Mao's Great Famine (43 page)

In these conditions, it does not come as a surprise that few if any medical experts were inclined to spend time in famished villages armed with scalpels and test tubes, trying to establish the determinants of mortality. The countryside, where most of the people died, was cut adrift. When the extent of the famine was finally recognised in the winter of 1960–1, emergency centres were set up in abandoned cow sheds or disused farms to help the starving. In Rongxian county, Sichuan, those brought in were dumped on a thin layer of straw directly on the floor. There were no blankets despite the bitter cold. The stench was overwhelming. Pitiful moans of anguish echoed through the air. Some were left without water for days on end – not to mention food or medicine. In Tongliang the living shared beds with the dead; nobody seemed to care.
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In Guanxian things sometimes worked out the other way around: the living were locked up with the dead, as those in charge could not wait for some people to die. Yan Xishan, a mechanical worker suffering from epilepsy, was tied up and left to die in the morgue. Rats had already eaten the eyes and the noses of six cadavers in the room.
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One of the most striking features of the famine is the low incidence of epidemics. Typhus, also called gaol fever, hospital fever or famine fever, was mentioned, but did not seem to kill in large quantities. Transmitted in the faeces of lice or fleas, it appeared in crowded, unsanitary conditions, and was associated with famine, war and cold weather. It was common in detention centres for migrants fleeing the countryside, even in cities such as Beijing and Shanghai.
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Some 10–15 per cent of victims could succumb to typhus, typhoid and relapsing fever in times of famine, but this may not have been the case in China. Could the widespread use of DDT, efficient in pest control, have helped? This is not likely, given that other insects survived the onslaught of the country’s war against nature. As we have seen, locusts actually thrived in a distressed landscape, as did other pests. The rat population, which carried the flea, was culled by the campaigns of eradication launched at the beginning of the Great Leap Forward. But rats breed ferociously fast and are not fussy feeders.

A more convincing reason why typhus, with its rash and high fever ending in delirium, may not have been widespread is that epidemics were rapidly isolated. Here was a military regime which openly denied the existence of famine yet pounced on suspected outbreaks of infectious diseases. This happened, for instance, in the case of cholera, which appeared in Guangdong in the summer of 1961. The epidemic started in early June when several fishermen fell ill after eating contaminated seafood. Within a matter of weeks thousands more were infected, and soon well over a hundred people were dying of the disease. The local authorities used the army to impose a cordon sanitaire around the affected region. While the quarantine could not prevent cholera from spreading as far as Jiangmen and Zhongshan – panic even broke out in Yangjiang – the overall number of casualties remained low.
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Plague, too, spread to an area the size of a province in March 1960 but seems to have been contained.
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But other major epidemics that historians have come to associate with famine are also noticeable for their absence from the archives. There were higher incidences of smallpox, dysentery and cholera, but there is little archival evidence, so far, of millions being swept away by major epidemics. And the official gazetteers published decades after the famine by local party committees do not mention them frequently either. On the contrary, where disease is mentioned the set sentence is invariably that ‘deaths by oedema caused by inadequate nutrition were high’.
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The picture which emerges from the record is that of a country in the grip of a whole variety of diseases, rather than suffering from the impact of two or three epidemics historically associated with famine alone. And this wide-ranging increase was as much due to the destructive effects of collectivisation on virtually every aspect of daily life, from crowded kindergartens, filthy canteens and hazardous workshops to under-equipped, overcrowded and understaffed hospitals, as it was a consequence of widespread starvation per se. In Hunan some 7,500 children died of measles in 1958, twice as many as in the previous year, as families were forced to leave their offspring in congested kindergartens. Cases of polio were fifteen times higher in 1959 than in 1958. The incidence of meningitis doubled, attributable, again, to disastrous conditions in boarding kindergartens.
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Snippets of information from other regions confirm this trend. Thousands of cases of meningitis, for instance, also appeared in Nanjing in the winter of 1958–9, claiming 140 lives.
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The rate of diphtheria also increased hugely, causing seven times more deaths in Nanjing in 1959 than in the previous year.
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Hepatitis soared, but tended to affect privileged city residents rather than the impoverished masses in the countryside. In the cities of Hubei one in five suffered from the disease in 1961. In Wuhan alone some 270,000 out of 900,000 people tested positive.
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In Shanghai too the number of infections was high enough to prompt some state enterprises to request special medical facilities to treat the illness.
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Malaria was endemic. In the summer of 1960 up to a quarter of all villagers in parts of Wuxi suffered from the disease.
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Snail fever, or schistosomiasis, caused by a parasitic worm that attacks the blood and liver, was prevalent. There were thousands of cases in many a county in Hubei, where people came into contact with freshwater snails when wading barefoot through irrigated rice fields or when they went fishing. In Hanyang, hungry factory workers descended upon the many lakes surrounding the city to cut barley in the summer of 1961. Three thousand people were infected, a dozen died.
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Hookworm, which sucks blood so voraciously that it leads to anaemia in the host, was common, even though reliable statistics remain elusive. But the problem was serious enough for the health authorities in Hunan to set a target of curing 3 million infected people in 1960 – in a mere eight counties.
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Everywhere the effects of collectivisation led to higher rates of illness. We have seen how people died from the heat of the backyard furnaces during the iron and steel campaign in 1958, but in the following years heatstroke continued to claim lives. Malnourished and exhausted workers were exposed to high temperatures all day long, and in Nanjing dozens of cases of heatstroke, several fatal, occurred in just two days in the summer of 1959.
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In Hubei even simple straw hats were lacking, but cultivators were compelled to work at noon in the blazing sun. Thousands suffered from the heat, some thirty cases being fatal.
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Even leprosy was on the increase. Caused by a bacterium that leaves permanent damage to the skin, nerves, limbs and eyes, it spread because of inadequate care, contaminated water and insufficient diet. Hospitals were creaking under the workload, turning away leprosy patients. In Nanjing some 250 cases were hospitalised, but lack of resources meant that they could not be segregated from other patients.
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Well over 2,000 lepers were known to exist in Wuhan, but a severe shortage of hospital beds condemned them to roam the city, scavenging for food.
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Lepers in the countryside could be less fortunate. In Qigong commune, Guangdong, a sixteen-year-old boy and an adult, both suffering from leprosy, were escorted up into the mountains and shot in the back of the head.
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Mental illness, however difficult to define, was widespread, no doubt because the incessant depredations of the state combined with widespread loss, pain and grief to drive famished people to insanity. Few meaningful studies were produced, but one Huazhou commune in Guangdong claimed that more than 500 villagers suffered from mental illness in 1959.
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In one curious case of mass hysteria, a third of some 600 students in a middle school in Rui’an county, Zhejiang, started crying and laughing without apparent reason in May 1960.
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Similar reports came from Sichuan, where hundreds of villagers in several counties went berserk, talking gibberish and bursting out in convulsive laughter.
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One estimate placed the national rate of mental illness at one per thousand, but as the case of Huazhou shows many more people must have been unable to cope with the sheer violence of collectivisation and the horror of famine (that much is clear from very high rates of suicide, as we shall see in the next chapter). In any event, few were ever cared for, as the medical authorities had other priorities. In Wuhan, for instance, some 2,000 known cases had no access to specialist care, as a mere thirty beds were available for psychotic cases in the entire city.
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Even when they were badly treated, the mad had one advantage: like the court jester, they got away with telling the truth. As one survivor from the Xinyang region remembers, only one man dared to mention the famine in his village, walking around all day in a craze, repeating to all and sundry a popular jingle: ‘man eats man, dog eat dog, even rats are so hungry that they nibble away at stones’. Nobody ever bothered him.
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Major epidemics usually associated with famine did not afflict the countryside in China. Instead the destructive effects of collectivisation increased a whole range of illnesses, including poisoning, as people took to famine foods. Some could be quite nutritious – edible kelp eaten in Ireland during the potato famine of 1846–8, or tulip bulbs in the Netherlands during the hunger winter of 1944–5 – but many led to digestive diseases.

Even before people started scrounging for edible roots and wild herbs, digestive problems could appear, caused by severe imbalances in diet. Urban residents were sometimes given a much higher proportion of pickles, salted vegetables and fermented bean curd as substitutes for fresh greens. In Nanjing, for instance, many factory workers had a salt intake of thirty to fifty grams a day, almost ten times the amount that would be recommended today. They added soy sauce to hot water to break a monotonous diet. In one case a man was found to have ingested some five litres of soy sauce in less than a month.
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But large amounts of leafy vegetables without sufficient carbohydrates also caused ill-health. When grain rations ran out by the end of the month and hungry people resorted to fresh produce instead, their skin would sometimes turn purple and they died, victims of phosphite poisoning. Dozens of fatal cases were reported in the countryside around Shanghai in 1961.
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Poor hygiene in the food industry caused diarrhoea outbreaks that claimed the weak and vulnerable. The chaos sown by collectivisation was felt at every level of the food-supply chain, as the state took command of production, storage, processing, distribution and catering. Food became just another output figure to be massaged, twisted and faked by factory bosses, while apathy, neglect and sabotage were common among workers. In Wuhan food poisoning was frequent in the summer of 1959, with hundreds of incidents being recorded every couple of days. Heat in the sweltering summer played a part, but a detailed investigation of six food producers identified widespread neglect as the main culprit. Flies were everywhere: one zealous inspector counted about twenty insects per square metre. Jugs and vats destined for the market had broken seals, their contents wriggling with worms. In one factory maggots were found in 40 tonnes of jam and maltose. Rotten eggs made their way into cakes and candies. There was no water on many of the premises, so workers did not wash their hands; some urinated on the floor. Once the foodstuffs reached the market, they rotted away in humid weather.
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A further problem was that many of the ingredients no longer came from the suburbs but were shipped over long distances instead. A batch of carrots from Zhejiang province, for instance, had rotted during transportation to Wuhan. And then the human and material tools for handling food were grossly inadequate. The pedlars who previously reached every corner of the market with fresh produce had been absorbed into a lumbering collective, while a sixth of all vegetables rotted in the streets simply because there were not enough bamboo baskets to distribute them.
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In the canteens the situation was no better. Flies were found in the food, while even basic utensils were missing. In one case 300 workers had to share thirty pairs of chopsticks during breakfast, which were rapidly rinsed in a washbasin filled with dirty water. Restaurants offered no escape from the cycle of neglect. The kitchens were described as chaotic, governed by flies rather than by people. When the flies were swatted they dropped into the food. In one eating place the vegetables were served covered in dirt. Insects were found in the vinegar and soy sauce containers.
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These examples are all from the cities – where people were relatively privileged in comparison to the abysmal conditions in the countryside. Since all the food was concentrated in large canteens, entire villages were affected by outbreaks of diarrhoea or food poisoning. In Jintang county, Sichuan, the thin gruel served to the 200 farmers in one canteen contained dozens of maggots. The reason was that the well used by the canteen was adjacent to a toilet, and drainage was poorly divided, in particular after heavy rain. Those who refused to eat the gruel went without any food for three days. The few who managed to down the concoction suffered from severe stomach pain. Dozens were taken ill. Ten died.
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Four vats with human excrement and urine, their contents spilling on to the floor, were found in a kitchen in Pengxian county. The water used to wash the food and dishes came from a stagnant pond by the doorstep. A quarter of the villagers were sick. Flies lorded it over people.
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In Jinyang, also in Sichuan, ‘chicken excrement is everywhere, human faeces have piled up, ditches are blocked and the stench is overwhelming’: local people referred to the canteen as ‘shit alley’.
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Even when there was food, canteens could run out of fuel or water. In Chengdu, where several branches of the Yangzi merged, some of the cooks had to travel half a mile to find water, and the grain was sometimes served raw.
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But in many cases, of course, the canteens did not operate at all. After they had run out of food and fuel, the doors were closed and villagers had to fend for themselves.