The Virulence of Poverty - The Monster at Our Door: The Global Threat of Avian Flu - page 10

to England and wartime requisitioning practices undoubtedly contributed to price inflation and food short-
ages as well.) In September, as the famine was worsening, the second—more deadly—wave of influenza
arrived, again via Bombay. 39
What followed was the kind of chain reaction (or positive feedback of disasters) that has become so
familiar in the history of the modern Third World. “In Bombay Presidency,” writes Mills, “the severe
second [influenza] wave came at the time of the harvest of the early crop, and sowing of the late crop.
With morbidity estimated to be in excess of 50 percent of the population, and with the concentration of
severe attacks in the most productive age range, 20-40 [years], the effect on agricultural production was
extreme.” The area of grain production decreased by one-fifth while staple food prices doubled. 40 The
“absolute lack of any public health organization redoubled infection's impact upon the famished popula-
tion.” The Raj heavily taxed the peasantry to support the Indian Army but spent virtually nothing on rural
medicine. (“The Surgeon-General conceded that mortality would have been reduced had it been possible
to provide immediate medical aid and suitable nourishment to those attacked.”) 41 The American mission-
ary Samuel Higginbottom, who was director of agriculture in the state of Gwalior, wrote to a friend that
“influenza has been fearful. Hundreds of bodies daily floating in the river. No official figures have been
published for India as a whole, but in villages in Gwalior State that are under my charge the death rate
during October and November was from 20 to 60 percent. Cholera, plague, and other epidemics from
which India suffers have never shown such a death rate as Influenza.” 42
Desperate refugees from the countryside flooded into the slum districts of Bombay and other cities;
there, influenza cut them down by the tens of thousands, “like rats without succour,” according to the na-
tionalist paper Young India. 43 Mortality, Mills emphasizes, was strictly “class oriented,” with almost eight
times as many deaths among low-caste people in Bombay as among Europeans or wealthy Indians—the
poor seemed to have been the victims of a sinister synergy between malnutrition, which suppressed their
immune response to infection, and rampant bacterial pneumonia. 44 Outside of the crowded urban slums,
flu mortality was generally highest in the famished west of India rather than in the east, where the crops
had not failed.
Presumably hunger played a similar role in influenza mortality in China, the East Indies, and even
Germany, where the Allied blockade had reduced the caloric intake of the urban poor, especially women
and children, to dangerous levels. Certainly, every writer on the pandemic has noted its particular affinity
for poverty, substandard housing, and inadequate diets. The slum districts of port cities, from Boston to
Bombay, seemed to offer especially favorable conditions for spread of the pandemic in its more virulent
form. 45
The pandemic also formed lucrative partnerships with other epidemic diseases. Iran was a grim case
in point: according to a careful study by historian Amir Afkhami, the nation of 11 million suffered the
greatest relative mortality of any major country, between 8 and 22 percent of the total population. The
pandemic hitchhiked the military supply route from Bombay to the British occupation force in this sup-
posedly neutral country. Iran was already reeling from several years of drought, famine, cholera out-
breaks, and the depredations of marauding armies. In addition, the British had callously aggravated the
famine by requisitioning the grain surplus from the large estates, leaving little for a hungry population.
Writes Afkhami,
At the dawn of influenza's outbreak in Iran in the spring of 1918, grain supplies were at a low
point, and prices had already more than doubled from the preceding six months (when they had
reached a ten-year peak). This scarcity continued even following the spring harvest, and villagers,
especially in the southern and central provinces, were scarcely surviving on millet-meal and ber-
ries. . . . As if starvation were not enough, in 1918 the Iranian people also had to grapple with a