Reassessing the Mortality Impact of the 1918 Influenza Pandemic in China

In accounts of the worldwide impact of the 1918 influenza pandemic, China remains a black hole of missing data. In the absence of systematically collected nationwide death statistics, scholars have used scattered and often impressionistic reports to suggest that the epidemic had only a mild impact in China and, in some cases, to raise the possibility that the epidemic originated in China. These works rely heavily on conclusions drawn from anecdotal reports of customs officers, a medical report from Canton, and uncritical use of Shanghai and Hong Kong crude death rates, which are shown herein to be seriously flawed or misstated. This article and its online supplement contribute to knowledge of the influenza epidemic in China by reassessing the available data on Hong Kong, Shanghai, and Canton and assessing hitherto neglected sources on seven majority-Chinese jurisdictions that enforced vital statistics reporting. The results refute the notion of a mild impact and show that the pandemic had an impact in most cases greater than that seen in Western countries like the United States and England and Wales.