!an!inAdepth!look!at!Bombay!during!
the!influenza!pandemic,!and!notes!that!collaboration!between!official!government!
relief!efforts!and!private!volunteer!organizations!helped!stem!some!of!the!death!toll,!
but!ultimately!argues,!“the!epidemic!was!seen!as!one!more!in!the!continual!stream!of!
epidemics!that!took!more!Indian!lives!than!British.”92!!Bombay’s!experience!provides!
a!glimpse!into!just!how!quickly!the!death!tolls!rose!and!the!government’s!limited!
attempts!to!stem!the!flood.!
The!Times$reported!a!decrease!in!death!rates!in!Bombay!on!October!12,!
1918,!opening!with!“The!hope!expressed!by!Dr.!Turner!that!the!epidemic!will!show!
signs!of!subsidence!this!week!is!being!realised.”93!!The!article!confidently!noted,!“If!
this!decline!continues!for!a!few!days!more,!a!!return!to!the!normal!times!in!regard!to!
mortality!may!be!anticipated!in!a!fortnight!or!so.!!Though!attacks!and!deaths!are!
lower!during!this!week!the!number!of!absentees!at!the!cotton!mills!continues!to!be!
very!large.”94!!It!then!detailed!the!relief!efforts!and!extent!to!which!volunteers!
distributed!food,!medicine,!and!blankets.!!It!also!emphasized!the!Indian!
community’s!contributions,!as!neither!doctors!nor!vaidyas!charged!for!medicine.95!!
The!article!did!not!go!so!far!as!to!attribute!the!downturn!in!death!tolls!to!these!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
91!Bombay$Report,$21.!
!
92!Ramanna,!87.!
!
93!“Influenza!Epidemic:!Declining!Death!Rate,”!Times$of$India,!October!12,!1918.!!!
!
94!“Influenza!Epidemic:!Declining!Death!Rate.”!!
!
95!“Influenza!Epidemic:!Declining!Death!Rate.”!!
!
!
37!
efforts,!but!took!a!strikingly!different!tone!roughly!one!week!after!the!worst!had!hit!
Bombay.!!The!pandemic!had!not!yet!hit!its!peak!elsewhere!but!for!the!moment,!
Bombay!could!breathe!a!little!easier!as!the!medical!community!seemingly!took!the!
reins.!
In!November,!the!Times!reported!an!even!steeper!decline!in!deaths!in!
Bombay,!noting!that!while!102!people!had!died!in!the!previous!day,!the!year!before!
saw!85!deaths!and!thus!the!death!rates!were!finally!approaching!normal.96!!Work!
absenteeism!had!gone!down!as!well,!and!“all!evidence!points!to!the!fact!that!the!
disease!is!now!under!control.”97!!The!word!“control”!implied!the!doctors!and!
medical!community!had!managed!influenza!even!as!evidence!proved!otherwise.!!
!
From!Bombay!the!influenza!virus!traveled!north!to!the!Punjab,!F.!Norman!
White’s!Preliminary$Report!reported!816,317!dead!in!the!Punjab,!out!of!a!population!
of!19.3!million!as!recorded!in!the!1911!census.98!!Unlike!some!of!the!other!provinces!
in!India,!this!estimation!hews!fairly!close!to!the!later!Annual$Report’s!official!tally!of!!
898,497,!or!45.4!per!thousand.99*!WHC!Forster,!the!Sanitary!Commissioner!of!the!
Punjab,!reported!that!the!milder!first!wave!hit!Europeans!in!the!Hill!Stations!
comparatively!hard,!but!noted,!“In!October!the!character!of!the!disease!changed!
completely,!and!the!Punjab!began!to!experience!the!worst!epidemic!in!its!history,!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
96!“Influenza!Epidemic:!Declining!Mortality,”!November!12!1918.!*Seventeen!excess!
deaths!seems!almost!trifling!compared!to!the!hundreds!upon!hundreds!of!excess!
deaths!every!day!for!weeks!at!a!time.!
!
97!“Influenza!Epidemic:!Declining!Mortality,”!November!12!1918.!!!
!
98!Preliminary$Report,!9.**!
!
99!Annual$Report,!57.!
!
!
38!
and!one!which,!with!almost!diabolical!malignancy,!selected!young!adults!for!its!
victims.”100!!Widespread!by!the!beginning!of!October,!the!disease!reached!its!peak!
throughout!the!Punjab!by!October!28th,!with!the!incidents!and!mortality!declining!
sharply!in!November.101!!Much!like!in!Bombay,!the!report!from!the!Punjab!noted!that!
European!officers!and!their!families!faced!“trivial”!mortality,!while!the!virus!
devastated!poorer!classes,!where!mortality!ranged!from!50%!and!above.!102!!!
Forster!observed!that!the!infection!spread!throughout!the!Punjab!via!
returning!military!personnel!and!the!post!office!although!Indian!people!generally!
attributed!the!spread!of!the!flu!solely!to!the!post!office,!both!agents!as!well!as!the!
mail!itself.103!!While!the!Sanitary!Commissioner!dismisses!the!notion!that!the!flu!
travelled!through!post!office!parcels,!!the!Indian!people!did!see!this!symbol!of!the!
British!Government!as!integral!to!the!spread!of!the!disease.104!!Even!within!the!early!
days!of!the!pandemic!the!Indian!people!made!a!link!between!the!transmission!of!the!
disease!and!the!presence!of!the!British!government.!!!
Postal!agents!most!likely!did!act!as!vectors!for!the!disease,!as!their!routes!took!
them!into!close!contact!with!a!multitude!of!people!and!the!Sanitary!Commissioner!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
100 !Punjab$Influenza$Report$1919,!IOR:P/10588,!1.!British!Library,!London,!United!
Kingdom.!!!
$
101 $Punjab$Report,*2.!*!
!
102 !Punjab$Report,$5.!*Case!mortality!indicates!the!number!of!deaths!per!infection,!so!
in!this!case,!one!out!of!every!two!poor!Indians!in!the!Punjab!who!contracted!
influenza!succumbed!to!the!disease.!!
!
103 !Punjab$Report,$3.!*
!
104 !Punjab$Report,$3.!!
!
!
39!
recommended!they!be!inspected!regularly!in!the!event!of!another!epidemic!to!
prevent!transmission.105!!!If!the!Annual$Report’s!numbers!were!correct,!the!Punjab!
lost!4.7%!of!it’s!population!in!under!12!weeks,!which!even!as!a!lower!bound,!staggers!
the!imagination,!with!the!Punjab$Report’s!description!of!bodies!littering!the!roads!
and!hospitals!overflowing!with!patients.106!!The!considerable!suffering!left!very!few!
households!untouched.!
!
Separated!from!the!Punjab!by!the!Indus!River,!the!NorthAWest!Frontier!
Province!was!the!next!area!stalked!by!influenza’s!deadly!footsteps.!!In!a!report!filed!
in!February!of!1919,!Major!H.!Crossle,!Chief!Medical!Officer!of!the!NorthAWest!
Frontier!Province,!warned!that!his!numbers!“must!be!received!with!caution!as!their!
accuracy!is!doubtful.!!While!the!mortality!statistics!may!be!taken!as!reasonably!
accurate,!there!is!little!doubt!that!far!more!died!than!the!numbers!record.!!It!is!
probable!that!half!to!twoAthirds!of!the!population!were!affected.”107!!The!second!
wave!made!its!appearance!in!Hazara!at!the!beginning!of!October,!and!lasted!until!
December!7th!in!Peshawar.108!!He!observed!that!towns!seemed!to!spread!the!disease!
incredibly!rapidly,!attributing!this!to!infection!spreading!through!human!contact!or!
“infected!dust.”109!!!Thus!the!NorthAWest!Frontier!province!suggests!a!divide!between!
urban!and!rural!experiences!with!the!flu.!!Crossle!also!noted!a!case!reported!by!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
105 !Punjab$Report,$6.!*!
!
106 !Punjab$Report,!1.!!
!
107 !Northwest$Frontier$Report,!3.!!
!
108 !Northwest$Frontier$Report,!2.!!!
!
109 !Northwest$Frontier$Report,!2.!*
!
!
40!
Civil!Surgeon!of!Kohat,!who!reports!on!two!comparatively!similar!towns!in!terms!of!
size!but!different!in!terms!of!their!distance!from!transportation!routes.!!Lachi!had!a!
population!of!4,203!with!most!of!its!adult!population!in!service!and!located!near!the!
center!of!traffic,!had!a!death!rate!of!47.66!per!thousand.!!In!comparison,!Teri,!with!a!
population!of!3,363!and!very!little!traffic—and!very!few!citizens!in!serviceAAhad!a!
rate!of!81.3!per!thousand.!!However,!Crossle!did!not!hazard!a!guess!as!to!why!Teri!
was!hit!so!hard,!although!one!may!surmise!that!Teri’s!lack!of!traffic!indicates!a!lack!of!
dispensaries!and!volunteer!organizations!that!may!have!treated!the!suffering.!!As!we!
will!see!in!Chapter!Four,!Teri!had!enough!traffic!to!bring!influenza!to!the!village,!but!
not!enough!to!bring!relief.!!Crossle!does!mention!the!village!of!Samsai,!as!he!noted!
that!this!town!cut!off!all!communication!with!the!outside!world!at!the!start!of!the!
epidemic!and!escaped!the!flu!entirely,!indicating!that!quarantine!was!a!drastic!but!
effective!measure.110!!The!NorthAWest!Frontier!province!saw!81,268!deaths!from!the!
pandemic!by!the!end!of!November!1918!out!of!a!1911!population!of!just!over!2!
million.!!This!gives!a!ratio!of!39.81!deaths!per!1000!people,!ranging!from!a!low!of!
15.03!in!Bappa!in!the!Hazara!district!to!a!high!of!59.43!in!Tank!in!the!Dera!Ismail!
Khan!district.!!Overall,!towns!fared!slightly!better!than!rural!areas,!with!an!average!
death!ratio!of!25.85!per!thousand!as!compared!to!the!rural!death!rate!of!41.26.111!!
The!1921!census!posits!that!the!difference!in!death!rates!in!towns!and!urban!areas!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
110 !Northwest$Frontier$Report,!3.!!!
!
111 !Northwest$Frontier$Report,!15.*!
!
!
41!
versus!rural!areas!could!be!attributed!to!the!more!populated!areas!having!better!
access!to!medical!care.112!
!
Flu!hit!the!relatively!tiny!province!of!Ajmer!Merwara!hard,!reporting!an!
average!death!toll!of!59.5!out!of!1000.!!The!death!toll!peaked!in!November,!and!in!
total!!they!lost!29,835!people!to!influenza!throughout!1918.113!!The!Annual$Sanitary$
Report$mentioned!that!death!tolls!varied!greatly!between!religions,!with!Hindus!
reporting!a!death!rate!of!114.49!and!Muslims!a!death!rate!of!104.51,!while!Christians!
escaped!with!a!death!rate!of!35.16!per!thousand.114!!The!report!also!notes,!!
Owing!to!war!conditions!and!the!failure!of!the!moonsoon![sic]!
there!was!general!scarcity!and!the!prices!of!food!and!clothing!
were!high.!!It!is!probable!that!owing!to!the!privations!so!caused,!
the!population!was!generally!in!a!reduced!state!of!health!and!
specially!liable!to!fall!victims!of!an!epidemic.115!!!
The!lurking!specter!of!famine!appears!behind!these!numbers,!pushing!them!ever!
higher!and!complicating!relief!efforts.!
!
From!AjmerAMerwara,!influenza!continued!its!grim!march!eastward,!with!
Delhi’s!outbreak!peaking!almost!simultaneously!with!the!peak!in!the!Punjab.!!
LieutenantAColonel!C.H.!James,!the!Chief!Medical!Officer!of!the!Delhi!province,!
submitted!a!very!brief!report!on!the!influenza!pandemic!in!his!province.!!Like!most!of!
his!contemporaries,!James!observed!that!there!was!an!early,!mild!wave,!followed!by!
a!far!more!virulent!wave!in!October!and!November.!!This!second!wave!peaked!in!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
112 !Census$of$India,$1921,!13.!!!
!
113 !Annual$Report,!57.!!
!
114 !Annual$Report,!86.!!
!
115 !Annual$Report,!86.!!
!
!
42!
city!of!Delhi!on!October!18th,!with!a!high!of!181!deaths!and!a!continuing!stream!of!
cases!until!the!8th!of!November,!with!the!disease!nearly!spent!by!the!end!of!
November.116 !Out!in!the!district,!the!peak!came!during!the!last!fortnight!of!
October.117!!James!personally!first!noted!influenza!in!a!European!traveling!home!
from!Simla!in!August,!where!his!family!had!been!suffering!from!the!disease,!followed!
shortly!by!another!European!in!the!same!household,!although!several!Indians!had!
already!been!infected!and!seen!in!a!different!hospital.!!He!also!notes!that!“Europeans!
suffered!as!much!as!Indians…![but]!the!strong!and!healthy!seemed!to!suffer!as!much!
as!the!weak!and!sickly,!although!the!latter!died!more!easily.”118!!James!came!no!closer!
acknowledging!the!difference!in!mortality!between!the!wealthy!and!the!poor.!!He!
recorded!the!death!toll!for!the!city!of!Delhi!as!7,044,!with!the!majority!of!the!deaths!
happening!in!October.!!!James!recalled!that!while!regular!dispensaries!reported!
13,194!cases,!street!dispensaries!and!volunteer!staff!saw!a!far!greater!number!of!
cases.119!!The!District!peaked!slightly!later!than!the!city!itself,!as!it!recorded!more!
deaths!in!November!than!in!October.!!Total!mortality!for!the!district!was!16,131!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
116 !The$Influenza$Epidemic$in$the$Delhi$Province,$Autumn$1918,!(henceforth!called!
Delhi$Report),!IOR!P/10588,!1.!British!Library,!London,!United!Kingdom.!!!
!
117 !Delhi$Report,!1.!!
!
118 !Delhi$Report,!1.!!
!
119 !Delhi$Report,!1.!!I!assume!by!“street!dispensaries”!he’s!referring!to!temporary!
dispensaries!or!traveling!medical!officers!doing!door!to!door!work.!!He!does!not!
define!this!term,!however.!
!
!
43!
between!October!and!November.!!This!brought!Delhi’s!total!reported!mortality!to!
23,612,!or!56.6!per!thousand.120!
!
James!mentioned!other!challenges!Delhi!faced!during!the!pandemic,!notably!
disposal!of!bodies.!!“The!burial!and!cremation!of!bodies!caused!much!trouble,”!he!
writes,!“but!was!eventually!over!come!by!getting!the!aid!of!voluntary!committees.”121!!
When!posed!the!question!of!how!to!prevent!another!epidemic,!or!to!suggest!possible!
causes!for!the!1918!pandemic,!James!replied!with!a!figurative!shrug.!!
!Why!it!should!take!on!this!virulent!character!at!this!particular!time!is!
one!of!the!mysteries!of!nature.!!The!panAdemic!has!practically!affected!
the!whole!world!within!a!few!months.!!This!disposes!of!temperature,!
climate,!humidity,!etc.,!as!being!either!exciting!or!predisposing!
causes….In!this!light!neither!famine!nor!scarcity!can!be!quoted!as!
predisposing!causes.!!The!rural!districts,!where!air!and!light!are!
plentiful,!suffered!as!severely!as!the!towns!where!those!conditions!were!
not!so!favourable.122!!!
!
James!did!not!see!the!famine!as!a!contributing!factor,!but!rather!felt!that!the!flu’s!high!
death!tolls!would!remain!a!mystery.!!!Unlike!some!of!his!contemporaries,!he!also!did!
not!see!a!difference!between!urban!and!rural!areas.!
!
The!influenza!virus!continued!its!deadly!trek!across!India!by!moving!into!the!
United!Provinces!next.!!Here,!the!first!wave!of!influenza!arrived!in!August!and!
September!and!as!elsewhere,!in!a!fairly!mild!form.!!Colonel!C.!MacTaggart,!Officiating!
Sanitary!Commissioner!of!the!United!Provinces,!pointed!to!returning!sepoys!and!
recruits!as!possible!sources!of!infection,!and!dismissed!a!report!of!postal!workers!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
120 !Annual$Report,!57.!!
!
121 !Delhi$Report,$2.!The!problem!of!corpses!and!their!disposal!will!be!explored!more!
thoroughly!in!chapter!five.*!
!
122 !Delhi$Report,!2.!!
!
!
44!
spreading!the!disease!in!Lucknow!as!“merely!a!coincidence”!as!no!other!health!
officers!in!his!jurisdiction!singled!out!postal!employees!as!vessels!of!transmission.123!!
The!second,!more!deadly!wave!appeared!in!October!almost!simultaneously!
throughout!the!province!and!hit!its!peak!in!midANovember,!tapering!off!rather!
quickly!after!that.124!!The!overall!mortality!rate!from!August!to!November!30th!
worked!out!to!23!per!thousand,!which!MacTaggart!observed!was!the!same!as!the!
average!mortality!from!all!causes!over!a!period!of!eight!months.125!!Rural!areas!had!a!
mortality!rate!of!!68.56!per!thousand!while!urban!areas!had!a!similar!rate!of!68.81!
per!thousand!for!the!four!months!comprising!the!worst!of!the!pandemic.126!!
MacTaggart!separated!the!death!tolls!into!two!separate!charts—one!listing!the!death!
tolls!in!municipalities!that!did!not!have!health!officers,!and!one!listing!municipalities!
with!health!officers.!!Combining!total!estimated!deaths!from!influenza!from!both!
charts!leaves!1,072,!671!out!of!a!population!of!46.8!million.127!!Later!the!Annual!
Sanitary!Report!revised!it!to!an!astonishing!2,034,!257,!giving!the!United!Provinces!
the!dubious!honor!of!the!highest!number!of!deaths!in!all!of!India.128!!While!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
123 !United$Provinces$Influenza$Report$1919,!1,!IOR:!PA10588.!British!Library,!London,!
United!Kingdom.!!!
!
124 !United$Provinces$Report,!1.!!
!
125 !United$Provinces$Report,!1.!!
!
126 !United$Provinces$Report,!1.!!
!
127 !United$Provinces$Report,!14A15.!The!total!population!is!based!on!the!1911!census,!
as!are!all!population!totals!in!these!reports,!and!again,!given!the!lax!reporting!and!
chaos!of!the!time,!this!is!only!an!absolute!minimum!of!deaths.!
!
128 !Annual$Report,!57.!!
!
!
45!
MacTaggart!warned!he!cannot!pinpoint!the!exact!peak!in!death!toll!throughout!the!
province,!he!did!identify!Cawnpore’s!apex!on!October!28th!while!Allahabad!peaked!
last,!on!November!13th.129!!!However,!MacTaggart!appeared!extremely!wary!of!the!
statistics,!as!he!frequently!warned!that!his!numbers!could!not!be!relied!upon,!as!in!
many!cases!the!numbers!were!simply!not!available.!!He!did!note,!much!like!the!rest!of!
his!contemporaries,!that!poor!people!fared!the!worst!in!this!deadly!pandemic,!with!
overcrowding!being!the!main!factor!in!his!opinion.130!!!This!conclusion!contradicted!
James’!experience!in!Delhi,!where!he!noted!that!rural!areas!suffered!as!severely!as!
densely!populated!towns.131!
The!Amrita$Bazar$Patrika!further!explored!this!connection,!and!wrote!that!a!
representative!of!the!Salvation!Army!in!Gujarat!found,!“that!influenza!is!everywhere!
causing!a!deathAroll!10!or!20!times!the!normal!because,!while!the!great!cities!are!
provided!for,!nothing!is!done!for!the!villages.”132!!This!charged!that!relief!efforts!
centered!their!attentions!in!large!metropolitan!areas!and!left!more!rural!areas!to!
fend!for!themselves.!!Survival!depended!on!access!to!medical!care,!but!some!felt!the!
Government!did!not!react!to!the!crisis!quickly!enough!in!order!to!get!everyone!help.!!!
The!medical!community!did!not!necessarily!agree,!as!a!note!on!influenza!
published!in!the!Indian$Medical$Gazette$credited!lower!rates!of!infection!in!places!far!
from!railways!and!in!urban!areas!to!“in!the!former!case!to!lack!of!facilities!for!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
129 !United$Provinces$Report,!2.!!!
!
130 !United$Provinces$Report,!6.!!
!
131 !Delhi$Report,!2.!*
!
132 !“Influenza!Epidemic,”!Amrita$Bazar$Patrika,!October!21,!1918.!*
*
!
46!
communication!to!the!outside!world,!and!in!the!latter!to!the!better!sanitary!
conditions!existing!in!towns,!where!the!general!population!is!better!clothed,!fed,!and!
housed!than!in!villages.”133!!These!contradictory!positions!raised!the!question!of!who!
should!be!responsible!for!managing!these!crises!and!meanwhile!the!flu!ran!
unchecked.!
!
From!the!United!Provinces!we!must!now!turn!to!Assam,!a!region!north!of!
Bengal!with!a!population!of!6.2!million,!that!saw!almost!70,000!deaths!from!
influenza!in!the!fall!of!1918.!!The!pandemic’s!immense!death!toll!makes!69,113!
deaths,!even!as!a!lower!bound,!seem!paltry.134!!The!Sanitary!Commissioner!of!Assam,!
Major!T.C.!McCombie!Young,!focused!his!report!on!the!difference!between!urban!and!
rural!death!rates,!noting!that!in!places!with!access!to!even!one!sanitary!inspector!had!
mortality!rates!of!6.8!per!thousand,!as!opposed!to!12!per!thousand!in!areas!without!
any!public!health!staff.135!!From!this!information,!it!would!appear!that!McCombie!
Young!believed!access!to!public!health!staff!had!a!significant!impact!on!survival.!!
Given!the!degree!of!latitude!in!how!Sanitary!Commissioners!assembled!their!reports,!
McCombie!Young!does!not!record!the!flu’s!peak.!!However,!if!we!assume!that!the!flu!
continued!its!pattern!traveling!along!communication!and!commerce!lines!from!west!
to!east!and!south!to!north,!Assam!likely!saw!the!virus!peak!in!mid!November,!after!it!
peaked!in!the!United!Provinces!and!several!weeks!before!it!peaked!in!Bengal!to!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
133 “Influenza!in!the!Punjab,”!Indian$Medical$Gazette,!Vol!LIV,!June!(1919),!223.!
!
134 !Assam$Influenza$Report$1919,$IOR:!P/10588,*2.*British!Library,!London,!United!
Kingdom.!!!
!
135 !Assam$Report,!2.!!
!
!
47!
south.!!McCombie!Young’s!inability!to!produce!a!completely!accurate!report!!and!
repeated!allusions!to!missing!figures!and!tight!deadlines!hint!at!scenes!of!confusion,!
even!though!Assam!escaped!the!total!devastation!of!other!areas.!!This!indicates!that!
even!in!places!where!the!death!toll!did!not!climb!to!astronomical!heights,!the!
situation!was!still!one!of!immense!chaos.!
The!flu!appeared!in!Bihar!and!Orissa!in!July,!but!only!lingered!for!a!few!weeks!
before!receding.136!!It!reappeared!in!September,!however,!and!“rapidly!spread!all!
over!the!province!generally!along!the!routes!of!communication!first.”137 !!The!disease!
peaked!in!October!in!Orissa,!and!elsewhere!it!crested!in!November!or!early!
December.!!Places!where!the!flu!hit!its!highest!point!early!had!much!lower!death!tolls!
than!places!where!mortality!peaked!in!November!or!December.!!S.!N.!Tiwari,!
Officiating!Sanitary!Commissioner!of!Bihar!and!Orissa!attributed!this!differential!to!
weather,!as!the!high!temperature!and!humidity!of!October!kept!respiratory!
complications!in!check.!138!!He!wrote,!“In!other!districts!the!disease!became!severe!in!
November!and!December!when!climatic!conditions!were!less!favourable!for!lung!
complications,!especially!among!the!illAclad!and!illAfed!poor;!and!this!accounts!for!the!
higher!mortality!in!them.!!As!already!stated,!rural!areas!saw!mortality!rates!almost!
twice!as!high!as!in!towns.”139!!Compared!to!the!previous!five!years,!1918!saw!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
136 !Annual$Sanitary$Report$of$the$Province$of!Bihar$and$Orissa$for$the$Year$1918,!
[hereafter!Bihar$and$Orissa$Annual$Report]!IOR:!V/24/3892,!British!Library,!London,!
United!Kingdom,!11.!!!
!
137 !Bihar$and$Orissa!Annual$Report,*11.*!
!
138 !Bihar$and$Orissa!Annual$Report,*11.*!
!
139 !Bihar$and$Orissa!Annual$Report,*11.*!
!
48!
597,437!more!deaths,!which!Tiwari!assigned!to!influenza.!!Much!like!in!the!NorthA
West!Frontier!Province,!influenza!killed!more!in!rural!areas!than!urban,!with!rural!
areas!in!Hazaribagh!reporting!death!rates!of!94.5!per!thousand,!while!the!town!
returned!deaths!at!a!rate!of!46.7!per!thousand.!!Additionally,!Tiwari!wrote!that!his!
area!took!few!steps!to!mitigate!the!pandemic,!saying,!!
No!bacteriological!or!pathological!investigations!were!undertaken!in!
connection!with!the!epidemic;!nor!could!any!preventative!measures!
be!adopted!beyond!circulating!leaflets!giving!general!information!
about!the!disease!and!care!of!the!patient!on!account!of!its!very!
pradie!and!wide!spread!prevalence!all!over!the!province.!!Remedial!
measures!were,!however,!taken!by!all!local!bodies!who!were!helped!
by!the!Government,!individual!philanthropists!and!other!societies!in!
each!district.140!
!
In!short,!the!pandemic!caught!British!government!in!Bihar!and!Orissa!completely!offA
guard,!to!the!extent!that!they!did!not!implement!many!precautions!to!try!and!
diminish!the!devastating!effect!of!influenza.!!Tiwari!acknowledged!that!the!poor!did!
not!fare!as!well,!but!did!not!examine!why!this!came!to!be!or!how!to!prevent!a!similar!
situation!in!the!future.!
!
With!just!over!13!million!people,!the!Central!Provinces!and!Berar!marked!the!
dividing!line!between!the!hardest!hit!provinces!and!areas!like!Bengal!that!managed!
to!elude!the!worst!of!the!flu’s!ravages.!!As!elsewhere,!the!mortality!was!higher!in!
rural!areas!than!in!villages,!and!the!Sanitary!Commissioner!reported!that!this!fact!
“testifies!to!the!severity!of!the!disease!in!villages,!where!the!people!could!not!get!help!
to!the!extent!it!was!available!in!towns.”141!!The!official!death!toll!was!recorded!as!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
140 !Bihar$and$Orissa!Annual$Report,*13.!!!
!
141 !Annual$Report,!78.!!
!
49!
924,949,!or!66.4!per!thousand.142!!Although!the!Central!Provinces!lost!fewer!people!
than!the!United!Provinces,!they!lost!a!higher!percentage!of!the!population.!!The!more!
virulent!wave!of!the!flu!arrived!in!September!and!peaked!in!November,!traveling!to!
rural!areas!on!railways.143 !!!Roughly!73%!of!the!year’s!deaths!were!recorded!in!the!
last!quarter,!a!staggering!statistic.144!!!British!officials!!saw!access!to!public!health!as!
a!key!element!to!surviving!the!pandemic,!which!in!the!face!of!the!overstretched!IMS!
meant!a!high!death!toll!for!already!underserved!populations.!
!
Bengal!did!not!suffer!to!the!same!extent!as!the!western!portions!of!the!
country!for!reasons!unknown.!!Bengal!saw!widespread!influenza!in!both!the!mild!
summer!wave,!and!the!deadlier!fall!wave.!!The!flu!came!to!Bengal!through!the!port!in!
the!summer,!and!the!dock!workers!fell!ill!first.!!The!second!wave!arrived!on!
September!26th!on!the!City$of$Delhi,!but!Bentley,!Officiating!Sanitary!Commissioner!
for!Bengal,!acknowledged!this!may!not!have!been!the!sole!source!of!infection!for!the!
entire!province,!positing!that!it!may!have!also!arrived!along!with!railway!traffic!in!
the!west.145!!!Assuming!Calcutta!as!the!sole!point!of!origin,!influenza!spread!out!along!
the!rail!lines!and!steamer!routes,!“and!in!almost!every!case!the!clerical!and!menial!
staff!of!the!railway!and!steamer!companies,!together!with!postal!clerks!and!mail!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
142 !Annual$Report,!57.!!
!
143 !Annual$Report,!78.!*
!
144 !Annual$Report!78.!!
!
145 !Bengal$Influenza$Report$1919,![hereafter!Bengal$Report]!IOR:!PA10588,!40.!British!
Library,!London,!United!Kingdom.!!!
!
!
50!
sorters,!were!the!first!to!be!attacked.”146!!Once!again,!we!see!symbols!of!the!British!
empire—industrial!and!practical—transmitting!the!disease!throughout!the!
countryside.!!!!
!
Unlike!other!British!officials,!Bentley!did!not!observe!higher!mortality!in!rural!
areas.!!Bentley!wrote,!“The!first!outbreak!was!characterised!by!the!rapidity!with!
which!it!spread,!the!large!numbers!attacked,!the!mildness!of!the!disease,!the!absence!
of!complications,!the!low!morality!and!the!fact!that!it!was!chiefly!confined!to!the!
towns.”147!!!Thus,!Bengal!may!have!escaped!the!massive!death!tolls!of!the!second!
wave!because!those!who!already!had!contracted!the!milder!form!had!a!measure!of!
immunity.!!Roughly!8.5!per!thousand!people!died!of!influenza!in!Bengal,!but!the!
death!toll!in!the!entirety!of!Bengal!paled!in!comparison!with!regions!like!the!
Punjab.148!
Far!to!the!south!and!more!isolated!from!other!British!provinces,!Coorg!also!
experienced!the!two!waves,!the!first!arriving!in!June!from!the!Malabar!coast,!and!the!
second!wave!exploding!in!October!with!much!higher!mortality!rates.149!!Lieutenant!
Colonel!E.!Hasell!Wright,!IMS!Civil!Surgeon!of!Coorg,!noted!the!quick!progression!of!
the!flu,!with!a!short!incubation!period!of!two!days!or!less!and!the!lack!of!prodromal!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
146 !Bengal$Report,!40.!!
!
147 !Bengal$Report,!40A41.!!
!
148 !Annual$Report,!57.!!
!
149 !Coorg$Influenza$Report$1919,![hereafter!Coorg$Report]!IOR:!PA10588,!1.!!British!
Library,!London,!United!Kingdom.!!!
!
!
51!
symptoms.150!!Wright!emphasized!the!importance!of!good!nursing!care,!complaining!
that!many!patients!would!leave!the!hospital!after!3A4!days!and!then!relapse.!!He!also!
commented!that!he!did!not!have!any!Europeans!or!wellAtoAdo!Coorgs!die,!making!
Coorg!yet!another!section!of!India!where!the!Europeans!escaped!far!more!lightly!
than!the!Indians.151!!However,!the!death!toll!in!Coorg!was!minor!compared!to!the!
devastation!of!Northern!areas,!with!4,070!total!deaths!from!the!influenza!pandemic!
recorded,!out!of!a!population!of!nearly!175,000.152!!!
!
Wright!also!published!two!articles!on!the!flu!in!Coorg!in!the!Indian$Medical$
Gazette,!one!titled!“Report!on!the!Pandemic!of!Influenza!(La!Grippe)!in!the!Province!
of!Coorg!During!the!Year!1918”!and!the!other!“A!Note!on!the!Prevalence!of!the!new!
Disease!(Influenza)!in!Coorg:!Symptoms,!Treatment!and!Prevention.”!!Wright!
observed!one!particular!anomaly!in!his!province,!notably,!!
Only!a!few!infants!under!one!year!were!attacked,!and!I!noticed!in!
many!European!houses!and!those!of!Coorgs!though!whole!families!
and!servants!went!down!with!influenza,!how!marked!was!the!escape!
of!infants!of!one!year!and!under,!and!this!in!spite!of!any!particular!
attention!being!taken!to!prevent!their!catching!the!infection.153!!!
!
What!this!observation!portended!is!debatable,!although!Wright!carefully!eliminated!
protection!of!the!infants!as!a!reason.154!!Later!Wright!commented,!“I!was!fortunate!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
150 !Coorg$Report,!2.!!
!
151 !Coorg$Report,!5.!!
!
152 !Annual$Report,!86.!!
!
153 !E.!Hasell!Wright,!“Report!on!the!Pandemic!of!Influenza!(La!Grippe)!in!the!
Province!of!Coorg!During!the!Year!1918,”!Indian$Medical$Gazette,!Vol!LIV,!August!
1919,!281.!
!
154 !“Report!on…Coorg”,!281.!
!
52!
not!to!get!a!single!death!amongst!the!Europeans!and!better!class!Coorgs!whom!I!
attended,!though,!as!stated!before,!no!house!or!family!escaped!attack.!Therefore!
prolonged!rest!is!imperative!after!an!attack,!both!mentally!and!bodily.”155 !!This!
comment!brings!into!stark!relief!the!difference!in!survival!between!the!wealthy!and!
the!poor.!!Wright!did!not!mention!the!importance!of!access!to!either!nursing!care!or!
food!here,!although!both!may!be!implied.156!!Wright’s!description!depicted!the!flu!as!
controlled,!but!also!raised!questions!about!who!the!flu!attacked!and!why.!
!
As!in!Coorg,!Madras!saw!a!relatively!light!death!toll.!Much!like!the!Delhi!
report,!the!broad!parameters!given!to!these!reports!means!that!while!some!officers!
sent!dozens!of!detailed!pages,!others,!like!the!men!in!Madras!and!Delhi,!sent!the!bare!
minimum.!!Similar!to!other!areas!affected!by!the!pandemic,!Madras!recorded!a!
disparity!between!the!wellAoff!Europeans!who!survived!and!poor!Indians,!who!often!
didn’t.!H.G.!Stokes,!Acting!Secretary!to!the!Government!of!Madras!reported!roughly!
509,667!deaths!within!the!entire!Presidency!from!influenza,!!having!arrived!at!that!
number!by!taking!the!total!mortality!for!JanuaryANovember!of!1918!and!subtracting!
the!average!mortality!“from!all!causes!except!plague,!cholera,!smallpox,!dysentery!
and!diarrhea!and!injuries”!from!JanuaryANovember!in!the!preceding!five!years.157!!
The!Annual$Report$of$the$Sanitary$Commissioner!reports!682,169!deaths!from!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
155 !“Report!on…Coorg”,!284.!
!
156 !After!all,!strict!bedrest!is!hard!to!manage!if!one!is!without!a!caretaker!or!access!
to!food.!
!
157 !Madras$Influenza$Report$1919,![hereafter!Madras$Report]!IOR:!PA10588,!1.!British!
Library,!London,!United!Kingdom.!!!
!
!
53!
influenza!for!the!entire!province,!or!16.7!per!thousand.158!!A!separate!report!filed!by!
the!IMS!commission!notes!the!first!signs!appeared!in!June!of!1918,!and!!
Undoubtedly!came!from!the!Bombay!Presidency!and!further!
influxes!of!infection!poured!in!from!steamers!arriving!in!the!
harbour.!!The!disease!spread!like!wildfire,!the!infection!taking!
place,!as!is!recognized,!by!the!respiratory!tract.!!In!the!beginning!of!
the!epidemic,!this!is!in!July,!the!attacks!were!sharp!and!short!as!a!
rule;!but!in!the!second!wave,!in!October,!the!infections!were!severe!
and!prolonged;!pneumonia!cases!predominating!with!a!
considerable!increase!in!mortality.159!!
!
!!The!IMS!committee!later!commented!that,!
All!classes!of!Indians!suffered,!there!may!have!been!a!slight!
immunity!among!the!upper!grades!that!lived!in!large!houses!with!
spacious!compounds.!!The!Europeans,!especially!those!under!better!
life!conditions,!suffered!very!little!if!at!all!from!the!severe!form!of!
the!disease.!!Nurses!and!Medical!men,!especially!of!the!country,!
suffered!severely.160!!!
!
The!British!noticed!the!role!that!poverty!played!in!flu!survival!rates,!but!failed!to!
address!how!this!could!be!alleviated.!!!
Burma,!with!its!population!of!9!million,!!also!managed!to!escape!the!worst!
ravages!of!the!influenza!pandemic.!!Once!again,!however,!influenza!did!not!impact!
every!class!affected!equally,!with!“the!better!class!Asiatics”!reporting!case!mortalities!
of!3%.!!Some!of!this!disparity!may!be!explained!by!the!fact!that!the!monsoons!did!not!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
158 !Annual$Report,!57.!However,!much!like!the!other!reports,!the!Annual!Report!does!
not!seem!very!confident!in!their!numbers,!offering!three!possible!methods!for!
calculating!death!tolls!and!then!averaging!them!albeit!“without!any!claim!to!
accuracy,”!56!
!
159 !Madras$Report,!4.*!
!
160 !Madras$Report,!5.!!
!
!
54!
fail!in!Burma,!with!rice!being!cheaper!overall!for!1918!than!it!had!been!in!1917.161 !!
Burma!had!no!break!between!the!summer!and!the!fall!waves!of!influenza!where!the!
province!could!have!been!considered!free!of!influenza.162!!With!a!death!toll!peaking!
the!week!of!November!9th!in!Rangoon,!Burma!lost!137,491!people!to!influenza,!a!
mortality!rate!of!13.9!per!1,000!people.!163!Still,!the!pandemic!hit!certain!sectors!
hard,!with!emergency!influenza!hospitals!reporting!case!mortality!rates!of!21%A
33%.164!!
!
Conclusion*
!
Influenza!took!an!immense!toll!in!India.!!As!the!above!numbers!show,!it!
affected!every!province!and!presidency,!although!some!more!than!others.!!The!
contemporary!conclusion!of!up!to!7!million!dead!has!long!been!rejected!as!
insufficient,!with!estimations!of!a!more!accurate!death!toll!reaching!as!high!as!18!
million!deaths,!or!three!times!as!severe.165!!The!work!of!demographers!Chandra,!et.!al!!
suggests!a!more!accurate!number!might!be!just!under!14!million.166!!!As!the!numbers!
described!above!demonstrate,!the!influenza!pandemic!had!only!one!constant—
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
161 !Annual$Report,!84.!*
!
162 !Annual$Report,!85.!!
!
163 !Annual$Report,!57,!58.!
!
164 !Annual$Report,!85.!!
!
165 !Annual$Report,!57,!and!Davis,!237.!While!the!Preliminary!Report!estimated!at!
least!6!million!dead,!the!Annual!Report!revised!that!estimate!up!to!7!million,!while!
still!acknowledging!that!those!numbers!are!likely!too!low.!
!
166 !Chandra,!et.!al.,!!857.!
!
55!
wherever!it!went,!it!killed.!!Other!than!that,!the!flu!had!varying!effects,!with!some!
regions!suffering!enormous,!catastrophic!losses,!and!others!facing!!lessAtotal!but!still!
considerable!devastation.!!The!poor!generally!suffered!more!than!the!rich,!with!
Europeans!escaping!almost!entirely!in!some!regions,!likely!due!to!their!better!access!
to!food!and!nutrition!as!well!as!health!care,!nursing,!and!spacious!homes!that!let!
them!avoid!the!spread!of!infection.!!In!some!areas!cities!and!towns!endured!more!
losses!than!rural!areas,!possibly!due!to!overcrowding,!but!in!other!provinces!rural!
areas!had!the!highest!death!tolls!possibly!due!to!a!lack!of!access!to!health!care.!!The!
famine!lurks!behind!all!the!reports,!although!not!all!British!officials!had!it!on!their!
radars.!!
!
The!influenza!pandemic!arrived!in!Bombay!in!June!of!1918,!and!by!October!of!
1918!thousands!of!people!were!dying!every!day!throughout!the!subcontinent.!!!The!
pandemic!arrived!swiftly,!with!little!warning,!and!burned!out!within!four!months.!!As!
we!will!see!in!future!chapters,!the!completely!overstretched!and!understaffed!Indian!
Medical!Service!did!its!best!to!provide!medical!services,!but!the!sheer!number!of!
patients!would!have!overwhelmed!them!even!during!the!best!of!times.!!
!
!
!
56!
Chapter*Two*
Fiddling$while$Bombay$Burns:$The$Official$Government$Response$$
!
!
I!am!at!one!with!the!Hon’ble!the!SurgeonAGeneral!in!thinking!that,!so!long!as!local!
bodies!are!in!charge!of!medical!institutions,!whether!they!be!district!boards!or!
municipalities,!they!should!take!the!initiative!in!that!respect,!do!all!that!lies!in!their!
power!to!combat!the!disease,!get!whatever!staff!is!available,!improve!the!staff!to!the!
utmost!of!their!capacity!and!satisfactorily!deal!with!this!problem.!!I!think!…!that!in!
view!of!the!peculiar!nature!of!the!disease!and!in!view!of!the!special!expenditure!to!
which!local!bodies!must!have!been!put!in!meeting!this!epidemic,!Government!would!
be!prepared!to!render!additional!financial!assistance.167!
!
!
In!1918!the!sprawling!bureaucracy!of!the!British!Government!in!India!
covered!millions!of!people,!and!relied!on!local!governing!bodies!to!do!the!heavy!
lifting!of!administration.!!This!policy!acted!as!a!doubleAedged!sword—while!it!
allowed!for!tailoring!responses!based!on!the!needs!of!the!local!population,!it!also!left!
a!heavy!burden!on!the!local!district!boards!with!limited!resources.!!As!A.S!Krishna!
Rao!pleaded!above,!local!boards!operated!in!their!own!best!interests!with!
governmental!financial!assistance,!but!this!process!did!not!always!work!as!
theorized.!!Speaking!in!midANovember!of!1918,!Rao’s!solution!to!send!money!to!
local!municipalities!that!required!assistance!would!most!likely!not!have!yielded!
excellent!results.!!In!particular,!it!overlooked!the!fact!that!the!pandemic!took!down!
British!officials!and!medical!personnel!alongside!Indian!civilians.!!While!poor!
Indians!died!in!far!greater!numbers,!British!doctors!and!officials!were!still!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
167 !The!Hon’ble!A.S.!Krishna!Rao!to!United!Provinces!Legislative!Council,!“Resolution!
Re!a!Committee!to!Investigate!the!Nature,!Etc.,!In!Regard!to!the!Influenza!Epidemic,”!
November!19th,!1918,!Proceedings$of!the$Council$of$his$honour$the$Lieutenant$
Governor,$United$Provinces$of$Agra$and$Oudh,$Assembled$for$the$Purpose$of$Making$
Laws$and$Regulations,$1918,$(Allahabad:!Office!of!the!Supt.,!Government!Press,!
United!Provinces,!1919),[hereafter!UPLC],!271.!*!
!
57!
incapacitated!by!the!disease.168!!It!would!be!difficult!for!local!infrastructure!to!apply!
for!special!funds!and!strengthen!local!medical!services!while!dealing!with!a!
pandemic!of!unbelievable!magnitude.!!The!British!had!managed!to!mobilize!and!
fund!a!massive!army!in!a!relatively!short!time,!but!when!the!flu!arrived!in!India!that!
governmental!might!was!nowhere!to!be!found.!!As!a!result,!far!too!few!local!officials,!
many!of!them!suffering!from!the!flu!themselves,!shouldered!the!burden!of!solving!
the!public!health!crisis!created!by!the!pandemic.!!The!short!lifeAspan!of!the!
pandemic!meant!that!by!the!time!the!government!resolved!to!send!aid,!the!worst!of!
the!pandemic!had!already!passed.!!The!British!had!also!taken!an!alienating!stance!
towards!traditional!Indian!medicine!and!created!barriers!for!Indian!men!wishing!to!
study!western!medicine.!!When!the!flu!arrived,!the!government!and!Indian!Medical!
Service!found!themselves!illAsituated!to!coordinate!an!effective!response.!*
!
The*Government*of*India*
Following!the!Uprising!of!1857,!India!shifted!from!the!control!of!the!British!
East!India!Company!to!the!status!of!a!colony!under!Queen!Victoria.!!Parliament!now!
had!responsibility!for!the!governance!of!India!and!created!a!topAdown!hierarchy!
where!London’s!decisions!trickled!down!to!India!through!the!Indian!Civil!Service.!!In!
Britain,!administration!of!India!went!through!the!India!Office!under!the!aegis!of!the!
Secretary!of!State!for!India.!!Officially!the!Viceroy!of!India!worked!under!the!
Secretary!of!State!and!had!a!viceregal!council!to!assist,!but!that!hierarchy!depended!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
168 !Preliminary$Report,!3.!!*
!
!
58!
heavily!the!level!of!power!and!effectiveness!of!the!Secretary!of!State.169 !!While!the!
India!Office!directed!the!bureaucracy!in!India,!in!general!the!men!on!the!ground!in!
India!handled!the!day!to!day!action.!!As!Kaminsky!argues,!the!India!Office!generally!
did!not!take!a!large!interest!in!dayAtoAday!administration,!but!did!maintain!tight!
control!over!major!policy!decisions.170!!!!!
The!Secretary!of!State!also!had!the!power!to!appoint!members!of!the!
Legislative!Council,!which!advised!the!GovernorAGeneral!and!until!1919!India!OfficeA
appointed!Members!retained!a!majority!on!the!Council.!!These!legislative!councils!
functioned!in!an!advisory!capacity,!and!while!they!could!issue!opinions!on!statues!
and!amendments,!“the!executive!was!not!bound!to!accept!these!suggestions.”171!
Local!Provincial!Councils!had!no!veto!power!over!the!Legislative!Council,!and!thus!
the!India!Office!maintained!control!over!the!increasingly!Indian!provincial!
councils.172!!Sandhya!Polu!argues!that!the!Government!of!India!deliberately!
decentralized!in!response!to!nationalist!pressure!but!ensured!that!the!
responsibilities!delegated!to!Indian!boards!and!municipalities!were!minor.!!True!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
169 !Patrick!O’Leary,!Servants$of$the$Empire:$The$Irish$in$Punjab$188181921,!Studies!in!
Imperialism!(Manchester ;!New!York:!Manchester!University!Press,!2011),!17.!!!
!
170 Arnold!P.!Kaminsky,!The$India$Office,$188081910,!Contributions!in!Comparative!
Colonial!Studies,!no.!20!(New!York:!Greenwood!Press,!1985),!124.!
!
171 !Mithi!Mukherjee,$India$in$the$Shadows$of$Empire:$A$Legal$and$Political$History!
(New!Delhi:!Oxford!University!Press,!2010),!97.!
!
172 !Kaminsky,!126.!
!
!
59!
power!remained!in!the!hands!of!the!British,!but!they!gave!the!appearance!of!
including!the!Indian!people!on!some!levels.173!!!
The!Government!of!India!became!increasingly!concerned!with!codification!
and!control!as!the!late!nineteenth!century!progressed.!!!!As!U.!Kalpagam’s!Rule$by$
Numbers:$Governmentality$in$Colonial$India!argues,!governance!in!India!came!to!
depend!heavily!on!statistics!and!scientifically!classified!knowledge.!!The!British!
categorized!India!through!censuses!and!surveys,!and!used!this!knowledge!to!“devise!
modalities!of!intervention!by!way!of!laws!and!regulations.”174!!This!reliance!
inherently!limited!the!ability!of!the!ICS!to!fully!understand!actual!events,!as!officials!
only!saw!the!information!the!state!had!created!a!system!to!collect.175!!!
This!method!of!obtaining!knowledge!and!exercising!control!dominated!the!
government!long!before!the!Fall!of!1918.!!British!men!rotated!rapidly!through!
positions,!searching!for!promotions,!which!served!to!undermine!their!ability!to!fully!
comprehend!problems!facing!Indian!people.!!“As!long!as!men!moved!rapidly!from!
one!district!to!another,!there!was!less!chance!of!their!becoming!disillusioned!with!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
173 !Sandhya!L.!L.!Polu,!Infectious$Disease$in$India,$189281940:$Policy8Making$and$the$
Perception$of$Risk$(Cambridge$Imperial$and$Post8Colonial$Studies$Series),!1!edition!
(Palgrave!Macmillan,!2012),!20.!
!
174 !U.!Kalpagam,!Rule$by$Numbers:$Governmentality$in$Colonial$India!(Lanham,!
Maryland:!Lexington!Books,!2014),!20.!
!
175 !James!C.!Scott,!Seeing$like$a$State:$How$Certain$Schemes$to$Improve$the$Human$
Condition$Have$Failed!(New!Haven,!Conn.:!Yale!University!Press,!1999),!3.!
!
!
60!
the!inability!of!government!to!understand!or!deal!effectively!with!the!complex!
problem!in!any!one!local!area,”!argues!Bradford!Spangenberg.176!
!
The!administrative!and!medical!infrastructure!that!had!to!confront!the!
pandemic!was!not!only!inadequate!but!also!representative!of!the!difference!
between!colonial!and!metropole!governments.!!By!the!outbreak!of!the!First!World!
War,!Indian!governance!was!a!large,!creaky,!leaking!ship.!!Both!the!Indian!Civil!
Service!(ICS)!and!the!Indian!Medical!Service!(IMS)!were!facing!failing!recruitment!
numbers,!clashes!over!Indianisation,!and!far!too!few!personnel!to!administer!the!
entire!subcontinent.!!The!ICS!had!been!in!existence!in!some!form!or!another!for!
most!of!the!nineteenth!century,!but!following!the!events!of!1857!it!became!more!
codified!under!the!control!of!the!British!Crown.!The!IMS,!in!contrast,!was!originally!
created!to!serve!the!medical!needs!of!officers!and!had!become!a!deAfacto!public!
health!service!by!1914.!!The!ICS!ran!the!government!while!the!IMS!provided!health!
care!for!some!sections!of!the!populace,!but!when!the!pandemic!hit,!the!IMS!found!
itself!on!the!front!lines!of!a!battle!they!had!not!prepared!to!fight.!
!
The!ICS!divided!India!into!250!districts.!!Each!district!had!a!member!of!the!
ICS!in!charge,!called!either!a!district!officer,!deputy!commissioner,!or!collector.177!!
Each!district!officer!reported!to!a!commissioner,!who!coordinated!the!
administration!of!three!or!four!districts.!!A!Lieutenant!Governor!was!then!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
176 !Bradford!Spangenberg,!British$Bureaucracy$in$India:$Status,$Policy,$and$the$I.C.S.$in$
the$Late$19th$Century!(Columbia,!Mo:!South!Asia!Books,!1976),!77.!
!
177 !O’Leary,!25.!The!average!district!at!the!time!had!around!931,000!people!and!
covered!4,430!square!miles.!
!
!
!
61!
responsible!for!all!the!districts!in!his!province,!and!the!Viceroy!was!in!charge!of!all!
the!provinces!under!British!control.178!!The!Viceroy,!also!known!as!the!GovernorA
General,!was!not!a!member!of!the!ICS!but!rather!appointed!in!London,!and!historian$
Patrick!O’Leary!notes!that!the!power!of!the!Viceroy!depended!heavily!on!the!
strength!of!the!Secretary!of!State!at!the!time.179!!The!Viceroy!appointed!Lieutenant!
Governors,!while!the!rest!of!the!positions!in!the!Civil!Service!were!open!on!a!
competitive!basis.!!The!ICS!opened!to!Indian!applicants!in!1853,!but!various!
restrictions!and!hurdles!meant!that!no!Indian!man!passed!the!exam!until!1869.180!!
For!example,!by!keeping!the!admission!exams!in!England,!the!bar!for!an!Indian!
applicant!was!significantly!higher!than!a!British!applicant,!who!would!have!had!far!
lower!travel!expenses!than!his!Indian!counterpart!to!take!the!exam.181!!Lower!level!
positions!that!did!not!require!an!exam!were!often!filled!by!Indian!men,!largely!
owing!to!the!small!numbers!of!British!in!India.182!!District!officers!functioned!as!a!all!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
178 !O’Leary,!25.!!!Madras!and!Bombay!had!governors!appointed!by!London!instead!of!
lieut.!Governors!pulled!from!the!ICS,!17.!
!
179 !O’Leary,!17.!
!
180 !Christopher!V.!Hill,!South$Asia:$An$Environmental$History,!ABCACLIO’s!Nature!and!
Human!Societies!Series!(Santa!Barbara,!Calif:!ABCACLIO,!2008),!113.!!Surendranath!
Banerjea!passed!the!exam!in!1869,!was!dismissed!on!a!technicality.!!He!appealed!
and!was!reinstated,!only!to!be!dismissed!again!on!a!different!technicality.!He!
eventually!became!a!leader!in!the!early!nationalist!movement.!
!
181 Sikata!Banerjee,!Muscular$Nationalism:$Gender,$Violence,$and$Empire$in$India$and$
Ireland,$191482004,!Gender!and!Political!Violence!Series!(New!York:!New!York!
University!Press,!2012),!150.!
!
182 !Hill,!104.!
!
!
62!
purpose!administrator!for!their!designated!regions,!handling!everything!from!
taxation!and!schools!to!policing!and!engineering!works.183!!!As!Hill!argues,!!
The!penal,!judicial,!revenue,!and!administrative!authority!were!
incorporated!into!one!young!Briton,!who!had!only!classroom!
knowledge!of!the!history,!society,!and!languages!of!India!and!no!
working!knowledge!of!his!particular!district,!let!alone!familiarity!
with!the!unique!dialect,!customs,!and!conventions!of!the!region!to!
which!he!had!been!assigned.184!!!
!
Thus,!the!Indian!Civil!Service!controlled!most!of!the!dayAtoAday!administration!of!
India!during!the!pandemic.185!!!
!
Each!province!also!had!a!legislative!council!with!both!British!and!Indian!
members.186!!These!councils!weren’t!entirely!representative!or!democratic—and!the!
Indian!positions!tended!to!be!dominated!by!highAcaste!Hindus??but!they!provided!
another!layer!of!governance!and!advice,!although!ultimately!the!ICS!and!the!Viceroy!
had!most!of!the!autonomous!power.187 !!Some!referred!to!the!ICS!as!“the!most!
powerful!officials!in!the!empire,”!and!many!Indians!saw!obtaining!a!position!within!
the!ICS!as!a!way!of!asserting!their!rights.188!!Working!within!the!ICS!became!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
183 !O’Leary,!25.!
!
184 !Hill,!94.!!In!this!instance!Hill!is!describing!the!ICS!in!its!earliest!form,!but!even!
after!the!institution!of!competitive!exams,!a!majority!of!the!dayAtoAday!activities!in!a!
province!were!under!the!jurisdiction!of!one!British!man!with!questionable!exposure!
to!Indian!culture.!
!
185 !O’Leary,!25.!!O’Leary!states!that!the!ICS!“rarely!exceed[ed]!1,200!in!number.”!
!
186 !O’Leary,!17.!!O’Leary!states!that!from!1880A1920!Indian!membership!on!the!
legislative!councils!increased!and!a!quick!survey!of!names!on!the!legislative!councils!
reveals!a!substantial!amount!of!Indian!members!by!1918.!
!
187 !O’Leary,!17.!
!
188 !Banerjee,!150.!
!
63!
increasingly!attractive!for!Indians!even!while!the!British!resisted!incorporating!
Indians!into!the!ICS.!!The!ICS!remained!predominantly!British!well!into!the!
twentieth!century,!but!this!autocratic!system!with!the!dressings!of!democracy!was!
facing!increasing!resistance!by!the!end!of!the!First!World!War.!
By!1918,!the!bureaucracy!in!India!faced!a!serious!understaffing!problem.!
British!bureaucrats!in!India!often!worked!with!a!skeleton!crew,!as!the!Indian!Civil!
Service!generally!operated!with!approximately!1200!men,!making!them!outnumbered!
by!Indian!citizens!200,000!to!one.189!!One!such!civilian,!Malcolm!Hailey,!the!Chief!
Commissioner!of!Delhi!from!1912A1918,!a!career!member!of!the!ICS,!had!been!in!India!
since!1894.!!In!the!late!summer!of!1918,!he!took!an!extended!leave!from!his!
position.190!!He!spent!August!to!October!in!Japan,!Korea,!and!China,!returning!home!to!
the!pandemonium!of!the!pandemic.191!!Hailey!reported!that!he!felt!a!strong!
connection!existed!between!the!high!death!toll!and!malnutrition,!but!shortly!after!his!
return!the!deaths!began!diminishing!and!on!November!6th!1918,!Hailey!turned!over!
his!position!to!the!next!commissioner.192!!!Although!some!important!members!of!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
189 !John!Whitson!Cell,!Hailey:$A$Study$in$British$Imperialism,$187281969!(Cambridge!
University!Press,!2002),!30.!!This!number!comes!from!the!early!20th!century,!but!
there!is!little!reason!to!believe!that!the!Indian!Civil!Service!had!increased!in!any!
significant!way!by!1918—in!fact,!it!is!entirely!possible!that!there!were!even!less!
British!officials!in!India!due!to!the!war.!
!
190 !Cell,!3,!57.!
!
191 !Cell,!57.!!Hailey’s!biographer!John!Cell!theorizes!that!Hailey!must!have!been!in!
extreme!duress!to!take!such!a!long!leave!during!that!critical!summer!of!the!First!
World!War,!although!Hailey!can!be!forgiven!for!not!foreseeing!the!flu!pandemic,!
something!no!one!anticipated.!
!
192 !Cell,!58.!!
!
64!
Civil!Service!noted!the!connection!between!flu!and!famine,!the!brief!nature!of!the!
pandemic!and!general!upheaval!of!the!Civil!Service!in!the!wake!of!the!war!let!it!pass!
unremarked!upon.!!The!war!spread!the!bureaucrats!thin,!and!the!end!of!the!war!and!
subsequent!shuffling!of!positions!only!led!to!more!gaps!in!oversight.!
The!established!bureaucracy!of!the!Government!of!India!did!not!make!for!
quick,!effective!action,!and!getting!the!necessary!changes!to!happen!would!be!like!
turning!the!Titanic!on!a!dime.!!The!government!instead!relied!on!district!boards!to!
provide!onAtheAground!reactions!to!crises.!!However,!in!the!case!of!the!influenza!
pandemic,!the!areas!worst!affected!could!not!mount!an!effective!response.!!As!a!result,!
India!came!to!be!governed!by!a!series!of!topAdown,!semiAautocratic!organizations!that!
operated!with!minimal!efficiency!in!the!deadly!fall!of!1918.!!!
*
Indian*Medical*Service*
The!ICS!and!the!Indian!Medical!Service!both!operated!with!a!fair!amount!of!
autonomy,!despite!their!qualms!about!their!degrading!status!as!the!twentieth!
century!progressed.!!!As!with!the!ICS,!the!IMS!had!a!large!degree!of!latitude!in!its!
mission,!with!officers!in!remote!areas!taking!over!positions!that!they!normally!
would!not.193!!Additionally,!the!IMS!and!ICS!were!far!outnumbered!by!the!people!
they!were!there!to!serve,!both!European!and!Indian.!!!This!situation!pushed!
members!of!the!ICS!and!IMS!into!unusual!roles!!as!their!missions!broadened!but!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!!
193 !O’Leary,!29.!
!
!
65!
their!recruitment!did!not.194!!Tension!among!centralized!authority,!a!sprawling!
bureaucracy,!and!men!performing!several!jobs!under!one!title!characterized!both!
the!IMS!and!the!ICS.!
The!IMS!handled!the!brunt!of!the!pandemic!in!1918,!largely!because!it!was!
the!largest!medical!organization!in!India!at!the!time.!!It!became!the!default!provider!
of!public!health!services!for!much!of!British!India,!although!it!was!originally!created!
to!service!only!military!members!and!their!families.195!!The!IMS!was!facing!several!
problems!before!1918!and!the!pandemic!exacerbated!the!cracks!in!the!increasingly!
overtaxed!service.!!!Much!like!the!ICS,!it!had!become!a!twoAtiered!organization!with!
British!men!in!the!high!paying!upper!echelons!and!largely!Indian!men!in!the!lower!
paying,!less!prestigious!positions.!
The!Indian!Medical!Service!had!existed!in!one!form!or!another!since!the!late!
eighteenth!century!and!grew!out!of!the!need!for!British!doctors!to!treat!company!staff!
and!ill!or!wounded!soldiers.196!!The!IMS!ran!hospitals!and!dispensaries!staffed!by!
British!trained!doctors!who!could!be!recalled!for!military!service,!as!many!were!
during!the!First!World!War.197!!However,!by!1918!the!IMS!had!been!declining!in!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
194 !O’Leary,!25.!!The!scope!of!responsibility!for!a!high!ranking!member!of!the!ICS!
was!truly!breathtaking,!as!they!were!in!charge!of!everything!from!jails!to!
agriculture.!
!
195 !Arnold,!Science,$Technology,$and$Medicine,!58.!!Arnold!observes!that!IMS!officials!
eventually!ran!prisons!and!mental!asylums!as!well!as!filled!professorial!positions!in!
various!scientific!fields.!!Arnold,!60.!
!!
196 !Arnold,!Science,$Technology$and$Medicine,!58.!!!
!
197 !Arnold,!Science,$Technology$and$Medicine,!59.!
!
!
66!
prestige!for!years,!and!the!dual!catastrophe!of!war!and!pandemic!hit!when!the!IMS!
had!already!been!hollowed!out!by!falling!recruitment.!!!
The!Indian!Medical!Service!modeled!itself!on!the!ICS,!with!similarly!
structured!entrance!exams!and!structure.198 !!Although!the!IMS’s!stated!purpose!was!
to!provide!medical!care!for!the!army,!“most!of!those!attached!to!regiments!and!
military!cantonments!also!served!Indian!civilians.”199!!However,!IMS!doctors!could!
also!practice!private!medicine,!which!brought!them!into!closer!contact!with!native!
populations!and!nonAmilitary!British!colonists.200!!Many!British!men!in!the!IMS!saw!
their!position!in!India!as!an!opportunity!to!research!rather!than!practice!medicine,!
and!since!the!early!nineteenth!century!the!IMS!had!been!an!important!contributor!
to!medical!and!scientific!research!on!tropical!diseases.201!Like!the!ICS,!the!IMS!
resisted!attempts!at!to!let!Indian!men!into!their!organization—called!IndianisationAA
but!both!organizations!also!had!a!subordinate!corps!of!Indian!men!to!carry!out!
other!duties!in!the!provinces!and!presidencies.202!
!
Criticisms!of!the!IMS!in!the!early!twentieth!century!came!from!within!and!
without.!!Internal!issues!were!largely!related!to!the!tension!between!the!need!for!
more!recruits!and!Indianisation,!as!those!inside!the!IMS!felt!that!more!white!recruits!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
198 !O’Leary,!28.!
!
199 !O’Leary,!28.!
!
200 !O’Leary,!30.!!O’Leary!does!note!that!not!every!IMS!post!allowed!doctors!to!
practice!privately,!but!many!did!to!supplement!their!incomes.!
!
201 !Mark!Harrison,!“Tropical!Medicine!in!Nineteenth!Century!India,”!The$British$
Journal$for$the$History$of$Science,!Vol.25,!No.!3!(September!1922),!300.!
!
202 !O’Leary,!30.!
!
!
67!
were!needed!and!those!outside!the!IMS!pushed!for!increasing!numbers!of!Indian!
recruits.203!!Externally,!some!criticized!the!IMS!for!stifling!competition!and!creating!
a!difficult!environment!for!private!practitioners.204!!The!IMS’s!reach!made!it!harder!
for!men!not!associated!with!the!IMS—either!British!or!Indian—to!set!up!their!own!
private!clinics,!and!the!medical!community!in!India!became!a!deAfacto!monopoly.!!As!
recruitment!dried!up!and!the!war!siphoned!off!members!of!the!IMS,!India!did!not!
have!a!private,!BritishAtrained!medical!community!to!fill!in!the!gaps.!
!
In!order!to!serve!with!the!IMS,!a!British!man!would!complete!medical!school!
and!then!take!an!entrance!exam!to!join!the!service.!!In!the!years!preceding!the!First!
World!War,!the!prestige!that!accompanied!serving!in!the!IMS!fell!sharply,!and!much!of!
the!discussion!around!the!IMS!during!the!war!centered!on!ways!to!entice!more!British!
men!to!join.205!!The!Government!of!India!blamed!the!decline!in!prestige!and!
accompanying!recruitment!slump!on!increasing!numbers!of!Indians!being!allowed!
into!the!IMS.!!Since!the!Government!of!India!saw!British!doctors!as!a!requirement!for!
the!proper!health!care!of!Europeans!in!India,!officials!clung!to!the!idea!of!a!EuropeanA
dominated!Indian!Medical!Service!as!an!absolute!necessity!despite!pushback!from!
high!level!members!of!the!government!in!Britain.206!!The!relative!difficulty!in!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
203 !Arnold,!Science,$Technology$and$Medicine,!65.!
!
204 !Arnold,!Science,$Technology$and$Medicine,!65.!
!
205 !!Arnold,!Science,$Technology$and$Medicine,!59A60.!
!
206 !Arnold,!Science,$Technology$and$Medicine,!59,!61!and!“The!Future!of!the!Indian!
Medical!Service,”!British$Medical$Journal,!July!6,!1918,!13.!*Arnold!claims!that!given!
the!sheer!number!of!Europeans!and!the!incredible!dearth!of!European!doctors,!by!
the!1920s!it!was!highly!unlikely!that!all!British!residents!of!India!were!seeing!
!
68!
recruiting!British!men!into!the!IMS!meant!that!the!highest!positions!were!occupied!by!
British!men!but!a!large!portion!of!the!other!operations!were!handled!by!Indian!men!
trained!in!western!medicine.!207!!A!handful!of!medical!schools!opened!specifically!for!
this!purpose,!and!between!1913!and!1922,!Indian!recruits!slightly!outnumbered!
European!recruits.208!!Despite!this!increase!in!Indian!doctors,!the!IMS!was!still!
woefully!understaffed.!
Indianisation!was!one!of!the!major!stumbling!blocks!between!the!Indian!
Medical!Service!and!the!British!government.!!London!looked!at!the!low!recruitment!
numbers!and!the!disastrous!ratio!of!doctors!to!people!and!concluded!the!best!
course!of!action!would!be!to!recruit!more!Indian!men.!!Indian!men!were!allowed!
into!the!IMS,!but!few!joined!en!masse.209!!Those!who!jointed!had!shortened!tenures,!
often!complaining!of!racism!and!hostility!as!their!reasons!for!leaving!the!IMS.210!!
Indianisation!was!met!with!cries!of!doom!and!gloom!by!both!the!upper!echelons!and!
the!rank!and!file!of!the!IMS.211!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
exclusively!white!doctors.!!However,!the!salient!point!is!that!the!government!
believed!that!having!a!primarily!European!IMS!was!of!utmost!importance.!!!
!
207 !Arnold,!Science$Technology$and$Medicine,!62.!
!
208 !Arnold,!Science,$Technology$and$Medicine,!60A62.!!1913A1922!saw!111!European!
recruits!and!122!Indian!recruits.!
!
209 !Arnold,!Science$Technology$and$Medicine,!64!
!
210 !Arnold,!Science$Technology$and$Medicine,!65.!
!
211 !O’Leary,!30,!and!Arnold$Science$Technology$and$Medicine,!60.!
!
69!
In!taking!steps!towards!rectifying!this!problem,!some!Indian!members!of!!the!
government!advocated!for!a!new,!civilian!led!medical!service!even!before!the!
vagaries!of!the!flu.!!In!March!of!1918,!the!Hon’ble!Sastri!said,!
I!do!not!deny!that!the!Indian!Medical!Service!has!done!wonders!for!
India!to!the!sum!of!medical!knowledge.!!But!when!all!this!is!said—and!I!
say!it!with!all!my!heart!without!meaning!to!take!away!anything!from!
the!credit!due!to!the!Indian!Medical!service—let!me!say!that!it!must!
not!be!allowed!any!more!to!dominate!the!whole!of!the!civil!medical!
profession,!to!keep!the!children!of!the!soil!out!of!what!is!their!rightful!
place,!and!generally!to!check!the!growth!of!the!independent!medical!
profession!…!thus!producing,!as!I!said!before,!some!harm!to!the!
progress!of!the!science!itself,!and!at!the!same!time,!in!many!cases,!
doing!no!good!to!the!positions!themselves.!
!
Sastri!raised!several!issues!with!the!organization!of!the!IMS.!!First!it!“dominated”!
the!civil!medical!profession,!and!second!it!kept!Indian!people!from!joining!medical!
practices!in!large!numbers.!!He!is!likely!referring!to!the!fact!that!while!the!IMS!
technically!accepted!Indian!men,!those!numbers!had!remained!low!for!most!of!the!
20th!century.212!!Sastri!even!positioned!himself!as!a!defender!of!science,!arguing!that!
the!stranglehold!the!IMS!had!on!research!and!professorial!positions!made!it!harder!
for!new!talent!with!different!ideas!to!break!through.!!These!charges!were!hardly!
unheard!of,!as!any!organization!that!has!an!essential!monopoly!over!a!field!in!a!
country!will!eventually!be!accused!of!being!too!insular!and!stifling!advancement.!!As!
a!prelude!to!the!complete!devastation!of!the!flu,!however,!the!charges!seem!eerily!
prescient.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
212 !Arnold,!Science$Technology$and$Medicine,!65.!!According!to!Arnold,!several!Indian!
members!of!the!IMS!resigned!after!short!careers,!“feeling!themselves!unwelcome!or!
undervalued!by!European!members!of!the!service.”!
!
!
70!
Edwin!Montagu,!Secretary!of!State!for!India,!came!down!in!favor!of!
Indianisation.!!The!British!Medical!Journal!reported!that!Montagu!believed!in!the!
mission!of!the!IMS!and!that,!“His!considered!opinion!is!that!the!Indian!Medical!
Service!is!essential!to!India,!and!that!the!conditions!under!which!it!is!recruited!and!
works!must!be!such!as!to!enable!it!to!attain!the!highest!efficiency.”213!!Montagu!
agreed!with!many!of!the!IMS’s!grievances!and!supported!their!desire!for!higher!
wages!and!better!leave!policies!to!allow!European!men!time!to!return!to!Britain.!!
However,!Montagu!also!stated,!“!the!Service!must!afford!in!its!organisation!
increased!and!increasing!opportunities!for!Indians!to!enter.”214 !!Montagu!advocated!
for!some!of!the!IMS!wish!list,!but!for!him,!Indianisation!was!the!way!of!the!future,!no!
matter!what!objections!the!IMS!lodged.!
Indian!men!had!not!entered!western!medical!schools!in!large!numbers!until!
the!early!20th!century!largely!due!to!the!prejudice!of!the!British!and!their!resistance!to!
integration!of!the!IMS.!!The!IMS!only!had!roughly!5,000!Indian!men!in!subordinate!
medical!positions!and!fiftyAfive!Indian!members!of!the!IMS!proper!by!the!start!of!the!
First!World!War.215!!After!the!war!concluded,!a!short!article!in!the!British$Medical$
Journal!announced!an!urgent!need!for!204!new!members!of!the!IMS,!with!136!of!those!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
213 !“The!Future!of!the!Indian!Medical!Service.”!!
!
214 !“The!Future!of!the!Indian!Medical!Service.”!!
!
215 !Arnold,!Science$Technology$and$Medicine,!64.!!4,000!men!served!as!subAassistant!
surgeons!and!1,000!as!assistant!surgeons!by!the!1920s,!according!to!Arnold,!while!
the!fifty!five!Indian!members!of!the!IMS!were!in!position!by!the!start!of!the!war.!
!
!
71!
positions!reserved!specifically!for!Europeans.216!!The!dearth!of!western!trained!
medical!men!willing!to!travel!to!or!live!in!India!combined!with!resistance!to!recruiting!
Indian!men!gave!the!IMS!an!almost!unintentional!monopoly!on!western!medicine.!!
Arnold!notes,!!
By!the!First!World!War,!as!enrolment!in!Indian!medical!schools!and!
colleges!began!to!soar,!a!growing!number!of!Indian!men!and!women!were!
entering!the!medical!profession…But!this!was!mainly!in!the!cities,!leaving!
the!small!towns!and!districts!to!folk!medicine,!to!the!practitioners!of!a!
revitalised!indigenous!medicine!and!to!the!few,!widely!scattered,!public!
health!institutions.217!
!
Therefore,!the!presence!of!western!medicine!in!India!was!at!once!both!widespread!
and!not!widely!available.!!This!stark!paradox!in!access!to!medical!professionals!will!be!
explored!in!a!later!chapter,!but!the!rural!and!urban!divide!would!eventually!have!an!
impact!on!flu!deaths,!as!the!ability!and!desire!to!use!available!medical!resources!
would!be!key!to!surviving!the!pandemic.!!!
Because!India!had!a!deficit!of!western!trained!medical!practitioners,!either!
Indian!or!white,!many!British!residents!of!India!most!likely!saw!Indian!doctors!
rather!than!members!of!the!IMS.218!!The!growing!number!of!men!in!Indian!medical!
schools!would!help!increase!western!doctors!in!India,!but!those!applicants!were!
Indian,!not!white.!!This!issue!became!a!bone!of!contention!in!the!IMS!and!within!the!
Indian!government,!as!the!need!for!more!doctors!warred!with!the!racism!of!empire.!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
216 !“The!needs!of!the!Indian!Medical!Service,”!British$Medical$Journal,$September!13,!
1919,!352.!!
!
217 !Arnold,!Science$Technology$and$Medicine,!65.!!!
!
218 !Arnold,!Science$Technology$and$Medicine,!59.!
!
!
72!
Traditional!Indian!systems!generally!served!the!Indian!population!while!the!
IMS!confined!itself!to!white!Britons,!but!as!the!nineteenth!century!drew!to!a!close,!
Indian!people!began!making!a!space!for!themselves!within!western!modes!of!
knowledge,!education,!and!thought.219!!As!larger!numbers!of!Indian!people!began!
entering!western!medical!colleges,!the!two!systems!started!to!come!into!closer!
contact—not!necessarily!because!Indian!men!brought!these!ideals!with!them!into!
medical!school!but!because!the!barriers!between!British!and!Indian!were!eroding.!
Pay!proved!to!be!another!problem.!!The!European!members!of!the!IMS!
continually!felt!that!their!pay!was!not!commensurate!with!their!expertise!and!
expenses.!!!A!retired!member!of!the!IMS!took!this!issue!to!task!in!the!British$Medical$
Journal,!breaking!down!the!pay!offered!to!a!member!of!the!IMS!as!compared!to!
expenses!and!to!other!employees!of!the!Government!of!India.!!He!argued,!“It!thus!
appears!that!the!medical!officer!is!the!worst!paid!of!any!of!the!principal!services!in!
India.!!This!fact!should!be!known!to!the!profession,!and!when!it!is!known!it!does!not!
appear!likely!that!Mr.!Montagu!will!get!the!recruits!he!is!asking!for,!which!are!so!
urgently!required!to!allow!of!the!overwrought!officers!getting!their!overdue!
leave.”220!!He!noted!the!unusual!expenses!a!British!family!living!in!India!faced,!
including!needing!to!send!children!back!to!England!for!education!and!the!high!cost!
associated!with!trips!back!and!forth!from!India!and!England.!!He!also!pointed!out!
that!despite!being!promised!furloughs!every!five!years!upon!joining!the!IMS,!many!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
219 !Arnold,!Science,$Technology,$and$Medicine,!64.!
!
220 !‘I.M.S.!Retired,’!“Letter!to!the!Editor,”!British$Medical$Journal,!February!28,!1920,!
308.!*Although!published!in!1920,!this!letter!is!an!excellent!breakdown!of!the!costs!
associated!with!being!a!member!of!the!IMS.!
!
!
73!
members!still!had!not!had!a!furlough!for!over!ten.!!He!concluded!that!the!IMS!
needed!an!immediate!50%!increase!in!pay!over!preAwar!levels,!an!increase!in!
pensions,!and!“free!passages!to!and!from!India.”221!!While!much!of!this!individual’s!
letter!focused!on!detailing!the!exact!expenses!a!family!in!India!would!face!on!an!IMS!
salary,!he!couched!his!call!for!better!compensation!as!integral!to!increasing!
recruitment!of!British!men.!!At!no!point!did!he!comment!on!the!difficulties!an!Indian!
man!would!face!on!this!salary,!likely!because!an!Indian!man!would!not!be!expected!
to!make!regular!trips!back!to!England,!nor!would!he!be!seen!as!“needing”!to!send!his!
children!to!Britain!for!education.!!!!
!
The!IMS!also!had!a!tenuous!relationship!with!the!Indian!people.!!In!1897!new!
Indian!legislation!intended!to!stop!the!spread!of!plague!allowed!segregation!of!plague!
camps!based!on!caste!and!religion!and!awarded!plague!committees!the!power!to!stop!
any!Indian!person!suspected!of!carrying!plague!from!traveling!via!railway.!!The!
legislation!contained!an!exemption!for!European!persons!which!led!to!unrest!as!
Indian!people!expressed!their!anger!at!unfair!treatment.222!Government!regulations!
and!sanitary!issues!exacerbated!tensions!on!the!ground!as!the!IMS!became!a!symbol!
of!European!indifference.!223!However,!one!should!not!view!the!IMS!as!a!purely!
European!model!of!health!care.!!While!it!did!operate!as!a!de!facto!public!health!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
221 !“Letter!to!the!Editor.”*!
!
222 !Harrison,!Contagion,$182A183.!!!
!
223 !In!Contagion,!Harrison!notes!that!not!all!members!of!the!IMS!in!1897!agreed!with!
this!legislation!and!encouraged!a!slower!approach!to!reforms!so!as!to!not!anger!
Indian!people,!but!they!were!overruled!by!younger!men!eager!to!make!definitive!
progress!against!disease.!!Harrison,!183.!
!
!
74!
organization,!interest!in!Indian!forms!of!medical!treatment!permeated!the!IMS!from!
its!inception,!as!British!doctors!consulted!vaids,!hakims,!and!translations!of!Indian!
medical!texts!to!understand!diseases!on!the!subcontinent.224!!Harrison!comments,!
“While!interaction!between!European!and!Indian!medical!practitioners!often!fell!far!
short!of!a!dialogue!between!equals,!the!willingness!of!Europeans!to!incorporate!
certain!indigenous!ideas!and!practices!led!to!the!emergence!of!a!distinctive!AngloA
Indian!medical!tradition.”225!!!
In!Medical$Encounters$in$British$India,!Kumar!argues!that!in!general,!Indian!
people!preferred!those!trained!in!indigenous!methods!to!western!medicine!but!
indigenous!practitioners!also!borrowed!from!western!practices,!publishing!journals!
and!posting!prices!much!like!their!British!counterparts.226!!This!syncretic!tradition!
was!reciprocal,!as!British!doctors!in!turn!embraced!the!use!of!traditional!drugs.227!!!As!
Arnold!warns,!one!should!not!assume!that!the!British!embraced!traditional!medicine!
as!equal!to!their!own,!but!rather!saw!elements!of!Indian!medicine!as!exploitable!and!
translatable!to!western!sensibilities.228!!In!this!way,!the!relationship!between!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
224 !Mark!Harrison,!Climates$&$Constitutions:$Health,$Race,$Environment$and$British$
Imperialism$in$India,$160081850!(New!Delhi ;!New!York:!Oxford!University!Press,!
1999),!7.!
$
225 !Arnold,!Science,$Technology$and$Medicine,!60!and!!Harrison,!Climates$&$
Constitutions,!8.!
!
226 !Deepak!Kumar,!“Probing!History!of!Medicine!and!Public!Health!in!India:!A!Study!
of!Encounters!at!Multiple!Sites,”!in!Medical$Encounters$in$British$India,$Deepak!
Kumar!and!Raj!Sekhar!Basu,!eds,!(New!Delhi:!Oxford!University!Press,!2013),!31.!!!
!
227 !Kumar,!“Probing!History!of!Medicine,”$31,!32.!!!
!
228 !Arnold,!Science,$Technology$and$Medicine,!66.!
!
!
75!
indigenous!and!western!medicine!in!India!was!one!of!tension,!adaptation,!and!
exchange.!!!
Deepak!Kumar!delves!further!into!this!relationship,!arguing!that!the!distance!
between!Western!and!indigenous!systems!of!medicine!made!it!a!nationalist!rallying!
cry!as!practitioners!“vehemently!denied!that!their!system!was!unscientific!or!
irrational.”229!!The!difference!in!approaches!between!the!two!systems!proved!
difficult!as!well,!as!western!medicine!tended!to!place!importance!on!the!cause!of!the!
disease!while!indigenous!systems!put!their!effort!into!treatment!of!symptoms.230!!
These!differing!approaches!added!yet!another!roadblock!to!the!parallel!medical!
communities!on!the!eve!of!the!outbreak!of!flu,!hampering!their!ability!to!work!
together!effectively.!
!
Public*Health*in*India*and*Britain*
Early!Victorian!public!health!efforts!in!Britain!had!focused!on!public!facilities!
like!sanitation!and!clean!water!as!upper!and!middle!class!Britons!attempted!to!
improve!their!quality!of!life!while!also!bringing!the!lower!classes!into!more!hygienic!
circumstances.!!Public!health!became!a!moral!imperative!for!Victorian!Britain,!as!
Anthony!Wohl!argues,!and!the!topAdown!attitude!towards!controlling!and!improving!
Victorian!cities!foreshadowed!British!perspectives!on!public!health!in!India.231 !!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
229 !Kumar,!“Probing!History!of!Medicine,”!36.!
!
230 !Kumar,!“Probing!History!of!Medicine,”$36.!
!
231 Anthony!S.!Wohl,!Endangered$Lives:$Public$Health$in$Victorian$Britain!(Cambridge,!
Mass:!Harvard!University!Press,!1983).,!6.!
!
!
76!
Similarly,!public!health!in!Britain!started!with!its!eyes!on!preventable!diseases,!
certain!that!conquering!preventable!illness!would!be!the!start!to!an!improved!
future.232!!When!faced!with!public!health!crises!in!India!in!the!late!nineteenth!and!
early!twentieth!centuries,!British!officials’!turned!to!quarantine!and!prevention!as!
the!first!line!of!defense.!
The!structure!of!public!health!in!India!echoed!the!structure!of!public!health!in!
Britain,!with!a!central!authority!operating!over!a!large,!sprawling!bureaucracy!that!
worked!in!concert!with!local!officials.233!!Medical!officers!in!Britain!attempted!to!
identify!sources!of!disease,!control!local!and!widespread!outbreaks!of!infection,!and!
conduct!extensive!scientific!research!into!the!cause,!treatment,!and!mitigation!of!
disease.234!!Officers!and!doctors!in!India!operated!in!much!the!same!way,!as!a!failsafe!
in!the!event!of!a!crisis!and!as!a!permanent!research!corps!attempting!to!solve!what!
they!saw!as!the!unique!the!problems!presented!by!India’s!tropical!climate.!!!
The!Indian!people!had!long!known!of!methods!to!prevent!epidemics,!as!the!
extensive!practice!of!variolation!against!smallpox!in!the!eighteenth!and!nineteenth!
centuries!demonstrates.235!!By!the!late!nineteenth!century!vaccination!had!replaced!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
232 !Wohl,!8.!
!
233 !Wohl,!150.!
!
234 !Wohl,!164.!
!
235 !Arnold,!Science,$Technology$and$Medicine,!72.!!Variolation!involved!rubbing!a!
patient’s!arm!with!cloth!for!several!minutes!and!then!pricking!the!skin!before!
placing!cotton!that!contained!“‘variolous!matter’!taken!from!pustules!produced!by!
the!previous!year’s!inoculations”!on!the!patient’s!skin.!!!Arnold!states!that!at!least!
60%!of!Bengal!and!its!surrounding!areas!protected!themselves!from!smallpox!in!
this!manner!in!the!late!eighteenth!century,!and!that!many!Indian!people!saw!
vaccination!as!polluting!the!body.!!Arnold,!74.!
!
77!
variolation!throughout!the!subcontinent!as!the!primary!form!of!defense!against!
smallpox.236 !!Variolation!and!vaccination!used!different!techniques—despite!their!
similar!ideological!underpinnings!of!exposing!the!body!to!a!form!of!the!disease!in!
order!to!trigger!an!immune!response—!and!the!British,!over!the!course!of!the!
nineteenth!century,!set!about!delegitimizing!variolation!and!proclaiming!it!inferior!
and!even!dangerous!when!compared!with!the!British!program!of!vaccination.!!Not!all!
British!medical!officials!resisted!variolation,!and!many!even!throughout!the!late!
nineteenth!century!argued!that!bringing!tikdars!into!the!fold!would!be!for!the!benefit!
of!all.237!In!the!case!of!smallpox!prevention,!the!British!instituted!a!formal!campaign!
against!Indian!traditional!medicine!and!won,!alienating!Indian!people!in!the!process.!!
When!the!flu!hit,!this!tension!may!have!accounted!for!why!the!British!did!not!
coordinate!very!well!with!traditional!practitioners.!
David!McLean!summarizes!one!of!the!major!challenges!of!British!public!health!
in!the!nineteenth!century!in!his!work!titled!Public$Health$and$Politics$in$the$Age$of$
Reform,!tracking!the!British!response!to!cholera!in!the!early!nineteenth!century.!!One!
of!the!first!major!public!health!crises!in!the!Industrial!Age,!cholera!required!both!
medical!and!sanitary!approaches!in!order!to!control.!!Similar!to!governmental!
responses!in!India!the!early!nineteenth!century,!cholera!epidemics!required!a!hybrid!
approach.!!McLean!writes,!!
Forming!Boards!of!Health,!dividing!Unions!into!medical!districts,!
appointing!district!medical!officers,!warning!the!citizenry!of!an!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
236 !Arnold,!Science,$Technology$and$Medicine,!73.!
!
237 !Arnold,!Science,$Technology$and$Medicine,!73.!
!
!
78!
epidemic,!ensuring!the!removal!of!nuisances,!organising!house!
inspections,!erecting!cholera!hospitals,!creating!houses!of!refuge,!issuing!
medicines!freely!to!the!poor!at!public!dispensaries!and!removing!the!
dead!from!public!places!were!all!the!responsibilities!of!Union!Guardians.!!
Some!Unions,!however,!were!perceived!to!have!undertaken!their!duties!
more!assiduously!than!others…238!
!
McLean!was!describing!a!cholera!outbreak!in!Britain!in!1849,!but!the!methods!and!
results!featured!above!bear!remarkable!similarities!to!public!health!policies!in!
British!India!in!the!waning!days!of!the!First!World!War.!!The!methodical!nature!and!
reliance!on!bureaucracy—districts!overseen!by!an!officer,!public!control!and!
monitoring!of!places!and!people!most!likely!at!risk—would!not!have!been!out!of!
place!in!the!United!Provinces!in!1918.!!Much!like!in!India!in!1918,!these!responses!
depended!heavily!on!the!competence!of!the!individuals!bearing!a!large!amount!of!
responsibility.!
!!!!!!!!!!!!!The!British!took!this!model!of!public!health!developed!in!nineteenth!century!
Britain!and!dropped!it!wholesale!into!the!subcontinent.!!What!worked!for!the!slums!
of!industrial!Britain!was!decreed!to!work!for!the!slums!of!Calcutta!and!Bombay.!!!
There!were!a!few!concessions!made!to!India’s!unique!character,!as!some!British!
men!acknowledged!the!potency!and!possible!efficacy!of!Indian!remedies!for!various!
infections!and!diseases.239!!The!bureaucratic!structure!codified!in!Britain!remained!
in!place!in!India,!albeit!with!possibly!even!less!oversight.!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
238 David!McLean,!Public$Health$and$Politics$in$the$Age$of$Reform:$Cholera,the$State$
and$the$Royal$Navy$in$Victorian$Britain,!International!Library!of!Historical!Studies!33!
(London ;!New!York :!New!York:!I.B.!Tauris ;!Distributed!in!the!U.S.!by!Palgrave!
Macmillan,!2006),!165A166.!!!
!
239 !Arnold,!Science,$Technology$and$Medicine,!70.!
!
!
79!
Medical*Schools*and*Restrictions!
!
In!the!first!few!decades!of!the!twentieth!century,!the!medical!community!in!
India!became!increasingly!regulated.!!Even!as!fewer!British!men!signed!up!to!serve!
as!doctors!in!India,!legislation!had!been!passed!in!the!previous!few!years—and!had!
been!discussed!for!longer!than!that—that!started!slowly!restricting!the!number!of!
approved!medical!schools!in!India.!!With!only!a!few!hundred!spots!per!school,!the!
lack!of!accredited!schools!for!such!a!large!population!should!have!caused!
consternation!among!the!British,!but!instead!they!presented!the!regulations!as!an!
attempt!to!improve!quality.!!It!also!reinforced!the!privileged!status!of!men!with!
British!medical!qualifications!and!created!no!small!amount!of!resentment!among!the!
Indian!people.240!
When!the!Bengal!Legislative!Council!met!in!September!of!1918,!they!
discussed!the!situation!of!accreditation!and!registration!of!medical!officials!
extensively.!!At!issue!were!acts!passed!in!1914!and!1916!that!laid!out!the!
standards!for!registered!medical!schools!and!doctors.!!Much!of!the!controversy!
centered!on!men!attending!Indian!medical!schools!who!would!not!receive!
proper!accreditation!and!would!not!be!able!to!register!as!doctors!in!India.!!Sir!
Henry!Wheeler!dismissed!these!complaints!as!irrelevant,!noting,!
If!they!went!to!a!school,!knowing!full!well!that!these!restrictions!on!
medical!degrees!were!in!the!air!as!far!back!as!1908,!they!have!no!
right!to!come!before!us!now!and!say!that!they!have!been!badly!
treated!because,!in!the!face!of!what!they!knew,!they!chose!to!stay!in!
an!institution!which!could!not!give!them!a!registrable!degree;!they!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
240 !Haynes,!215A216.!
!
!
80!
have!to!suffer!from!the!consequences!of!what!they!themselves!
chose!to!do.241!
This!attitude!raised!several!problems.!!First,!Wheeler!seemed!to!assume!that!men!
attending!Indian!medical!colleges!knew!which!schools!would!be!considered!for!
accreditation!and!which!would!not,!and!it!is!not!at!all!clear!that!the!general!public!had!
access!to!this!information.!!P.C.!Mitter!pointed!this!out,!arguing!that!while!the!Act!had!
been!considered!since!1908,!people!could!not!be!held!accountable!for!something!that!
had!not!been!implemented!at!the!time!they!joined!medical!school.242!!Second,!it!hints!
at!a!broader!problem!and!racism!in!the!medical!community!in!India,!as!restrictions!
tightened!just!before!the!country!would!need!the!medical!community!the!most.!!Now,!
obviously!no!one!can!fault!them!for!failing!to!foresee!the!absolute!devastation!the!flu!
would!bring,!as!this!meeting!came!before!the!epidemic.!!Lack!of!foresight!is!not!the!
issue!here,!but!rather!the!growing!trend!toward!limiting!and!restricting!qualified!
medical!personnel!in!India.!!While!a!lack!of!proper!accreditation!would!not!have!
deprived!men!attending!Indian!medicals!schools!of!their!knowledge—and!thus!they!
may!have!been!able!to!assist!in!some!capacity!when!the!pandemic!hit—it!did!constrict!
the!number!of!practitioners!the!government!could!organize!in!the!event!of!a!
pandemic.!!Even!before!the!First!World!War!began,!the!IMS!had!only!1,500!positions!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
241 !Sir!Henry!Wheeler!to!the!Bengal!Legislative!Council,!“Resolutions,”!September!3,!
1918,!Proceedings$of$the$Bengal$Legislative$Council$for$the$meeting$held$on$3rd$
September,$1918,*(Calcutta:!Bengal!Secretariat!Book!Depot,!1918),![hereafter!BLC,!
918A919.!
!
242 !The!Hon’ble!P.C.!Mitter!to!the!Bengal!Legislative!Council,!“Resolutions,”!
September!3,!1918,!BLC,!918A919.!!!
!
!
81!
for!doctors!in!India,!with!several!thousand!more!positions!at!lower!levels.243!!With!a!
population!of!over!240!million!people!the!IMS!alone!had!little!chance!against!the!
virulence!of!the!flu.!
Wheeler!went!on!to!assert!that!men!could!just!“go!practice!in!the!bazaars”!and!
this!restriction!only!meant!they!could!not!append!certain!degrees!to!their!name.!!Babu!
Surendra!Nath!Ray!rebutted!this!claim,!alleging!that!he!knew!a!doctor!let!go!from!his!
position!when!the!Medical!Act!passed,!and!the!claim!that!these!men!would!still!
practice!in!the!manner!in!which!they!had!in!the!past!did!not!hold!water.244!!Clearly,!
these!restrictions!caused!upheaval!in!the!medical!community,!forcing!qualified!
medical!practitioners!out!of!their!jobs!mere!months!before!they!would!be!desperately!
needed.!!While!these!limitations!would!not!have!retroactively!deleted!their!
knowledge!of!medicine,!being!unable!to!be!registered!as!a!doctor!would!hamper!their!
ability!to!be!useful!during!a!time!of!crisis.!!The!coordinated!efforts!of!nursing,!
hospitals,!and!relief!centers!helped!alleviate!suffering,!and!men!who!had!attended!
institutions!that!were!denied!accreditation!by!the!Medical!Acts!could!not!be!a!part!of!
these!efforts.!
!
The!Medical!Act!of!1914!in!Bengal,!in!fact,!expressly!prohibited!anyone!not!
meeting!official!standards!from!practicing!medicine.!!It!stated,!!
Except!with!the!special!sanction!of!the!Local!Government,!no!person!
other!than!a!registered!practitioner!shall!be!competent!to!hold!any!
appointment!as!medical!officer!of!health,!or!as!physician!surgeon!or!
other!medical!officer!in!any!hospital,!asylum,!infirmary,!dispensary!or!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
243 !Haynes,!224.!
!
244 !Sir!Henry!Wheeler!to!the!Bengal!Legislative!Council,!“Resolutions,”!921.!!
!
!
82!
lyingAinAhospital!which!is!supported!partially!or!entirely!by!public!or!
local!funds.245!
!
By!tying!governmental!accreditation!and!registration!to!a!job!in!any!medical!facility!
supported!by!public!funds,!the!Government!in!Bengal!attempted!to!create!a!
standardized!method!of!measuring!medical!qualifications.!!Barring!these!men!from!
any!medical!facility!that!received!public!or!local!funds!meant!cutting!loose!men!with!
medical!knowledge!at!a!time!when!that!knowledge!would!soon!be!at!a!premium.!!
The!First!World!War!siphoned!off!many!qualified!medical!personnel!to!begin!with,!
and!these!restrictions!only!contributed!to!the!problem.! !!
In!another!exchange,!a!representative!at!the!Bengal!Legislative!Council!
claimed!the!effect!of!the!act!was!“to!deprive!all!privately!managed!medical!
institutions!such!as!the!Belgachia!Institution!of!the!power!of!granting!diplomas!or!a!
registrable!certificate.”246!!While!the!government!of!four!years!previously!cannot!be!
held!directly!responsible!for!not!foreseeing!a!catastrophic!worldwide!pandemic,!the!
in!the!end!the!act!deliberately!restricted!the!amount!of!medical!personnel!in!India.!!
The!debate!centered!on!getting!more!men!admitted,!but!the!fact!remained!that!the!
Act!of!1914!placed!India!in!a!position!of!having!even!fewer!medical!personnel!than!
possible!on!the!eve!of!a!desperate!need!for!them.!!!This!debate!tied!into!the!IMS’s!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
245 !Manual$of$Rules$for$the$Management$of$Hospitals$and$Dispensaries$Under$the$
Supervision$of$the$Government$of$Bengal$(Corrected$up$to$1920),!(Calcutta:!The!
Bengal!Secretariat!Book!Depot,!1921),!49.!!IOR:!V/852/9,!British!Library,!London,!
United!Kingdom.*!
!
246 !Babu!Surendra!Nath!Ray!to!the!Bengal!Legislative!Council,!“Resolutions,”!
September!3,!1918,!BLC,!913.!!!
!
!
83!
near!strangleAhold!on!western!medicine,!as!an!independent!medical!corps!in!India!
had!failed!to!develop.247!
!
Different*Traditions*
While!western!medicine!had!made!a!foothold!in!India,!traditional!Indian!
practitioners!had!long!provided!care!for!Indian!people.!!In!a!moment!of!prescience,!
in!the!summer!of!1918!the!Government!of!India!had!commissioned!a!study!on!the!
chemical!composition!of!the!drugs!used!in!traditional!systems!of!medicine.!!In!the!
United!Provinces!Legislative!Council!the!report!was!met!with!serious!debate!as!to!
the!nature!of!science!and!validity!of!accepting!Unani!and!Ayurvedic!systems!of!
medicine.!!The!debate!centered!on!the!incorporation!of!these!remedies!into!western!
medicine,!with!Sir!Alexander!Cardew!arguing,!“I!understand!the!Hon’ble!Mr.!Ranga!
Achariyar’s!attitude!in!this!matter,!!This!is!an!Indian!system,!he!is!an!Indian!and!
therefore!he!is!naturally!interested!in!it.”248!Cardew’s!condescending!tone!
continued,!“I!can!understand!that.!!But!in!such!a!matter!we!cannot!be!guided!by!
patriotism.!!This!is!a!case!of!science.!!You!cannot!have!an!Indian!mathematics,!any!
more!than!you!can!have!French!or!Japanese!mathematics.!!In!that!same!way!you!
cannot!have!an!Indian!system!of!medicine.”249!!This!mindset!demonstrates!the!uphill!
battle!Indian!modes!of!knowledge!had!to!fight!for!recognition.!!Even!this!report,!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
247 !Arnold,!Science,$Technology$and$Medicine,!65.!
!
248 !Sir!Alexander!Cardew!to!the!Legislative!Council!of!the!United!Provinces,!
“Resolution!Re!Encouragement!of!Ayurvedic!and!Unani!Systems!of!Medicines,”!
August!15,!1918,!UPLC,!122.!!!
!
249 !Cardew,!“Resolution,”!122.!!!
!
!
84!
which!had!been!commissioned!with!the!express!notion!of!incorporating!Indian!
medicines!into!western!medical!knowledge,!framed!!the!debate!in!an!inherently!
western!way.!!Similarly,!quinine!had!been!part!of!a!treatment!for!“Burdwan!fever”!
created!by!kavirajs!in!Bengal!and!hakims!in!the!Punjab!since!the!1860s!and!by!the!
1920s!was!being!sold!by!the!British!to!combat!malaria.250!!By!operating!under!the!
mindset!that!Indian!remedies!could!only!be!understood!via!western!science—and!
that!there!is!only!one!“science”!much!like!there!is!only!one!“math”—the!British!took!
an!alienating!position.!!!
British!control!of!Indian!knowledge!extended!as!far!as!the!government.!!
Cardew’s!condescending!tone!implies!that!he!did!not!believe!the!Indian!people!ere!
capable!of!separating!their!desire!to!elevate!their!country!and!the!necessity!of!
knowledge.!!!This!patriarchal!attitude!alienated!Indian!people,!who!viewed!British!
intervention,!particularly!in!matters!of!public!health,!with!a!healthy!amount!of!
skepticism.!!Drawing!on!a!long!memory!of!neglect!during!other!times!of!crisis,!such!
as!the!famines!of!the!late!nineteenth!century,!and!unfairly!applied!procedures!to!
stem!the!spread!of!plague,!the!Indian!people!appeared!reluctant!to!trust!the!
British.251!!The!British!government!dug!a!deep!hole!for!itself!right!before!the!
pandemic!began,!even!in!terms!of!projects!that!were!meant!to!improve!the!quality!of!
life!in!India.!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
250 !Arnold,!Science$Technology$and$Medicine,!71.!!Burdwan!fever!was!a!name!for!
malaria!was!which!epidemic!in!Bengal!at!the!time.!
!
251 !Polu,!46!and!Davis,!31.!
!
!
85!
Bureaucratic*Strain*
The!Bengal!Legislative!Council!raised!questions!about!the!lack!of!men!
available!for!Sanitary!Inspector!positions!in!the!early!days!of!the!flu!pandemic.!!The!
British!government!believed!sanitation!and!public!health!to!be!closely!linked,!and!
“the!concept!of!‘sanitary!engineering’…developed!to!denote!‘environmental!health’!
rather!than!the!limited!original!concept!of!‘plumbing.’”252!!!The!sanitation!movement!
in!Britain!gained!momentum!in!the!1860s!and!1870s,!led!largely!by!men!with!
medical!degrees!who!saw!better!sanitation!as!a!way!to!improve!health.253!!As!a!
result,!positions!in!sanitation!were!increasingly!given!to!men!with!medical!
qualifications,!since!the!relationship!between!issues!like!clean!water!and!public!
health!were!so!closely!linked.!!The!Bengal!Legislative!Council!requested!an!
explanation!for!the!unfilled!Sanitary!Inspector!positions!for!an!explanation!of!the!
qualifications!required.!!Mr.!O’Malley!replied,!“Yes,!the!reason!is!the!paucity!of!
candidates!who!passed!the!sanitary!engineering!portion!of!the!examination!after!the!
session!of!1916.!!It!was!accordingly!decided!that!the!only!passed!subAoverseers!
would!be!admitted!to!the!class!as!men!without!their!training!appeared!to!be!unable!
to!reach!the!standard!required.”254!!He!went!on!to!display!a!list!of!the!requirements!
for!Sanitary!Inspectors.!!These!men!acted!as!both!health!officers!and!engineers,!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
252 !Kumar,!“Probing!History!of!Medicine,”!33.!
!
253 !Jeanne!L.!Brand,!Doctors$and$the$State:$The$British$Medical$Profession$and$
Government$Action$in$Public$Health$187081912,!1st!edition!(The!Johns!Hopkins!
University!Press,!1965),!8.!
!
254 !Hon’ble!Mr.!O’Malley!to!the!Bengal!Legislative!Council,!“Questions!and!Answers,”!
September!3,!1918,!BLC,!874.**!
!
!
86!
required!to!oversee!the!“hygiene”!of!their!area.!!These!requirements!made!a!certain!
amount!of!sense,!as!both!proper!drainage!and!knowledge!of!vaccinations!would!be!
required!to!keep!a!populace!healthy.!!It!placed!a!strain!on!the!officials!who!were!
required!to!perform!the!duties!of!two!separate!jobs.!
!
The!required!elements!for!a!Sanitary!Inspector!of!any!level!were!attendance!
to!training!and!lectures!on!hygiene,!vaccines,!infectious!diseases!of!animals,!and!
disinfection,!as!well!as!surveying,!latrines,!construction,!water!supply,!drainage,!and!
engineering!works!in!their!municipalities.255!!These!requirements!intended!to!
improve!the!health!of!the!local!population,!and!the!link!between!poor!sanitation!and!
infectious!diseases!was!well!known!throughout!the!British!Empire.!!Thus,!putting!
the!oversight!of!both!under!one!office!follows!fairly!naturally.!!Just!as!the!flu!began!
to!kill!hundreds!upon!thousands!of!Indian!people,!the!offices!went!unfilled!as!men!
could!not!meet!the!requirements!of!both!halves!of!the!job!in!another!example!of!the!
understaffed!British!bureaucracy!in!India.!
!
Nigeria!provides!another!example!of!other!parts!of!the!empire!where!the!
governmental!apparatus!failed!to!operate!effectively.!!In!Nigeria,!an!anticolonial!
newspaper!accused!authorities!of!creating!“a!panic!worse!than!influenza!itself”!and!
that!“People!are!even!afraid!to!be!sick.”256!!The!author!singled!out!quarantine!
stations!as!particularly!unhelpful,!writing,!!
Many!people!who!had!been!to!the!Quarantine!Station!have!
complained!of!being!made!to!sleep!on!bare!cement!floor!or!with!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
255 !K.C.!De,!Officiating!Secretary!to!the!Government!of!Bengal,!“Notification,”!
September!3,!1918,!BLC,!876.!!
!
256 !Editorial!“Influenza!in!Lagos,”!Lagos$Standard,$October!2,!1918.***
!
!
87!
only!palm!leaves!on!the!floor!to!serve!as!mats.!!And!many!of!these!
people!have!been!compelled!to!leave!their!comfortable!beds!and!
good!homes!with!good!and!abundant!food!to!undergo!as!Influenza!
“contacts”!the!hardships!both!of!want!of!food!and!physical!
discomfort!and!be!exposed!to!conditions!that!might!make!them!
catch!their!deaths!of!cold.257!!!
!
The!newspaper!took!authorities,!specifically!members!of!the!Sanitary!boards!and!
medical!officers,!to!task!for!their!attempts!to!control!the!pandemic!by!shutting!down!
areas!and!limiting!transportation.!!The!writer!advocated!for!the!sanitary!authorities!
to!limit!their!actions!to!“closing!of!the!schools,![…]!issuing!of!instructions!for!the!
guidance!of!the!people,!and!the!Medical!Office!of!Health!had!spent!his!energy!in!
advising!Medical!practitioners!as!to!the!proper!method!of!isolating!patients!in!their!
homes…”258!!Any!other!steps!were!unnecessary!and!caused!more!harm!than!good.!
We!are!given!a!picture!of!a!colonial!state!in!chaos,!drawing!the!ire!of!the!indigenous!
people.!!The!drastic!measures!not!only!did!nothing!to!improve!the!situation,!it!
argued,!but!actually!worsened!the!pandemic!for!many.!
!
Another!Nigerian!correspondent!felt!that!British!colonial!government!had!
done!too!little.!!He!wrote,!“Early!precautionary!measures!are!essential!to!protect!our!
people!in!the!hinterland,”!claiming!that!the!impact!of!the!disease!could!be!softened!if!
a!government!agent!could!direct!people!on!precautionary!measures!and!“rescue!
them!from!the!dreadful!devastation!of!the!plague!and!the!barbarous!treatment!with!
the!native!medicene![sic]…perhaps!a!Travelling!Doctor!&c!&c!may!be!spared!for!this!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
257 !Editorial!“Influenza!in!Lagos,”!Lagos$Standard,$October!2,!1918.!!*
!
258 !Editorial!“Influenza!in!Lagos,”!Lagos$Standard,$October!2,!1918.!!*
!
!
88!
purpose.”259!!The!Nigerian!correspondent!placed!their!faith!in!preventative!
measures!and!limited!steps!by!the!government!to!support!western!medicine.!
The!war,!of!course,!changed!the!situation!dramatically.!!In!1914,!Britain!
entered!the!First!World!War!which!dragged!on!until!the!waning!days!of!1918!and!
consume!enormous!reserves!of!manpower.!!As!a!nominally!military!organization,!
the!IMS!sent!many!men!to!the!front.!!The!war!dried!!up!the!supply!of!possible!new!
recruits!for!the!next!four!years,!as!qualified!doctors!signed!up!for!service!in!the!war!
instead!of!in!India.260!!What!had!been!an!already!sluggish!process!of!recruitment!
slowed!to!a!trickle!as!the!war!continued.!!This!drain!on!personnel!would!add!an!
overwhelming!burden!to!those!doctors!who!remained!in!India!during!the!pandemic!
and!ties!the!narrative!of!the!pandemic!closely!with!the!narrative!of!the!war.!
The!Indian!Medical!Service!faced!numerous!challenges!by!1918.!!The!First!
World!War!provided!the!most!obvious!obstacle,!drawing!qualified!medical!men!
away!from!India,!out!of!the!recruiting!pool,!and!sending!them!to!the!front!lines!
instead.!!By!the!fall!of!1918,!four!years!of!constant!warfare!left!only!a!skeleton!crew!
behind!in!India.!!Additionally,!the!IMS!had!been!complaining!for!years!of!
diminishing!returns!on!recruits,!as!more!and!more!men!rejected!the!Indian!Medical!
Service!as!a!viable!option.!!Members!of!the!upper!echelons!of!the!IMS!attributed!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
259 !J.A.!Oduenade,!“Letter!to!the!Editor!dated!October!28!1918,”!in!the!Lagos$
Standard,!October!30,!1918.!!
!
260 !Arnold,!Science,$Technology$and$Medicine,!60.!
!
!
89!
their!falling!recruitment!numbers!to!a!loss!of!prestige,!caused!by!the!low!pay!and!by!
the!increasing!visibility!in!Indian!men!in!the!IMS.261!
!
For!the!duration!of!1918,!the!IMS!was!plagued!with!organizational!problems!
and!perceived!itself!to!be!illAused!by!the!war!effort,!as!reflected!by!an!article!in!the!
British$Medical$Journal!!detailing!medical!care!during!the!First!World!War.!!In!August!
of!1918,!the!article!claimed,!“The!failure!of!the!Mesopotamia!campaign!in!its!early!
stages!was!primarily!due!to!the!inadequate!conception!the!Government!of!India!and!
the!CommanderAinAChief!of!India!formed!of!the!magnitude!of!the!military!task.!…The!
medical!units!were!insufficient,!and!their!equipment!out!of!date.”262!!This!strident!
claim!set!the!tone!for!the!article’s!list!of!failures,!which!revealed!an!illAprepared!
medical!corps!doing!their!best!in!the!face!of!poor!odds.!!!“Moreover,!when!the!scope!
of!operations!was!extended,!reinforcements!were!sent!without!essential!medical!
units!to!join!a!force!fighting!in!a!treacherous!climate,”!the!article!continued.263!!The!
lack!of!preparation!and!foresight!in!sending!reinforcements!without!the!necessary!
support!personnel!loomed!large!in!this!indictment!of!the!military.!!Finally,!it!
concluded,!“It!was!of!course!inevitable,!when!failure!overtook!the!expedition,!that!
the!medical!organization!should!suffer!with!the!rest,!and!indeed!more!than!the!rest,!
for!the!task!of!the!medical!service!in!a!retreat!is!extraordinarily!difficult!even!when!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
261 !I.M.S!Retired,!“The!Indian!Medical!Service:!Is!it!Worthwhile?”!British!Medical!
Journal,!February!28,!1920,!308,!and!Arnold,!Science,$Technology$and$Medicine,!61.!
!
262 !“The!Fifth!Year,”!British$Medical$Journal$August!10,!1918,!137.!!
!
263 !“The!Fifth!Year,”!137.!!
!
!
90!
the!transport!is!adequate!and!lines!of!communication!free…”264!!The!article!
portrayed!the!failure!not!as!a!fault!of!the!medical!corps,!but!as!a!result!of!an!
inadequately!prepared!bureaucracy.!!The!strain!between!the!IMS!and!the!
Government!of!India!added!one!more!burden!to!an!already!tenuous!system.!!
Even!before!the!flu!hit,!the!IMS!was!voicing!its!displeasure!with!the!way!the!
war!effort!was!using!doctors.!!A!major!complaint!was!that!the!Army!Medical!Service!
was!not!using!members!of!the!IMS!in!the!best!way!possible,!and!that!the!war!effort!
was!suffering!as!a!result.!!An!August!1918!article!in!the!British$Medical$Journal!
grumbled,!“The!Indian!Medical!Service!became!little!more!than!a!supply!department!
for!certain!purposes;!officers!of!that!service!enured!to!the!prevention!and!treatment!
of!tropical!diseases,!and!surgeons!of!wide!clinical!experience!were!not!used,!or!were!
placed!in!subordinate!positions!where!they!could!have!little!influence!on!the!course!of!
events.”265!!Not!only!were!the!officers!not!effectively!deployed,!but!this!failure!led!to!
unnecessary!and!possibly!preventable!deaths.!!The!article!revealed!the!depth!to!which!
the!IMS!was!feeling!illAused!and!ignored!throughout!the!war!stated,!“To!malaria,!
dysentery,!and!wound!infections!the!men!fell!victims!in!thousands,!while!the!I.M.S.!
officers!and!civilian!practitioners!with!the!army!had!to!stand!by!powerless!to!apply!
the!preventative!measures!which!they!knew!would!have!saved!lives!and!lessened!
invaliding.”!266!!This!article!revealed!the!depth!to!which!the!IMS!was!feeling!illAused!
and!ignored!throughout!the!war.!!It!also!indicates!that!many!members!of!the!IMS!had!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
264 !“The!Fifth!Year,”!137.!!
!
265 !“The!Fifth!Year,”!137.*!
!
266 !“The!Fifth!Year,”!137.*!
!
!
91!
been!subsumed!into!the!war!effort,!leaving!a!skeleton!crew!in!India!that!would!not!
have!been!capable!of!handling!a!massive!pandemic,!as!well!as!India’s!status!as!a!
subordinate!colony!that!was!burdened!with!supplying!the!war!effort!and!received!
little!in!turn.!!
!An!article!published!in!the!British$Medical$Journal!in!July!of!1918!outlined!
problems!with!the!IMS!although!it!was!subsequently!less!critical!of!“competing”!
medical!organizations.!!This!article!summarized!the!various!issues!the!IMS!faced,!
including!over!300!civilians!switching!to!the!military!for!the!war,!a!need!for!longer!
breaks!so!IMS!officers!could!return!to!Britain,!and!the!need!to!increase!
opportunities!for!Indians!to!enter.267!!Some!of!the!problems!were!written!off!as!
temporary,!such!as!the!war!drawing!more!men!into!military!service,!but!the!article!
portrays!others!as!mere!hiccups!or!annoyances,!which!could!be!easily!solved!with!
more!leave.!!!!!
!
During!the!First!World!War,!some!members!of!the!IMS!seemed!overly!
preoccupied!with!their!pensions,!with!dozens!of!letters!to!the!British!Medical!Journal!
and!the!Indian!Medical!Gazette!lamenting!the!decreasing!pension.268!!The!pension!
wars!were!intricately!linked!to!issues!with!recruitment,!as!members!of!the!IMS!clearly!
believed!that!the!low!pensions!for!new!IMS!recruits!were!adversely!affecting!their!
numbers!at!a!time!when!they!could!illAafford!fewer!recruits.!!Tension!over!the!Royal!
Army!Medical!Corps!(RAMC)!existed!as!well,!as!members!of!the!IMS!seemed!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
267 !“The!Future!of!the!Indian!Medical!Service,”!British$Medical$Journal,!July!6,!1918,*
13.*!
!
!
268 !“Letter!to!the!Editor,”!and!“The!Future!of!the!Indian!Medical!Service.”!*!
!
92!
perpetually!worried!they!would!be!subsumed!into!the!RAMC.!!Competition!for!
qualified!doctors!exploded!during!the!war!as!men!were!needed!at!the!front,!and!the!
IMS’s!various!recruiting!challenges!seemed!insurmountable.!
!
The!war!was!not!just!a!distant!conflict!for!India,!but!in!fact!a!very!real!
presence.!!Demands!of!the!war!placed!a!heavy!burden!on!the!Indian!army,!drawing!
men!to!the!front!lines!in!France!as!well!as!in!other!theaters.!269!!Sick!and!wounded!
men!were!invalided!back!to!India!for!care,!and!“a!number!of!war!hospitals!have!been!
formed,!other!hospitals!have!been!expanded!and!improved,!and!ruling!chiefs!and!
others!have!generously!provided!hospitals!and!convalescent!homes!in!Bombay!and!
elsewhere…”270!!For!India!the!First!World!War!was!a!real!and!immediate!concern,!
with!men!leaving!for!the!front!lines!and!returning!to!be!nursed!back!to!health!on!
Indian!soil.!
!
The!situation!in!India!was!not!unique.!Even!Britain!saw!its!medical!community!
stretched!to!nearly!the!breaking!point!during!World!War!I.!!A!British$Medical$Journal!
article!described!how!the!pandemic!“greatly!aggravated!the!shortage!of!civilian!
practitioners,”!in!Britain.271!!It!continued,!
Owing!to!the!prevalence!of!influenza!for!some!months!past!the!calls!
on!the!civil!medical!profession!had!been!heavy!and,!simultaneously,!
severe!fighting!on!a!great!scale!on!all!the!fronts!had!imposed!
additional!strain!on!our!medical!resources.!!Concurrently!with!the!
increasing!spread!of!influenza!the!number!of!doctors!employed!on!
medical!boards!had!been!reduced,!an!in!order!further!to!reinforce!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
269 !“The!War:!India!and!the!War,”!British$Medical$Journal,*December!7,!1918,*612.*!
!
270 !“The!War:!India!and!the!War,”*612.*!
!
271 !“Influenza!and!the!Shortage!of!Doctors,”$British$Medical$Journal,$November!2,!
1918,!495.*!
!
!
93!
doctors!available!for!the!civil!population,!medical!examinations!of!
recruits!in!advance!had!been!suspended!for!the!present,!while!the!
medical!staffs!of!hospitals!had!been!strengthened!so!far!as!resources!
permit.272!!!
!
Britain!faced!the!same!strain!as!India,!as!the!war!ate!up!valuable!medical!resources!at!
a!time!when!the!civilian!population!was!in!desperate!need.!!The!British!people!did!not!
have!much!choice!in!this!matter—the!western!front!needed!doctors!as!much!if!not!
more!than!the!home!front—but!the!end!result!remained!was!similar!to!India.*
However,!the!smaller!population!of!the!island!of!Britain,!coupled!with!the!various!
advantages!of!the!metropole,!made!the!situation!slightly!less!dire.!
!
In!his!Preliminary$Report$on$the$Influenza$Pandemic,!F.!Norman!White!reported!
on!the!dismal!state!of!the!medical!community!in!India!prior!to!the!pandemic.!!He!
wrote,!“The!epidemic!struck!India!at!a!time!when!she!was!least!prepared!to!cope!with!
a!calamity!of!such!magnitude.!!War!had!depleted!her!medical!personnel,!which!at!best!
is!inadequate!when!compared!to!the!size!of!her!population.!!The!overAworked!medical!
personnel!that!remained!was!stricken!down!in!large!numbers.”273!!As!a!Major!in!the!
IMS!and!the!Sanitary!Commissioner!for!all!of!India,!White!would!have!been!uniquely!
qualified!to!commenting!on!both!preAwar!staffing!and!contemporary!staffing!levels,!
both!of!which!he!deemed!inadequate.!!Col.!MacTaggart!echoed!this!statement,!
claiming,!“The!demands!owing!to!the!war!on!the!medical!personnel!of!the!Provinces!
have!been!extensive!and!the!Provinces!have!been!depleted!of!their!medical!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
272 !“Influenza!and!the!Shortage!of!Doctors,”!495.!!
!
273 !Preliminary$Report,!12.!!!
!
!
94!
establishments!superior!and!subordinate,!to!an!extent!which!no!one!prior!to!the!war!
had!ever!for!a!moment!contemplated!as!being!possible.”274!
The!number!of!“officiating”!instead!of!“official”!sanitary!commissioners!in!the!
provinces!also!implied!an!organization!in!flux!when!the!pandemic!hit.!!The!First!
World!War!had!siphoned!off!both!current!members!and!potential!recruits!for!the!ICS!
and!IMS,!and!the!top!echelons!of!the!IMS!seemed!far!more!concerned!with!the!longA
term!health!of!the!organization!rather!than!preparing!for!an!asAyetAunforeseen!
pandemic.!!Many!officials,!when!filing!their!reports!on!the!flu,!responded!with!a!
figurative!shrug!to!questions!of!how!to!prepare!for!a!future!pandemic.!!They!felt!that!
vaccination!would!be!insufficient!to!protect!a!majority!of!the!populace,!and!while!
relief!centers!provided!some!measure!of!respite!from!the!ravages!of!influenza,!they!
were!not!widespread!enough!nor!used!enough!by!the!poorest!people.275!!In!short,!the!
IMS!was!not!only!illAprepared!to!handle!the!pandemic,!they!doubted!their!very!ability!
to!respond!effectively!if!another!pandemic!struck.!
!
Conclusion*
!
The!bureaucracy!governing!India!in!1918!found!itself!in!a!precarious!
position.!!Built!on!nineteenth!century!principles!of!governance,!the!ICS!resisted!
Indianisation!as!strenuously!as!possible,!while!members!of!the!ICS!operated!semiA
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
274 !United$Provinces$Report,!205.!!
!
275 !Calcutta$Report,!2.!In!his!report!Crake!peevishly!notes!of!the!poorest!people!in!his!
district,!“They!are!a!difficult!class!to!deal!with,!and!not!only!conceal!cases!but!often!
refuse!all!advice!and!treatment.”!
!
!
!
95!
fiefdoms!throughout!the!subcontinent.!!The!strict!hierarchy!combined!with!a!small!
number!of!men!controlling!vast!swaths!of!people!and!land!made!for!a!difficult!
combination.!!The!Indian!Medical!Service!operated!on!two!parallel!missionsAA!
originally!intended!to!serve!just!the!military!they!eventually!expanded!their!role!
until!they!were!the!deAfacto!public!health!organization!in!India.!!The!IMS’s!
stranglehold!on!western!medicine,!coupled!with!resistance!to!Indianisation!and!
decreasing!opportunities!for!Indian!men!to!enter!accredited!medical!schools,!meant!
that!India!in!1918!faced!a!serious!shortage!of!westernAtrained!doctors.!!Indigenous!
medicine!had!a!long!history!in!India!and!some!western!practitioners!embraced!
traditional!remedies,!but!the!tension!between!white!doctors!and!the!Indian!people!
went!far!deeper!than!those!overtures!could!fix.!!!
!
The!First!World!War!killed!millions!of!young!soldiers,!but!it!also!created!a!
tremendous!drain!on!resources!for!the!nations!involved.!!Britain!diverted!enormous!
reserves!of!manpower!and!material!to!the!Western!Front!and!this!led!to!a!strain!on!
India’s!own!resources.!!As!fewer!men!signed!up!to!serve!in!the!empire!both!the!
Indian!Medical!Service!and!the!Indian!Civil!Service!found!themselves!operating!a!
thinly!spread!bureaucracy!in!the!midst!of!both!a!war!and!a!public!health!crisis.!!
These!structural!flaws!would!be!more!fully!revealed!when!the!flu!pandemic!hit!and!
the!major!institutions!on!the!front!lines!did!not!seem!able!to!cope!effectively.!
!
!
!
!
!
!
96!
Chapter*Three*
Footsteps$of$Famine:$The$Situation$Worsens$
$
*
All!classes!and!creeds!are!liable!to!suffer,!but!the!mortality!varies!with!classes.!!
Europeans!who!live!under!almost!ideal!hygienic!conditions!suffer!very!slightly.!!
Indians!under!good!conditions!of!livelihood!and!assured!of!proper!medical!
attendance,!food,!and!clothing,!escape!comparatively!lightly.!!The!people!who!suffer!
most!are!the!poor!and!the!rural!classes,!whose!housing!conditions,!medical!
attendance,!food!and!clothing!are!in!defect.!…!In!the!present!epidemic!the!poor!and!
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!owing!to!the!
fodder!famine.276!!
!
In!1918,!the!ghostly!footsteps!of!famine!lurked!behind!the!flu!pandemic,!and!
the!Sanitary!Commissioner!of!the!Punjab!drew!a!direct!connection!between!the!death!
toll!of!the!influenza!pandemic!and!the!famine!sweeping!through!the!subcontinent.!277!!
The!monsoons!failed,!and!by!early!fall!prices!rose!across!India!due!to!a!smaller!than!
usual!harvest.!!FamineAdriven!price!spikes!hit!the!poorest!people!the!hardest!who!in!
turn!suffered!the!highest!death!tolls!from!the!flu.278!!Through!it!all,!British!officials!in!
India—both!in!the!Indian!Medical!Service!and!the!Government!of!India—faced!a!dual!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
276 !Punjab$Report,!5A6.!!!
!
277 !Sen,!Poverty$and$Famine,!49.!!In!the!same!vein,!Keneally!compares!the!famines!of!
Ireland!in!1845,!Bengal!in!1943,!and!the!Ethiopian!famines!of!the!1970s!and!1980s.!!
While!these!famines!have!different!causes!and!conditions,!Keneally’s!discussion!of!
famines!and!state!power—particularly!a!government!at!war!in!1943—!furnish!a!
solid!methodology!for!the!study!of!famines.!!
!
278 !Preliminary$Report,!8.!*Europeans!in!Bombay!died!at!a!rate!of!8.3!per!thousand,!
while!lowAcaste!Hindus!saw!death!tolls!of!61.6!per!thousand.!
!
!
97!
catastrophe!of!famine!and!disease.279!!Many!officials!chose!to!focus!on!the!famine,!but!
while!it!may!have!been!an!exacerbating!factor!in!the!pandemic,!it!was!not!the!main!
cause!of!death.!!The!impending!famine!complicated!the!official!response!to!the!
influenza!pandemic,!and!the!pandemic!complicated!famine!relief.!!In!spite!of!the!large!
death!toll!from!influenza,!the!British!by!and!large!came!to!see!their!limited!
intervention!in!the!1918!famine!as!successful.!!The!Indian!people!did!not!agree,!and!
connected!the!British!failure!to!a!larger!critique!of!empire.!!Newspapers!portrayed!the!
British!as!heartless!tyrants,!and!members!of!Legislative!Councils!called!for!more!
intervention!than!the!British!deemed!necessary.!
Amartya!Sen!uses!the!term!“entitlement”!in!Poverty$and$Famine!to!parse!how!
access!to!food!is!determined,!and!notes,!“In!the!Bengal!famine!of!1943!the!people!who!
died!in!front!of!wellAstocked!food!shops!protected!by!the!state!were!denied!food!
because!of!lack!of!legal!entitlement.”280!!The!core!problem!in!famines!was!not!a!dearth!
of!food!itself!but!inadequate!access!to!it.!!State!intervention!in!the!market!would!have!
solved!much!of!the!scarcity,!but!British!adherence!to!classical!liberal!free!market!
principles!rejected!such!intervention.!
The!pandemic!of!1918!arrived!four!years!into!a!war!that!required!both!
resources!and!personnel!from!India,!further!sapping!the!morale!of!the!British!people!
and!stretching!the!resources!of!both!the!IMS!and!the!army!to!the!breaking!point.!!The!
IMS!had!experience!with!the!influenza!virus,!but!when!the!flu!exploded!worldwide!
with!unparalleled!mortality,!the!already!overwhelmed!medical!service!had!very!little!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
279 !Or!a!triple!catastrophe,!depending!on!how!avoidable!you!consider!the!First!
World!War.!
!
280 !Sen,!49.!
!
98!
time!to!adequately!prepare.!!Then,!less!than!three!months!after!the!flu!began!claiming!
hundreds!of!victims!a!day,!it!virtually!disappeared.!!The!flashAinAtheApan!nature!of!the!
pandemic!made!it!nigh!impossible!to!prepare!for,!and!once!it!disappeared,!it!may!have!
simply!been!easier!to!ignore!it!than!to!address!the!fallout!in!a!functional!way.!!
In!contrast,!the!British!had!extensive!experience!with!preparing!for!famines!
when!the!monsoons!failed!to!materialize!as!usual!in!the!late!summer!of!1918.!!The!
Famine!Codes,!a!provincial!set!of!procedures!for!officials!to!follow,!were!well!
established.!!Despite!the!strain!placed!on!the!bureaucracy!by!the!war,!the!British!
considered!themselves!well!placed!to!weather!a!famine.!!Kharif,$or!wet!season!crops!
like!rice,!cotton!and!fodder!crops!failed,!and!rabi,$or!dry!season,!crops!like!wheat,!
“were!confined!to!tracts!with!irrigational!facilities.”281!The!relatively!minor!famine!of!
1918—“There!was!wonderfully!little!acute!distress!amongst!human!beings,”!
proclaimed!the!Review$of$the$Famine$Relief$Administration$in$the$Bombay$Presidency$$
During$the$Year$191881919$—seemed!well!suited!to!British!modes!of!control.!!
However,!the!arrival!of!the!flu!just!as!price!spikes!appeared!added!a!new!layer!of!
difficulty!to!managing!the!famine.!
When!faced!with!the!flu!and!a!famine,!the!British!chose!to!expend!their!energy!
on!famine!relief,!limited!though!it!might!have!been.!Famine!had!established!
procedures!in!place,!and!although!the!government!could!not!replace!the!rains!they!
could!diminish!the!fallout.!!Deadly!influenza!was!new.!!The!strain!between!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
281 !Review$of$the$Famine$Relief$Administration$in$the$Bombay$Presidency$$During$the$
Year$191881919,$(Bombay:!Government!Central!Press,!1920),!1A3,![hereafter!Bombay$
Famine$Report!191881919]!and*Resolution$on$the$Administration$of$Famine$Relief$in$
the$United$Provinces$of$Agra$and$Oudh$during$the$years$1918$and$1919,$!(Allahabad:!
Superintendent!Government!Press,!United!Provinces,!1920),!1![hereafter!United$
Provinces$Famine$Report$191881919].!!
!
99!
centralized!bureaucracy!of!the!Government!of!India!and!the!reliance!on!local!
governments!to!provide!immediate!relief,!as!explored!in!the!previous!chapter,!proved!
another!obstacle!to!efficient!relief.!!Institutional!blindness!also!contributed!to!the!
disproportionate!focus!on!the!famine,!as!the!Government!of!India!had!established!
procedures!to!warn!of!and!prepare!for!famine,!while!flu!did!not.!!The!overwhelming!
death!toll!of!influenza!inordinately!affected!poorer!Indians,!making!it!easier!for!
wealthy!British!officials!to!overlook!its!terrible!legacy!and!focus!on!the!famine.!
!
Famine*History*
Famine!in!India!had!a!long,!difficult!history,!particularly!India!under!British!
control.!!While!British!policies!may!have!played!a!role!in!both!creating!and!worsening!
famines,!the!initial!causes!of!the!scarcity!were!often!out!of!their!control.!!British!
policies!often!created!more!chaos!than!they!solved,!and!only!after!the!dawn!of!the!20th!
century!did!the!British!management!of!famines!improve.!!Before!the!twentieth!
century,!famine!in!British!India!was!synonymous!with!horrific!loss!of!life!and!callous!
British!officials!prioritizing!British!profits!over!Indian!lives.282!
Amartya!Sen!in!Poverty$and$Famines!argues!that!structures!put!into!place!by!
imperial!powers!to!control!food!can!push!an!area!into!famine!as!the!state!either!
grants!or!denies!access.!!The!Famine!Codes,!created!by!the!British!in!the!1880s!to!
create!a!coherent!governmental!policy!regarding!Indian!famines,!play!an!important!
role!in!this!determination,!but,!as!Sen!argues,!the!existence!of!the!codes!did!not!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
282 !Davis,!28.*
*
!
100!
necessarily!guarantee!their!implementation.283!!B.M.!Bhatia!also!posits!that!while!
India!did!experience!famines!prior!to!British!rule,!those!famines!increased!in!
frequency!in!the!nineteenth!century,!particularly!after!the!British!crown!assumed!
official!control!of!India.284!!The!latter!half!of!the!nineteenth!century!saw!localized!
famines!turn!into!sharp!price!increases!across!the!subcontinent,!putting!food!out!of!
reach!for!the!poorest!people.285!!In!the!case!of!the!1918!famine,!the!poorest!people!
were!the!ones!the!most!directly!affected!by!the!influenza!pandemic!as!well.!
Late!19th!century!famines!cost!India!between!12.2!and!29.3!million!people!
from!1876!to!1902.286!!Mike!Davis’!Late$Victorian$Holocausts!lays!the!blame!for!the!
death!toll!at!the!feet!of!the!British!government!and!details!the!!connection!between!
famine!and!disease,!writing,!“Famine!synergizes!with!disease!in!two!different!if!
mutually!reinforcing!modes,”!those!modes!being!“exposure”!and!“susceptibility.”287!!
People!weakened!by!malnutrition!are!more!likely!to!fall!victim!to!epidemic!diseases,!
such!as!malaria!or!typhus,!or!they!may!be!more!exposed!to!diseases!like!cholera!in!
crowded!refugee!camps!and!work!camps!created!to!house!and!feed!victims!of!
famine.288!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
283 !Sen,!Hunger$and$Public$Action,!126!and!Davis,!58A59.!
!
284 !Bhatia,!8.!
!
285 !Bhatia,!9.!
!
286 !Davis,!7.*
*
287 !Davis,!22.!
!
288 !Keneally,!13!and!Davis,!40.!
!
!
101!
Very!few!victims!of!famine!die!from!starvation—in!fact,!only!10%!die!of!
starvation!alone.289 !!Bodies!denied!proper!nutrition!begin!mining!liver!tissue!for!
stores!of!glycogen,!which!can!be!turned!into!the!desperately!needed!glucose.!!The!
body!uses!amino!acids!and!body!fats!in!the!same!way,!and!any!glucose!produced!in!
this!manner!is!assigned!to!brain!function!above!all!else,!leaving!muscles,!tissues,!and!
organs!to!slowly!waste!away.290!!In!this!weakened!state,!famine!victims!are!prime!
targets!for!infections.!
The!most!common!infections!for!famine!victims!are!diseases!like!typhus!and!
dysentery,!both!of!which!thrive!in!close!quarters.!!When!famine!strikes,!people!
become!mobile,!looking!for!new!sources!of!food.291!!These!groups!of!people!spreading!
pathogens,!and!in!the!case!of!late!19th!and!early!20th!century!India,!famine!meant!
work!camps.!!The!British!government!would!set!up!camps!to!feed!victims,!provided!
they!worked!for!their!keep.!!These!camps!could!be!breeding!grounds!for!illness,!
something!highlighted!in!the!Famine!Codes!as!the!British!sought!to!keep!disease!from!
spreading.292!!Even!for!those!not!in!camps,!famine!brought!along!with!it!high!rates!of!
death!from!disease.!!In!the!1896!famine,!for!example,!“The!high!mortality!caused!by!
such!diseases!as!cholera,!dysentery,!malaria!fever!and!smallApox!was!due!to!
insufficiency!of!food!consumption!at!prevailing!high!prices,!which!debilitated!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
289 Keneally,!13.!
!
290 !Keneally,!12.!
!
291 !Davis,!22.!
!
292 !Bombay$Famine$Report$191881919,!8.!*The!Report!cheerfully!notes,!“Cholera!
broke!out...but!it!yielded!promptly!to!the!measures!taken!to!check!its!spread.”!
!
!
102!
people!and!reduced!their!power!of!resistance!against!diseases.”293!!When!the!flu!
arrived!on!the!heels!of!the!1918!famine,!it!found!a!populace!primed!for!disaster.!
!
Famine*Codes*and*Procedures*
The!Famine!Codes!contained!a!long,!complicated!set!of!procedures!intended!to!
allay!some!of!the!destruction!wrought!by!famine.!!Each!province!maintained!these!
codes!and!revised!them!periodically.294!!From!indirect!relief!in!the!form!of!suspension!
of!revenue!demand!and!loans!to!stricken!areas!to!direct!relief!in!the!form!of!poor!
houses,!kitchens,!and!relief!works!to!provide!employment!for!the!starving,!the!Famine!
Codes!provided!a!road!map!for!British!officials!faced!with!impending!famines,!
resulting!in!long,!detailed!handbooks.295!!The!long!history!of!famine!in!India!found!its!
match!in!the!British!need!for!order.!
In!1913,!Bengal!published!a!revised!edition!of!their!famine!code.296!!Three!
chapters!alone!describe!procedures!for!times!of!ordinary!harvest!and!times!when!
information!indicated!that!famine!or!scarcity!may!be!looming,!and!fifteen!chapters!on!
procedures!once!famine!or!scarcity!were!present.297!!This!incredibly!detailed!code!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
293 !Bhatia,!242.!
!
294 !Davis,!58A59.!
!
295 !Bhatia,!245,!258A259.!
!
296 !Each!province!had!their!own!famine!code!intended!to!be!area!specific,!but!the!
practices!did!not!vary!widely.!!Roughly!the!same!procedures!were!followed!in!each!
area!under!British!jurisdiction,!with!some!minor!alternations!based!on!geography!
and!population.!
!
297 !Bengal$Famine$Code,$Revised$Edition$of$1913,!(Calcutta:!The!Bengal!Secretariat!
Book!Depot,!1913),!i.!!*
!
103!
describes!methods!of!intelligence!gathering!on!rainfall!amounts,!crop!strength,!retail!
prices,!and!overall!health!of!people!and!animals!in!each!district.298!*However,!these!
carefully!collected!statistics!could!never!fully!capture!the!impact!of!the!famine.!!As!
Scott!argues!in!Seeing$Like$the$State,!“These!state!simplifications…did!not!successfully!
represent!the!actual!activity!of!the!society!they!depicted,!nor!were!they!intended!to;!
they!represented!only!that!slice!of!it!that!interested!the!official!observer.”299!!Even!the!
most!detailed!statistics!lost!some!complexity,!and!information!on!influenza!had!no!
place!within!the!data!collected!on!the!famine.!
Within!the!Famine!Codes,!areas!particularly!liable!to!famine!required!extra!
scrutiny,!and!standing!preparations!called!for!yearly!revised!estimates!as!to!how!
many!people!in!a!given!area!would!need!relief!should!famine!occur.!!These!
preparations!also!called!for!two!levels!of!planned!relief!works—sanctioned!projects!
would!be!implemented!first,!and!emergency!projects!categorized!as!unsanctioned!
would!only!be!used!in!times!of!extreme!crisis.300 !!Every!year!the!District!Engineer!
submitted!a!form!listing!public!works!projects!such!as!road!improvements,!
embankments,!and!irrigation!or!drainage!works,!suitable!for!times!of!famine,!and!“In!
the!selection!of!works!regard!should!be!not!only!to!their!utility!but!to!the!prospect!of!
their!being!completed!either!during!or!soon!after!the!famine.”301!The!level!of!detail!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
298 !Bengal$Famine$Code,$Revised$Edition$of$1913,!1.!!!
!
299 !Scott,!3,!46A47.!
!
300 !Bengal$Famine$Code,$Revised$Edition$of$1913,!4.!
!
301 !Bengal$Famine$Code,$Revised$Edition$of$1913,!5.**!
*
!
104!
indicated!how!seriously!the!British!took!threats!of!famine!and!the!extent!to!which!
they!felt!they!could!either!control!or!mitigate!famine.!The!focus!on!control!defined!
British!responses!to!famines,!both!minor!and!severe.!!Contingencies!were!planned!for!
in!every!instance,!and!their!extensive!experience!with!previous!failures!to!manage!
scarcity!and!famines!informed!every!step!of!the!process.302!
Interestingly,!the!Famine!Code!included!as!a!top!priority!keeping!the!morale!of!
afflicted!populations!high.!!It!stated,!“When!the!rains!fail!and!anxiety!is!felt,!it!is!of!the!
utmost!importance!to!make!active!preparations!and!thereby!put!heart!into!the!people.!!
There!is!no!greater!evil!than!the!depression!of!the!people,!for!the!moral!depression!
leads!directly!to!physical!deterioration.”303 !!This!mindset!partially!explains!the!flurry!
of!preparation!for!the!1918!famine,!despite!its!relative!mildness.!!It!appears!that!the!
British!felt!that!even!the!impression!of!famine!preparations!would!help!bolster!the!
spirits!of!the!Indian!people,!even!if!those!preparations!never!came!to!fruition.!!The!
Famine!Code!also!emphasized!tracking!any!possible!increase!in!crime,!one!of!the!first!
things!the!famine!codes!called!for!when!the!first!signs!of!scarcity!occur.!!Of!particular!
importance!was!the!establishment!and!maintenance!of!order,!as!illustrated!by!an!
increase!in!crime!being!the!first!item!on!the!list.!!The!British!saw!controlling!famine!as!
a!way!to!forestall!unrest,!rather!than!as!a!strictly!humanitarian!response.!!After!filing!
reports!on!rainfall!and!grain,!the!District!Officer!would!receive!from!the!
Superintendent!of!Police!reports!on:!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
302 !This!is!not!to!say!that!British!methods!were!actually!in!the!best!interests!of!the!
Indian!people,!only!that!these!were!the!responses!the!British!felt!were!most!
effective.!
!
303 !Bengal$Famine$Code,$Revised$Edition$of$1913,!11.***
!
!
105!
1)
2)
3)
4)
!Any!increase!in!crime!attributable!to!a!general!rise!in!prices!
or!scarcity!of!food.!
Any!wandering!of!needy,!starving!persons.!
Any!emigration!from,!or!immigration!into,!the!area.!
Any!unusual!increase!of!mortality.!304!
!
Control!fell!one!step!behind!relief!in!the!British!government’s!priority!so!that!the!link!
between!famine!and!crime—in!this!case,!petty!crime!most!likely—demanded!
immediate!attention.!!*
!
The!step!by!step!rules!of!the!famine!code,!plus!the!vast!array!of!forms!included!
for!each!District!Officer!reveal!a!bureaucracy!determined!to!control!the!famine.!!By!
maintaining!order!and!getting!ahead!of!famines,!the!British!intended!to!mitigate!at!
least!some!of!the!suffering.!!Projects!were!organized!and!put!on!standby,!and!the!
officials!in!each!district!had!a!set!standard!of!procedures!to!follow.!!After!well!over!a!
century!of!experience!with!famine,!including!many!notable!failures,!the!British!
considered!themselves!experts!on!managing!food!shortages.!
!
The*1918*Famine*
In!1918,!the!monsoons!failed!in!several!areas,!primarily!in!the!north!and!west.!
Once!officials!registered!this!fact,!the!British!government!flew!into!action,!preparing!
for!the!possibility!of!famine,!or!at!the!very!least,!scarcity.!!Focusing!on!the!famine!led!
to!a!blind!spot!where!the!flu!response!should!have!been,!even!though!the!famine!
contributed!directly!to!the!flu’s!death!toll,!something!repeatedly!noted!by!sanitary!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
304 !Bengal$Famine$Code,$Revised$Edition$of$1913,!11.!
!
!
106!
commissioners!across!the!subcontinent.305!!The!archival!records!of!the!impact!of!the!
1918!famine!are!somewhat!sparse,!perhaps!due!to!the!complicating!factors!of!the!flu!
and!the!war.!!The!1918!famine’s!lack!of!severity!may!also!contribute!to!the!relatively!
sparse!record.!!Indeed,!the!Bombay$Famine$Report!observed,!“The!most!notable!
feature!of!the!latter!year![1918A1919]!was!that!it!never!produced!in!any!district!
visible!signs!of!emaciation!or!aimless!wandering.!!There!was!no!famine!in!the!sense!of!
starvation!!among!the!people.”306!!Still,!the!famine!occupied!a!large!portion!of!the!
British!official!mind,!often!superseding!the!far!deadlier!flu.307!!!
!
The!United$Provinces$Famine$Report$of$1918819*listed!relief!projects!put!into!
place!that!were!not!only!useful!for!the!purposes!of!providing!work!for!those!who!
needed!food,!but!also!to!improve!the!areas!in!which!they!were!situated.!!The!report!
justified!nearly!every!project!with!the!phrase!“of!permanent!utility,”!indicating!that!
the!British!placed!an!emphasis!on!relief!works!providing!a!benefit!to!the!community!
both!during!and!after!the!famine.308!!This!focus!also!demonstrated!the!tremendous!
value!British!placed!on!work,!with!only!certain!specific!kinds!of!productivity!being!
seen!as!true!“labor.”!!In!order!to!survive!during!a!famine,!those!seeking!relief!would!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
305 !J.A.!Turner,!“Influenza!Pandemic:!Health!Officer’s!Appeal,”!!Times$of$India,*
September!28,!1918.***Dr.!Turner!laments!high!food!prices!in!this!article,!and!the!
Annual$Sanitary$Report$for$1918!makes!this!connection!as!well.!!Annual$Report,!!86.*
*
306 *Bombay$Famine$Report!191881919,$3.!
!
307 !The!extent!to!which!the!upper!echelons!of!the!British!and!Indian!governments!
ignored!the!flu!in!favor!of!the!famine!will!be!explored!in!further!detail!in!chapter!
four,!as!that!discussion!requires!a!dissection!of!the!response!to!the!flu!in!order!to!
fully!untangle!these!two!crises.!
!
308 !United$Provinces$Famine$Report$191881919,!12.!
!
!
107!
need!to!earn!their!keep!by!improving!the!community!with!projects!specifically!chosen!
by!the!British!as!the!most!useful!to!a!particular!area.!!Famine!relief!projects!could!then!
provide!multiple!uses,!supporting!those!stricken!by!famine!and!then!using!the!labor!
provided!in!the!relief!works!to!improve!the!area.!!The!British!believed!that!Indians!
would!shirk!work!at!the!slightest!opportunity,!and!thus!relief!works!forced!famine!
victims!into!punishingly!heavy!labor!to!ensure!that!they!would!not!become!lazy!and!
indolent.309!
Before!1918,!famines!in!the!late!19th!century!had!been!incredibly!deadly!
despite!popular!optimism!that!railways!in!India!would!alleviate!scarcity.!!As!Davis!
argues,!Indian!railroads!were!not!used!to!distribute!grain!to!the!hungry,!but!rather!to!
ship!grain!towards!the!coast!for!protection!against!rioters!and!hoarding.!!Better!
communication!systems,!including!the!telegraph,!allowed!for!price!gouging!across!the!
subcontinent,!even!in!places!that!did!not!suffer!the!drought!that!led!to!famine.!310!!!
Grain!riots!spiked!across!India!in!the!fall!of!1896,!but!the!Government!of!India!
continued!to!adhere!to!its!free!trade!policy.311 !!In!1896!as!in!1918,!the!entire!wheat!
crop!in!India!was!not!affected,!but!prices!rose!throughout!the!subcontinent!whether!
or!not!the!area!had!been!hit!by!the!famine.312!!In!this!way,!famine!hit!all!of!India!just!as!
the!flu!arrived!in!1918.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
309 !Davis,!166.!
!
310 !Davis,!26.!
!
311 !Bhatia,!40.!!!
!
312 !Bhatia,!241.!
!
!
108!
The*United!Provinces!had!experience!with!a!famine!similar!to!1918!in!1907!
due!to!irregular!rains.313 !!This!famine!most!closely!resembled!the!1918!famine,!and!as!
such!provides!a!useful!comparison.!!The!1907!famine!struck!only!this!province,!so!
while!prices!rose!sharply!there,!the!overall!impact!on!the!country’s!grain!production!
was!relatively!negligible.!!Other!provinces!could!easily!send!grain!to!hard!hit!areas,!
and!people!could!migrate!to!other!areas!and!find!work.314!The!government!
implemented!small!but!significant!changes!in!the!way!relief!works!operated,!with!
workers!paid!according!to!market!wage!rather!than!fixed!wages!intended!to!support!
that!laborer!only.315!!Relief!works!were!also!more!decentralized!and!focused!on!
improving!areas!near!villages,!rather!than!the!large!scale!relief!projects!of!previous!
famines.!!The!1907!famine!had!far!lower!death!rates!than!previous!famines,!but!as!
Bhatia!argued,!“This!happy!result!was!attributable!more!to!the!combination!of!several!
favourable!circumstances!than!to!the!relief!measures!adopted!by!the!Government.”316!!
The!1907!famine!marked!a!turning!point!in!Indian!famine!history,!as!the!price!of!food!
replaced!drought!as!the!top!concern.!!Massive!relief!works!began!to!fall!out!of!favor,!
and!“Famine!no!more!meant!starvation!because!of!want!of!food;!it!came!to!
imply…high!prices!of!foodgrains!unaccompanied!by!a!proportionate!increase!in!wages!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
313 !Bhatia,!265.!!The!United$Provinces$Famine$Report$of$191881919!notes!the!
similarities!between!1907!and!1918!as!well.!!United$Provinces$Famine$Report$of$
191881919,!4.!
!
314 !Bhatia,!267.!
!
315 !Bhatia,!268.!!The!problem!with!wages!calculated!to!support!one!worker!alone!
was!that!many!workers!had!several!dependents!to!care!for,!significantly!diminishing!
the!relief!that!wage!was!intended!to!provide.!
!
316 !Bhatia,!269.!
!
!
109!
resulting!in!reduced!consumption!of!foodgrains!on!the!part!of!the!poor!and,!therefore,!
semiAstarvation.”317!!The!famine!caused!prices!everywhere!to!rise!regardless!of!the!
region’s!monsoon!activity!but!did!not!cause!widespread!starvation!and!chaos.!318!!!The!
United$Provinces$Famine$Report$of$191881919!reported,!“The!main!problem…was!not!
how!to!supply!the!labouring!classes!with!employment!so!that!they!might!earn!money,!
but!how!to!transport!food!in!sufficient!quantities!to!the!remote!and!inaccessible!
homes!of!the!people!who!required!it.”319!
*
Governmental*Response*
The!Indian!Legislative!Council!met!in!the!fall!of!1918!to!discuss!India’s!
economic!future.!!In!particular,!they!discussed!India’s!status!as!a!largely!agrarian!
society!and!the!steps!that!could!be!taken!to!improve!access!to!food!for!all!Indian!
people,!demonstrating!concern!that!the!British!had!not!done!quite!enough!to!
insulate!the!Indian!people!from!the!effects!of!famine.320!!The!topic!had!been!
broached!before,!as!the!Hon’ble!Rai!Bahadur!B.D.!Shukul!chided,!
It!was!in!the!year!1900!that!the!Congress!unanimously!passed!a!resolution!
that!‘having!regard!to!the!oftArecurring!famines!in!India!and!the!manifestly!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
317 !Bhatia,!270.!
!
318 !Lord!Kitchener!to!Harcourt!Butler,!December!4,!1918,!Butler!Collection:!Private!
Papers!and!Correspondence!of!Sir!Harcourt!(Spencer)!Butler,!British!Library,!
London,!United!Kingdom,!MSS!F!116/20.!!*
!
319 !United$Provinces$Famine$Report$of$191881919,$4,!!
!
320 !“Rai!Bahadur!B.D.!Shukul!on!the!Appointment!of!a!Committee!to!Inquire!into!the!
Economic!Condition!of!Agricultralists,”!September!24th,!ILC,!350.**The!report!notes!
that!80%!of!Indians!are!involved!with!agricultural!activities!at!that!point,!as!
compared!to!20%!in!England!and!Wales.!
!
!
110!
decreasing!power!of!resistance!on!the!part!of!its!population!to!face!a!single!
failure!of!harvest,!leading!as!it!frequently!does!to!human!suffering,!loss!of!life,!
destruction!of!liveAstock,!disorganization!of!rural!operations!and!interference!
with!the!legitimate!work!of!the!administrative!machinery!it!earnestly!prayed!
that!the!Government!of!India!might!be!pleased!to!institute,!at!an!early!date,!a!
full!and!independent!inquiry!into!the!economic!conditions!of!the!people!of!
India,!with!a!view!to!ascertainment!and!substantial!adoption!of!practical!
remedies.’!Nearly!18!years!have!passed!and!this!important!inquiry!has!not!
yet!been!instituted.321 !
!
As!another!famine!threatened!India,!members!of!the!Legislative!Council!expressed!
their!displeasure!that!the!Government!of!India!had!yet!to!sufficiently!address!
famines.!!India!remained!a!country!that!devoted!the!majority!of!its!workforce!to!
agriculture!yet!still!had!an!unremitting!famine!problem.!!Shukul!later!continued,!!
The!repeated!visitation!of!plague,!cholera!and!other!epidemics!and!
…!the!oftArecurring!famines!and!the!manifestly!decreasing!power!of!
resistance!on!the!part!of!the!people!in!the!face!of!a!single!failure!of!
harvest,!and!above!all!the!widespread!ignorance!which!have!all!
combined!to!affect!seriously!the!material!and!moral!progress!of!the!
bulk!of!our!population.322!!!
!
While!the!famine!was!only!in!the!earliest!stages,!Shukul’s!warnings!stood!out.!
Nevertheless,!the!British!government!began!preparing!relief!works!when!the!
possibility!of!scarcity!arose!that!summer.!!The!United!Provinces!selected!several!
necessary!irrigation!and!water!storage!projects!to!be!converted!to!famine!relief!
works!should!the!need!arise,!but!“none!of!these!projects!were!completed!as!famine!
works.”323!!Famine!works!were!designed!to!provide!both!needed!services!and!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
321 !“Rai!Bahadur!B.D.!Shukul!on!…!the!Economic!Condition!of!Agricultralists,”!350A
351.*!
!
322 !“Rai!Bahadur!B.D.!Shukul!on!…!the!Economic!Condition!of!Agricultralists,”!351A
352.!!
!
323 !United$Provinces$Famine$Report$191881919,!8.!!!
!
!
111!
needed!aid,!so!when!Indians!failed!to!flock!to!these!work!camps!the!government!
completed!the!projects!as!planned.324!!
The!Bengal!Legislative!Council!met!in!November!and!December!of!1918!to!
debate!floods,!embezzlement,!and!rice!prices,!but!!did!not!discuss!the!flu!pandemic.325!
Instead,!taken!in!context!with!their!discussion!of!price!relief!for!grain,!it!appears!that!
the!legislative!apparatus!for!Bengal!focused!solely!on!problems!they!could!manage!
more!effectively,!rather!than!the!seemingly!uncontrollable!flu.!!The!Council!laid!out!a!
specific!plan!for!dealing!with!the!price!increases!for!rice,!including!increasing!imports!
from!Rangoon!and!prohibiting!exports!by!rail!unless!approved!by!the!Foodstuffs!
Commissioner,!although!they!took!care!to!note!that!the!price!of!rice!was!not!
substantially!higher!than!the!previous!five!year!mean.326!!This!demonstrates!that!
while!the!apparatus!of!the!British!government!did!attempt!to!alleviate!suffering,!their!
efforts!were!not!entirely!successful.!!!This!disconnect!would!be!magnified!as!the!flu!
exploded!across!the!subcontinent.!
The!flu!and!famine!relief!effort!melded!into!one!when!the!private!charity!the!
Indian!Peoples’!Famine!Trust!distributed!blankets!and!clothing!to!convalescents!
from!influenza.327!!!The!apparatus!meant!to!relieve!massive!starvation!was!adapted!
to!help!with!the!flu,!but!the!Government!of!India!did!not!seem!to!even!consider!this!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
324 !Bengal$Famine$Code,$Revised$Edition$of$1913,!5.!!!
!
325 !Hon’ble!Maulvi!Abul!Kasem,!“Resolutions,”*November!26,!1918,*Bengal!
Legislative!Council,!1078,!and!Hon’ble!Mr.!McAlpin,!“Questions!and!Answers,”!
December!19,!1918,$BLC,!1120A1121.!!
!
326 !Hon’ble!Mr.!McAlpin,!“Questions!and!Answers,”!December!19th,!1918,!1120.!!
!
327 !!United$Provinces$Famine$Report$191881919,!8.!!!
!
!
112!
option.!!These!efforts!provided!flu!victims!with!desperately!needed!blankets!and!
warm!clothing.!!Indeed,!nursing!and!convalescent!care!was!one!of!the!few!things!
that!could!help!flu!victims,328!and!aiding!those!who!had!survived!the!worst!of!the!flu!
recuperate!was!a!project!that!fell!more!often!to!private!organizations!as!the!official!
branches!were!overwhelmed!with!the!most!serious!and!deadly!cases.!!The!famine!
report!for!the!United!Provinces!concluded!with!a!list!of!various!individuals!and!
organizations!that!provided!private!relief!during!the!famine,!once!again!revealing!
the!close!dependence!of!the!British!Government!in!India!had!upon!private!
organizations!in!times!of!catastrophe.329!!!
The!preoccupation!in!British!communications!with!the!famine!indicates!that!
they!saw!the!famine!as!a!preventable,!or!at!least!diminishable,!problem,!while!the!flu!
defied!all!expectations!and!attempts!to!control!its!spread.!!Scarcity!due!to!the!war!also!
complicated!the!famine,!as!the!economic!strain!facing!all!corners!of!the!British!Empire!
appeared!in!India!as!elsewhere.330!!
!
War,*Famine,*and*Finances*
The!British!government!looked!at!the!flu!through!the!lens!of!the!famine,!rather!
than!the!other!way!around,!despite!the!flu’s!far!more!devastating!death!tolls.!!As!the!
flu!hit,!agricultural!laborers!were!unable!to!work!to!their!full!capacity,!compounding!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
328 !Kent,!14.!
!
329 !United$Provinces$Famine$Report$191881919,!8A11.!*
*
330 !United$Provinces$Famine$Report$191881919,!1.**!
!
!
113!
the!scarcity!caused!by!the!failure!of!the!monsoons.!!The!Bombay$Famine$Relief$
Administration!noted,!!
This!year!influenza!had!taken!a!very!heavy!toll!and!was!still!raging!as!
the!season!for!cutting!grass!began,!and!the!people!were!so!weak!as!to!
be!unable!to!do!a!full!day’s!work.!!The!difficulties!of!obtaining!food!too!
seemed!likely!to!!be!acute.!!The!effects!of!war!entailing!!Munitions!
Work,!high!prices!and!labour!scarcity!were!intensified!by!the!extensive!
crop!failure.331!
!
Here,!we!see!a!confluence!of!events!combining!to!create!a!devastating!catastrophe.!!
The!flu!weakened!farm!laborers,!lessening!productivity,!which!combined!with!the!
monsoon!failure!to!create!smaller!harvests!that!led!to!high!prices!and!famine.!!These!
high!prices!put!necessary!nutrition!out!of!reach!of!the!poorest!classes,!leading!to!
high!levels!of!malnourishment.!!This!malnourishment!led!to!higher!death!rates!in!
poor!classes,!contributing!to!India’s!massive!death!toll!from!the!flu.!!The!flu!
contributed!to!the!famine,!which!in!turn!contributed!to!the!flu.!!As!the!United$
Provinces$Report!on!the!famine!proclaimed,!“The!effect!of!the!partial!failure!of!the!
monsoon!was!profoundly!influenced!by!the!results!of!the!disastrous!epidemic!of!
influenza,!and!also!by!the!disturbance!of!economic!conditions!owing!to!the!war.”332!!!
Sir!James!Meston’s!Financial!Statement!for!1919A1920,!presented!to!the!India!
Legislative!Council,!proclaimed,!“It![the!influenza!pandemic]!has!had!most!
depressing!results!on!rural!efficiency,!and!has!complicated!the!task!of!famine!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
331 !Bombay$Famine$Report$191881919,!35.**!
!
332 !United$Provinces$Famine$Report$191881919,!1.**!
!
!
114!
relief.”333!!The!flu!came!to!be!talked!about!in!terms!of!how!it!complicated!the!famine,!
rather!than!the!other!way!around.!!!
!
As!a!colony!of!Britain,!India!was!expected!to!contribute!their!share!to!the!war!
effort,!in!terms!of!soldiers,!supplies,!and!financial!support.!!In!Modern$India,$18858
1947$Sumit!Sarkar!argues,!“The!‘drain!of!wealth’!took!on!during!the!War!years!the!
character!of!a!massive!plunder!of!Indian!human!and!material!resources.”334!!The!war!
created!a!300%!increase!in!defense!expenditure!that!the!Government!of!India!paid!for!
through!war!loans!and!a!major!restructuring!of!India’s!financial!system.!!Taxes!rose,!
including!customs,!and!income!taxes!became!an!increasingly!important!source!of!
revenue.335!
!
The!war!disrupted!usual!trade!routes,!and!the!demand!for!industrial!goods!
created!by!the!war!also!increased!prices!for!material!goods!in!India,!but!the!export!
prices!of!Indian!agricultural!products!stayed!stagnant.336!!The!famine!exacerbated!this!
existing!financial!strain!as!the!monsoon!failure!drove!prices!up!even!further!across!
India.!!Meston’s!Financial!Statement!noted,!
By!this!time![Fall!1918],!also!it!had!unfortunately!become!evident!that!
considerable!areas!in!Bombay,!the!United!Provinces!and!other!parts!of!
India!would!be!unable!to!share!in!the!general!rejoicings!about!peace;!
for!the!monsoon!had!failed!badly,!scarcity!was!imminent,!and!at!the!
most!critical!time!a!fierce!epidemic!of!influenza!attacked!the!whole!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
333 !Sir!James!Meston,!“Financial!Statement!for!1919A1920,”!March!1,!1919,*ILC,$659.***!
!
334 !Sumit!Sarkar,!Modern$India,$188581947!(Delhi:!Macmillan!India,!1983),!169.!
!
335 !Sarkar,!170.!!Sarkar!states!that!income!tax!went!from!2%!of!gross!revenue!in!
1911A12!to!11.75%!in!1919A20.!
!
336 !Sarkar,!170.!
!
!
115!
country,!took!a!very!heavy!toll!of!the!rural!masses,!and!seriously!
weakened!the!agricultural!labour!power.337!
!
Notably,!Meston!concerned!himself!with!the!loss!of!man!power!caused!by!the!flu!and!
famine.!!Later!he!tallies!the!cost!of!famine!relief!but!the!cost!of!flu!relief!makes!no!
appearance!in!his!financial!statement.338 !!“It!is!not!expected!that!there!will!be!any!
excess!over!the!normal!grant!for!Famine!Relief!Insurance.!!The!Imperial!share!of!
actual!relief!measures!will!cost!about!£400,000,”!he!wrote.339!
!
Mr.!Kamini!Kumar!Chanda!took!the!Government!of!India!to!task!over!their!
spending!priorities!in!his!response!to!Meston’s!Financial!Statement.!!He!summarized!
the!devastation!caused!by!the!flu!and!then!said,!
You!have!piled!crores!upon!crores!for!civil!and!military!
expenditure!and!upon!railway!construction,!but!what!have!you!
done!for!health?!…Sir,!it!is!a!matter!for!regret!that!not!only!is!
there!no!substantial!allotment!for!sanitation!and!health,!but!
health!is!not!even!mentioned!as!one!of!the!subjects!for!
expenditure!on!which!Local!Governments!are!now!permitted!to!
draw!on!their!cash!balances,!presumably!on!the!ground!that!
expenditure!on!health!is!not!reckoned!as!remunerative.340!
!
He!excoriated!the!British!for!their!failure!to!fund!flu!relief,!and!also!criticized!them!for!
restricting!the!number!of!qualified!medical!men,!as!discussed!in!chapter!two.!!His!
charge!that!money!spent!on!health!would!not!give!the!government!a!monetary!return!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
337 !Meston,!“Financial!Statement!for!1919A1920,”!654.*!
!
338 !Meston,!“Financial!Statement!for!1919A1920,”!668.*!
!
339 !Meston,!“Financial!Statement!for!1919A1920,”!668.**For!comparison,!the!
expenditures!on!railways!amounted!to!£2.3!million.!
!
340 !“Mr.!Kamini!Kumar!Chanda!to!the!Indian!Legislative!Council!on!the!Financial!
Statement!1919A1920,”!728A729.!!*
*
!
116!
is!particularly!damning,!as!is!the!fact!that!local!governments!could!not!use!their!own!
discretion!when!it!came!to!public!health!crises.!
Kumar!Chanda!also!censured!the!lack!of!adequate!distribution!of!funds!during!
the!famine.!!He!appealed,!
Famine!and!scarcity!are!localised,!confined!to!specified!parts!of!
the!country,!and!we!are!grateful!for!the!provision!made!for!
famine!expenditure.!!But!what!about!the!distress!caused!to!a!
much!larger!population!by!oppressively!high!and!ruinous!prices!
for!almost!every!commodity?!!We!will!be!grateful,!Sir,!if!some!of!
the!more!ambitious!projects!be!cut!down!and!the!money!
diverted!to!some!measures!for!alleviating!the!misery!of!these!
people.341!
!
The!British!may!have!thought!they!had!managed!the!famine!of!1918!easily,!but!
Kumar!Chanda!felt!otherwise.!!He!called!for!less!funding!of!relief!work!projects—
and!their!accompanying!work!camps—and!instead!urged!for!more!price!relief.!!
Since!the!famine!caused!local!scarcity!but!widespread!price!spikes,!his!method!of!
intervention!would!have!lessened!the!strain.!!This!intervention!could!have,!in!turn,!
lessened!the!death!toll!from!the!flu.!!As!he!noted,!“It!would!appear!that!no!country!
suffered!as!severely!as!India!did!during!the!last!quarter!of!1918.”342!
!
Famine*and*Influenza*
Not!every!venue!presented!the!flu!as!conquerable!or!separate!from!the!
famine.!!In!a!late!September!article!titled!“Agricultural!Situation:!Outlook!in!
Bombay”!the!author!summarized!the!flu!and!famine!situation!before!noting,!“I!am!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
341 !!“Mr.!Kamini!Kumar!Chanda!to!the!Indian!Legislative!Council!on!the!Financial!
Statement!1919A1920,”!729.!!*
!
342 !“Mr.!Kamini!Kumar!Chanda!to!the!Indian!Legislative!Council!on!the!Financial!
Statement!1919A1920,”!728.!!*
!
!
117!
not!a!medical!man…but!I!fear!that!owing!to!the!record!dearth!of!food!stuffs!and!
piece!goods!the!staying!power!of!the!masses!is!seriously!curtailed!and!they!lie!
exposed!to!death!by!disease!in!any!epidemic!or!virulent!form.”343!Again!the!
pandemic!became!characterized!as!part!of!the!famine,!even!as!Bombay!neared!the!
peak!of!the!pandemic,!as!the!famine!prices!caused!malnutrition!and!contributed!to!
the!skyArocketing!death!tolls.!344 !!!
The!1918!influenza!virus!preyed!primarily!on!two!different!groups:!the!
immunoAcompromised,!and!young!adults.!!While!the!immunoAcompromised!in!
general!tended!to!be!the!very!young!and!the!very!old,!the!added!complication!of!
malnutrition!spurred!by!the!famine!of!1918!very!likely!increased!the!number!of!
people!who!could!be!considered!immunoAcompromised.!!Major!White!noted,!“Though!
no!claim!that!the!disease!originates!in!malnutrition!can!be!substantiated,!it!cannot!be!
denied!that!malnutrition!was!occasionally!a!factor!of!importance!in!determining!a!
fatal!issue.”345!!As!their!bodies!mined!precious!stores!of!body!fat!for!glucose,!their!
defense!system!would!be!in!disarray.!!On!the!other!hand,!influenza!victims!with!
healthy!immune!systems!and!proper!nutrition!died!because!their!bodies!launched!
such!a!massive!defense!against!the!virus!that!they!destroyed!their!own!lung!tissue.346!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
343 !“Agricultural!Situation:!Outlook!in!Bombay,”!Times$of$India,*September!30,!1918.***
!
344 !Preliminary$Report,!!3.!!As!Bombay!was!at!the!entryway!of!the!flu!to!India,!the!
death!tolls!peaked!there!first!on!October!6th.!
!
345 !Preliminary$Report,!2.!!!
!
346 !Kent,!2.!
!
!
118!
The!relatively!wellAfed!Britain!lost!nearly!a!quarter!million!people!to!the!flu,!
and!while!this!number!would!not!be!not!paltry!to!the!families!of!the!some!250,000!
victims,!as!a!percentage!of!the!population!it!paled!in!comparison!to!India’s!loss.!347!!
When!influenza!arrived!in!famine!plagued!India,!it!found!several!categories!of!perfect!
victims:!the!very!young,!the!very!old,!the!malnourished!poor,!and!healthy!young!
adults.!!Many!of!the!deaths!were!due!to!respiratory!complications!such!as!
pneumonia.348!!This!dual!catastrophe!may!account!for!India’s!outsized!death!toll!
compared!to!the!rest!of!the!world.!!!
F.!Norman!White!drew!strong!connections!between!the!flu,!famine,!and!war!
in!his!Preliminary$Report$on$Influenza.!!He!singled!out!private!and!charitable!relief!
organizations!for!their!efforts!at!relieving!the!suffering,!calling!them!“the!one!bright!
feature!in!the!long!record!of!misery!and!death,”!during!the!fall!of!1918.349!!He!
detailed!the!impact!of!the!war,!most!notably!draining!medical!personnel!from!the!
subcontinent,!and!then!claimed,!!
Still!more!serious!were!the!effects!of!the!almost!total!failure!of!the!
monsoon,!practically!throughout!the!country.!!The!staple!food!grains,!
were!at!famine!prices!and!the!scarcity!of!fodder!enormously!reduced!
the!quantity!of!milk!available.!!The!price!of!blankets!and!warm!clothing!
was!extremely!high.!Actual!famine!conditions!prevailed!nowhere,!
though!there!was!undoubtedly!a!greater!degree!of!malnutrition!than!
has!been!the!case!during!many!years!past.350!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
347 !Kent,!11.!
!
348 !Preliminary$Report,!1.!!
!
349 !Preliminary$Report,!12.!!!
!
350 !Preliminary$Report,!12.!!!
!
!
119!
The!note!about!the!price!of!fodder!indicates!that!the!true!pain!of!the!failure!of!the!
monsoons!was!felt!in!indirect,!economic!ways.!!If!it!cost!more!to!feed!animals!due!to!
rising!fodder!prices,!then!many!animals!would!be!left!to!die!rather!than!produce!
milk.!!A!lower!quantity!of!milk—a!good!source!of!nutrients!for!those!afflicted!by!the!
pandemic—meant!increased!suffering!from!the!disease.!!In!addition,!widespread!
malnutrition!would!create!conditions!ripe!for!immense!death!due!to!the!influenza!
virus,!as!people’s!weakened!immune!systems!could!not!fight!off!the!invader.!
The!flu!and!famine!worked!in!concert!to!create!an!ouroboros!of!scarcity!and!
death.!!Laborers!sick!with!influenza!could!not!work!to!bring!in!the!harvest,!which!had!
been!already!in!danger!because!of!the!failure!of!the!monsoons.!!The!Bombay$Famine$
Report$of$191881919!famine!noted,!!
Although!the!failure!of!the!rains!almost!as!complete!as!in!the!severe!
famine!of!1899A1900,!the!conditions!of!that!year,!as!far!as!acute!
distress!among!the!population!of!this!Presidency!and!the!necessity!
for!widespread!relief!operations!are!concerned,!were!not!
reproduced.!!The!agricultural!population!throughout!the!Presidency!
had!acquired!far!greater!powers!of!resistance.351 !!!
!
It!went!on!to!comment!that!the!poorest!people!in!Gujarat!suffered,!but!“It!was!only!
late!in!the!season!and!in!a!few!of!the!worst!localities!that!there!was!any!considerable!
demand!for!relief!works.”352!
!
An!April!3,!1919!British$Medical$Journal!article!focused!specifically!on!the!
large!death!toll!in!India!and!suggested!the!famine!was!why!the!subcontinent!
suffered!so!greatly.!!“The!explanation!suggested!for!this!enormous!death!roll!is!that!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
351 !Bombay$Famine$Report$191881919,!1.!!!
!
352 !Bombay$Famine$Report$191881919,!3.!!!
!
!
120!
Indians!have!a!low!resisting!power!to!pneumonic!infection,”!the!authors!offered!
before!they!complicated!that!explanation!by!noting!that!the!case!mortalities!do!not!
always!support!this!conclusion.353!!The!article!continued,!“Another!factor!was!a!
scarcity!of!food!grains,!and!especially!of!fodder,!which!was!responsible!for!a!dearth!
of!milk,!both!being!results!of!the!failure!of!the!monsoon.”354!!This!article!made!yet!
another!direct!connection!between!the!famine!and!high!mortality!rates!in!India,!
although!unlike!some!other!medical!contemporaries!it!did!not!attribute!those!high!
mortality!rates!solely!to!complications!of!pneumonia.!!“The!extent!to!which!this!
factor!contributed!to!the!mortality!is!naturally!difficult!to!determine,!and!the!same!
difficulty!exists!in!interpreting!the!relation!between!the!European!food!shortage!and!
our!own!experience!of!influenza.”355!!In!drawing!a!parallel!between!the!Indian!
experience!and!the!flu,!the!author!connected!the!unavoidableAAif!unnamedAA
consequence!of!war!and!the!pandemic!worldwide,!although!a!little!more!
acknowledgement!that!the!Indian!situation!may!have!been!more!severe!would!not!
have!gone!amiss!here.!!The!author!maintained,!!“No!epidemiologist!supposes!that!
the!origin!of!the!epidemic!series!was!lack!of!food,!but!the!world!shortage!has!had!
something!to!do!with!the!fatality!is!not!a!proposition!lightly!to!be!denied.”356!!Thus!
both!popular!media!and!medical!journals!highlighted!the!link!between!influenza!
death!tolls!and!limited!access!to!food.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
353 !“Influenza!in!India,”!British$Medical$Journal,$April!3,!1919,!417.!!!
!
354 !“Influenza!in!India,”!417.!
!
355 !“Influenza!in!India,”!417.!
!
356 !“Influenza!in!India,”!417.!
!
121!
!
Critiques*of*the*Famine*Response*
Despite!how!the!Government!of!India!felt!about!their!response!to!the!famine,!
critiques!abounded.!!The!Times$of$India!wrote,!!
It!is!not!at!all!contended!that!the!Government!have!done!no!thing!till!now!to!
meet!the!situation!that!has!arisen!from!time!to!time.!!The!said!development!
in!the!shape!of!failure!of!food!grain!crops!over!the!major!a!part!of!the!
Presidency!necessitates!more!means!being!employed!to!ensure!a!steady!
supply!of!food!grains.357 !!!
!
Ensuring!more!equitable!distribution!of!food!in!times!of!famine!became!linked!to!
the!flu!pandemic,!as!the!author!had!already!noted!the!connection!between!lack!of!
access!to!food!and!the!horrific!death!tolls!throughout!the!Presidency.!!He!also!
observed!that!while!the!Government!had!made!an!effort!more!still!needed!to!be!
done.!!!
!
An!article!in!The$Hindu!criticized!the!Government’s!response!to!the!famine!
in!particular,!writing!“There!is!a!very!widespread!impression!that!the!authorities!
could!have!averted!the!heartArending!spectacle!that!is!witnessed!at!present!of!the!
terrible,!silent!suffering!on!the!part!of!the!indigent!population...”358!!The!author!
suggested!that!consulting!“those!who!were!in!a!position!to!offer!advice!and!
suggestions!on!the!matter”!would!have!lessened!the!devastation.359!!It!demonstrated!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
357 !“Agricultural!Situation:!Outlook!in!Bombay.”!!
!
358 !The!Bombay!Council,”!The$Hindu,$November!22,!1918.!*
!
359 !The!Bombay!Council.”!!
!
!
122!
that!while!the!Legislative!Councils!left!much!to!be!desired!in!their!activities,!they!at!
least!attempted!to!address!the!issues!created!by!the!famine!and!pandemic.*
!
!Criticism!over!lack!of!action!to!stem!high!prices!not!only!for!food!but!also!
for!cloth!had!appeared!in!the!news!media!as!already!in!early!September,!when!The$
Hindu!reported!on!the!“cloth!famine.”!Mr.!C.!F!Andrews,!a!close!associate!of!
Mohandas!Gandhi,!took!to!task!the!increase!in!prices!and!subsequent!profits!for!the!
cloth!merchants.!!He!wrote,!!
Again!cloth!merchants!have!been!raising!the!price!of!cloth!till!it!has!got!
beyond!the!reach!of!the!impoverished!villagers.!!In!England!all!this!is!
called!by!one!simple!name—“War!profiteering.”!!In!a!war!like!this!which!
is!declared!to!be!fought!on!behalf!of!the!oppressed!and!helpless!it!is!a!
hateful!thing!that!the!poor!should!be!made!to!suffer!and!the!rich!should!
grow!richer!out!of!the!very!poverty!of!the!poor.360!
!
This!“appeal!to!charity”!as!it!is!termed!also!served!as!a!subtle!appeal!to!the!
government!to!step!in.!!Andrews!also!makes!a!direct!connection!between!the!war!
being!fought!for!those!oppressed!and!helpless!in!Europe!and!the!impoverished!in!
India.!!Published!before!the!flu!took!a!deadly!foothold!on!the!subcontinent,!this!
article!raised!issues!that!would!soon!become!pressing.!!In!the!current!economic!
climate,!the!poorest!were!at!the!steepest!disadvantage!when!prices!rose.!!When!the!
flu!arrived!and!nursing!and!blankets!became!key!to!survival,!the!decks!were!already!
stacked!against!the!poor.!
!
By!early!October!The$Hindu!was!still!calling!for!more!Government!
intervention!in!the!famine.!!They!wrote,!“It!is!some!consolation!to!note!that!the!
Government!Of!India!seem,!at!any!rate!at!present,!to!have!realised!the!urgency!as!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
360 !“The!Cloth!Famine:!situation!in!Bengal,”!The$Hindu,$AP$of$India,!September!6!
1918.!*
!
!
123!
well!as!the!importance!of!solving!the!food!problem.”361!!While!this!article!admitted!
the!Government!had!taken!steps,!it!belies!a!tone!of!“better!late!than!never,”!
particularly!damning!considering!the!extent!to!which!the!upper!echelons!of!the!
Government!and!ICS!had!prepared!for!the!famine.!!Clearly,!early!preparation!did!not!
translate!into!concrete!steps!that!would!draw!positive!attention!from!the!press.!
On!October!11th,!The$Hindu!reported!on!a!communiqué!from!the!United!
Provinces,!which!saw!the!second!wave!of!the!flu!arrive!in!October.362!!They!
announced,!“The!present!high!prices!of!food!grains!have!been!engaging!the!
attention!of!the!Local!Government.”363!!This!article!both!announced!the!increased!
attention!to!the!food!crisis!and!drew!attention!to!new!steps!to!solve!it.!!It!continued,!!
“The!Government!of!India!have!agreed!to!the!prohibition!of!export!of!all!food!grains!
from!the!provinces!without!license!from!the!Director!of!Civil!Supplies,!United!
Provinces.!!Other!measures!for!reducing!the!prices!are!also!receiving!attention!and!
it!is!hoped!an!announcement!will!be!made!very!shortly.”364!!This!portrays!the!
Government!of!India!as!working!actively!to!control!food!prices!and!ensure!access!to!
adequate!food,!although!it!also!calls!into!question!whether!or!not!the!Government!
reacted!quickly!enough.!!The!failure!of!the!monsoon!had!been!noted!several!months!
earlier,!but!yet!at!least!in!the!United!Provinces,!price!controls!had!not!yet!been!
implemented.!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
361 !“Food!Control,”!The$Hindu,!October!11,!1918.*!
*
362 !United$Provinces$Report,!1.!!
!
363 !“Food!Control.”!
!
364 !“Food!Control.”!
!
!
!
124!
By!early!November!more!steps!had!been!taken!to!control!food!prices,!as!
reported!by!The$Hindu.!!An!Associated!Press!of!India!article!titled!“Food!Control!In!
Bombay”!noted!that!anyone!in!possession!of!food!grains!“in!excess!of!50!Bengal!
maunds,”!must!report!by!the!8th!of!November!both!the!amount!and!price!they!had!in!
their!control.365!!“Any!person!intentionally!omitting!to!make!the!return!called!on!for!
or!making!a!return!which!he!knows!or!believes!to!be!untrue!will!be!liable!to!
punishment!under!clause!5!of!the!Commissioner’s!ordinance,”!the!article!
concluded.366!!While!there!is!no!mention!of!calling!the!failure!to!report!holdings!war!
profiteering!as!a!previous!article!had!accused,!this!does!demonstrate!the!more!
drastic!measures!the!government!took!to!control!the!famine.!!In!contrast!to!the!flu,!
however,!the!famine!had!established!protocols!for!required!actions.!
!
Still!more!criticism!came!from!a!Times$of$India!article,!republished!in!The$
Hindu$on!November!15th,!1918.!!Most!of!this!issue!was!overshadowed!by!coverage!of!
the!Armistice,!which!had!taken!place!a!mere!four!days!previously.!!However,!both!
flu!and!famine!loomed!large!in!an!anecdotal!story!told!by!an!unnamed!Brahmin!
clerk.!!!
My!pay!is!twentyAeight!rupees!a!month.!!My!family!numbers!five.!!We!
had!only!just!enough!to!live!on!a!year!ago,!but!the!cost!of!our!food!has!
doubled!since!then!and!the!prices!of!all!other!necessaries!has!greatly!
increased.!!And!now!my!brother!has!died!of!influenza!and!his!widow!
and!four!children!have!joined!my!household!and!I!have!to!keep!them!
also.367!!!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
365 !“Food!Control!In!Bombay,”!The$Hindu,!November!1,!1918.!*
!
366 !Food!Control!In!Bombay.”!*
!
367 !!“Notes,”!The$Hindu,$November!15!1918.!
!
!
125!
Famine!and!influenza!intertwine!!as!skyrocketing!prices!and!pressures!to!provide!
for!fluAstricken!kin!add!to!an!already!considerable!burden.!!Written!in!the!context!of!
the!Bombay!Legislative!Council!reiterating!that!no!further!action!on!the!famine!had!
been!issued,!the!anecdote!frames!the!flu!and!famine!as!dual!pressures!on!Indian!
people,!made!all!the!worse!by!the!Government’s!failure!to!act!properly.!!The!flu!
added!another!burden!to!the!clerk,!beyond!high!food!prices!and!a!low!salary.!
!
!The!article!concluded,!“if!the!‘higher!authorities’!create!unrest!in!their!
services!by!the!dilatory!way!they!have!handled!this!matter!they!have!none!but!
themselves!to!thank!for!it.!The!more!is!the!pity,!since!the!higher!services!have!had!in!
the!early!days!of!the!war!granted!to!them!handsome!personal!allowances.”368!!This!
article!simultaneously!blames!the!government!for!inaction!on!high!food!prices—or!
at!the!very!least!insufficient!action—and!blames!them!for!any!subsequent!unrest!
related!to!the!food.!!It!also!implies!that!the!Government!mismanaged!funds,!given!
that!some!had!received!“handsome!personal!allowances”!a!few!years!previously,!
and!that!more!judicious!use!of!funds!could!have!forestalled!this!calamity.!
!
A!November!article!in!The$Hindu!also!stated,!!
The!Government!of!Mysore!have!sanctioned!a!scheme!for!food!
supply!arrangements!throughout!the!State!and!have!appointed!
a!whole!time!officer!of!the!Grade!of!Deputy!Commissioner!to!
organise!arrangements!on!a!uniform!scale.!There!will!be!a!
provincial!depot!or!clearing!house!under!his!management.!369!!
!
While!hardly!groundbreaking,!this!was!yet!another!small!note!on!the!extent!to!
which!the!Government!was!working!to!aid!people!faced!with!the!famine.!!While!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
368 !“Notes.”$!!
!
369 !“Food!Control!in!Mysore,”!The$Hindu,$November!15,!1918.!!
!
!
126!
there!are!similar!articles!about!the!flu,!the!tone!of!the!articles!suggests!that!the!
Government!was!unfamiliar!with!the!best!steps!for!handling!the!flu!pandemic—
hence!the!confusion!over!the!origin!of!the!flu!and!best!practices!for!controlling!it—
but!the!famine!had!an!easy,!step!by!step!process!to!fix.!!Roughly!a!week!later!more!
action!had!been!taken.!!Prices!in!Mysore!were!fixed,!as$The$Hindu!wrote,!“The!
Mysore!Government!have!decided!on!the!bold!but!what!appears!in!the!
circumstances!to!be!the!statesmanlike!task!of!commandeering!stocks!of!
foodstuffs.”370!!Thus,!despite!the!engine!of!government!gearing!up!over!the!summer!
to!face!down!a!possible!famine,!some!governments!had!yet!to!enact!food!control!
measures!that!worked.!
!
The!Behar$Herald!published!a!tirade!on!British!action!over!the!famine!that!
asserted,!“What!shall!we!however!say!of!our!soAcalled!leaders!whose!attitude!on!this!
occasion!may!be!compared!to!that!of!Nero!when!he!is!said!to!have!fiddled!while!
Rome!was!burning?”371!!Drawing!allusions!to!the!villainous!emperor!with!no!
compassion!for!his!people!certainly!sets!a!stark,!accusatory!tone.!!Rather!than!the!
involved!Government!attempting!to!manage!a!famine,!the!article!depicts!careless!
aristocrats!unconcerned!by!high!prices!affecting!the!poorest!people.!!!“While!they!
have!been!busy!in!advertising!their!loyalty!by!making!demands!from!the!people!of!
three!days!of!their!hard!earned!income!to!be!spent!on!lights!and!rockets,!have!they!
had!the!loyalty!to!point!out!to!Government,!the!serious!condition!of!the!people!and!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
370 !“Notes.”!!
!
371 !Food!Prices,”!Behar$Herald,!November!30,!1918.!!
!
!
127!
the!impending!catastrophe?”372!!The!article!is!not!clear!on!who!these!leaders!are,!
but!one!can!assume!they!are!referring!to!Indian!leaders,!and!not!the!government!
itself.!!“Loyalty”!becomes!a!by!word,!accusing!these!leaders!of!pushing!people!to!
sacrifice!for!the!sake!of!the!government!but!being!unwilling!to!!push!the!government!
to!sacrifice!for!the!sake!of!the!people.!!This!demonstrates!an!intriguing!look!at!who!
should!share!the!blame!for!the!famine:!not!the!government!itself,!but!the!Indian!
representatives!within!it.!!“If!it!comes!to!the!worst,!which!may!Heaven!forfend,!will!
not!the!State!be!justified!in!repeaching![sic]!its!natural!advisers!for!their!silence!and!
apathy!in!the!midst!of!a!grave!crisis?373!The!Herald!criticizes!these!“natural!
advisors”!for!not!doing!more!to!aid!their!people.!!It!implied!that!the!Government!of!
India!would!naturally!provide!for!its!citizens!if!they!understood!the!extent!of!their!
suffering,!and!suggests!that!said!knowledge!of!suffering!should!be!imparted!by!the!
“natural!advisors.”!!This!strident!denunciation!of!the!Government!of!India,!published!
at!the!end!of!November!as!the!flu!finally!began!to!diminish,!portrays!a!populace!
quickly!coming!to!their!wits!end!with!ineffective!British!management!of!crises.!
!
Conclusion!
Faced!with!two!possible!catastrophes,!the!Government!of!India!chose!to!
focus!on!the!one!it!understood.!!However,!in!the!immediate!aftermath!of!the!flu,!the!
famine!began!to!overshadow!the!devastation!of!the!influenza!pandemic!in!the!
“official!mind”!of!British!administrators!in!large!part!because!the!British!felt!they!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
372 !Food!Prices.”!!
!
373 !Food!Prices.”!!
!
128!
could!control!the!famine!whereas!the!flu!had!run!wild,!unchecked!and!untamable.!!
The!actions!of!the!Government!of!India!reveal!several!critical!facets!of!their!
priorities.!!The!heavy!reliance!on!local!governments!and!private!charities!to!provide!
the!bulk!of!relief!in!times!of!crisis!made!sense!on!a!large!scale,!in!that!it!allowed!for!
stricken!areas!to!meet!their!specific!needs!quickly.!!However,!in!the!event!of!a!
pandemic!like!the!flu!that!hit!all!segments!of!the!population!very!hard—unlike!
famine,!which!representatives!of!the!government!could!often!weather!without!much!
trouble—this!reliance!on!locals!to!provide!relief!hamstrung!the!response.!!The!
threat!of!famine!seemed!to!preoccupy!any!official!that!wasn’t!facing!the!flu!head!on,!
and!the!famine!came!to!supersede!the!flu!in!the!official!mind!as!the!controllable!
issue!of!famine!seemed!far!more!palatable!than!a!devastating!illness!of!uncertain!
origin.!!The!flu!had!no!solution;!famine!had!several.!
However,!the!British!were!not!as!successful!in!controlling!the!famine!as!they!
thought.!!A!variety!of!news!sources!attacked!the!Government!for!ignoring!the!plight!
of!the!people,!although!there!does!appear!to!be!some!variation!in!where!the!blame!
was!placed.!!Some!accused!Indian!representatives!of!not!explaining!the!plight!of!
their!people!to!the!Government,!while!others!seemed!to!blame!the!Government!
itself.!!!
The!flu!happened!so!quickly!and!afflicted!far!more!Indians!than!British,!and!
as!the!British!officials!fixated!on!the!famine,!so!to!the!archival!records!came!to!
reflect!that!fixation.!!Reports!on!the!flu!focused!on!calculating!death!tolls,!and!very!
few!addressed!how!to!prevent!or!forestall!a!future!pandemic.!!The!flu!seemed!
unstoppable!and!uncontrollable,!and!compared!to!the!relative!ease!with!which!the!
!
129!
famine!was!handled,!the!British!officials!let!the!flu!drift!from!their!mind.!!As!
information!went!up!the!official!food!chain,!fewer!and!fewer!mentions!of!influenza!
were!recorded.!!As!a!result,!faded!from!official!consciousness!as!distance!lessened!
the!impact.!Thus,!influenza!became!a!footnote!in!history.!!!
!
!
!
130!
Chapter*Four*
Doctors$and$the$Government:$The$Front$Line$Defense$Against$the$Flu$
$
$
Medical!personnel!possess!no!special!immunity!to!the!disease!and!the!fact!that!their!
calling!brought!them!into!closer!contact!with!infection!than!any!other,!resulted!in!a!
large!percentage!of!them!becoming!incapacitated,!when!their!services!were!most!in!
demand.374!!
!
!
!
The!burden!of!fighting!the!flu!fell!most!heavily!on!the!medical!community,!
both!Indian!and!British.!!They!had!few!resources!with!which!to!fight!it,!however,!as!
the!flu!defied!all!of!contemporary!scientific!knowledge.!!Without!knowing!what!
caused!the!flu,!they!found!themselves!trying!to!simply!alleviate!the!worst!of!the!
symptoms.!!Surviving!a!bout!of!the!flu!depended!heavily!on!nursing!care,!but!India!
lacked!enough!medical!professionals!of!any!type!to!organize!substantial!relief.!!
Western!nations!had!suffered!under!the!flu!in!a!similar!manner,!but!the!famine!that!
caused!a!spike!in!prices!put!India!at!a!disadvantage:!with!necessities!like!grain,!milk!
and!blankets!suddenly!far!more!expensive,!people!had!to!stretch!already!limited!
resources!even!further.!!Simply!put,!the!medical!personnel!in!India!were!fighting!a!
losing!battle!from!the!moment!influenza!arrived!on!their!shores.!
The!history!of!!the!British!medical!presence!in!India!is!crowded!with!
misunderstandings,!illAadvised!intervention,!and!heavyAhanded!imposition!of!British!
policies!with!little!or!no!cooperation!with!the!Indian!people.!!As!a!result,!one!can!
hardly!be!surprised!that!the!Indian!people!viewed!the!Indian!Medical!Service!with!
something!between!wary!skepticism!and!outright!suspicion.!!During!the!influenza!
outbreak!western!doctors!may!have!seen!themselves!as!putting!forth!a!valiant!effort,!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
374 !Preliminary$Report,!3.!!
!
131!
but!the!Indian!people!often!disagreed.!!The!disparity!between!rural!and!urban!access!
to!medical!care,!briefly!touched!on!in!chapter!one,!also!played!a!role!in!the!large!death!
toll.!!Meanwhile!upper!level!governmental!officials!took!almost!no!notice!of!the!flu!
pandemic!swirling!around!them.!
Outbreaks!of!plague!in!the!early!20th!century!had!been!met!with!a!swift!and!
harsh!British!response,!requiring!segregation!of!the!ill!and!travel!restrictions,!as!well!
as!a!disregard!for!traditional!Indian!practices!such!as!purdah.375!!!These!measures!
were!deeply!unpopular,!and!as!John!Cell!writes,!“They!were!imposed!by!an!alien!
government;!and!they!were!obviously!unsuccessful.!…!The!blunt!truth…was!that!the!
government!and!medical!science!alike!were!impotent.”376!!As!discussed!in!chapter!
two,!British!attitudes!toward!public!health!situations!in!India!fundamentally!centered!
on!control—they!intended!to!corral!disease!and!prevent!its!spread,!and!they!felt!that!
British!policies!should!take!precedence!over!Indian!preferences.!!So!the!British!
initiated!restrictions!on!travel!to!control!plague!and!cholera!outbreaks!in!spite!of!
Indian!opposition.377!!!!These!restrictions!would!have!been!present!in!the!minds!of!
Indian!people!as!they!faced!down!influenza,!adding!yet!another!barrier!to!effective!
control!of!the!pandemic!as!the!British!had!not!given!the!Indian!people!any!reason!to!
trust!their!public!health!efforts.!
The!Indian!Medical!Service!and!British!Government’s!emphasis!on!quarantine!
without!applying!the!same!rules!to!British!residents!made!implementing!public!health!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
375 !Cell,!27.!!Purdah!is!a!primarily!Muslim!practice!of!segregating!women!from!men.!!!
!
376 !!Cell,!27.!
!
377 !Polu,!59.!
!
!
132!
policies!challenging.!!Additionally,!tensions!over!smallpox!vaccinations!had!somewhat!
soured!relations!between!the!Indian!people!and!public!health!officials,!positioning!the!
IMS!in!a!difficult!place!just!as!the!pandemic!got!underway.!
!
Medicine*and*Influenza*in*India*
!The!Indian!environment!heavily!informed!the!character!of!British!medicine!
in!India.!!As!early!as!the1820s,!British!researchers!in!India!encouraged!the!medical!
community!to!focus!on!geography,!climate,!and!topography!and!their!role!in!
influencing!disease.378!!Much!of!this!focus!centered!on!the!susceptibility!of!
Europeans!to!indigenous!diseases,!especially!during!the!first!half!of!the!nineteenth!
century.!!This!philosophy!led!to!an!attitude!of!India!as!a!dangerous!force!against!the!
British!constitution.379!!By!the!advent!of!the!First!World!War!some!of!these!attitudes!
had!fallen!out!of!favor,!!but!the!heavy!emphasis!on!medical!topography!remained.!!!
!The!evolution!of!the!Indian!Medical!Service!from!a!primarily!military!service!
to!the!beginnings!of!public!health!system!for!all!of!British!India!occurred!gradually!
over!the!course!of!the!nineteenth!century.!!Members!of!the!IMS!held!a!dual!
commission!with!the!IMS!and!the!British!military,!although!by!the!end!of!the!
nineteenth!century!they!also!held!civilian!posts!such!as!sanitary!commissioners.380!!
The!illAdefined!mission!of!the!IMS!hindered!them!as!the!main!corps!of!British!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
378 !Harrison,!“Tropical!Medicine!in!Nineteenth!Century!India,”!305.!
!
379 !Harrison,!“Tropical!Medicine!in!Nineteenth!Century!India,”!306.!
!
380 !!Arnold,!Science$Technology$and$Medicine,!59A60.!!Arnold!notes!that!many!
members!of!the!IMS!took!positions!as!Sanitary!Commissioner!even!though!until!the!
1890s!they!often!weren’t!trained!for!those!jobs.!
!
!
133!
trained!doctors!in!India!became!a!mishAmash!of!researchers!of!tropical!disease!and!
civilian!bureaucrats,!all!while!steadily!losing!numbers.!
In!1918,!the!medical!community!found!itself!impeded!by!their!focus!on!
diseases!other!than!the!influenza!virus,!and!while!doctors!cannot!be!faulted!for!not!
understanding!the!agent!of!infection,!their!almost!myopic!focus!on!“tropical!diseases”!
and!research!gave!them!a!blind!spot!when!it!came!to!the!flu.!!On!the!one!hand,!prior!to!
1918,!influenza!presented!a!minor!threat!compared!to!diseases!like!cholera,!smallpox,!
malaria,!and!plague!and!their!focus!seems!understandable.!Caught!offAguard,!much!
like!the!rest!of!the!world,!the!IMS!could!do!little!to!forestall!the!pandemic!short!of!
providing!rudimentary!nursing!care!and!suggesting!people!stay!away!from!crowded!
areas.!!Viruses!could!not!be!seen!with!contemporary!microscopes,!and!scientists!did!
not!identify!the!influenza!virus!until!1933.!381!!Research!into!the!flu!began!almost!
immediately,!but!it!yielded!little.!
This!deficit!left!public!heath!officials!with!two!courses!of!action:!they!could!
try!to!slow!the!spread!of!the!disease!and!they!could!try!to!mitigate!its!symptoms.!!
For!the!first!course!of!action,!the!Government!of!India’s!response!differed!little!from!
reactions!around!the!world.!!In!the!United!States!and!England,!doctors!and!
government!officials!handed!out!pamphlets!describing!treatments!and!urging!
people!to!stay!home.382!*By!attempting!to!limit!large!crowds,!officials!were!following!
the!best!known!practices!to!stem!the!tide.!!However,!these!measures!had!the!taint!of!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
381 !Phillips!and!Killingray,!6.!
!
382 !Kent,!13,!Crosby!71,!74!and!Bombay$Report,!2.!!
!
!
134!
quarantine!to!them,!something!that!did!not!always!sit!easily!with!the!Indian!people!
thanks!to!the!government’s!previous!missteps!regarding!quarantine!and!plague.!!!
Various!remedies!were!suggested,!such!as!antiseptic!mouthwashes!for!
gargling,!but!these!had!little!to!no!influence!on!the!virus!itself.383!!MacTaggart!
reported!that!in!Lucknow,!doctors!suggested,!!“Absolute!rest,!fresh!air,!and!frequent!
small!feeds!of!milk!and!soup!constitute!the!basis!of!the!treatment!of!influenzal!
pneumonia.!!Local!applications!to!the!chest,!inhalations!of!various!oils!like!
eucalyptus,!the!steam!kettle!and!small!doses!of!alcohol,!as!a!food!rather!than!as!a!
stimulant.”384!!However,!if!that!did!not!work,!MacTaggart!reported!that!doctors!
turned!to!other!treatments.!!!
Oxygen!was!often!required,!injections!of!camphor!and!ether!
were!the!favourite!stimulants,!while!some!physicians!favoured!
digitalis!strophathus!and!strychnine!in!cases!of!a!failing!heart.!!
Rectal!salines!and!intravenous!salines!seemed!to!save!one!or!two!
cases!which!were!collapsed!and!piturin!appeared!to!be!useful!in!
a!few!cases.385!!!
!
MacTaggart’s!prescriptions,!particularly!on!open!air!treatment,!were!echoed!by!
physicians!around!the!world.386!!!MacTaggart!then!noted,!“It!is!just!as!well!to!admit!
that!medical!science!does!not!score!a!triumph!in!the!treatment!of!influenza!and!its!
complications,!though!under!proper!treatment!many!lives!are!saved!that!would!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
383 !!Bombay$Report,!7.!!
!
384 !United$Provinces$Report,!120!
!
385 !United$Provinces$Report,!120.!!
!
386 !Kent,!69,!75,!83.!!Kent’s!collection!of!documents!features!advice!suggesting!openA
air!treatment!from!Victoria,!Australia,!Oakland,!California,!and!London,!England.!
!
!
135!
otherwise!be!lost.”387!!Thus,!the!best!courses!of!treatment!simply!focused!on!
treating!the!symptoms!of!influenza.!!These!symptoms!echoed!typical!influenza!
symptoms!for!the!most!part,!with!fever,!aches,!and!chills!providing!the!main!
complaints.!!!The!incredible!virulence!of!this!form!of!influenza!triggered!a!massive!
immune!response,!and!the!level!of!cytokines!released!into!some!sufferer’s!bodies!
overwhelmed!their!respiratory!systems!which!often!led!to!complications!such!as!
pneumonia.388!!If!sufferers!managed!to!make!it!through!the!worst!of!it,!sometimes!
extreme!fatigue—for!up!to!several!months!after!their!bout—set!in,!further!
complicating!recovery.389!!
Access!to!nursing!care!made!a!patient!far!more!likely!to!survive!because!in!
Having!someone!nearby—trained!or!not—to!aid!with!feeding!and!other!necessities!
was!critical.!!Family!members!could!and!often!did!fill!this!role,!but!given!the!
virulence,!many!families!were!struck!down!at!the!same!time.!!The!flu’s!tendency!to!
target!adults!in!their!prime!also!worked!against!victims,!as!if!both!parents!fell!ill!and!
the!children!too!small!to!be!of!much!help,!the!entire!family!could!be!in!danger.!!Close!
contact!with!an!afflicted!person!could!also!infect!the!caretaker,!and!thus!influenza!
made!caring!for!its!victims!that!much!more!difficult.!
One!interesting!blind!spot!in!the!historical!record!regarding!the!flu!in!India!is!
the!complete!lack!of!mention!of!nursing!as!a!profession.!!Despite!the!knowledge!that!
nursing!care!seemed!to!make!a!difference!in!the!outcome!of!flu!sufferers,!no!one!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
387 !United$Provinces$Report,!120.!!
!
388 !Kent,!2.!
!
389 !Kent,!7.!
!
!
136!
discussed!establishing!a!nursing!corps!to!help!out.!!Suggestions!point!to!the!
organization!of!dispensaries,!but!no!group!made!any!specific!effort!to!rally!nurses.!!
Part!of!this!may!be!because!nursing!in!India,!at!least!on!the!part!of!westernAtrained!
nurses,!seemed!to!be!focused!on!primarily!female!patients!and!birthing.!!!A!concrete!
reason!would!be!difficult!to!surmise,!but!it!is!possible!that!the!emphasis!on!
midwifery!in!India!made!medical!organizations!overlook!the!nursing!corps.!!It!is!
also!possible!that!in!the!flurry!of!activity!as!the!flu!hit,!neither!the!government!nor!
the!medical!community!considered!activating!nurses!on!a!large!scale.!
The!inscrutability!of!the!disease!also!worked!against!medical!professionals.!!
F.!Norman!White!expressed!doubt!that!the!influenza!bacillus!they!identified!was!the!
true!cause!of!the!disease!and!wrote,!!
There!is!no!doubt!whatever!that!the!virus!of!influenza!is!a!living!
germ!capable!of!being!transmitted!directly!from!man!to!man.!!…!The!
soAcalled!influenza!bacillus!was!certainly!almost!constantly!present!
in!the!cases!investigated!during!the!second!severe!epidemic!wave!in!
India;!it!does!not!appear!to!have!been!demonstrated!so!frequently!
during!the!early!mild!stages!of!the!epidemic.390!!!
!
White!elegantly!outlined!the!major!challenges!facing!those!searching!for!a!scientific!
explanation!for!the!flu,!as!well!as!the!salient!points!regarding!its!spread.!!He!
determined!that!it!spread!from!person!to!person,!and!there!appeared!to!be!a!specific!
bacillus!present!in!!most!cases!in!the!second!wave,!but!the!close!relationship!of!the!
first!and!second!wave—and!the!subsequent!lack!of!the!bacillus!in!the!first!wave—
brought!it!into!doubt!as!a!cause.!!Instead,!it!may!have!only!been!a!concomitant,!or!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
390 !Preliminary$Report,!2.!!
!
!
137!
coexisting!factor.391!!Scientific!minds!faced!these!challenges!as!they!attempted!to!
create!a!cure!or!at!the!very!least,!a!vaccine,!for!a!disease!whose!cause!they!had!yet!to!
confidently!identify.!
Finding!a!cure!for!a!disease!with!an!unknown!cause!is!incredibly!difficult,!
even!today.!!In!vain,!the!British!poured!enormous!resources!into!discovering!the!
cause!of!influenza.!!Doctors!knew!of!influenza!as!it!appeared!in!both!epidemic!and!
nonAepidemic!form!quite!frequently!in!India!and!in!Britain.392**!As!a!result!the!
medical!community!was!prepared!to!handle!it!in!the!abstract,!knowing!that!the!flu!
generally!targeted!the!very!young!and!the!very!old,!and!that!rest,!warmth,!and!
nourishing!food!were!important,!along!with!nursing!care.!!The!1918!version,!with!its!
attendant!horrific!symptoms!such!as!heliotrope!cyanosis!and!pneumonia,!made!
those!few!steps!seem!paltry.!!!The!medical!community!in!India!threw!themselves!
into!finding!a!cure,!but!nothing!seemed!to!work.!!Sanitary!Inspector!of!the!United!
Provinces,!Col.!MacTaggart,!claimed,!“It!is!just!as!well!to!admit!that!medical!science!
does!not!score!a!triumph!in!the!treatment!of!influenza!and!its!complications,!though!
under!proper!treatment!many!lives!are!saved!that!would!otherwise!be!lost.”393!
!
That!fall,!the!medical!community!led!by!the!IMS!quickly!came!to!agree!on!a!
course!of!treatment,!primarily!placing!patients!in!the!open!air.!!They!understood!
that!being!in!enclosed!spaces!increased!transmission!and!knew!that!the!disease!
passed!via!droplets!in!the!air,!and!thus!the!first!step!in!limiting!transmission!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
391 !Preliminary$Report,!2.!*
!
392 !Preliminary$Report,!1.!
!
393 !United$Provinces$Report,!120.!!
!
!
138!
involved!keeping!patients!in!outdoor!hospitals!wards.394!!Doctors!also!felt!that!this!
method!would!be!critical!to!keeping!health!care!workers!safe!and!pointed!to!a!case!
in!the!United!Provinces!where!male!patients!stayed!in!open!air!and!female!patients!
did!not,!leading!to!three!deaths!for!dais!in!the!female!ward!and!none!in!the!male!
ward.395!!At!other!medical!institutions!in!the!United!Provinces,!roughly!50%!of!the!
staff!were!infected,!although!case!mortality!did!not!rise!above!5%.396!!!Health!care!
workers!put!themselves!at!great!risk!of!contracting!the!flu,!but!their!overall!case!
mortality!did!not!rise!to!the!same!level!as!the!worst!afflicted!areas.397!!!These!
numbers!may!have!been!owing!to!increased!access!to!care!or!possibly!being!able!to!
afford!increasingly!expensive!food!in!the!midst!of!the!concurrent!famine.!
!
The*Problem*of*Access*
*
Lack!of!access!to!medical!care!proved!to!be!a!major!problem!in!India!in!the!
autumn!of!1918!thanks!to!understaffing!and!a!lack!of!dispensaries!in!rural!areas.!!
Many!of!the!reports!filed!on!the!flu!pandemic!emphasize!the!extent!to!which!medical!
officials!pushed!themselves,!echoing!the!complaints!of!understaffed!offices!without!
saying!so!directly.!!C.H.!James,!a!Lt.!Colonel!in!the!IMS!and!the!Chief!Medical!Officer!
in!Delhi,!wrote!of!his!men,!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
394 !“What!We!Know!of!Influenza,”!Indian$Medical$Gazette,!Vol.!LIV,!February!1919,!
63A64.!
!
395 !United$Provinces$Report,!115.!A!dai!is!an!indigenous!midwife.!
!
396 !United$Provinces$Report,!115.!!
!
397 !As!stated!in!chapter!one,!Indian!case!mortality!ranged!between!6A10%!overall.!
!
!
139!
The!medical!men!in!every!part!of!the!Province!were!worked!almost!to!a!
standstill.!!One!medical!practitioner!never!took!off!his!clothes!for!several!
consecutive!nights!and!days.!!As!the!medical!profession!suffered!as!severely!as!
every!one!else,!it!was!at!times!difficult!to!keep!the!dispensaries!properly!
staffed.!!Men!often!had!to!work!before!they!had!properly!recovered!from!the!
attacks!themselves.!!I!may!mention!the!case!of!one!dispensary!where!I!found!
the!medical!officer!himself!ill!and!his!wife!down!with!double!pneumonia!in!the!
next!room,!running!the!dispensary!singled!handed,!both!his!compounders!and!
all!the!menial!staff!as!well!as!the!medical!officer!who!had!been!sent!to!relieve!
him,!were!down!with!the!disease!at!the!same!time.398 !
This!attitude!of!selfAsacrifice!demonstrates!that!in!the!minds!of!the!British,!they!were!
doing!the!best!they!could!under!very!difficult!circumstances.!!In!contrast,!as!Ramanna!
reports,!in!the!minds!of!Indians—particularly!those!in!rural!areas!without!easy!access!
to!British!relief!efforts—“the!epidemic!was!seen!as!one!more!in!the!continual!stream!
of!epidemics!that!took!more!Indian!lives!than!British.”399!!This!disconnect!in!
perception!would!continue!to!plague!the!British!throughout!the!pandemic.!
The!case!of!Lachi!and!Teri,!two!small!towns!in!the!NorthAWest!Frontier!
Province!briefly!discussed!in!chapter!one,!highlights!both!the!varying!death!tolls!
caused!by!the!pandemic!and!the!impact!of!access!to!transportation.!!The!relatively!
isolated!Teri!lost!81.3!per!thousand!people,!which!amounts!to!273!deaths!in!a!town!of!
less!than!3,400!people.400!!In!comparison,!the!better!connected!Lachi!lost!200!people,!
despite!having!almost!1,000!more!residents.!!While!one!might!surmise!that!Lachi!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
398 !Delhi$Report,!2.!*
!
399 !Ramanna,!87.!
!
400 !Northwest$Frontier$Report,!3.!*Lachi’s!population!was!4,203!and!Teri’s!was!3,363,!
as!reported!in!the!first!chapter,!although!it’s!fine!if!you!forgot!that!already.!!There’s!
been!a!lot!of!numbers!so!far.!
!
!
140!
would!have!been!at!greater!risk!for!a!high!death!toll,!its!comparatively!better!access!to!
other!locations!may!have!allowed!for!more!relief!efforts.!!
!MacTaggart’s!records!for!the!United!Provinces!complicate!the!theory!that!lack!
of!access!to!health!officers!added!to!any!region’s!higher!death!toll.!!MacTaggart!
divided!his!influenza!report!data!into!two!separate!charts:!areas!with!health!officers,!
and!areas!without.!!MacTaggart!reported!that!in!districts!without!health!officers!
present,!death!rates!for!influenza!ranged!from!30.4!per!thousand!to!114.21!per!
thousand.401 !!!!Areas!with!health!officers,!although!covering!a!much!smaller!segment!
of!the!population,!had!death!rates!of!8.17!to!115.39!per!thousand.!!While!the!average!
death!toll!for!both!categories!hovered!around!68!per!thousand,!the!median!for!areas!
with!health!officers!was!around!60!per!thousand!and!the!median!for!areas!without!
health!officers!was!roughly!75!per!thousand.402!!Clearly,!these!comparisons!indicate!
that!surviving!the!pandemic!required!more!than!mere!access!to!British!health!officers,!
and!the!towns!of!Lachi!and!Teri!indicate!that!transportation!and!access!to!other!
regions!may!have!played!a!role!as!well.!
In!comparison,!F.!Norman!White!noted!in!his!Preliminary$Report!that!Calcutta!
seemed!to!have!escaped!relatively!unscathed.!!Although!Calcutta!suffered!less!than!
areas!like!the!Northwest!Frontier!and!the!United!Provinces,!it!provides!a!useful!
glimpse!into!the!flu!in!an!urban!area!with!access!to!relief!centers.!!H.M.!Crake,!Health!
Officer,!filed!a!report!in!January!of!1919!detailing!the!influenza!outbreak!in!Calcutta,!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
401 !United$Provinces$Report,!210.!!!
!
402 !United$Provinces$Report,!210A211.!*Areas!with!health!officers!had!a!death!rate!of!
68.81!per!thousand,!and!areas!without!came!in!at!68.56!per!thousand.!
!
!
141!
and!while!the!death!toll!averaged!4.1!per!thousand,!he!noted!that!certain!areas!were!
hit!far!harder.403!!!For!example,!influenza!hit!the!neighborhood!of!Kidderpore!the!
hardest;!Crake!determined!the!infection!first!here.!!Crake!noted!that!Kidderpore!as!
the!locus!of!infection!meant!influenza!most!likely!arrived!via!the!sea,!not!by!train.404!!
Kidderpore!saw!a!mortality!rate!of!21.1!per!mille,!more!than!five!times!the!average!
mortality!rate!in!Calcutta.!!Crake!wrote,!!
The!excessive!mortality!in!Kidderpore!appears!to!be!due!mainly!to!
the!large!coolie!population,!ignorant!and!povertyAstricken,!living!
under!most!insanitary!conditions!in!damp,!dark,!dirty!huts.!!They!
are!a!difficult!class!to!deal!with,!and!not!only!conceal!cases!but!
often!refuse!all!advice!and!treatment.405!!!
!
Crake!also!acknowledged!that!this!neighborhood!had!many!relief!centres,!but!they!
did!not!open!quickly!and!generally!failed!to!provide!the!same!measure!of!success!that!
they!did!in!other!neighborhoods.!!He!noted!that!areas!mainly!inhabited!by!wealthy!
Europeans!had!mortality!rates!far!below!average,!but!also!commented,!!
In!Wards!2,!3,!4,!6,!8,!and!11!the!mortality!rates!from!influenza!
were!below!3!per!mille.!!Though!overcrowded!and!with!many!
insanitary!features!these!wards,!generally!speaking,!contain!a!fair!
proportion!of!middle!class!people,!the!ignorant,!povertyAstricken!
bustee!dweller!being!in!a!minority.406!!!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
403 !Calcutta$Report,$1.!!
!
404 !Calcutta$Report,!1.!!
!
405 !Calcutta$Report,!2.!!
!
406 !Calcutta$Report,!2.!!!The!“first!class!residential!areas,!inhabited!chiefly!by!wellAtoA
doAEuropeans”!had!mortality!rates!of!2.0!and!1.6!per!mille,!Crake!notes.!
!
!
142!
Crake!drew!a!direct!line!between!survival!rates!and!social!class,!dismissing!the!living!
conditions!as!a!possible!cause!of!high!mortality!and!instead!attributing!high!death!
rates!to!those!living!in!ignorance!and!poverty!instead.!
Crake!did!not!mention!the!famine,!although!the!high!prices!sparked!by!the!
dual!crisis!of!famine!and!war!certainly!affected!Calcutta!as!well.!!His!disdain!for!“this!
illAclad,!illAfed!and!badlyAhoused!section!of!the!community![that]!suffered!far!more!
severely!than!the!rest!of!the!population,”!bleeds!into!the!report.407!!The!brief!mention!
of!malnutrition!is!the!closest!he!came!to!mentioning!the!famine.!!He!also!commented!
that!in!early!October!he!toured!Kidderpore!and!found!that!many!families!had!been!
struck!down!entirely,!too!sick!to!travel!to!the!relief!centres.!!Crake!decided!that!
houseAtoAhouse!deliveries!of!medicine!would!be!the!most!effective!relief!possible!in!
this!situation,!and!later!argued!that!even!a!fullyAstaffed!Health!Department!would!be!
inadequate!should!a!similar!epidemic!arise.408!!In!the!event!of!a!future!pandemic,!he!
prescribed!maintaining!contact!with!volunteer!networks!and!medical!societies,!both!
of!which!assisted!with!the!relief!centres.409!!!In!the!case!of!Calcutta,!we!see!that!relief!
works!may!not!have!made!much!of!a!difference!because!Calcutta!escaped!the!flu!and!
the!famine!relatively!lightly,!both!of!which!may!account!for!the!lower!mortality!rates.!
Nutrition!and!living!conditions!likely!played!a!large!role!in!survival,!as!the!disparity!
between!rich!and!poor!existed!in!Calcutta!as!well.!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
407 !Calcutta$Report,!2.!!!
!
408 !Calcutta$Report,!3A4.!!*
!
409 !Calcutta$Report,!4A5.!!
!
!
143!
An*Ounce*of*Prevention*
The!IMS!remained!largely!stumped!when!it!came!to!prescribing!possible!
preventative!measures!for!the!future.!!“It!is!obviously!useless!to!discuss!elaborate!
measures!of!personal!prophylaxis,”!MacTaggart!wrote.410!!He!then!discussed!
problems!with!creating!an!effective!vaccine,!before!protesting,!!
How,!I!ask,!is!it!possible!for!Government!to!produce!this!vaccine!
in!sufficient!quantity!to!be!of!the!slightest!use!in!preventing!an!
epidemic!of!influenza,!the!characteristic!features!of!which!are!
the!extraordinary!rapidity!with!which!it!spreads,!its!practically!
universal!incidence!and!its!short!life!of!a!month!or!six!weeks?411!!
!!
He!dissected!the!probability!of!producing!enough!vaccine,!as!well!as!the!probability!
of!the!limited!medical!personnel!being!able!to!inoculate!the!entire!province,!before!
concluding,!“Assuming!that!we!had!unlimited!vaccine!and!an!unlimited!medical!
personnel,!is!it!in!the!slightest!degree!probable!that!the!people!could!be!persuaded!to!
accept!inoculation!as!a!preventative!measure!for!influenza?!!The!answer!to!this!
question!must!be!a!decided!negative.”412!!MacTaggart’s!disillusionment!did!not!end!
with!the!vaccine!and!he!continued!on!for!several!paragraphs,!explaining!that!the!only!
true!preventative!for!high!mortality!rates!would!be!to!raise!the!living!standards!of!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
410 !United$Provinces$Report,!206.!!
!
411 !United$Provinces$Report,!207.!The!entire!rant!is!well!worth!a!read.!!MacTaggart!
was!clearly!the!Eeyore!of!the!IMS.!
!
412 !United$Provinces$Report,!207.!*MacTaggart!reports!the!full!establishment!of!
medical!subordinates!(those!with!qualifications!at!or!above!subAassistant!surgeons)!
at!500!for!the!entirety!of!the!United!Provinces.!!With!a!population!of!46.8!million!
people,!this!amounts!to!roughly!one!IMS!certified!medical!man!for!every!93,600!
people,!hardly!a!scenario!for!success.!!The!1911!census!for!districts!with!health!
officers!indicates!that!only!about!1.4!million!people!lived!in!areas!with!any!access!to!
health!officers!at!all.!
!
!
144!
Indian!people!to!that!of!Americans!or!British.!!While!influenza!had!been!epidemic!in!
both!of!those!countries,!the!death!rates!were!far!lower!and!the!devastation!far!less.!!
“If![influenza]!be!more!fatal!in!India!it!is!not!due!to!the!fact!that!sanitary!conditions!
are!worse!in!India!but!to!the!fact!that!economic!conditions!are!worse.!!The!people!of!
India!are!worse!housed,!worse!clothed!and!worse!fed!and!can!consequently!offer!less!
resistance!to!disease!than!those!in!England!and!America.”413!!While!MacTaggart!did!
not!explicitly!reference!the!famine!here,!the!link!between!malnutrition,!poverty,!and!
high!death!rates!from!influenza!appear!in!the!United!Provinces!and!throughout!the!
rest!of!British!India.!
!
MacTaggart!also!dismissed!the!idea!that!bringing!nasal!sprays,!face!masks!
and!the!like!would!be!of!any!use!in!future!pandemics,!noting!that!while!these!
practices!might!be!useful!for!nurses!and!doctors,!“[it]!cannot!be!expected!to!come!
into!general!use!among!the!populations!of!the!most!advance!countries!and!still!less!
in!India.!!Most!sensible!men!would!rather!run!the!risk!of!getting!influenza!and!the!
small!risk!of!dying!from!the!disease!rather!than!resort!to!the!habitual!use!of!such!
contrivances.”414 !!!
!
British!doctors!looked!to!a!vaccine,!hoping!that!if!they!could!not!cure!
influenza,!they!would!at!least!be!able!to!vaccinate!people!and!help!stem!the!spread.!!
As!mentioned!above,!they!did!not!know!the!cause!of!the!disease!and!thus!reverse!
engineering!a!vaccine!would!prove!to!be!a!fruitless!endeavor.!MacTaggart!stated,!“It!
is!quite!possible!that!a!vaccine!containing!dead!influenza!bacilli,!pneumococci!and!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
413 !United$Provinces$Report,!208.!*MacTaggart,!for!the!win.!
!
414 !United$Provinces$Report,!206.!!
!
!
145!
streptococci!may!have!a!definite!value!in!preventing!complications,!for!this!purpose!
it!should!be!given!on!the!first!day!of!the!illness,!but!there!is!as!yet!no!experimental!
evidence!to!prove!its!efficacy.”415!!He!prescribed!it!with!the!rationale!that!it!can’t!
hurt,!even!if!it!does!not!help.!He!then!turned!his!ire!to!the!possibility!of!creating!a!
vaccine!for!all!of!India!to!inoculate!against!influenza,!dismissing!it!completely!out!of!
hand.!
Inoculations!against!plague!and!smallpox!had!proved!to!be!fairly!useful!in!the!
decades!before!the!First!World!War,!and!so!British!doctors!naturally!sought!a!
vaccination!against!influenza.416!!Since!the!nineteenth!century,!British!doctors!had!
been!heavily!focused!on!research!in!India,!and!on!the!whole!put!more!of!their!effort!
toward!eliminating!diseases!than!treating!patients.!!As!Harrison!argues,!“By!
eradicating!the!vectors!which!spread!diseases!like!malaria,!or!by!inoculation,!they!
hoped!to!render!the!tropics!as!safe!as!Europe!or!North!America.”417!!The!IMS!
therefore!sank!considerable!amounts!of!time!and!money!into!various!vaccination!
projects,!trying!in!vain!to!develop!an!effective!flu!vaccine!even!as!contemporaries!
raised!doubts.!!White’s!Preliminary$Report!contained!a!section!on!the!scientific!
research!into!a!vaccine,!although!he!lamented!that!the!general!public!seemed!to!
misunderstand!the!process!of!creating!a!vaccine.!!!
As!usual!popular!opinion!demanded!an!immediate!explanation!and!the!
demand!for!a!panacea!in!the!form!of!a!vaccine!was!insistent.!!It!was!
commonly!forgotten!that!research!into!the!causation!of!disease!is,!as!a!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
415 !United$Provinces$Report,!205.!!
!
416 !Polu,!59.!
!
417 !Harrison,!Climates$and$Constitutions,!209.!
!
!
146!
rule,!a!matter!of!months!or!years!and!not!of!days.!!The!perhaps!not!
unnatural!demand!for!immediate!results!by!the!illAinformed!is!rather!
an!embarrassment!than!a!help!to!researches!of!this!nature.418!!!
!
White!echoed!MacTaggart’s!pessimism,!stating!that!while!a!formulation!for!a!vaccine!
had!been!agreed!upon!by!December!of!1918,!only!300,000!doses!would!be!kept!in!
case!of!a!reemergence!of!the!pandemic.!!He!continued,!
It!must!be!realised,!however,!that!in!the!event!of!a!recrudescence!of!the!
epidemic,!in!a!form!in!any!way!comparable!to!the!last,!inoculation!
would!be!little!likely!to!confer!any!appreciable!benefit!on!India!as!a!
whole.!…In!relatively!small!communities!such!as!the!army,!jails,!labour!
forces!and!the!like,!inoculation!with!a!suitable!vaccine!might!be!of!very!
considerable!value.!Inoculation!on!a!wholesale!scale,!in!anticipation!of!a!
recrudescence,!would!not!commend!itself!as!a!reasonable!proposition!
even!were!the!chances!of!a!!recrudescence!!greater!than!they!appear!to!
be.419!
!
The!only!preventative!plan!the!best!medical!minds!of!India!could!develop!would!be!
effective!for!a!small!percentage!of!the!population.!!The!rest!of!the!Indian!population!
would!be!left!to!the!mercies!of!nature!should!another!virulent!pandemic!emerge.!
!
In!spite!of!the!very!difficult!odds!facing!the!British!medical!community,!
MacTaggart!had!words!of!cautious!optimism.!!He!stated,!!
The!…!description!of!the!bacteriology!of!the!disease!suggests!that!
it!is!hopeless!to!deal!with!the!disease!until!more!light!is!thrown!on!
the!exact!nature!of!the!virus,!but!this!pessimistic!attitude!is!by!no!
means!justified.!!We!know!enough!about!the!nature!of!the!virus!
and!its!characteristic!behavior!to!enable!us!to!deal!with!the!
disease!which!it!causes,!even!though!we!may!be!in!serious!doubt!
as!to!its!identity.420!!!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
418 !Preliminary$Report,!12.!!!
!
419 !Preliminary$Report,!14.!!
!
420 !United$Provinces$Report,$199.!!
!
!
147!
This!highlights!two!separate!problems!the!British!medical!community!in!India—the!
issue!of!the!pandemic!as!it!happened,!and!the!issue!of!preventing!a!future!epidemic.!!
Of!these!two!problems,!MacTaggart!was!considerably!more!bullish!on!the!former,!
noting!that!when!local!populations!had!medical!care!available!and!used!it,!death!
tolls!could!be!decreased.421!!When!it!came!to!creating!a!vaccine!or!instituting!a!
policy!to!control!the!spread!of!another!epidemic,!MacTaggart!realistically!did!not!
see!much!use.!!!
Despite!the!negative!attitudes!towards!the!flu!vaccine’s!efficacy,!the!
government!still!manufactured!it!and!created!a!list!of!rules!for!its!distribution.!!The!
vaccine!was!available!for!“any!Civil!Surgeon!and!health!officer!who!wishes!to!use!it,”!
as!well!as!for!private!practitioners!upon!request.422!!The!United$Provinces$Medical$
Manual!gave!strict!instructions!for!storing!the!vaccine!and!for!how!administering!it,!
but!rather!dejectedly!noted,!“In!any!case!it!cannot!be!said!that!the!usefulness!of!the!
vaccine,!either!as!a!prophylactic!or!as!a!curative!agent,!has!so!far!been!thoroughly!
established.”423!!The!fact!that!the!government!went!ahead!with!manufacturing!the!
vaccine,!despite!very!little!faith!in!it,!raises!some!interesting!issues.!!It!shows!the!
level!of!willful!blindness!and!desperation!some!could!have!when!it!came!to!western!
medicine—they!manufactured!vaccines!even!though!they!probably!did!not!work!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
421 !!United$Provinces$Report,!205A205.!!
!
422 !The$United$Provinces$Medical$Manual$Containing$Rules$for$the$Management$of$
Charitable$Dispensaries$and$Hospitals,$and$the$for$the$Guidance$of$Medical$Officers$
under$the$Government$of$the$United$Provinces$of$Agra$and$Oud.!(Allahabad,!
Government!Press,!United!Provinces,!1921),!175.!!!
!
423 !United$Provinces$Medical$Manual,!175.!!
!
!
148!
because!there!was!a!demand!for!action,!and!the!mere!fact!that!a!the!vaccine!didn’t!
appear!to!be!harmful!was!enough.!!The!mere!appearance!of!action!in!the!form!of!a!
vaccine—even!just!a!vaccine!for!health!officials,!who!likely!would!have!known!and!
had!their!own!doubts!about!its!effectiveness—was!better!than!nothing.!
!
Analyzing*the*flu*
!
Within!medical!journals,!doctors!discussed!their!doubts!about!the!origins!of!
the!virus!and!treatment!methods.!!An!April!3,!1919!British$Medical$Journal$article!
looked!at!Major!White’s!assumption!that!exposure!to!an!earlier!wave!of!influenza!
left!some!natural!immunity,!perhaps!explaining!why!the!third!wave!was!no!where!
near!as!deadly!as!the!second.424!!It!warned,!“Whether!we!can!count!upon!this!natural!
immunization!to!put!a!period!to!the!disease,!or!whether!a!further!succession!of!
waves!is!to!be!apprehended,!are!questions!we!cannot!answer.”425 !!The!article!
demonstrated!the!medical!community’s!confusion!and!helplessness,!as!they!found!
themselves!outmatched!by!influenza.!!
!
A!letter!to!the!editor!in!the!Indian$Medical$Gazette$written!by!Debendranath!
Sen,!a!pathologist!in!Calcutta,!offered!advice!on!isolating!Pfeiffer’s!Bacillus.!!He!
noted!that!like!many!others!he!failed!to!find!the!bacterium!in!internal!organs!and!
then!turned!to!“the!various!recesses!communicating!with!the!nasal!cavity,”!where!he!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
424 !“Influenza!in!India,”!British$Medical$Journal,!April!3,!1919,!418.!
!
425 !“Influenza!in!India,”!418.*
*
!
149!
discovered!a!“mucoid!substance!with!yellowish!lumps!embedded!in!it.”426!!Those!
lumps!grew!bacteria!“identical!with!Pfeiffer’s!bacillus,”!and!thus!Sen!offered!a!new!
avenue!of!investigation!to!his!peers!as!the!community!grappled!with!fighting!the!
disease.!
!
Technical!articles!were!not!limited!to!the!medical!presses,!however,!as!a!
Behar$Herald!piece!debated!the!very!nature!of!influenza!!and!showed!a!few!cracks!in!
the!united!façade!of!the!medical!community.!!It!offered!the!following!suggestions,!
Dr.!Row!of!Bombay!has!however!found!influenza!bacilli!in!the![e]xcreta!
of!patients.!!The!Sanitary!Commissioner!of!Bihar!and!Orissa!suspects!
some!connection!with!malaria!and!recommends!as!prophylactic!a!
regular!course!of!8!or!10!grains!of!quinine!per!day.!!On!the!other!hand!
the!Sanitary!Commissioner!with!the!Government!of!India!in!his!recent!
note!on!the!subject!says!categorically—“Quinine,!at!one!time!vaunted!
as!a!preventive!(sic)!of!influenza,!is!of!doubtful!value.”427!
!
Reporting!conflicting!advice!likely!did!little!to!help!the!public!understand!the!best!
course!of!treatment,!but!then!again!told!people!what!remedy!might!not!work!and!
offered!an!alternative!for!those!seeking!one.!!
!
Not!all!in!the!medical!community!came!to!the!same!consensus!for!treating!
influenza,!an!understandable!problem!when!so!little!of!their!knowledge!seemed!to!
work.!!Cecil!WebbAJohnson,!a!captain!in!the!RAMC!stationed!in!Calcutta!wrote!a!
letter!to!the!editor!of!the!Indian$Medical$Gazette!with!his!opinions!on!the!best!course!
of!treatment,!some!of!which!went!against!prevailing!medical!opinion.!!Most!notably!
he!suggested,!“No!food!of!any!description!should!be!allowed!until!the!fever!has!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
426!Debendranath!Sen,!“Letter!to!the!Editor:!Influenza,”!Indian$Medical$Gazette,$Vol!
LIV,!March!1919,!114.!!
!
427 !“When!Doctor’s!Differ!What!is!the!layman!to!do?”!Behard$Herald,$November!16,!
1918.!!!
!
!
150!
abated,!and!the!old!idea!of!‘keeping!the!strength!up,’!by!piling!in!nourishment!is!
exploded.”428!!He!also!advised!using!alcohol!in!“proper!doses,”!as!“the!whip!or!spur!
often!decides!a!race.”429!!WebbAJohnson!maintained!that!the!proper!treatment!
involved!protecting!the!heart!and!lungs!from!the!start,!and!built!his!letter!around!
that!very!principle.!!!However,!the!doubts!expressed!in!the!medical!journals!did!not!
appear!in!popular!newspapers,!at!least!not!from!official!medical!sources.!
!
The*Government*and*the*Medical*Community*
The!Government!of!India!attempted!to!set!up!other!systems!of!relief!in!
addition!to!their!quixotic!quest!for!a!vaccine.!!The!Bengal!Legislative!Council!
considered!the!distribution!of!money!to!local!boards,!with!Mahendra!Chandra!Mitra!
Bahadur!asking!,!“What!amount!has!been!actually!spent!by!each!of!the!district!boards!
for!the!treatment!of!the!poor!people!attacked!with!influenza?”!and!“What!amount!has!
been!contributed!by!Government!to!each!district!board!for!the!said!purpose?”430!!In!
response,!the!council!presented!Bahadur!with!a!list!of!expenditures!by!district!
boards—although!the!exact!recipients!were!not!named,!simply!the!amount!spent—
and!to!his!second!question,!O’Malley!replied,!“No!applications!have!been!made!for!
financial!assistance!and!no!grants!have!been!made!by!Government!for!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
428 !Cecil!WebbAJohnson,!“Treatment!of!Influenza!in!India,”Indian$Medical$Gazette,!Vol!!
LIV,!March!1919,!114.!
!
429 !WebbAJohnson,!“Treatment!of!Influenza!in!India,”114.!
!
430 !Mahendra!Chandra!Mitra!Bahadur!to!the!Bengal!Legislative!Council,!“Questions!
and!Answers,”!24,!!
!
!
151!
purpose.”431!!This!absence!raises!a!series!of!interesting!questions.!!While!Bengal!did!
not!have!the!massive!number!of!deaths!from!the!influenza!virus!as!provinces!like!the!
Punjab,!considerable!suffering!still!occurred.!!District!boards!did!not!apply!for!
additional!support,!indicating!that!perhaps!they!did!not!think!more!money!would!help!
solve!the!crisis.!!It!is!also!possible!that!by!the!time!they!could!have!gathered!together!
materials!for!a!grant,!the!worst!had!already!passed.!!One!of!the!cruel!vagaries!of!the!
1918!pandemic!was!its!quick!nature,!and!this!made!the!slow!apparatus!of!
governmental!wrangling!seem!more!useless!than!ever.!
Attempting!to!assuage!the!problems!of!an!understaffed!medical!corps,!the!IMS!
created!partnerships!with!voluntary!organizations!to!staff!dispensaries!and!makeshift!
hospitals.!!Ramanna!details!these!partnerships!in!“The!Bombay!Experience,”!and!
credits!them!with!helping!alleviate!the!death!toll.432!!However,!only!urban!areas!had!
access!to!these!services,!while!rural!areas!were!left!to!their!own!devices.!!Rural!areas!
tended!to!have!limited!infrastructure!and!lacked!the!necessary!resources!to!set!up!
relief!centers!and!temporary!dispensaries,!so!simply!by!dint!of!their!location!they!had!
less!access!to!BritishAsanctioned!medical!care.!!These!limitations!lead!to!a!paradox!in!
the!Indian!flu!experience:!!the!virus!spread!more!quickly!throughout!densely!
populated!areas,!but!those!areas!were!simultaneously!more!likely!to!have!systems!in!
place!to!combat!the!worst!of!it.!!Rural!areas,!with!their!comparatively!less!dense!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
431 !Mahendra!Chandra!Mitra!Bahadur!to!the!Bengal!Legislative!Council,!“Questions!
and!Answers,”!24,!!
!
432 !Ramanna,!87.!
!
!
152!
population,!may!not!have!had!the!same!rate!of!infection,!but!the!lack!of!coordinated!
relief!efforts!made!the!flu!more!deadly.!!!!The!Annual$Report!noted,!
Help!there!was,!but!it!could!not!be!universal,!and!difficulties!were!
naturally!felt!in!organization!of!effort!owing!to!the!absence!of!public!
health!staffs!for!rural!areas.!Rural!areas!depend!for!their!medical!aid!
on!dispensaries,!and!these!dispensaries!are,!speaking!for!India!as!a!
whole,!too!widely!separated!to!be!of!general!utility!in!a!wide!spread!
epidemic.433!
!
These!facts!do!not!take!into!consideration!issues!of!relative!wealth!and!poverty.!!The!
urban!poor!may!have!had!the!opportunity!to!access!relief!centers!but!lacked!the!
desire,!ability,!or!requisite!trust!in!the!Government!of!India!to!seek!assistance!there,!
while!the!rural!poor!faced!neglect!even!as!the!flu!spread!more!slowly!through!the!
countryside.!!
In!addition!to!these!obstacles,!the!IMS!was!already!illAprepared!to!handle!a!
massive!pandemic.!!MacTaggart!took!to!task!the!understaffing!of!medical!
departments,!writing,!
Unfortunately!the!epidemic!occurred!at!a!time!when!the!Medical!and!Sanitary!
Departments!of!the!Provinces!were!least!prepared!to!meet!it.!!The!demands!
made!owing!to!the!war!on!the!medical!personnel!of!the!Provinces!have!been!
very!extensive!and!the!Provinces!have!been!depleted!of!their!medical!
establishments,!superior!and!subordinate,!to!an!extent!which!no!one!prior!to!
the!war!had!ever!for!a!moment!contemplated!as!being!possible.434!
!
He!then!boasted!that!“These!Provinces!have!in!their!establishment!of!travelling!
dispensaries!probably!better!facilities!for!affording!medical!relief!in!epidemics!than!
any!other!Indian!province!possesses.”435!!MacTaggart!discussed!the!various!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
433 !Annual$Report,!67.$
$
434 !United$Provinces$Report,!205.$!
!
435 !United$Provinces$Report,!205.!!
!
153!
volunteer!networks!that!helped!staff!temporary!dispensaries,!while!noting!that!
Government!assistance!to!set!up!these!dispensaries!was!indispensable.436!
!
Presenting*a*United*Front**
Some!in!the!media!played!up!the!idea!of!medical!men!uniting!to!fight!the!flu!
in!order!to!bolster!public!confidence!as!the!fall!wave!raged.!!S.S.!Vyas,!a!subA
assistant!surgeon!in!Indore,!wrote!in!to!the!Indian$Medical$Gazette$!not!to,!in!his!
words!“to!give!any!elaborate!or!comprehensive!history!of!the!disease…[but]!to!give,!
in!brief,!a!few!features!of!this!disease!that!came!to!my!notice!in!the!recent!
epidemic.”437!!Vyas!highlighted!the!communal!efforts!of!the!medical!community,!
much!like!popular!newspapers.!!He!wrote,!“About!a!dozen!and!a!half!doctors!
volunteered!to!work!in!connection!with!the!epidemic,!and!with!the!generous!
monetary!help!of!the!State!more!than!a!dozen!medical!depots!were!opened!in!the!
city!for!free!distribution!of!medicine.”438 !!Vyas!painted!a!picture!of!a!community!
coming!together!for!the!good!of!its!residents,!noting!that!many!medical!personnel!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
436 !I!had!to.!!Don’t!hate!me.!
!
437 !S.S.!Vyas,!“Some!Observations!on!Influenza,”!Indian$Medical$Gazette$Vol.!LIV,!
January!(1919),!35.!!The!letter!was!written!in!November,!1918!but!given!publishing!
time!tables!was!not!included!in!the!Indian$Medical$Gazette!until!January!of!1919.!!As!
a!result!of!the!late!onset!of!the!flu!the!majority!of!the!articles!concerning!influenza!
appeared!in!1919,!not!1918.!
!
438 !“Some!Observations,”!35.!!!
!
!
154!
went!doorAtoAdoor!and!that!nearly!800!medical!students!also!volunteered!to!
provide!relief.439!!!
Perhaps!in!order!to!bolster!this!impression!of!unity,!the!Chairman!of!the!
Medical!Relief!SubACommittee!issued!a!plea!for!“the!services!of!medical!men!and!
medical!students”!through!a!letter!to!the!editor!of!the!Times$of$India.440!!Indicating!
the!current!level!of!chaos,!Currimbhoy!also!said!“we!shall!sincerely!welcome!the!
offer!of!services!of!any!layAmen!who!would!be!ready!to!help!in!the!work!of!visiting!
the!poor,!giving!elementary!instructions!and!supplying!information!of!cases!that!
might!require!particular!attention.”441!!The!article!did!not!discuss!the!implied!
disorder!directly,!but!it!lurked!just!below!the!surface.!!Breaking!down!this!relatively!
benign!plea!into!its!separate!elements,!a!picture!of!disruption!emerges.!!First,!the!
loose!call!for!those!with!any!medical!experience!hinted!at!the!shortage!of!doctors!
due!to!the!war!and!increasing!restrictions!on!medical!accreditation.!!Second,!the!
additional!request!for!anyone!willing!to!pitch!in!indicated!a!city!in!chaos!and!
desperate!for!any!volunteers.!!Third,!the!outreach!efforts!focused!on!the!poor,!likely!
due!to!the!previously!discussed!problems!in!getting!the!poorest!people!access!to!
medical!help.!!!The!medical!community!banded!together!to!project!an!image!of!
collaboration!and!competence.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
439 !“Some!Observations,”!35.!!!
!
440 !Rahimtulla!Currimbhoy,!“Appeal!for!Relief!Workers,”!Times$of$India,$October!2,!
1918.!!
!
441 !“Appeal!for!Relief!Workers.”!!!
!
!
155!
The!Government!bore!the!brunt!of!the!criticism!for!pandemic!related!crises,!
as!evidenced!by!a!!letter!to!the!editor!published!in!the!Times!of$India.!!The!writer,!
signed!“An!Anxious!Parent,”!observed!that!people!have!been!warned!away!from!
crowded!areas!and!college!examinations!postponed!before!wondering,!“Is!it!not!
necessary!for!the!school!authorities!to!close!their!schools!where!children!come!from!
infected!areas!and!sit!together!nearly!for!six!hours!in!a!crowded!room!and!give!relief!
to!parents?!…The!sooner!the!schools!are!closed!the!better.”442!!Considering!previous!
assertions!that!corralling!the!flu!would!be!next!to!impossible,!one!sees!the!difficult!
predicament!the!Government!of!India!faced.!!On!the!one!hand,!medical!officials!
claimed!little!could!be!done!to!stop!the!virus!from!spreading!while!on!the!other!
hand,!people!clamored!for!a!solution!that!perhaps!did!not!exist.!!!The!history!of!
quarantine!in!India!may!have!made!that!prospect!unappealing!on!a!countryAwide!or!
even!provinceAwide!scale.443!!!
!
!The$Empire!also!critiqued!local!governments!for!not!doing!more!to!stem!the!
tide.!!One!such!article!claimed,!!
!‘It!is!much!to!be!regretted,’!writes!our!correspondent,!‘that!our!Local!
SelfAGovernment!instead!of!adopting!the!necessary!precautionary!
measures!to!check!the!spread!of!the!disease!and!to!relieve!the!
sufferers!is!indifferent!to!the!disgraceful!state!of!the!locality.!!The!cry!
of!the!people,!it!is!hoped,!will!reach!the!higher!authorities,!leading!to!
the!adoption!of!necessary!measures!to!combat!the!epidemic.’444!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
442 !‘An!Anxious!Parent!Letter!to!the!Editor,”!Times$of$India,!October!1,!1918.!!!
!
443 !Cell,!27.!!!
!
444 !The$Empire,!“Influenza:!Panic!at!Serampore,”!October!29th,!1918.!*
!
!
156!
This!appraisal!of!the!situation!differed!slightly!from!the!one!published!by!the!Times,!
in!that!the!writer!aimed!his!criticism!at!the!local!government!and!asked!for!higher!
authorities!to!step!in.!!The!pitiful!line!“the!cry!of!the!people,”!deliberately!brought!to!
mind!an!abandoned,!desolate!citizenry.!!Again,!the!Government!in!India!found!itself!
taken!to!task!in!newspapers!for!far!too!little!action!in!preventing!the!spread!of!
influenza.!
!
The$Empire!continued!the!criticism!in!an!article!that!claimed,!“Naturally!
both!the!‘Bengalee’!and!the!‘Amrita!Bazar!Patrika’!this!morning!voice!horrified!
indignation!for!that!the!Bengal!Government!should!be!so!cruel!as!not!to!allow!the!
rateApayers!of!Hooghly!and!Chinsurah!to!enjoy!their!cholera!and!other!inefficient!–
municipalityAbred!epidemics!for!an!indefinite!period.”445!!!While!this!piece!did!not!
name!check!the!pandemic,!the!callous!slur!about!“enjoying!their!epidemics”!
indicated!that!the!editorial!board!of!The$Empire!felt!their!readership!would!agree!in!
attributing!mass!casualties!in!epidemics!to!poor!Indian!leadership!and!not!to!any!
fault!of!the!British!Government.!!The$Empire!called!local!governments!an!oligarchy!
that!did!not!protect!its!people,!as!it!argued,!!
Of!course,!considerations!of!the!health!and!wellAbeing!of!
30,000!maladministered!rateApayers!are!as!nothing!against!the!
giving!of!another!argument!to!antiAHome!Rulers.!!Essentially!a!
Home!Rulers’!view—the!view!of!the!would!be!“educated”!
oligarchy!who!would!let!thousands!suffer!in!preference!to!
being!bereft!of!their!power.446 !!!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
445 !!“Calcutta!Day!By!Day,”!The$Empire,$October!10,!1918.!!
!
446 !Calcutta!Day!by!Day.”!!
!
!
157!
!The!derisive!description!of!Indian!government!clearly!indicated!a!strong!under!
current!of!antiAHome!Rule!sentiment!and!distrust!in!the!Indian!people’s!ability!to!
handle!public!health!crises.!!Despite!the!top!down!structure!of!the!Government!of!
India,!The$Empire!felt!responsibility!for!the!flu!lay!with!lower!echelons!of!
government!and!their!failure!demonstrated!flaws!in!Indianisation.!
!
A!note!on!the!Bombay!Council!similarly!called!lower!level!government!
councils!to!task,!noting!that!the!upcoming!meeting!will!deal!“with!problems!
affecting!the!health,!comfort,!and!economic!condition!of!the!people!of!this!
Presidency!at!this!time!of!acute!distress.”447!!The!article!continued!in!a!critical!vein!
as!it!argued,!“Such!questions!should!have!been!discussed!and!debated!upon!as!they!
arose!for!solution!if!the!legislatures!of!the!country!met!oftenes[sic]!than!they!do!and!
really!represented!the!people!and!controlled!the!executive…”448!!Criticism!of!the!
legislative!councils!for!being!unrepresentative!had!occurred!before!1918!but!in!light!
of!the!series!of!crises!facing!the!Indian!people,!their!infrequent!meetings!and!less!
than!representative!make!up!appeared!all!the!more!glaring.449!!Still,!The!Hindu!held!
out!hope!for!improvement!as!they!claimed,!“we!hope!that!the!Government!will!
realise!the!gravity!of!the!situation,!make!as!complete!statements!on!the!points!
raised!as!they!can!and!take!the!Council!into!their!confidence.”450!!By!professing!hope!
that!the!Government!would!lend!more!weight!to!legislative!councils,!however,!The$
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
447 !The!Bombay!Council,”!The$Hindu,$November!22,!1918.!!*
!
448 !The!Bombay!Council.”!*
!
449 !O’Leary,!17.!
!
450 !The!Bombay!Council.”*
!
!
158!
Hindu!implied!that!the!fault!lay!not!with!the!councils!but!with!a!Government!that!did!
not!heed!the!council’s!advice.!!!
!
The$Hindu!also!explicitly!condemned!the!government’s!actions!regarding!the!
existing!medical!system.!!A!November!7th,!1918!article!claimed,!
The!unreasonable!attitude!of!the!Government!towards!the!question!of!
encouraging!the!indigenous!systems!of!medicine!may!to!some!extent!be!
overAlooked!if!medical!institutions!following!the!European!system!have!
been!extensively!and!widely!established!throughout!the!country!so!as!to!
place!aid!within!easy!reach!of!the!people.!!The!ridiculously!limited!
number!of!hospitals!and!dispensaries!that!have!so!far!been!placed!at!the!
disposal!of!the!public!renders!the!indifference!of!the!Government!to!
Ayurvedic!and!Unani!systems…”451 !
!
While!this!entire!article!never!once!directly!mentioned!the!influenza!pandemic—a!
curious!omission,!to!say!the!least—it!questioned!the!Government!of!India’s!
inefficient!system!of!public!health.!!The!war!drained!medical!men!from!India!which!
resulted!in!the!closings!of!dispensaries!and!hospitals,!and!the!article!argued!that!
British!resistance!to!using!Indian!medicine!became!doubly!harmful!when!paired!
with!their!own!beleaguered!system.!!The!author!continued,!“Just!appreciation!of!the!
merits!of!Indian!medical!science!is!all!that!is!required!and!ridicule!and!scorn!which!
now!pass!for!argument!in!certain!quarters!can!hardly!tend!to!the!speedy!discovery!
of!a!remedy!for!a!serious!problem.”452!!While!some!scholars!have!said!that!the!
European!medical!community!in!India!had!a!unique!measure!of!respect!for!Indian!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
451 !“Government!and!Medical!Aid,”!November!8,!1918,!The$Hindu.$$Unfortunately!due!
to!the!quality!of!the!microfilm!copy,!the!next!seven!lines!are!unreadable.!!However,!
later!in!the!article!the!author!refers!to!“pleas!!put!forward!on!behalf!of!the!general!
Indian!public,”!which!likely!indicates!the!pandemic.!
$
452 !Government!and!Medical!Aid.”!The!“serious!problem”!is!likely!the!influenza!
pandemic!given!the!timing!of!the!article!but!still,!its!complete!absence!from!the!
article!is!a!curious!thing.!
!
!
159!
medicine!when!compared!to!other!parts!of!Empire,!this!limited!amount!of!
consideration!clearly!did!not!amount!to!much.453!!The!flu!laid!bare!the!Government!
of!India’s!failings!with!!regards!to!public!health.!!The!Government!had!not!done!
enough!prior!to!the!pandemic!to!ensure!health!care!for!its!citizens,!and!now,!with!
war,!famine,!and!disease!stalking!the!land,!those!citizens!wanted!more.!
!
The!article!also!held!the!Government!specifically!responsible!for!the!shortage!
in!medical!care.!!“The!efforts!initiated!by!Government,!on!the!other!hand,!for!
extension!of!allopathic!treatment!are!meagre,!halting!and!fall!short!of!the!felt!
needs.”454!!Not!only!did!the!government!fail!at!providing!western!health!care,!but!
their!lack!of!support!for!alternative!treatments!fell!short!as!well.!!Even!protestations!
about!funding!from!the!medical!community!were!taken!to!task.!!“The!overworked!
argument!of!lack!of!funds!is!always!trotted!out!in!reply!to!requests!for!a!large!
increase!in!the!number!of!hospitals,!and!the!inconvenience,!discomfort!and!suffering!
of!the!people!are!allowed!to!run!their!course.”455 !!Clearly,!the!lack!of!funding!did!not!
tug!any!heartstrings!at!The$Hindu,!which!felt!the!explanation!amounted!to!little!
more!than!an!excuse.!!The$Hindu!did!not!accept!the!war!as!a!reason!either,!as!the!
article!claimed,!“Even!in!war!time,!the!spectacle!of!an!actual!decrease!in!the!number!
of!hospitals!open!to!the!public!is!a!phenomenon!which!can[not]!but!arouse!a!feeling!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
453 !Mark!Harrison,!“Science!and!the!British!Empire,”!Isis,!Vol.!96,!No.!1,!(March!
2005),!61.!
!
454 !Government!and!Medical!Aid.”$!
!
455 !Government!and!Medical!Aid.”!!
!
!
160!
of!deep!regret!and!humiliation.”456!!Surviving!the!flu!depended!on!access!to!nursing!
and!health!care,!and!thus!while!the!hospitals!may!have!been!closed!earlier!in!the!
war!due!to!the!dearth!of!medical!personnel,!their!closure!added!yet!another!barrier!
to!survival!for!the!Indian!people!when!the!pandemic!hit.!!However,!the!public!
blamed!the!government!and!not!the!doctors.!
!
Perhaps!the!most!heartfelt!plea!in!the!article!read,!“The!reduction!in!number!
[of!hospitals]!is!small,!but!it!is!obvious!that,!in!the!matter!of!saving!lives!and!
alleviating!human!misery,!there!can!be!no!standing!still.”457!!By!the!date!of!
publication,!many!of!the!eventual!twelve!million!or!so!dead!from!the!pandemic!had!
already!been!stricken.!!While!the!flu!would!continue!to!be!severe!for!roughly!the!
next!month,!the!hardest!hit!areas!in!the!north!and!west!had!already!peaked.458 !!The!
article!spoke!to!a!nation!suffering!immense!death!with!even!more!limited!access!to!
healthcare!than!a!mere!four!years!previously,!but!yet,!in!the!words!of!the!writer,!the!
Government!was!“standing!still.”!*
*
Questioning*the*Process*
In!January!of!1919,!the!United!Provinces!Legislative!Council!asked!for!a!report!
on!steps!taken!to!mitigate!the!pandemic.!!The!report!stated,!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
456 !Government!and!Medical!Aid.”!!
!
457 !Government!and!Medical!Aid.”!!
!
458 !Annual$Report,!57.!!Provinces!like!the!Punjab!and!United!Provinces!saw!their!
death!tolls!peak!before!midANovember,!while!areas!further!east!peaked!slightly!
later.!
!
!
!
161!
The!whole!of!the!temporary!and!permanent!plague!staff!of!the!province!
was!utilized!for!influenza!work.!!All!the!permanent!travelling!
dispensaries,!110!in!number,!were!also!so!utilized.!!As!far!as!possible!
two!were!sent!to!each!district!and!the!remainder!were!placed!at!the!
disposal!of!the!Health!Officers!or!Civil!Surgeons!of!those!places!where!
their!services!seemed!to!be!most!required.459!
!
The!report!listed!other!steps!taken!to!provide!relief,!including!calling!on!vaccinators!
and!school!teachers!to!distribute!medication!on!an!itinerant!basis.!!Students!from!
medical!colleges!were!assigned!to!dispensaries,!and!district!boards!“were!asked!to!
employ!any!available!private!practitioners,!such!as!vaids!and!hakims,!to!provide!
them!with!medicine!and!utilize!their!services!in!every!possible!way.”460!!While!some!
local!governments!did!attempt!to!give!combating!the!flu!a!high!priority,!given!the!
eventual!mortality!rate!for!the!entire!province!rose!to!over!two!million!people,!these!
efforts!of!the!British!government!were!found!wanting.461!
The!public!did!have!access!to!charitable!dispensaries.!!The!Bengal!Dispensary!
Manual!stated!that!every!person!was!entitled!to!free!medical!advice!and!medicine,!
although!it!also!suggested!that!should!the!medical!officer!have!reason!to!believe!that!
the!individual!could!afford!to!pay,!they!should!be!encouraged!to!do!so!and!abuse!of!
the!charitable!dispensaries!should!be!reported.462 !!In!this!respect!the!British!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
459 !Mr.!Keane!to!the!United!Provinces!Legislative!Council,!“Questions!and!Answers,”!
January!24th!1919,!UPLC,!10.!!!
!
460 !Mr.!Keane,!“Questions!and!Answers,”!10.!!!
!
461 !Annual$Report,!57.!!
!
462 !Manual$of$Rules$for$the$Management$of$Hospitals$and$Dispensaries!(Calcutta:!
Bengal!Secretariat!Book!Depot,!1915),!17.!!
!
!
162!
attempted!to!lower!a!barrier!to!health!care,!although!the!success!appears!to!have!
been!middling!at!best.!
The!haphazard!enforcement!of!public!health!codes!and!the!perception!that!
the!codes!unfairly!burdened!the!Indian!people!worked!against!the!British!
government’s!efforts.!!As!Polu!writes,!“In!reality,!the!government!at!times!
inconsistently!applied!the!conventions,!tending!toward!greater!stringency,!when!it!
deemed!it!expedient.”463!!Many!of!the!issues!around!public!health—especially!
quarantine—circled!around!the!prevention!of!plague!and!Muslim!pilgrimages.!!
Restriction!of!international!travel!placed!undue!burdens!on!Muslims!who!intended!
to!take!the!hajj,!and!the!British!government!tried!to!balance!pressure!from!the!
international!community!with!an!important!political!bloc.464!!The!success!of!these!
limitations!depended!heavily!on!Muslim!elites!convincing!others!that!the!
restrictions!were!necessary,!and!this!had!a!somewhat!uneven!result.!!Perceptions!of!
the!Government!of!India!unfairly!enforcing!quarantine!abounded.!
At!the!same!time,!newspapers!from!Kansas!to!Nigeria!tracked!the!flu’s!spread!
around!the!world!and!reported!on!symptoms!as!well!as!steps!local!medical!
communities!took.465!!Much!like!its!contemporaries!the!Times$of$India$spent!the!fall!
reporting!on!the!progress!of!the!pandemic,!noting!death!tolls!and!relying!on!medical!
experts!for!advice!and!interpretation.!!J.A.!Turner,!Public!Heath!Officer,!published!an!
article!in!the!Times!in!late!September!of!1918!requesting!assistance!in!spreading!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
463 !Polu,!46.!
!
464 !Polu,!57.!
!
465 !Kent,!52,!58.!
!
!
163!
information!about!the!pandemic!to!“the!poorer!and!illiterate!classes.”466 !!He!!wrote,!
“the!dark,!illAventilated,!overAcrowded!houses!of!the!poor,!the!want!of!stamina!and!
absence!of!proper!food,!nursing!and!medicine!render!the!people!easy!victims.”467!!
The!famine!also!made!frequent!appearances!in!news!media!coverage!of!the!
pandemic,!further!underlining!the!link!between!malnutrition!across!the!
subcontinent!and!high!death!tolls.!!Turner!also!drew!a!connection!between!poverty!
and!susceptibility!to!the!flu,!a!correlation!that!would!be!born!out!in!subsequent!
sanitary!reports.468!
Turner!outlined!preventative!measures!for!the!general!public!as!well,!
although!he!also!voiced!his!doubts.!!!In!the!same!article!he!said,!
The!result![of!preventative!measures]!could!never!be!successfully!
enforced,!even!if!the!patient!were!willing!to!submit!to!isolation.!!The!
extremely!short!incubation!period!of!the!disease,!its!infectivity!in!its!
earliest!stage!before!it!can!be!recognised,!the!frequence!of!mild,!
unrecognised!but!nevertheless!infectious!cases!and!the!difficulties!of!
diagnosis,!all!combine!to!render!such!measures!also!impracticable,!
and!it!does!not!appear!likely!that!the!isolation!of!infectious!patients!
on!a!scale!sufficiently!large!to!influence!the!result!could!ever!be!
carried!out!on!a!large!scale.469!
!
For!someone!requesting!the!public’s!help!in!controlling!the!pandemic,!Turner!
appeared!realistic—if!also!a!bit!pessimisticAAabout!their!chances.!!Not!only!did!he!
see!isolation!as!impossible!to!enforce,!but!he!noted!that!the!incubation!period!made!
isolations!and!quarantines!almost!pointless.!!He!left!the!impression!that!the!flu!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
466 !“Influenza!Pandemic:!Health!Officer’s!Appeal.”!!!
!
467 !Influenza!Pandemic:!Health!Officer’s!Appeal.”!!!
!
468 !Preliminary$Report,!2.!!!
!
469 !Influenza!Pandemic:!Health!Officer’s!Appeal.”!!!
!
!
164!
simply!had!no!solutions,!despite!his!later!suggestions!for!treatment!and!limiting!
exposure!to!crowded!areas.470!!!
The!Times$of$India!later!published!an!article!titled!“Influenza!Epidemic:!Work!
Among!the!Poor”!that!detailed!Bombay’s!efforts!at!reaching!destitute!flu!victims.!!It!
focused!on!Turner’s!efforts!to!increase!access!to!medical!treatment!across!Bombay,!
and!noted!that!he!arranged!with!the!military!to!have!an!extra!500!beds!and!two!
ambulances!available!for!those!who!required!hospitalization.471!!Given!the!
aforementioned!problem!of!convincing!the!Indian!people!to!access!British!health!
care,!as!well!as!the!sheer!number!of!flu!victims,!Turner’s!efforts!may!not!have!made!
any!difference.472 !!Still,!the!above!articles!demonstrate!that!the!medical!community!
attempted!to!provide!services!for!those!in!the!cities,!while!people!in!rural!areas!
seem!to!have!been!left!to!their!own!devices.!
!
Turner’s!efforts!also!extended!to!home!visits!to!the!poor!to!identify!who!
needed!extra!food!and!who!should!be!hospitalized.!!The!Times!reported!that!Turner!
instructed!his!men!to!encourage!those!who!could!not!afford!treatment!to,!“go!to!
hospital!at!once,!so!that!they!can!receive!treatment!and!the!disease!will!not!spread!
to!the!rest!of!the!family.”!!Isolation!of!the!infected!as!well!as!proper!nutrition!took!
precedence!in!Turner’s!directions,!and!the!article!also!detailed!the!actions!of!the!
Social!Service!League,!a!volunteer!organization!that!worked!with!the!Municipal!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
470 !Influenza!Pandemic:!Health!Officer’s!Appeal.”!!
!
471 !“Influenza!Epidemic:!Work!Among!the!Poor,”!October!2,!1918,!Times$of$India,!!
!
472 !Mr.!Keane,!“Questions!and!Answers,”!10.!!!
!
!
165!
Health!Department!to!provide!medical!treatment!for!the!poor.473!!These!volunteers!
operated!with!the!same!parameters!described!above—they!identified!cases,!
distributed!food!and!medicine!as!needed,!and!advised!families!on!preventative!
measures!and!treatment!options.474!!!
!
A!similar!scene!played!out!in!Madras,!as!The$Hindu!published!a!treatise!by!Dr.!
K.!Raghavadra!Rao,!Acting!Health!Officer.!!Dr.!Rao!acted!as!an!expert!opinion!and!
listed!the!various!hospitals!that!accepted!flu!patients!as!well!as!noted!that!medicine!
would!be!“freely!distributed”!to!those!who!needed!it.!!He!further!encouraged!the!
public!“to!avoid!exposing!themselves!to!infection!by!attending!theatres,!cinemas!and!
other!places!of!public!resort.”475!!SelfAquarantine!and!selfAreporting!appeared!to!be!
the!first!step!as!Madras!faced!down!the!pandemic.!!Rao!continued!his!plea,!stating,!
“It!is!absolutely!necessary!to!seek!medical!aid!as!soon!as!symptoms!of!fever!appear.”!!
Once!again,!he!issued!requests!general!public,!not!commands.!!The!focus!of!relief!
efforts!centered!on!Madras!and!not!on!the!surrounding!areas,!of!which!he!made!no!
mention.!!Hints!of!the!urban!and!rural!gap!pervaded!the!coverage!of!the!flu,!as!
populated!centers!received!more!help!and!attention!than!small!villages.!!!
Due!to!previous!failures,!the!government!created!a!situation!wherein!when!
they!could!provide!aid—and!surviving!the!pandemic!depended!on!nursing!care—
the!Indian!people!had!no!reason!or!desire!to!use!their!services.!!While!not!
intentional,!decades!of!British!mismanagement!of!issues!relating!to!Indian!health!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
473 !“Influenza!Epidemic:!Work!Among!the!Poor.”!
!
474 !“Influenza!Epidemic:!Work!Among!the!Poor.”!*
!
475 !“Influenza!in!Madras,”!The$Hindu,$October!11,!1918.*
!
!
166!
created!a!situation!where!the!British!could!have!eased!some!of!the!suffering,!but!the!
people!who!needed!it!most!had!no!reason!to!believe!or!trust!their!word.!!
International!concerns!about!plague!transmission!had!led!the!British!to!crack!down,!
which!led!to!distrust!of!the!British!government’s!judgment.!
!
The*Indian*Response*
The!tension!between!western!medicine!and!Indian!medicine!had!a!long!
history!in!India,!starting!almost!directly!after!the!British!takeover.!The!Indian!
Medical!Service!was!created!to!provide!medical!service!to!the!British!army,!and!as!
the!population!of!British!citizens!in!India!grew,!their!mission!expanded!
accordingly.476!!This!strain!served!to!create!a!division!between!western!medicine!
and!Indian!medicine,!as!ayurvedic!and!unani!systems!continued!to!operate!parallel!
to!western!systems.477!!Arnold!notes!that!while!the!British!did!seem!to!recognize!
traditional!Indian!medicine!as!valuable!knowledge,!he!argues!that!the!British!did!not!
welcome!this!knowledge!as!equal!to!western!medicine,!but!rather!assumed!that!
once!Indians!had!been!exposed!to!western!medicine!they!would!quickly!accept!it!as!
superior.478!
A!note!from!Hailey,!a!high!ranking!member!of!the!ICS,!published!in!The$
Hindu,$!praised!the!joint!efforts!of!western!and!Indian!medical!personnel!and!gave!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
476 !Arnold,!Science,$Technology,$and$Medicine,!59.!
!
477 !Arnold,!Science,$Technology,$and$Medicine,!62A63.!!!
!
478 !Arnold,!Science,$Technology,$and$Medicine,$63.!!Arnold!also!observes!that!despite!
this,!British!doctors!were!known!to!use!“cheap!native!remedies”!when!their!own!
medicines!were!too!expensive!or!difficult!to!obtain.!
!
!
167!
an!overall!impression!of!unity.!!He!observed,!“though!the!epidemic!is!still!causing!a!
great!number!of!deaths!in!Delhi!there!is!reason!to!hope!that!it!is!now!definitely!on!
the!decline,”!before!listing!the!death!tolls!for!much!of!October.479!!Hailey!then!
described!the!efforts!of!various!charitable!organizations!and!philanthropists,!as!well!
as!the!hospital’s!efforts!to!treat!the!wounded.!!In!addition!to!a!list!of!the!people!who!
spearheaded!both!public!health!and!public!sanitation!efforts,!Hailey!singled!out!
several!Indian!leaders.!!He!wrote,!“The!most!important!of!the!private!organisations!
for!relief!was!Anjumani!Khudammi!Vallimain!which!being!assisted!by!HaziqAulAMulk!
Hakim,!Md.!Ahmal!Khan,!Dr.!Ansari!and!a!number!of!Hakims!and!vaids!!gave!house!
to!house!assistance!to!many!thousands!of!patients.”480!!Hailey!drew!a!picture!of!a!
country!on!the!upswing,!banding!together!against!the!flu!as!death!tolls!declined.!!
The!theme!of!the!medical!community!and!country!coming!together!appeared!again!
and!again!news!media,!regardless!of!their!success.!
!
A!recurring!problem!in!empire!was!persuading!the!indigenous!populace!to!
both!trust!and!use!western!systems!of!medicine.!!The!existence!of!ayurveda!and!
unani!meant!that!the!Indian!people!had!a!plethora!of!options!when!it!came!to!health!
care,!and!the!British!government!often!gave!them!little!reason!to!trust!western!
medicine.!!Decades!of!British!mismanagement!and!unfairly!applied!quarantines!
made!the!Indian!people!distrustful!of!British!methods,!and!with!good!reason.!!The!
British!medical!community!was!trying!to!control!an!uncontrollable!pandemic,!and!to!
them!knowing!and!controlling!patient’s!treatment!was!of!utmost!importance.!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
479 !“The!Influenza”!The$Hindu,$November!8th,!1918.!!!
!
480 !The!Influenza.”$!
!
!
168!
Indian!people!choosing!traditional!remedies!put!them!outside!the!control!of!the!
British!empire.!!This!brings!up!issues!of!imperial!power,!its!effectiveness!and!its!
relative!morality.!!On!the!one!hand,!the!flu!was!a!devastating!pandemic!that!
required!quarantine!and!effective!medical!systems!to!provide!care!on!an!
unprecedented!scale.!!On!the!other!hand,!implementation!of!this!on!a!large!scale!
would!have!required!the!government!to!ignore!the!wishes!of!the!people!and!declare!
itself!the!guardian!of!the!greater!good.!!The!Government!of!India!chose!to!have!a!
more!bottom!up!approach,!with!medical!establishments!and!boards!in!each!district!
responsible!for!relief!in!their!immediate!area.!!This!allowed!for!regional!variations!
in!response!and!seemed!to!have!embraced!indigenous!medical!traditions!as!at!least!
a!partner!in!the!fight!against!the!!flu!but!did!not!come!close!to!coordinating!the!
massive!effort!India!needed.!!
!
Problems*of*Relief*
The!strain!between!the!Government!and!the!Indian!Medical!Service!also!
worked!against!the!British!government’s!effectiveness.!!As!the!British!government!
pushed!for!broader!access!to!the!IMS!for!men!of!Indian!descent,!the!upper!echelons!of!
the!IMS!found!themselves!on!the!defensive,!arguing!that!Indianisation!would!lead!to!a!
further!decline!in!prestige!for!the!IMS!and!create!more!obstacles!for!recruitment.!!The!
Government!of!India!and!the!IMS!had!fundamentally!different!ideas!about!the!future!
of!the!organization!at!the!outbreak!of!the!flu.!!The!IMS!did!not!deliberately!drag!their!
feet!in!response!to!the!flu,!but!it!does!stand!to!reason!that!the!strain!over!different!
!
169!
opinions!on!the!future!of!the!IMS!negatively!impacted!their!relationship!and!ability!to!
work!together!efficiently.!!!
During!the!pandemic!some!IMS!officials!reported!that!the!reliance!on!local!
governments!caused!some!problems.!!In!a!report!made!in!November!of!1918,!MajorA
General!Giffard!complained,!
Your!Excellency,!I!may!say!that!as!far!as!I!have!been!concerned!and!
the!part!of!the!department!under!my!control,!urgent!steps!have!been!
taken.!!Every!man!who!can!be!spared!has!been!put!on!duty,!but!Your!
Excellency’s!Government!know!perfectly!well!that!the!Medical!
Department!of!this!Presidency!is,!very!largely,!not!under!the!control!of!
the!SurgeonAGeneral.!!It!is!split!up!into!24!different!departments!with!
24!different!administrator!(sic)!and!if!these!administrators!of!the!
medical!department!of!the!Presidency!have!not!done!all!the!can!to!
take!urgent!steps!to!afford!medical!relief!to!the!people,!it!is!not!my!
fault.!!Those!who!have!applied!to!me!for!help!have!received!it!as!
quickly!as!possible.!!I!cannot!supply!subordinates!when!they!do!not!
exist!and!there!is!no!use!transferring!subordinates!from!one!part!to!
the!other!when!the!epidemic!has!spread!all!over!the!Presidency.481 !
!
Here!we!see!an!official!grappling!with!an!enormous!bureaucracy!and!a!limited!
amount!of!personnel.!!In!a!crisis!like!the!pandemic,!moving!manpower!from!one!area!
to!another!would!simply!lessen!the!impact!in!one!area!while!increasing!it!in!another.!!
It!is!a!paradox!similar!to!the!law!of!Conservation!of!Mass—!one!cannot!create!
something!out!of!nothing,!and!similarly!Giffard!could!not!deploy!medical!personnel!
that!he!did!not!have.!Giffard!became!defensive!about!his!abilities!to!balance!the!
needs!of!twenty!four!different!departments!and!outright!stated!he!could!not!be!held!
at!fault.!!While!this!may!be!true!in!the!broadest!sense!of!the!term—in!that!he!did!his!
absolute!best!with!a!limited!capacity—it!is!also!striking!that!he!felt!the!need!to!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
481 !Major!Giffard,!“Resolution!Re!A!Committee!to!Investigate!the!Nature,!Etc,!In!
Regard!to!the!Influenza!Pandemic,”!November!19,!1918,!UPLC,!370.!!
!
!
170!
defend!himself!in!such!strident!terms.!!He!disavowed!his!responsibility!for!the!large!
death!toll!at!a!time!when!death!tolls!continued!to!mount,!and!placed!the!blame!on!an!
overstretched!bureaucracy.!!!
Relief!efforts!did!not!stop!at!medical!support,!however,!as!the!Government!of!
India!attempted!to!stall!the!spread!of!the!disease.!!Giffard’s!report!noted!that!they!
distributed!pamphlets!and!handbills!with!information!on!the!prevention!and!
treatment!of!influenza,!as!well!as!blankets,!coats!and!milk.482!!“Every!effort!was!made!
to!provide!treatment!at!their!homes!for!people!who!most!required!it.!!In!some!places!
temporary!hospitals!were!opened,!but!it!was!found!that!people!would!not!resort!to!
them!to!any!extent.”483!!The!last!sentence!is!crucial,!as!during!any!epidemic!trust!of!
the!afflicted!population—and!willingness!to!use!resources!provided—is!key.!!This!
reluctance!is!not!to!blame!the!Indian!population!for!their!distrust,!but!to!show!that!
the!British!government!was!fighting!an!uphill!battle.!!
The!British!government!often!relied!on!private!charities!to!fill!in!gaps!when!
their!staff!could!not!meet!demand.!!The!United!Provinces!Medical!Manual!illuminated!
that!reliance,!stating,!“The!committee!should!draw!up!a!scheme!for!organizing!
private!charity!and!collecting!subscriptions!so!as!to!provide!medical!comforts,!
clothing,!etc.,!for!sufferers!from!an!epidemic,!and!should!prepare!a!scheme!for!the!
effective!distribution!of!the!proceeds!of!such!private!charity.”484!!This!publicAprivate!
partnership!would!be!an!excellent!interim!measure!in!times!of!crisis,!and!indeed!it!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
482 !Giffard,!“Resolution!..!In!Regard!to!the!Influenza!Pandemic,”!370.!
!
483 !Giffard,!“Resolution!..!In!Regard!to!the!Influenza!Pandemic,”!370.*
!
484 !The!United!Provinces!Medical!Manual,!174.*!
!
!
171!
appears!that!the!British!relied!heavily!on!private!charities!throughout!the!pandemic!
and!famine.!!The!manual!also!set!up!a!procedure!for!sending!financial!aid!to!those!
groups!and!people!in!most!need!of!it.!
Yet!another!paradox!of!the!British!bureaucracy!is!that!it!had!become!at!once!
labyrinthine!and!entirely!too!small.!!Coordinating!massive!relief!efforts!with!the!
many!different!departments!would!be!difficult!even!with!enough!staff.!!However,!
with!the!flu!pandemic!striking!health!care!workers!at!a!rate!higher!than!the!general!
population!due!to!their!increased!exposure!to!the!virus,!providing!adequate!support!
staff!and!medical!personnel!to!the!worst!afflicted!areas!proved!to!be!nearly!
impossible.!!This!meant!that!the!British!response!to!the!flu!pandemic!could!only!be!a!
stopAgap!measure,!with!doctors!in!each!region!doing!the!best!they!could—often!with!
no!backup!and!limited!resources—with!little!tangible!results.!!!!
!
Fading*into*the*background*
Given!the!adAhoc!nature!of!the!medical!response!to!the!flu,!it!is!hardly!
surprising!that!the!upper!echelons!of!the!British!government!seemed!more!
concerned!with!business!proceeding!as!usual!during!the!pandemic.!!A!letter!from!the!
Governor!of!Bombay!to!Lord!Chelmsford!in!October!of!1918!reveals!the!havoc!the!
pandemic!created,!and!he!appeared!to!be!very!upset!that!Chelmsford!expected!him!to!
host!a!committee!exploring!possible!future!reforms.!!He!responded!with!a!litany!of!
reasons!why!!Bombay!would!be!illAsuited!to!handling!that!responsibility!at!the!
moment.!!He!wrote,!
I!want!to!put!very!clearly!before!you!the!present!condition!of!things!in!
this!Presidency,!in!order!that!you!all!who!live!in!Simla!may!realise!the!
!
172!
immense!difficulties!for!the!present!situation,!and!appreciate!how!
difficult,!indeed!how!practically!impossible!it!is!to!give!you!in!the!
short!time!allowed!to!us…complete!answers!to!the!continuous!
references!which!come!pouring!in!upon!us!both!with!regard!to!
Reforms!and!with!regard!to!police!and!other!equally!important!
matters.!
We!are!very!shortAhanded!owing!to!the!numbers!of!our!officers!
who!have!left!us!for!military!duty.!!We!have!much!extra!work!with!
regard!to!recruiting:!we!are!on!the!verge!of!very!serious!famine!
conditions,!and!the!whole!Presidency!is!being!ravaged!by!this!
influenza!epidemic!which!gives!a!very!large!amount!of!extra!work!to!
district!officers!concerned.485!
!
Chelmsford!was!in!India,!which!makes!the!fact!that!Willingdon!felt!the!need!to!
emphasize!just!how!terribly!far!they!were!stretched!intriguing.!!He!clearly!felt!that!
Chelmsford!did!not!have!reasonable!expectations,!but!at!the!same!time!he!
acknowledged!that!Chelmsford!may!not!have!known!the!extent!of!the!pandemic.!!
While!the!letter!is!dated!at!the!start!of!October,!which!marked!the!beginning!of!the!
worst!of!the!pandemic!throughout!India,!Bombay!had!just!hit!its!height.!!Given!the!
amount!of!correspondence!between!the!two,!Chelmsford!should!have!been!well!
aware!of!the!dire!status!of!Bombay.!!Willingdon!also!presents!the!flu!last,!after!a!
litany!of!other!reasons!why!his!men!are!overstretched.!!Both!the!war!and!the!famine!
take!precedence,!possibly!because!they!are!more!longAterm!concerns.!!However,!
Bombay!was!losing!several!hundred!people!a!day!shortly!before!Willingdon!wrote!
this!letter!and!its!absence!is!curious.!
!
Willingdon’s!letter!continued!as!he!explained!why!they!could!not!receive!the!
Southborough!Commission.!!He!emphasized!their!current!staffing!crisis!while!also!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
485 !Lord!Willingdon!to!Lord!Chelmsford,!October!10,!1918,!Correspondence!of!First!
Marquess!of!Willingdon!as!Governor!of!Bombay,!British!Library,!London,!United!
Kingdom,!MSS!Eur!F93/1.!!!
!
173!
commenting!on!the!extent!to!which!his!men!are!working!harder!than!most.!!He!
noted,!
!
There!is!not!an!officer!who!is!not!doing!twice!the!work!that!he!
would!do!under!normal!conditions,!and,!while!one!Assistant!Collector!
has!died!of!this!influenza,!many!others!must!break!if!the!pressure!is!kept!
up.!
!
We!are!all!ready!to!do!all!we!can,!but!human!nature!has!its!limits,!
and!the!climatic!conditions!under!which!men!have!to!work!here!are!very!
much!more!trying!than!in!many!other!parts!of!India.!
!
The!pressure!of!war!work!of!all!sorts!too!has!fallen!far!more!
heavily!upon!us!than!any!other!province.486 !
!
Again,!he!mentioned!influenza!not!as!a!catastrophe!of!unimaginable!proportions,!
but!as!an!impediment!to!work.!!He!listed!only!one!casualty—a!member!of!the!civil!
service—and!emphasized!the!tremendous!strain!that!influenza!placed!on!his!
employees.!!While!this!was!certainly!the!case,!he!notably!elided!the!increasingly!
high!death!tolls!and!havoc!influenza!was!wreaking!around!Bombay.!!Perhaps!
Willingdon!felt!that!Chelmsford!understood!that!implicitly,!or!simply!did!not!see!the!
plight!of!the!population!of!Bombay!as!germane!to!their!discussion.!!Influenza’s!
absence!in!the!record!is!almost!as!important!as!its!presence—it!is!what!British!
officials!did!say!as!well!as!what!they!did!not.!!At!the!height!of!the!pandemic,!one!of!
the!most!powerful!officials!in!Bombay!described!influenza!as!an!obstacle!to!work!
rather!than!devastation!of!unparalleled!magnitude.!!He!only!mentioned!the!death!of!
a!member!of!staff,!and!again!presented!the!flu!as!just!another!in!a!long!line!of!
injustices!that!make!it!difficult!for!them!to!complete!their!work.!!Even!the!weather!
got!a!mention!in!his!litany!of!reasons,!putting!it!on!par!with!the!flu.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
486 !Lord!Willingdon!to!Lord!Chelmsford,!October!10,!1918.!
!
174!
Letters!from!the!Lieutenant!Governor!of!the!United!Provinces!barely!even!
address!the!flu,!even!in!the!immediate!aftermath.!!In!a!December!4th!letter!included!
in!Butler’s!correspondence,!he!inventoried!the!various!issues!facing!the!United!
Provinces!but!neglected!to!even!nameAcheck!the!influenza!pandemic.!!He!wrote,!“We!
are!threatened!with!serious!scarcity,!but!there!has!never!been!more!money!in!the!
districts.!!I!got!out!2!million!rupees!in!advances!at!an!early!date!and!the!people!are!
in!good!heart.!!There!are!no!signs!of!distress!yet.”487!At!the!time!of!his!letter,!the!
pandemic!had!already!peaked!so!his!summary!of!a!happy,!distressAfree!populace!
seems!rather!odd,!especially!given!the!two!million!souls!lost!to!the!pandemic!in!the!
United!Provinces.488!!He!felt!he!had!done!his!duty!by!dispersing!the!2!million!rupees!
in!relief!and!paid!little!attention!to!the!clamor!for!more!government!action!for!both!
the!flu!and!the!famine,!and!indeed!did!not!even!notice!the!devastation!surrounding!
him.!
The!Lieutenant!Governor!continued,!!“A!good!winter!rain!will!put!everything!
right!and!secure!a!fine!spring!harvest!though!on!a!reduced!area.!!Prices!are!steadier.!!
The!price!of!cloth!has!largely!fallen!since!Government!intervened.!!I!hope!things!will!
gradually!rectify!themselves.”489!!He!presented!the!resolution!of!the!famine!as!a$fait$
accompli,!while!only!a!few!weeks!before!national!newspapers!had!been!calling!for!
more!intervention.!!The!flu!did!not!seem!to!exist,!and!the!famine!was!all!but!fixed.!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
487 !Lord!Kitchener!to!Harcourt!Butler,!December!4,!1918.!!
!
488 !United$Provinces$Report,$198!and!Annual$Report,!57.!!!
!
489 !Lord!Kitchener!to!Harcourt!Butler,!December!4,!1918.*!
!
!
175!
The!interaction!between!the!two—well!documented!by!many!contemporaries—was!
similarly!invisible.!
The!letter!concluded,!“Everything!is!very!dry;!but!I!managed!to!get!two!
hundred!couple!![sic]of!snipe!so!far!this!season.!!I!find!snipe!shooting!a!necessary!
sedative!to!me!in!my!relations!with!the!Government!of!India.!!They!seem!far!away!
when!more!important!things!like!snipe!are!about.!The!victories!of!the!Allies!have!
caused!some!genuine!rejoicing.!!The!first!thought!has!been—now!prices!will!fall.”490!!
Influenza!peaked!in!his!province!on!October!28th!and!began!dying!down!after!
November!13th,!less!than!a!month!before!he!wrote!the!letter.491!!At!first!blush!one!
might!surmise!that!influenza!was!no!longer!a!pressing!issue,!but!the!inclusion!of!the!
end!of!the!war,!which!happened!nearly!simultaneously!with!the!peak!in!death!tolls,!
puts!paid!to!that!possibility.!!The!problems!of!scarcity!and!lack!of!rain!warrant!a!
mention,!as!does!the!Armistice,!but!the!flu—which!had!taken!thousands!upon!of!
thousands!of!lives!in!his!province!by!this!point—appears!nowhere!in!the!letter.!!His!
line!describing!the!lack!of!distress,!while!clearly!alluding!to!the!issues!of!scarcity,!
downplays!the!severity!of!the!pandemic.!!Additionally,!his!comment!about!snipe!
shooting,!while!clearly!meant!in!jest,!is!unsettling.!!In!just!a!few!paragraphs!he!
describes!the!situation!of!his!province!without!once!referring!to!the!absolutely!
massive!death!tolls!that!had!rocked!the!subcontinent.!!While!influenza!had!clearly!
already!faded!from!his!mind,!it!is!unlikely!that!the!families!of!its!victims!felt!the!
same!way.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
490 !Lord!Kitchener!to!Harcourt!Butler,!December!4,!1918.!!*
!
491 !United$Provinces$Report,$198.**
!
!
!
176!
Again,!this!letter!reveals!the!extent!to!which!the!famine!dominated!the!
British!official!mind.!!Mere!weeks!after!the!United!Provinces!saw!over!two!million!
people!die!in!just!a!few!months!the!Lieutenant!Governor!mentioned!the!war!and!the!
famine!but!the!flu!was!lost!to!the!ether.492!!Whether!he!was!simply!unaware!of!the!
devastation!of!the!flu—possible,!although!that!raises!questions!as!to!his!powers!of!
observation—or!just!felt!that!the!pandemic!had!run!its!course!and!had!no!place!in!a!
letter!is!unknown.!!It!highlights!the!way!other!crises!quickly!replaced!influenza,!and!
hints!at!why!the!flu’s!narrative!in!India!languished!untold!for!so!long.!
!
Understanding*the*Flu*Through*the*Lens*of*Famine*
The!British!government!also!saw!epidemic!diseases!as!part!and!parcel!of!a!
famine!situation.!!They!intended!to!control!the!flu!as!part!of!a!famine,!not!as!a!
separate!entity!in!and!of!itself.!!As!demonstrated!by!the!United!Provinces!Medical!
Manual,!officials!saw!epidemic!disease!as!a!side!effect!of!famine.!!It!declared,!!!
It!should!be!clearly!understood!that!the!close!surveillance!of!medical!
arrangements!for!famine!relief!is,!in!times!of!famine,!the!Civil!
Surgeon’s!first!and!most!important!duty.!!The!development!of!surgical!
or!other!work!at!the!Sadr!Hospital!must!take!second!place!till!the!
famine!is!over.!!Civil!Surgeons!must!personally!satisfy!themselves!as!to!
the!adequacy!of!the!arrangements!for!dealing!with!epidemic!disease,!
and!the!more!incompetent!the!medical!subordinates!on!the!works!are!
the!greater!is!the!necessity!for!constant!supervision!on!the!part!of!
medical!officers.493 !!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
492 !Annual$Report,$57.*!
!
493 !United$Provinces$Medical$Manual,!167.!!
!
!
177!
The!manual!calls!for!strict!oversight,!especially!in!the!case!of!“incompetent!medical!
subordinates,”!and!frames!the!role!of!preventing!epidemic!disease!as!the!most!
important!job!during!a!famine.!!Once!again!epidemic!disease!becomes!subsumed!
into!the!category!of!famine.!!While!this!excerpt!does!not!address!influenza!directly,!
the!presence!of!influenza!hovers!at!the!edges,!being!described!in!surrounding!
paragraphs.!!With!famine!being!a!natural!catastrophe!that!the!British!had!extensive!
experience!with!and!one!that!seemed!far!more!controllable!than!the!wildfire!of!
influenza,!it!follows!that!they!would!couch!suggestions!for!controlling!epidemic!
diseases!through!the!lens!of!famine.!!
!
In!fact,!when!discussing!the!famine!the!British!government!hardly!
acknowledged!the!influenza!pandemic,!a!striking!oversight.!!F.!Norman!White’s!
Preliminary!Report!on!the!pandemic!drew!a!strong!connection!between!the!flu!and!
famine,!but!in!the!annals!of!governmental!debates!this!connection!was!often!
overlooked.494!!The!Indian!Legislative!Council!received!a!report!on!the!famine!and!
relief!efforts!in!February!of!1919!that!contained!only!one!reference!to!influenza!at!
all.!!It!read,!“It!has!hitherto!been!an!accepted!principle,!embodied!in!the!famine!
codes,!that!gratuitous!relief!should!not!be!given!before!scarcity!has!been!declared,!
but!we!have!found!it!necessary!to!relax!this!principle!in!some!cases!where!the!
economic!distress!has!been!aggravated!by!the!epidemic!of!influenza.”495!!The!report!
only!mentioned!influenza!as!a!mitigating!factor!in!famine!relief!and!did!not!discuss!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
494 !Preliminary$Report,!2.!!
!
495 !Hon’ble!Sir!Claude!Hill!to!the!Indian!Legislative!Council,!“Foodstuffs,”!February!
19,!1919,!ILC,!607.!!!
!
!
178!
workers!being!too!sick!to!work!in!the!fields,!despite!that!phenomenon!being!well!
documented.496!!Influenza!created!extra!economic!distress,!but!once!again!the!
British!government!viewed!it!as!part!of!the!famine!rather!than!as!a!catastrophe!in!
and!of!itself.!!In!this!way!the!Government!of!India!came!to!place!the!famine!above!
influenza!and!the!flu!began!to!disappear!into!the!cracks!of!history.!
The!blind!spot!about!the!flu!stretched!into!the!highest!echelons!of!the!
government.!!In!early!October,!Viceroy!Chelmsford!reported!to!the!king!on!the!
current!state!of!India.!!He!wrote,!!
Apart!from!the!war!our!dominating!concern!has!been!the!failure!of!the!
monsoon!over!very!nearly!twoAthirds!of!India.!!…!and!now!there!will!be!a!call!
for!them!to!take!on!the!additional!traffic!involved!in!bringing!food!from!the!
wellAtoAdo!districts!to!those!which!are!in!want.!!Our!food!returns!show!that!
we!have!sufficient,!if!only!we!can!convey!it!to!the!points!of!danger.497!
!
Nowhere!does!he!mention!the!pandemic,!which!had!reached!critical!heights!in!
Bombay.!!While!the!full!extent!of!the!pandemic!still!lay!before!him,!the!complete!
radio!silence!gives!weight!to!the!theory!that!the!British!government!chose!the!
impending!famine—which!Chelmsford!spent!most!of!his!time!on—as!the!crisis!to!
focus!on.!!Aside!from!the!war,!he!faced!major!problems!with!distribution!of!food.!!
The!failure!of!the!monsoons!posed!a!serious!problem,!but!the!British!fixation!on!the!
famine!to!the!exclusion!of!the!influenza!pandemic!remains!puzzling.!!While!the!
famine’s!high!prices!played!directly!into!the!worsening!of!the!pandemic,!he!did!not!
mention!that!link—and!indeed!he!may!not!have!known!yet.!!So!while!working!to!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
496 !Bombay$Famine$Report$191881919,!35.!!!
!
497 !Lord!Chelmsford!to!the!KingAEmperor,!October!4th!1918,!Papers!of!the!First!
Viscount!Chelsmford!as!Viceroy!of!India,!British!Library,!London,!United!Kingdom,!
MSS!Eur!E!264/1.!!!
!
179!
control!high!food!prices!and!make!sure!hard!hit!areas!received!adequate!food!would!
be!useful!in!controlling!the!pandemic,!the!fact!remains!that!the!pandemic!did!not!
seem!to!be!on!the!radar!of!the!highest!officials.!!This!myopic!mindset!did!the!British!
government!no!favors!in!terms!of!their!response.!
!
Once!the!worst!of!the!pandemic!had!ended,!the!flu!receded!into!the!
background!of!the!British!official!mind.!!The!famine,!however,!remained!front!and!
center!in!their!concerns.!!In!a!letter!from!Viceroy!Chelmsford!to!the!King,!the!havoc!
of!the!pandemic!gets!nary!a!mention.!!He!wrote,!
This!is!the!first!letter!which!I!have!written!to!Your!Majesty!since!the!
Armistice.!
!
A!widespread!sense!of!relief!was!the!result!throughout!India!and!your!
Majesty’s!gracious!message!on!the!occasion!was!very!much!appreciated.!!
With!the!Armistice,!however,!we!have!reaped!a!fresh!crop!of!difficulties.!!In!
the!first!place,!we!lose!that!desire!to!coAoperate!which!existed!while!the!war!
had!yet!to!be!won.!!The!public!was!ready!to!put!up!with!inconveniences!
which!were!seen!to!be!the!direct!result!of!the!war.!!It!does!not!sufficiently!
realise!that!the!war!has!its!aftermath!and!that!it!is!impossible!to!step!straight!
back!into!preAwar!conditions.!!Prices!still!run!high,!food!is!scarce!and!has!to!
be!controlled,!shopping!is!scanty!and!travelling!must!of!necessity!be!
circumscribed.!!This!latter!fact!reacts!with!special!hardship!upon!those!who!
have!been!forced!by!the!war!to!remain!in!India!without!their!usual!spell!
home,!and!this!applies!not!only!to!women!and,!children!but!to!members!of!
the!Services!who!have!been!overworked!and!strained!by!the!difficult!and!
arduous!conditions!of!the!past!four!years.”498!
!
Chelmsford’s!list!of!grievances!and!challenges!facing!the!British!and!Indian!people!
never!once!mentions!the!flu.!!By!February!the!worst!had!ended,!but!high!death!tolls!
had!been!seen!on!the!subcontinent!as!recently!as!December.499!!The!difficulties!he!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
498 !Lord!Chelmsford!to!the!KingAEmperor,!February!14!1919,!Papers!of!the!First!
Viscount!Chelsmford!as!Viceroy!of!India,!British!Library,!London,!United!Kingdom,!
MSS!Eur!E!264/1.!!
!
499 !Bihar$and$Orissa$Annual$Report,!11.!!
!
180!
mentioned!are!a!loss!of!cooperation,!high!food!prices,!and!a!lack!of!leave!for!
members!of!the!Civil!Service!and!their!families.!!Most!intriguingly!he!alleged!that!the!
public!would!not!cooperate!in!the!same!way!as!they!did!during!the!war.!!He!did!not!
enumerate!the!“inconveniences”!they!faced,!but!he!did!point!out!that!wars!have!an!
aftermath!and!bemoaned!the!public’s!inability!or!reluctance!to!accept!that!fact.!!He!
also!listed!various!challenges!and!restrictions!facing!the!general!public—meaning!
the!Indian!people!alongside!British!officials.!!The!high!prices!of!food!demonstrated!
the!lingering!effects!of!famine.!!The!flu’s!absence!looms!nearly!as!large!as!its!
presence!would!have.!
!This!filtering!of!information—from!Governor!to!Viceroy!to!King—also!shows!
how!the!pandemic!became!swallowed!by!official!channels.!!A!minor!problem!
presented!by!the!Governor!of!Bombay!to!Lord!Chelmsford!does!not!warrant!a!
mention!from!Chelmsford!to!the!King.!!In!this!way,!the!pandemic!was!lost!in!the!
annals!of!history,!as!the!major!crisis!on!the!ground!became!downplayed!in!favor!of!a!
more!controllable!crisis!and!the!information!that!trickled!up!to!the!highest!levels!
became!more!and!more!selective.!!Thus!the!deaths!of!hundreds!of!people!a!day!
passed!with!nary!a!mention,!and!the!pandemic!faded!into!the!background.!
!
During!the!height!of!the!pandemic,!the!Government!of!India!was!in!contact!
with!other!branches!of!empire!and!made!their!difficulties!with!the!pandemic!well!
known.!Colonial!Office!records!demonstrate!a!desperate!search!for!medical!
personnel!across!the!empire!as!the!flu!ravaged!nearly!every!corner!of!the!globe.!!J.H.!
Seabrook,!Undersecretary!of!the!Colonial!Office,!wrote!in!response!to!a!request!for!
more!doctors,!!
!
181!
I!am!directed!to!acknowledge!the!receipt!of!your!letter!of!the!14th!
December!No.!59424/18,!and!to!say!with!much!regret!that!Mr.!
Secretary!Montagu!has!ascertained!that!the!Government!of!India!are!
not!in!a!position!to!supply!assistance!for!combating!the!outbreak!of!
influenza!in!the!Somaliland!Protectorate,!in!view!of!the!gravity!of!the!
outbreak!in!India!itself!and!the!extent!to!which!that!country!has!been!
denuded!of!medical!personnel!to!meet!the!needs!of!Expeditionary!
Forces.!
!
A!copy!of!your!letter!has!however!been!sent!to!the!War!Office!
with!the!suggestion!that!assistance!might!be!available!from!the!forces!
in!Egypt!or!Palestine.500!
!
This!letter!reveals!several!interesting!facts.!!First,!by!the!middle!of!December!India!
did!not!feel!able!to!spare!medical!personnel!with!the!rest!of!the!empire,!indicating!
that!despite!the!lack!of!references!to!the!flu!in!other!official!correspondence,!they!
worried!about!a!recrudesce!of!the!pandemic.!!They!would!also!have!been!at!the!tail!
end!of!the!worst!of!the!pandemic—and!at!the!start!of!the!far!less!deadly!winter!
wave—so!clearly,!the!virus!still!threatened!India.!!Secondly,!it!reveals!the!
desperation!of!all!corners!of!the!empire,!as!they!attempted!to!round!up!enough!
qualified!medical!personnel!to!face!a!heretofore!unknown!foe.!!The!war’s!impact!on!
medical!staffing!also!gets!a!mention,!but!the!response!places!it!on!par!with!the!
“gravity”!of!India’s!situation.!!Clearly!other!places!within!the!empire!knew!just!how!
bad!the!situation!in!India!had!gotten,!even!though!that!knowledge!seems!to!have!
fallen!through!the!cracks!as!information!trickled!upward.!!
!
Conclusion*
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
500 !J.H.!Seabrook!to!the!Commissioner!of!Somaliland,!IOR:!L/MIL/7/14633,!British!
Library,!London,!United!Kingdom.!
!
!
182!
!
The!influenza!virus!outmatched!British!medicine!and!the!death!tolls!mounted!
throughout!the!fall!of!1918.!!The!Indian!Medical!Service!did!its!!best!to!treat!the!
symptoms,!but!very!little!seemed!to!be!effective.!!As!a!result,!hundreds!upon!
thousands!of!Indian!people!died!of!the!flu,!all!while!the!administration!of!British!
India!appeared!to!be!preoccupied!with!the!famine!and!war!instead.!!They!devoted!
considerable!effort!to!finding!a!vaccine,!but!very!few!believed!the!vaccine!would!
ever!be!efficacious.!!They!poured!money!and!resources!into!creating!a!vaccine!that!
doctors!were!reluctant!to!dispense,!and!which!could!never!have!been!manufactured!
in!a!large!enough!scale!to!prevent!a!future!pandemic.!!Highly!placed!governmental!
officials!carried!on!with!business!as!usual!and!seemed!unconcerned!with!the!
mounting!death!toll.!!Their!failure!to!truly!comprehend!or!manage!the!pandemic!
meant!it!slowly!got!swallowed!up!in!official!channels,!and!thus!the!flu!pandemic!in!
India!was!forgotten.!
!
!
!
!
!
!
!
183!
Chapter*Five*
Post8Mortem:$The$Flu$in$Retrospect$
$
$
By!exploiting!the!resources!of!India![the!Government!of!India]!has!made!the!country!
so!poor!that!toAday!about!a!fourth!part!of!her!population!can!hardly!afford!to!get!one!
meal!a!day.!!It!is!therefore!no!wonder!that!we!are!dying!like!flies!and!that!if!a!certain!
year!happens!to!be!a!little!colder!hundreds!of!thousands!succumb!to!influenza.!!In!
former!days!also!cold!winds!blew!and!rats!existed!but!then!people!had!enough!to!
eat!and!were!strong!enough!to!resist!such!disease.501!
!
!
An!unnamed!author!wrote!the!above!criticism!of!the!British!government!in!
1922,!four!years!after!the!influenza!pandemic,!but!mentions!of!the!flu!like!this!one!
are!few!and!far!between!in!nationalist!writings.!!Quickly!subsumed!by!the!end!of!the!
war,!the!flu!only!appeared!in!nationalist!writings!as!simply!one!in!a!long!line!of!
grievances.!!The!flu!itself!soon!fell!by!the!wayside!in!face!of!far!more!egregious!
atrocities,!such!as!the!massacre!at!Amritsar.!!The!outrages!of!the!Rowlatt!Act!and!the!
depravity!of!Dyer’s!actions!at!Amritsar!quickly!pushed!aside!the!influenza!pandemic!
in!the!narrative!of!history.!!The!flu!faded!into!obscurity,!appearing!only!occasionally!
in!nationalist!critiques.!
Meanwhile,!the!British!took!the!1918!pandemic!as!a!learning!opportunity,!
although!their!lessons!were!not!particularly!insightful.!!They!continued!to!debate!
the!role!of!the!Indian!Medical!Service!in!comparison!to!the!merits!of!something!akin!
to!the!Ministry!of!Health,!and!the!issue!of!increasing!Indianisation!of!the!service!
took!precedence.!The!emphasis!on!tropical!research!that!began!in!the!late!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
501 !Babu!Jhuman!Lal!Jaini,!Mulk$aur$Qaum$ki$halat$aur$Jainion$ka$farz,!(Saharanpur:!
Faruqi!Press,)!Government!of!India!declared!it!forfeited!March!27th,!1922!and!
summarized!and!translated!selected!excerpts.!!India!Office!Papers!1910A1930,!
British!Library,!London,!United!Kingdom,!MSS!Eur!F!242.!
!
!
184!
nineteenth!century!accelerated!in!the!postwar!years,!but!the!isolated!and!elitist!
nature!of!that!research!clashed!with!Indian!calls!for!increased!attention!to!the!
scientific!merits!of!Ayurveda!and!Unani.502 !!The!Government!of!India!Act!of!1919!
transferred!some!powers!to!provinces!and!elected!ministers,!and!“this!had!the!
effect,!however,!of!making!medical!expenditure!and!health!policy!subject!to!a!
greater!degree!of!political!scrutiny.”503!!Despite!some!efforts!in!the!immediate!
aftermath!of!the!flu!to!consider!a!new,!national!health!service!for!India,!the!IMS!
limped!along!without!substantial!reforms.504!!Medical!research!found!itself!on!the!
chopping!block!periodically!throughout!the!1920s!as!government!officials!searched!
for!places!to!save!money.505!!Officials!debated!influenza!vaccines!and!their!efficacy,!
and!paid!more!attention!to!isolated!cases!of!influenza,!but!the!overall!structure!of!
the!medical!establishment!in!India!did!not!change!substantially!following!the!loss!of!
somewhere!between!six!and!fourteen!million!people!to!influenza!in!less!than!a!
year.506!
!
Bodies*and*the*Aftermath*
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
502 !Arnold,!Science,$Technology,$and$Medicine,!146,!184A185.!
!
503 !Arnold,!Science,$Technology,$and$Medicine,!183.!
!
504 !Arnold,!Science,$Technology,$and$Medicine,!188.!!Arnold!observes!that!in!1930!the!
Retrenchment!Committee!proposed!abolishing!the!post!of!DirectorAGeneral!of!the!
IMS!and!Health!Commissioner,!but!the!motions!were!defeated!in!exchange!for!
budget!cuts!in!other!areas.!
!
505 !Arnold,!Science,$Technology,$and$Medicine,!!187A188.!
!
506 !Arnold,!Science,$Technology,$and$Medicine,!61!and!Chandra,!et!al,!1.!
!
!
185!
Faced!with!the!chaos!of!the!flu!and!the!government’s!inability!to!slow!the!tide!
of!death,!many!in!the!media!and!government!turned!to!managing!the!problem!of!
bodies.!!For!some,!corpse!disposal!was!a!topic!with!a!far!easier!solution!than!the!
flu.507!!No!new!scientific!advancements!would!be!needed!to!solve!it,!simply!more!
attention!and!organization.!!F.!Norman!White,!the!Sanitary!Commissioner!wrote,!
“dead!and!dying!people!were!being!removed!from!the!trains;!the!burning!ghats!and!
burial!grounds!were!literally!swamped!with!corpses;!whilst!an!even!greater!number!
awaited!removal.”508!!The!media!also!covered!the!problem!with!excess!bodies!as!the!
Amrita$Bazar$Patrika!noted!a!“Heart!Rending!Spectacle”!in!Bombay,!observing,!!
On!Friday!last!it!was!found!at!the!cremation!ground!all!was!
confusion!and!havoc!on!account!of!the!incessant!arrival!of!dead!
bodies.!!Thanks!however!to!the!commendable!zeal!of!Messr.!Mehta!
and!Tairsee!relief!measures!were!promptly!put!in!hand!and!
arrangements!were!made!to!improvise!the!large!quantities!of!fuel!
which!were!absolutely!necessary!to!dispose!of!the!dead!bodies.!!It!
may!also!be!said!that!since!Saturday,!the!work!of!disposing!of!the!
dead!bodies!has!been!greatly!facilitated!and!even!expedited.!!
Otherwise!dead!bodies!had!to!be!kept!waiting!for!their!turn!for!
hours!together,!and!at!times!this!led!to!disputes!among!mourning!
parties!for!priority.!!But!now!things!are!infinitely!better!and!what!
the!Committee!of!Management!failed!to!do!the!spirit!of!social!service!
among!people!has!supplied.509!
!
The!theme!of!body!disposal,!particularly!in!Bombay,!appears!often!in!the!flu’s!
narrative.!The!Amrita$Bazar$Patrika!added!a!new!twist!with!their!criticism!of!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
507 !Newspapers!in!Sierra!Leone!reported!problems!with!a!lack!of!coffins!as!well.!!
Kent,!49A50.!
!
508 !Preliminary$Report,!8A9.!White!was!reporting!!the!Sanitary!Commissioner!of!the!
Punjab’s!words!in!his!preliminary!report.!
!
509 !“’Mystery!Fever’!Epidemic:!No!Signs!of!Abatement,”*Amrita$Bazar$Patrika,!
October!4,!1918.!*
*
!
186!
British!presence.!The!article!described!scenes!of!chaos!before!relief!measures!were!
instituted.!“What!the!Committee!of!Management!failed!to!do!the!spirit!of!social!
service!among!people!has!supplied,”!the!article!claimed,!blaming!the!bureaucracy!
and!praising!the!Indian!people!in!the!same!breath.!!The!Indian!people!managed!to!
control!the!issue!of!excess!corpses!where!the!government!had!failed.*
!
The!Amrita$Bazar$Patrika$continued!on!this!theme,!highlighting!the!horrors!
of!overwhelmed!crematoriums.!!They!noted!that!between!one!hundred!and!fifty!and!
two!hundred!bodies!arrived!each!day!and!wrote,!“The!work!that!has!to!be!done!is!
thus!great!and!incessant.”510!!The!author!gave!credit!to!the!Water!Supply!
Department!and!to!“effective!organisation”!for!increasing!the!efficiency!of!the!
crematoriums,!but!that!does!not!outweigh!the!horrors!he!described.!!He!observed,!
On!the!ground!itself,!it!is!gruesome!spectacle—(sic)!dead!bodies!in!
various!stages!of!burning!and!more!bodies!scattered!about,!awaiting!
their!turn,!the!surcharged!atmosphere!and!the!variegated!colouring!
produced!by!the!flames:!all!these!go!to!make!the!scene!one!of!
indescribable!sorrow,!if!not!of!horror,!and!to!be!threading!one’s!way!
among!an!ever!moving!but!downcast!concourse!of!human!beings!must!
make!the!most!callous!realise!the!tragedy!of!the!disaster!that!has!
overtake!the!community.511!
!
The!detailed!description!of!corpses!did!not!appear!to!quite!the!same!extent!in!every!
publication,!although!this!same!level!of!overwhelming!death!did!appear!in!official!
publications!such!as!the!Preliminary$Report.512!!The!Amrita$Bazar$Patrika!brought!
the!horror!to!the!people!however,!and!spared!little!detail.!!Unlike!other!papers!that!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
510 !“Arrangements!for!Fuel!Supply,”!Amrita$Bazar$Patrika,!October!4,!1918.!!
!
511 !“A!Gruesome!Spectacle,”$Amrita$Bazar$Patrika,!October!4,!1918.!*
!
512 !Preliminary$Report,!8A9.!*
!
!
187!
used!corpses!to!demonstrate!how!either!the!people!or!the!government!managed!the!
problem,!the!Amrita$Bazar$Patrika!presented!the!gruesome!particulars!of!an!
unmitigated!disaster.!
!
Similarly,!The$Empire!reported!on!corpses!in!the!Hooghly!district,!noting!that!
it!was!a!“violent!type”!of!the!flu!had!affected!every!house!in!some!areas.!!In!some!
cases!entire!households!passed,!and!“There!was!none!to!remove!the!dead!bodies!
and!the!jackals!made!a!feast,!it!is!said.”513!!This!gruesome!description!indicated!a!
complete!breakdown!in!the!normal!modes!of!civilization,!where!dead!bodies!would!
be!disposed!of!quickly!and!with!dignity,!not!left!for!wild!animals!to!eat!but!did!not!
discuss!how!to!ensure!that!other!families!were!not!left!to!the!vagaries!of!the!
wilderness.!
!
The!Amrita$Bazar$Patrika!reported!on!a!slight!downturn!in!deaths!in!
Bombay,!but!still!observed,!“The!great!amount!of!burning!at!the!Hindu!burning!
ghats!has!led!in!some!quarters!to!a!renewal!of!the!demand!made!among!advanced!
Hindus!a!few!years!ago!for!the!erection!of!a!municipal!crematorium!on!the!scientific!
lines!adopted!in!Western!countries.”514!!The!havoc!of!the!flu!managed!to!spark!
tension!between!ancient!tradition!and!new!methods!of!honoring!those!traditions!
exacerbated!by!high!death!tolls.!!These!debates!also!highlighted!the!growing!strain!
on!services!caused!by!the!flu,!not!just!in!handling!the!sick!but!also!the!dead.!!Unlike!
the!flu,!however,!corpses!presented!a!predicament!with!a!solution.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
513 !“Influenza!Epidemic!in!Hooghly!District,”!The$Empire,$October!24,!1918.!*
!
514 !“Influenza!Epidemic:!Bombay!Turning!a!Corner,”!Amrita$Bazar$Patrika,!October!
10,!1918.!!
!
!
!
188!
The!Times$of$India!covered!similar!problems!in!the!context!of!the!issue!of!
disposal!of!Parsi!bodies.!!The!author!of!a!letter!to!the!editor!signed!“R.C.L,”!took!
issue!with!an!earlier!assertion!that!the!Parsi!community!would!never!accept!
cremation!as!an!alternative!for!body!disposal!to!their!preferred!method!of!leaving!
bodies!on!the!Tower!of!Silence!for!vultures.!!R.C.L!claimed!that!not!all!Parsis!would!
object!to!cremation,!and!notes!that!the!flu!pandemic!doubled!the!usual!number!of!
bodies!left!for!the!vultures.!!“There!are!perhaps!two!or!three!dozen!vultures!at!the!
Tower!of!Silence!and!at!the!most!they!can!devour!ten!corpses!daily,!so!the!corpses!
are!bound!to!accumulate,!decompose!and!breed!all!sorts!of!deadly!germs!during!an!
epidemic.”515!!The!flu!pandemic!and!the!excess!corpses!and!disposal!thereof!thus!
took!center!stage!in!the!conflict!between!different!opinions!within!the!Parsi!
community!as!the!general!public!also!turned!their!attention!to!a!solvable!problem.!
!
On!November!11th,!the!Bombay!Municipal!Corporation$met!to!debate!
creating!a!new!crematorium!in!Bombay.!!An!AP$of$India!article!noted!that!“It!was!
finally!decided!to!appoint!a!committee!to!report!on!the!subject,”!but!in!the!end!
“Amendments!were!moved!to!postpone!the!questions!until!the!Corporation!had!
received!a!numerously!signed!petition!on!the!subject!and!to!ask!the!Commissioner!
for!opinion!on!the!subject!of!future!burning!of!Hindu!bodies!in!the!event!of!
epidemics!such!as!had!recently!occurred.”516!!Even!while!the!pandemic!continued!to!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
515 !R.C.L.,!“Cremation!Or?!A!Parsi!View”,!Times$of$India,$November!4,!1918.!*R.C.L!
gives!the!usual!number!of!Parsi!deaths!at!seven!or!eight!per!day,!and!if!the!vultures!
could!only!consume!ten!corpses,!that!would!lead!between!four!and!six!unconsumed!
each!day—quite!a!build!up.!
!
516 !“Cremation!in!Bombay,”!The$Hindu,$November!15,!1918.!*
*
!
189!
rage!in!other!places,!Bombay!prepared!to!improve!their!situation!in!the!event!!of!
another!catastrophe!of!similar!proportions,!as!disposal!of!bodies!had!become!a!
recurring!issue!within!the!Presidency.!!When!little!could!be!done!to!stop!the!dying,!
people!turned!to!caring!for!the!dead!instead.!!The!breadth!of!articles!covering!body!
disposal!demonstrated!that!this!was!a!priority!for!the!Indian!people.!!The!grim!
specter!of!death!could!be!tackled!and!sorted,!even!if!the!flu!remained!uncontrollable!
with!a!cause!that!remained!unknown.!!In!this!sad!task,!at!least,!the!Indian!people!
and!the!government!could!work!together.!
!
Questions:*Raised*and*Abandoned*
India!also!faced!questions!as!to!their!place!within!the!empire,!as!after!World!
War!I,!India!existed!in!a!state!of!flux.!!The!Indian!people!had!thrown!themselves!into!
the!war!effort,!losing!some!60,000!men.517!!Gandhi!organized!an!ambulance!corps!
and!many!Indian!nationalists!expected!Britain!to!repay!their!sacrifices!with!
increased!autonomy,!either!in!the!form!of!Home!Rule!or!major!reforms.518!!Instead,!
the!Rowlatt!Acts!extended!the!Government’s!wartime!power!to!quash!sedition!in!the!
Great!War!and!these!restrictions!felt!like!a!slap!in!the!face.!
Tension!due!to!the!Rowlatt!Acts!and!accompanying!British!crackdowns!
erupted!in!the!spring!of!1919,!with!a!series!of!hartals,!or!strikes,!intended!to!express!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
517 !Hill,!165,!Sugata!Bose!and!Ayesha!Jalal,!Modern$South$Asia:$History,$Culture,$
Political$Economy!(Psychology!Press,!2004)102.!
!
518 !Hill,!165,!B.!R.!Nanda,!Gandhi:$Pan8Islamism,$Imperialism,$and$Nationalism$in$India!
(Bombay ;!New!York:!Oxford!University!Press,!1989),!158!and!Bose!and!Jalal,!102A
103!
!
!
190!
displeasure.519!!Despite!martial!law!several!hundred!peaceful,!unarmed!protesters!
assembled!in!the!Jallianwala!Bagh!in!Amritsar!in!the!Punjab!on!April!13,!1919.!!
General!Dyer!opened!fire!into!the!crowd!in!order!to!get!them!to!disperse,!although!
he!failed!to!give!any!warning,!fired!until!his!men!ran!out!of!ammunition,!and!then!
refused!to!allow!anyone!to!care!for!the!wounded.!!Nearly!four!hundred!people!died!
that!day!with!well!over!a!thousand!wounded,!and!within!a!year!Gandhi!had!
launched!his!NonACooperation!movement.520!
The!Government!of!India!operated!within!this!milieu!as!they!attempted!to!
learn!from!the!influenza!pandemic.!!While!some!changes!happened!quickly,!such!as!
flu!being!categorized!as!a!reportable!disease,!debates!over!and!incremental!changes!
to!the!IMS!marked!the!years!following!the!pandemic.521!!Facing!an!increasingly!
angry!and!hostile!public,!the!Government!of!!India!did!little!to!assuage!any!fears!of!
the!pandemic!and!instead!focused!on!putting!small!patches!on!a!very!leaky!boat.!
Much!of!the!Government!of!India!and!India!Office’s!efforts!in!the!two!years!
immediately!following!the!influenza!pandemic!centered!on!collecting!data!on!the!
1918A1919!pandemic!itself.!!As!explored!in!chapter!one,!provinces!filed!a!special!
report!on!influenza,!while!the!head!of!the!IMS!compiled!a!Preliminary$Report!on!the!
pandemic!as!well.!!Both!the!Annual$Report!and!the!1921!census!contain!extensive!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
519 !Kent,!18.!
!
520 !Green,!Martin,!Gandhi$in$India,$in$His$Own$Words!(Hanover,!N.H:!Published!for!
Tufts!University!by!University!Press!of!New!England,!1987),!2.!
!
521 !United$Provinces$Medical$Manual,!174.!**A!circular!included!in!the!manual!
includes!instructions!for!local!organizations!in!the!event!of!an!influenza!pandemic!
dated!April!16th,!1919.!
!
!
191!
retrospective!analysis!of!the!pandemic’s!progress!through!the!subcontinent!as!they!
tried!to!understand!what!caused!the!flu!and!how!it!travelled.522!!The!India!Office!
assembled!reports!on!other!areas!of!empire!as!well.523!!This!attention!to!influenza!
continued!into!the!early!1920s,!as!the!Sanitary$Report!for!the!Punjab!in!1920!also!
highlighted!the!recurrence!of!influenza!in!the!two!page!summary!preceding!the!full!
report.524!!!
The!Annual$Report!did!contain!recommendations!for!strengthening!the!
public!health!staff!across!India,!particularly!to!prepare!for!another!epidemic!but!also!
noted!that!even!in!the!best!of!times,!rural!access!was!already!limited.!!It!prescribed,!!
For!an!epidemic!limited!in!area!travelling!dispensaries!can!be!
organised,!but!such!dispensaries!can!only!be!staffed!by!taking!men!
from!less!urgent!duties!elsewhere.!!When!the!epidemic!is!universal!
medical!officers!must!be!employed!in!their!ordinary!stations,!and!the!
staffing!of!travelling!dispensaries!becomes!difficult,!if!not!impossible.!!
In!addition!to!the!shortage!of!Medical!Officers!the!recent!epidemic!has!
taught!India!the!need!for!organization!and!coAordination.!!An!efficient!
organization!for!epidemics!is!based!on!the!employment!of!a!health!
staff!sufficient!for!ordinary!requirements,!for!unless!the!staff!be!
sufficient!for!ordinary!requirements!its!expansion!to!meet!a!severe!
epidemic!is!well!nigh!impossible.525!
!
The!report!suggested!coordinating!with!voluntary!and!charitable!organizations!in!
the!event!of!another!widespread!pandemic,!and!urged!that!preventing!the!spread!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
522 !Annual$Report,!56A86..!Census$of$India,$1921,*12A18.*!
!
523 !Report!on!Influenza!Epidemic!in!Persia,!IOR:!L/PS/11/187,*British!Library,!
London,!United!Kingdom.!!!
!
524 !W.H.C.!Forster,!Report$on$the$Sanitary$Administration$of$the$Punjab$and$
Proceedings$of$the$Sanitary$Board$for$the$year$1920,!(Lahore:!Superintendent!
Government!Printing,!Punjab,!1921),!2.!!*
*
525 !Annual$Report,!67.!
!
!
192!
and!curing!the!disease!should!be!orchestrated!in!a!complementary!manner.526!!
However,!there!is!little!evidence!that!these!suggestions!were!ever!adopted.!
February!of!1919!saw!discussions!on!streamlining!medical!research!in!India.!!
Montagu!spoke!on!February!10th!to!the!British!Medical!Association!the!British$
Medical$Journal$duly!reported!his!suggestions.!!Montagu!identified!the!three!medical!
departments!performing!research!in!the!Raj—the!Sanitary!Department,!the!
Bacteriological!Department,!and!the!Indian!Research!Fund!Association—and!
broached!the!option!of!either!combining!the!Sanitary!Department!and!
Bacteriological!Departments,!or!combining!“the!provincial!sanitary!departments!
into!one!service,!and!to!make!one!Imperial!Service!of!Public!Health.”527!!The!article!
continued,!“Under!that!scheme!sanitation,!which!would!include!public!health,!would!
be!in!charge!of!a!minister!chosen!from!the!elected!members!of!the!provincial!
legislative!council,!who!would!be!assisted!by!a!standing!committee!elected!by!the!
legislative!council!from!among!its!own!members.”528!!Montagu’s!suggestion!of!an!
Imperial!Service!of!Public!Health!echoed!British!efforts!to!create!a!Ministry!of!Health!
in!the!wake!of!the!1918!pandemic,!although!this!desire!never!came!to!fruition!in!
India.529!!Intriguingly,!the!article!never!referenced!the!pandemic,!despite!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
526 !Annual$Report,!67.!
!
527!“Medical!Research!in!India,”$British$Medical$Journal,$March!15,!1919,!313.**
*
“Medical!Research!in!India.”**
*
529*“The!Ministry!of!Health,”!British$Medical$Journal,$June!28,!1919,!805A806$*and!
NPAS!Johnson,!“The!Overshadowed!Killer:!Influenza!in!Britain!1918A1919,”!in*The$
Spanish$Influenza$Pandemic$of$1918819:$New$Perspectives,!Killingray!and!Phillips,!
eds.,!Routledge!Studies!in!the!Social!History!of!Medicine!12!(London ;!New!York:!
!
193!
considerable!pressure!placed!on!the!medical!community!during!the!fall!of!1918.!!
The!flu!revealed!the!cracks!in!the!western!medical!system!in!India,!but!in!the!
aftermath!it!faded!into!the!mist.!
At!a!minimum!Montagu!realized!the!necessity!of!creating!a!unified!public!
health!service!in!India.!!He!knew!the!challenges!this!would!produce,!and!the!article!
mused!over!the!possibilities!for!redundancy!and!the!difficulties!of!determining!how!
departments!would!be!run.!!The!article!observed,!“Vast!extension!of!research!in!
public!health!services!and!institutions!was!necessary.”530 !!No!matter!what!followed,!
for!a!brief!moment,!the!efficacy!of!the!IMS,!the!Sanitary!Departments,!and!
overlapping!research!organizations!had!their!efficacy!questioned!by!the!highest!
levels!of!Government.!!However,!the!upheaval!of!the!spring!of!1919!and!subsequent!
years!seem!to!have!overshadowed!any!actual!attempts!at!meaningful!reform.!
The!need!for!more!medical!personnel!took!priority!in!discussing!the!
aftermath!of!the!flu.!!“The!Indian!Medical!Service!is!giving!me!much!anxiety,”!
Montagu!wrote.531!!He!declared!that!getting!the!IMS!“on!a!sound!basis”!to!be!
“absolutely!essential,!and!then!observed,!“I!am!assured!by!my!advisers,!who!are!in!
touch!with!medical!matters!here,!that!this!can!only!be!done!by!a!substantial!increase!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Routledge,!2003),!151.!!The!Local!Governing!Boards,!the!previous!public!health!
authority,!handed!over!power!to!the!Ministry!of!Health!in!July,!1919.!
!!
530 !“Medical!Research!in!India.”$*
*
531*Edwin!Samuel!Montagu!to!Lord!Chelmsford,!November!21!1918,!Papers!of!the!
First!Viscount!Chelsmford!as!Viceroy!of!India,!British!Library,!London,!United!
Kingdom,!MSS!Eur!E!264/4.!*!
*
!
194!
in!pay.”532!!!Montagu!tied!his!concerns!to!the!limited!amount!of!medical!personnel!in!
India!and!to!the!smaller!cohorts!of!men!entering!medical!school.!!He!concluded,!!
There!is!a!great!demand!here!for!medical!men!in!connection!with!
social!reform;!and!the!creation!of!a!Ministry!of!Health,!which!is!
inevitable!at!an!early!date,!will!further!increase!the!demand!on!a!
somewhat!limited!market!which!has!not!been!replenished!by!the!
usual!crop!of!students!during!the!last!few!years.!!I!do!not,!therefore,!
anticipate!that!the!situation!as!regards!medical!men!will!become!
easier!in!the!immediate!future,!and!we!shall!have!to!take!account!of!
that!fact!in!determining!the!new!scale.!533!!
!
Although!Montagu!vouched!for!the!necessity!of!the!Indian!Medical!Service!and!
advocates!for!their!importance!in!what!he!terms!“social!reform,”!he!did!not!address!
the!IMS’!service!during!the!pandemic.!!He!described!issues!with!lack!of!supply,!and!
anticipated!that!the!problem!would!continue,!but!even!though!the!flu!ravaged!India!
for!weeks—and!members!of!the!IMS!often!presented!the!only!line!of!defense!against!
it—the!flu!is!nowhere!to!be!found,!once!again!subsumed!by!pressing!issues!of!the!
future.!!Issues!of!pay!and!recruitment!took!precedence,!and!at!no!point!did!Montagu!
acknowledge!how!hard!the!men!of!the!IMS!worked,!or!point!to!the!flu!pandemic!as!
evidence!of!their!necessity.!!The!flu!disappears!into!the!ether,!discounted!and!
unremembered.!
!
In!Britain,!the!government!did!take!steps!to!create!a!unified!Ministry!of!
Health!in!the!aftermath!of!the!flu.!!However,!as!Johnson!argues,!the!impulse!to!
reform!the!public!health!system!in!Britain!had!been!well!established!before!the!war,!
starting!with!the!Public!Health!Acts!of!1875!and!1890!and!continuing!with!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
532*Edwin!Samuel!Montagu!to!Lord!Chelmsford,!November!21!1918.**
!
533 !Edwin!Samuel!Montagu!to!Lord!Chelmsford,!November!21!1918.*!
!
!
195!
National!Health!Insurance!Act!of!1911.534!!The!war!may!have!interrupted!the!
process!of!creating!a!more!coherent!system!of!public!health!but!the!influenza!
pandemic!likely!reinvigorated!the!movement.535!!While!the!metropole!took!concrete!
steps!to!unify!the!health!service,!the!IMS!and!Indian!medical!community!remained!
bogged!down!by!the!same!debates!over!Indianisation!and!prestige!instead.!
!
Moving*Forward*
Some!members!of!government!attempted!to!rectify!the!problems,!however.!!
The!issue!of!too!few!medical!personnel!arose!in!the!January!1919!meeting!of!the!
Bengal!Legislative!Council!as!Rai!Mahendra!Chandra!Mitra!Bahadur!requested!an!
update!into!how!many!qualified!applicants!had!been!rejected!from!Indian!medical!
schools!in!the!past!ten!years,!as!well!as!requesting!the!Government!account!for!its!
plans!to!accept!more!students.!!The!Medical!College!of!Calcutta!had!the!most!striking!
list,!rejecting!81!applicants!in!1909!and!an!astonishing!459!in!1918.!!The!Campbell!
Medical!School!had!less!complete!numbers,!but!between!1917!and!1918!the!rejections!
rose!from!176!to!531.536!!There!are!many!possible!reasons!for!this!spike!in!rejections,!
including!the!possibility!that!1918!saw!more!men!clamoring!to!apply,!perhaps!to!aid!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
534 !Johnson,!151.!
!
535 !Johnson,!151,!and!John!M.!Eyler,!Sir$Arthur$Newsholme$and$State$Medicine,$18858
1935,!Cambridge!History!of!Medicine!(Cambridge ;!New!York:!Cambridge!University!
Press,!1997),!334A336.!
!
536 !Mahendra!Chandra!Mitra!Bahadur!to!the!Bengal!Legislative!Council,!“Questions!
and!Answers,”!27.!*However,!it!is!worth!noting!that!1915!and!1916!saw!317!and!413!
rejections,!respectively,!making!1917’s!numbers!somewhat!of!an!anomaly.!
!
!
196!
in!the!war,!or!perhaps!driven!to!the!study!of!medicine!because!of!the!pandemic.537!!
Similarly,!they!give!no!information!as!to!whether!or!not!more!men!these!rejections!
happened!because!of!less!available!space,!although!it!does!not!appear!that!any!of!the!
medical!colleges!were!in!the!process!of!restricting!enrollment,!indicating!that!the!
imbalance!is!on!the!part!of!increased!applications.!!Mr.!Donald!also!noted!that!both!
Campbell!and!Dacca!Medical!schools!intended!to!increase!their!rosters!to!500!and!400!
respectively,!up!from!!300!and!200!as!allowed!in!1916.!!He!also!commented!that!there!
had!been!discussion!of!opening!a!new!medical!school!at!Burdwan.538!!One!can!
extrapolate!from!this!information!that!in!the!wake!of!the!massive!death!tolls!of!the!
1918!pandemic!the!medical!community!finally!took!steps!to!increase!the!number!of!
medical!personnel!in!the!subcontinent.!!In!contrast!to!the!movement!to!restrict!
accreditation!that!had!gained!popularity!before!the!flu,!the!Legislative!Councils!
switched!to!encouraging!more!medical!personnel.!
!
In!May!of!1919,!representatives!also!submitted!a!recommendation!that!all!
graduates!from!nonArecognized!medical!institutions!be!allowed!to!sit!the!final!
licentiate!exam.!!One!representative!argued,!
!My!Lord,!various!epidemics,!such!as!influenza,!war!fever,!cholera!and!
malaria!are!ravaging!the!province,!and!Your!Excellency’s!Government!are!
very!anxious!for!the!lives!of!the!people,!and!the!number!of!qualified!
doctors!being!small!Your!Excellency’s!Government!could!not!meet!the!
requisite!wants!in!different!places.!!If!the!resolution!I!have!the!honour!to!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
537 !It!does!not!report!when!these!applications!occurred—if!men!needed!to!apply!by!
July,!for!example,!the!flu!can!be!ruled!out!as!an!instigating!factor.!!If!applications!
were!due!in!December,!however,!the!flu!should!be!considered!as!a!possible!causal!
agent!for!the!spike.!
!
538 !Mahendra!Chandra!Mitra!Bahadur!to!the!Bengal!Legislative!Council,!“Questions!
and!Answers,”!27.!*
!
!
197!
move!be!accepted,!it!will!help!in!a!great!measure!to!allay!the!anxiety!Your!
Excellency’s!Government!is!feeling!now.!…The!public!will!derive!great!
benefit!by!these!doctors!by!treated!by!them!when!they!will!pass.539!!!
!
The!argument!maintained!that!even!if!someone!attended!unqualified!medical!schools,!
if!they!could!pass!the!exam!they!should!be!allowed!to!practice!as!doctors.!!Presented!
as!a!solution!to!the!problems!of!several!diseases!ravaging!Bengal,!this!motion!would!
have!addressed!the!problems!with!unaccredited!medical!colleges!and!colleges!losing!
their!accreditation.!!This!motion,!combined!with!the!above!discussion!on!increasing!
enrollment!in!medical!colleges,!demonstrated!that!immediately!following!the!
pandemic!the!Government!of!India!looked!for!various!solutions!to!their!problem!of!
too!few!medical!personnel.!
The!need!for!increased!access!to!health!care!in!rural!areas!seemingly!got!lost!in!
this!discussion!of!more!medical!personnel!despite!widespread!knowledge!that!it!had!
been!one!of!the!major!factors!in!mortality.!The!1921!Census!mused!on!the!paradox!
between!death!tolls!in!rural!areas!and!urban!ones!during!the!1918!pandemic!and!
noted,!“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!organised!effort.”540!!Thus!the!link!between!access!to!“qualified!medical!aid”!had!
been!established!as!essential!to!surviving!pandemics!like!influenza!in!the!minds!of!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
539 !Khan!Sahib!Aman!Ali!to!the!Bengal!Legislative!Council,!“Resolutions,”!BLC,!69.!!
!
540 !Census$of$India,$1921,*13.**!
!
!
198!
British,!although!little!came!of!this!knowledge.541!!!!It!followed!that!increasing!the!size!
of!services!like!the!Indian!Medical!Service!would!help!alleviate!this!problem,!but!few!
discussed!the!practical!needs!behind!posting!doctors!in!farther!flung!locals.!!Despite!
the!attention!paid!to!the!difference!in!mortality!rates!in!rural!and!urban!areas!during!
the!pandemic,!the!IMS!did!not!put!forth!any!real!effort!to!alleviate!the!problem.!!
In!1921,!the!Government!of!India!also!published!Moore’s$Manual$of$Family$
Medicine$&$Hygiene$for$India!that!trumpeted!the!improvements!to!Indian!health.!!
Cuthbert!Allan!Sprawson!claimed!in!the!preface,!!
The!great!increase!in!railway!communications,!the!improvement!of!
roads,!and!the!introduction!of!motorAcars!have!brought!highly!
skilled!medical!aid!much!nearer!many!people!than!was!formerly!the!
case;!while!the!gradual!establishment!of!an!independent!medical!
profession,!the!multiplication!of!branch!dispensaries,!and!the!
growth!of!druggists’!shops!and!‘medical!halls’!selling!the!remedies!
deployed!by!Western!medicine!have!brought!near,!even!to!many!
remote!parts!of!India,!medical!aid!and!European!drugs.542!
!
In!hindsight,!these!claims!appear!overly!lofty.!!Where!Sprawson!saw!improvement!
in!transportation!and!increased!access,!the!1918!pandemic!laid!bare!the!flaws!in!
this!boast.!!Many!small!villages!and!rural!areas!had!no!access!to!health!care!and!as!a!
result!died!in!much!larger!numbers!than!their!better!cared!for!counterparts.!!
Additionally,!Sprawson!lauded!“the!gradual!establishment!of!an!independent!
medical!profession,”!despite!ample!evidence!that!the!IMS!had!a!virtual!stranglehold!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
541 !“Qualified”!is!not!specifically!defined,!but!one!can!reasonably!assume!they!mean!
someone!with!training!in!Western,!scientific!methods!of!medical!practice.!
!
542 !Cuthbert!Allan!Sprawson,!Moore’s$Manual$of$Family$Medicine,!(London:!J.&A.!
Churchill,!1921),!ix.!*Sprawson,!a!Lt.!Colonel!in!the!IMS,!wrote!a!preface!in!1915!that!
was!included!in!the!1921!version!as!well.!
!
!
199!
on!medical!practice!in!India.!!In!short,!Sprawson’s!boasts,!while!likely!made!in!good!
faith,!would!not!bear!out!when!the!system!was!put!under!great!stress!in!1918.!!!
!
Doctors*Reflect*
!
Doctors!put!considerable!effort!into!dissecting!the!causes!of!the!1918!
pandemic!in!hopes!of!finding!either!a!cure!or!a!way!to!prevent!another!devastating!
bout!with!the!disease!but!the!desired!vaccine!never!materialized.!!!A!reprint!of!a!
paper!presented!by!Dr.!Bhupal!Singh!to!the!Medical!Association!of!Meerut!in!the!
Indian$Medical$Gazette$!dismissed!the!usefulness!of!a!vaccine!and!!instead!looked!at!
treatment!options.!!He!spoke!at!length!about!the!necessity!between!understanding!
the!difference!between!“wellAventilated”!rooms!and!a!“draught.”543!!He!rejected!the!
proposition!to!place!pneumonia!patients!on!an!open!air!verandah,!because!“it!is!a!
great!pity!that!no!line!is!drawn!between!ventilation!and!draught.”544!!In!particular,!
he!argued,!the!difference!between!an!adequately!ventilated!room!and!dangerously!
exposing!patients!to!the!cold!could!be!especially!dangerous!for!the!poor.!!He!
claimed,!“When!we!talk!of!throwing!open!the!rooms!to!let!in!the!fresh!air,!we!very!
conveniently!forget!that!perhaps!in!a!household!of!five!or!six!inmates!there!may!be!
only!one!old!ragged!lihaf!to!protect!them!from!cold!in!the!night.”545!!Singh!
emphasized!the!importance!of!understanding!the!limitations!poverty!would!place!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
543*Dr.!Bhupal!Singh,!“Influenza,”!Indian$Medical$Gazette,!Vol.!LV,!January!1920,!17A
18.**
*
544*Singh,!“Influenza,”!January!1920,!17.*
*
545*Singh,*“Influenza,”!January!1920,!17.!!Lihaf!means!“quilt.”*
*
!
200!
on!treatment.!!He!observed,!“Bad!ventilation!is!just!as!powerful!an!agent!in!lowering!
defensive!powers!of!an!individual!as!draught,!and!we!have!to!steer!clear!of!the!
two—not!forgetting!the!economic!condition!of!the!people!in!our!calculations.”546!!
Unfortunately,!this!attention!to!the!socioeconomic!status!of!victims!did!not!seem!to!
carry!over!into!government!policy!as!they!prepared!for!future!pandemics,!despite!its!
well!documented!influence!on!survival.!!The!Government!of!India!focused!on!
increasing!the!number!of!doctors!in!India!but!did!little!to!remedy!any!of!the!other!
problems!the!flu!revealed.!
!
The!medical!community,!in!turn,!emphasized!inAdepth!explorations!of!
individual!experiences!with!the!flu!as!a!way!of!gathering!more!information!on!the!
pandemic.!!Sir!Koilas!Chandra!Bose!recounted!his!experience!in!Calcutta!with!the!
pandemic!in!the!May,!1920!issue!of!the!Indian$Medical$Gazette.!!Bose!described!a!
community!that!attempted!to!control!the!spread!of!influenza!and!treated!it!to!the!
best!of!their!ability.!!“The!municipality!took!up!the!matter!in!right!earnest,”!he!
wrote.547!!He!recalled!relief!centers!being!opened,!schools!closed,!and!“qualified!
medical!men!with!their!medicine!chests!travelled!…!through!the!lanes!and!alleys!of!
the!city!to!distribute!medicine!to!the!poor!people.”548!!Calcutta’s!low!mortality!rates!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
546*Singh,*“Influenza,”!January!1920,!17.!*
!
547 !Sir!Koilas!Chandra!Bose,!“Epidemic!Influenza!in!and!Around!the!City!of!Calcutta,”!
Indian$Medical$Gazette,!Vol.!LV,!May!1920,!169.!*
*
548*Koilas!Chandra!Bose,!“Epidemic!Influenza!in!and!Around!the!City!of!Calcutta,”!
169.*
!
!
201!
may!account!for!why!Bose!did!not!make!much!comparison!to!other!areas.549!!The!
low!mortality!rates!could!have!been!for!several!reasons,!including!advance!notice!of!
the!flu!which!gave!them!the!ability!to!react!a!little!more!quickly!and!possibly!a!
higher!rate!of!infection!in!the!summer!wave.!!On!the!summer!wave,!Bose!stated,!
“Although!the!Assessor!of!Death!was!not!very!exorbitant!in!his!demands,!still!the!
strength!and!energy!of!the!citizens!were!almost!exhausted!and!many!of!them!had!
been!carried!to!the!very!threshold!of!their!eternal!home.”550!!However,!he!overall!
gave!the!impression!of!a!medical!community!that!came!together!to!aid!stricken!
citizens!in!the!deadly!fall!wave!of!influenza.!!“All!measures!failed!to!prevent!
dissemination!and!the!dispensaries!had!to!be!kept!going!throughout!the!year,”!he!
noted.551!!By!1920!most!medical!minds!turned!to!quarantine!and!prevention!as!the!
best!course!of!action!should!another!pandemic!erupt!despite!their!uncertainty!that!
it!would!work.!
!
Bose!further!complicated!the!suggestion!of!quarantine!and!limited!contact!
when!he!wrote,!“Of!prophylactic!treatment!nothing!is!more!safe!and!reliable!than!to!
quit!the!infected!area!and!return!to!a!healthy!locality.!!But!this!is!a!procedure!which!
can!never!be!adopted!by!the!Indians,!whose!social!customs!are!very!much!against!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
549 !Annual$Report,!56.!Bengal’s!mortality!rate!hovered!at!8.5!deaths!per!thousand!
people,!significantly!lower!than!areas!like!the!Punjab!which!saw!45.4!deaths!per!
thousand!people.!
!
550 !Koilas!Chandra!Bose,!“Epidemic!Influenza!in!and!Around!the!City!of!Calcutta,”!
169.!!I!do!love!a!lyrical!sentence.!
!
551 !Koilas!Chandra!Bose,!“Epidemic!Influenza!in!and!Around!the!City!of!Calcutta,”!
169.*
*
!
202!
it.”552!!Bose!categorized!quarantine!as!useless!due!to!a!quirk!of!Indian!culture,!
something!which!does!not!seem!to!appear!in!the!general!discussion!of!postA
pandemic!procedure.!!Perhaps!the!British!omitted!this!due!to!deliberate!obtuseness,!
or!perhaps!Bose!was!simply!alone!in!his!observation!of!Indian!culture.!!He!also!
claimed,!of!flu!victims,!“The!women!of!his!family!will!cling!to!the!bedside!of!the!
patient,!to!nurse!him!and!do!everything!for!his!comfort,!sacrificing!the!fundamental!
rules!of!hygiene.!!The!slovenly!habit!of!preserving!the!soiled!linen!saturated!with!
sputum!is!to!be!condemned.”553!!Bose!used!a!distanced!tone!and!observed!their!
disregard!for!hygiene!and!“slovenly”!habits!with!pronounced!distaste,!seemingly!
unwilling!to!proclaim!the!Indian!people!capable!of!handling!a!future!flu!pandemic.!
!
Bose!also!referred!to!Ayurvedic!texts!in!his!quest!for!understanding!
influenza.!!He!observed,!“From!the!ancient!literature!dealing!with!the!epidemic!
diseases!in!India!I!find!no!mention!of!influenza!in!the!Ayurvedic!system!of!medicine!
which!is!supposed!to!be!a!complete!encyclopaedia!of!diseases!that!affect!the!human!
race.”554!!The!Ayurvedic!sources!could!have!been!possible!sources!of!information,!
but!did!not!have!useful!information!on!influenza.!!However,!Indian!nationalists!
would!also!use!the!lack!of!pandemic!influenza!prior!to!the!British!arrival!as!a!further!
indictment!of!British!dereliction!of!duty.!!He!continued,!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
552*Koilas!Chandra!Bose,!“Epidemic!Influenza!in!and!Around!the!City!of!Calcutta,”!
173.*
*
553*Koilas!Chandra!Bose,!“Epidemic!Influenza!in!and!Around!the!City!of!Calcutta,”!
173.*
!
554 !Koilas!Chandra!Bose,!“Epidemic!Influenza!in!and!Around!the!City!of!Calcutta,”!
169.!
!
!
203!
Beyond!the!description!of!the!disease!given!in!the!volumes!dealing!
with!the!epidemic!diseases!of!Europe!we!have!no!authentic!record!
on!the!subject.!!Previous!to!the!year!1890!!influenza!was!absent!
from!the!list!of!epidemic!diseases!of!the!country.!!There!may!have!
been!mild!cases!of!the!disease,!but!no!special!attention!was!paid!to!
its!study.555!
!
Bose!did!not!make!any!connection!between!the!advent!of!influenza!and!the!presence!
of!the!British,!as!some!nationalist!writers!would!do.!!Nor!did!he!seem!interested!in!
tracking!how!the!flu!arrived!on!India’s!shores,!instead!focusing!on!treatments!and!
particular!cases.!!!
An!editorial!in!the!October,!1920!Indian$Medical$Gazette!concentrated!on!
economic!factors.!“The!last!epidemic!cost!India!5,000,000!lives—an!economic!loss!
which!justifies!expenditure!of!money!and!energy!in!an!effort!to!prevent!its!
repetition.”556!!!The!editorial!advocated!small!measures!that!would!prevent!loss!of!
life,!but!framed!it!in!economic!terms.!!The!author!then!observed,!“Whatever!views!
we!hold!as!to!the!actual!cause!of!influenza,!prevention!would!seem!to!be!more!
important!than!cure,!both!from!an!individual!and!public!point!of!view.”557 !!They!
argued!that!Dr.!Sajous’!theory!that!inhaling!iodine!and!iodizing!public!places!“both!
as!a!prophylactic!and!curative!measure”!in!India!could!be!a!possible!way!of!
preventing!a!further!pandemic!and!wrote,!“Provided!Dr.!Sajous’!convictions!are!
confirmed!experimentally!in!this!country,!there!is!no!reason!why!public!places!such!
as!churches,!theatres,!and!the!like!should!not!be!iodised!(and!at!a!small!cost)!when!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
555 !Koilas!Chandra!Bose,!“Epidemic!Influenza!in!and!Around!the!City!of!Calcutta,”!
170.
!
556 !“Influenza,”!Indian$Medical$Gazette,!Vol.!LV,!October!1920,!382.*
*
557*“Influenza,”!October!1920,!381.*
*
!
204!
influenza!is!prevalent.”558!!The!emphasis!on!practicality!and!economy!pervades!the!
editorial!as!it!argued!for!measured!steps!that!could!have!a!larger!impact!on!the!
public!as!a!whole.!
!
The!editorial!argued!that!the!most!useful!lesson!from!influenza!was!that!an!
epidemic!could!be!controlled!upon!arrival.!!They!recommended!“1)!Quarantine!at!
the!ports.!2)!Early!diagnosis,!notification,!and!isolation!of!the!infected.!3)!A!proper!
system!of!hospitalization.”559!!It!dismissed!inoculation!as!not!having!“any!proved!
value,”!and!thus!control!became!more!valuable!than!prevention.!!The!suggestion!of!
notification!marked!a!sea!change!from!earlier!policies!that!hampered!the!1918!relief!
effort,!as!influenza’s!status!as!a!nonAnotifiable!disease!had!caused!significant!
problems.560!The!article!concluded,!!
A!communication!from!so!high!an!authority!as!Dr.!Sajous!cannot!be!
lightly!laid!aside,!and!we!would!suggest!that!the!new!principles!in!
prevention!and!treatment!of!influenza!put!forward!in!his!paper!should!
receive!the!serious!attention!of!the!Government!of!India.!!Their!
applicability!to!India!and!their!utility!should!be!thoroughly!tested.561!
!
This!conclusion!revealed!two!interesting!facts:!first,!by!the!fall!of!1920,!the!editors!
of!the!Indian$Medical$Gazette!felt!Government!of!India!still!had!not!created!a!
satisfactory!method!to!handle!a!future!pandemic.!!!Second,!the!worldwide!medical!
community!still!had!not!reached!a!consensus!on!the!cause!of!the!flu,!much!less!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
558*“Influenza,”!October!1920,!381A382.*
*
559*“Influenza,”!October!1920,!382.*
!
560 !Ramanna,!88.!!
!
561 !“Influenza,”!October!1920,!382.!
!
!
205!
best!practices!to!prevent!a!new!pandemic.!!The!could!only!suggest!quarantine!and!
control,!the!old!standbys!of!public!health.!
Quarantine!made!an!appearance!in!the!United$Provinces$Medical$Manual.!!The!
manual!tailored!specific!steps!for!the!case!of!famine!works,!and!highlighted!the!lack!of!
progress!made!in!controlling!or!limiting!the!spread!of!influenza!several!years!after!the!
pandemic.!!It!stated,!
It!is!possible!that!influenza!may!be!met!with!as!an!epidemic!disease!in!
famine!works.!!The!careful!isolation!of!early!cases!and!contacts!is!the!
only!practical!measure!which!can!be!adopted,!but!when!it!appears!in!
really!epidemic!form!the!only!possible!step!which!can!be!taken!is!to!
break!up!the!work!immediately!as!is!done!in!the!case!of!cholera.!!If!the!
workers!remain!on!the!work!the!disease!would!spread!through!them!
like!wild!fire!and!it!would!be!absolutely!impossible!to!deal!with!the!
cases!coming!into!the!famine!hospitals.562!
!
Even!in!1921,!we!still!see!a!sense!of!helplessness!when!it!comes!to!stopping!influenza.!!
Quarantine!of!the!earliest!cases!appears!as!the!first—and!really,!only—line!of!defense.!!
If!the!quarantine!failed,!the!relief!works!would!be!shut!down!because!no!other!
solution!existed.!!Drawing!on!the!lessons!of!the!pandemic!that!high!population!density!
could!increase!fatalities!but!ignoring!the!message!that!increased!access!to!health!care!
could!make!a!difference,!the!Medical$Manual!fell!back!on!simple!quarantine!as!a!
solution.!!The!defeatist!attitude,!while!possibly!practical,!indicated!that!medical!
personnel!had!little!faith!they!could!do!anything!in!the!event!of!another!pandemic!
except!try!and!stop!its!transmission.!
The!manual!continued!with!further!steps!should!a!pandemic!arise.!!It!
ordered,!“In!every!district!and!municipality!a!small!committee!should!be!formed!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
562 !The$United$Provinces$Medical$Manual,$174.!!
!
!
206!
to!make!arrangements!for!meeting!epidemics!of!influenza.”563!While!it!allowed!
some!leeway!in!how!each!district!and!municipality!intended!to!handle!the!
epidemic,!by!1921!the!Government!of!India!did!have!some!structures!in!place!
should!another!massive!pandemic!hit!the!subcontinent.!!No!such!pandemic!arose,!
and!thus!the!plans!remained!invisible!to!the!public!at!large!and!their!efficiency!
untested.!
Creating!a!useful!vaccine!continued!to!be!a!thorn!in!the!side!of!those!
preparing!for!a!future!pandemic,!even!though!fears!of!a!recurrence!of!1918!never!
came!to!fruition.!!The!United$Provinces$Medical$Manual!demonstrated!the!lack!of!
faith!in!an!influenza!vaccine!for!preventing!or!controlling!future!pandemics,!noting!
that!a!vaccine!was!available!but!“it!cannot!be!said!that!the!usefulness!of!the!vaccine,!
either!as!a!prophylactic!or!as!a!curative!agent,!has!so!far!been!thoroughly!
established.”564!!Recalling!MacTaggart’s!woeful!prediction!that!an!influenza!vaccine!
could!not!be!manufactured!in!large!enough!quantities!to!make!a!difference,!in!1921!
the!manual!stated,!
It!is!very!probable!that!the!protection!afforded!by!influenza!vaccine!
(if!any)!is!extremely!shortAlived.!!It!is!accordingly!wasteful!to!
inoculate!people!in!nonAepidemic!times!and!so!deplete!the!stocks!
which!would!be!of!value!in!the!event!of!a!recrudescence!of!the!
epidemic.!No!illAeffects!need!be!feared!as!regards!a!negative!phase!or!
period!of!increased!susceptibility!after!injection,!so!that!inoculation!
can!be!carried!out!in!the!presence!of!an!epidemic.565!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
563 !The$United$Provinces$Medical$Manual,$174.!
!
564 !The$United$Provinces$Medical$Manual,!175.!
!
565 !The$United$Provinces$Medical$Manual,!176.!
!
!
207!
This!particular!warning!focused!on!the!need!to!vaccinate!efficiently;!vaccinating!
large!swaths!of!the!population!with!no!current!threat!of!influenza!would!be!
wasteful,!since!the!dubious!protection!offered!by!the!vaccine!would!not!last!long.!!
Additionally,!the!fact!remained!that!producing!large!enough!quantities!of!the!
vaccine!and!distributing!them!to!the!afflicted!populace!in!the!right!time!frame!to!
protect!them!would!be!too!large!for!the!government!to!tackle.!!Officials!included!
vaccines!as!a!prophylactic!not!out!of!any!real!belief!that!they!would!help,!but!
because!any!action!would!be!seen!as!better!than!none.!!
!
India,*Influenza,*and*Imperial*Power*
!
However,!the!British!faced!more!challenges!in!India!than!just!influenza’s!
possible!return.!!Edwin!Montagu!had!given!the!impression!in!1917!that!India!would!
follow!other!colonies!like!Canada!and!Australia!on!the!way!to!selfAgovernment!but!
the!reforms!offered!in!1919!undercut!that!implied!promise.566!!Many!moderate!
nationalists!pinned!their!hopes!on!the!proposed!reforms,!but!the!MontaguA
Chelmsford!reforms!did!not!prove!to!be!the!liberal!concessions!they!wanted.!!!While!
the!reforms!did!increase!Indian!participation!in!the!government,!“The!new!
franchise,!based!on!property!and!educational!qualifications,!was!tilted!in!favour!of!
the!raj’s!friends,!not!its!critics.”567!!The!1919!acts!gave!some!powers!to!local!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
566 !Barbara!D.!Metcalf!and!Thomas!R.!Metcalf,!A$Concise$History$of$Modern$India,!2!
edition!(New!York:!Cambridge!University!Press,!2006),!176.!!They!record!Montagu’s!
exact!words!as!“gradual!development!of!selfAgoverning!institutions!with!a!view!to!
the!progressive!realization!of!responsible!government!in!India!as!an!integral!part!of!
the!British!Empire.”!
!
567 !Bose!and!Jalal,!105.!!
!
208!
provincial!governments!but!kept!the!British!firmly!in!control!of!important!
departments,!like!police!and!revenue.568!!The!utter!failure!of!the!government!to!
provide!Indian!people!with!the!reforms!they!so!desired!galvanized!Indian!
nationalists!who!turned!to!Mohandas!Gandhi!and!his!ideals!that!appealed!to!people!
outside!elite!circles!and!presented!a!new!way!of!expressing!resentment!of!British!
colonial!power.569!
Shortly!after!the!British!government!in!the!United!Kingdom!enacted!
centralizing!legislation!in!the!form!of!the!Ministry!of!Health!Bill,!the!Government!of!
India!moved!towards!decentralization!and!provincialization!with!the!reforms!of!
1919.!!The!Indian!Medical!Service!remained!intact!and!Montagu’s!hopedAfor!
Imperial!Health!Service!never!came!to!fruition.!!Streamlining!and!improving!the!
public!health!system!seemed!less!important!than!handling!the!upheavals!of!the!
spring!of!1919!and!thus!India’s!public!health!service!stagnated.!
*
While!the!atrocities!at!Amritsar!and!the!unjustified!crackdown!of!the!Rowlatt!
Act!quickly!overshadowed!the!flu!it!did!appear!in!some!nationalist!discourse,!
usually!as!one!more!in!a!long!line!of!failures!by!the!British.!!In!February!of!1919,!an!
article!in!Young$India!reported,!“The!country!is!face!to!face!with!famine!and!has!
suffered!very!heavily!from!the!influenza!epidemic.!!It!seems!that!one!more!scourge!
has!been!added!to!the!long!list!of!diseases!which!have!been!ravaging!the!country!for!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
568 !Metcalf!and!Metcalf,!168.!
!
569 !Metcalf!and!Metcalf,!174A175.!
!
!
209!
so!many!years—malaria,!cholera,!plague—and!now!influenza.”570!!!Like!Bose!
observed,!influenza!was!new!to!India,!although!this!article!used!the!scourge!to!
charge!the!British!with!misdeeds.!!The!article!later!observed,!“The!chief!cause!of!
heavy!mortality!in!India!from!all!kinds!of!diseases!is!the!low!vitality!of!the!people,!
the!direct!outcome!of!insufficient!food—a!cause!from!which!about!100!millions!of!
the!population,!at!least,!suffer,!even!in!prosperous!years.”571!!!The!link!between!
famine!and!flu!had!been!well!documented!by!this!point,!appearing!in!both!the!
popular!and!medical!presses!as!well!as!in!official!documents.!!Now!nationalists!
pushing!for!more!reform!used!this!link!as!further!proof!of!Britain’s!mismanagement.!
Young$India!also!recorded!a!September!1919!speech!by!Gandhi!that!also!
covered!the!link!between!flu!and!famine.!!It!stated,!!
The!speaker!congratulated!the!Sahayva!Mandal!for!their!splendid!work!
during!the!influenza!epidemic!and!the!late!famine.!!He!however!
ventured!to!suggest!that!true!and!lasting!social!service!lay!in!
organising!preventive!measures!whist!it!was!good!to!relieve!suffering!
in!times!of!plague!or!famine,!it!was!better!to!band!together!in!order!to!
prevent!a!!recurrence!of!plague!or!famine.!!He!is!a!wise!and!
philanthropic!doctor!or!lawyer!who!prevents!diseases!or!quarrels.!!
Social!servants!ought!not!to!wait!for!influenza!or!famine!for!giving!
their!service!to!the!nation.572!
!
Gandhi!prescribed!working!to!prevent!both!rather!than!simply!helping!alleviate!
suffering!and!requested!preventative!measures!for!both!flu!and!famine.!!While!his!
requests!did!dovetail!with!what!the!medical!community!recommended,!Gandhi!
directed!his!remarks!to!the!Indian!people!rather!than!the!IMS!or!the!British!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
570 !“Famine!and!Grip!Sweeping!India,”$Young$India,!Vol.!II,!no.!2,!February!1919,!41.!
*
571*Famine!and!Grip!Sweeping!India.”*
!
572 !“Social!Service,”!Young$India,!Vol.!I!no!45,!October!1919,!4.!
!
!
210!
government,!moving!the!responsibility!of!protecting!Indian!people!to!their!fellow!
citizens.!!The!British!Government!and!their!extensive!Famine!Codes!would!likely!
have!taken!offense!to!the!implication!that!they!did!not!prepare!for!a!famine.!!
However,!this!reveals!an!important!dichotomy:!the!Government!of!India!prided!
itself!on!their!responses!to!famine,!and!portrayed!themselves!as!reacting!quickly!
and!effectively!to!even!the!merest!hint!of!famine!while!the!Indian!people!felt!
otherwise.573!!!Where!the!British!saw!an!effective!response,!the!Indian!people!saw!
no!real!relief.!!Where!the!British!saw!themselves!as!proactive,!the!Indian!people!saw!
a!flailing,!reactive!response.!
!
Gandhi!also!addressed!the!divide!between!urban!and!rural!areas,!as!the!
article!reported,!“Truer!service!of!the!constructive!and!preventive!type!could!be!
rendered!in!the!villages.!!And!if!we!succeeded!in!keeping!our!villages!pure,!clear,!
healthy!and!prosperous,!the!big!cities!would!take!care!of!themselves.”574!!Gandhi!
asked!for!more!attention!the!places!that!generally!faced!the!highest!death!tolls!from!
influenza!and!posed!the!biggest!problem!for!famine!relief,!as!distributing!food!to!
places!without!easy!railway!access!tended!to!stymie!British!officials.575!!By!focusing!
the!improvement!efforts!on!small!villages,!Gandhi!indicated!that!should!those!areas!
be!taken!care!of!efficiently,!the!cities!would!prosper!as!well.!!This!advice!proposed!
to!reverse!the!governmental!dynamic!of!providing!relief!to!cities!while!less!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
573 !Bombay$Famine$Report$191881919,!3.!The!Bombay!famine!report!indicated!that!
the!lack!of!starvation!proved!their!efficacy.!
!
574 !“Social!Service,”!4.!
!
575 !United$Provinces$Famine$Report$of$191881919,$4.!!*
!
!
211!
trafficked!areas!fended!for!themselves.!!By!addressing!fellow!Indians,!Gandhi!moved!
the!agent!of!change!from!the!Government!of!India!to!Indians!themselves.!!While!
Indians!had!in!the!government!for!years!at!this!point,!it!relocated!the!apex!of!power!
from!the!British!to!the!Indian!people!as!Gandhi!urged!them!to!take!care!of!their!own!
rather!than!waiting!for!the!British!to!do!so.!!Gandhi!set!the!tone!for!many!nationalist!
conversations!in!the!immediate!aftermath!of!the!war,!and!as!Partha!Chatterjee!
argues,!Gandhi!focused!much!of!his!ire!toward!modern!civilization!and!individual!
interests,!advocating!!“social!morality,!based!on!certain!universal!ethical!values!
shared!by!the!whole!community.”576!!Appalled!by!the!government’s!actions!in!1919,!
Indian!nationalists!rejected!the!moderate!hopes!that!dominated!the!war!years!and!
moved!forward!with!a!new,!more!stridently!nationalistic!tone.577!
Even!in!the!shadow!of!deliberate!atrocities,!the!flu!appeared!in!nationalist!
pamphlets.!!The!British!made!a!habit!of!confiscating!any!publications!that!appeared!
to!encourage!sedition!amongst!the!Indian!people!and!translated!them!for!officers!
not!fluent!in!Indian!languages.!!One!such!nationalist!work!claimed,!!
By!exploiting!the!resources!of!India!it[the!Government!of!India]!has!
made!the!country!so!poor!that!toAday!about!a!fourth!part!of!her!
population!can!hardly!afford!to!get!one!meal!a!day.!!It!is!therefore!no!
wonder!that!we!are!dying!like!flies!and!that!if!a!certain!year!happens!
to!be!a!little!colder!hundreds!of!thousands!succumb!to!influenza.!!In!
former!days!also!cold!winds!blew!and!rats!existed!but!then!people!had!
enough!to!eat!and!were!strong!enough!to!resist!such!disease.578!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
576 !Partha!Chatterjee,!The$Partha$Chatterjee$Omnibus!(New!Delhi ;!New!York:!Oxford!
University!Press,!1999),!90A91.!
!
577 !Bose!and!Jalal,!105.!
!
578 !Babu!Jhuman!Lal!Jaini,!Mulk$aur$Qaum$ki$halat$aur$Jainion$ka$farz,!263.!!
!
!
212!
Collected!by!British!officials!in!March!of!1922,!this!work!echoed!Gandhi’s!claim!that!
the!British!had!created!the!perpetual!food!crisis!in!India.!!The!writer!observed!that!
the!Indian!people!were!“dying!like!flies”!and!also!accuses!the!British!of!creating!a!
situation!where!a!slight!change!in!weather!would!result!in!the!deaths!of!“hundreds!
of!thousands”!due!to!influenza.579!!The!writer!then!contrasted!the!current!conditions!
under!the!British!and!concluded!that!prior!to!the!British!presence,!these!factors!did!
not!result!in!the!immediate!death!of!his!countrymen!and!therefore!these!deaths!fall!
at!the!feet!of!the!British.!
!
Other!nationalist!works!banned!by!the!Government!of!India!had!similar!
rhetoric!about!other!events,!bolstering!the!case!that!the!flu!was!seen!in!the!same!
vein!as!other!acts!of!negligence.!!An!1921!poem!on!the!NonACooperation!movement!
asked,!“Why!should!we!endure!these!hardships!when!all!the!country,!wealth!and!
property!is!our!own[?]”580!!The!image!of!India!as!a!selfAsufficient!country!prior!to!
the!arrival!of!the!British!appeared!often,!pointing!out!hardships!created!by!the!
Government!of!India!and!demanding!change.!!A!note!from!a!British!summary!of!one!
such!banned!work!noted,!“the!poet!then!describes!the!former!condition!of!India!and!
compared!its!present!condition!with!that!of!the!past.!!He!also!compares!the!present!
state!of!India!with!that!of!other!countries!and!says!that!Indians!condition!is!the!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
579 !Babu!Jhuman!Lal!Jaini,!Mulk$aur$Qaum$ki$halat$aur$Jainion$ka$farz,!263.!
!
580 !Pandit!Madhava!Nandanji!Misra,!“Asahyogya!Tarang,”!(Cawnpore:!Rajhans!
Press),!227.!!Government!of!India!declared!it!forfeited!October!26,!1921,!and!
summarized!and!translated!selected!excerpts.!!India!Office!Papers,!British!Library,!
London,!United!Kingdom,!MSS:!Eur!F/242.!!!
!
!
213!
worst.”581!!By!juxtaposing!India!both!to!her!past!and!to!other!countries!in!the!
present,!the!nationalist!writer!drew!unflattering!parallels!to!India!under!the!thumb!
of!the!British.!!!“Indians!are!crying!out!everywhere!for!food,!but!the!food!is!being!
exported!to!foreign!countries.!!It!is!strange!that!you!are!being!deprived!of!your!food!
and!clothing!and!the!foreigners!are!supplied!with!them.!!You!cannot!pull!on!your!life!
under!these!circumstances,”!the!same!song!continued.!582!!This!song!went!further!
than!simply!comparing!India!under!British!control!to!the!past!and!coming!up!
wanting,!but!in!fact!accuses!the!British!of!taking!food!and!sending!it!to!foreigners!
rather!than!keeping!it!in!India.!!Cloth!shortages!also!recalls!the!situation!in!the!fall!of!
1918,!when!cloth!prices!shot!up!just!as!the!Indian!people!had!a!need!for!more!
blankets!for!flu!sufferers.!!Again!and!again,!the!Indian!people!felt!they!were!left!in!
the!cold!as!the!British!served!their!own!interests!first!and!the!Indian!people’s!
second!and!the!flu!became!one!more!example.!
Another!supposedly!seditious!work!named!bureaucracy!as!a!cause!of!India’s!
problems.!!It!claimed,!“We!die!and!die!owing!to!influenza!and!malaria,!still!the!sin!of!
bureaucracy!is!increasing!every!day.!!The!walls!of!houses!shiver!with!their!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
581 !Pandit!Madhava!Nandanji!Misra,!“Asahyogya!Tarang,”!227.,!October!26th,!1921.!!
Originals!were!not!included!in!the!India!Office!Records,!and!thus!we!must!trust!in!
these!translation!and!summaries.!
!
582 !“Swadeshi!Gita!Anjali,”!(Aligarh:!Bharat!Bandhu!Press,).!!The!Government!of!
India!declared!it!forfeited!October!20th,!1921,!India!Office!Papers!1910A1930,!British!
Library,!London,!United!Kingdom!MSS:!Eur!F/242.!!The!translation!describes!the!
work!as!a!book!of!songs,!although!at!times!refers!to!them!as!poems.!
!
!
214!
tyrannies.”583!!!!The!term!“the!sin!of!bureaucracy”!indicated!that!the!author!felt!that!
the!existing!government!did!not!handle!these!crises!effectively.!!In!fact,!the!
government!bore!the!brunt!of!the!blame,!and!the!evocative!image!of!houses!
shivering!with!tyrannies!went!even!farther.!!The!author!made!clear!the!link!between!
death!and!government!neglect!in!this!stark!imagery.!
!
Themes!of!theft,!starvation,!and!illness!at!the!hands!of!the!British!appear!
often!in!banned!nationalist!poems,!songs,!and!books.!!One!such!work!lamented,!“The!
days!are!gone!when!you!were!enjoying!at!ease,!sleeping!at!rest!and!idling!in!laziness.!!
At!that!time!the!house!was!full!of!corn!and!various!kinds!of!wealth.!!But!now,!alas!!
not!a!single!grain!is!left.”584!!Time!and!again!these!works!portray!India!as!a!formerly!
wealthy!country!that!had!been!robbed!and!left!to!starve!by!the!pernicious!British.!!
The!poem!continued,!“It!(country)!has!been!attacked!with!the!cough!of!deceit,!
irreligiousness!and!has!been!laid!down!with!dysentery!and!poverty.!!Above!all!
destructive!fever!of!ignorance!has!overtaken!it.”585!!Here,!the!language!of!influenza!
pervades!the!text,!with!cough!and!fever!used!to!describe!abstract!concepts.!!Flu!had!
ceased!to!just!be!a!disease!and!had!become!a!metaphor!in!and!of!itself.!
!
Another!poem!turned!its!ire!to!the!Legislative!Council!and!the!Indian!
representatives!who!failed!to!adequately!serve!the!needs!of!their!people.!!After!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
583 !Jagannath!Prasad!Gupta,“Sudhar!ki!Sirhi”!(Benares:!Sri!Lakshmi!Narayan!Press)!
The!Government!of!India!declared!it!forfeited!December!14th,!1921,!India!Office!
Papers!1910A1930,!British!Library,!London,!United!Kingdom,!MSS!Eur!F/242.!
!
584 “!Vir!Bharti,”!Sital!Prasad!Vishnoi,!ed,!(Cawnpore:!Raj!Hans!Press),!declared!foreit!
by!the!Government!of!India!on!June!8,!1921!India!Office!Papers!1910A1930,!British!
Library,!London,!United!Kingdom,!MSS!Eur!F/242.*
*
585“!Vir!Bharti.”!**
*
!
215!
criticizing!the!Englishmen!who!generally!run!it,!the!author!moved!on!to!Indian!
representatives!and!claimed,!!
In!short,!all!its!members!are!flatterers!and!timid!men.!!They!do!not!
think!of!measures!for!prevention!of!famine!and!plague…These!
empty!shows!cannot!result!in!preventing!famines,!reducing!taxes,!
spreading!industry,!introducing!administration!of!real!justice,!filling!
the!belly!of!cultivators,!and!removing!plague.586!!!
!
These!works!that!the!British!government!found!seditious!enough!to!seize!and!ban!
considered!famine!and!disease!inextricably!linked.!!Additionally,!like!Gandhi!argued!
in!1919,!the!author!holds!prevention!of!famine!and!disease!in!utmost!importance.!!
Once!again,!this!reveals!the!dichotomy!in!perception!that!dominated!how!the!British!
and!Indian!people!viewed!government!in!the!aftermath!of!the!flu.!!The!British!
Government!prided!itself!on!responses!to!famine,!as!evidenced!by!their!reports!on!
the!1918!food!shortage.587!!By!the!early!1920s,!the!Government!of!India!considered!
themselves!experts!in!managing!famines!and!epidemics,!but!the!fact!remained!that!
while!they!had!temporarily!figured!out!how!to!prevent!fullAscale!starvation!and!
created!limited!measures!in!the!event!of!a!return!of!influenza,!the!dayAtoAday!
shortages!and!needs!of!the!Indian!people!remained!far!from!being!met.!
!
Conclusion*
!
The!British!in!India!appeared!to!learn!little!from!their!experiences!with!the!
1918!influenza!pandemic.!!Perhaps!it!was!simply!too!short!to!spur!lasting!change!on!
a!nationwide!level,!but!aside!from!closer!monitoring!of!influenza!cases!and!a!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
586“!Vir!Bharti.”!**
!
587 !See:!United$Provinces$Famine$Report$of$1918—1919$and!Bombay$Famine$Report$
191881919$for!examples.!
!
216!
continued!emphasis!on!creating!a!vaccine,!very!little!changed!as!a!result!of!the!flu.!!
The!government!kept!on!at!the!status!quo,!following!a!pre!ordained!line!that!had!
been!drawn!in!prior!to!the!flu.!!The!Indian!Medical!Service!likewise!continued!apace,!
with!little!but!cosmetic!changes.!
!
While!the!loss!of!between!ten!and!fifteen!million!of!their!countrymen!did!not!
cause!the!Indian!people!to!immediately!demand!change,!it!still!left!an!impact.!!Taken!
in!context!with!previous!famines!and!neglect,!the!flu!became!just!one!more!in!a!long!
line!of!British!outrages.!!The!tension!between!Indian!medical!practitioners—both!
traditional!and!western—and!western,!British!medical!practitioners!did!not!abate.!
As!the!years!dragged!on,!the!flu,!with!all!its!unsolvable!problems!and!uncontrollable!
nature,!faded!into!the!background.!
!
!
!
!
217!
Conclusion*
!
The!world!had!never!seen!a!virus!like!the!influenza!virus!of!1918!that!killed!
millions!of!people!worldwide.!!Even!though!flu!typically!tears!through!communities!
in!the!fall!and!winter,!this!virus!first!appeared!in!early!spring!and!summer!before!
mutating!into!a!far!deadlier!version!in!the!fall.!!The!first!wave!cost!thousands!of!lost!
hours!in!manpower,!and!during!the!fall!British!officials!reported!death!tolls!of!some!
six!million!in!India!while!arguing!that!the!true!tally!was!likely!double.!!The!British!
government’s!response!did!little!to!stop!the!mounting!death!tolls,!and!an!
accompanying!famine!kept!a!large!portion!of!the!limited!staff!in!India!preoccupied.!!!
In!the!end,!the!flu!killed!millions!of!Indian!civilians!but!produced!little!lasting!
change!on!a!governmental!level.!
!
As!the!First!World!War—itself!deadlier!than!most!imagined!possible—drew!
to!a!close,!the!flu!honed!in!on!young!adults,!who!had!already!borne!the!heaviest!
burden!during!the!war.!!The!flu!also!hit!malnourished!populations!particularly!hard.!!
In!addition!to!the!spike!in!victims!between!the!ages!of!15A45,!India’s!poorest!died!in!
massive!numbers!owing!to!the!recent!famine.!!The!price!of!necessities!rose!out!of!
reach!of!the!lowest!classes!while!wealthier!members!of!society!managed!to!weather!
the!increased!prices!without!sacrificing!nutrition.!!!This!combination!of!natural!
disasters!at!the!end!of!a!war!left!officials!scrambling!for!solutions!that!either!did!not!
exist!or!were!ineffective.!
The!deadliest!version!of!the!H1N1!virus!reached!India!in!September!of!1918!
and!all!across!the!subcontinent!people!sickened!and!died!from!a!disease!that!
!
218!
normally!took!only!a!tiny!percentage!of!the!population.!!Northern!and!western!
provinces!had!the!highest!death!tolls,!!but!places!that!had!limited!access!to!medical!
personnel!generally!saw!much!higher!death!tolls.!!The!Government!of!India!found!
itself!outmatched!by!these!catastrophes,!and!the!flu!made!occasional!as!a!critique!of!
the!colonial!state!in!nationalist!literature.!
!
The!historiography!around!the!flu!has!not!thus!far!done!a!sufficient!job!of!
exploring!the!flu’s!impact!in!India.!!Articles!like!Ramanna’s!and!Chandra’s!either!give!
a!short!glimpse!into!one!area!or!a!glancing!overview!of!the!entire!death!toll,!but!as!
of!this!writing!no!one!else!has!explored!the!flu!in!a!full!project.!!Far!more!needs!to!be!
done!on!multiple!levels,!including!a!longer!overview!of!the!flu’s!influence!on!
anticolonial!movements.!!On!a!local!level,!studies!of!individual!provinces!and!their!
experiences!during!the!pandemic!would!provide!greater!context!for!the!issues!
discussed!here.!!Greater!attention!should!be!paid!to!the!different!economic!and!
geographic!character!of!each!province!to!bring!a!more!nuanced!look!to!the!flu!in!
India.!!Influenza!affected!each!province,!but!their!experiences!were!not!universal.!!!
In!the!midst!of!the!devastation!of!the!flu!pandemic,!the!bureaucracy!and!
medical!system!in!India!proved!to!be!ineffective!at!best!and!possibly!negligent!at!
worst.!!TopAdown!hierarchies!that!gave!far!too!much!autonomous!power!to!a!single!
individual!plagued!both!the!Indian!Medical!Service!and!the!Indian!Civil!Service.!!
When!the!flu!arrived,!the!skeleton!structures!of!the!IMS!and!ICS!could!not!
adequately!respond.!!Both!organizations!faced!falling!recruitment,!and!the!Indian!
Medical!Service!had!been!hollowing!out!for!years!before!the!First!World!War!
arrived!to!place!even!more!of!a!drain!on!their!system.!!The!flu!struck!at!a!time!the!
!
219!
British!government!could!ill!afford!to!spare!the!manpower,!either!bureaucratic!or!
medical.!!Better!access!to!medical!care!may!have!improved!survival!rates!in!India,!
but!the!overwhelmed!IMS!and!ICS!simply!did!not!have!the!men!or!the!ability!to!
deploy!on!a!widespread!basis.!!Instead!they!fell!back!on!the!usual!scaffolding!of!
empire,!with!medical!men!working!mostly!in!densely!populated!areas,!leaving!
sparser!rural!areas!to!do!without.!!The!ICS!focused!its!limited!energy!on!famine!
relief,!and!although!better!nutrition!could!have!also!improved!some!peoples’!
chances!at!survival,!the!famine!measures!taken!did!not!do!enough.!!!
!
The!insufficient!responses!to!the!flu!and!famine!also!reveals!the!gulf!between!
the!intentions!of!the!British!and!the!results!of!their!actions.!!While!some!members!of!
the!ICS!and!IMS!did!their!best!under!overwhelming!circumstances,!their!
participation!in!the!inherently!exploitive!structure!of!empire!undermined!even!the!
best!of!intentions.!!The!Indian!people,!in!turn,!had!little!reason!to!trust!the!ICS!and!
IMS!after!decades!upon!decades!of!mismanagement!and!neglect.!!When!a!
catastrophe!that!would!require!the!ICS!and!IMS!to!spring!into!action!descended!
upon!India,!the!end!result!was!death!and!chaos.!
Many!discussions!of!the!Indian!Civil!Service!and!government!in!1918!focus!
most!of!their!energy!on!the!First!World!War!and!its!corresponding!siphoning!of!
manpower.!!While!that!emphasis!is!understandable,!these!discussions!would!benefit!
from!more!attention!to!influenza!and!the!way!it!affected!work!in!India!owing!to!both!
men!too!sick!to!come!to!work!and!the!general!chaos!caused!by!the!pandemic.!!The!
pandemic!created!a!period!of!intense!crisis!in!India!that!coincided!with!the!end!of!
the!war,!and!the!lack!of!staff!only!exacerbated!the!situation.!!
!
220!
At!the!same!time!as!flu!unfurled!its!deadly!claws,!famine!stalked!the!land.!!
The!government!sprang!into!action!the!moment!the!monsoons!failed!but!the!
priority!appeared!to!simply!be!stopping!large!scale!starvation.!!When!that!did!not!
happen,!the!Government!of!India!congratulated!itself!on!a!job!well!done,!despite!the!
prices!of!necessities!rising!all!across!the!country.!!The!famine!of!1918!never!
required!relief!works,!but!still!reverberated!throughout!the!country!in!concert!with!
the!flu.!!Influenza!kept!many!agricultural!laborers!from!the!fields!during!the!growing!
season,!and!then!the!high!prices!driven!by!the!poor!harvest!hit!those!same!poorer!
classes!the!hardest!while!the!flu!was!at!its!peak.!!As!access!to!nutritious!food!formed!
an!important!buffer!against!the!flu,!the!famine!thus!contributed!to!the!influenza!
death!tolls!even!as!it!came!to!overshadow!the!flu!in!the!bureaucratic!mind.!!After!all,!
famine!occurred!regularly!in!India!while!influenza!was!a!devastating!unknown,!and!
bureaucratic!powers!threw!themselves!into!solving!the!problem!they!were!
prepared!to!understand.!!Unfortunately!for!the!Indian!people,!bureaucratic!
solutions!to!the!famine!did!little!to!ease!the!scarcity!and!made!the!pandemic!all!the!
more!deadly.!!
The!history!of!famine!in!India!would!likewise!benefit!from!closer!analysis!of!
the!flu.!!Reincorporating!the!flu!into!the!narrative!of!famine—as!Kohei!Wakimura!
did!in!his!article!“Famines,!Epidemics!and!Mortality!in!Northern!India,!1870A
1921”—would!serve!to!illuminate!both!historiographies!in!new!ways.!!The!British!
preoccupation!with!famine!did!a!disservice!to!combating!the!flu,!but!taken!together!
the!Government!of!India’s!response!to!flu!and!famine!revealed!much!about!their!
ability!to!handle!crises!on!a!large!scale.!!While!the!British!prided!themselves!on!their!
!
221!
response!to!the!1918!famine,!the!public!at!large!disagreed.!!In!the!aftermath!of!the!
flu!the!British!created!a!few!guidelines,!but!without!any!real!safeguards!or!lessons!
learned.!!In!short,!the!British!learned!about!the!flu!from!their!experience!with!the!
famine,!but!the!lessons!they!took!from!famine!were!ineffectual!at!best.!!Procedures!
for!reporting!incidents!of!flu!would!not!alleviate!the!lack!of!access!to!healthcare!that!
rural!residents!suffered!under.!
!
The!flu!also!revealed!the!particular!weaknesses!of!the!Indian!Medical!Service,!
which!originally!functioned!as!a!medical!service!only!for!British!military!officers!and!
their!families.588!!By!1918!it!had!become!the!deAfacto!public!health!service!for!
British!India,!but!its!recruitment!had!not!increased!as!its!mission!broadened.!!While!
some!in!the!upper!echelons!of!the!British!government!wanted!to!increase!Indian!
recruitment!in!order!to!ease!the!strain!the!IMS!found!itself!under,!many!men!within!
the!IMS!resisted!these!attempts!at!Indianisation.589!!This!resulted!in!far!too!few!
doctors!for!the!population!they!served,!with!additional!tension!because!of!the!long!
history!of!British!exploitation!of!Indian!people!who!may!have!viewed!IMS!doctors!
with!suspicion.!!Legislative!councils!across!India!debated!new!restrictions!on!
medical!colleges!that!made!it!harder!for!those!possible!recruits!to!gain!the!
knowledge!and!accreditation!necessary!for!a!position!in!the!IMS.!!Just!as!India!would!
need!as!many!men!with!any!sort!of!medical!training!as!possible,!the!government!
took!steps!to!limit!the!number!of!men!with!access!to!medical!training.!!The!strain!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
588 !Arnold,!59.!
!
589 !“The!Future!of!the!Indian!Medical!Service,”!British$Medical$Journal,!July!1918,!13,!
and!Arnold,!59.!
!
222!
made!itself!felt!throughout!the!subcontinent!as!people!died!because!of!this!lack!of!
access!to!medical!care.!!!
!
The!medical!community!in!India!attempted!to!respond!to!the!flu!pandemic!as!
best!they!could,!but!found!themselves!held!back!by!several!factors.!!First,!the!IMS’s!
aforementioned!low!recruitment!placed!immense!pressure!on!an!already!strained!
system.!!Second,!the!best!medical!minds!could!not!agree!on!the!cause!of!influenza,!
much!less!settle!on!a!particular!course!of!action.!!The!western!medical!community!in!
India!worked!with!the!traditional!Indian!medical!community,!but!the!tension!
between!the!two!medical!communities!also!may!have!inhibited!their!ability!to!
create!a!unified!and!effective!response.!!Finally,!most!western!trained!medical!men!
looked!to!a!vaccine!to!help!stem!the!spread!of!the!virus,!but!their!lack!of!information!
on!the!actual!cause!meant!that!their!best!hope!came!to!nothing.!!!!
The!issue!of!a!vaccine!plagued!the!medical!community!and!the!government!
for!years!after!the!end!of!the!pandemic.!!As!people!evaluated!how!the!pandemic!had!
come!to!pass,!many!settled!on!prevention!as!the!solution.!!Unfortunately,!the!best!
way!of!preventing!a!further!pandemic!simply!did!not!pan!out,!as!attempt!after!
attempt!to!create!a!vaccine—both!in!India!and!around!the!world—failed.590!!Thus!
the!medical!community!fell!back!on!rather!anemic!measures,!such!as!
recommendations!for!quarantine!and!personal!hygiene!in!the!event!of!another!
epidemic.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
590 !Crosby,!100A101,!239!and!Geoffrey!W.!Rice,!“Japan!and!New!Zealand!in!the!1918!
influenza!pandemic:!comparative!perspectives!on!official!responses!and!crisis!
management!in!The$Spanish$Influenza$Pandemic$of$1918819:$New$Perspectives,!
Killingray!and!Phillips,!eds.,!Routledge!Studies!in!the!Social!History!of!Medicine!12!
(London ;!New!York:!Routledge,!2003),!82.!
!
!
223!
The!literature!focusing!on!medicine!in!India!during!the!First!World!War!also!
needs!a!deeper!exploration!of!the!1918!flu.!!Many!very!thorough!works!either!
conclude!at!1914!or!begin!at!1918,!and!the!works!that!cover!the!intervening!years!
focus!mainly!on!the!war.!!While!the!war!is!certainly!important,!having!an!in!depth!
exploration!of!the!contributions!that!the!flu!made!to!western!medicine!would!help!
fill!in!some!gaps!missing!in!our!knowledge.!!!
!
More!work!should!also!be!done!on!the!tension!between!western!medicine!
and!Indian!traditional!medicine.!!While!Arnold,!Harrison,!Polu,!and!others!deftly!
explore!long!term!trends!in!western!medicine!and!its!interactions!with!traditional!
practitioners,!a!closer!look!at!the!contact!between!the!two!during!the!pandemic!
itself!would!deepen!the!history!of!both!medicine!and!the!pandemic.!!Many!major!
studies!of!medicine!on!the!subcontinent!ignore!the!flu!in!favor!of!the!usual!suspects!
such!as!typhoid!and!cholera.!!Sandhya!Polu’s!Infectious$Disease$in$India,$189281940,$!
for!example,!provides!a!comprehensive!look!at!the!history!of!various!pandemics!and!
research!in!India!but!leaves!influenza!out!entirely,!a!curious!omission!when!one!
takes!into!consideration!the!death!toll!of!the!1918!pandemic.!!The!emphasis!on!
tropical!diseases!in!Indian!medical!research!appears!to!have!bled!over!into!the!
historiography,!and!while!the!abundant!sources!for!tropical!research!and!relative!
dearth!of!sources!for!influenza!research!likely!influence!this!bias,!the!flu’s!complete!
absence!from!the!narrative!of!medicine!in!India!needs!to!be!rectified.!!The!flu!may!
not!have!fundamentally!changed!medicine!itself!in!either!tradition,!but!exploring!
how!influenza!pressured!these!different!medical!traditions!would!bring!new!light!to!
our!understanding!of!medicine!in!the!early!twentieth!century.!!!
!
224!
The!Indian!people!did!not!always!embrace!western!medicine,!not!owing!to!
superstition!but!thanks!to!a!wellAearned!suspicion!of!British!motives.!!The!British!
had!previously!enforced!quarantines!unfairly!and!their!treatment!of!the!Indian!
people!overall!instilled!little!confidence.!!The!British!government!had!shown!itself!
willing!to!spend!thousands!upon!thousands!of!pounds!to!protect!their!own!interests,!
but!felt!similar!expenditures!on!the!wellAbeing!of!the!Indian!people!were!
unnecessary.!!One!can!hardly!blame!the!Indian!people!for!not!welcoming!British!
relief!efforts!with!open!arms,!given!their!terrible!track!record.!!Many!charged!that!
the!government!had!failed!to!protect!its!people,!and!demanded!assurances!that!
things!would!be!handled!better!in!the!future.!!Others!saw!the!flu!as!proof!of!the!
failure!of!the!colonial!state.!!Newspapers!covered!the!pandemic!with!one!eye!on!
reassuring!the!public!and!another!on!critiquing!the!government’s!inaction.!!Once!the!
flu!subsided!the!conversation!continued!in!the!same!vein,!but!added!little!new!
information!to!the!discussion.!!The!nationalist!discourse!shifted!sharply!in!the!
spring!of!1919!!and!the!Government!of!India!moved!toward!a!broader!program!of!
decentralization!under!dyarchy!that!gave!power!over!medical!expenditures!to!local!
governments!and!left!the!IMS!more!or!less!unchanged.591 !
As!the!months!passed!and!people!turned!to!more!pressing!issues!than!the!
pandemic,!the!world!breathed!a!sigh!of!relief!and!looked!to!the!future.592!!In!India,!
the!flu!remained!at!the!edges,!!appearing!occasionally!in!nationalist!literature!that!
considered!the!flu!to!be!yet!another!catastrophe!brought!on!by!British!negligence.!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
591 !Metcalf!and!Metcalf,!167,!Arnold,!183,!and!Bose!and!Jalal,!105.!
!
592 !Kent,!23.!
!
225!
Eventually!the!flu!pandemic!faded!away,!washed!out!by!more!visible!atrocities!like!
the!Rowlatt!Act!and!Amritsar!Massacre.!!!
This!still!leaves!a!series!of!unanswered!questions!that!would!require!even!
more!research!to!answer.!!While!this!dissertation!provides!a!comprehensive!look!at!
the!experience!and!response!of!the!British!government!to!the!flu!in!India,!the!Indian!
side!of!the!story!still!needs!to!be!told.!!Deeper!research!into!Indian!archives!would!
be!required!for!such!a!project,!which!would!be!a!bookAlength!undertaking!in!and!of!
itself.!!In!particular,!I!believe!there!is!a!rich!story!to!be!found!looking!at!Indians!in!
government,!both!on!the!councils!and!working!within!the!ICS.!!The!average!Indian!
experience!should!also!be!explored,!which!would!require!a!close!reading!of!the!
multitude!of!IndianAlanguage!newspapers!available!as!well!as!any!personal!stories!
and!records!left!behind!by!those!who!suffered!or!witnessed!the!suffering!caused!by!
the!flu.!
More!work!will!also!be!needed!to!look!at!how!vaidyas!and!unanis!responded!
to!the!influenza!pandemic!and!their!view!of!the!British!medical!establishment,!as!
well!as!Indian!members!of!the!IMS.!!Practitioners!of!traditional!medicine!also!
manned!the!front!lines!of!the!fight!against!the!flu,!but!the!British!did!not!report!as!
heavily!on!their!efforts.!!Examining!the!treatments,!thoughts,!and!opinions!of!Indian!
practitioners!would!provide!an!excellent!counterpoint!to!this!work.!!Strained!as!
their!tenure!may!have!been,!Indian!members!of!the!IMS!also!deserve!a!closer!look!as!
they!took!on!the!flu.!!A!more!inAdepth!exploration!of!their!personal!records—if!
available—would!be!invaluable!to!our!understanding!of!the!pandemic!in!India.!
!
226!
Finally,!greater!attention!should!be!paid!to!the!role!of!influenza!in!sparking!
anticolonial!movements!in!the!spring!of!1919.!!While!the!events!of!Amritsar!and!the!
Rowlatt!Act!have!been!explored!from!many!different!angles,!influenza’s!role!in!
sparking!the!protests!that!led!to!the!awful!spring!day!at!Jallianwala!Bagh!needs!
more!investigation.!!The!subject!has!been!touched!on!in!the!final!pages!of!this!work,!
but!much!like!exploring!the!Indian!experience!of!the!pandemic,!this!topic!would!
provide!enough!material!for!an!entire!project.!
The!1918!influenza!pandemic!in!India!hit!quickly!but!then!receded!from!
memory!as!major!world!events!lined!up!to!steal!the!spotlight.!By!the!middle!of!the!
1920s,!India!was!entangled!in!a!fight!for!freedom!that!would!last!until!1947!and!the!
deaths!of!millions!of!people!in!1918A1919!were!largely!forgotten.!!
!
!
!
!
!
227!
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