Managing Epidemic: The British Approach to 1918–1919 Influenza in Lagos

Introduction

The history of the 1918 influenza epidemic has received considerable scholarly attention globally (Alam, 1978; Arnold, 1988; Brown, 1987; Burnet and White, 1972; Echeverri Dávila, 1993; Heaton and Falola, 2006; MacLeod and Milton, 2005; Mills, 1986; Mueller, 1995; Patterson, 1983; Phillips, 1990; Phimister, 1973; Rice, 1988; Tomkins, 1992, 1994) within the context of the ideology that underpinned colonial medicine; that is, a situation whereby colonial medicine was presented as an act of benevolence used by the imperial power to legitimise imperial rule (Alam, 1978; Arnold, 1988). Even though epidemics provided colonial administrations with political opportunities to entrench colonial rule, racial segregation and space delineation, as well as a platform for the experimentation of new ideas defined in metropolitan medical and sanitary schools (MacLeod and Milton, 2005), the social implications of these ideological standpoints have often been treated as footnotes to clinical manifestations of diseases. For example, Heaton and Falola (2006), in view of the socio-cultural peculiarities of epidemics held the view that disease though a global phenomenon cannot be perceived as a single integrated phenomenon with similar trends in different places, and argued that epidemic outbreak must be studied within the socio-political context of its society regardless of its geographical spread.

In the case of the 1918 influenza epidemic, most scholars favour studying the demographic effects of the pandemic across space and time in Africa, because, essentially, its spread occurred in phases and the colonial response to its outbreak differs across geographical space. While scholars like Curtin (1985), Olukoju (1994) and Swanson (1977) have drawn attention to the nexus between disease control and urban planning in Africa, these studies glossed over the impacts of urban planning on African means of livelihood and its social implications. Aderinto’s study on the control of venereal disease in Lagos (Aderinto, 2012), perhaps represents one of the very few attempts by scholars to look at the social implications of medicine on the people of Lagos; however, his study was limited in scope and it was gender focused. Arguably, Schram (1972) provides a good background to epidemiological study in Nigeria, though devoted as the study seems to be to medical historiography it comes across as a mere chronicle of epochs and a dateline of the medical profession in Nigeria.

Though some studies have provided a broad picture of the influenza epidemic in British West Africa and demonstrated how successive colonial governments dealt with the disease, their perception that the response of the administration followed the same pattern in all colonised territories is too generalised to be an accurate picture (Patterson, 1983; Tomkins, 1994). Indeed, if many studies have highlighted how the disease spread across the British imperial space, they failed to note the role played in making policy decisions by the peculiarity and policy preferences of ‘men on the spot’. This is true of scholars who have engaged in the study of Lagos during the period of colonialism (Heaton and Falola, 2006); they underplayed the importance of the peculiarity of the sanitary condition of Lagos at the period leading up to the outbreak. In essence, the impact of the influenza epidemic on the social formation of Lagos has yet to receive serious attention. The severity of the epidemic in Lagos and the abundance of literature about it because its importance as the leading port in British West Africa provide a sound basis for studying both the city and the epidemic in isolation.

This paper, therefore, seeks to examine how the British managed the 1918–1919 influenza epidemic in Lagos, the reactions of the local population to new sanitary and medical policies enforced during the period, and its social and political implications for future epidemic management in the colony. Lagos is chosen as the terrain of discussion because of the ample data generated in the course of the 19th and 20th centuries (not just between European missionaries and the indigenous Lagosians, but also for other influential cultural and ethnic groups such as the Saro and Amaro (migrants from Brazil), and the Indian influence on medical policies in Lagos).

Influenza: spread, morbidity and clinical manifestations

The year 1918 was in many ways significant. It marked the end of World War 1 and the beginning of an outbreak of an influenza pandemic that killed more people than the war. Recent studies have revealed an estimate fluctuating from 50 to 100 million casualties worldwide (De Almeida, 2013). It came in phases and encircled the world through increased human mobility, especially via sea route transportation. It would not be an overstatement to say that if the 1918 influenza was marked so much in popular minds as the world’s first major pandemic it is precisely because it was, in many ways, the first major epidemic outbreak; this global spread resulted from the same instruments that had been at the root – or were perceived to be – of the modern globalised world, namely: the steamship and world trade. No region in the world escaped its devastating effects. From the United States it spread speedily to Europe and Asia. By April 1918, Australia was hit. By late August, completing its imperial ‘grand tour,’ the ‘unwanted visitor’ surfaced in West Africa, probably first in Sierra Leone and Ghana, later making its way to Lagos. The medical machinery of the imperial establishment was overwhelmed, and its response was slowed down by a serious lack of understanding of the influenza (Killingray, 2003). Prior to its appearance in Lagos, the disease had earlier devastated the British colony of Sierra Leone where it was reported to have claimed the lives of four per cent of the population (Tomkins, 1994). Sea communication and the volume of trade and human traffic between the two colonies suggest that the appearance of the influenza in Lagos would only be a matter of time. This must have prompted the Governor of Sierra Leone to send a cablegram to the senior sanitary officer of Lagos on 30 August 1918, informing him of the seriousness of the pandemic in his colony (Tomkins, 1994). He further advised that all ships entering Lagos, especially those from Britain, should be considered infected (Public Record Office (PRO), London, 1919). Based on the advice of the sanitary board, the influenza was declared as infectious on the strength of the Public Health Ordinance of 1917. The rapidity at which it developed and the severity of its symptoms are graphically described by Killingray:

The virus is transmitted from person to person by the respiratory route, with a short incubation period of 24–27 hours, so that the virus can spread rapidly. In serious cases, the symptoms are bloody sputum, bleeding from the nose, and lung failure associated with haemorrhagic and oedematous complications. Influenza does kill directly but frequently, the virus leads to serious bacterial pneumonic complications which result in death (Killingray, 1983).

Influenza officially hit Lagos on 14 September 1918 (Public Record Office (PRO), London, 1919). The medical officer for the colony not only notified the public by public notices in newspapers and the government gazette, but private medical doctors were also co-opted into the campaign (Public Record Office (PRO), London, 1919). It is interesting to note that prior to this period, segregation of the medical profession based on a racial divide was an official policy in Lagos. Most of the indigenous doctors were refused employment in the colonial medical service. Not surprisingly, many of them formed the bedrock of the anti-colonial movement in Lagos.

The first human case in Lagos was confirmed on 14 September 1918. Three crew men of the SS Panayiotis were discovered by Dr Gray, a colonial medical officer, to be seriously ill and lying on the Iddo wharf opposite the island. The anxiety created by the news of the epidemic and its virulent features made every illness in Lagos susceptible to being described as influenza. These three crew men were removed to the infectious disease hospital in Ikoyi after they were diagnosed with the disease (Public Record Office (PRO), London, 1919). The ship was ‘arrested’ and disinfected by the sanitary authority and subsequently sent to the pool, the pool was an isolated area where all disinfected ships are kept. The rate of the spread and infection in Lagos were rapid and devastating.

The efficiency of imperial transport networks became, in this context, a lethal mechanism of infection for British West Africa which was intricately connected to the rest of the empire via trade and sea communication (Collier, 1974; Johnson and Mueller, 2002; Jordan, 1927; Patterson and Pyle, 1991; Phillips and Killingray, 2003). Ships coming from other parts of the region arrived at Lagos with sick people on-board. A few minutes after the arrival of the SS Panayiotis, the SS Ashanti arrived from Sierra Leone with six passengers diagnosed with the influenza; they also were transferred to a quarantine station. One of these passengers had died aboard before the arrival of the ship in Lagos. Post-mortem examination confirmed that he died of influenza (Public Record Office (PRO), London, 1919).

By mid-September, all the merchant ships anchored in Lagos were infected. In fact one of these ships was credited to have caused the wide spread of the influenza in Lagos. More precisely, SS Bida was said to have been “the chief means introducing the influenza to Nigeria” (Public Record Office (PRO), London, 1919). The SS Bida had left the Gold Coast for Nigeria and arrived in Lagos on the 14 September with two hundred and thirty-nine passengers. The inadequacy and complacency of the Lagos sanitary control was exposed when all passengers had been let free without thorough examination and left to disappear and intermix with the local population. They were speculated to be also the chief carrier of the pandemic in the hinterland. Although the ship was later quarantined by the sanitary department, the failure of its agents to track the men and women who had come from the Gold Coast only signalled the deficiency of the system put in place by the colonial administration (Tomkins, 1994). The complacency of the sanitary officer in charge of the sea port of Lagos was later confirmed by the Acting Governor of the colony; in his memo to the British Secretary of State he wrote:

…the master of the S.S. “Bida” was one of the few ships’ captains who brought was also recognised pilot of the port of Lagos, and, therefore, brought his ship directly alongside the customs Wharf without usual boarding by one of the official pilots stationed in Lagos, who would, in accordance with instructions at the time in force, have inquired into the history of the vessels (Public Record Office (PRO), London, 1919).

The failure to track the ship in accordance with quarantine rules could not be more succinctly put. More cases of infected passengers who had travelled on the SS Bida were recorded than for any other ship anchored at Lagos at that time. The following cases were reported and linked to the ship:

September of 1918 was a decisive month for Lagos. The colonial government struggled to control the infection. From 14 September when the infection was first confirmed in the city, cases of infection were reported every day from ships coming in from neighbouring colonies (Public Record Office (PRO), London, 1919). In September the rate of its spread and the rapidity at which it claimed its victims was unimaginable. The victims cut across the social stratum as members of all classes were infected by the influenza. Within the first hours of the outbreak, the medical facilities of the colonial hospital and the infectious disease hospital were overstretched. Victims were lying on the street, while rescuers also became victims (Public Record Office (PRO), London, 1919).

Infectious cases from the port were easily tracked and isolated by the sanitary authority. It was however difficult, if not impossible, to monitor those who were infected away from the ship. The colonial government noted that it was “quite impossible to curtail the spread of the disease” (Public Record Office (PRO), London, 1919). The admissibility of the failure of its efforts only confirmed the idea that the colonial authorities were ill-equipped to deal with the situation. The late admission of the sanitary officer only serves to corroborates this interpretation: “the disease was widely scattered and that no measure of quarantine was likely to stop its progress” (Public Record Office (PRO), London, 1919). The port of Lagos and the entire colony were eventually declared infected on 25 September, and on 26 September an Observation Hospital was opened in Ikoyi as part of the measures to control the epidemic. People suspected of influenza infection were sent to the hospital located in the north east of Lagos for close observation. The hospital was to cater for cases that could not be diagnosed instantly.

It must be noted that both human and material resources of the colonial government were overstretched by the epidemic. For instance, the new Observation Hospital at Ikoyi was a Technical School that had later been converted to a prison before it eventually became an emergency hospital in reaction to the lack of existing appropriate facilities. Furthermore, the reaction of the colonial authorities to the epidemic was largely shaped by the medical policy of the government in London, which was to prevent the disease from spreading rather than providing succour for the victims. Perhaps, the adoption of such policy was to cut cost, because it was more expensive to provide relief materials for epidemic victims than to control the epidemic itself (interview by the author with Murray Last, 12 June 2013). This perhaps reflects the Manchester doctrine of minimal financial commitment to the colony even when the epidemic threatened the basis of colonialism. The famous Manchester doctrine was formulated by the colonial government to ensure that colonies are self sufficient in terms of finance.

The official policy of the British government as recommended by the Local Government Board was to devise means of containment rather than measures to cure the victims. This recommendation was explained clearly in a document sent to the overseas colonies during the epidemic by the local government board. Unfortunately, by the time the mail arrived in Britain’s West African colonies, their cemeteries were already full of the corpses of the influenza’s many victims (Tomkins, 1994). Some scholars have noted that the ‘lacklustre’ response of the British administration was due to their lack of preparation to combat such an epidemic. These scholars have argued that colonial government was only concerned with tropical diseases insofar as they directly threatened the existence of the colonial enterprise and its European managers (Tomkins, 1994; Interview by the author with Dr Hillary, Birkbeck College, University of London, 21 May 2013). Earlier medical research had essentially been devoted to diseases that were prevalent in the tropics notably, mosquito-borne diseases such as malaria, water-borne disease such as the yellow fever and the tuberculosis that had for long put the life of sailors and administrators at risk. When the influenza epidemic finally hit Lagos, the colonial government had therefore no medical understanding of the disease and no ideas as to how to combat and prevent it.

In the first two months of the outbreak the enormity of the casualties was overwhelming. Figure 1 shows the number of infected people and the deaths recorded in the first two months of the outbreak.

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Figure 1.

Reported cases of influenza and deaths certified as due to influenza in October 1918 in the Township of Lagos.

Figure 1 does not represent the total number of infections from Lagos; rather it represents the number of cases reported at the port. For example, in contrast to figures shown in Figure 1, the number of deaths registered for the month of October only show that over 1,602 individuals died of the influenza (Public Record Office (PRO), London, 1919). In the same month, the number of uncertified deaths adduced to the influenza was 690 (Public Record Office (PRO), London, 1919). Following the outbreak and the dramatic number of the casualties, the panic induced by the fear of the disease resulted in massive migration as people fled Lagos by roads and water. Those who fled by water were detained for medical examination by the colonial government, while it became impossible for the colonial government to halt the exodus of the people from the colony who left by land – a majority of those who left were reported to have died of the influenza (Public Record Office (PRO), London, 1919). Within the four months that the epidemic ravaged the colony, the medical department gave what it called a ‘moderate figure’ of 1,200 deaths. The breakdown shows that in the month of September, three people succumbed to the influenza, the month of October recorded the largest number of casualties, (1,062), November recorded 17 casualties, and during December and the whole of 1919 there were only eight casualties recorded. While the number of uncertified deaths was put at 110, in all, 1,200 people died of the epidemic according to the colonial record (Public Record Office (PRO), London, 1919). From the figure above, Lagos lost 1.5% of its population to the epidemic as its official population was put at 81,941 (Public Record Office (PRO), London, 1919). The figure given by the colonial government nevertheless is grossly inaccurate as it did not include those who died in their homes and whose deaths were not reported to the sanitary officer. Also, this figure does not include minors whose deaths were not reported to the authorities because these deaths were considered as abnormal in the dominant South Western Nigerian Yoruba culture. Such corpses were removed to the bush in the night in line with Yoruba tradition. Many of the victims of the pandemic concealed their identity and those who died of the influenza were concealed by their immediate family.

The diagnosis of the influenza unleashed an unprecedented panic which impacted on the entire community during the outbreak with disastrous effects such that the fear of being sent to an infectious diseases hospital and being isolated from their family prompted individuals to conceal from their relatives victims of the influenza.

Colonial response to influenza in Lagos, 1918–1919

The imperial colonial enterprise in Africa was directly linked to the advancement of medicine. In the first hundred years of colonial enterprise, diseases like malaria, tuberculosis, yellow fever, cow disease, dysentery and black water disease threatened the foundation of the developing African colonies. Faced with this quagmire, many colonial governments established medical schools to research vaccines and solutions to tropical diseases with the clear and undisputed objective to make tropical regions more accessible to economic explorers and missionaries. By the 1890s the London School of Hygienic and Tropical Medicine had demystified malaria by identifying the carrier of the parasite. The result of this discovery was the institutionalisation of racial segregation recommended as a panacea to the mosquito menace (Ross, 1910). In Lagos, the colonial government under Governor Macgregor, rebuffed attempts by the British government to introduce such policy into the colony. His argument was predicated on the fact that such policy would inevitably lead to racial antagonism. In Lagos, contrarily to other colonies such as South Africa, Ghana and Sierra Leone for example, to combat malaria, the colonial government embarked on an ambitious policy of land reclamation and draining of swamps, and introducing simultaneously, sanitary measures to improve the sanitary state of the colony.

However, the outbreak of the influenza in 1918 caught the colonial government by surprise. They were slow in response, and when they eventually responded, it was quite ineffective. The pandemic was not a tropical disease; it was imported to the continent through trade and sea communication. In British West Africa, directives were issued to local medical and sanitary officers by civil servants based thousands of kilometres away in the Colonial Office in London.

In Lagos, however, the response of the colonial authority was dictated by the prevailing circumstances rather than the regional pattern of the British colonies. At the outbreak of the epidemic, the director of medical and sanitary services, Dr Hood, CMG, convened meetings with the senior staff of the colony, unofficial and official medical practitioners with the objective of discussing the epidemic (Public Record Office (PRO), London, 1919). The first meeting took place on 24 September and a second meeting followed on 7 October. The significance of these meetings lies in the fact that the crisis bridged the racial divide in medicine in Lagos. Indigenous medical practitioners were called in because of the suspicion that pervaded western medical intervention. Before then, the African medical practitioners were not given opportunity within the colonial medical service because of the racial policy of the Colonial Office. At the meeting, two native medical practitioners submitted a draft that contained the aetiology of the disease and also suggested ways in which the problem could be abated. The content of this draft revealed that the initial relative success recorded by the colonial government was actually the result of remedial measures suggested by the ‘native’ doctors. Three categories of measures were outlined in the colonial report. Firstly, “when vessels were infected, but the shore was free, measures were directed to the prevention of importing the disease. Secondly, when Lagos was infected, as well as ships; measures were taken to prevent the spread from Lagos to other ports and places. Thirdly, when Nigeria was infected as a whole and ships were either clean or heavily or moderately infected, action was taken to prevent infection of clean ships, to prevent importation from heavily infected ships, with the intention of excluding a more virulent organism if such there were: whilst no action was taken with regard to moderately infected ships, such being regarded as infected equally with shore” (sic) (Public Record Office (PRO), London, 1919).

These preventive measures were accepted by the colonial authorities, printed and circulated in Yoruba and English languages within Lagos and its environs. However, broader measures were taken to halt the spread and prevent panic in neighbouring towns and communities. It was a crisis that could not be contained alone by the medical establishment. The intervention of the Church was sought to persuade the people to obey sanitary regulations and co-operate with the medical officers. While the epidemic raged, the colonial government was conscious of its economic implications for the Lagos colony and the colonial enterprise in Nigeria. To safeguard the economic lifeline of the colony, the medical officer warned that “it was necessary to interfere as little as possible with shipping and to prevent a panic in the neighbouring towns and villages upon which the food supply of Lagos depends” (Public Record Office (PRO), London, 1919). Ships suspected of infection were not allowed to anchor with other ships in the port as such ships were anchored in the ‘pool’ under quarantine conditions. To cater for those who had been infected from the ships, arrangements were made at quarantine stations. According to the medical department:

Removing contacts from the ships and shore to the quarantine station, so long as this measure gave any hope of being of service. From ocean ships this applied as a rule to passenger only, as the ships with crews were usually kept isolated so long as they were considered infected, or until they sailed. (Public Record Office (PRO), London, 1919).

In an extraordinary measure, the marine department arranged a ferry service between Lagos and the offshore station to provide food for those who were detained offshore. Those who had been certified by the medical team to be carriers of the influenza were temporarily sheltered in emergency shelters erected close to the port for onward transfer to the quarantine station, and later to the disease hospital at the Ikoyi end of Lagos.

Furthermore, ships and houses were sprayed with sulphur fumigation and with solution of the cyllin disinfectant. The process was discontinued at one point by the medical and sanitary department chiefly because of shortage of the disinfectant and shortage of labour (Public Record Office (PRO), London, 1919). The shortage of labour was connected to the fact that the spraying gang employed for the colony abandoned the job because most of them contracted the disease and ran away so as not be sent to quarantine or disease hospital. This scenario was reduced to a common joke among the people: Owo re, ikure, oyinbo pe e ko wa gba (here is money, here is death, the white man is calling you to come and take) (interview by the author with Mama Akingbola, age 96, 30 April 2013 – her mother died of the disease). House to house inspection was carried out by the health gang and people found to be infected were removed to the Observation Hospital or isolation camp in Ikoyi. The first visit to people’s residences was carried out on 18 September by the sanitary inspector, with the aim of carrying out discrete enquiries about infectious patients. This measure yielded an astonishing result as people were found to be concealing the information and also suffering from other disease (The African Messenger, 1922).

The severity of the disease in Lagos was underlined by these extraordinary measures. Schools and churches, cinemas and mosques were closed and all public meetings prohibited by the government. The severity of the situation was succinctly captured by The African Messenger in an article dated 9 March, 1922:

…the mortality while the epidemic lasted was so high that there seemed to have been one continuous stream of funeral procession day in day out. The energies of ministers of religion as well as grave-diggers, not to talk of undertakers, were taxed almost to breaking point in order to cope with the demands that were being made on their services (The African Messenger, 1922).

To combat the epidemic, the medical authorities in Lagos invoked the provision of the Health Ordinance of 1917. The influenza was declared as an infectious disease through public notice. The legal recognition of the epidemic provided the colonial state with the mandate to intrude forcefully and sometimes aggressively into the private houses of people; this was unprecedented in Lagos. The effect of these intrusions nevertheless created further panic among Lagosians resulting in a wave of discrete escapes to the hinterland by sick people, thereby spreading the influenza. By implication, the epidemic ushered in legal control in what Arnold (1988) refers to as ‘colonising the body’. Under this regime of medicalisation of the body, people could now be detained and put under forced medical regulation.

Further control measures were inaugurated. Due to acute shortage of manpower, the medical department dispatched a circular to all government departments, including the West African Royal Force, requesting for volunteers to help in the house to house visits (The African Messenger, 1922). People across the class and racial divides responded to this call and visitation gangs were formed. The results of this appeal are shown Figure 2.

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Figure 2.

Circular Ccalling for volunteers.

Conclusion

The first three decades of the 20th century in Lagos were gloomy. The community was embroiled in many epidemic outbreaks. Sanitary control by the colonial government was received with little enthusiasm by the indigenous Lagosian society. The quest for improved sanitary conditions in the colonies received unprecedented enthusiasm from the colonial government as a result of its inevitability, government because there was a new policy by the colonial government to improve sanitary condition in the colonies, and because the sustainability of the imperial business was inextricably linked to improved conditions of hygiene in the colonies. This paper has argued that the large casualties recorded among the African people during the influenza epidemic were due in part, to official neglect. Africans were considered as free labour to be exploited and segregated in a labour pool rather than a co-inhabitant of a living space that deserves similar sanitary facilities to the European society.

The political economy of the imperial government influenced policies and politics related to public health in the colonies. Outbreaks of epidemic provided the needed pretext for the implementation of these goals. However, the outbreak of the influenza epidemic in 1918 changed the physical complexion of the colonies. Colonial states used medical ideology to further the aim of colonialism and to reinforce racial superiority. The influenza though a global pandemic ravaging the entire globe was blamed on the insanitary area of Lagos (Public Record Office (PRO), London, 1919). This assertion could be construed as part of racial propaganda to appropriate the living space of the native population and to use medical policy as an excuse for policing the colonial state.

The outcome of the epidemics was unimaginable. Prior to this period, there were spasmodic attempts at sanitary improvement in Lagos. The campaign for profound actions to improve conditions of sanitation was sustained by the Saro elite; the influenza epidemic brought the agitation for improved sanitary conditions to fore of discourse among the Lagos elite.

The intensification of the sanitary campaign by the colonial government in the last decade of the 19th century must be located within the context of the larger imperial agenda. Sanitary control and education about improved hygiene was the major strategy employed by the governing elites to ensure the survival of the colonial enterprise in the colonies. The sanitary peculiarity of Lagos posed serious environmental challenges to the colonial government. The problem was compounded by the desire of the colonial government to appropriate natives’ land in the name of sanitation. Sanitary control rather than military might was skilfully employed to implement the socio-political agenda of the British government. Put differently the imperial agenda was clothed in sanitary control. This might help to explain why Lagosians in 1918–1919 refused to evacuate places identified to be prone to disease.