From Pale Rider: The Spanish Flu of 1918 and How It Changed the World, by Laura Spinney (PublicAffairs, 2017), Kindle pp. 116-120:
Mashed was still medieval in 1918, but its mud walls were crumbling. It was a city of graveyards where pilgrims who came to die had been buried on top of each other for centuries, and where, from time to time, old graves simply gave out, dissolving into the water supply. This took the form of man-made channels called qanats, that brought the water into the city from the nearby mountains. The water flowed uncovered down the middle of the main street–a permanent throng of pilgrims, merchants, camels and mules–and in the absence of a separate and enclosed sewage system, was easily contaminated. Germ theory had made its mark in Persia by 1918, but only in the literate 5 per cent. When it came to water, most people were guided by a religious prescription according to which water was clean if it was flowing, and if its volume exceeded one korr (350 litres). They therefore washed their pots and pans, their donkeys and themselves, very close to the open qanats.
Because Mashed was a holy city, the shrine managers wielded great power–not only spiritually, but also financially, since the shrine owned large amounts of real estate. In 1918, Islamic thinking was still based on ninth-century teaching when it came to epidemics. It accommodated the concept of contagion, but only up to a point. The general rule was that those inside a plague-stricken area should not flee, while those outside it, who were still healthy, should keep away. But there was also a fatalistic element to the prescriptions: plague was a martyrdom for believers and an agonising punishment for infidels. When sick, the vast majority of Persians turned to hakims or herb doctors, who followed two apparently complementary systems of medicine: the Galenic, and one that held that the Quran offered the best protection against disease. They might put an illness down to a humoral imbalance and recommend a change in diet, in line with the first; or they might identify the cause of the illness to be the sting of a jinn, and recommend strapping a prayer to the arm, in line with the second.
Qavam wrote to the shrine managers on 18 September, asking them to implement the recommendations. He was asking them to suspend centuries-old traditions, potentially even challenging sacred texts, and he must have anticipated the possibility of a rebuff, but his famous powers of persuasion saw him through. … Graves, he ordered, should be at least one metre deep. After the corpse had been placed inside, it should be covered with a thick layer of earth and lime, ‘to eliminate the risk of noxious air rising from the corpse’. Anyone who failed to obey the new rules would be severely punished.
It was a breakthrough, of sorts, though not one that was likely to rein in an illness of winds–and certainly not at that late stage. The epidemic ran its natural course in Mashed. The worst was over by 21 September, by which time Khorasan and neighbouring Sistan provinces were thoroughly infected, and the flu was travelling west to Tehran at the speed of a ‘prairie schooner’–the American nickname for a diligence. [Americans call the diligence a stagecoach, not a prairie schooner.–J] From Mashed, it rippled out with pilgrims, merchants and soldiers to the four corners of the country. By the end of September it was almost gone from the city, though it was still depleting outlying areas. At that point, life for Mashedis eased in one way and one way only: raids and attacks on pilgrims became rare. Qavam’s policy of zero tolerance towards bandits may have begun to bite, but the hiatus was probably also an ominous sign of the havoc the flu had wrought in the mountains.
In a city with fewer than a hundred hospital beds, some 45,000 people, or two-thirds of the population, had come down with flu. An insight into the state of mind of the survivors–not only in Mashed, but in Persia as a whole–is provided by the words of the city’s chief astrologer, spoken at a public meeting towards the end of September. Astrologers were essentially mystics to whom Persians turned in times of crisis, and whose credibility was bolstered by the Islamic belief in predestiny. The chief astrologer relayed prophecies made a few days earlier by his counterpart in Tehran, to the effect that the British government would be annihilated the following year, 1920 would see the return to Persia of the current shah’s father, who had been deposed in 1909, and 1921 the return of the Mahdi, the long-awaited Twelfth Imam, who would rid the world of evil.
Qavam survived the turbulence of General Reza Khan’s British-backed coup in 1921, and finding favour with the new shah, went on to serve five terms as the country’s prime minister. The shah eventually rebuilt Mashed on a rectilinear plan, linked it to Tehran by a modern road, and demolished its graveyards. Hoffman, who stayed on there until 1947, witnessed the transformation: ‘The bones of centuries were shovelled into wheelbarrows and dumped into unmarked pits, the gravestones being used for street curbs and sidewalks.’