900906

research-article2020
JAS0010.1177/0021909619900906Journal of Asian and African StudiesOjo

Original Article
JAAS
Journal of Asian and African Studies

Socio-Economic Impacts of
2020, Vol. 55(7) 1023­–1032
© The Author(s) 2020
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1918–19 Influenza Epidemic sagepub.com/journals-permissions
DOI: 10.1177/0021909619900906
https://doi.org/10.1177/0021909619900906
in Punjab journals.sagepub.com/home/jas

Olusola Bamidele Ojo

Department of History, Government College University, Lahore, Pakistan

Abstract
The 1918–19 influenza epidemic arguably remains the worst natural disaster in the annals of colonial India.
The scourge of the 1918–19 influenza in Punjab eclipsed the significant malaria epidemics of 1908 and the
Bubonic plague catastrophe of the first decade of the 20th century. Over 800,000 people died from the
outbreak between October and November 1918. This article examines the social and economic impacts of
the 1918–19 influenza outbreak in Punjab. It argues that the scarcity of everyday food items as well as an
escalation in the prices of staple foodstuffs were direct consequences of the epidemic. This study discovered
that massive influenza mortalities triggered severe disruptions in the agricultural activities and public services
in Punjab. Other studies had focused mainly on the spread and mortality of the epidemic in the public
domains of colonial India. However, this study illuminates the socio-economic effects of an outbreak from a
regional perspective. A focus on Punjab, the colonial capital of Northern India, affords us a rare privilege to
gauge how epidemics influence the socio-economic spaces on a provincial basis.

Keywords
India, Punjab, influenza, medicine, economy, epidemic

Introduction
The significance of the 1918–19-influenza pandemic could not be over-emphasised in modern his-
tory because of the overwhelming fatalities attributed to the contagion. The epidemic killed roughly
between 50 and 100 million people globally (De Almeida, 2013). Colonial India remained one of
the worst-hit nations, with an estimated mortality of 13 million (Chandra et al., 2012). However,
some provinces suffered more fatalities than others in the subcontinent. Punjab grossed most prov-
inces with a death rate of 4.2% per population. Despite these staggering statistics, the social and
economic consequences of these vast fatalities on the inhabitants of Punjab remained mostly
untouched. Therefore, this becomes the central focus of this study.
The history of the 1918–19 influenza pandemic was often a neglected one. It usually remains
embedded within the broader historical events of the preceding First World War and wider contexts
of colonial medicine from colonisers’ perspectives. In this context, the colonialists deployed epi-
demic campaigns as one of the tools to validate colonialism (Mills, 1986; Phillips, 1990; Tomkins,

Corresponding author:
Olusola Bamidele Ojo, Department of History, Government College University, New Hostel, Lahore 54000, Pakistan.
Email: Olusolabamidele@gcu.edu.pk
1024 Journal of Asian and African Studies 55(7)

1994). They often construed epidemic campaigns such as influenza control as an act of benevo-
lence from the imperialists to the colonised (Arnold, 1988).
These epidemic control measures usually provided the pretext for colonisers to engender their
segregationist ideology. They also became an avenue for medical experimentation of new ideas
conceptualised in municipal sanitary schools (Macleod and Milton, 2005). Nevertheless, the socio-
economic impacts of such epidemics, as well as implementation of their control campaigns meas-
ures on the local populations, had received less academic attention. Often at times, previous
scholarship had relegated such discourses to the footprints of mortalities of the epidemics and other
epidemiological attributes of the causating virus. In this regard, many new papers have re-exam-
ined the fatality figures of the 1918 influenza pandemic in colonial India. Chandra et al. (2012) and
Hill (2009) re-estimated the total mortality of the 1918–19 influenza epidemic in India. They dis-
covered a mortality rate between 11 and 13.88 million. The initial estimates of around 5 million did
not account for many influenza deaths in the hinterlands.
In a related vein, some researchers delved into the consequences of 1918–19 influenza pan-
demic across different countries. Almond (2006) and Lin and Liu (2014) highlighted the harmful
effects of influenza on babies whose mothers suffered from flu during pregnancies in the United
States. From a similar perspective and economic context of the USA, Brainerd and Siegler (2003)
discovered that states with higher death rates in 1918 witnessed rapid economic growth in the
1920s. Garrett (2009) observed positive effects of influenza epidemics on wages and salaries. In
contrast, Klepser (2014) revealed influenza epidemics provoked a substantial economic burden on
the US Government.
In the Indian setting, only a few scholars have exposed the socio-economic consequences of the
1918–19 influenza pandemic on local populations. Many existing studies have focused on the epi-
demiological contexts and demographic impacts of the influenza epidemic. For example, Hill
(2009) discovered that the epidemic augmented the crude death rate from 1918 to 1920. The mor-
tality rate increased by 14 per 1,000 of the population within the period compared with the 1914–
17 and 1921–24 mortality values. Chandra et al. (2013) seek to unravel the reason why some areas
were more prone to influenza than others. They found out that areas with higher population density
are more prone to a higher mortality rate from flu because of the associated ease of diffusion.
Shaman and Kohn (2009) conducted a laboratory experiment on guinea pigs, which reveals that
low relative or absolute humidity favours the spread of influenza.
In the context of studies relating to the economic impacts of influenza in India, Bagchi (2014)
studied the effects of the First World War on the Indian economy. He posits that the vast export of
wheat and other staple food items occasioned by the war mainly triggered economic depression
and famine in India. Harnetty (2001) explained that the civilising mission underpins the response
of missionaries to purported 1919 starvation. He highlighted further that the failure of rain before
the 1918–19 influenza epidemic contributed to the scarcity of agricultural produce. Even though
these studies unearthed the dynamics of the First World War and the impact of climate on the eco-
nomic milieu of colonial India in the 1918–19 era, they failed to point out the socio-economic
implications of the outbreak. Arnold (2015) explains why influenza epidemics of 1918 provoked
less panic compared with previous plague outbreaks in colonial India. Although he noted the scar-
city of fodder milk resulting from the plague of influenza, his work is inadequate to analyse the
economic effects of the pandemic on regional contexts of India. Fashola and Heaton (2006) sug-
gested studying global diseases within the meaning of each society because it delineates the pecu-
liar consequences of such epidemics on different cultures. This aspect led us to focus on this study.
As stated earlier, the history of the 1918–19 influenza epidemic is a neglected episode in mod-
ern history. In this vein, there is a shortage of profound studies on the social consequences of
1918–19 flu in Punjab; however, Ruby Bala (2011) highlighted its epidemiological features. As
Ojo 1025

usual, she focused on its spread and mortality, with no recourse to its impact on the natives. This
paper, therefore, seeks to examine the social and economic effects of the 1918–19 influenza epi-
demic in Punjab and its implications in assessing the impacts of other outbreaks. It will also help
to heighten our understanding of the social consequences of an outbreak from a provincial
perspective.
This historical research deployed relevant archival sources from Punjab archives and libraries
such as Sanitary and Medical Proceedings and Home Proceedings.

Historical epidemiology of 1918–19 influenza epidemic in Punjab

Humanity has often suffered attacks from influenza-like ailments almost throughout its recorded
history (Hirsch, 1883). Influenza epidemics have swept across large areas of the world, often leav-
ing large populations decimated. Hippocrates identified a disease with similar clinical features to
influenza, about 400 years before the birth of Christ, and coined the term ‘Cough of Perinthus’ to
describe it. He attributed the ailment to the periodical changes of winds – this disease caused fre-
quent relapses and deaths from pneumonia (Collier, 1974). Roman historian Titus Livius cited
another plausible influenza epidemic. In August of 212BC, during the siege of Syracuse, a strange
respiratory disease erupted among the Roman and the Syracusian armies that halted hostilities for
a period. So many were afflicted, consequently resulting in countless unburied corpses (Crookshaft,
1922). In 1580, a pandemic erupted from Asia that spread to Europe, Africa and America. It was so
virulent that it affected all the nations in Europe within six weeks (William, 1977).
Between 1170 and 1889, there were only six reported pandemics of influenza in Europe (Pyle
and Patterson, 1984). However, from 1889 to 1997, the world witnessed up to 10 different devas-
tating outbreaks of flu. The reasons are not far-fetched. The growing wave of industrialisation and
globalisation played a significant role in this regard. It accounted for the upsurge in the frequency
of outbreaks. The rapid growth of large urban centres facilitated by fluid rail, road and sea transport
networks enhanced the swift transmission of influenza (Hoyle, 1968). The influenza outbreaks of
1889–90, 1918–19 and 1957 are of special interests to epidemiologists, virologists and historians
alike. They allowed scholars to establish the sporadic and unpredictable nature of viruses that are
responsible for the influenza outbreaks. For instance, the pandemic of 1889–90 wreaked great
havoc among infant and older adults while sparing young adults; even its mortality rate was milder
in the latter age group (Webster and Laver, 1975). However, the reverse was the case during the
1918–19 outbreak, which caused high mortalities among young adults and spared children and the
elderly. Moreover – and perhaps much more significant to its epidemiological history – it produced
the highest mortality rates in the annals of global epidemics in the modern world.
In the Indian subcontinent, influenza outbreaks had occurred before the early 20th century.
However, the epidemic of 1918–19 was unique for specific reasons. The death toll from the disease
remained the worst in the annals of the subcontinent. The mortality rate of influenza surpassed
other epidemic diseases considering its relatively short period of infectivity and the resulting death
rate. The influenza epidemic raged for roughly three months, leaving about 13 million people dead
in the Indian subcontinent (Chandra et al., 2012). However, this epidemic was not unprecedented
in the history of the subcontinent. In the 19th century, there were reported outbreaks in 1803, 1833,
1837, 1840 and 1890. In January 1890, influenza broke out in Bombay. It subsequently spread to
Lucknow, Delhi, Lahore, and the whole of North India within a few weeks.1 Nevertheless, its
recrudescence in 1918 was catastrophic regarding fatalities and the consequent socio-economic
deficits.
In May 1918, the first case of influenza occurred in Bombay. It diffused rapidly to Delhi and
Meerut districts of northern India, and by June, it had dispersed to adjoining areas such as Lucknow
1026 Journal of Asian and African Studies 55(7)

and Simla.2 During this period, however, it had no significance as an epidemic disease. Even
though some natives presented with influenza-like symptoms in some parts of Punjab in July 1918,
there was no concrete evidence to substantiate the claim of an epidemic. However, by August of
the same year, sanitary inspectors identified specific cases in Simla and Lahore districts. Even at
this time, there was still low cause for alarm because of its low virulence. By the beginning of
October, however, it had spread to most areas of Punjab with devastating virulence.
Although its clinical manifestation was similar to the 1890s influenza pandemic, the 1918–19
disease was more virulent. The Sanitary Commissioner of Punjab described the clinical picture of
early mild cases of 1918–19 as follows:

Fevers of 3–7 days duration, the shorter period of the fever were marked high maximum with slight
remission and larger periods by a more irregular chart with considerate remission. Slow pulse rate
compared with the temperature, in the short fever case 80–90 with a temperature of 39◦C was the general
rule. Great pain in the head, back and limbs; Subnormal temperature with marked physical and mental
depression for 7–10 days during convalescence. Respiratory distress with catarrhal inflammation of the
larger air passage.3

The mortality rate of influenza disease usually depends on the mutagenic properties of the virus.
The mortality rate was specifically higher between the ages of 20 and 40, while pregnant women
suffered more from the plague of influenza of 1918–19 in India.4 Some researchers have reported
that the bias for young adults is attributable to the induction of cytokine storm by the influenza
virus. For instance, Lin and Liu (2014) observed that excessive stimulation of the immune system
culminated in more deaths in young adults. Thus, young adults with a stronger immune system
were more prone to die from the disease in the 1918–19 pandemic. The constant genetic mutation
of the antigens of the influenza virus determines its variable epidemiology manifestations from
place to place. The influenza virus undergoes recurrent modifications, after which it becomes more
virulent and spreads rapidly, with catastrophic mortalities. This explained its quiescent period from
May until October when the disease started assuming epidemic proportions in India. It reached
coastal cities of India in September 1918 and spread rapidly all over the subcontinent. This rapid
spread was attributable to fluid rail, road and sea communication as well as the dispersal of soldiers
returning from the war. They acted as an essential reservoir of infections.
The returning military personnel and the Post Office employee established the foci of infection
by September 1918; from there, the disease quickly dispersed through the agency of general travel,
trade and cinemas. The public was inclined to attribute the primary infection to the Post Office.
They perceived that letters and parcels from a previously infected area of the coast transported
influenza. The Post Office employees at Karachi and Bombay were infected, and they in turn
affected the postal peons that distribute parcels and letters to the hinterlands. In Lahore, Simla and
other places in Punjab, the initial disease originated from the Post Office. By the beginning of
October, in India, the epidemic had started spreading its ‘fangs of terror’. By the end of November,
it affected most areas of Punjab, with devastating fatalities.

1918–19 Influenza epidemic mortality in Punjab

Punjab suffered tremendously among other regions. From 15 October to 10 November 1918,
between 4% and 5% of its population had died from the influenza epidemic. According to the
Sanitary Commissioner of Punjab, the scourge of the 1918 influenza outbreaks surpassed previous
outbreaks of plague and malaria. In his words:
Ojo 1027

Table 1.  Influenza mortality in British India from 10 October to 30 November 1918.

Province Population Total estimated Percentage

influenza deaths of population
United Provinces 48.820,506 1,072,671 2.2
Bombay 19,587,383 900,000 4.5
Punjab 19,337,146 816,317 4.2
Central Provinces and Berar 13,916,308 790,820 5.6
Madras 40,005,735 509,667 1.2
Bihar and Orrisa 34,489,846 359,482 1.0
Bengal 45,329.247 213,098 0.4
North-West Frontier Province 2,041,377 82,000 4.0
Assam 6,051,507 69,113 1.1
Burma 9,856,853 60,000 0.6
Delhi 416,656 23,175 5.5
Coorg 174,976 3,382 1.9
British India 238,026,240 4,899,725 2.0

Source: Preliminary Report of the Influenza of 1918 in India, 1919: p. 4.

Throughout the length and breadth of the province from Gurgaon to Campbellpur, from Simla to Multan,
in towns and villages, the disease raged with a fury new in our experience. The great malaria of 1908 and
the worst years of plague fade into insignificance beside this epidemic which in the two months of October
and November killed over 800, 000 people.5

The influenza outbreak of 1918 claimed over 5 million British lives in less than a month in
British India, while an estimated 800,000 people died in Punjab. Table 1 portrays the influenza
mortality rates in British India, including Punjab:
The table shows that the mortality rate of Punjab (4.2) exceeded the average for British India
that stood at 2.0. Only Delhi, Bombay and Central provinces trumped Punjab. In other words,
Punjab suffered substantially from the scourge of the influenza outbreak in 1918.

Colonial handling of 1918–19 influenza epidemic in Punjab

The influenza epidemic of 1918 took the colonial administrators of India by surprise. They were
ill-prepared for the outbreak. Some factors were inherently responsible for the nature of the colo-
nial response to the plague of influenza in Punjab. The major one appears to relate to its mysterious
epidemiological features. In India, like any other part of the globe, the apparent mystery of the
disease resulting from inadequate comprehension of its causating agent and clinical features ham-
pered the definitive management of the epidemic. Before 1918, many scientists attributed influ-
enza pandemics primarily to a bacterium – H. Influenza. However, they later discovered that it is
just a secondary invader. The 1918–19 influenza pandemic confused medical personnel because
sufferers presented with different clinical features from previous outbreaks. This is not surprising,
because of the unstable properties of the influenza virus; consequently, distinct symptomatology
usually occurs for different pandemics. Thus, clinical features resulting from the infection differs
from place to place in most cases.
In Punjab, the Sanitary Commissioner promptly redeployed human health resources from other
epidemic campaigns to tackle influenza. The colonial medical administrators drafted medical per-
sonnel from plague and smallpox vaccination units into emergency influenza relief unit. The
1028 Journal of Asian and African Studies 55(7)

Sanitary Commissioner engaged the entire malaria staff in many regions for influenza surveillance
and relief duties for its sufferers. The colonial administration also engaged indigenous medical
practitioners – Hakims and Vaids – as well as retired medical men in the emergency unit to provide
sustenance for the influenza victims. According to the Sanitary Commissioner, the Punjab govern-
ment devised the following measures:

The civil surgeon has been instructed to immediately suspend plague and vaccination operation and utilise
plague supervision to the fullest extent on influenza medical work. The entire malaria medical staff in
various districts has also been put on influenza duty since the commencement of the epidemic. Civil
Surgeon to make every effort with the help of Deputy Commissioners, President of local Boards, Municipal
Commissioners and leading citizen to secure services of retired medical men, as also indigenous agency of
in the way of the Vaids and Hakims, members of St John Ambulance Association and all those trained in
First Aid, for itinerating dispensaries and relief centres for distribution of medicine, medical comforts,
nourishment, blankets and clothing.6

The colonial response to the 1918–19 influenza epidemic was not overtly comprehensive; nev-
ertheless, Punjabis felt its impact. The British considered that land quarantines were useless, hence
the colonial health administrators did not enforce them. They had learnt from the adverse local
responses this has created during the plague moments of earlier decennium. However, to mitigate
against the rapid spread of the contagion, the British took some decisive actions. The colonial
administrators closed schools and colleges earlier while proscribing fairs and other social gather-
ings. They did not suspend postal services. However, the Sanitary Commissioner instructed travel-
ling employee to imbibe necessary sanitary conditions to prevent continued diffusion of influenza
into the general populace. The colonial government advocated antiseptic treatment of nasopharynx
on a personal basis and at district medical stations. It involved daily gargling with a mild sterile
solution such as thymol, condy or potassium permanganate. Nevertheless, most of these measures
proved ineffective in tackling the menace of the influenza epidemic in Punjab.
As expected, the apparent inability of the colonial administration to curtail the spread of the
plague of influenza heightened fears and tensions in Punjab. People consequently resorted to vain
remedies; in due course, they started moving from disease-prone areas to free areas that further
enhanced its dispersal. Fortunately, the scourge did not last more than a few months; however, it
left cataclysmic consequences in its trail because of the massive mortalities and the resultant socio-
economic disruptions.

Socio-economic impacts of 1918–19 influenza epidemic in Punjab

In Punjab, the huge fatalities of the outbreak portended harmful impacts on the socio-economic
landscape of the region. Apart from causing havoc on the demographic growth of Punjab, it also
triggered social dislocation and severe economic meltdown. There was general disruption of com-
mercial ventures with devastating impacts for individuals and the region at large. Those that
depended on daily economic activities such as merchants, shopkeepers, artisans, suppliers could
not go out for their daily transactions. As commented by Mr Marten in his report of the 1921 census
concerning the economic effects of influenza mortality, ‘it is usually held that mortality and eco-
nomic distress run parallel, to a great extent this is true of India’.7 This statement captures the
debilitating effects of influenza on the industrial atmosphere of India even after a few years of the
scourge. According to Mills (1989), the crude death rate increased substantially between 1918 and
1920 because of influenza epidemics, and expectedly it indicates devastating effects on the eco-
nomic landscape of India, including Punjab.
Ojo 1029

Table 2.  Wheat output in British India (in ‘000tons) 1916–17 to 1918–19.

1916–1917 1917–18 1918–19

British India 8401 8276 6469
Greater Punjab 2881 3334 2840
United Province 3061 2889 2304
Bombay-Sindh 680 748 259
Central Provinces 1125 763 677

Note: Greater Punjab comprises of Punjab, Delhi and North Western Frontiers.
Source: Bagchi (2014) Table 3.

These impacts are not restricted to trade and commercial activities; the agricultural sector suf-
fered more considering the agrarian preponderance of Punjab, specifically during the period of the
outbreak. Massive mortalities of influenza occasioned acute shortage of workforce. Some Punjabi
residents, including farmers and allied workers, suffered from the influenza infection, which
resulted in considerable exhaustion that hampered their productivity. These factors triggered the
scarcity of some agricultural produce. The Sanitary Commissioner of Punjab asserted in his report
on the influenza epidemic that ‘food prices were high and the sufficiency of the blanket and warm
clothing almost impossible to obtain and milk was scarce owing to the fodder’.8 In some provinces,
the colonial administrators declared famine because of the huge scarcity of farm products (Bagchi,
2014). For instance, in Central provinces and Berar with the highest mortality rate of influenza per
population (5.6), the British declared a famine in 1918–19 in some districts. Most regions in British
India, including Punjab, suffered a decline in their farm outputs. Table 2 displays productions of
wheat in British India between 1916 and 1919.
As shown in Table 2, most provinces witnessed a steady growth between 1916–17 and 1917–18
except Central regions and United areas, probably because of increasing exports that ensued during
the First World War. However, all the provinces including Greater Punjab witnessed a substantial
decline in output between the influenza moments of 1917–18 and 1918–19. This emphasises the
enormous impact the outbreak had on the agricultural landscape of India, including Punjab.
Demographic deficits occasioned by massive influenza mortality stifled the overall productivity of
the agrarian sector in Punjab. Probably more important were the inefficiencies caused by the weak-
ening effects of influenza on the socio-economic domains of Punjab. In other words, exhaustion of
survivors disrupted key farming processes such as planting and harvesting of crops as well as the
processing of farm produce. While other factors are responsible for an apparent dip in wheat and
different agricultural outputs, the infiltration of influenza in Punjab domain played a considerable
role in the scarcity and escalation of food prices. It explains the rationale for inflation of food prices
in Punjab after the epidemic had abated.
The epidemic in Punjab also affected the social spaces of the natives. Even though the colonial
administrators relaxed influenza measures in comparison to the Bubonic plague strategies of the
first decade of the 20th century, the colossal mortality adversely affected the social domains of
Punjab. The colonial government must have realised the apparent ineffectiveness of the restrictive
measures during the encounter with Bubonic plague in Punjab. Hence, they cautiously applied
sanitary laws in Punjab and elsewhere in India. Nevertheless, the epidemic itself and the mild colo-
nial handling of the scourge still had harmful impacts on the social architecture of the natives.
Public services and other social amenities suffered considerably because of the fatalities triggered
by the outbreak. The colonial government ordered the closure of schools and colleges, cinemas and
other places of social gatherings. They also imposed a ban on fairs and religious activities. In the
same vein, public services such as postal services implemented rigid travelling policies for their
1030 Journal of Asian and African Studies 55(7)

staff. The Sanitary Commissioners reported the planned strategies to combat the 1918–19 influ-
enza epidemic in Punjab as follows:

On the whole, so far as general measures are concerned, it comes to this. In the face of threatened
epidemics, schools, colleges etc can be closed early; the people can be advised to eschew railway travelling,
places of amusements and fairs; fairs can be prohibited; general advice as to open air can be issued;
provision can be made for extensive temporary hospital accommodation; the Medical Department on the
basis of present experience can organise the forces at its disposal; a volunteer organisation of laymen to
assist the poor can be formed in rural and urban domains. This latter measures would connote the formation
of local committees to coordinate measures. Finally, the Post Office could be asked to institute a rigid
medical inspection of its travelling staff.9

Nevertheless, the Sanitary Commissioner captured the devastating impacts of the outbreak on the
social landscape of Punjab with this report in the aftermath of the epidemic:

A peculiarly fatal type of pneumonia appear as a concomitant, and from 15 October to November 8, the
state of the Province was such as to render adequate description impossible. The hospitals were choked so
that it was impossible to remove the dead quickly to make room for the dying; the streets and the lanes of
the cities were littered with the dead and the dying; postal and telegraph services were completely
disorganised; the train service continued but of all the principal stations, dead and dying were being
removed from the trains; burning grits and burial grounds were literally swamped with corpses.10

The propositions of the above report were clear in the Punjab context. The enormous fatalities
that resulted from the virulent outbreak of influenza disrupted public services. The postal services
became disorganised, which in turn hampered communication. Acute care of the vast number of
influenza patients and the dying overwhelmed the medical personnel. It became a massive task for
medical staff to cope with the demands of the outbreak. Health workers discovered many dead and
decomposing corpses on the streets and in the trains. The dead and the dying in public spaces cre-
ated other sanitary hazards. Even without any prohibition from the British, it was clear why social
activities such as fairs and religious events were difficult to organise during the influenza moments
of Punjab.

Conclusion
Punjab province suffered substantially from the plague of 1918 influenza. The colonial administra-
tion was unprepared for the 1918–19 influenza epidemic in Punjab. The aetiology and management
remained obscure and shrouded in mystery. Thus, they devised sanitary and medical measures,
which proved mainly ineffective in curtailing the fatalities of the influenza epidemic. Hence,
Punjab witnessed an unparalleled loss of lives from the 1918–19 influenza epidemic that surpassed
previous moments of plague and malaria.
Acute shortages of workforce occasioned by vast mortalities affected the agrarian structure of
Punjab. Demographic deficits caused by influenza deaths as well as the exhaustion of farmers and
labourers led to a substantial dip in agricultural output. Thus, this article argues that the adverse
demographic effects of the 1918–19 influenza epidemic played a significant role in causing scar-
city of agricultural produce and consequent inflation in prices of food items in Punjab, among other
factors. Other contributory factors remained excessive exportation of food items to sustain the
course of the First World War, as well as an apparent shortage of rainfall before the influenza epi-
demic in Punjab and other parts of India. From a different perspective, the outbreak also provoked
severe disruptions in social services in Punjab.
Ojo 1031

Funding
The author received no financial support for the research, authorship, and/or publication of this article.

ORCID iD
Olusola Bamidele Ojo https://orcid.org/0000-0002-9705-9724

Notes
 1. Education and Sanitary Proceeding, March 1919/ 17-39, National Archive of India, GOI, p. 162.
 2. Khalsa Samanchar, Amritsar, June 8.
  3. Punjab Sanitary and Administration Report, 1918, pp xv.
 4. Indian Medical Gazette, September 1924, p.465.
  5. Home Department Proceedings of the Government of Punjab, February 1919, p.96.
  6. Home Department Proceedings of the Government of Punjab, February 1919, p.93.
 7. Indian Medical Gazette, September 1924, p.466.
  8. Punjab Sanitary and Administration Report, 1918 .pp. 4
  9. Home Department Proceedings of the Government of Punjab, February 1919.p.94-5
10. Home Department Proceedings of the Government of Punjab, February 1919, 100.

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Author biography
Olusola Bamidele Ojo is affiliated to the Department of History, Government College University, Lahore,
Pakistan. He is in the advanced stage of his Doctorate Programme in History of Medicine.