The British Government was, at the time, buying rats alive at some fraction of a farthing a head. They had already purchased 25,000 in the town when I was there, and everywhere one met industrious Hindus carrying rats in cages to the official rat-collector. Whether the price was high enough to induce industrious Hindus to breed rats for the British market, I do not know. But I believe it was found that the reduction of the rat population gave the survivors such increased vitality that never had such active and powerful specimens of rat been seen before.
There is no very strict rule about the season for plague. Sometimes it comes in the rains, sometimes in the drought. Usually it is worst at the end of winter, but in 1907, when nearly 70,000 people died in a week in the Punjab, it was approaching the height of summer. As a rule the season lasts three months, and in bad seasons at Poona the cases go up to 100 a day. While I was there, the rate, as I said above, was comparatively low—only 12, 15, or 20 cases a day. But in the Presidency of Bombay, as a whole, people were dying by 7000 a week, and that seems a good deal, even though the population of the provinces is 18,000,000, including Scinde. The British Isles count for more than twice that number, but if we began dying of plague by 7000 a week, I dare say there would arise such a commotion for escape as when you stir up an ants’ nest with a stick.
In Poona the Government had erected rows of tin huts as a hospital on some vacant ground just beyond the railway station, and there I was able to observe cases of the pestilence in every stage. There were from 80 to 100 men, women, and children admitted as patients, and the men and women were laid in separate rows. But otherwise not much difference could be made between the patients as to caste and habits, though some of the Brahmans had their food sent in from outside when they were recovering, like first-class misdemeanants in our prisons. It is rather peculiar that the Brahmans offer least resistance to the disease, and this the Sister-in-charge attributed to the strictness of their vegetarianism for ages past. To Europeans it is less fatal than to any Indians, but, next to Europeans, the lowest or “sweeper” caste, who will eat anything anyhow, almost like Europeans themselves, are the best patients, and show the most recoveries. There may, however, be other reasons for this difference besides the food—I mean the natural hardiness of the labouring class, and the natural tendency of all highly organized and sensitive beings to collapse under fever.
Each patient in hospital lay in a separate cubicle, and mothers or other relations were allowed to visit and sit there. A plague-stricken mother might, I believe, even bring a young child with her, so great was the confidence in the new theory of infection and in the absence of rats. The stories of instant and unavoidable contagion in other plagues, such as the plague of London, seem to separate those diseases in kind from this bubonic plague; but very likely the stories were not true, or what was considered to be contagion was in reality an underlying common origin.
It was some comfort to a mother to be allowed to watch her thin, bright-eyed child panting its life away, but the absorbed intensity of her watching, as a rule, had not to continue long. The disease begins with violent headache and a rapidly increasing temperature; the breath becomes terrible, and the tongue chalky white or bluish. There is a strong objection to taking food or drink, and milk is often spat out by a spasm in the throat, as in hydrophobia. Delirium supervenes about the third day and usually lasts to the sixth, when most patients die. During the delirium there is an extreme desire to get up and walk about, so that many patients have to be strapped down to their beds. Far the most important thing is to keep the patient absolutely still, as death most frequently comes from collapse of the heart, and recovery depends almost entirely upon the patient’s constitutional power of heart action. An English lady, who had come through the disease, told me that even during the delirium she seemed to be dimly conscious of the strain on the heart; but this memory may have been only suggestion. I think the delirious patients that I saw would be incapable of remembering anything of those three days, even if they recovered.
Meantime, in their benign efforts to work off the poison in the blood, the glands have from a very early stage developed into hard lumps that usually suppurate and have to be incised, but sometimes absorb without operation. When I touched the glands in the groin, they felt like walnuts under the skin, and it is, as I said, the presence of this obvious symptom which gives the plague its characteristic name of “bubonic,” from the Greek word for groin. After incision, the patient’s temperature often goes down rapidly, but, in any case, the pain from the glands is usually very great; indeed, I think it is the chief cause of such pain as the plague gives.
Next to heart failure, the commonest cause of death is lung complication after the crisis of fever is passed. The prostration when the temperature begins to decline is usually extreme, and some patients whom I saw were so emaciated that they appeared to be parodies of famine—legs and arms like sticks, back and ribs like frameworks of bone. It is true that probably they were not very fat when they went into hospital. The delirium often leaves the patients silly, and if I had been in Central Africa again, I should have said at once that several of them had sleeping sickness in the third or fourth month—the time when, in sleeping sickness, the control over the emotions begins to fail. The nurses in the hospital were Indian women, under the direction of a European Sister.[13]
While I was still in Poona, Sir George Clarke, the new Governor of Bombay, who was already winning the confidence and respect of Indians in all parties by his straightforward ways and his freedom from official routine, issued a proclamation giving the actual statistics of the plague, and calling on the people to submit themselves voluntarily to inoculation as the only means of defence yet discovered. The proclamation was read about the streets in Mahrati, the people listening patiently, and then reflecting. Many Indians have a feeling against inoculation, just as thousands of English people have. They regard it as some sort of contamination, even when it is voluntary, and the memory of an old error in the serum that poisoned a village dies hard.[14] There is also a certain amount of national and even religious prejudice on the subject. The thing is European; it does not fit in with Hindu tradition, and Mr. Tilak, the most powerful political and religious force in Poona, was known at that time to oppose it. Still, it had been proved that, as a rule, no great harm was done, and, on the off-chance that it might save their lives, many took it. For inoculation there was the further inducement of sixpence bestowed on each patient by a considerate Government, so as to tide over the two or three days’ gentle illness that usually follows the operation.
A Village Street.