Impact of 1918 influenza pandemic on mental asylums in India: An analysis of asylum reports

INTRODUCTION: Not much is known about impact of 1918 Influenza on patients confined inside mental asylums of that period. AIM AND METHODS: The study aimed to assess impact of Influenza pandemic on mentally ill patients in asylums, based on data extracted from provincial asylum reports (1915–1923) from British India. RESULTS: The asylum population in most provinces was impacted both in terms of direct mortality (1918) as well as all-cause morbidity and mortality (1918; 1918–1920). Agra and Oudh lost 9.5% of average daily asylum strength directly due to influenza in 1918. All-cause mortality (1918) was highest for mental asylum/s in provinces of Agra and Oudh (16.83%), Punjab (14.83%), and Bombay (14.4%). Isolated outbreaks continued till 1923. Another peculiar finding was markedly reduced sickness and death rates in 1921–1923 compared to 1915–1917, across asylums of all provinces. CONCLUSION: Findings point to a significant impact of Influenza pandemic in mental asylums across several provinces, and provide historical insights with implications for the current pandemic.