TERROR AND CONFUSION

Otago Witness, Issue 3400, 14 May 1919, Page 7

TERROR AND CONFUSION

PANDEMIC IN INDIA. AT LEAST SIX MILLION PEOPLE PERISH. Influenza in the virulent form in which it has swept over the world first appeared in India in Juno of last year. In the course of a few months it killed at least six million people. A report on the pandemic in India, which has been furnished by the Government Sanitary Commissioner, Major 1 ? . Norman White, M.D., says that from 50 to 80 per cent, of the total population suffered from the disease. The following vivid description of the effect of the epidemic, in Punjab, which was contained in a report by the Provincial Sanitary Commissioner, is, he says, equally applicable to the conditions which prevailed in other severely affected tracts: —"The hospitals were choked, so that it was impossible to remove the dead quickly enough to make room for the dying; the streets and lanes of the cities were littered with dead and dying people j the postal and telegraph services were completely disorganised; the train service continued, but at the principal stations dead and dying peoplo 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, 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." ihe following; is a summary of some of the more striking features of Dr White's report:—

Th<*re is not the least evidence that the diseass was"any other than influenza; it was in no sense a new disease. It was not an unusual manifestation of plague ; the two diseases are completely separate and distinct. There s no evidence which directly connects the epidemic with the war; influenza is not a "war-disease," and it prevailed more virulently in countries remote from the war areas than it did in those which were the scene of military operations. There is no evidence that the disease originates in malnutrition; it prevailed in virulent form, in countries such as the Unite<] States of America, where food was by no means scarce; the well-to-do classes wera in no sense immune to attack. The incidence of the disease was very high in the well-fed BrHish troops in India; incidentally, it may be noted that the incidence was greater among British than among Indian troops. Though no claim that the disease originates in malnutrition can then be tubstantiated, it cannot be denied that malnutritioi was occasionally a factor of importance in determining a fatal issue. A sufficiency of nourishing food, both during the attack and during: convalescence, is more than desirable, and it was most unfortunate that the epidemio should havo afflicted India in a year when the monsoon had failed. During" the latter half of 1918 the stocks of food grains in India were relatively low, prices were abnormally high, and a scarcity of fodder was responsible for the scarcity of milk, which was m some places unprocurable. Such wild, unfounded rumours as those which attributed the pandemic to the expensive xise of poison gas on the western front ,or to the evil machinations of our unscrupulous enemy, would scarcely have deserved mention had they not been so ourrent in India during the months of October and November. _ There is no specific cure or certain preventive for influenza, and when it spreads with the alarming rapidity to which reference haij been made medical science can do but little to check its incidence. Overcrowded, ill ventilated dwellings, and large congregations of people offer unrivalled facilities for the rapid dissemination of epidemic diseases of the influenza > type. Unfavourable environmental conditions doubtless contributed in many instances to the severity of the outbreak, but even the most up-to-date sanitary surroundings by no means postulate complete immunity from influenza. A study of the figures hitherto received indicates that influenza, as experienced in India, was especially fatal between the ages of 10 and 40, and that females suffered to a somewhat greater degree than males. Outbreaks that occurred in certain outposts garrisoned by Indian troops, notably in Persia, were characterised by an appalling virulence; in one small post there were no fewer than 90 deaths among a garrison of 125; that is to say,- 72.8 per cent, of the total strength succumbed. The first mild wave of influenza appeared in the Central Provinces in July. The disease was so mild in type that it produced but little effect on the mortality rate, and it occasioned but little alarm. The second culminating wave, which appeared in September, was the most violent outbreak of disease of which we have record in India. No districts escaped the ravages of the disease, though the inoidence was by no means uniform. During the six months, June to November, four districts had death rates from all causes in excess of 100 per mille. These were Damoh, 129.42 (22.20); Yeotmal, 116.86 (22.64); Akola, 1C6.69 (22.75); and Saugor, 103.77 (22.97). The figures in parentheses denote the mean mortality rates in these districts for the corresponding six months of the previous five years. During two months influenza claimed as many victims in the Central Provinces as died during the whole of 1897—the disastrous famine year. Two months of influenza caused twice as many deaths as have 22 years of plague in these provinces. In two months influenza killed 5.7 per cent, of the total population of the Central Provinces. Much of the mortality hore, as elsewhere in India, was attributable to tho impossibility of securing for the sufferers sufficient attention or any attention at all. It was by no means infrequent to find all tho members of a household down with the disease at one and the some time, ana each had to fend for himself or herself as best he could. Delhi Province has a urban population of 225,471 and a rural population of 187,512. In Delhi City during the months of October and November influenza was responsible for 7044 deaths, equivalent to a death rate of 31.2 per mille. During the same period 16.151 deaths attributable to influenza were reported from rural areas. This \s equivalent to a death rate of 86.0 per mille. In these two months 5.55 per cent, of the total population of the province fell victims to tho disease. In Delhi City ths largest number of deaths reported on any on© day was 418, on October 26. About this time, it would not be an exaggeration to state tha»() more- than thres-quarters of the total population of Delhi wero either

suffering or recovering from an attack of influenza. The number of deaths declined fairly rapidly to 55 on November 12, by the end of 'which month the mortality wan net appreciably in excoss of the normal. The sudden onset of the disease in a severe form simultaneously in all parts of the province was noteworthy. No drugs appeal- _ to have any specific curative value, but (riven nourishing food in readily assimilable form, care, and attention, it was surprising what apparently desperate cases ultimately recovered. In Delhi province, as in .other parts of India, tho disposal of the dead was a matter which tried the resources of all concerned. The heartrending scenes witnessed by all who took an active part in endeavouring to' combat the influenza outbreak in India in 1918 -will never bs forgotten. The Bombay Presidency was the first province in India to report tho existence of epidemic influenza in 1918. It is generally believed that infection was introduced into tho Presidency by two ships, the first of which arrived in Bombay on May 29, the second in Karachi on June 20. Complete mortality returns from the Bombay districts for the month of November are not all available, and the rough estimate of 900,000 influenza deaths during September, October, and November is likely to prove an underestimate. That figure is equivalent to a cleath-rate of 45.9 per mille of the total population of the Presidency. Deaths are more numerous among females than among males. Old people generally appear to have escaped. The disease was specially severe in malarial districts, where it ie stated tho use of quinine as a preventive against malaria appeared to product* some protection from influenza. This observation is at variance with army experience, which allowed that tho daily administration of larger doses at intervals was entirely valueless as a prophylactic against influenza. At the present time it can be stated without fear of exaggeration that from 50 to 80 per cent, of the total population of India have recently suffered from influenza.