VI. Influenza
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The 1918 influenza epidemic that swept the world is often called the Spanish Flu though it did not originate in Spain. During the First World War, Spain remained neutral and, unlike the Allied and Central Powers nations, did not suppress or censor news. The Spanish media was free to report on the outbreak and hence Spain was mistaken to be the county of origin for the epidemic. The flu epidemic caused about 40 million deaths worldwide, most of which were aged between 20 and 40 years. After an incubation period of two or three days, the infected person began to experience symptoms such as cough, sore throat, chills, high fever, fatigue, and joint pain. The 1918 influenza epidemic was not the first flu attack on Taiwan but its impact was undoubtedly the most profound.
In May 1918, the flu invaded Taiwan with cases first occurring in Keelung and then spreading to Taipei. It might have been brought in by the military arriving from Japan or other alighting passengers from overseas vessels. The Japanese army had been fighting in Europe during the First World War, and might have brought the virus back and then into Taiwan. In 1908, construction of the railway along the west coast was completed, linking the north and the south on tracks. The convenience in travel contributed to the spread of the epidemic to the south. Cases started emerging in Taoyuan, Hsinchu, Taichung and other places, but the epidemic remained sporadic. The medical staff at the time did not know that this was flu, and considered it “a fever of unknown cause”. As the weather became hotter, the epidemic gradually disappeared. When autumn came, flu cases reappeared, and Anping, Tainan had the first flu patient in mid-October. Since then, the virus spread from the port to the city and swept across Taiwan, eventually causing nearly 780,000 infections and more than 25,000 deaths. Another epidemic in 1920 caused 150,000 infections and nearly 20,000 deaths. On the western plain, the most severely hit areas were the Tainan chō (臺南廳), the present-day Tainan and Kaohsiung, with highest number of both infections and deaths. This administrative region was the most populous in Taiwan. Influenza virus transmitted by droplets was very contagious, especially in densely populated villages. Faced with a communicable disease with unknown etiology, the medical practitioners were greatly confused. At that time, viruses could not be isolated, least examined under a microscope. The disease was generally considered to be caused by "flu bacteria". On November 3, 1918, the Taiwan Medical Conference was held and participants included medical officials and doctors under the Government-General of Taiwan. Changes were made to the agenda for discussion on the epidemic. After receiving suggestions made at the meeting, the Government-General of Taiwan instructed that local governments should issue regulations on epidemic prevention. Preventive measures stipulated mandatory mask wearing for caregivers, proper disposal of excrement, and that people should pay greater attention to personal and home hygiene, maintain ventilation, carry out disinfection, stay away from the infected, boil clothing and towel boiled before use and avoid going to public places while patients were prohibited from leaving home. The Baojia teams were also asked to ensure that people rinsed their mouth thoroughly with disinfectant mouthwash and wore masks when going out. Nevertheless, before these preventive measures were carried out, the influenza virus had already infected the Baojia teams, thus paralyzing the monitoring work. Not even cleaning of the environment and prompt report of cases to the Police Department would be performed by the Baojia teams. In addition, there was no specific medicine for influenza, and medical units could only provide supportive care. As it was highly contagious through droplet infection, maintaining distance and waiting for one’s immunity to overcome the virus was the main and only strategy for coping with this disease. In 1920, the Government-General of Taiwan actively encouraged people to be vaccinated against streptococcus pneumonia to reduce the chance of death from pneumonia caused by influenza.  Figure 25: Diary of George Leslie Mackay in 1891
Source: Identifier: T1015_009-0075, George Leslie Mackay Papers (1871-1901) In 1872, Mackay, a doctor and a missionary of the Presbyterian Church in Canada, settled in Tamsui, and started practicing medicine, offering education and evangelizing. On August 20, 1891, he wrote in his diary that his three children and seven from the Oxford College and the Girls’ School he founded got infected with influenza.
 Figure 26: Resume and certificate of courses attended by Wu Sen-yu submitted for doctor’s license application Source: Identifier: 000009690220197, 000009690220198, Official Documents of Government-General of Taiwan (1895-1947) During the epidemics, Taiwanese doctors trained by the medical school established by the Government-General of Taiwan played an important role in local epidemic prevention and medical care. In 1904, Wu Sen-yu, a graduate from the Medical School of the Government-General of Taiwan having completed courses on internal medicine, surgery, physiology, and pathology, applied for a doctor’s license. He then started practicing in Tainan City and opened the Zhong-He Tang Hospital. On December 2, 1918, Taiwan Daily News reported that during the influenza epidemic, Wu was seeing patients from 7 in the morning till 12 midnight. He hired a rickshaw to take him around so as to see more patients. He was so busy that there was misinformed news that he died from overwork. In fact, he passed away only in 1923.
 Figure 27: Nurses (with masks) and patients in communicable disease ward of Red Cross Hospital Taiwan Branch Source: Identifier: T0744_0001-0020, Yearbook of Medical and Commercial Education School in Japanese colonial Taiwan  Figure 28: Diary of the Shuizhu Villa’s Host (Chang Li-jun) in 1920
Source: Identifier: LJ01_00_13_0077, Chang Li-jun Papers (1843-1980) On January 27th, Chang Li-jun wrote in his diary that the influenza epidemic was rampant in Huludun (the present-day Fengyuan, Taichung), and people were very worried. To invoke divine protection and to pray for health and safety, the five Heavenly Goddesses from Chaotian Temple of Beigang, Fongtian Temple of Nangang, Nanyao Temple of Changhua, Matzu Temple of Lugang and Chaoyuan Temple of Wuqi; the Three Great Emperor-Officials from Ziwei Temple of Chenping Village (the present-day Beitun, Taichung), the Three Princes from Fushun Temple of Shuiligang (the present-day Longjing, Taichung), and the Guanyin Buddha from Tzu Yun Temple of Niumatou (the present-day Qingshui, Taichung) were all invited to Zhujai Temple of Huludun. A procession of the deities was organized showering blessings to the people in the village in the hope of bringing peace to the heart of the people through the power of faith.
 Figure 29: Diary of Governor-General of Taiwan Den Kenjiro in 1920
Source: Identifier: T0818_01_02-0065,Den Kenjiro Papers (1919-1923)  Figure 30: Notice of reduced tobacco supply from Monopoly Bureau of Ministry of Finance, Japan in 1920
Source: Identifier: 0010022100000-0275, Official Documents of Monopoly Bureau of Government-General of Taiwan (1895-1947) Japan had been ravaged by influenza since 1918. On November 8th, Taiwan Daily News reported caskets piling up at the crematorium, revealing the severity of the epidemic. By 1920, 24 million were infected and 380,000 died. On March 16, 1920, the Monopoly Bureau of Ministry of Finance of Japan notified the Monopoly Bureau of Government-General of Taiwan of a reduced amount of tobacco to be delivered. The decline in supply was caused by decreased production due to a fire at the Yodobashi branch and the outbreak of influenza at various plants. On March 27, Den Kenjiro, Governor-General of Taiwan from 1919 to 1923, who was in Japan for a family visit, wrote in his diary about his friend Hayashi Kenkichirou, a businessman, hospitalized after being infected with influenza. The flu then turned into pneumonia and his friend was admitted to Red Cross Hospital for treatment. Den Kenjiro visited his friend in the hospital but this friend passed away in August of the same year. |