Census data on epidemics: An estimated 1,11,340 died in Spanish Flu that struck Assam a century ago

The Census Reports of 1921 show that an estimated 1,11,340 died in Spanish Flu pandemic in then Assam in 1918. An estimated 12 to 13 million people died in the pandemic in India. Total population of Assam was 7,060,521 in 1911 and 7,990,246 in 1921. An extract of data on the pandemic incorporated in the Census Reports 1921:

"Apart from the more normal causes of mortality the distinctive features of the decade of 1901 to 1911 had been the progress through India of the plague epidemic and the mortality, which it caused. The recorded number of deaths from plague during that period was about 6½ millions. In the recent decade the deaths recorded are less than half that number. There were however serious outbreaks of plague in Bombay, the Punjab, the United Provinces and the Central Provinces in the first two years of the decade; the mortality was again high in 1915 and higher still in 1917 and 1918, when the disease was severe in practically every part of northern and central India.

Cholera is normally most prevalent in the Eastern Provinces. It was especially virulent in Assam and in parts of Bihar and Orissa and Bengal, while in several provinces outbreaks of the disease either accompanied or immediately followed the influenza epidemic. Cholera in its most severe form has usually been associated with the deterioration in physique, which accompanied famine conditions before famine organization had been perfected. Virulent as the epidemic can still be when its hold is established it is now usually of a temporary and local nature, and the total death rate in British India from the disease during the decade did not amount to more than 1.5 percent.

By far the largest numbers of deaths in India are entered under the category of "fever" and allowing for inaccuracy of diagnosis it has usually been assumed that about two thirds of the deaths so recorded may be ascribed to malaria. Recent investigations made in special areas, however, suggest that this proportion has been considerably fourth of the number of reported fever cases, the he remainder being cases of dysentery, pneumonia, phthisis and other diseases. * Malaria is endemic in large areas of the continent, both in the forest clad country which fringes the mountain ranges and in tracts of Bengal, Assam, and Burma, where the configuration of the country prevents the drainage of the flood water after the monsoon. In such areas, besides raising the average level of the death rate, it permanently lowers the vitality of the people and reacts both on the birth rate and on their general economic condition.

Photo courtesy : National Health Mission, Assam

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

The first epidemic was most prevalent in urban areas, but it was not of an especially virulent type and, probably for that reason, it is said to have affected young children and old people most severely. The morality curve went to a peak in July and then dropped and there is evidence of a distinct interval between the first and second waves but not of any real break of continuity, as sporadic cases were reported throughout the intervening period. It is impossible to say where the more virulent virus of the second invasion came from.

There are certain facts, which suggest that the disease began in the Poona district in September. It spread from province o province, lasting in a virulent form generally from eight to ten weeks, when mortality, usually due to respiratory disease, reached its highest point. The rural areas were most severely infected, the reason probably being that while villages have little advantage over towns in the matter of overcrowding, sanitation and ventilation the urban areas have the benefit of qualified medical aid and organized effort. Mortality was especially high among adults (20-40), particularly among adult females, the diseases being generally fatal to women in pregnancy.

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

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

The comparative severity of the epidemic in the different parts of India is shown in the map on the opposite page. *It is not possible to explain the peculiar variations in the local prevalence of the diseases, which seems to have been entirely capricious in its incidence. The coastline escaped with a low mortality while in the hilly country the disease was usually special fatal, though this was apparently not always the case in the Punjab.

The Eastern Provinces escaped lightly and Calcutta was not attacked as severely as other cities. It has been suggested that the mortality was determined by the comparative liability of the people to respiratory complications or, in other words, their susceptibility to pneumonia, and it looks as if the epidemic was more virulent in a cold dry climate than where there was comparative warmth or humidity.

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

Even this, however, must be a substantial underestimate since, owing to the complete breakdown of the reporting staff, the registration of vital statistics was in many cases suspended during the progress of the epidemic in 1918 and when the time came to reconstruct the figures the number of omissions, especially in the case of women, must have formed a high proportion. In some cases the Census Superintendents give estimates of deaths considerably higher than those given in the margin, which are taken from the Sanitary Commissioner's report and, as we shall see in paragraph 14 below, there is a difference of nearly 4 millions between the census figures and the deduced population, a considerable proportion of which must be due to omissions of influenza deaths. In any case the figure given above applies only to the areas under registration, which contain little more than three quarters of the population of India.

The epidemic was especially virulent in the Rajputana and Central India Agencies and in the States of the Punjab, Central Provinces and Bihar and Orissa, while the attack was severe in Kashmir and Mysore and acute in Hyderabad and parts of Baroda. We have no statistics for these areas, at any rate none that are trustworthy, but a rough estimate would put the direct mortality in them, from the disease in 1918 and 1919, at least in the same proportion as in British territory. We thus arrive at a total mortality of between 12 and 13 millions for India. It is interesting to note that even this conservative estimate of a mortality, the large part of which occurred in the space of three or four months, exceeds by nearly two millions the total estimated deaths from plague extending over 20 years (1898-1918), and is a good deal more than double the death rate directly attributable to the famines, of the period 1897-1901.

The number of deaths, however, is not, of course, the measure of the loss of life from the epidemic. The case mortality has been put roughly at about 10 percent and on this basis the total number of persons affected by the disease was about 125 millions or two fifths of the total population of India. The effect on the general health of the people is shown by the reaction on the birth rate, which dropped below the death rate in 1918 and 1919 and only gave a slight excess in India in 1920."

1918- Provinces, Eetimated number of death and death rate per mile of population

Source: Census Report 1921

Provinces, birth rate and death rate during 1918, 1919, 1920

Source: Census Report 1921

(Source : http://censusindia.gov.in/Census_And_You/old_report/census_1921.aspx )

NEZINE Bureau