Raghavendra Rao Park, Choolai, named after the man who fought influenza, pic courtesy The Hindu

We are all locked in in 2020 facing a virus that has so far infected 20 lakh people worldwide and killed 135,226 (source –Worldometers.info) 

Bad enough. But it still pales into insignificance when compared with the Spanish influenza epidemic of 1918-1920, which affected 50 crore people – a quarter of the world population at that time and killed anywhere between 1.7 to 5 to 10 crore people worldwide (all figures from Wikipedia entry on this pandemic).

Did Madras face it? And if so what was its experience? Before I go on, I must thank my dear friend and colleague Karthik Bhatt for setting me off on this, by sending me the relevant Corporation of Madras report for that period.

Firstly it may not have had anything to do with Spain. It probably originated in a non-human mammal (sounds dreadfully familiar), somewhere as far away as in the USA and then spread. It was brought to India by troops returning after the First World War. As the maximum numbers arrived in Bombay, that became the first city to be infected and the suffered the worst possible spread. It therefore came to be known as Bombay fever throughout India.

In Madras, the fever hit sometime early in 1918, and J Chartres Molony ICS, the President of the Corporation of Madras, noted in his report that year that the overall death rate, owing to all causes, was around 40 people to a thousand of population and by end 1918 had reached 62. He added that Dr K Raghavendra Rao, then Health Officer was working hard along with his staff to contain the spread of the disease. Molony, while attributing much of this increased death rate to Bombay fever, also felt that there were some ‘quasi-permanent’ contributors such as cholera, smallpox and a general lack of hygiene in Madras that anyway kept the death rate high. In all, over 3,000 people died that year in the city from the influenza. When you consider that the population was 5 lakh, it is a significant number.

The next year saw the epidemic return with greater vigour – this was the second and deadlier wave of influenza the world over. But Madras contained the deaths to just 1,300 people. How was this managed? The man behind it was K Raghavendra Rao. He read the signs and took action.

In June 1919, the epidemic was showing signs of a strong comeback. 22 people died of it in July and by August the numbers had gone up to 120. But it was still less than what it was the previous year thanks to certain steps taken by the Corporation.  Early in July it published a note in influenza in all the local newspapers so that people were aware of its occurrence and also educated on some minimum preventive steps. On July 15, 1919, Raghavendra Rao convened a meeting of ‘medical men’ and this included Lt Col. Charles Donovan, IMS. He was then the star among the city’s medical professionals – in 1903 he had been one of the two researchers who had isolated the organism that caused kala azar, a deadly fever of that era. William B Leishman of Calcutta had also identified it at around the same time, and another star of India – Sir Ronald Ross, discoverer of the malarial parasite, had come up with a winner of an idea – the kala azar organism would be called Leishman Donovani, after both researchers. 1919 was Col Donovan’s last year in Madras and he was then medical superintendent at the Royapettah Hospital and a professor at the Madras Medical College. Over 150 doctors attended the meeting called by Raghavendra Rao and presided over by Donovan. A special committee was formed with Donovan as Chairman and Raghavendra Rao as Secretary to combat the epidemic. The action points that emerged read very much like what has been done for COVID, barring the lockdown of course, which was anyway not something that was done in that era.

The first step decided on was to isolate the infected so that they did not spread the disease. As hospitals were not sufficient, special influenza homes were created in the affected areas and patients were removed to them. Next, an appeal was sent to all doctors in the city to be on the watch for influenza cases, report them, and convince the patients to move to the influenza homes. This was published in all the newspapers as well on July 24, 1919. Special posters in English, Tamil and Telugu were prepared on influenza and were pasted at all popular spots. On July 31st, the Government was petitioned to notify influenza as a dangerous disease and this was duly done on August 13th.

The Corporation of Madras sanctioned Rs 15,000 for relief and with that money, nine influenza homes were opened with attendant staff. Doctors of the city helped by identifying and strictly monitoring those who fell ill and convincing the families to move the ill to the influenza homes. Patients brought in were admitted and treated for free, and this included medicine and food. A total of 614 people were admitted in these homes and of these just 49 died. The Corporation spent a total of Rs 19,000 on the fight against influenza.

Raghavendra Rao is a man of few words and does not sensationalise the report. But the statistics speak for themselves – a reduction of one third in death rates speaks volumes about the effectiveness of the campaign. Of course the number of those infected was always far less than Bombay as Madras was a smaller port and so had fewer arrivals. The same reason is given out even today – Chennai is not so favoured a destination when compared to Mumbai and Bangalore when it comes to International arrivals and so it had fewer cases till the much-vaunted but now nameless incident came along.

The continuation of some basic hygiene factors -warn the public, report cases and isolate those ill – makes for interesting reading in this current COVID situation.

The residence of Dr K Raghavendra Rao, now the Children’s Garden School

For the record, K Raghavendra Rao was born in 1884 in Mysore and after a BA at the Bangalore Central College, qualified with the MB &CM (the then equivalent of MBBS) at the MMC. He joined the services of the Corporation of Madras and there became its Health Officer. In 1920, he qualified with a DPH from Cambridge. He became Special Malaria Officer and later in 1926 was appointed Assistant Director of Public Health, Government of Madras. He later became the Director and retired from service in 1940, passing away a year after. A park in Choolai commemorates this remarkable man. His house, off Radhakrishnan Salai, is where the Children’s Garden School now functions from.

This article is part of a series I am writing on health scares and epidemics faced by Madras/Chennai. You can read the other parts here

How Madras eradicated smallpox

How Madras fought tuberculosis