The 1918 influenza pandemic

In front of the Manila Cathedral, the statue of the Spanish King Carlos IV pays tribute to his act of sending smallpox vaccines to colonies like the Philippines in 1802. We’re no stranger to epidemics, and neither is the world. The World Health Organization lists three pandemics during the 20th century: “Spanish influenza” in 1918, “Asian influenza” in 1957, and “Hong Kong influenza” in 1968. But the mother of all outbreaks was the 1918 pandemic.

Back in 2006, the Harvard School of Public Health warned that “Recurrence of a Flu Pandemic Similar to Infamous 1918 Flu Could Kill 62 Million.” The article adds an additional insight into the Philippine fatalities in 1918: “The disparities between the developed and developing worlds during this period are striking. For example, in Denmark 0.2 percent of the population succumbed to the flu. In the United States, that figure is 0.3 percent (based on data from 24 states). In the Philippines, the mortality rate was 2.8 percent, in the Bombay region of India, 6.2 percent, and in central India, 7.8 percent, which was the highest rate of the countries and regions analyzed. According to this data then, from Denmark to central India, death rates from the 1918-1920 flu pandemic varied more than 39-fold.”

The influenza pandemic of 1918 ended up being called the “Spanish flu” because Spain was the first and most open to report about the flu, which then traveled the world in waves. The fascinating book “Colonial Pathologies” by Warwick Anderson mentions the 1918 flu pandemic, and reproduces this extract concerning the at times heavy-handed efforts of the Americans in their campaigns against rinderpest, malaria, tuberculosis, leprosy, and cholera, from an outraged letter by Trinidad H. Pardo de Tavera (himself a physician, and a member of the Philippine Commission) to Governor General William Howard Taft: “…the people fear the Board of Health a great deal more than they fear the epidemic. The sanitary inspectors, white, brown, black, civil and military have committed and still commit all kinds of abuses… [there are complaints] against the barbarities of the health agents… [In Pasig, the provincial treasurer] set fire to a house where a victim of the cholera had died and the flames extended to two neighboring houses… [while the provincial inspector] went about with a gun on his shoulder in order to intimidate the people to make them obey sanitary laws…”

Anderson writes that American public health officials were often mistrustful of Filipinos and skeptical of the capacity of Filipinos to undertake public health, with every possible shortcoming being used as proof of the incapacity of Filipinos to govern themselves: “[Public health director] Heiser and most of his compatriots continued to find in the failures to enforce smallpox vaccination, the recurrence of cholera, and a rising death rate in the archipelago evidence of the unreadiness for office of the Filipinos they had trained. American papers unsympathetic to the Democratic administration declared that ‘the full harvest of the ‘new era’ is now in the reaping in the Philippines.’”

“‘The Filipinization wind,’ warned the New York Herald, had caused the incidence of plague to ‘jump’ in the islands. Even the increasingly Filipinized health service conceded that in Manila the mortality rate for each one thousand inhabitants — 42.28 in 1903, at the end of the war, but as low as 24.48 in 1913 — had risen in 1918 to 46.33, and in 1919 was 27.55. To Heiser this was a clear indictment of Filipino management. But Dr. Vicente de Jesús, the acting director of public health, had another explanation: the influenza pandemic of 1918 had exacted a heavy toll in lives and caused a ‘weakened organic resistance’ to other diseases among the population.”

Concerning the Philippines, here’s the relevant passage in “America’s Forgotten Pandemic” by Alfred W. Crosby: “The flu morbidity and mortality statistics of the Philippine Islands, which had a population of 9 to 10.5 million, depending on which authority you consult, are undependable. Something like 40 percent of Filipinos contracted the disease, and 70,000-90,000 died. By even the most conservative estimate, the pandemic killed 2 percent of those it made ill. In many villages in the worst days there weren’t enough well people to bury the dead. The pandemic seems to have wreaked the worst damage in the remote areas, such as in Cotabato province in Mindanao, where 95 percent fell ill.”

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