Covid-19 Exclusives: Lessons to Learn from Penang's 1918 Influenza Pandemic

By Wong Yee Tuan

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In light of Covid-19, Penang's Influenza of 1918 may just provide valuable insights on how to effectively manage the current, and future, pandemics.

One of the major concerns of regional – in fact of all – governments today is the sudden spread of deadly diseases. Modern travel has allowed germs, bacteria and viruses to reach distant corners of the globe in no time at all. Learning from the way past epidemics were handled will provide valuable information for us to prepare for future disasters.

Penang as an entrepot during colonial times was not only a collection and distribution centre for trading commodities but also housed a cosmopolitan migrant population. This certainly made it a bustling and exciting site for social, cultural and economic exchange. However, with such dynamic human interaction, it also became vulnerable to infectious diseases.

Since its establishment, the spread of diseases was of great concern to the settlers of the island. Cholera, malaria, smallpox and plague frequently troubled them. In 1819, the first cholera outbreak occurred in Penang and killed 2,000 people – i.e. 5.5% of the inhabitants of the settlement.

About 90 years later, in 1918, the Spanish flu or influenza outbreak hit Penang, inflicting a heavy death toll – at least 1,500 fatalities. The colonial authorities explained that away by saying that the heavy loss of life was inevitable due to the uncontrollable global epidemic. But this official explanation was too simplistic. 

That influenza pandemic is thought to have its origins on the battlefields of Western Europe during the First World War. It was a new strain of the influenza virus, and it spread rapidly, reaching Penang in late June of 1918. The epidemic caused a heavy sick rate but fatal cases remained low. Because of the low mortality, the colonial authorities of Penang had taken influenza lightly and overlooked the looming threat of the virus. It was not until the second wave of influenza that came in October that the colonial authorities realised its destructiveness.

On October 12, 1918, the Governor General of South Africa sent a telegram to the Governor of the Straits Settlements to warn him about the dangers of the influenza. Unfortunately, it was too late for the authorities to act and the second wave brought numerous deaths. For 41 days, from October 1 to November 10, 1,347 deaths were recorded in Penang. In other words, 33 persons perished in one day on average. The influenza virus did not discriminate against social divides, infecting both nobles and peasants, rich and poor. Oon Geok Teah Neoh, wife of Koh Seang Tat, a prominent Chinese businessman and community leader, was one of the influenza victims. She contracted the disease and died after four days at the age of 87. Another victim was John E. Sco Brown, a chartered accountant of Penang Rubber Estates Co.Ltd. After a week-long struggle with the disease, he died in the General Hospital at the age of 33.

A major gure to perish in the influenza was Sultan Abdul Jalil of Perak. The epidemic spread in no time from Penang to Perak. The Sultan of Perak contracted influenza and fell ill for five days. On October 26, he succumbed to the disease at the age of 52. His reign was probably the shortest in the state. He ascended the throne in January 1916.

For 41 days, from October 1 to November 10, 1,347 deaths were recorded in Penang. In other words, 33 persons perished in one day on average. The influenza virus did not discriminate against social divides, infecting both nobles and peasants, rich and poor.

This appalling human disaster raises the question of the colonial authorities’ response to the epidemic: did they provide competent service to the populace? To a very great degree, the authorities failed to provide leadership and to mobilise resources to cope with the influenza. This can be seen from the lack of security regulations, dire shortage of doctors and nurses in hospitals, and ineffective implementation of preventive measures. 

Sultan Abdul Jalil

Since the 1870s, the colonial authorities in Penang had an established epidemiological mechanism covering the early detection of infectious diseases from foreign ports and a network of quarantine camps. However, there was a fundamental loophole in the structure: the Quarantine and Prevention of Disease Ordinance 1915 did not include influenza in the list of notifiable contagious diseases alongside plague, smallpox and cholera. As a result, many influenza-infected immigrants who entered Penang escaped the colonial authorities’ scrutiny and worsened the epidemic in the colony. 

In the Straits Settlements, Penang had the most number of hospitals: five on the island and three in Province Wellesley1. Nevertheless, the colonial authorities could not deal with the epidemic effectively as the hospitals were direly understaffed. For the whole of Penang, there were only 16 nurses and three to four doctors serving in the hospitals. Such a severe shortage hence led to high death rates. For instance, it was reported that 267 influenza victims died within 48 hours of admission to the General Hospital of Penang.

When the second wave of the epidemic hit Penang in early October 1918, the local medical authority and the municipality were unprepared despite their experience with the first wave in June. Strictly speaking, the colonial authorities did not take any action at all to deal with the epidemic raging in Penang in early October. It was not until mid-October that the Straits Echo, a local newspaper, published a list of preventive measures to fight the disease. But the authorities still failed to enforce any rules or regulations to require the public to observe these measures. As a result, some people who had no faith in western medicine sought local and traditional prevention and treatment of influenza, such as the mixture of powdered musk and milk, tea made by boiling cinnamon, ginger, coriander and garlic, and a mixture of boiled pumpkins, potatoes and coriander leaves. This haphazard situation left people confused about the effective way in fighting influenza. This eventually caused more fatalities.

Khoo Sian Ewe.

The failure of the authorities in providing leadership and coordinating relief efforts prompted community leaders, merchants and professionals to organise relief efforts for influenza victims. The latter demonstrated an ability to institutionalise efforts comprising medical, financial and social welfare within less than a fortnight.

Influenza Relief Fund and Lam Wah Ee Relief Fund were set up to help the poor defray medical expenses. Altogether, about $13,000 and $5,000 were collected respectively by the two funds. Apart from the funds, personal efforts were also contributed to fight against the epidemic. For example, Lim Eow Thoon provided a motor lorry to act as a travelling dispensary to distribute medicines, blankets and milk to poor persons suffering from influenza. Khoo Sian Ewe secured the service of Dr Teoh Cheng Toe, who gave free medical attendance and distributed European medicine to poor patients, irrespective of races, at their own houses.

As quickly as it had come, the epidemic subsided in November and disappeared by December. The registered mortality rate in Penang was relatively low compared to the total mortality in the Malayan Peninsula as a whole which amounted to about 35,000. However, the pandemic impact on Malaya and Penang was still minimal if one sees the crisis mortality in India and Burma scoring at 12.5 million and 300,0002.

In retrospect, some useful lessons can be learned from this long-forgotten 1918 influenza outbreak. First, influenza is not a new epidemic disease and it had been posing deadly threats not only to certain groups of people, but to the wellbeing of the whole community since the early 20th century. In this regard, studies of its historical manifestation can lead us to have a better understanding of the disease’s behaviour. Second, the authorities must show firm and accountable leadership in fighting outbreaks rather than downplaying the epidemic. Hospitals need to be provided with suffcient doctors and nurses, and equipped with modern medical facilities and medicines. Most importantly, the public needs to be educated and inculcated with knowledge associated with health-protective behaviours and outbreak control measures. Third, the influenza virus, considering its swiftness and fatality in claiming victims, is still the most fearful contagious disease, even when compared to AIDS and tuberculosis. Penang as a major travel destination and a port is undoubtedly susceptible to this virulent disease. There is no known reason why another catastrophic epidemic like that of 1918 or even worse should not happen again in Penang.
In order to prevent a reoccurrence of such undesirable human tragedy, Penang should not only improve its public health procedures but also conduct medical research to find radical and long-term cures for the disease.

1 Straits Settlements Blue Book for the year 1917.

2 Judith L. Richell (2006), Disease and Demography in Colonial Burma, Singapore and Copenhagen: NUS and NIAS Press.

Wong Yee Tuan

is Fellow and Head of Penang Institute’s History and Heritage Programme. He hails from Malim Nawar and has profound research interest in the history of Penang.