Epidemics, pandemics: India (history)

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Cholera, plague in 19th, early 20th centuries

Syed Akbar, During British & Nizam era, lockdown was paid holiday, April 26, 2020: The Times of India

A special camp called Cordon Sanitaries set up to quarantine plague patients
From: Syed Akbar, During British & Nizam era, lockdown was paid holiday, April 26, 2020: The Times of India

HYDERABAD: Lockdowns may have helped in the containment of Covid-19 across the world, but not many know that a similar exercise was carried out in the princely state of Hyderabad and parts of British India to prevent the spread of infectious diseases like cholera and plague in the 19th and the early 20th centuries.

Though the term ‘lockdown’ was not used then, British officials had believed that a “holiday” with wages paid would help curb the notorious cholera that had created havoc in parts of British India in several episodes. They had also argued that ‘holiday’ (read lockdown) would boost the morale and health of people.

The princely state of Hyderabad and the British India had their own versions of lockdowns, containment zones, migrant labour issues, isolation hospitals and special passes for movement in cases of emergency during plague and cholera outbreaks. Most of them resemble the guidellines being followed now to fight Covid-19.

British India official records in the National Archives of India (NAI), New Delhi, and British India medical history archival data reveal that British and Nizam governments had suggested a lockdown as trains and caravans were considered as carriers of infectious diseases, particularly cholera. There was no nationwide lockdown, but curbs on travel and movement of passenger and transport vehicles including ships were imposed in parts of British India.

“Special containment zones (then called cordon sanitaires) were create. They were manned by armed police and military personnel. Only those with special police passes (then called plague passports) were permitted to enter cities on the condition that they undergo sanitation drives and health check-ups every alternate day,” said INTACH city convener P Anuradha Reddy.

Like the migrant issue now, the British India too had its own migrant workers problems but British and Hyderabad officials had shifted the workers to areas within three km of their homes to provide them work and monitor progress and containment of infectious diseases. They were also paid 32 days of wages in advance.

According to File No. 120 of 1897 (Simla records), department of revenue and agriculture, GOI, available with NAI, during a conference held on March 20, 1897 at Allahabad, British officials had proposed a holiday (now called lockdown) for a month for workers to contain the disease and boost their morale and health. Workers in small groups of 500 each were shifted to their native places unlike now where migrant workers are kept at shelters far away from their states.

1896, 1902, 1911-12, 1918

Ram Sundaram and Kamini Mathai, April 27, 2020: The Times of India

A plague camp in Madras Presidency where infected were treated and kept away from others
From: Ram Sundaram and Kamini Mathai, April 27, 2020: The Times of India
A Times of India story from October 1, 1918 talking about the influence the epidemic had “It happened in the shadow of World War I when there was a lot of movement of troops. At that time the incubation period was just one or two days. People were infecting each other rapidly and the mortality rate was high,” says Dr Lalit Kant, independent public health consultant and formerly with the Indian Council for Medical Research.
From: Ram Sundaram and Kamini Mathai, April 27, 2020: The Times of India

Authorities scampering to restrict public movement, thousands being isolated and people hoping the bad times would pass was the norm in 1902 during the plague. In 1918 came Spanish flu, and precautions to contain the spread were thorough hand washing and physical distancing. Waiting behind shuttered doors for normal life to resume is not new to people in Tamil Nadu. Details of government regulations to control diseases in a bygone era reveal similarities and differences in precautions taken more than a century later, while dealing the coronavirus. During the plague and Spanish flu, Bombay was the first Indian city to be affected. In 1896, the deadly plague that killed lakhs of people. If bats are suspected to have played a role in Covid-19, rats were responsible for the spread of the plague. In Madras Presidency, 72,000 died of the epidemic in the next 13 years. But despite the rudimentary medical infrastructure, Madras city reported only 78 deaths. Medical reports and research papers of the time show stringent enforcement of public health measures and favourable geographical and climatic conditions helped check the disease. Four years before the first case was reported in Madras in 1906, the authorities framed rules to handle the incumbent danger. The disease was first reported at a village near Paracherry in North Madras. A dead rat thrown from the nearby Mauritius Fiji Emigration Depot caused the spread, T S Ross, health officer of Madras in 1906, noted in his report. The village was evacuated and workers sent by the government set it on fire to kill the rats. Some rodents still managed to escape. As a result, Cassimode Kuppam (Kasimedu) became a hotspot of the disease. Similar to rescue efforts for Covid-19, doctors and health officials isolated all plague patients, suspected cases and those in contact with them for at least 10 days at hospitals, plague camps or in their houses. A local plague inspector’s manual shows that following isolation, houses and in some cases entire colonies were vacated for disinfection, with occupants being handed special passes for relocation. People venturing out of infected areas were issued ‘Plague Passports’. Madras port, Perambur and Bitragunta (near Nellore in Andhra) railway stations were primary screening and passport centres, where passport holders were quarantined for 10 days. Large-scale disinfection drives were carried out in localities, trains and camps with mercuric chloride and hydrochloric acid procured from Madras Medical College (MMC). Timely intervention and support from institutions like MMC and the King Institute helped reduce fatalities with more than 12 lakh people being vaccinated in Madras Presidency in 1904-05. But it was not just the vaccine that did the job. Volunteers and health department officials patrolled streets and identified cases, while police cracked down on violators of restricted movement and fined them `1,000 each. “Police officers were given powers to inquire into suspicious cases of plague,” Captain J Taylor, member of Plague Research Commission, said in his report.

In the Stone Age of technology, awareness about the disease and the message to stay at home was created through handmade posters stuck outside houses. Prominently visible warning notices were pasted outside infected buildings and owners of overcrowded structures were given 24 hours to vacate. During the Spanish flu too, physical distancing was one of the most important strategies used. In a notification to the media in 1919, Corporation of Madras health officer Dr K Raghavendra Rao warned about the increase in the incidence of fever cases, which he explained was due to a “recrudescence of influenza”. Detailing the symptoms he asked people to be careful about fever with little cold in the nose and slight cough. Advising disinfection of items used by the infected person at home, he asked patients to be “isolated in an airy, well-ventilated room”. According to a 2014 research paper, ‘The evolution of pandemic influenza: evidence from India, 1918-19’ by Siddharth Chandra, the pandemic was believed to have originated from influenza-infected World War I troops returning home. The then Sanitary Commissioner of India stated, “The railway played a prominent part as was inevitable”. There were reports about “isolation” relief homes being set up to treat those with the flu, free. In terms of severity, Bombay, the Central Provinces, and parts of Madras were hit hardest, but the public following the rules and government working to arrest the numbers helped battle the pandemic.

When a crashing Skylab sent Chennai scurrying home

The US space station, launched by NASA in 1973, had mechanism to be brought back after the end of mission. In 1979, fear spread that Skylab could crash in an uncontrolled manner and district collectors in Tamil Nadu asked people to stay indoors

Plague rules in early 20th century

Suspicious and confirmed cases were kept in isolation at hospitals, camps and homes

Plague passports were issued to people who came from infected areas to Madras city

Special passes were given for those selling food and fuel 10 to 20 million deaths due to Spanish flu in India, the largest number of fatalities in the world

The pandemic was believed to have originated from influenza infected World War I troops returning home

In Madras, cases were seen first in mid-September 1918. The death rate was 16.7

1918: Spanish flu

Avijit Ghosh, April 28, 2020: The Times of India

The capital is among the biggest hotspots of the novel coronavirus in India today. Similarly, over 100 years ago, the city was a red zone for another contagion — the deadly global influenza that claimed an estimated 18-20 million lives in the Indian subcontinent.

The killer fever, popularly but erroneously known as the Spanish Flu, arrived from the sea in May-June of 1918 in Bombay. In her book Pale Rider, science journalist Laura Spinney quotes a Bombay-based health officer, “The Spanish flu arrived ‘like a thief in the night, its onset, rapid and insidious.” Over the next few months, the epidemic spread to other cities through the railways. And the second wave that came in September was far more lethal than the first.

New Orleans-based writer John Barry paints a horrifying but vivid picture of the days in his compelling book, The Great Influenza. “Trains left one station with the living. They arrived with the dead and dying, the corpses removed as the trains pulled into station…One hospital in Delhi treated 13,190 influenza patients, 7,044 of those patients died.”

In such calamitous times, Delhi’s chief commissioner, William Malcolm Hailey, went on a three months’ leave from August 1918 onwards. During this period, he visited Japan. “After a little fishing, Hailey returned through Korea and north China,” writes his biographer John W Cell in Hailey: A Study in British Imperialism.

Hailey — a central Delhi road is named after the administrator — came back to the capital around mid-October. He wrote to Lord Chelmsford on October 19, “Delhi is in the throes of a horrible attack of influenza — very fatal when neglected. Yesterday’s deaths amount to 264. Nearly everyone is down with it.”

On November 7, 1918, The Times of India published a November 5 note on the influenza epidemic by Hailey where he said “though the epidemic is still causing great number of deaths in Delhi, there is reason to hope that it is now definitely on the decline”.

The daily fatality figures from October 15-31 make for startling reading: 116, 126, 115, 234, 250, 276, 351, 333, 357, 418, 656 (two days), 326, 317, 317 and 259. Incidentally, none of the figures provided in the note matches with 264, the number mentioned in the letter. On November 1, the figure fell to 210 and on November 2-3, to 297 (two days). “The death toll in the British India capital was estimated at 23,000,” writes Cell .

Hailey’s note further says, “The severity of the epidemic caused a very severe strain on the municipal health department and the local hospital and dispensaries.” Between October 12-31,10,613 cases were attended to in the “ordinary, state and municipal hospitals and dispensaries”, in addition to 29,126 in street dispensaries.

Now, as the capital battles another virus, Delhi has witnessed 2,081 Covid-19 cases, including 47 deaths till April 20. That’s roughly 11% of total cases (18,589) across India.

In this fight against the pandemic, volunteers are frontline warriors. Even in 1918,“health officer received assistance in manning street dispensaries from volunteers of the Indraprastha Sewak Mandal, St Stephen’s College and Arya Sewak Sabha. Haji Muhammad Rafi contributed the entire cost of one dispensary…”

Hailey’s note also says that “at an early stage (of the epidemic) the arrangements for the burning and burial of corpses broke down”. In his novel Twilight in Delhi (1940), Ahmed Ali evocatively details this tragic aspect of the disease. He writes how Delhi became “a city for the dead” where shroud thieves (kafan chors) were rampant, overstrained gravediggers raised their fees, cloth merchants hiked the prices of winding sheets for the dead and songsters wrote ironic ditties and sold them as pamphlets.

He says, “There was not a single hour of the day when a few dead bodies were not carried outside the city to be buried. Soon the graveyards became full, and it was difficult to find even three yards of ground to put a person in his final resting place. In life they had no peace, and even in death there seemed no hope for rest.”

“Hindus were lucky that way. They just went to the bank of the river Yamuna, cremated the dead, and threw away the ashes. Many were thrown away without a shroud of cremation. Yet in death it was immaterial whether you were naked or clothed or burnt thrown away to be devoured by vultures and jackals.”

Lessons from earlier epidemics

Chinmay Tumbe’s analysis

‘Study India’s earlier pandemics — collective memory holds vital lessons’

Chinmay Tumbe teaches economics at the Indian Institute of Management, Ahmedabad. He has researched the history of pandemics which impacted India earlier. Sharing his findings with Times Evoke , he discusses important lessons time offers us to navigate present healthcare challenges:

India lost around 40 million people to the pandemics of cholera, plague and influenza between 1817 and 1920 — it was the most affected country in each of those pandemics. A very important lesson from those experiences is not to celebrate the end of a pandemic. Premature celebrations haunted the British as pandemics ripped through the subcontinent. Unfortunately, we saw that happen this time as well, with claims of having overcome Covid-19. The other important lesson is not to overspeculate on regional variations as the science that eventually answers those questions takes time and often overturns initial hypotheses — many people were lulled into a fantasy in 2020 that Indians were less affected by Covid-19 than the US because of some kind of ‘natural immunity’. But the whole point of a pandemic is that there are new pathogen strains that need to be consistently monitored, a crucial area where we must keep pace.

In my book ‘The Age of Pandemics’, I argue that there appear to be four stages of a pandemic — denial, confusion, acceptance and erasure. Erasure happens when we forget to take the lessons from the event and move on. Many East Asian countries were affected by SARS and swine flu in recent years and thus, they had some experience in facing this pandemic. This was also the case in Kerala due to the Nipah virus outbreak of 2018. The more we erase memory, the more we live in denial mode when the next pandemic comes around. One of the many reasons the 1918 influenza outbreak was forgotten was because it occurred in the context of World War I — ironically, that war enters our school textbooks, focused as they are on political history, even though the pandemic killed more people than the war itself.

The similarities of these public health events echo through history. During the 1918 influenza pandemic, for instance, a leading health official sarcastically quipped that never before had the rich in India worked so hard for the welfare of the poor. However, when the official infrastructure collapses, as it did in 1918, civil society has to step in. Leaders from our freedom movement, like Bal Gangadhar Tilak, Gopal Krishna Gokhale and Sardar Patel, in fact became well-known due to their involvement in pandemic management. Savitribai Phule started a plague clinic to help the poor and eventually succumbed to the illness. The struggle was enormous though. Large segments of the underprivileged had to fend for themselves. They often used their own devices to communicate the health situation. In the mid-19th century, during the cholera outbreaks, chapatis would be circulated from village to village, possibly as a warning to others that cholera was in the vicinity.

India’s challenge with crowded situations existed earlier too. However, there were practices in the past where pilgrimages in particular, possibly the largest crowd-generating events, were suspended. In some years, strong quarantines were in place and it was compulsory to get a cholera vaccination before setting off on a pilgrimage. Each disease is unique and understanding its transmission is extremely important. Some authorities did rise to the challenges earlier epidemics posed. One strategy was similar to the ‘Chase the Patient’ policy the BMC enforced. During the influenza outbreak in 1918, it was understood that with some basic nourishment, people could survive the disease — in Bengaluru in particular, interesting arrangements were made where volunteers would go door to door, provide basic food supplies and monitor the temperature and health of residents. It is key to reduce the load on hospitals in a pandemic and hence, only those who absolutely need hospitalisation should get access.

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