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When Sneeze Kills:
Indonesia's Influenza Pandemic of 1918
by Arie Rukmantara
Influenza pandemic in 1918 was probably the greatest single natural disaster ever to hit
this earth. The impact of the pandemic made a catastrophe to every country, including Indonesia,
then the Netherlands Indies.
In the midst of World War I, a deadly flu hit Southeast Asia. Historical records said the
Dutch colonial authority believed that the disease originated from China. In early 1918, some
patients were detected to have influenza in Hong Kong port. These people were on their way to
Southeast Asia.
Another historical source said it was generally believed that Influenza pandemic of
1918 started in the United States of America in March 1918, and spread to Europe along with the
arrival of the US troops sent there. Few weeks later, the disease started to spread to other parts
of the world. In June, the flu reached Bombay, India, and in the same month, it reached
Pankattan, in the east coast of Sumatra. The place is now known as Pangkatan District in North
Sumatra. It is suspected that the disease came from the Straits Settlements (Singapore or Malay
Peninsula).
The Dutch consulate in Singapore saw the threat and warned Batavia about possible
arrival of people with flu symptoms. It advised Batavia to ban arrivals of ships from influenzaaffected areas. The Batavia authority managed to prevent the advent of influenza, but other ports
in the archipelago failed to apply the same measures. The Dutch flagship carrier was reported to
have carried flu patients with them to the Netherlands Indies. Ports in Banjarmasin, Makassar
and Buleleng in Bali soon reported emerging influenza cases.
From Buleleng, Bali, the virus spread to East Java, also through sea. Within two
weeks, the deadly flu arrived in Surabaya. According to Dutch Colonial Health Office, the city
recorded tens of thousands of influenza patients.
In early 1919, the flu spreads to Central Java and then entered West Java. The Batavia
administration was shocked to see the flock of new flu patients, outnumbering patients of pest,
which had severely hit Central and East Java in the previous year.
The administration decided to apply anti-malarial drug, known locally as “ pil kina”, as
prophylaxis. To minimize possible complications among people with underlying and other
chronic diseases, the administration also advised certain patients to consume opium.
Another historical record said that on July 1st 1918, residents of Tanjong Pandan in the
eastern part of Sumatra, were infected by passengers on a ship arriving from Singapore. Soon
afterwards, the disease was reported to have infected people in Weltevreden (popularly known as
Batavia), Medan, and Borneo, Bandjermasin and Stagen (Pulu Laut) in Kalimantan, also known
as Borneo. From those places, it spread to the rest of the archipelago. In July, several epicenters
had been reported: one in Bandung, West Java, one in Central Java: Purworedjo and Kudus, and
one in East Java: Kertosono, Surabaya, and Djatiroto. By the end of July, major outbreaks of the
disease had been recorded in most parts of Java and Kalimantan.
During this initial attack, the disease seemed to have penetrated no further east than
Java: Bali, Sulawesi, and the islands to the east were, for the time, untouched. And although high
levels of morbidity were recorded, mortality was generally quite low.
The Netherlands Indies colonial government’s health agency, the Netherlands Indies
Public Health Service (Burgerlijken Geneeskundigen Dienst) made an investigation and came up
with some conclusions on the characteristics of the new infectious disease. The BGD concluded
that the influenza was imported to the Netherlands Indies from the Straits Settlements. The quick
spread of the disease was carried by travelers. The health agency also concluded that the high
morbidity of the flu was caused by factors such as the susceptibility of the population to infection
by influenza; the short period of incubation; the fact that the virus can cause severe health
impacts between 2 and 5 days; the transmission’s mode was that the virus spread from the
respiratory organs from a patient to another through speaking, coughing, sneezing; and the fact
that many who were slightly ill remained working and continued to socialize with others
including those who worked in schools, factories, mosques, and churches that helped spread the
virus.
Historical records showed that there was a time gap between the first influenza case
and the later cases. The first period lasted for 14 days. After this period the flu epidemic
developed rapidly and within two weeks it reached its peak. This height of the flu epidemic
remained for two weeks. For a few weeks afterward, the Netherlands Indies recorded a decline in
cases and fatalities. Another wave then reemerged. Each of the flu epidemic waves lasted four to
six weeks.
The occurrence of the influenza in Netherlands Indies in the year 1918 is divided into
two waves. The first and more benign one took place during July-August, and the beginning of
September, principally in the western part of the Archipelago. The second, the very malignant
one, occurred from the end of the October until December in the eastern part of the Netherlands
Indies. At the end of the year, the deadly flu has spread over the whole archipelago.
Historians said the July epidemic wave was not such a great deal compared that of
November. The first chiefly attacked places in Java and Sumatra, whilst Celebes, the Moluccas
and the Little Sunda Islands remained free from it. In the first epidemic, the source of infections
can still be traced. The July epidemic burst out explosively and thus showed a great morbidity
during a very short time; the persons attacked generally did not show serious symptoms. This
was without exception unanimously reported by all observers. The mortality in the first epidemic
was low.
The November epidemic covered a much larger territory; there were few areas in
Netherlands East Indies which were not infected by the influenza.
As to the morbidity of the second wave vary in different places. No complete record is
available to show the numbers of patients or the fatalities during the pandemic. The November
wave was characterized by its maliciousness; the flu symptoms were much more severe.
The disease showed an inclination to complications, through which the duration of the
disease generally was much longer. For example, while in the first epidemic the attack had an
average duration of five days, this became eight and a half days during November.
At the same time, the Netherlands Indies had also suffered attacks of other infectious
diseases, making the government figures on mortality surge in the year 1918.
Some records said in the year of 1918 in Java and Madura almost 10,000 people died
of cholera, more than 900 from smallpox and some 700 from other plagues. Altogether more
than 11,000 people died from these contagious diseases. This number dwindles to nothing in
comparison with more than 400,000 deaths due to influenza in November 1918 alone. Statistics
are scarce and it is hard to gain a sense of what truly happened. Records showed that most
fatalities occurred in the young adult age bracket.
In the 1980s, a historian published a paper titled The Influenza Pandemic of 1918 in
Indonesia, which gives an idea of what happened during the period. The estimation was that
around 1.5 million people died in Dutch East Indies, which was then home to just some 30
million people. These deaths were recorded in the Dutch’s Kolonial Verslaag (Colonial Journal).
Historians showed the horror of the pandemic situation. In Southeast Sulawesi, a
Catholic missionary was quoted as saying that "deaths are everywhere". According to the report,
in one Sulawesi village, a third of its population died in a period of just three weeks.
In Tana Toraja, 10 percent of the population reportedly died from the flu. Some Toraja
tribe leaders still pass the stories of the outbreak through oral tradition, read out during
traditional ceremonies. The mysterious outbreak, dubbed locally as Raa’ba Biang (loosely
translated as fallen threes), killed hundreds of people in the hilly areas of Tana Toraja.
In early 1920, the Dutch Colonial government issued an “Influenza Ordinance” to ensure
that response and mitigation measures were carried out promptly and correctly and that any
future outbreaks in the archipelago could be rapidly detected and contained. It also set up a
commission to investigate the cause of the pandemic. The law consists of information of
influenza symptoms, response and prevention measures for people and administrations across the
nation.
The government also took into account risk communication measures by instructing its
information office to spread information on pandemic influenza. A brochure was printed to
promote awareness on influenza prevention habits among the public.