In the winter of 1908, a malaria epidemic swept through Punjab, killing three hundred thousand people in around ninety days. Although malaria epidemics were common in the region, the 1908 outbreak was the most lethal in at least forty years: 18 out of every 1,000 residents of Punjab succumbed to the illness. The death toll was even higher in the mud huts of landless labourers, artisans and servants. An official inquiry led by Major SR Christophers, a Liverpool-born doctor, found that malaria infected the rich and the poor alike, but it was much more likely to kill in poor households.
“If we examine in detail any town affected by the epidemic, we shall find the heaviest mortality has been in those classes, which are the poorest and living in the greatest squalor,” the inquiry report, released in 1911, stated. It concluded that “the determining causes of the outbreak were excessive rainfall and ‘scarcity’; the former is an essential while the latter is an almost equally powerful influencing factor.”
“Scarcity” was an administrative term used to denote destitution and famine. That excessive rainfall contributed to spikes in malarial infection was well known to the British administration. That destitution and starvation exacerbated fatalities from disease was not. Christophers argued that the massive incidence of death in 1908 was a function of “compromised immune competence,” which refers to a body losing its capacity to sustain an adequate immunological response under conditions of acute hunger and starvation. “What acute hunger means is insufficient food below the requirement of the basal metabolic rate—the level below which the body starts using its own storage,” Sheila Zurbrigg, a physician and malaria scholar, told me. “At this stage, the body starts to waste away because it has to survive.”