1918-1919: Spreading Like Brush Fire
The Spanish Flu is the deadliest pandemic in history, wiping out tens of millions of people between 1918 and 1919. It was also a nightmare in the Dutch East Indies.
FRITZ Basiang was 13 years old when many people in his village of Saluputti, Tana Toraja, South Sulawesi, suddenly died in a very short time. Illness spread in those highlands, but no doctors were there to take care of the sick. “We had just buried someone in the morning, but by noon another person had died. After that burial, somebody else had died in the afternoon,” Basiang said in A Toraja Pilgrimage: The Life of Fritz Basiang, written by social anthropologist Roxana Waterson from the National University of Singapore.
That event in 1918 spurred Basiang to become a physician. He became the first Torajan to pursue his medical degree all the way to Europe. The disease which killed so many in his village was a flu pandemic known amongst Torajans as ra’ba biang, which means death that arrives like falling weed blown by the wind.
According to data from the colonial Dutch government at the time, some 300 out of 3,000 Toraja inhabitants were killed by the flu. Even now, a mass grave can still be found in Toraja with human bones. “Those who died were not able to be buried according to the proper rituals, as even many of the corpse bearers had died,” Tubagus Arie Rukmana, a pandemic historian, said in a written answer.
These swift and mass deaths could be found throughout the Dutch East Indies regions at that time. Arie Rukmana quoted a report from the Burgerlijken Geneeskundigen Dienst (BGD) or the public health office from 1920 that said: “Almost none of the villages in the East Indies escaped the flu infection.”
Some believed that the flu was easier spread in lower regions than in the highlands. “However, that was not proven as Magelang (Central Java) and Tana Toraja, which on average are in areas higher than 3,000 meters from sea level, also had deadly flu cases,” said Arie, who co-wrote Yang Terlupakan: Pandemi Influenza 1918 di Hindia Belanda (The Forgotten: The 1918 Flu Pandemic in the Dutch East Indies).
In Makassar, according to a news article in the Indonesische Persbureau (Indonesian Press Agency) on February 11, 1919, funerals appear like a market as it was always busy with people burying their relatives. Kirsty Walker, writer of The Influenza Pandemic of 1918 in Southeast Asia, said that in a number of regions in Java, one phrase became familiar to residents: “Sick in the morning, dead in the afternoon; sick in the afternoon, dead in the morning.”
Warnings that the disease would hit the Dutch East Indies like a whirlwind actually already came in April 1918. At that time, the Dutch consul in Singapore corresponded with the administration in Batavia (today Jakarta) to bar ships from Hong Kong from docking and unloading passengers as the area had been hit by the pandemic. Similar restrictions were implemented by the British government in Singapore. However, Tubagus Arie Rukmana’s book The Forgotten said that no significant steps were taken by the government in Batavia after receiving those warnings.
The media also appeared bewildered in its reporting on the disease. One of the earliest reports mentioning the flu pandemic was in De Sumatra Post on July 4, 1918. The brief column reported that an epidemic had broken out in Singapore, affecting almost half the population with joint pains, headaches, and waist and back pains. The disease was still called by different names at the time, such as ‘the Singapore disease’, ‘the Russian flu’, and ‘people’s disease’. Ten people reportedly died. However, in its July 16, 1918, edition, the daily assured that “this disease is not dangerous and appears to be similar to the regular flu with symptoms like headaches, fever, and muscle aches. Aspirins should do it. There is no need for concern.”
Yang Terlupakan: Pandemi Influenza 1918 di Hindia Belanda (The Forgotten: The 1918 Flu Pandemic in the Dutch East Indies)./Tempo
Only one day after that reassuring news, De Sumatra Post reported that the flu had arrived in Surabaya, East Java. It spread among village residents and navy personnel, and some 200 out of the 1,500 inmates in the Surabaya jail were reported to have been infected by the flu virus.
The term ‘Spanish flu’ started to be used in the article De Epidemie in the Bataviaasch Nieuwsblad on July 18, 1918. The article reported that the Spanish flu had already spread among hundreds of Dutch battalion soldiers in Batavia. The public health office also received reports regarding a similar disease in the eastern shores of Sumatra and in Surabaya. The illnesses were related to the pandemic raging globally, with no medication to battle it. The article called on curbing the disease from spreading by refraining from going to work and isolated oneself in cases of fever and slime formation. “In case of coughing or sneezing, stay away from others and don’t spit on the ground!”
Like dry weeds catching fire, news about the virus spread throughout the whole Dutch East Indies in a matter of weeks. De Sumatra Post reported that the flu hit plantations in North Sumatra in July 1918. The company hospital was overwhelmed as it had to accommodate over 100 patients a day with fevers. Plantations had to be shut down and production was halted. In Batavia, many companies were also in crisis due to a lack of personnel plagued by the virus. Hospitals in Semarang, Central Java, were packed, among others because one-third of railway workers were sick. A majority of transportation services personnel in Probolinggo and Mojokerto in East Java were also infected.
A brief report in the Batavian daily at the end of July also confirmed that the flu had spread to Jepara, Central Java, with a very high mortality rate. Physicians had asked for assistance. From Tanjungpandan in the Belitung Island (today in the Bangka-Belitung Islands Province) came reports that the whole island was contaminated. The virus also attacked the armed forces, the police, the native, Chinese, and European communities.
In August it was reported that some 600 mine workers in Sawahlunto, West Sumatra, fell ill, but hospitals were already full and health workers were also infected. In addition, between 20 and 30 members of daily patrollers had returned to Fort de Kock carrying the virus. “It is not yet known how this disease spreads, but halting the troops’ activities should become a policy before it hits other victims,” De Sumatra Post wrote.
On December 13, 1918, the Malaysia Tribune reported that a telegram had arrived in Amsterdam from Java with estimates that some one million people in the Dutch East Indies had been hit by the flu pandemic.
However, Dutch East Indies Governor General Paul van Limburg Stirum believed that the report was exaggerated. Van Limburg Stirum, as quoted by Singaporean daily The Straits Times on April 17, 1919, said that mortality rates in Java, Madura, Bali and Lombok between July and October 1918 did not go up significantly from the same period in the previous year. However, in November 1918 some 359,600 deaths were connected to the Spanish flu. “That is 188 deaths per 1,000 residents. Compare that to 20 deaths per 1,000 people in November 1917,” the news report said.
Demographic studies after the pandemic abated found a very high mortality rate from the Spanish flu in the Dutch East Indies. Research by Colin Brown in 1987 in The Influenza Pandemic of 1918 in Indonesia found that deaths in the Dutch East Indies between 1918 and 1919 due to the influenza exceeded 1.5 million people. Meanwhile, in a study with the same topic in 2013, Siddarth Chandra from the Michigan State University in the United States estimated that mortality rates were more than double of that calculated by Brown. “From our figures, it seems that in Java and Madura alone between 4.26 million and 4.37 million people lost their lives,” Chandra said.
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THE extensive spread of the Spanish flu in the Dutch East Indies stems from the scant attention paid on the pandemic that had already killed millions in the United States and Europe. The book written by Tubagus Arie Rukmana and friends focused on the numerous Dutch officials in East Indies who neglected the information on the pandemic’s spread. Early warnings to prohibit the ship from Hong Kong, which harbored the virus, from entering the territory were ignored due to conflict of interest. “This conflict of interest had an impact on delays in handling the matter,” said Arie, who is currently a public communication member of the Covid-19 acceleration mitigation task force.
The colonial government only formed an emergency team to combat the pandemic in November 1918. At that time, according to Siddarth Chandra’s study, the first wave of the pandemic had already hit coastal towns in Java, Sumatra, and parts of Kalimantan. This first wave in June and July 1918 was followed by a bigger and swifter one in October, which lasted till the end of that year. East Java was the epicenter of the disease, which quickly spread until Makassar in South Sulawesi, Seram Island in Maluku, and Fakfak in Papua.
The Oakland Auditorium in California, United States, turned to a temporary hospital during the Spanish flu pandemic, 1918./wikimedia
Efforts to ease the spread was proposed by Public Health Office Chief Dr. W.T. de Vogel, after he toured to inspect conditions of flu sufferers throughout Java in December 1918. In addition to discovering staggering victims’ statistics, De Vogel also concluded that the virus was difficult to control because the absence of any legal basis had caused regional administrations to take their own actions amidst the emergency. He proposed that a special regulation be drafted to stem the disease on a national scope. That regulation was known as the Influenza Ordonnantie, which was ready in early 1919.
The Influenza Ordonnantie was designed based on the quarantine regulation in Staatsblad van Nederlandsch Indie No. 277. Staatsblad is an official publication containing laws, regulations and decrees issued by the Dutch state. With the Ordonnantie, government officials were able to issue regional quarantine orders in order to curb the pandemic. There were criminal penalties for those who went in and out of infected areas. The regulation also prohibited public gatherings in large numbers.
University of Indonesia Historian Achmad Sunjayadi explained that when Governor General Van Limburg Stirum disseminated the orders to government and private institutions, it was met with fierce protest from the Koninklijk Paketvaart-Maatschappij. This shipping company with routes from Sabang in Aceh until Papua said the regulation would obstruct their work, not to mention fines of up to 2,000 guilders for ship skippers who violate the regulations. “It would cause big losses for the company,” Achmad said when contacted in the beginning of May.
Justice Department Director D. Rutgers also believed that the Ordonnantie took away people’s rights to gather and associate. Other institutions were also provoked to voice their objections for the regulation. “There was almost no support from the government for the Ordonnantie draft,” Achmad said. “The Influenza Ordonnantie was only ratified in 1920, after the government realized that the disease had already spread all the way to Papua.”
As it took two years to establish a national strategy, local community initiatives had mushroomed, the majority of which actually worsened conditions. For example, while the virus spread, colonial doctors believed the disease could be cured by quinine pills generally used to combat malaria. This prescription was given without prior studies. In the book The Forgotten there was also mention of opium as temporary medication to soothe pain due to lower immune systems after being infected by the virus.
Health services were also not evenly distributed. Many physicians were not willing to treat poor indigenous patients. Some doctors prioritized European or Chinese patients, who had more money to pay them. Others also took advantage of the pandemic by increasing their fees. Arie gave the example of doctor Hoefer and doctor Rademaker in Surabaya, who raised their fees from 1.5 guilders to three guilders. “Their excuse was that this way they wouldn’t have to treat that many patients,” Arie explained.
The number of patients indeed did not match the number of health workers. Koloniaal Weekblad noted in 1919 that throughout the pandemic, one doctor would have handled up to 800 patients. Historian Peter Carey added that students from medical faculty STOVIA in Jakarta who had not yet graduated but had already gone through their last year of studies were asked to help out with patients. “A thesis was not required,” Carey said in an interview in April.
A hospital in Sumuran, North Sumatra, 1919./Tropenmuseum
Medicine that had not yet been proven for its effectiveness was publicized in the media. The Straits Times on February 20, 1919, quoted two dailies in Java as reporting that doctor J. Samuel in Magelang had found an effective method which cured 800 patients without any deaths. The method, among others, prescribed that patients could not take a bath before the fever subsided, and had to drink a concoction—detailed in the article—five times a day. The article assured that the fever would go down within two days after following that prescription.
Amidst these rather chaotic medical handlings, traditional medicine was often preferred. Old Javanese literature, such as Serat Centhini (1814) and Kawruh Bab Jampi-jampi Jawi (1858), contained a number of jamu (traditional herbal medicine) recipes that could be consumed by the Javanese to maintain and recuperate health. This became the reference for communities in Rembang and Blora in Central Java, who took temu lawak (Curcuma zanthorrhiza) and cabai lempuyang (Zingiber zerumbet) as shields for the flu.
In addition, numerous rituals were carried out in many Javanese cities. In the article De spaansche griep te Modjowarno (The Spanish flu in Modjowarno) in the Christian monthly Maandblad der Samenwerkende Zending-Corporaties, (1919), C. W. Nortier wrote about the people of Wojowarno in East Java who made flower and water buffaloe offerings at the tomb of Kiai Abisai and Kiai Emos (kiai is an honorific title for experts), who were pioneers in spreading Christianity in that region. The ritual was hoped to expel the evil spirit who carried the virus to Mojowarno. This happened despite Arie Rukmana’s findings, based on Nortier’s documentation, that Mojowarno had hospitals complete with doctors and health workers, and even pastors.
The Forgotten: The 1918 Flu Pandemic in the Dutch East Indies book
In Kudus, Central Java, the traditional Chinese toapekong (a Chinese deity) procession circled the town four times in October 1918. It included a barongsai (lion dance), flags, tambourines, musical instruments, and prayers. Residents believed that the flu ‘devil’ would be afraid of the procession. “By organizing a ceremony, should God grant our pleas, the disease would cease immediately and all of Kudus’ residents, men and women, Muslim, Chinese or Dutch, will be saved,” Tan Boen Kim wrote in Peroesoehan Koedoes (Kudus Unrest) published in 1920.
These so-called solutions without any scientific bases could be among the reasons for the high mortality rates in the Dutch East Indies, Arie said. Coupled with the bad coordination among state officials, the Spanish flu only disappeared there in 1921, without ever really getting to the root of the problem.
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A century after this disease dubbed ‘the mother of all pandemics’ blew over, experts around the globe still disagree about how the Spanish flu came, and eventually disappeared. Memories about the pandemic are also blurred as it coincided with an event that dominated history books: World War I. In fact, according to epidemiologist John Barry, the disease killed between 21 million and 50 million people, many more than the number of victims of the Great War, which are estimated to be between 9.2 million and 15.9 million lives.
In The Geography and Mortality of the 1918 Influenza Pandemic, David Patterson and Gerald Pyle explained the three dissemination phases of this flu. The first phase was in the spring in March 1918, when the first wave hit the center of the United States and Europe, and arrived in Northern Africa, India, China, and Australia in July. The fall season phase started in late August in France, before spreading to all corners of the world, making it the deadliest wave. The last phase in 1919 showed many of the same symptoms from the pandemic that occurred two decades prior to that.
Patterson and Pyle noted that the earliest Spanish flu case documented was at a military training camp in Funston in Kansas, United States, on March 5, 1918. The virus spread along with the soldiers’ movements to France, then on to Portugal and Spain. Due to the war, the disease that started spreading was censored in the media. The flu pandemic was only widely reported in Spain, at that time a neutral country with a free press. This is why it became known as the Spanish flu, even though the Spanish prefer to call it the ‘French flu’.
The H1N1 virus causing this disease can be airborne, which is the reason for its high infection rate. It was estimated that one-third of the world population, or some 500 million people, were infected with the virus. Meanwhile, the highest mortality rate was found in children under the age of five, people aged between 20 and 40, and people over 65, “The high mortality rate in the productive age range is a unique characteristic of the Spanish flu which still defies explanation,” the United States Health Department wrote.
Edvard Munch’s painting Self-Portrait with the Spanish Flu, 1919./wikimedia
During the first wave, the flu symptoms tended to be light with fevers and exhaustion which usually passed within a few days. However, a mutated strain of the virus in the second wave could kill a patient in a matter of hours after symptoms occur.
Spanish flu victims include German economist and sociologist Max Weber, who died of acute pneumonia after contracting the Spanish flu at the age of 56. Meanwhile, Norwegian artist Edvard Munch, creator of renowned painting The Scream, was infected but recuperated. Munch even made two self-portraits of his illness: Self-Portrait with the Spanish Flu (1919) and Self-Portrait after the Spanish Flu (1919-1920). Both paintings are part of Norway’s National Museum collection.