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to Philippine Studies
The Philippines in
the World of the
Influenza Pandemic
of 1918-1919
states to the crisis. The pandemic exhibited the same virological and
epidemiological characteristics in the Philippines as it did in the rest of
the disease has yet to enter the historical assessments of public health
during the American colonial period.
Although many scholars from other areas and world regions have stud-
ied the influenza pandemic of 1918-1919, there is a dearth of serious, in-
depth study of the pandemic as it impacted the Philippines. Despite the
evidently global pat ern that can be established in understanding the conta-
gion, the particular conditions of the Philippines during the period needs to
be understo d in order to highlight the place of the Philippines in the world
of the influenza pandemic. The specific problems and chal enges faced
by colonial public health programs at the height of the epidemic have not
been examined also; on the contrary, these are overshadowed in traditional
as es ments that celebrate the supposed suc es of health programs in the
American-oc upied Philippines. To redres these historiographie imbalances
is the purpose of this article.
The virus responsible for the pandemic had unique characteristics. Accord-
ing to Greger (2006, 19):
Markel and others (2006, 34) clarified that the influenza virus is actu-
ally an RNA virus of the family Orthomyxoviridae arranged in a helical
nucleocapsid that includes eight segments and whose lipoprotein contains
two glycoproteins hemagglutinin (H) and neuraminidase (N). What makes
the spread of the virus unique is that these are transferable from one species
host to another, a fact that renders it necessary to control not only human-
to-human transmission but, more importantly, its initial animal-to-human
transfer.
The global reach of the pandemic was one of its most phenomenal features
As the epidemic spread to other areas of the world, its movement assumed t
pattern of an outward movement of ever-enlarging waves. Brest in France
Freetown in Sierra Leone, and Boston in Massachusetts became epicenters
from where the virus spread outwards, especially during its second, mor
virulent wave. Most of the U.S. soldiers disembarked in Brest, France, an
carried the virus to Europe and the British Isles. Freetown, Sierra Leone
became the African epicenter because it was where the British had a maj
coaling center. The dockworkers involved in refueling ships with coal we
infected, and then spread the virus to other parts of Africa when they re
turned to their homes (Sherman 2006, 396). In a few short years, the flu w
worldwide and death followed its wake.
Africa was one of the hardest hit continents of the pandemic. Earlier
studies already pointed that the spread to Africa came from its west coa
fronting the Atlantic. From Sierra Leone or its neighborhood, the West Af
can colonies of Senegal, Nigeria, Gambia, and others were infected begin
ning in late August 1918 onward. Because the first outbreaks in South Afri
began about the middle of September, it was likely to have been derived
from West Africa rather than from Europe (Burnet and Clark 1942, 71-72
Reports indicated the death rate in South Africa as 27 per 1,000 and in Ca
Town 2,000 children were suddenly orphaned as a result of the pandemic
(Morton 1973, 27).
From the port cities of Africa, the epidemic spread using the colonia
railways. Studies showed that the rail system in southern and central Afric
and steamers on the rivers of the Congo basin, provided especially efficien
means of dispersal of the virus (Patterson and Pyle 1991, 9). However, oth
nonrail communities in the south were also hit by the outbreak. The natu
of colonial governance contributed to the spread of the epidemic in man
parts of southern Africa. According to Ranger (1988, 173), the influenza e
demic broke out among Southern Rhodesian Africans wherever they wer
clustered together and in contact with travelers. In some large towns, a ma
P"CE
India
regard to the spread and containment of the disease. Australia was relatively
successful in containing the initial spread of the disease through a systematic
imposition of quarantine, although it was also later infected through its ports.
Official reports stated that authorities immediately put into effect a quaran-
tine program devised to keep out infective diseases. Ships carrying infected
persons arrived at Darwin, Townsville, Brisbane, Sydney, Melbourne, Ade-
laide, Hobart, Fremantle, and Broome, and at each port the quarantine cor-
don was tight. Steps were taken to isolate every person suffering from the
disease. All who had been exposed to infection were kept in quarantine for
one week. Over 3,000 persons were handled in this manner. There were
over 500 patients, and mortality was kept at the relatively low figure of 3.8
percent (The Medical Journal of Australia 1918, 454-55).
Australia's success in limiting the spread of the pandemic was trans-
lated to a relatively low mortality figure for the continent compared with
other countries. Even contemporary reports noted the program's efficacy
in containing the spread of the epidemic. One report stated that, dur-
ing the period October to December 1918, there were 128 deaths from
influenza in Victoria with a population of 1,411,004, and 207 deaths in
New South Wales with a population of 1,890,654. Had the same death
rate in South Africa prevailed in Australia, the deaths in Victoria would
have numbered 11,667 and in New South Wales 15,633. In New Zealand,
with a population of 1,160,188, 33 percent of the population was affected
and 5,471 individuals died. Had the disease of a similar virulence and
prevalence invaded Victoria and New South Wales, the number of deaths
would have been 6,652 and 8,915 respectively ( The Medical Journal of
Australia 1919, 160-62).
In New Zealand severe influenza of a pandemic type appeared in the
neighborhood of Auckland in October 1918. The mortality from the first
wave, although abnormal for New Zealand, was not alarming; but the viru-
lence of the second wave was far in excess of anything that had been experi-
enced with influenza. The second wave came to New Zealand soon after the
primary. It began in October 1918, reached its peak in November, and then
faded quickly. From October to December, there were 6,500 deaths in New
Zealand from influenza and its complications. The influenza mortality rate
The year was a particularly disastrous one from the standpoint of epi-
demiology: never in its history, excepting perhaps during the years of
the cholera epidemics of 1902 and 1903, have the resources of the
Health Services been taxed so heavily. For this reason, although all the
usual activities of the work were carried on throughout the year, few
permanent sanitary improvements could be effected. Influenza and
smallpox proved to be the most serious of the epidemiological prob-
lems during the year. From influenza alone there occurred an estimat-
ed 85,000 deaths. The disease appeared first in a mild form, with low
mortality but the second wave which swept over the archipelago from
Aparri to Sulu from the latter part of September to the end of the year
caused a mortality of about 1.8 percent. Most of the deaths were due
to respiratory, cardiac, and renal complications. (Boston Medical and
Surgical Journal 1920, 512)
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
Average
*The fifteen
Norte, Iloilo
Source: Padu
Cordiller
ing than
Another
pines was
6 clearly
months o
significan
to Decem
was mor
seasonali
indicate,
periods
months o
Tables 8
viewed f
the youn
highest m
as the U-
pandemic
PROVINCE
Abra
Albay
Batanes 84 6
Batangas
Bohol
Bulacan
Cagayan
Capiz
Cavite
Cebu
llocos Norte
llocos Sur
Iloilo
Isabela
Laguna
La Union
Leyte
Mindoro
Oriental Negros
Pampanga 15 3,773 5
Pangasinan
Rizal
Romblon 124 9
Samar
Sorsogon
Tarlac
Tayabas
Zambales
Total
Sutu
RombLon
Manila
Davao
Benguet
La Union
February
March
April
June
July
October
November
December
Total
Source: P
March
April
May
June
July
August 71 7 31.64
Under 30 days
Another important cause of the spread and virulence of the disease was
the military mobilization campaigns of the colonial administration in prepa-
First. The epidemic that raged from May to July was the grippe, also
so-called influenza or trancazo.
Second. The disease had a preference for the age groups between 10
and 29 years.
Third. The epidemic of October was merely a recrudescence and a
continuation of the May to June epidemic.
Fourth. The attack of influenza during the first period of the epidemic
conferred immunity against another attack of the second.
Fifth. The epidemic was of autochthonous origin, but the importation
of foreign strains increased the virulence of the native strains.
Sixth. Maritime and land quarantines, hospitalization and the closing
of schools and places of amusement failed to cut the diffusion of the
epidemic short.
While other societies were quick to ascribe an external origin to the dis-
ease, Philippine officials were quick to ascribe to it an autochthonous origin,
and were comfortable in claiming that the epidemic was native to the coun-
try. The use of the local term trancazo helped in the linguistic localization
of its origin. By using trancazo in official discourse, the health officials were
no longer concerned with "othering" the disease, but rather were comfort-
able in owning it.
At the same time, the triumphalism in the scientific and medical field was
drowned by the admission that the measures adopted by health authorities in
combating the disease failed. The admission of failure was not only forthcoming
but was largely anticipated by most sectors. This admission veered away from the
mood of the earlier era of Victor Heiser, with its great celebrations highlighting
the achievements and successes of public health measures. In a way, if the
control of the cholera epidemic in the early twentieth century was presented
as the remarkable triumph of the American colonial health program in the
Philippines, the debacle of influenza represented its most obvious failure.
One impact of the influenza pandemic was the reorientation of the
manner by which health authorities reported the occurrence, handled the
outbreak, controlled the spread, and contained the mortality and morbidity
Of all the important changes made for the proposed sanitary code, the
inclusion of influenza as a "subsequent addition" to the list of reportable
diseases became one of the most significant (ibid., 17, 25-26). This was a
new development considering that information and reporting was critical
in the control of disease transmission at the initial outbreak of the epidemic.
Conclusion
Apart from the view of contemporaries, the failure of containing the spread
of the disease could be seen as part of the intrinsic conflict between West-
ern medicine and public health measures and the colonial society's differ-
ing views on health and medicine. In assessing the African experience, for
example, Harrison (2004, 152) states that the popular response to influenza
varied enormously from one country to another, and within countries too.
If Western medicine had little effect in treating a powerful disease like influ-
enza, then confidence in the entire system could easily be shaken.
The other dimension of this conflict between the delivery of public
health programs based on Western public health measures and the practices
of local communities pertained to hygiene, public health, and medicine as
areas and arenas of contestation of various levels of existence, as Bashford
(2004, 115) has pointed out. The attempts at implementing new hygienic-
cultural practices to be effective on a personal level became national cam-
paigns. For colonial and imperial powers, these became areas of projection
of their effective territorial control over large areas populated by different
societies with different cultural and social practices and attitudes regarding
disease and wellness. Bashford points that quarantine efforts were actually
done as part of the administrative development of nations and states attempt-
ing to define its boundaries, to draw the line between those that it can create
as geobodies subject to the medical-administrative rules of states, and those
that it cannot contain because it is part of a larger international body, that
will eventually separate the sick from the healthy, the foreign from the local,
and the outsider from the insider.
Notes
1 The mortality rates for every 100,000 population were as follows: Eastern India: Bengal 850,
Burma 1,390; Madras 1,670; Assam 1,860; Bihar and Orissa 2,050; Western and Central India:
United Provinces 4,340; NW Frontier 4,360; Punjab, 4,500; Bombay 5,490; Central Provinces
6,600 (Burnet and Clark 1942, 75).
2 According to Long and de Jesus (1919, 5) , among those who resigned were John D. Long, Director
of Health; Senior Medical Inspectors Gilbert Cullen, Arlington Pond, Claude E. Norris, Senior
Surgeons Domingo Santos and Andres Bautista, and Surgeons Guillermo Jimenez and Jose
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