THE PLAGUE

From Overland to India, vol. 2

By Sven Hedin

Who has not heard of the Black Death which spread in the fourteenth century from its original home, Asia, over Europe, devastating enormous stretches of country, and even in certain parts of Sweden almost exterminating the population ? From certain old-established centres in the Old World this terrible epidemic seems, time after time, fortunately at long intervals, to have found its proper soil in human bodies, or rather the conditions under which men lived in certain districts were favourable for its propagation, and it spread slowly but irresistibly over wide areas. About twenty years ago China suffered from such a plague period, and in 1894 the disease reached Hongkong, and afterwards spread westwards to India, where it remained for a space of years. Especially in 1896 and 1897 numbers of people in India were carried off by it, and during nine years the plague had seized as many as three million victims.

But with regard to the plague and other great epidemics which have their roots in Asia, a wide field is open for all kinds of speculations. Are plague and cholera necessary evils, a means in the hand of nature to check the increase of the human race upon the earth? And if the number of human beings increases in the course of time, will these epidemics and their ravages increase at the same rate ? It is a triumph of science to be able to check and suppress the spread of pestilence by means of serum; but is it an advantage to the human race as a whole that a natural weeding out should take place from time to time? The plague last raged in the seventeenth century; for more than 300 years the germs had lain quiescent. Why did they become active now and spread among men and animals over so large a part of the world ? These and many other questions relating to the plague are still unanswered.

Now Seistan was having its turn. As far as was known, and there was every reason to believe it to be true, the first case occurred in November 1904. Then the epidemic spread during the winter with such virulence that the Government despatched a doctor with Hindu assistants to Seistan, partly to observe the disease on the spot, partly also, and more especially, to do all that was possible to prevent it spreading westwards. For if from Seistan it got a firm hold of Persia, Europe also would be in danger.

The physician chosen was Captain Surgeon Kelly, who had been shortly before General Macdonald's staff surgeon on Younghusband's memorable expedition to Lhasa. During my stay in the English Consulate I had then an inexhaustible subject of conversation with Captain Kelly. He gave me much interesting information about Tibet, and much advice which was afterwards of great service to me. But what, under the present circumstances, was more interesting to me than anything else was to listen to his experiences of the plague in Seistan.

The belt of reeds round the Hamun is called Nesar. In that part of it which lies north-west of Nasretabad lives the Seiyat tribe, the members of which do not marry outside their tribe. It was among them, in November of the preceding year, that the first case of plague occurred, in the village Deh-Seiyat-gur, where a cowherd, Meshedi Hussein, sickened and died.

Captain Kelly had marked down all the villages where cases of plague occurred on a large-scale map, and had put down also their dates. By collecting notices from all directions and corners he had been able to follow the geographical distribution of the plague, and he called the village just mentioned its primary focus. From this it spread in three directions,-east-north-east, south-east, and south-south-west.

Two Belgian gentlemen, in the Persian service, were thensuperintending the Persian customs on the frontier Baluchistan. They were also officially instructed to assist in checking the plague. After several difficulties they succeeded in their endeavours. They persuaded the inhabitants to burn the clothes of the dead, their huts and household furniture, in fact, everything that had come in contact with those who had been stricken by plague or died of it. In return, they distributed new clothes to the heirs and provided them with means of building new reed hut By these means they stopped the plague in its progress in two of the above directions.

In the third direction things were worse. The plague was carried by thirty-eight fugitives from Deh-Seiyat-gur to Pusht-i-Kuh-i-Khoja, where thirty-five of the fugitives died after letting loose the microbes in the latter village. The corpses were buried, not in the village, but in a burial ground between it and Deh-gurg, situated farther to the east. A mollah and several relations from Deh-gurg attended the funerals, and on returning to their village carried the infection with them, and also infected all the camps and villages on the way. The village Pusht-l-Kuh-i-Khoja is inhabited by Seiyats, but, unlike their northern fellow tribesmen, they marry outside the tribe, particularly with the inhabitants of permanent villages in the delta country on the east. Therefore their connections came to be present at the interments. Pusht-i-Kuh-i-Khoja became, therefore, a secondary focus from which the plague continued its victorious march through the country. The small, poverty-stricken village Deh-gurg had only 170 inhabitants, and of these I50 had died at the time of my arrival in Seistan, but yet the 20 survivors remained in the dreadful, infected village. Before I left I heard that these 20 were either dead or had left, and Deh-gurg was empty and desolate.

Deh-gurg became, then, a third focus, whence the disease spread northwards to Daudeh, if this village did not receive a secondary immigration of microbes direct from Pusht. At any rate, the village had 450 inhabitants, among whom the plague raged most horribly. The people were opposed to European ideas, and permitted no preventive measures. Therefore most of them died. According to one version, the infection was carried to Daudeh by a peasant who had been to Pusht to buy feathers and wildfowl.

When the epidemic had spread in all directions and threatened the whole country, and when whole villages had died, the authorities were induced to draw a cordon of several hundred soldiers round the infected area to localise the pestilence, and cut off all connections. But Persian soldiers are well known. They had as little conception of the danger as the rest of the people, and did not obey their instructions. Two of them betook themselves to the unfortunate Daudeh, and ate their dinner in a house where a man had ust died of plague. Both died. What can be expected of other people when the guard, instead of stopping the disease, contributes to its spread ?

Furthermore, the soldiers soon grew weary of this service, and wanted to go to their homes in Eastern Persia. The authorities thoughtlessly gave way, and granted their request, and thus the whole country was exposed to danger. We afterwards heard reports of cases of illness in Turbet-iHaidari, but they fortunately turned out to be exaggerated.

The plague reached Pusht in the beginning of January. Now, when the cordon of soldiers had been removed, all Seistan lay open to the disease which spread by invisible means in all directions from village to village. At last it reached, three weeks before my arrival, the twin town Nasretabad-Husseinabad. Owing to superstition, suspicion of Europeans, and a reluctance to give an account of themselves and their affairs, Captain Kelly had met with great difficulties in his attempt to trace in detail the paths of the disease through the country, and many reports he had been unable to check. Nevertheless, he had been able to follow its progress in the main, and his plague map was of exceptional interest and of the very greatest value as a contribution to our knowledge of the disease. The villages on the lower Hilmend were still untouched, but they are separated from the infected country by an uninhabited region.

Captain Kelly said that no better geographical conditions for hemming in and localizing an epidemic could be conceived : the river to the east, to the north and west the Hamun, and a desert on the south. Here the evil would be as in a rat-trap if all entrances and exits were blocked. In the worst case the whole population might perish, what were a hundred thousand persons compared to all Persia? And if the plague came so far the whole world would be opened to it, and no one could tell where it would end.

One question Captain Kelly, with all his zealous efforts, investigations, and inquiries had not been able to answer, and that was, How did the plague come to Seistan? How did the infection first reach Deh-Seiyat-gur ? Seistan was surrounded on all sides by unaffected country, and Karachi more than 600 miles distant was the nearest plague-stricken place. Three routes only were imaginable: by land, water, or air. By water it could not come, for the Hilmend descends from invigorating highlands, and its water remains in the Hamun. It seems that it could not have come by caravan, for the people of Deh-Seiyat-gur were poor, and bought no goods from Hindustan, at besides, a caravan takes nearly two months to travel from Nushki to Nasretabad, and if it carried the disease, places on the road would be infected, which was not the case. Infection is not carried through the air, for in India it is found to spread quite independently of wind.

There remain, then, birds of passage, and it was these that Captain Kelly's suspicions rested. He thought of the ducks and geese which fly from India to Seistan, perhaps after coming into contact with a corpse thrown into a river. But here another difficulty arose: wild geese and ducks fly north-westwards from India in the spring, the first case of plague occurred in November. It is possible that the infection was really introduced in spring, but was not propagated till autumn.

Selfish and thoughtless men worked in the interests of the devouring bacilli. The famine which prevailed everywhere enfeebled the people, and rendered them more liable to disease. Under ordinary circumstances large quantities of the grain harvest are bought up by a few rich persons, who then raise the prices to many times the value. The scarcity now prevailing was due in great measure to the failure of the crops in Kain, and large quantities of grain had been sent thither from Seistan, so that the country itself came at last to want. All the poor people, that is, the majority of the population, must either starve to death or support life with soft reed shoots and other plants, and had thus to struggle for life for six weeks more, till the new harvest was ready.

As the unscrupulous rich speculators were deprived of their profits, they stirred up the people against the Belgians, and circulated false reports about them. They asserted that they burned the Koran, and that they burned clothes and dressed the people in new ones, in order to get hold of nicely dressed women, that they did everything to spread disease, exterminate the people, and render it easier for Europeans to take the country.

Then there were the mushtehids and mollahs, the literates and priests who also backed up the movement, and fanned the discontent and distrust. They were afraid lest the people should bestow their confidence on Europeans and unbelievers, and they themselves should lose their influence over the masses. We Europeans were justified in hoping that one or two high ecclesiastics would be attacked by the plague, so that the work for the benefit of the people might proceed unhindered.

Meanwhile these wretches succeeded so well in their wicked purpose that the mob, prompted by hatred and ill-will, made an attack, on March 27, on the Belgian hospital, which was burned down. Then nearly 500 fanatics rushed to the English Consulate, where they behaved in a barbarous and extravagant fashion. Captains Macpherson and Kelly went out to pacify them, but were received with a shower of clods and stones. Then the dispensary was broken into, and all the vessels containing medicine were broken, as well as everything in the shape of furniture, tables, doors, and cupboards. Fortunately as it happened, the serum tubes were kept in another place. One fellow climbed up on the roof to stir up and incite the rest, and the peace-breakers did not withdraw till some revolver shots had whistled through the air. The Consul, Captai Macpherson, sent at once a mounted messenger to Robz in Baluchistan to fetch assistance, and the troops sent to Nasretabad were still there on my arrival.

The immediate consequence of the attack was that the distribution of medicine ceased, for the drugs had been destroyed. Before, all the sick who presented themselves had received medicine gratis. The people, therefore, began to see how foolishly they had behaved, and their displeasure was directed against the instigators and leaders of the riot.

After that they had been obliged to look after themselves; but in the English Consulate preparations had to be made for another attack. The large store of provisions which usually lay in the warehouse, where it could be easily stolen or set on fire, was moved into the main building: This could soon be turned into a fortress, and from the flat roof, surrounded by battlements, the court would be exposed to fire in case of an assault. The guard of the Consulate consisted only of twenty Indian cavalry soldiers, but they were, like the six Sahibs, well armed.

One must, however, forgive the misguided and ignorant people who, brought to despair by famine and plague, knew not what to believe. They could not understand why Europeans, without reward, nay, with considerable sacrifice to themselves, came to their aid with advice and active assistance. They could not believe that it was simply from feelings of humanity and philanthropy. And., when their own educated men and priests assured them that Englishmen laid out trade roads in Baluchistan soley to introduce the plague into the country, and that under pretence of distributing medicine they only spread poison, it was certainly no wonder if the poor people were irritated. Moreover, they saw how they themselves were decimated, while the Europeans were immune-not a single European was attacked by the plague. The Governor, Mir Mohsin Khan, ran about like an idiot from village to village, flying from the plague, and the colonel of a regiment intended, it was said, to remove to Kuh-i-Kho.ja, as if the plague could not reach him just as well there. A recrudescence of the plague and famine might at any moment produce a general panic, and the frenzy would, first of all, vent itself on Englishmen. Therefore, it was evidently necessary that a large quantity of provisions must be stored in the Consulate, and even this might be a temptation during famine.

Under normal circumstances the small double town has 7000 inhabitants, 2500 dwelling in Nasretabad and 4500 in Husseinabad. In these two closely - packed, insanitary, poor, and dirty communities, the Angel of Death had now established his headquarters. The day before my arrival 35 cases had been reported, io of which resulted in death. On April 10 there were eleven deaths ; on the 13th, 13 ; on the 14th, 15 ; and the plague seemed to be making progress. The reports were, of course, not made up till the following day. On April 17, 8 deaths were reported after eleven o'clock on the same day. But the natives themselves hardly ever reported the deaths of their relations and friends. In the English Consulate information was obtained by means of spies and from merchants from India. The burial-grounds were also watched, but this means was little reliable, for the natives, expressly to conceal deaths, buried the corpses anywhere, and the interments were generally carried out at night. Englishmen, therefore, took it for granted that the actual numbers of deaths were much larger than reported. At any rate they were excessive for so small a town, and, besides, large numbers of people had emigrated. In Husseinabad it was estimated that only about 2000 inhabitants were left. Nasretabad was practically evacuated, only ioo inhabitants, mostly soldiers and beggars, remaining. The town was without administration, all the shops and bazaars were closed, and the streets were empty and deserted.

Husseinabad presents a conglomeration of cupolas and walls, square houses and windmills, all grey and colourless, seldom relieved by a little verdure, some poor garden with mulberry and apple trees well sheltered by walls from the strong summer wind.

Nasretabad is of a quadrilateral form, somewhat longer from north to south than from east to west. It is surrounded by a mud wall and a moat filled with water. Here also are a couple of gardens and palms. One feels depressed after a walk through this unfortunate, devastated town. To reach it you go westwards from the great gate of the Consulate, and pass a kind of square between the two towns. To the left are first some plague-smitten huts, and to the right the English bank within its own wall; beyond that the whole southern side of the town wall of Nasretabad with round towers at the corners and in the sides. Farther off to the left is a long, low building, in much the same style as the Consulate, containing the shops of English subjects, and still farther off the warehouse of Russian subjects.

We enter by the south gate of Nasretabad, where some emaciated and pitiable beggars hold out their hands. Here begins the principal street which runs right through the town from gate to gate, and in which the bazaar shops are situated. The street is narrow, dusty, and dirty, a horrid ditch full of sweepings and offal, and the only people we meet are dingy soldiers and beggars who can hardly keep their rags on their bodies. The town is so small that it takes only a few minutes to cross. In the north-west corner is the ark or Governor's residence. Everything seems in decay, wearisome and miserable. I would not spend a single photographic plate on it. Even the residence was empty and desolate, for the Governor had left it, taking with him his whole staff of servants and ferrashes.

And yet this den at that time deserved a large measure of the world's attention. In political affairs Seistan is of great interest, owing to the secret rivalry or contest for influence between England and Russia. The country half-way between India and Teheran, and between Transcaspia and the Persian Gulf. Strained relations may at any time reach an acute stage, and the struggle may begin at Seistan.

More fearful, however, was the danger that the bubonic plague might extend from Seistan. After the report that Turbet-i-Haidari was infected, all seemed to be in favorable for the spread of the pestilence westwards. If it reached Meshed with its 150,000 pilgrims in the year the disaster was certain. Then by the numerous routes radiating out from this town the whole Mohammedan world in Western Asia would be attacked, and it would be hopeless to stem the course of the disease. How much better it would have been to stop infection at Seistan! Fortunately, the pestilence did not this time spread farther west, but it might easily have done so, and then the Persian authorities and, above all, the priesthood, would have been to blame for the incalculable misfortunes which would have resulted.

The plague is less mysterious than cholera in its behaviour in so far that its propagation can be explained. If it is introduced into a family and seizes its victims, it does not leave the house till all the inmates are dead. Cholera, on the other hand, may attack and kill one member of a family and spare the rest. Cholera is more insidious and uncertain. As regards the plague, it is known that an absolutely isolated house can be protected, while all that dwell in the immediate neighbourhood of the sick are doomed. The spread of the disease can only be combated by the most energetic measures. In an infected house, or rather mud cabin, fuel should be strewn on the earthen floor and lighted. The mud walls can only rendered safe by a heat of several hundred degrees. All clothes and household goods should be thrown into the fire, and thus the infection may be stamped out. With fire the spread of infection in the northern Seiyat villages had been successfully checked.

Captain Kelly had visited many plague-stricken persons. He said that the patients suffered fearful tortures, became apathetic and indifferent, and desired only to be left to die in peace. The parts of the body where the buboes break out are especially painful. If the bubo burst in time the patient may recover. But if the pus penetrates by an internal wound into the lymph glands and blood, death soon ensues. Pneumonic plague, that is the form of disease which attacks the lungs, is almost always fatal, because the microbes are there safe from the cells which destroy them. The doctor is more exposed to danger near such a patient than anywhere. All that is necessary to give him the disease is that the patient should cough and the smallest particle of expectoration light in the doctor's eyes, where the microbes can thrive in moisture. If he has the smallest scratch in the conjunctiva caused, for example, by a minute grain of sand, the microbes enter and do their work.

Rats contribute greatly to the spread of plague, and this was also true of rats in Nasretabad. They die of plague themselves, and their parasites spread. When a rat dies his parasites leave the carcase as soon as it is cold and watch for an opportunity of settling on some other creature near, perhaps a man. I heard from Captain Kelly that dogs are supposed to be immune, but their vermin, dog ticks, may transfer the infection to men, for the microbes live in these parasites. During in Nasretabad my dogs were tied up outside the men's abode, but the doors of the Consulate went out and in as they pleased, especially at meal-times.

Captain Kelly had arranged his laboratory in a fine large Indian officer's tent, set up on a common before the Consulate. A microscope stood on a table, and here I had an opportunity of making acquaintance with the horrible microbes which were exhibited in various preparations. They were dead and stained, and were wonderfully conspicuous. They were really not much to look at - a quantity of small insignificant black specks. And yet these specks are more dangerous to man than the most perfect destructive engines of the modern art, and more devastating than any campaign. I looked at them through the microscope with a certain respect. They were magnified twelve hundred times, and yet were exceedingly minute.

When I expressed a wish to see, not indeed the microbes themselves in their activity, but at least their sphere of work, a dying man, and to observe the symptoms when an unfortunate sinner succumbs in the unequal strife, Captain Kelly peremptorily refused, not so much because of the danger that threatened me from suspicious malevolence, but rather because of the direct danger of infection. I proposed to accompany the doctor when he next visited a patient in a far-advanced stage of the disease and wait will death supervened. But he would not consent, the risk was too great.

"But the risk is just as great for yourself," I returned.

"Yes, of course; but I am only doing my bounden duty in visiting the sick."

"I can accompany you as a temporary assistant."

"No; I will not take the responsibility for your life. When a man dies of plague his vermin emigrate, and those who happen to be near are very likely to catch them, and take the plague with them."

Large quantities of plague serum had been sent from Bombay for Captain Kelly's use. The microbes to be used for cultivations are taken from the bubo of a sick man, and the operation is very dangerous. The operator must be quite sure that he has not the least scratch on his hands, and be careful not to wound himself with the point of the small syringe with which the deadly fluid is extracted. On such an occasion one of Dr. Kelly's assistants had failed to notice a small prick in his finger. He died within thirteen hours.

The yellow serum is preserved in small annealed glass tubes, each containing 5 cubic centimetres, or enough for a single injection. The doctor must make sure that the tube is absolutely perfect and hermetically closed before he breaks off the end and fills the hypodermic syringe, after it has been cleaned and his hands washed in carbolic acid. In Bombay it once happened that there was an insignificant crack in a large glass tube, but sufficient to pollute the fluid. The seventeen persons who were inoculated with serum from this tube all died, an accident the more to be deplored because it naturally shook the people's faith in the doctors.

At first the people in Seistan could not be persuaded to allow themselves to be inoculated, and the priests actually forbade believers to submit themselves to such an experiment. But when the plague spread, and fear and anxiety drove the unfortunates to try any remedy at hand, they came, bared their left arms, let the assistant wash them with carbolic acid, and the doctor run the small fine needle syringe under the skin. Most of them did not believe that this extraordinary process could save them the plague, but they saw at any rate that they suffered no harm from it. Two occurrences fortunately helped the doctor. In one house the man only had allowed himself to be inoculated, but his wife and daughter would not submit to the operation. Both died, while the man escaped. A great impression was made on the people of Nasretabad when the plague visited the home of the Consulate's gardener, killing four members of the family, but sparing the man himself, who had previously been inoculated. Then they perceived that this treatment was the only preventive they could find. The remedy is not, indeed, absolutely certain, but it reduces the cases of mortality by 75 per cent, and that is a splendid result. Ninety-five per cent of the sick natives died.

Immediately on my arrival in Nasretabad I was advised to submit myself to inoculation like the other European residents. The operation took place in a small room in the hospital. A large lump rose on the arm after the 5 cubic centimetres of serum had been forced in under the skin, and a slight burning feeling was experienced. It soon subsided but returned again after two hours. The arm became stiff and difficult to bend, and in the night I had a touch of fever, but nothing to cause discomfort. Next morning I felt nothing at all.

Captain Kelly kept an exact record of all the inoculated. My number was considerably over 400. Of all those who had been inoculated up to that time not one had died. The natives themselves began to take note whether a man who died had been inoculated, and could draw their own conclusions. But still their distrust had not been overcome, and 400 was a trifling percentage of the whole population.

In Husseinabad the natives resorted to the following barbarous remedy handed down from the Middle Ages. The aching boil is covered with a piece of felt. Over this salt and water are poured and a hot iron is pressed on it, and the heat penetrates through the boil down to the muscles. It is certainly a severe remedy against microbe colonies, and the bacilli which come in contact with the iron must surely suffer. Some men who were treated in this manner are said to have actually recovered.

When the epidemic began its work of destruction in Nasretabad the mushtehids and mollahs thought that they could drive away and exorcise the plague demon by parching daily round the town wall with a sacrificial goat the head of the procession. They carried the Koran and read prayers from it; they had music and black flags, or rather a square piece of cloth stretched between two poles, and when the circuit was completed the goat was offered up to Ali. These processions became very popular, and the people believed in their effectiveness. They embodied, so to speak, in the eyes of the credulous the divine powers, and the priests in their white turbans and long kaftans appeared imposing as mediators and intercessors with God. In reality they helped to a large extent spread the epidemic. How many who walked in these processions came straight from plague-stricken houses and gave the infection to those who walked beside them ? Exorcising processions, under the protection of Allah, were nothing but dances of death-a march to the grave.

Afterwards, the processions ceased, not because they were useless, but simply from lack of people and goats. People died instead, and the custom died out; people fled from the infected town, and at length there was no one left who cared or had the means to pay for the goats.

Those who were left resorted to another expedient. The chief mushtehid of the place, Mollah Malidi, collected the people to rosa-kkaiteh, or prayer-meetings, in the square before the mosque which bears his name, Meshid Mollah Mahdi. There tea and kalians were passed round among the guests, and the blinded and obstinate men found another means of spreading the plague by means of gatherings.

The Englishmen tried in vain to bring this Mollah Mahdi and the other priests in Nasretabad to reason. With their assistance it would have been easy to extirpate the plague in a month ; but nothing could be done with them, for their chief aim was not to lose their hold and influence over the people. As far as possible deaths were kept secret from Englishmen, and most of the burials took place at night. When Macpherson and I were out one day for a walk we met some men bearing a coffin, and another time saw men washing a corpse in a pool of stagnant water. Horrible scenes occurred when the poor could not afford burial, and threw the corpses into the street.

The small town possessed only two coffins, and in these simple boxes all the dead made their last journey to the burial-grounds. The coffins were not buried, but served only as biers. At the grave the body was lowered into the ground and placed in a niche or excavation, so that the earth might not weigh on it. The coffins were carried by men, and were naturally another medium for spread infection. These coffins were in constant use, and often went to and fro several times in a night. Interments were more and more carelessly performed, and we heard of two cases in which natives digged their own graves that they might have them ready in time, and might be sure of decent burial, and not be exposed to birds of prey and jackals. There was a certain affecting resignation in this. On April 15, it was reported that at two houses, where deaths had occurred, the inmates had cleared out with all their belongings, locking the doors and leaving the corpses to corruption. It was anticipated that poor wretches would break into these houses and settle in them. We had heard, as far back as April 10, of cases where people did not take the trouble to carry bodies to the usual burial-grounds, but buried them anywhere, in courtyards and fields. On April 11, it was reported that a poor wretch had dragged a body along in the dust of the street and thrown it down before some shops, that their owners might see after its interment.

The fresh, cool weather still prevailing was considered very favourable to plague. It has been noticed in India that plague declines and almost ceases in midsummer. It was, therefore, hoped that the great heat would put an end to the epidemic in Seistan. The reason seems great measure that in cool weather the people remain indoors and crowd together in small stuffy dens. When it is warm the people are more scattered, and the infection is prevented from passing from one to another.

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