g(^.l1^. Ih2 In 2r mtI)eCttpof3lmgork CoHese of ^fjpsiiciang mtt burgeons Hibrarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge. Commons http://www.archive.org/details/plagueinindia18901nath GOVERNMENT OF INDIA. HOME DEPARTMENT. THE PLAGUE IN INDIA, 1896, 1897. Compiled by r. Nathan, INDIAN CIVIL SERVICE. Vol. L SIMLA; PRINTED AT THE GOVERNMENT CENTRAL PRINTING OFFICE, 1898. ^t>\cc fct dd c| 4 voU,, ^>. 15, on 5l-«^. GOVERNMENT CENTRAL PKINTING OFFICE, SIMLA. 03 CONTENTS. CHAPTER I. Introductory. pages Period covered by the report— Main object of the report— Mode of treatment of the subject and brief summary of the contents of the chapters— Appendices ....... i 2 ;?- CHAPTER H. f^ Description of Plague : its Causes and Characteristics, V Cause and nature of plague— Plague due to a specific bacillus— De- ^ scription of the bacillus— Its action on the human organism, and ^ the forms of disease it engenders— The plague bacillus a septicae- mic microbe — General characteristics of septicsemic microbes — Similarity between plague and anthrax— The three main forms of plague— classification of different forms of plague based on symp- toms— Symptoms of plague— Descriptions given by Hirsch and Yersin and description contained in General Gatacre's Report — Mortality -General statistics— Mortality in plague hospitals- Mortality during the Hong-kong epidemic — Signs after death — Bacteriological examination of different forms of plague : simple I bubonic, septicsemic and pneumonic — Difficulties of diagnosis — Scheube's remarks— Failure to detect the existence of plague in Bombay— Difficulty in diagnosing cases experienced in Bombay— Special difficulty with regard to pneumonic cases- Cases incorrectly diagnosed as plague— Important instance which occurred at Calcutta— Period of incubation— Conclusions from former epidemics — Ten days' period adopted for practical purposes in the Venice Convention— Experience derived from segregation camps during the present epidemic — Predisposing and protective circumstances in the individual— Occupation, race, age, sex— Second attacks — Dissemination of the bacillus from the sick — Different degrees ofdanger from different forms of plague — --5V- The plague bacillus in nature — Summary contained in the report Aj of the Technical Committee of the Venice Sanitary Conference— "i^ Account given by Dr. Bitter— Experiments on the vitality of the bacillus made by the German Plague Commission and Mr. Han- kin — Possibility that the bacillus may retain its vitality for a con- siderable time in a moist condition — Instance from the Wetljanka epidemic— Instance from an ocean liner during the present epi- demic — Action of chemical disinfectants on the bacillus — Vitality of the bacillus in food-stuffs and corpses— Mode in which the bacillus enters the system — Difference between the observations recorded at Hong-kong and Bombay— Infection through the broken skin, tonsils, intestinal tract and lungs— Infection through the broken skin without local reaction— Experiments made on I Ob Contents. monkeys by the Russian Plague Commission— Remarks by pages Drs. VlcCabe Dallas and Wilkins (Bombay)— The plague and animals— Rats— Domestic animals— Monkeys — Mode of disse- mination— 'Primary danger exists in the sick person and his surroundme^s — Danger largely enhanced by insanitary and ill-ventilated surroundings— Notoriety of this fact— Remarks by Hirsch— Similar testimony given by many observers— Indian examples— Dr. Whyte and Gujarat— Dr. Ranken and Rajput- ana — Dr. Hutcheson and Mahamari— Instances from the present epidemic — Immunity enjoyed by Europeans — Non-infectious character of plague in hospitals— Comparative immunity of persons employed on plague duty — Health and segregation camps— Plague spread from place to place by persons infected with the disease and their effects — Instances— Danger of spread by animals— Rats — Danger from food-stufis less important — Ex- port of grain from Sind — Articles of commerce— Danger less than was formerly considered the case— Dr. Bitter's remarks — Articles classed as susceptible in the Venice Convention — No authenticated case of infection through merchandise during the present epidemic— Other possible sources of infection of minor importance— Influence of climate and other natural conditions — Hong-kong — Bombay Presidency — Altitude and geological characteristics have no influence— Origin and course of plague epidemics — Discussion regarding origin — Slow onset — Duration — Occurrence of fresh epidemics in endemic centres — Curative treatment— Medical treatment of little avail— Influence of good nursing and healthy surroundings — Use of curative serum — Experiments by M. Yersin and M. Haffkine— In- conclusive result — Remarks of German, Russian and Egyptian Plague Commissions — Preventive inoculation by M. Haff- kine — Principle of the system — Number of persons inoculated — Experiments in the Byculla Jail, Bombay — General results of 7,905 inoculations — Successful and extensive experiments at Daman— Symptoms after inoculation— Remarks of the German and Egyptian Commissions ...<•*. 3—64 CHAPTER III. General History and Geographical Distribution. The plague in remote antiquity — The Justinian Plague — Plague in mediaeval times— The Black Death — Plague in the 15th, i6th and 17th Centuries— Retreat from the west and centre of Europe— Extinction in Europe — Last outbreaks in England, France and Germany— The great plague of London — The plague of Marseilles— Turkey, the starting point of plague in Europe— Plague in Africa — Egypt the starting point— Plague in Tripoli, Tunis, Algiers and Morocco — Extinction of plague in Africa except on the Tripoli coast -Old plague centres of Western Asia — Syria, Asia Minor, Armenia, and Caucasia — Plague centres in Western Asia during the second-half of the 19th Century — Arabia, Persia and Mesopotamia — Plague in further Asia — India — The Gujarat epidemic of 1812 to 1821 — The Rajputana plague of 1836— The endemic plague centre in Garhwal and Kumaun — Plague in China—The endemic centre in the highlands of Yunan— Spread to the southern plateau of Yunan and to the Provinces of Kwei-Chan, Kwangsi, and Kwangtung — The Canton plague of 1894 — The Hong-kong epidemics of 1894 and 1896 65—70 Contents. \\\ CHAPTER IV. Previous History of Plague in India. Notices of pestilence in early Indian History — Pestilence in India in pages the 14th, 15th and i6th Centuries — Outbreak in 1618 in the District of Ahmedabad— Second outbreak in 16S3-89 — Pever epidemics in the i8th Century— First undoubted plague epidemic in Gujarat in 1812-21 — Description of Cutch— Account of the outbreak in Cutch in 1812 — Spread to Radhanpur State and Sind in 1816 — Outbreak in Kathiawar — Description of Kathiawar — Account of the epidemic in Kathiaw-ir by Drs. Gilder and Whyte— Course of the disease in Kathiawar in 1816-19 — Ravages madeby the epidemic — Extinction in 1821 — Dr. Gilder's clinical account — Bubonic and pulmonary forms of the disease — Dr. Whyte's report — Morvi — Vankaner — Muli— Sayla — Dr. Whyte's discussion on the origin and spread of the disease — The disease spread by infection and fostered by endemic causes — Insanitary condition of Kathiawar — Remedial measures suggested by Dr. Whyte — Segregation of the infected in the open and destruction of contaminated clothing — Description of the Ahmedabad District — Quarantine measures enforced to arrest the spread of the disease — Quarantine ineffectual — Outbreaks at Dhandhuka and Ahmedabad — High mortality — The Pali outbreak of 1836-37 — Dr. Ranken's report — Description of Marwar, Mewar and Merwara — Outbreak at Pali in July 1836 — Cloth printers first affected — Virulence of the epidemic — Origin of the disease unknown — Conjecture that it was imported from the Gujarat ports — Dr. Irvine's reasons for belief in this theory — Flight of the inhabitants of Pali — Disease spread by the refugees — Progress of the plague in Marwar and Mewar — Extinction in the spring of 1838 — Mortality—Contemporaneous epidemic fever in Rohilkhand — Dr. Guthrie on the Rohilkhand fever — Symptoms of the Pali epidemic — Bubonic and pul- monary forms — Description by Assistant Surgeon Maclean — The epidemic fostered by dirty and insanitary conditions of life — Insanitary condition of Rajputana — Land quarantine and preventive cordons — Dr. Ranken's opinion on the subject of land quarantine— Breach of the Merwara cordon — Dr. Ranken's advocacy of sanitary reform — Advice with regard to Calcutta — Measures proposed by Dr. Irvine for combating an outbreak of plague — Encampment of the healthy outside the scene of infection — Mahamari, the Himalayan plague — Endemic plague centre in the Himalayas — Garhwal and Kumaun — Outbreak of 1823 at Kedarnath-— Subsequent outbreaks — Variable intensity of the outbreaks, 1834 — 1835— 1853-1854 — Extension to places in the Bijnor and Moradabad Districts and in the Rampore State — 1860 — 1877-78 — Later outbreaks not severe — The disease fostered by dirty and unwholesome surround- ings — Symptoms of Mahamari identical with those of ordinary plague— Virulence of the disease— Flight of the inhabitants from infected villages— Spontaneous and imported outbreaks — Mortality among rats— Causes of spontaneous outbreaks — Outbreak of 1897 at Okhimath — Preventive measures adopted — Their success— Closing the pilgrim route through Okhimath — Danger of the spread of Mahamari . . . 71—94 iv Contents, CHAPTER V, Extent and Course of the Plague in the Bombay Presidency. Preliminary remarks — Brief description of the Bombay Presidency — Pages Extent and population — Physical aspects — Division into dis- tricts — Agriculture —Climate — Inhabitants — Executive adminis- tration — General remarks on the plague epidemic — Total mortal- ity — Bombay City— Description of the City — Insanitary tene- ments — Population— Commencement of the outbreak — First public announcement— M. Haffkine's investigation — Diagnosis confirmed — Failure to discover the disease — Early suspicious cases — High mortality in the city — On discovery, the disease found to be widely diffused — Immediate cause of the outbreak unknown — Possibility of importation from China — Abnor- mal climatic conditions of 1896— Outbreak discovered in Mandvi — Statistics and maps — Inaccuracy in reporting — Total seizures month by month — General course of the epi- demic — Flight of the populace — Course of the epidemic in different wards — Manner in which the infection spread — Com- parative intensity of the epidemic in different wards — Localities chiefly affected —The Bombay Presidency proper — Statistics and maps — Geographical distribution of the disease — Four main divisons— The Konkan Coast, the chief seat of the epidemic — Thana — Kolaba — Daman — The Deccan, the second division — Poona City— Poona District — Satara — Gujarat, the third division — Palanpur State — Kathiawar— Cutch, the fourth divi- sion — Mandvi — Course of the epidemic in the different divi- sions — Thana — Surat — Kolaba — Baroda State — Daman — Poona City and District — Nasik and Ahmednagar— Palanpur — Kathia- war— Mandvi — Sind — Infected localities — Karachi — Description of the town — Insanitary condition of the main body of the town — Beginning of the outbreak — Plague declared epidemic— Spread of infection — Climax during first week in February — Total morta- lity month by month— Decline of the epidemic — Karachi Dis- trict — Tatta — jangshahi — Kotri — Hyderabad District — City of Hyderabad — Tando Alahyar— Shikarpur District — Sukkur — Rohri — Villages in the District— End of the epidemic in Sind— Recrudescence of plague in the Bombay Presidency proper — General statistics — Bombay City — Konkan Coast — Surat and Palanpur — Deccan Districts — Karnatak — Satara District — Im- provement in the districts duringDecember . . , , 95—126 CHAPTER VI. General Account of preventive Measures. The Epidemic Diseases Act. Summary of measures adopted to combat the plague — General prin- ciples — Measures adopted in plague centres — Measures to prevent isolated cases spreading an epidemic — Measures to prevent the spread of infectior\ by persons travelling by land — By persons travelling by sea — By merchandise and food-stuffs — The Epidemic Diseases Act — Events leading up to the passing of the Act — Its provisions— Powers conferred on Local Govern- . mentb and Administrations — Enactments against plague passed in Native States — Rules and orders issued by Local Governments and Administrations under the Act — Orders issued by the Gov- ernment of India under the Act ...... 127 — 132 Co nt en is. CHAPTER VII. Measures in the City or Bombay. Measures during the early period of the epidemic— Beginning- of the pages epidemic— General course of the epidemic— Conduct of operations by the municipal authorities— The constitution of the municipal government— Regulations of the Municipal Act against danger- ous disease— Section 434 of the Municipal Act— First measures- Activity of the Municipal Health Department— Committee ap- pomted by the Local Government— Powers conferred on the Muni- cipal Commissioner— Proclamation of the Municipal Commis- sioner—Alarm and excitement of the population— Modification of the orders— Explanatory proclamation— Extent to which isola- tion of the sick was enforced— Private and caste hospitals- Increase of hospital accommodation— The Plague Research Committee— Sanitary precautions in November and December- Visit of Surgeon- Major-General Cleghorn to Bombay- Memorandum of Bombay medical gentlemen recommending the removal of the inmates of infected houses— Dr. Cleghorn's concur- rence— The Government of India recommend the proposal to evacuate infected houses to the Government of Bombay— Sum- mary of the measures adopted presented to the House of Com- mons—Evacuation of infected houses again suggested by the Government of India— Difficulties of carrying out the measure represented by the Government of Bombay— The Government of India urge that the experiment should be made— Measures adopt- ed by the Government of Bombay to give effect to the wishes of the Government of India— Regulations for the City of Bombay under the Epidemic Diseases Act— Payment of compensation and incidence of expenditure— Establishment of the Parel Gov- ernment House Hospital— Appointment of the Bombay Plague Committee— Powers conferred on the Committee— Objects with whiqh the Committee was appointed— Enlistment of the services of influential native gentlemen— Attitude of the native commu- nity towards the plague regulations— Privacy of the home and of women, and the caste system— Adaptation of precautionary measures to the feelings and customs of the people— Opposition of the Sunni Muhammadans— Petition to the Governor—Depu- tation to General Gatacre— Mass meeting in the Jama Masjid— General Gatacre's reply to the resolution of the meeting- General Gatacre's address to a meeting of the Muhammadan community— Proclamation issued by the Plague Committee- Subsidence of the opposition— Help given by influential native gentlerten— Tact and patience of the Committee— General re- marks on the operations of the Committee— Organisation— Divi- sion of the city into ten districts— District Medical Officers— Sub-divisions— Staff— Aid afforded by the Military— Military staff— Native soldiers chiefly employed— Clothing, arms, and sanitary precautions— Cordiality between the military staff and the civil population— Detailed account of No. X District— Equip- ment and description of the District— Sub-divisional staff— Detec- tion of cases and removal of patients to hospital— House-to- house visitation— Importance of the aid afforded by Justices of the Peace— Inauguration of the work— Description of the method of house-to-house visitation— Ambulances -Treatment of the sick in hospital— General features and aims of the hospital system- Rapid establishment of fresh hospitals— Fifteen government hospitals— Twenty-nine private hospitals— Their distribution among districts and among communities— Usefulness of private vi Contents. hospitals — Hospitals for individuals and families disallowed — pages Multiplication of hospitals caused nospread of the disease — Con- struction and equipment of Government and private hospitals — Precautions against infection in hospitals— Sanitary precau- tions in the Grant Road Hospital— Medical and nursing staff — Difficulty of procuring nurses — Aid given by the Roman Catholic convents— Nurses procured in India and from England — General supervision of nurses — Their division into classes, remuneration and duties — Useful and devoted work of the Roman Catholic sisters— Aptitude of the English nurses — Disposal of corpses — Sanitary condition of burial-grounds — Closure of the Grant Road Muhammadan burial-ground — Last rites performed by the relatives— General rule for hospitals — Arrangements in the Grant Road Hospital — Segregation of persons likely t^) be infect- ed — Treatment of infected and insanitary buildings — Method of disinfection— Evacuation — General sanitary measures — Vigor- ous work initiated by the Municipality continued— Statistical statement of work done— Treatment of dwellings reported to be insanii;ary by the District Medical Officers of Health— The " U. H. H."* system — Cleansing and disinfecting of entire local- ities — Seven instances — Kamathipura — Tarwadi — Mazagon— Worli — Siwri — Parel — Mahim — General lesson to be derived from the seven cases — Disposal of the city refuse — General im- provement of the sanitation of Bombay ..... 133 — 182 CHAPTER Vni. Measures in the Bombay Presidency and Sind. Preliminary remarks— General measures — Regulations under the Epidemic Diseases Act— Officers— Appointment of plague authorities — Duties of the District Magistrate and the Police — Detection of cases— Three main measures adopted— Compul- sory report — Grant of certificate of cause of death— Action to be taken on receipt of information — Examination of corpses — Feel- ings of the people — Rajputana— ^Sind — Hard war — Bombay City — Poona — Officials stationed at burning and burial grounds- Periodical mortality statements — Segregation of the sick and of persons likely to be infected — Disposal of corpses— Funeral processions and burial and burning of corpses — Persons touching plague corpses — Disinfection of clothing, etc. — Disinfection of houses and general sanitary precautions —Disuse of infected and insanitary houses — Abatement of overcrowding — Cleansing and disinfection — Destruction of huts — Ventilation — Evacuation of in- fected localities — Payment of compensation— Principle enunci- ated by the Government of India — Compensation not claimable of right, but liberality to be shown to poor people— General rule issued by the Government of Bombay— Appointment of Plague Committees for large towns — Poona, Karachi, Hyderabad, and Sukkur and Rohri — No Plague Committees in rural areas — Constitution of Committees— General rules for Committees — Arrangements for the rainy season — Difficulty of carrying out measures during the rains — Provision of weather-proof shelter in the districts — Suspension of the " U. H. H." system in the City of Bombay— Caution in destroying dwellings in * " Unfit for human habitation." Contents. vH the districts — Incidence of expenditure— Allocation of expenditure pages between local funds and general revenues— Temporary grants — Rules of the Government of Bombay — Expenditure incurred by Plague Committees — Allocation of expenditure between the Government and Railway Administrations — Amount of expendi- ture — Expenditure in the Bombay Presidency in 1896-97 — Estimate for 1897-98 — Estimate for April and May 1897 — Revision of the estimate for 1897-98 with reference to the re- crudescence of plague — Loans under the Local Authorities (Emergency) Loans Act — Sums advanced by the Government of Bombay to Plague Committees and other authorities — Oper- ations carried out at particular plague centres — Poona — Measures taken before the appointment of a Plague Committee — General organisation of the operations of the Committee— Appointment and constitution of the Committee — Position of affairs at the time of the appointment of the Committee — Division ot the city, employment of troops and outline of principal measures — Assist- ance of the military largely utilised — Volunteers from the troops — Plague duty camp — Total number of troops employed— Un- founded accusations made against the troops — Good conduct of the troops — Opposition encountered — The populace excited to thwart the authorities — Malicious rumours set afoot — Murder of Mr. Rand and Lieutenant Ayerst— Arrest of a person on suspicion — Prosecution for sedition and conviction of the proprietor of the Kesari newspaper— Detection of plague cases— Search parties— Division of the city — Method of search — Search parties accompanied by ladies — Help given by native gentlemen — Difficulties in the way of the search — Attitude of the people except the Brahmins on the whole friendly — Results — Search by municipal officers — Improvement of death registration — Officers posted at burial and burning grounds — Treatment of the sick ir hospital — The Sassoon General Hospital and the General Plague Hospital — The private Muhammadan Hospital — Construction and accommodation — Management — Number of cases — Value of the hospital — Hindu and Parsi private hospitals — Systematic segregation of inmates of infected houses— Arrangements for the removal of persons to be segregated — Objects of segregation — The General, Muham- madan, Cantonment, and Parsi segregation camps — NumDer of persons segregated and number of plague cases amongst them — Cleansing and disinfection of infected houses — Disinfecting and limewashing parties — Preliminary arrangements — List of houses to be disinfected — Method of disinfection — Cleansing and lime- washing parties— Method of procedure — Work done by the Municipality — Payment of compensation — Careful arrange- ments to prevent poor people from suffering loss — General sanitary precautions — Improvement of sewage and conservancy arrangements — Appointment of inspectors — Work done — Poona Cantonment and Suburban Municipality — Kolaba District — Report by Dr. Collins — General arrangements — Visit of the Bombay Plague Committee — Limewashing and disinfecting of all towns in the district — Difficulties in dealing with the people — Good effects of segregating healthy inmates of infected surround- ings — Cutch-Mandvi — Report by Dr. Wilkins — Beginning of the epidemic — Desperate situation — Help sent from Bombay — Detection of cases — Search parties — Difficulties in dealing with the people— Ambulances— Death registration — Treatment of the sick in hospital- Five plague hospitals— Hospital staff — De- scription of the hospitals — Evacuation of infected houses and quarters — Voluntary and compulsory evacuation— Failure to viii Contents. segregate the inmates of infected houses after evacuation — pages Spread of plague into the interior — Plan recommended by Dr. VVilkins— Cleansing and disinfection of houses — Large disinfect- ing stafT sent from Bombay — Extensive cleansing and disinfect- ing operations — Description of the work — Recommendations made by Dr. Wilkins for much needed sanitary improvements in Cutch-Mandvi' — Success of operations in Mandvi — Spread of plague and precautions taken in the interior — Sind — General remarks and arrangement — Karachi — Beginning of the epidemic —Opposition of the people to the precautionary measures — Limited segregation in hospital — Cleansing and disinfecting — Caste hospitals — Attitude of the people prevented compulsory segregation of the sick — Spread of the disease— First attempt at evacuating infected quarters — Removal of the Nasarpuris to camp — The Nasarpuri camp — Visit of Dr. Cleghorn — Extension of the evacuation system — General remarks on the health camps — Operations in progress at the end of January — No segregation of the sick — Revision of disinfecting organisation and increase of staff — Supervision of burial and burning grounds — Trans-Lyari Quarter — Successful attempts made to treat and segregate the sick— Officers appointed to look after the sick — A plague hospital equipped — Nurses — General improve- ment — Kiamari and JVIanora — Special trains to camps — End of February : measures completely carried out — Evacuation of the Trans-Lyari Quarter — Private hospitals— Rules under the Epidemic Diseases Act — Appointment of a Plague Committee — Disinfection of clothing and bedding before removal to camp — ■ Military search parties — Close of the operations— Hyderabad — Course of the epidemic — Organisation— Segregation of the sick and the inmates of infected houses — Private and public hospitals— Appointment of a Plague Committee — Health camps ^Close of the operations— Sukkur and Rohri — Situation and importance of the two places — Opposition excited by compulsory segregation— Concealment of cases — Flight of inhabitants — Detection of concealed cases — Existence of many cases— Deser- tion of New Sukkur — Increase of supervising staff —Trained labour from Karachi — Military assistance — Plague Committee appointed — Improvement in the situation — Accommodation for the sick — Nurses—Extension of evacuation and camp system — Cleansing and disinfection — Rohri— Evacuation of infected streets — Villages in the Shikarpur District — General account — Out- break at Dharki — Evacuation and disinfection — General remarks on health camps in Sind — Mr. Wingate's memorandum — Evacu- ation of infected localities the special characteristic of the Sind system — Variations in the conditions of different camps — No disinfection or segregation in the Nasarpuri camp — Results in the Nasarpuri camp — Camps with strict segregation and medical supervision — Instances from Karachi and Sukkur — Efficacy of segregation after disinfection — General remarks on the disinfec- tion of houses — Use of corrosive sublimate solution — Its advan- tages — Mr. Hankin's experiments on the floors of houses— The floor is the portion of the house most in need of disinfection — Principle of the experiments — Method — Experiments in the Hardvvar laboratory — Results — Deductions— Disinfection by fire — Disinfection of latrines by fire — Duration of the action of different disinfectants — Sulphur fumigation not reliable — Dis- infection by oxidation — Disinfection should be done twice over — Practical rules 183 — 246 Contents, IX CHAPTER IX. Measures outside the Bombay Presidency. Preliminary remarks— Regulations issued under the Epidemic Dis- pages eases Act— North-Western Provinces and Oudh original and revised regulations -First orders of the Government of Bengal / —Resolution appointing the Medical Board— Notification under the Epidemic Diseases Act — General regulations for Calcutta and other Municipalities— Draft rules of June 1897— Revised regulations of November 1897— Bengal Plague Commission- Punjab rules— Madras rules— Rules in other provinces- Measures to ascertain the existence of plague cases— Maintenance of village registers at police stations— Rules for the detection and report of cases enforced in the North-Western Provinces and Oudh, Bengal, the Punjab and Madras— Measures to be adopted on the occurrence of plague cases and epidemics- Division of the subject— Treatment and segregation of patients —Native opinion on the subject of segregation— Original segregation rule framed by the Government of the North- western Provinces and Oudh— Revised rule— Home segrega- tion allowed— Home segregation found impossible at Hard war and Kankhal— Revised Bengal rule— Home segregation not allowed— Caste hospitals— Arrangements in Calcutta— Centra! Provinces, Punjab and Madras rules— Segregation of persons likely to be infected — Conveyance of patients— Disinfection or destruction of infected dwellings— Disinfection or destruction of infected articles— Payment of compensation— General principles — North-Western Provinces, Bengal, and Punjab rules— Dis- posal of corpses— Feelings of the native community— North- Western Provinces original and revised rules — Use of quicklime — Sanitary precautions— Infected conveyances— Evacuation of infected localities— Simple instructions on the occurrence of plague cases in a rural locality — General sanitary measures— Summary of rules issued by Local Governments and Administrations — Sanitary survey of Calcutta— Shocking insanitary condition of Calcutta— Cleansing of the city— Revised building regulations- Reform of the Municipal Administration— Places outside Calcutta — Sanitary improvement of municipalities near Calcutta — Cleansing of towns in the North-Western Provinces and Oudh— Financial— General principles regulating incidence of expenditure— Summary of rules made by Local Governments — Hardwar— The Hardwar Municipal Union— Hardwar out- break of April to June 1897 — Kankhal outbreak of September to November 1897 — North-Western Provinces and Oudh Govern- ment Resolutions describing operations at Hardwar and Kankhal —Religious fair of April— Arrangements for dealing with pilgrims —Sanitary arrangements— Medical staff— Hospital and segrega- tion accommodation— Agency for detecting cases— First plague cases— Precautions adopted— Evacuation of infected areas- Treatment of houses — Examination of corpses— Pilgrims made to reside in special camps— Discouraging pilgrimages to Hardwar — Pilgrim camp— Sanitary arrangements— Fresh cases of plague— Staff— Bacteriological examination of suspicious cases— Precau- tionary measures in the neighbourhood— Disinfection of clothes — Probable introduction of the disease from Sind— Location of the plague cases— Subordinate staff— End of the epidemic and re- moval of restrictions— Kankhal— Plague among rats— Its dis- appearance— Cause of new outbreak— First case — Total cases — Foci of disease— Measures adopted — Isolation — Evacuation of Contents. infected portions of the town— Camps— Attitude of the people — pages Disinfection — Increase in subordinate estabh'shments— Disinfect- ing gangs — Grain stores — Guard — Plague among monkeys- Pilgrimage — Temporary stoppage of railway booking— Decline of the epidemic — Khan,draoni — Position of affairs at the time the epidemic was discovered — Evacuation of the village — Classifica- tion of inmates— Arrangements in the hospital and segregation camps — Food supply — Roll call — Support and comfort of inmates — Harvest — Arrangements for guarding the camps — Cleansing and disinfection of the village — Measures to prevent the spread of infection to surrounding villages— Daily reports from neigh- bouring villages — Return of emigrants from Khandraoni — Arrivals from Bombay — Absentees in Bombay — Directions to villagers of the neighbourhood — Inspection of neighbouring villages— Ex- tinction" of the epidemic— Mortality — Breaking up of camps- Compensation i . . . . • . • . 247 — 290 CHAPTER X. Measures to prevent the Spread of Infection by Land. Proposals made for land quarantine and the stoppage of third class rail- way traffic— Objections to land quarantine— Previous experience in India— Statement of objections — Dresden and Venice Conven- tions on the subject of land quarantine— Objections to the stoppage of third class railway traffic— Alternative precautions prescribed by the Government of India— Proposals of the Government of Bombay for the enforcement of local land quarantine—Objections to local" land quarantine— Modification of the general rules issued by the Government of Bombay on the subject of land quarantine — Rules to control egress from infected localities issued by the Government of Bombay in October 1897— Remarks of the Gov- ernment of India — Restricting the movement of people not the main object— Protection of the Surat District against Daman- Original strict quarantine— Cordon of the Salt guard— Relax- ation of the rules — Observation post and camp on the frontier — Passage of goods into Daman — Guarding of the cordon line — Additional precautions— Further history of the stoppage of third class railway traffic— Sukkur—Rohri— Baluchistan — Proposals made during the recrudescence— Inspection of railway passengers —Early arrangements in Bengal, the North-Western Provinces, and the Central Provinces— Co-operation with railway authorities —Orders issued by the East Indian and the Bombay, Baroda and Central India Railway Administrations— Instructions issued by the Government of India to the Government of Bombay- Arrangements made by the Government of Bombay and by the Central Provinces and Ajmere Administrations— Extension of the first arrangements- Arrangements on the East Indian Railway- Arrangements in the Bombay Presidency, at Ahmedabad, in the Punjab, the Central Provinces, Madras, and Rajputana— Precau- tions against Karachi— Orders issued by the Government of India — Arra^ngements in Sind— The Punjab Conference, and orders issued by the Local Government— Arrangements in the North- Western Provinces, and in Baluchistan — Extension of the arrange- ments after the passing of the Epidemic Diseases Act— Clause of the Epidemic Diseases Act relating to the examination of travel- lers—Orders issued by the Government of India— Appointment Contents. XI of principal inspection stations, and method of examin- pages ation at such stations — Account of the principal inspection stations— Arranojements within the Bombay Presidency — Inspection of up-trains in and near Bombay City — Arrange- ments for protection against Cutch-Mandvi— Method of inspec- tion — Orders of the Government of Bombay — Co-operation of the servants of Railway Companies— Detention of suspicious cases — Hospital and segregation accommodation — Minor inspection stations — Sind — Arrangements at Kalyan and Bhusa- wal — Inspection staff -Female inspectors — Success of the Bom- bay arrangements — Orders of the Government of the North- western Provinces and Oudh — Principal inspection stations — Examination of passengers— Segregation of suspects and treat- ment of plague cases in hospital — Companions and attendants — Rules for minor inspection stations and way-side listations — Inspection circles— Staff — Female inspectors — Arrangements at Manikpur — The Punjab general rules — Inspection of passengers — Segregation of suspect cases— Friends and attendants — Stations without inspecting officers — Hospitals and staff — Female inspectors— Hospital and segregation sheds — The Bengal general rules— Segregation of suspect cases— Females — Hospitals and temporary accommodation— The Khana Inspec- tion station — Arrangements in the observation camp — Inspec- tion of trains — Examination of passengers — Suspects from Bombay — Disposal of suspects— The camp— Police force — General rules for observation camps in Bengal — Staff — Rules issued by other Local Governments — Hospital accommodation and medical staff in different Provinces — Prevention of the eva- sion of inspection — Examples from Sind, Baluchistan, Shikar- pur, and Khanpur — Rules of the Madras and Bengal Govern- ments — Lighting of stations — Travellers by goods trains — Results of the inspection system — Surveillance of travellers — Orders issued by the Government of India — Registration of the names, addresses, etc., of passengers for communication to local author- ities — Functions of the railway staff — Rules made by Local Governments and Administrations— Central Provinces — Bombay Presidency — Sholapur District — North-Western Provinces — Bengal — General regulations for the surveillance of travellers from infected localities enforced in the North- Western Provinces, the Punjab, and the Central Provinces — Registers maintained for villages in communication with Bombay Presidency and of arrivals from that Presidency— Disinfection of clothing and baggage — Special arrangements at principal inspection stations — Rules framed by Local Governments — Instructions issued by the Government of India for disinfection of baggage near the Bombay frontier — Method of disinfection — Principal disinfection stations at Hotgi, Bhusawal and Ruk in the Bombay Presidency — Disinfection and observation station at Khanpur in the Punjab — Examination of passengers and removal to camp — The camp~ Disinfecting arrangements— Compensation — Inspection of passengers and observation of the suspicious — Statistics — Special arrangements for female passengers— Disinfection of railway carriages— Disinfection of carriages in which cases of plague have been discovered — Disinfection of non-suspect vehicles from the infected area — Relaxation of the rules for non-suspect carriages- Measures to prevent the spread of infection by road and river — Measures adopted in the Bombay Presidency — General rules issued by the Government of Bombay to control intercourse between infected and healthy localities, for the inspec- tion of persons coming from infected areas, for the establishment xii Contents. of observation posts on roads, and to secure the co- pages operation of the villagers — Arrangements made to protect Mahableshwar : an instance of the working of the general rules — Measures adopted to prevent the re-infection of Bombay City by foot-passengers- — Protection of the Punjab Frontier — Pilgrimages in India — Orders prohibiting certain fairs issued by the Government of Bombay — Hardwar^ — The Jagannath festival in Bengal — The Singhast Mela at Ujjain in Gwalior — Precautions to prevent the spread of plague across the frontier — Summary of the Punjab precautions— Protection of Afghanis- tan — Protection of Baluchistan — Inspection posts in Kashmir — Success of the measures for the protection of the frontier — Precautionary measures in countries beyond the border — Kandahar — Persia — Mesopotamia — Russian Turkistan and China . 291—352 CHAPTER XI. Measures to prevent the Spread of Infection by Sea. Original quarantine measures — Previous history of sea quarantine in India— A and B quarantine rules of 1879 — History of quaran- tine from 1881 to 1893 — Quarantine against Hong-kong and Canton, 1894 — Quarantine against Bombay, 1896— Rules for Aden, Karachi, Calcutta, Madras, and Rangoon — Quarantine against Karachi — Modification of the rules at Karachi — Epidemic Diseases Act, section 2, (2), (a) — Extension of quaran- tine to minor ports — Inspection of the inward sea traffic at Bombay — Regulations of the 12th April 1897 — Establishment — Steamer traffic — Native craft — Treatment of the suspicious — Results of the inspection — Rules for minor ports in Bombay — Precautions against arrivals from Cutch — Quarantine at Aden — Modification of the Ader. rules — Revised rules issued by the Government of Madras— Original measures for the inspection of outward-bound vessels — Rules for Bombay and Karachi — Details regarding the inspection at Bombay— Results — Staff — Difficulties — Place of examination — Examination of crew — Suc- cess of the measures — Risk of the spread of infection by ocean traffic said to be small — Inspection of vessels at the ports of Calcutta and Madras — Bengal rules — Madras rules — Tuticorin and Ceylon — The Venice Sanitary Convention of 1897 — General scope and arrangement — Indian delegates — Regulations pre- scribed by the Convention based on previous Conventions — Im- portant points of difference— Preventive measures to be adopted outside Europe — Notification — Inspection of vessels sailing from infected ports — Pilgrim traffic — The Red Sea and the Suez Canal— The Persian Gulf — Measures to be adopted by European Governments — Measures to be adopted m Europe at ports of arrival — Three-fold classification of ships — Infected vessels — Suspected vessels— Healthy vessels — Regulations for inspection of inward-bound vessels based on the Venice Con- vention — Instructions of the Government of India — Revision of the Quarantine Kules of the Local Governments — Period of'obser- vation — Infected and healthy vessels— Bombay Presidency — Rules for the inspection of vessels arriving at the port of Bombay from infected ports— Rules for Aden — Three-fold Contents. xili classification of vessels — Period after which free pratique may pages be given— Vessels whose destination is Aden — Vessels using Aden as a port of call — Modification of the Aden rules with regard to the grant of free pratique — Transhipment in quaran- tine—Landing mails and cargo — Supplies for vessels in quaran- tine — Vessels communicating with vessels from an infected port — Bill of health — Bengal — Draft rules for Calcutta prepared by the Government of Bengal — The Government of India point out that healthy , passengers must not be detained on board ship— Publication of revised rules for Calcutta— Three-fold classification of vessels — Treatment of vessels of each class in accordance with the Venice Convention — Madras Presidency — Publication of revised rules for ports in the Madras Presidency based on the English Local Government Board rules and the Venice Convention — Classification of ships — Measures on arrival— Examination of persons on board — Treatment of the sick — Treatment of the healthy — Observation and surveillance — Grant of clean Bill of Health — Disinfection of the vessel— De- struction or disinfection of contaminated and suspected articles — Water-supply — Mails and cargo — Supplies — Burma— Draft rules for Rangoon based on Bengal rules— Definition of infected port — Publication of revised rules for Burma ports — Regulations for inspection of outward-bound vessels based on the Venice Convention — Instructions of the Government of India — Inspec- tion to be conducted as prescribed in the Venice Convention — Bombay Presidency — Draft rules for the port of Bombay- Substance of rules — Inspection on board and on shore — Reasons why inspectioii on shore not made obligatory at Bombay — Plague cases discovered on board to be mentioned in the Bill of Health — Other matters — Bengal— Draft rules for ports in Bengal — Difficulty of examination on shore— Examination on board authorised — Mention of plague cases on board in the Bill of Health— Issue of modified rules by the Government of Bengal — Substance of rules — Madras Presidency — Vessels using ports in the Madras Presidency as ports of call— Revised rules issued by the Government of Madras — Restrictions regarding embarkation of residents of infected localities, and sailing of labourers from Tuticorin to Colombo — General substance of rules — Remarks by the Government of India — Examination on board and on shore — Removal of special re- strictions regarding embarkation of passengers from infected districts except in case of vessels bound for Ceylon— Applica- tion of rules to vessels sailing for Burma— Prohibition of emi- gration from the infected area 353—388 CHAPTER XIL Measures to prevent the Spread of Infection by Mer- chandise and food-stuffs. Objects soiled with the excreta of patients a dangerous source of in- fection — Orders of the Government of India forbidding the bring- ing of susceptible articles from the Bombay Presidency and Sind into other parts of India — Regulations with respect to rags, etc., issued by Local Governments— List of susceptible articles con- ^ tained in the Venice Convention— Treatment of susceptible articles prescribed by the Convention — The prohibition against import is only optional — Reasons why the Government of India did not issue any further prohibitory orders with respect to the XIV Contents. transport of merchandise— Precautionary measures with regard to food-stuffs— Fear that plague infection might be brought from Sind into the Punjab in grain or other food-stuffs — Prohibition of the export not considered necessary — Careful precautions prescribed and carried out — Precautionary measures in the City of Bombay ... . ...... PAGES 389—394 CHAPTER XIII. Staff. Preliminary remarks— .Medical Staff — Tabular statement — Strain on the Medical Services— Private Practitioners —Staff at the time of the recrudescence — Excellent work of the Medical Staff— Orders ^ranting special remuneration to different classes of medical officers— Commissioned Medical Officers of the Indian Medical Service and Army Medical Staff — Commissioned Medical Officers sent from England— Uncovenanted Medical Officers- Applicants for employment in the Uncovenanted Medical Service— Civil and Military Assistant Surgeons-— Retired Military Assistant Surgeons — Civil and Military Hospital Assistants — Military Staff— Work done by the Staff— Tabular statement — Sanitary and Guard duty — Remuneration— Com- pensation for wear and tear of clothing— Grant of conveyance allowances— Pensions for the widows and children of deceased police officers . 395-404 CHAPTER XIV. Regulations against Arrivals from India enforced in othei Countries. General remarks— Summary of regulations — Alarm in Europe — Venice Sanitary Conference — Regulations modified in accordance with the Venice Convention — Regulations respecting vessels and pas- sengers—Passage of the Suez Canal— Plague Regulations of 1894 put into force by the Egyptian Sanitary Board — Treatment of healthy, suspected and infected ships — Passage of the Canal by the infected ship Dilwara — Regulations of the Venice Con- vention — Three-fold classification of ships — Healthy ships pass the Canal in quarantine— Treatment of healthy and infected ships— The United Kingdom — Local Government Board Rules of Novem- ber 1896 — Healthy and infected ships — Examination of persons on board — Removal of the sick — Addresses of other persons taken — Disinfection — Change of water — ^ Prance — Alarm and severe restrictions— General rules of January 1897 — Later orders — pas- sengers eventually allowed to land at Marseilles — Italy — Onerous restrictions — Later regulations based on the Venice Convention — Arrangements to facilitate the precautionary measures— Belgium — Royal decree of 1895 enforced — Treatment of healthy vessels at Docl — Regulations based on the Venice Convention — British dependencies in the Mediterranean — Malta— Severe restrictive measures— Partial relaxation — Gibraltar — Cyprus—Other Euro- pean countries — Holland, Spain, Portugal, Russia, Roumania, Turkey — Temporary closure of the Dardanelles to Indian ships — Persian Gulf — Imposition in Turkish Arabia and in Persia of the quarantine regulations of the Ottoman Empire— Muscat — Contents, XV Regulations for the Persian Gulf in the Paris Convention, 1894, tages and in the Venice Convention, 1897 — Ceylon — Fifteen days' quarantine — Regulations modified in accordance with Venice Convention — Other Asiatic ports— Goa, Netherlands India, and Siam — Egypt — Plague regulations of 1894 and regulations based on the Venice Convention of 1897 — Treatment of infected, sus- pected, and healthy ships— Other African ports— Algiers, Morocco, Madagascar and Natal — America aud Australia — United States — Brazil— Peru—Australian Colonies — Regulations regarding merchandise— Venice Convention — Susceptible articles of Indian trade — Hides and skins, raw wool, raw silk — Statistics of the trade in hides and skins — Countries concerned in the trade — Restrictive measures enforced in Germany, France, and Italy — Protest of the Calcutta merchants — Relaxation of the restrictions —Statistics of the trade in raw wool — Discussion regarding the importation of raw wool into the United Kingdom — Regulations issued in France — Silk trade chiefly centred in Bengal — No restrictions imposed— General regulations issued by Foreign Governments — Statistics of export trade to Europe — Restrictions in European countries— France — Italy — Belgium*— Germany — Austria- Hungary — Other European countries — Indian tea at Batoum — Export trade to Asiatic countries — Ceylon— Persia — Muscat — Netherlands — India— China— Export trade to Africa — Egypt — Reunion ...... 405 — 4,26 \ CHAPTER XV. The Pilgrimage to Mecca. The suspension of the pilgrimage from India— Alarm in Europe lest the plague should be spread by pilgrims — Closure of the ^r- ports of Bombay and Karachi to the pilgrim traffic — Endea- vour to dissuade persons from making the pilgrimage — • Calcutta and Madras open to the pilgrim traffic— Asiatic Russian pilgrims— Protests against the embarkation of pilgrims from Madras — Precautionary instructions issued by the Govern- ment of India — Detention of pilgrims in an observation camp in the Bombay Presidency — Further protests from Madras and Bengal — Prohibition of the pilgrimage in the case of persons who had been in the Bombay Presidency or Sind — Muhammadan traditional law on the subject of plague and pilgrimages— Precautions to be taken in the case of intending pilgrims from places outside the Bombay Presidency and Sind — Dissuasion — Detention in observation camps away from the ports — Removal from camp to place of embarkation — Complete suspen- sion of the pilgrimage — The prohibitory notification— Making public the causes which led to the suspension — Return of intending pilgrims to their homes — Detention of the pilgrims in observation camp at Nasik in the Bombay Presidency— Arrangements for return home after undergoing observation— Despatch of the pilgrims to the Nasik camp — .Arrangements at the camp — Despatch of the pilgrims from the camp to their homes — Pecu- niary concessions made to returning pilgrims — Central Asian pilgrims— The return of the pilgrims from Jeddah— Arrangements j^yj Contents. » to prevent their spreading infection on return— Despatch from pages Bombay by special Irains without being permitted to mix with the infected population— Outbreal< of plague at Jeddah— Jeddah treated as an infected port under the Venice Convencion, and special precautions taken to prevent the spread of infection by returning pilgrims — Arrangements at Bombay — End of the epidemic at jeddah and discontinuance of the precautions . 427 — 434 CHAPTER XVI. Conclusion. Lessons to be derived from the recent experience of plague— Condi- tions which foster and which destroy the infection — Measures best adapted to suppress plague epidemics — Evacuation, segrega- tion and disinfection — Special difficulties in India- Prevention of the spread of infection by land, by sea, and by merchandise and food-stuffs 435—137 CHAPTER I. INTRODUCTORY. At the time that the preparation of this narrative was begun Period covered it was hoped that the epidemic of plague which had almost died ^' e rcpor . out in the Bombay Presidency would soon completely disappear. Unfortunately this hope was not realized. With the rainy season a recrudescence of the disease began, which spread and increased with alarming rapidity. The present account deals mainly with the first period of the epidemic, which lasted, roughly, from August 1896 to July 1897, and although some observations have been recorded on the progress of the recrudescence and the further measures adopted on its occurrence, the subsequent history of the plague will have to be examined in another report and at a later date. The main object of the report is to furnish an account of the Main object, epidemic, of the conclusions arrived at with regard to the nature of the disease and of the measures best calculated to check and to stay it, and of the operations that have been carried out in the Bombay Presidency and elsewhere with this view. It appeared to the Gov- ernment of India that a narrative of the measures adopted at different places and under different conditions, and of the results following on the measures, would serve as a useful guide for future occasions, should such a guide unfortunately be needed. As a main object of the report is to serve as a work of reference, the account of the remedial and preventive measures has been given in considerable detail. Chapter II of the report deals with the causes and characteristics Causes and char- of plague with special reference to the observations recorded by the ^^'^^'''^'^'^^ °^ . Tc J , 1 . - . . , plague. most qualmed observers durmg tne present epidemic. Particular attention is paid to those portions of the subject which throw light on the manner in which the disease is spread and the direction in which the efforts to combat it are most likely to be successful. Chapters III to V deal with the history of plague. In Chapter III a History of brief account is given of the general history and geographical distribu- P'^S^s. tion of the diseasei The previous history of plague in India is I 2 Introductory. [ Chap. I. described in greater detail in Chapter IV, and Chapter V contains a short history of the course and extent of the present epidemic. Remedial and The next portion of the report deals with the remedial and preven- nieasures. ^'^'^ measures. Chapter VI gives a general account of the measures. Measures adopt- Chapters VII to IX deal with the measures adopted in the plague centres ed in plague themselves, separate chapters being devoted to the City of Bombay, to the remainder of the Bombay Presidency and Sind, and to places Measures to outside the Bombay Presidency. Chapters X to XII describe the P'''^J'^"'^ f'^-'f . measures that were adopted to prevent the spread of plague by land, tion. by sea, and by articles likely to carry the germs of the disease. Staff. In Chapter XIII some details are given regarding the medical and military staf¥ employed on duty connected with the plague, and of the Regulations remuneration that was granted to them, Chapter XIV contains an forei'c^n coun- account of the regulations enforced in foreign countries against persons tries. and merchandise arriving from India. Chapter XV deals with the to M^'cca. '^ pilgrimage to Mecca from the point of view of the danger apprehended of the introduction of plague into the Hedjaz and thence into Europe. Lessons to be In the sixteenth and last chapter a brief summary is given of rec-ntexpedence ^^ conclusions with regard to the best means of combating plague of plague. which are to be derived from the experience of the present and former epidemics. Appendices to Attached to the report are a set of appendices consisting mainly of ^^° ■ copies of the orders issued by the Government of India and the Local Governments and Administrations, of a selection of papers from the official correspondence on the subject of the plague, and of reports submitted by officers in charge of the operations at important plague centres. The appendices are arranged under heads corresponding to the chapters. CHAPTER II. DESCRIPTION OF PLAGUE: ITS CAUSES AND CHARACTERISTICS. Cause and Nature of Plague.* It has been demonstrated that plague is due to a specific bacillus. P'ag.ue due to a ^' The existence of the plague bacillus," says Metchnikoff, "had long Disco\xry by"'* been foreshadowed, but no proof of its existence could be given until ^''^''^^^to and Yersin the labours of Pasteur and subsequently of Koch, and of their schools had paved the way," The discovery of the bacillus was made almost simultaneously and independently by Kitasato and Yersin during the Hong-kong epidemic of 1894. During the present epidemic the previous conclusions have been verified and the investigation into the bacteriology of the disease has been carried further by M. Haffkine, Mr. Hank'in, various medical officers of the Government of India, the members of the scientific missions sent to Bombay by Egypt, Ger- many, Austria, and Russia, and other foreign scientists. The so-called cocco-bacillus of plague is a short thick rod with Description of rounded ends. It is found in large numbers in the buboes, and may occu^r^^nceln^"'^ be present in the blood, expectoration, urine and excreta of the sick. '^^ human The bacillus can be cultivated in artificial nutritive media. The Cultivatioac growth in bouillon containing an excess of fat is specially character- istic. * Hirsch, Handbook of Geographical and Historical Pathology (New Sydenham Society's translation). B. Scheube, Die Krankhelten der Warmen Lander; Fischer, Jena, 1896. Yersin, La Paste Bubonique k Hong-kong; Annales de I'lnstitut Pasteur, 1894. Yersin, Calmetta et Borrel, La Paste Bubonique ; Annales de I'lnstitut Pasteur, 1895. Wilm, A Report on the Epidemic of Bubonic Plague at Hong-kong in the year 1896. Colonial Reports, Miscellaneous, No. 6, Hong-kong, Bubonic Plague, 1896. James Report on the 1894 epidemic of Bubonic Plague at Hong-kong; Indian La}:cct, Sep- tember i6th, 1897. Gatacre, Report on the Bubonic Plague in Bombay. Report on the Plague in Poena (Appendix VI). Report on the Plague in Sind (.Appendix VI). Report of the Commis- sion sent by the Egyptian Government to Bombay to study Plague. Article ret^ardino- the conclusions of the German Plague Commisjion in the Deutscher Reichs-Anzeiger und Koniglich Preuszischer Siaats-Anzeigcr of the 20th July, 1S97. Wyssokowitz and Zabolotny, Members of the Russian Plague Commission, Recherches sur la Peste Bubonique ; Annales de I'lnstitut Pasteur, 1S97, Metchnikoff, Sur la Peste Bubonique • Annales de L'Institut Pasteur, 1897. 4 Description of Plague : [ Chap. II. Action of the Dr. H. Bitter (of the Egyptian Plague Commission) has given the onfhehimTn^ following clear and important statement of the manner in which the organism. microbe acts on the human organism and the forms of disease which it engenders : — " La peste, comme on le sait, est une maladie des plus multiformes connues ; tons les anciens auteurs qui ont observe des epidemies, insistent sur ce point. Multiform nature " Aussi fus-je surpis moi-meme au commencement de mes of plague. observations de voir combien les symtomes cliniques de la maladie sont differents, et combien peuvent varier les alterations patholo- giques que Ton trouve lors de I'autopsic. " Si Ton prend en consideration combien dans d'autres maladies epidemiques, telles que la fievre typhoide, la fievre ^ rechutes, la petite verole, la pneumonic, les cas se ressemblent, presentant presque invariablement le meme tableau clinique, et que dans d'autres, comme le cholera, la diphtheric, les symptomes ne varient que dans des limites assez etroites, on pourrait de prime abord, conclure que les differentes formes de peste sont autant de maladies differentes. " Comme je I'ai dit plus haut, je n'entrerai pas dans les details cliniques et pathologiques, je donnerai seulement ce qui est necessaire pour faire comprendre mes explications sur la nature de la maladie. Three distinct '' Pour le moment, il suffira de dire que tout le pele-m^le de forms o p ague, gyj^pf-^^^gg qy} semblait presque inextricable au commencement, peut 6tre reduit a trois formes assez distinctes de la maladie, les- quelles ne sont pas construites artificiellement mais qui se basent ^ logiquement sur la differente localisation dans I'organisme du bacille pathogene, qui d'apr^s son si^ge cause des symptomes et des lesions pathologiques differents. "Avant d'entrerdans une description detaillee de ces trois formes, il me semble necessaire pour me faire bien comprendre, d'expliquer brievement I'idee generale que I'ensemble de mes examens m'a donne sur la nature de la peste et du bacille que la prodult. " En posant deja ici le resultat definitif de mes etudes, je crois rendre plus clair ce que j'ai a dire sur la pathologic et les symptomes de la peste qui m'ont amene a mes conclusions. " Le bacille de la peste appartient a la classe des microbes septice- miques. Ces bacteries se caracterisent de la maniere suivante : General " Quand on inocule \ un animal susceptible une quantite mj'nime characteristics i j • i i • of septi:seinic d une culture du microbe, ce dernier commence immediateme.nt k se '^^^'"'' ' mukiplier, et, sans produire une reaction locale apparente, il • entre ^ dans le sang de I'animal ou il trouve le champ reel de son developpe- ment et ou il pullule librement jusqu'a ce que tout le sysfcme ^vasculaire soit rempli de bacilles et que I'animal succombe. Chap. II. ] its causes and characteristics. 5 " Get effet se produit invariablement si ranimal inocule est S7iS' ceptible au plus haul degr^. "Pour chaque sorte de septicemie, il y a uno ou plusieurs esp^ces d'animaux qui poss^dent cette susceptibilite absolue. U y en a d'autres qui ne sont point susceptibles ; on peut leur inoculer des quantites enormes d'un bacille septicemique, et n'obtenir aucun effet. Mais parmi les espfeces predisposees et les espfeces refrac- taireS; il existe ordinairement des races d'animaux qui accusent toutes les gradations de sensibilite. Generalement une susceptibilite diminuee s'observe de la maniere suivante : Tandis que I'animal predispose ne montre aucune reaction aprfes Tinoculation, Tanimal moins susceptible reagit au contraire par une inflammation locale plus on moins forte. Nous devons voir dans cette reaction une action de I'organisme contre le microbe. Quelque fois le bacille reussit quand meme k entrer dans le sang et I'animal succombe. Mais dans d'autres cas, I'organisme arrive a maitriser le micro-organisme sur le point d'inoculation ; il y est tue dans le tissu inflamme qui souvent apres finit par etre detruit par suppuration. " En realite, les phenom^nes que je viens d'esquisser, sont beaucoup plus compliques. Comme il y a une sensibilite differente par races, il s'y ajoute souvent, chez les animaux d'une susceptibilite incomplete, I'influence d'une predisposition individuelle. En outre, la virulence du bacille inocule et la quantite de microbes introduits dans I'orga- nisme, peuvent exercer une influence considerable sur le resultat de I'inoculation. II serait trop long d'exposer ici d'une fafon detaillee toutes ces eventualites, bien que chacune d'elles puisse exercer son influence dans la peste. " L'exemple le meilleur et le mieux connu d^une septicemie du Instance of genre decrit, est le charbon. La quantite la plus faible du bacille ^"*^'■^^■ specifique introduite dans une petite plaie, aux souris ou aux cobayes, les tue avec une surete absolue sans que la moindre reaction locale soit visible. Chez les lapins, il se montre deja souvent une reaction locale, tr^s faible il est vrai ; cependant il y aparfois des ani- maux qui survivent. Chez les boeufs et les chevaux, la reaction locale est tres prononcee sous la forme d'un oedeme enorme qui apparait autour de I'endroit de I'inoculation. Mais malgre cela, une grande partie des animaux meurt encore de septicemie. " Chez Vhomme^ la susceptibilite pour le charbon est encore moin- dre. La reaction locale se prodiut tr&s nettement et d'une maniere tres prononcee sousja forme de Id. pustule inaligne ou de V anthrax, Dans la plupart des cas, I'indiyidu echappe, mais d'autre part il y a un assez grand nombre d'anthrax suivis de septicemie mortelle. Si, les bacilles charbonneux entrent (avec la nourriture, etc.) dans I'intestin 6 Description of Plague i [Chap. II. de rhomme, la consequence est une inflammation aigue de cet organe (enterite) qui est suivie presque toujours d'une septicemic mortelle. De meme les spores entres dans le poumon y causent d'abord une pneumonic qui donnc lieu ensuite a la septicemic. Similarity '' O'^) *^3,ns la peste, nous trouvons vis-k-vis d'une maladie qui between plague rcssemble SOUS beaucoup de points au charbon. and anthrax. . ^ . ^ . . , ., " La plus faible quantite du bacille specifique virulent inocule aux souris et aux rats, les tue invariablement par septicemic, sans qu'une reaction locale apparcnte se produisc. Degree of <' L'hommc, dc son cote, ne prossede pas cette susceptibilite maxima susceptibility , i i -i, i , , •, , • )\ j • , • i yr of man to r,\a ^ ^ ^ l- ^ ^ glands. d autres septicemics connues ; c est qu en general, la reaction locale causec par 1' invasion du bacille de la peste, ne se produit pas a Vendroit de r inoculation meme, mais dans les glandes lymphatiques de la region correspondante. Buboes. " Cette reaction s'accuse surtout par un gonflement douloureux plus ou moins prononce des glandes. Ce sont precisement ces glandes gonflees, que Ton appelle bubons, et qui depuis longtemps, sont considerecs comme le symptome le plus caracteristiquc dc la peste et qui lui ont valu le surnom de peste bubonique. Cases in which '' Au commencement de la maladie, les bacilles sont confines exclu- doesnot "^ sivcment dans CCS glandes; ils s'y multiplient et creent par cela, penetrate outrc Ics alterations locales, des symptomes generaux plus ou moins affected glands, gravcs. Dans un certain nombre de cas, les microbes restent dans les glandes pendant toute la durec de la maladie; ils n'entrent ni dans le tissu qui se trouve autour des glandes ni dans le s^-steme vasculairc. L'organisme qui lutte contre cux, reussit -^ les empechcr dc puUuler davantage et k les tucr enfin sur le champ de leur premier deve- loppement. Les tumeurs glandulaires finissent alors, dans un petit nombre de cas, par etre resorbees, ou, dans la majorite des cas, leur pulpe est transformee en pus ; les cas de ce genre sont ordinairement suivis de guerison. Cases in which '< Dans unc autre categoric de cas, I'organisme succombe dans la the^baciilus ^^^^^ contre le bacille. II n'est pas en etat de le confiner dans les the general glandes. Lc microbc vainqucur rompt pour ainsi dire le ^Itre que ^^^ ^™" I'organisme lui oppose et pen^tre dans le tissu avoisinant et finale- ment dans le sang oia il se devcloppe libreinent. Nous avons alors la septicemie qui est toujours fatale. Chap. II. ] its causes and characteristics. 7 " 11 existe une troisii^me classe de cas, qui a une analogic avcc le Pneumonic r^ ■,. 1 11 i"- ' £ lorm or plague, charbon pulmonaire. Tandis que dans les deux categories prece- dentes, la porta d'entrtie du microbe est form^e par une petite plaie elle est representee dans la derniere par le systame respiratoire. Le bacille entre par inhalation directement dans les poumons ct s'y localise sur un ou plusieurs endroits, et commence k se multiplier. La consequence est une forte reaction locale qui se montre sous la forme d'une pneumonic lobulaire plus ou moins etendue. Dans ces cas on ne trouve pas de buhons. "II semble que dans des cas pareils I'organisme n'arrive guere \ maitriser le bacille ; Les cas observes k Bombay furent, sauf un, tous mortels. '' Pour le repeter encore une fois, nous pouvons done distinguer The three forms trois differentes formes de la peste. ° ^ ^•^"®' ''i°. La forme <5?^(5^?^z'^z/^ ^m//^ ou r infection reste restreinte k une seule ou k un groupe de glandes lymphatiques. Ces cas sont ordinairement suivis de guerison. .2°, La forme sepiticemiqiie qui est toujours mortelle. j°. La forme pneumonique. " 11 n'est pas impossible qu'il existe encore d'autres formes de Other possible peste, par example une forme intestinale dont font mention les auteurs qui ont observe la peste a Hong-kong. Mais k Bombay, ni dans les observations cliniques ni dans les autopsies, je n'ai pu trouver aucun indice prouvant une infection de ce genre. " La multitude des symptomes cliniques et des lesions patliologi- ques que j'ai mentionnes plus haut, s'explique du reste enti^rement par les trois formes de la peste que je viens d'indiquer, et, en outre, par le fait qu'il arrive assez frequemment dans la premiere et seconde forme d^ infections secondaires par d'autres micro-organismes, surtout par les microcoques pyogenes qui de leur c6te influent sur I'ap- parence clinique. " The follovv^ing classification of the different forms of the disease. Classification oi based on symptoms, and derived from a review of the opinions of the different forms of J r } ^ JT ^ ^ plague contained different medical officers who studied the plague in Bombay, is given in General in General Gatacre's report on the Bombay Plague: — Gatacre s report. 'Femoral. Inguinal. *'i. With enlarged glands (gravity according to >{ Axillary, symptoms and severity of attack). Cervical. ^.Tonsilar, Description of Plague: [ CHAP. II. fSepticsemic. Pneumonic. ••'2. Without enlarged glands (almost ■{ Mesenteric, enteric or gastro-inlestinal. always fatal). Nephritic. 1^ Cerebral. " The characters of the forms and types are due to a variation In the method of entry into the body of the poison which is the direct source of the disease and common to all. The forms and types may be mixed so as to produce a combination of the characters of two or more, and each may be varied by a degree of intensity, mild, severe, or haemorrhagic. The haemorrhagic condition is more often associated with those types of the disease in which the glands are not enlarged, and is always most grave as it shows great destruction of the blood constituents. The haemorrhages may be petechise, or extravasations or exudations from the mucous tracts. " It must be carefully observed that the diagnosis of a type is net made upon the complications which are likely to occur in all. Many cases of the form with buboes show complications affecting the lungs or the brain, but the type is a definite one, and the complications are distinct from the evidences of a type. Relative " The relative proportion in which different types occur is fairly proportion in represented by the following records :— which the types r j o Bombay. Povt Trust Hospital. Enlargement of cervical gland 5 i.. „ of axillary glands „ of femoral and inguinal glands Mixed variety ... ... Abortive „ .„ ... ... In No. 10 District. With enlargement of glands generally jj „ of femoral and inguinal glands „ „ of axillary „ „ of cervical Pneumonic type Gastro-enteric type ... ... ... It would seem that Dr. Bitter is not right in saying that the intes- tinal form of plague did not exist in the Bombay epidemic. It is stated in General Gatacre's report that, though rare, this type did exist as a primary form of the disease. About 5i per cent. 14 )> 48 J) 2| » 28 i> 85 per cent. 60 » 17 j« 9 >j 12 5> 3 » Chap. II. ] ils causes and characleytstlcs. ' g Symptoms. Hirsch gives the following description of the symptoms of plague : — Hirsch's '* Plague is an acute infective disease, characterised essentially by fcscnption of p , ' J J the symptoms, an affection of the lymphatic system, namely, inflammatory swellings of the external and internal lymphatic glands (buboes) ; to these are joined not unfrequently other local lesions, and a series of symptoms proceeding from general infection, which, however, are neither constant nor properly pathognomonic of the morbid process. In plague, as in all acute infective diseases, various gradations of form may be distinguished, according to the severity of the sickness : first, an explosive type in which the patient dies of general poisoning within two or three days, without developing buboes to any consider- able extent ; next, severe or moderately severe cases with full devel- opment of the local process ; and finally, a mild form in which there are buboes without any general symptoms, and the prognosis uniformly good. All these various degrees of development in the disease have been found side by side in all epidemics of plague; and the unity of the morbid process is further evinced in the fact that all the affec- tions, local or general, that complicate the process are met with more or less frequently in every epidemic." This description which is based on the experience of former epi- Versin's demies corresponds closely to the description of the disease given by desciiption. those who have observed it in the recent epidemics in Hong-kong and the Bombay Presidency. The following is Yersin's description of the course of the malady and its symptoms as observed in the Hon^-kono- epidemic of 1894: — - " There is a period of incubation of from four to six days after which the onset is sudden and accompanied by depression and pros- tration. The patient is immediately attacked by strong fever, often accompanied by delirium. After the first day a bubo, usually a single one, appears. In 75 per cent, of the cases it is situated in the groin, and in 10 per cent, in the armpit ; more rarely it appears in the neck or in some other part. "The gland soon swells to the size of a hen's egg. Death occurs at the end of 48 hours, or often earlier. When the patient lives for more than five or six days, the prognosis is better, the bubo suppurates and can be operated on. «' In some cases there is not time for the bubo to develop; in such cases the only morbid appearances are mucous haemorrhage or pete- chial spots on the skin." An enormous number of clinical observations have been made and Descriotion recorded during the present epidemic and have added largely to the siven in 2 toms, 10 Description of Plague : [ Chap. II. General Gatacre's medical knowledge of the disease. The following very complete ^f^"^'' account Is extracted from General Gatacre's report and is based on the observations of the many experts who studied the disease in Bombay : — General synip- <' The possibility oT such a classification of plague as the forego- ing {reproduced in the preceding section of this chapter) shows that each type has characteristic signs and symptoms due to the typical development of the case, but at the same time there are certain general symptoms common to all cases which are due to the viruS; the fountain-head of all the manifestations of the disease. These are now well known, and with them are associated the different features of some one or more types, so that the general symptoms are the basis of the diagnosis of the disease, while the local or visceral conditions constitute the revelation of the type. " The onset is, as a rule, very sudden, and commences with a more or less severe rigor, followed by a rapid rise of temperature, or there may be only a sudden rise of temperature. The countenance has an expression of fear ; there are nausea and often vomiting which may be severe and constant, intense headache, injection of the ocular conjunction, and a feeling of great prostration, aggravated by the vomiting and, further, by inability to sleep which is a marked symptom. The character of the tongue is a definite one, and the patient is irritable in showing it and does so in a jerky way, or moves it rapidly from side to side when protruding it. It is moist and thickened, the edges and tip are clean and coloured from light to deeplsh red, and it is coated on the rest of its surface with a thin fur, often of a peculiar white glistening appearance, or of a light reddish brown colour. There is also a perceptible impediment in the speech. " The pulse varies in rate from lOo to 140, and also in volume ; usually it is full, soft and dicrotic, the latter sign being recognisable even in the early stages of the disease, and it becomes thready as the heart's action gets dangerously weak. ' The bowels are generally constipated, often to an obstinate degree, but in some cases they are relaxed, and the motions then have a peculiarly offensive smell. "There may be also a short dry cough, and a darting pain in some lymphatic gland regions. The urine is highly acid and rapidly decom- poses on standing, triple phosphates being deposited, and the specific gravity varies from loio to 1035. The urea and uric acid are dim- inished, and albumen is present in a number of cases. '' With the progress of the case the temperature rises quickly, usually reaching a maximum of 103, 104, or higher, about the third or Chap. II. ] Us causes and characteristics, \\ fourth day, though in severe cases earlier; the pulse becomes weaker, and in the worst cases the temperature rises very high and the patient succumbs to the pecuh'arly exhausting effects of the disease in a very short time : 24 or 48 hours, or even less. If the patient survives the acute early stage, the febrile symptoms are more aggravated with the rise of temperature, the pulse becomes thready, the tongue is less moist and more irritable at the tip and edges, while the prostration and insomnia increase and cause a look of deep anxiety and distress. " In those cases where cerebral symptoms supervene, certain features manifest themselves about the third day, which are due either to congestion of the nervous centres or to involvement of them ■ in the septicasmic process. The look of anxiety now gives way to heavy expressionless countenance, which is liable to be mistaken for an improvement, but is really due to want of control over the muscles and loss of tone in them. The patient is sensible of all that goes on near him, but appears to be only partially conscious, listless and drowsy, and it is with difficulty he can be made to hear distinctly. His speech is thick and indistinct from loss of power of co-cordina- tion of muscular movements, which is noticed also in most of his other muscular efforts ; these effects are due not only to an implica- tion of the cerebral and spinal centres in the toxasmic results, but also to some general peripheral neuritis, the results of which continue as sequelae in some of the cases. There may be also cramps in the muscles. In other cases there is a great irritability of the cerebral centres, which is shown by violent delirium. The further progress of the case depends upon its circumstances according to type, and in those cases where the symptoms peculiar to the type improve and the temperature goes down, the cerebral symptoms remain for some time and then gradually subside. When the primary symptoms increase or the type is complicated, the symptoms attributable to the nervous system may assume the form of violent delirium or coma vigil, the latter being most grave. " The general symptoms above detailed characterise all the types of plague, and the adjunctive features peculiar to each type may- receive brief mention. " The glandular or bubonic is the common form of plague, and Bubonic type, comprises about 80 to 90 per cent, of all cases. Coincident with all or some of the general symptoms, one or more swellings appear at some of the positions in which lymphatic glands exist, the usual ones affected being those of the femoral region, and those less commonly- affected being the glands of the anterior axillary and cervical regions. The swelling sometimes appear at the onset, usually on the second or third day, and often not until later, in the course of the 12 Description of Plagtie: [ Chap. II. attack. They consist of single glands, chains of glands, or two or more separate glands agglomerated into a mass. The skin over them is warm, tense if the bubo be large, and very tender. Sometimes they subside and gradually disappear. Very often they suppurate and burst, and a sudden rise of the temperature in the course of an attack generally indicates the appearance of a fresh bubo. Tonsilar type. "The tonsilar type is a very peculiar one, and is characterised by great swelling of the tonsils and the glands of the neck on one or both sides. There is also nasal catarrh, and the appearance of the patient is strange, with the large swollen neck, open mouth, and inflamed sore nose, from which secretion runs. The great dangers of these cases are asphyxia from oedema, and cellulitis extending down into the chest. Septicssmictype. "The septicajmic type is, characterised by an intensity of the general symptoms due to direct entry of the virus into the blood. Enlarged glands may appear in several regions later on. rncumonic type. '' The pneumonic or thoracic type is that variety in which the lungs are primarily infected, most probably by inhalation of the virus, and one or both of the lungs are attacked most commonly with lobular pneumonia, although conditions indicative of lobar pneumonia are also sometimes found. An abstract of the report of the Russian Plague Commission read by Professor Wyssokowitz before the Bombay Medical and Physical Society shows that after a certain period the patches of the lobular pneumonia coalesce so as to form ~ circumscribed areas of exudation in healthy tissue, and that the whole lobe is never consolidated in plague pneumonia, as it is in lobar pneumonia. This type is very fatal, and in severe cases is occasionally complicated with the development of external buboes, which arise from a secondary extension of the virus. Q , _ , . " The gastro-enteric or abdominal type as a primary form of plague type. is rare and the earlier symptoms are difficult to distinguish from those of the tropical enteric fever which they greatly resemble. The diagnosis would mostly depend upon the general symptoms and the peculiar form of the abdominal symptoms which are its leading features. The eruption, if there is any, is more petechial in character; the abdominal distension appears early and has not the signs of that which occurs in typhoid ; also there are severe lumbar pains, retching and vomiting, and inability to gain rest except in certain postures. If diarrhoea occurs, the characters of the stool do not resemble those of typhoid ; the bowels may be inactive, but this is by no means a criterion, as many cases of tropical typhoid fever are accompanied with constipation in the early phases. The diagno- sis must rest on the recognition of the general symptoms, the early Chap. II. ] its causes and characteristics, 13 appearance of abdominal distension, the characters of the stools and bacteriological tests, and examinations of the blood. A variety of this type has been seen which is choleraic in character, the predominant symptoms being" an imperceptible or only slightly perceptible pulse, cold extremities, and excessive vomiting and diarrhoea. The presence of a high temperature as indicated by the thermometer would indicate the nature of the disease. "A symptomatic effect which has been seen in the glandular form Hydrophobic of plague is one cti hydrophobic symptoms. It has been described as a '^P'" hydrophobic type, the prominent symptoms being a terrified expres- sion, difficulty in swallowing fluids, inability to spit or expectorate and extreme restlessness. The fever and the bubo reveal the true nature of the illness, and the hydrophobic symptoms may be a hysteri- cal display of the terror with which the disease is associated." In the account of the plague given by Hirsch stress is laid on the Pulmonary type fact that the pneumonic type is a characteristic form of plague in India. '" ^of '\ ^"^ 1" He pomts out that although the complication of plague with bleeding from the lungs has occurred in many other epidemics, it is only in the case of the Black Death and Indian plagues that the cases are frequent enough to amount to a clearly marked feature of the epidemic. The pulmonary disorder was frequently observed both in the 1812 — 1S21 outbreak in Gujarat and in the 1836 outbreak in Rajputana. The account given above shows that the pulmonary form of the disorder has been equally marked in the present epidemic. The extremely fatal nature of plague is notorious and has charac- High mortality, terlsed all epidemics of the disease. A comparison of the total number of reported seizures and deaths In the Bombay Presidency and Sind from the beginning of the outbreak up to the 27th August gives 80 per cent, of fatal cases. It Is difficult to say how nearly this figure approximates to the actual circumstances. On the one Cg^^^^, hand, It is probable that cases which were not really plague were statistics, included In the reports, and, on the other hand, the less severe cases readily escape detection. The mortality shown by the hospital Mortality in returns is less than the above figure. The following was the per- ^o^pi'^'s- centage of fatal cases during the first period of the epidemic In the hospitals at Bombay, Karachi, and Poona : — Bombay ... ... ... ,,. ,^, ^^-j Karachi ... ... ,,. ,,, ,,, pg-j Poona ... ... ... ,.. ,,^ 64-1* * This figure is only approximate. 14 Description of Plague : [ Chap. IL A circumstance lending to increase the mortality in plague hospitals is that the severe cases are the more likely to be brought there. Many patients were admitted in a moribund condition. Mortahty in The following extract from a report by Sir William Robinson, the Governor of Hong-kong, on the Hong-kong epidemic of 1896 shows that the rate of mortality during the Hong-kong plague was higher than the rate has been in India : — "The mortality generally, as compared Avith 1S94, shows a slight improvement. The total number of Chinese cases up to noon on the 4th instant was 675, and the number of deaths 602, or a little more than 8g per cent., Avhereas in 1894 the mortality among the Chinese who were treated in hospitals was 93 per cent. ; and it must also be borne in mind that in the latter calculation no account is taken of dead bodies found in the streets and sent at once to the burial- ground, while the returns for the current year include all deaths from the plague. " Mortality in j^ the account given by Dr. Bitter, reproduced in the first section different types , , . , . . . i 1 , .1 • ^ ^ ^ • n i • of plague. of this chapter, it is said that the simple bubonic cases usually end m recovery, and that the septicaemic cases are invariably fatal. The reports of the Bombay hospitals show that this last statement is somewhat too emphatic, though no doubt recovery in both septicaemic and pneumonic cases is comparatively rare. Surgeon-Captain Thomson gives the following account of the results observed at the Pare! Hospital, Bombay : — "Cases without palpable buboes were most fatal, averaging 78*6 per cent. Many of such cases died early of convulsions, coma, and syncope, overwhelmed by toxic products suddenly attacking the o-reat nerve centres, as it were, before there was time for an inflamed gland to arise. "The next most fatal were left axilliary and right cervical in the same proportions, then right axilliary and right parotid in nearly the same ratio; next came inguinal, and next femoral; and multiple seemed to be least fatal. Buboes on the right side had ... 667 per cent, mortality. „ „ left „ „ ... 58'3 » M „ in the upper part of the body ... 69-3 „ „ „ M j> )j lower ,, ,, „ „ ... 57'2 » j> » " The nearer the head the more fatal the case, and those with buboes in the neck, and especially in its anterior aspect were very fatal. " , „ , Comoarino- the experience of the different hospitals, race does Influence 0! racei v^wn ^o. ^ , , rr ^ c ^ tj- T^i sex and age. not Seem to have any marked effect on the rate 01 miortaiity. iiie Chap. II. ] its causes and characteristics. I5 female sex has shown a general excess of mortality. Age does not seem to influence the course of the disease. Signs after Death. The following description is from General Gatacre's report : — ■ '' If the position of the body has not been altered after death, it will Description in invariably be found lying on either side with the knees flexed and the Ga"p^cre's Report head leaning towards the chest; rigor mortis is delayed ; there is of the signs after softness and want of cohesion of the fibres of the muscles, the thumbs point towards the palms of the hands ; the features have a fixed anxious expression; the eyes are sunk in and muddy in aspect with a peculiar lustre of the cornea, the pupils being dilated and the lids half closed ; the tongue is swollen and coated with fur of a glisten- ing appearance and is clean at the tip and edges ; the fur is dry, white or yellowish-brown, cleft down the centre, and horny. The complexion is opaque and dingy, the skin is dry, and if death has been recent, the forehead and hands are cold and clammy ; and enlargement of the glands in one or other locality would decide the opinion that death had been due to plague. " If death occur during delirium or convulsions, there may be distortion of the features, in which, if the patient dies while on his back, the head is thrown to either side and the legs are separated. Petechial spots may also be noted, although in the epidemic in Bombay they have been comparatively few. In death from pneumonic plague the body and face have a dusky bluish livid hue, sputum hangs about the lips, and the body seems shrunken and collapsed. '^ Bacteriological examination of different forms of Plague. The following is a summary of Dr. Bitter's bacteriological exam- Dr. Bitter's Ination of different forms of plague. The subject is of particular ^^'^'^'^■°S''^^' , . , •- cc J 1 J ii • 1-7 examination cf importance masmuch as it aftords a clue to the manner in which different types o£ plague is spread from sick persons. p'.ague. Simple Bubonic Plague — The bacilli die quickly in a suppurating gland. No bacilli were found in the blood of any patient who recovered from plague. Nor were bacilli found in the sputum, urine or fsecal matter of any patient suffering from simple bubonic plague. Septic3smic Type- — An examination of living patients showed the existence of bacilli in the primary bubo and the surrounding tissue. i6 Description of Plague : [ Chap. II. Shortly before death bacilli were found in numbers in the blood and bacilli were in two cases detected in blood-stained sputum. An examination of dead bodies disclosed the presence of enormous quantities of bacilli inthe glands primarily affected. In the neighbour- ing glands they were found in smaller number. BacilU were found in all cases in the blood ; in most cases abundant and in some cases rare. In the liver, kidneys and lungs they were found to about the same extent as in the blood ; in the spleen they were more abundant. Bacilli were discovered in the urine, in the large intestine and in the sputum. Pnemnonic Type. — Enormous quantities of bacilli were found in the pneumonic foci and in the congested parts surrounding them. In the healthy tissue of the lung they were not frequent. Large numbers were found in the fluid in the bronchi. In the bronchial glands there were no bacilli at all, or only a few. In the blood and in the spleen and other abdominal organs few bacilli were detected. In the lymphatic glands there were either none or they were not more numerous than in the blood. Difficulties of Diagnosis. Scheube's Scheube makes the following remarks : — remarks on " The diagnosis of the plague is frequently difficult particularly at diagnosis. =" . . ^ J r j ^ the commencement of epidemics. In severe cases, malignant malaria and typhus may be mistaken for it ; and in milder ones venereal buboes and other lymphatic inflammations may lead to errors in diagnosis What is decisive for the diagnosis is epidemic occurrence, ?'.5 2 J> 2 J* I case. ... I j> 2 cases 20 Description of Plague : [ Chap. II. Occupation, race, age and sex. Second attacks. Predisposing and protective circumstances in the Individual. The following information is derived from the reports of the Parel and Grant Road Plague Hospitals in Bombay. No occupations in themselves predispose to plague. There is also no race predisposition, but the classes who attend to personal cleanli- ness and live in healthy surroundings secured a marked immunity :— " The ages most exposed to risk range between 20 and 40 years in both sexes. Thirty years seems the maximum danger point. From youth up to this figure the disease gradually increases, and having reached its height then, manifests a corresponding decline as the age advances. Plague then may be characterised as more virulent in adult life than at any other period. " Approximately in relation to the sexes, males have been attacked in rather more than twice the number of females, this being prob- ably due to their greater exposure and partly to the fact that a large number of women and children left the city during the course of the epidemic.'^ Second attacks of plague are certainly rare, but one attack does not seem to confer complete immunity. The following examples are given in the report of the Parel Hospital :— " One attack does not confer immunity from another, as one patient had a second and fatal attack, and one had a relapse. The second attack was in a woman aged 40; convalescent 18 days; attacked 27 days after the initial symptoms of the primary attack ; and died five days afterwards. The primary attack lasted nine days and the fatal one five days, and in the latter she developed a fresh bubo in a different site from the original one, had fever, delirium, stupor, coma, and unconsciousness. The general characters of an acute attack were present in the tongue ; pulse, respiration, skin, eyes, intestinal canal, typhoid state and mental condition. Her temperature had been normal 18 days when the fatal attack came on." banger of infection varies in different types. Simple bubonic type. Dissemination of the Bacillus from the Sick. The bacillus multiplies in the organism of those attacked by the disease, and the first stage in the study of its dissemination is to ascer- tain the mode in which it emerges from them. This differs considerably in the different forms of the disease. According to Dr. Bitter the danger of infection from the simple type of bubonic plague is com- paratively trifling. There is no danger from the excretions since Chap, II.] its causes and characteristics, 2t they do not contain the bacillus, nor can there be any danger from the bubo whilst it remaii^s closed. If the bubo opens naturally by suppur- ation there is still practically no danger of infection, since by the time this occurs the bacilli will probably have died. If the bubo is artificially opened before the bacilli have been killed in the course of suppuration, the infectious germs may emerge. But in practice this operation would usually take place in hospital and under proper pre- cautions. The septicsemic form plays a more important part in the Sepilcsemic propagation of plague since the bacilli are contained in the excreta ^^P^* of the sick. The pneumonic form is generally admitted to be the most dangerous Pneumonic from the point of view of infection, and this danger is augmented *^P^' by the fact that it is the most difficult form to recognise. The cases furnish an immense amount of infectious matter, the patient continually expectorating what is practically a pure culture of plague bacilli. Dr. McCabe Dallas (Grant Road Hospital, Bombay) brings the point to special notice. '' I would lay stress, " he says, " on the infectious dis- position of pneumonic plague and its deceptive character to the inexperi- enced, since, in the absence of any external glandular swelling, such a case might be mistaken for ordinary pneumonia or broncho-pneu- monia, whereas every particle of sputa escaping is really a nursery of bacilli in itself. " Surgeon-Captain Thomson (Parel Hospital, Bombay) states that the disease is certainly most infectious in the acute stage. '^ Once the temperature becomes normal, the risk of infection is over. No instance of the spread of the disease from convalescents to patients near them under observation or suffering from other diseases was met with." He also quotes a remark by Professor Dieudonne that repeated exam- inations failed to show the presence of the bacilli in the blood or buboes of convalescents when once the temperature had become normal. The Plague Bacillus in Nature. From a practical point of view this subject is of the utmost import- Importance of ance, since an accurate knowledge regarding the vitality and action *^® subject. of the bacillus under ordinary circumstances is an all-important factor in determining the extent to which, and the manner in which, the disease is infectious, and in consequence the nature of the precautions which should be taken to guard against it. The state of knowledge, at the time of the outbreak in Bombay, Summary in on the subject of the behaviour of the plague bacillus outside living TeVhmS°^'^^ organisms, is clearly summed up in the following passage from the Committee of 22 Description of Plague : [ CHAP. II. the Venice report of the Technical Committee of the Venice Sanitary Conference Sanitary J- Conference of Ot IbQj : — ^^97' a Lg^ presence du contage dans les grands milieux, notamment dans le sol, constitue un des faits les plus interessants dont la science epidemiologique est redevable aux observations recentes. Ce fait nous rend compte des influences locales depuis longtemps consta- tees. II nous explique pourpuoi *elle se repand difficilement, tandis quele cholera comme I'a fortbien dit notre collegue M. Thorne Thorne, se propage le long des voies de communication humaine, et surtout le long de voies fluviales, avec une rapidite qui echappe a tout controle.' " Attache au sol souille des habitations depourvues de pave, de plancher, le microbe semble perdre sa virulence quand 11 vit en sapro- phyte. On pent hesiter, dfes lors, k considerer comme dangereux ou suspects des ballots de marchandises qui auraient sejourne sur les quais loin des quartiers infectes. '' D'autre part, il n'a pas ete demontre jusqu'ici que les eauxouver- tes aient servi ^ la dissemination du germe de la maladie^ La Com- mission juge neanttioins prudent de recommander une surveillance rigoureuse sur I'eau potable, puisque la longue persistance du bacille y semble prouveepar certaines experiences. '' Enfin, les observations recentes et anciennes montrent que le principe generateur de la peste perd rapidement k I'air son activite morbifique. Elle ne se transmet done pas a de longues distances par les courants atmospheriques et la contagion ne parait agir que dans un rayon limite. La faible resistance du germe ^ la dessication, aux actions germicides en general, demontreepar les experiences de labor- atoire, vient confirmer ces donnees de puis longtemps admises par les epidemiologistes." Dr. Bitter's Dj^. Bitter has given the following excellent account of the account. behaviour of the bacillus under different normal conditions; derived from his observations during the present epidemic :— Contamination of " Les bacilles qui sortent du corps du pestifere par les voies que je the environment yiens d^enumerer, contamineront en premier lieu les vetements et la of the patien . j-^-g^j^ ^u malade, ensuite, plus ou moins tout ce qui Tentoure, surtout le solde la chambre, les cloisons, et enfin les mains et les vetements des personnes qui assistent le malade. Wider contami- " Une partie des bacilles entrera avec les dejections dans les lat- nation. rines, ou sera versee sur le sol des cours interieures de maisons ou m6me sur la voie publique ou dans les cours d'eau. Des puits et des denrees alimentaires pourraient Stre egalement contamines. Avec Chap. II.] Us causes and characteristics. 23 les cadavres, une masse enorme do bacilles est enterree dans le sol des cimeticires. " II se pose maintenant la question de savo'ir si tous ces depots sent autant de sources d'infection et quelle est eventuellement lour valeur relative pour la propagation du fleau. " Pour resoudre cette question, il faut en premier lieu savoir si les The bacillus is bacilles evacues par le malade ou contenus dans les cadavres frais, '^-'^P^^'! °f V A . . producing sont a meme ou non de causer une nouvelle infection sans qu'ils subis- infection in the sent prealablement un changement quelconque, ou sans que des condi- fgaleslhe'"^^ ''^ tions locales plus ou moins mysterieuses ne viennent ci leur aide. patient. ''Comme on le sait, Tecole localiste representee par Pettenkofer, se prononce a cet egard dans un sens affirmatif pour toutes les maladies epidemiques, tandis que les hygienistes modernes, que Ton nomme contagionistes, son d'avis que le microbe tel qu'il est fourni par le malade et par lui-meme seul, pent produire la meme maladie sur une autre personne. " Bien qu'a premiere vue il soit plus vraisemblable que I'opinion des contagionistes, adoptee a present partout dans la science pour les mala- dies epidemiques connues, soit egalement valable dans le cas de la peste, voyons comment les faits se prononcent a cet egard. " Or, il est absolument certain que le bacille de la peste, tel qu' il sort du corps humain, pent immediatement crier une Jiouvelle infection, Les animaux rongeurs sont, commeje I'ai dit, capables de contracter la forme septicemique de la maladie. Si on inocule a des animaux de ce genre des secretions d'un pestifere contenant des bacilles specifi- ques, ils succomberont aussi bien et aussi promptement en presentant tous les symptomes caracteristiques, comme si on les avait inocules d'une culture pure. " Bien plus, nous connaissons plusieurs exemples d'anatomistes pathologiques qui se sont inocules involontalrement en faisant une autopsie sur un cadavre frais de pestifere ; ils ont contracte une forme severe de la peste. " Le bacille de la peste n'a done pas besoin de murir dans le sol ou quelque part pour qu'il devienne infectieux. " La seconde question a laquelle nous devons repondre, c'est si le Extent to which germe specifique peut J>,? multiplier en dehors de I'organisme, par J^yjJ'i^^^Jj^^tgj^j" ^ exemple dans le sol, dans I'eau, sur des denrees alimentaires. living or£anism. " Ces questions, pour le dire des le commencement, n'ont pas encore ete resolues experimentalement d'une fa^on complete. " Mais tout ce que noussavons sur la nature du microbe en question nous donne le droit de supposer qu 'une multiplication considerable ne peut pas avoir lieu ni dans le sol superficiel ni dans I'eau, ou tout au 24 Description of Plague [Chap. II. The bacillus requires a rich medium and is very susceptible to the action of saprophytic microbes. Latrines and drains unfavour- able to the life of the bacillus. The bacillus perishes in corpses. Possibility of development in food-stuffs. Retention and loss of infective property of bacillus. moins, un tel developpement ne se produit que sous des conditions speciales, qui en nature sont tr^s rarement donn^es. Dans les couches profondes du sol, un developpement doit, d'apres nos connaisances, etre considere comme impossible. " Le bacille est assez pretentieux et tr6s exigeant quant k ses sub- stances nutritives ; il demande un milieu riche pour son developpe- ment. D'autre part, il semble tres susceptible centre la concurrence, comme les microbes pathogenes en general, des microbes saprophytes dent toujours des quantites enormes pullulent dans le sol et dans I'eau. " Les bacilles que Yersin a trouves, dans le sol k Hong-kong k 7 pouces de profondeur ne semblent point avoir ete les bacilles de la peste. D'apres Lawson leurs caractferes morphblogiques furent differents et, chose ^ remarquer, ils ne furent point pathogenes pour des animaux. "La susceptibilite pour la concurrence d'autres bacteries nepermet- tra gu^re au bacille de la peste de pousser ou meme rester longtemps vivant dans les latrines ou les egouts. Ici, en outre la production con- siderable de carbonate d'ammoniaque aura une influence delet^re sur le bacille tr^s susceptible centre un exc^s d'alcali. D'apres tout vraisemblance, il perira tr^s vite dans les vidanges. II y a un autre fait que je pourrai citer en faveur d'une telle opinion. Parmi es 2,000 vidangeurs employes par la municipalite de Bombay, il y a eu tres peu de cas de peste, moins m6me que Ton ne pourrait les supposer, dans un milieu de personnes vivant dans des conditions miserables de la basse classe de la population. " Or, ces gens, par la nature du syst&me de vidange qui est en usage ^ Bombay, devaient forcement contaminer leurs mains et leurs vete- ments tous les jour, par des dejections, et il ne peut exister de doute, qu'assez frequemment des dejections provenant des pestiferes ne se soient trouvees dans les recipients k vider. " Le microbe ne saurait guere non plus pousser dans les cadavres enterres. 11 est presque certain qu'ils perissent assez vite dans les cadavres. " Un developpement sur certaines denrees alimentaires, doit etre admis comme possible, mais il semble que nous n'avons pas a nous preoccuper beaucoup d'une possibilite pareille, parce que, selon toute vraisemblance, les aliments ne jouent pas un role appreciable dans la transmission de la maladie. * * -x- * * * " Apr^s avoir constate que les microbes de la peste ne peuvent pas se multiplier en dehors de I'organisme d'une mani&re ayant une import- ance pratique, il faut maintenant que nous rendions compte sur le temps pendant lequel ils peuvent garder leur infectiogite, et sous quel- les conditions ils la perdent. Chap, II, ] its causes and characteristics. 25 Les reclierches qui ont ete faites jusqu' k present k cet ^gard, sont The bacillus 13 assez incompletes. Ce que nous savons pourtant, c'est que le bacille ^"^^^P'^'}'''^ to est assez susceptible contre le dessechement. Je n'ai pas pu contre- prendre des essais suffisants de ce genre, en raisonde cequ'ils exigent un materiel plus complet que je n'avais k ma disposition a Bombay. "Quelques experiences faites par Kitasato ont eu pour resultat que le bacille etait mort apr^s quatre jours de dessication et qu'ily est egalement tue par une exposition au soleil durant plusieurs heures. Les quelques essais que j'ai pu faire m'ont convaincu egalement d'une fa9on absolue que le bacille ne peut persister ^ I'etat sec que pendant quelques jours. '' Ce fait est d'une grande importance pour la propagation de la peste. II le rend trfes invraisemblable que le germe pourraifc ^tre transports a longues distances par I'air dans la poussiere et nous permet de supposer que les matiferes infectieuses qui sont jetees sur lavoie publique y soient rendues inoffensives assez vite par la force combinee du dessfechement et des rayons du soleil. " D'un autre cote, il est tr6s probable de prime abord (les quelques The bac-llus can experiences que j'ai faites venant a I'appui d'une telle opinion) que le P''o'^?'^'y regain bacille puisse conserver sa vitalite pendant un laps de temps plus ou conM-?erabii°' ^ moins long, quand il se trouve a V eta.t /i urn id e, fixe sur des vetements P^'''°'^ '^ ^^P^ dans la literie, etc., et sur le sol et les cloisons des chambres. II y con- favourable me- servera sa virulence d'autant plus longtemps, qu'il sera proteo-e contre un dessechement complet. II ressemble a ce point de vue au bacille du cholera, qui peut, commenousle savons, se tenir vivant pendant un temps considerable sous des conditions pareilles; seulementle microbe de la peste est encore plus resistant. " Si nous resumons bri^vement ce que nous venons de dire la valeur relative des sources d'infection creees par le pestifere doit etre appreciee comme suit : " Le plus grand danger est le malade lui-meme ; ses vetements The greatest st sa literie souilles, et la cJiainhre dans laquelle il se trouve. danger is from ,, T 1 -ii • • i. J ^ ^ , ' 1 , , ^^^ s'ck person, " Les bacilles qui viennent dans les latrines, dans les egouts, sur la his clothes, bed- voie publique, etc., jouent un role bien secondaire dans le propagation J'"^ ^""^ '^^^™' de la maladie, et les cadavres enterres peuvent meme etre consideres comme inoffensifs. " The result of the investigations of the German Commission (of Investigation of which Professor Koch was a member) was similar in effect to Dr !-^^ German TT,. , , . .T-1 r 11 • ■ , '■•Commission. Bitters conclusions. ihe tollowing summary is taken from the ''Deutscher Reichs-Anzeiger und Koniglich Preuszischer Staats- Anzeiger " of the 20th July : — " Outside of the body of man or of the bodies of certain animals the Outside the plague bacillus shows a notable tendency to perish. Pure cultivations bodies of man *- ^ * *■ and certaiq 4 26 Description of Plague : [Chap. II. animals the Qf the pla^ue bacillus from different sources and of different bacillus shows a . 7, . ■, ^^ ^ t c i i_ i •- j j ri notable tendency ages in fluid or on solid media were found to be quite dead after 15 to perish. minutes' continuous exposure to a heat of 7o°C. When the heat was 8o°C., five minutes was enough for sterilisation. A cultivation sus- pended in water, when examined immediately after exposure to ioo°C.,* was found to contain no living plague bacilli. •X- -X- 5K * * * Experiments of «' Material containing the plague bacilli was placed in different CommisTion. ways upon linen, wool, silk stuff (and also threads), gauze, filter paper, pieces of glass, earth, etc., kept in different conditions, and tested from time to time as to its infectiousness. The life of the bacilli under these circumstances was at most eight to ten clays, and often only two to five days. Suspended in ordinary pipe-water the bacilli were found to be dead at the latest in three days ; in sterile bilge-water after five days ; in sterile pipe-water at the latest after eight days. The infectiousness of bacilli on the dried skin of two mice that had died of plague was extinguished in the one case on the fourth, and in the other on the sixth day. Sputum of plague pneumonia, containing large quantities of plague bacilli, and kept fluid in a test tube, closed with a cotton wool plug, in the ice-box, proved to be still infectious on the tenth day, but on the sixteenth day had ceased to be so. In all these experiments the plague bacilli showed themselves to be organisms which cannot grow without access of atmospheric oxygen. " Experiments on Mr. Hankinf also made a series of experiments in Bombay to test bacillus iifgrain^j the vitality of the plague bacillus in grain of different species and in seeds, wool, other food-stuffs, and in wool and similar commodities. cotton, and jute made by Mr. ^ij-^ Hankin injected into mice extracts prepared from grain H3.nlciri Conclusion that infected with (i) pure cultures of the bacillus, (ii) portions of the the infectious ors'ans of deceased rats and mice, (iii) secretions of the human powers are lost = . 1 • •• ht tt i • • 1 in not more than patient. The conclusions at which Mr. Hankin arrived were that SIX days. ^^^ bubonic microbe . derived from pure cultures perished within thirteen days after being added to the specimens of grains and seeds employed, and that grain infected with the organs of animals dead of the plague or the sputum of a human patient loses its- infectious powers within six days. In so far as Mr. Hankin was able to com- plete his investigation into the vitality of the bacillus in wool and other such commodites, he considered that the results tended to show that the bubonic microbe, whether derived from cultures or the organs of deceased animals, and whether placed on cotton, or sheep's wool or gunny cloth, uniformly dies out within six days. * 212° Fahrenheit. ■\ Appendix I. Chap. II.] its causes and characteristics. 27 But the Government of India were advised that these laboratory The<;e laboratory experiments, though they may demonstrate the loss of pathogenic condusivras"°' property, are inconclusive as demonstrating the loss of vitality in demonstrating the bacillus, which might quite conceivably, although non-pathogenic yit^alUy in the at the time of the final experiments, again become pathogenic under bacillus. favourable local conditions. Dr. Bitter remarks that it seems probable that in a moist condition Experience the bacillus may retain its vitality for a considerable time in surround- con"er"v^tion of ings favourable to its life, such as contaminated clothing or bedding, vitality. and experience favours this view. Hirsch recites an example from the We\^a'nka!°'" epidemic at Wetljanka in 1878-79. There was a girl of ten years of age in the house of whose parents a box of clothing had been deposited, coming from a house in which all the inhabitants had died two months previously. The girl opened the box, which up to that time had remained untouched and was about to be burnt. She took a piece of clothing out and set to work on it, and four days later, the epidemic having disappeared, the first symptoms of the disease showed themselves in her. Another interesting instance occurred on board a liner durincr the Instance on a Bombay epidemic. The vessel embarked her crew at Bombay on Bombay""^ the 20th August and anchored in the Thames on the i ith September, epidemic. There were from three to four hundred passengers on board, and durino- the voyage there was no suspicion of plague among them or among the crew. On the 26th or 27th September one of the Indian Portuguese stewards fell ill and died on the 3rd October. Clinical and bac- teriological evidence pointed to plague. Another of the stewards who slept in the same cabin as the first was also taken ill about the 26th September and died on the 27th before he could be removed to hospital. The result of a careful enquiry was to the effect that the infection was derived from clothing contained in bundles which remained unopened until the end of the voyage. Both the German Plague Commission and Mr. Hankin made experi- Action of ments to test the action of chemical disinfectants on the plague disinfectants, bacillus. The following is a summary of the conclusions of the German Commission : — " A solution of corrosive sublimate of the strength of i : i,coo killed Experiments of the bacilli at once. Carbolic acid or lysol of the strensfth of 1 in 100 tj'e German 1 Ml 1 1 MT • 1 • • Commission, killed the bacilli withm 10 minutes. When suspensions of the bacilli were treated with soft soap (3 in 100) or chloride of lime (i in lOo), they were found after 5 minutes still to contain virulent bacilli, but in 15 minutes sterility had been produced by the chloride of lime, and in 30 minutes by the soap. Sterilised faeces copiously infected with plague bacilli, and then mixed with equal parts of ordinary milk of 2 8 Description of Plague : [ Chap. II. iime, contained virulent bacilli after 30 minutes, and had become sterile in an hour. The plague bacilli were found to be extremely sensitive to mineral acids ; for the plague bacilli contained in the mixture were killed in less than 5 minutes by pure sulphuric acid diluted to i : 2,000. Bacilli dried in thin layers on splinters of glass and exposed to direct sunlight died within an hour. " Experiments of Mr. Hankin's researches on the action of disinfecting agents were Mr. Hankin. ^^ ^^^ following effect : — "A. Phenols and their allies. — The bubonic microbe was found to be somewhat resistant to the action of carbolic acid, a one per cent, solution not being always sufficient to kill it under the condition of the experiment. Phenyle, lysol, and izal were found in all cases to destro}^ the microbe when in a quarter per cent, solution. The limit of dilution of the solutions of these substances necessary to destroy the microbe was not however found. Naphthaline, both pure and impure, and a patent preparation ' naphtho-sublimate ' were found to exert no disinfectant action although tested in solutions containing an undis- solved excess of these substances. "B. Corrosive sublimate and copper sublimate. — Corrosive sub- limate was found to destroy the microbe in a strength of one in five thousand, but the lower limit of its action was not investigated. Copper sulphate was found to be efficient in a strength of one in a thousand. A five per cent, solution of this substance was used by the French Government in 1892 in combating cholera. It is easily obtainable in India, and might under certain conditions be used against the plague as shown by the above result. " C. Alkalies. — The microbe appears to be relatively resistant to the action of alkalies including ammonia, caustic potash, and freshly slaked lime. Under the conditions under which lime washing must be carried out in India, it must not be regarded as a disinfectant for the infection of bubonic plague. " D. Acids. — The microbe is extremely sensitive to the action of acids. The sensitiveness is greater in the case of inorganic acids, but certain organic acids were also found to destroy the microbe rapidly. The following results were obtained : — With inorganic acids. Under the conditions of the experiments the microbe was_de- stroysd in five minutes by — Nitric acid of a strength of i in 133. Hydrochloric acid of a strength of i in 500. Sulphuric acid of a strength of i in 1,429. Chap. II. ] its causes and characteristics. 29 A mixture of four parts of sulphuric acid and one part of nitric acid was found to be as efficient as sulphuric acid in destroying the plague microbe. With organic acids. The microbe was destroyed in five minutes by — Formic acid of a strength of i in 100. Acetic acid of a strength of i in 142. Lactic acid in a strength of i in 333. '' E. Reducing agents. — The microbe was found to be extremely resistant to the action of ferrous sulphate, a substance that has been frequently recommended for the treatment of sewage and filth. It appears generally to die out when evaporated to diryness in a thin film on glass in the presence of the air, but Was found still alive after five days when evaporated to dryness in glass bulbs in a current of hydro- gen gas, " F. Oxidizing agents. — The microbe was found to be destroyed by a solution of one in ten thousand of chloride of lime, but the lower limit of the action of this substance was not detected. Permanganate of potash was found to be capable of destroying it, under the artificial conditions of my experiments, in a dilution of i in 50,000, that is to say, in a solution in which the pink colour is but faintly marked. In certain cases it appeared that the organic matter present was sufficient to destroy all the permanganate used, after the lapse of some hours. In these cases the microbes were first destroyed and afterwards the permanganate was reduced. It was shown however by experiment that the quantity of readily reducible organic matter present on a cowdung floor is so great that probably a four per cent, solution of permanganate would be necessary to produce a safe disinfection. " Mr. Hankin recognised that the conditions under which the labor- Laboratory • . 1 111 r i_7 t conditions atory experiments were carried out were puobably more tavourable to favourable to the the disinfectant than would be the case in practice. " This fact while ^ftjon of the ^ r 1 disinrectant. tending to justify the condemnation of a disinfectant from the results of such experiments, necessitates caution in using such experiments to recommend a disinfectant. The fact that a disinfectant can destroy a microbe suspended in water, as was the case in my experiments, does not prove that it would be capable of destroying the microbe when contained in human dejecta soaked into a cowdung floor. Hence it appeared to me to be advisable to carry out some experiments in which practical conditions would be more closely imitated. " 30 Description of Plague : [ Chap. II. In pursuance of this view Mr. Hankin made a series of interesting experiments on the floors of houses, which are described in Chapter VIII in deahng with, the subject of disinfection, and which are repro- duced in Appendix VI. Vitality of Mr. Hankin made the following interesting deductions regarding fo^od-stuffs and the vitality of the bacilli in food-stuffs and dead bodies from its sus- dead bodies from ceptibility to the action of organic acids : — point of view of susceptibility to " In view of the fact that most articles of diet either possess an action of orsranic .1 ,. .,, • •, ,^ t r i acids. 2.c\a reaction or rapidly acquire it on the onset ot decomposition owing to the appearance of the above acids or their allies, it seems scarcely probable that food-stuffs should retain for long the microbe of bubonic plague. In the case of milk this speculation has been put to an extended test by Dr. Srinivasa Rau in my laboratory in Bombay. He found that as soon as milk has been kept long enough to acquire a well marked acid reaction, that is to say, within a few hours of milking under ordinary conditions, it has the power of destroying the bubonic microbe within an hour. If, on the other hand, the milk is made faintly alkaline, it is incapable of so doing, and appears to be a good food medium for the bubonic microbe. Dr, Rau has also carried out exper- iments on the vitality of the bubonic microbe in rotten grain. This substance nearly always has an acid reaction, and is then capable of rapidly destroying the bubonic microbe. I propose to describe his experiments at length in another report. The tissues of animals after death acquire an acid reaction owing to the development of an ally of lactic acid. Dr. Rohak under my direction has found that this acid reaction appears in the bodies of animals dead of plague. This point, though it has no bearing on the admitted danger of handling and washing plague corpses, may, if worked out, be found to have an im- portant bearing on the old idea that gravej^ards may be a lasting source of infection. '^ Mode in v>7hich the Bacillus enters the System. Scheube. Scheube states that infection can take place by the air or touch, and consequently the poison may gain access to the body by the respira- tory organs or by the skin. liong-kong Among the observers of the Hong-kong plague Surgeon-Major observers. j-j_ £_ j^_ James states that the bacillus so far as is known gains access by {a) respiration, [b] inoculation and [c) food. Staff Surgeon Wilm ex- pressed the opinion that infection through the skin is not common ; '' for, on the one hand, in the great majority of cases the buboes do not appear Chap. II.] its causes and characteristics. 31 until after the onset of severe symptoms ; and, on the other hand, were such a mode of infection common, we should expect to see much more frequently local affections of the skin, since the plague bacillus when injected into animals usually causes intense inflammation with a haemorrhagic gelatinous exudation." "The plague bacillus appears to enter the body,^' says Staff Surgeon Wilm, " most frequently by way of the alimentary tract. This view is substantiated by the result of ex- periments on animals, and by these cases in which, both during the occurrence of the disease and on Wy^ post-mortem table, the principal changes were found to be in the stomach, the mesenteric glands, and the other abdominal organs." This opinion and these observations differ widely from the results of the investigations pursued at Bombay. Dr. Bitter deduced the following conclusions from his experi- Dr. Bitter, ments : — [a) In all cases in which the buboes appear in the lymphatic infection glands of the extremities {e.g.^ inguinal, femoral and axillary), the germ through— of infection enters through a discontinuity in the skin, [b) In some cases (h) The tons'iis where buboes appear in the cervical glands the infection may take place W ^'^'^ intesti- through, the tonsils, [c] Infection may sometimes take place through (c^) The lungs, the intestinal tract, the primary infection occurring in Peyer'spatchesj the solitary follicles, or the mesenteric glands, [d) In primary pneu- monic cases the infection occurs throuo;h^ the lungs. The following are the arguments on which Dr. Bitter bases these Arguments on conclusions : — n'^^'^pwf . Ur. Bitter s "' II ne pent exister le moindre doute que dans les cas buboniques conclusions are simples et dans les cas septicemiques, les bubons ne representent re- ellement la localisation primaire, le premier foyer de developpement pour le bacille specifique. Tant les observations faites sur le vivant que les resultats des autopsies parlent entierement en faveur d'une telle supposition. " Mais les bacilles comment entrent-t-ils dans les bubons ? '• Les sieges des bubons primaires £ont la region femorale et inguinale, cubitale et axillaire, et enfin la region cervicale. Les groupes des glandes lymphatiques qui se trouvent dans ces endroits, resolvent les vases lymphatiques d'une certf.ine region, et constituent pour ainsi dire les passoirs par lesquelles la lymphe doit etre filtree avant d'entrer dans le systeme lymphatique interieur. Ainsi, par exemple, les glandes femorales et inguinales appartiennent a I'ex- tremite inferieure, les glandes cubitales et axillaires au bras. Une fonction principale de ces glandes est certainement de servir comme une esp^ce de barri^re pour arr^ter les elements corpusculaires nuisibles, surtout des bacteries, qui essayent d'envanir I'organisme par la voie lymphatique de la peripherie. 32 Description of Plague : [ Chap. 11. " Lorsqu'tmc ou plusieurs glandes d^'un seul groupe se gonflent, s'enflamment ou arrivent au degre de suppuration, la cause en est presque reguli^rement une lesion infectee qui se trouve dans la peau de la region peripherique correspondante; C'est Xk une ancienne experience medicale ; ces glandes gonflees portent comme dans la peste le nom de bubons. " Nous observons egalement que parfois dans ces cas, les bacteries ne restent pas confinees dans les glandes, mais qu'elles franchissent la barriere et creent une infection generale de I'organisme. Les infections bien connues causees par des streptococques pourraient servir d' exemples pour ceque je viens de dire. *' Or, I'analogie avec les alterations creees par la peste saute aux yeux. Aussi dans cette maladie, ce ne sont, dans le plus grande majorite des cas, qu'une ou plusieurs glandes appartenant a un seul Infection crroupe, Qui montrent les affections specifiques. Rien n'est done plus ordinarily & i ' ^ , , i . • • n . / i i -n i- through a naturel que de supposer qu'egalement ici, 1 entree des bacilles a lieu discontinuity of j p6ripherie. the skin. r r f .,,... "Comme toutes nos experiences bactenologiques sont contraires a I'idee que le bacille puisse traverser le peau intacte, la porte d'entree ne pourrait etre qu'une petite plaie. En effet, si nousprenons en consideration toutes les possibilites qui exissent pour le transport dans les glanders primaires, des bacilles specifiques, nous arrivons a cette conclusion, que dans tous les cas de peste, oia les bubons primitifs se trouvent dans les groupes de glandes lymphatiques des extremites, le germe infectieux a fait son entree par une discontinuite de la peau de la region peripherique en question. On ne pourrait guere trouver une autre explication plausible, etant donne le fait que les glandes specifiquement affectees, sont la localisation primaire. " Parfois, j'ai rencontre une idee vague que le bacille entrait par les voies respiratoires ou digestives, et qu'il etait de W transporte dans la glande primaire. "Ce transport devrait se faire on par Ik voie lymphatique ou par celle du sang. En admettant le premiere possibilite, il serait trfes difficile, si non impossible, d'expliquer pourquoi W localisation primaire aurait justement lieu dans les glandes peripheriques et non pas, comme il serait naturel, dans les glandes mesenteriales ou bron- chiales, et pourquoi I'infection est presque toujours restreinte k un seul group anatomique des glandes. Aussi le transport par le sang est tout k fait invraisemblable. En entrant dans le systeme vascu- laire, les bacilles devraient ou s'y multiplier, comme ils le peuvent, ou tout au moins la localisation primaire devrait se faire dans la rate, qui est specialement apte k retenir des bacteries comme nous le gavons, tant d'autres maladies infectieuses que de la forme septicemi- Chap. II.] its causes and characteristics. 33 ^'&Q de la pcstc meme. Une fois entrc dans les poumons, )c bacillc de la peste ordinairement ne manquera pas de produire Ics alterations pneumoniques mentionnees plus haut. ** La theorie de V infection a vote indirecte est done tout autant Theory of contraire aux faits anatomiques qu'aux habitudes des bacilles specifi- '"^'^'^'^'^ infection ^ ^ ^ not tenable. ques. *' Ce qui, k premi&re vue, ne semble pas bien se ranafer k I'jd^e '^^-'^^ *^^® ""^""^ 1, • r . , , 1 , , f 's often not d une intection cutanee c est que dans beaucoup de cas de peste, on discoverable ne trouve pas de plaies constituant la porte d'entree du baciile, cequi <3oes not disprove . . ^ ' T theory of est presque toujours possible dans les cas analogues causes par infection through d'autres bact^ries. Ces dernieres, creent ordinairement une reaction f- discontinuity m the skin, plus ou moins forte k la porte d'entree, que Ton pent meme trfes souvent suivre le long des vaisseaux lymphatiques jusqu'aux glandes gonflees. " Le baciile de la peste, de son cote, ne produit que tres rarement one alteration locale. II ne commence a se multiplier et a provoquer une reaction que dans les glandes. ** Comme la discontinuite de la peau qui lui a servi de porta d'entree peut etre tout a fait minime, elle pourrait etre bien guerie au moment ou les symptomes glandulaires deviennent manifestes et a echapper ainsi a I'observation. " Quand on exam?ne du reste bien la peau, on trouve dans une grande partie des cas de peste, assez d'egratignures et de disconti- nuites dans la region du corps correspondarit au bubon, qui auraient pu servir de porte d'infection. " Enfin, I'infection par voie de petites plaies, a ete observe e plusi- eurs fois d'une fagon directe et incontestable, Plusieurs anatomistes pathclogiques qui se sont piques le doigt en faisant I'autopsie d'un pestif6re, ont contracte par cela la maladie, et les bubons se trouverent dans I'aisselle correspondant a la lesion. *' II existe du reste des maladies ou I'infection a certainement lieu par de petites discontinuites de la peau et dans lesquelles on ne reussit que trfes rarement a prouver leur presence. Ainsi, par exemple, dans I'erysipele a la face qui r&gne parfois d^une raaniere epidemique. Ce n'est que la bacteriologie moderne qui a trace dans cette maladie la voie d' infection. Dans le temps on I'appelait souvent erysipele idiopathique pour le distinguer des erysipeles chirurgicales, cii on 'reconnaissait facilement une plaie comme porte d'infection. J'ai vu a Bombay deux cas qui montrerent I'affection primaire dans infection through les glandes cervicales profondes. Les alterations constatees a *^^ tonsils. i autopsie, le rendirent des plus probables que I'infection eut pris son origine des tonsilles. Cela n'a rien d'etonnant, si nous nous rappelons 5 34 Description of Plague : [ Chap. IT, que les lacunes des tonsilles sont en communication directe et ouverte avec le systeme lymphatique du cou. II est bien probable que dans un certain nombre de cas de bubons cervlcaux, I'infection se produit de cette manifere. Infection " De nieme, une infection prenant son origine dela voie intestinale, orisinatinof in the » . • •! i t^ -i ii cc j* • • i • i_ intestinal track. ^'' ^^^ P^^ mipossible. Uans un cas pared I arrection prnnaire devrait se trouver ou dans les plaques de Payer ou dans les follicules solitaires ou bien dans les glandes mesenteriales. " Les observateurs qui ont fait des autopsies ^ Hong-kong, preten- dent avoir vu souvent des formes pareilles. Wilm, est menie d'cpinion que I'infection par I'intestin est la plus frequente. A Bombay, je n'ai jamais constate une forme semblable ; aucune autopsie n'a releve des faits qui parlent en faveur d'une infection intestinale. " Dans les cas que j'ai examines, j'ai vu, c'est vrai, parfois les glandes mesenteriales gonflees, mais il ne s'agissait pas la du gonfle- ment specifique qui est caracteristique pour les glandes primaires. Dans tous ces cas, du reste, la localisation primitive put etre con^tatee ailleures. ' Aussi, les autres observateurs, qui ont etudie la peste ^ Bombay et qui ont fait beaucoup d'autopsies, m'ont assure qu'ils n'ont jamais vu de cas intestinaux. " Je ne saurais expliquer pour quelles raisons les ol)servateurs de Hong-kong ont une opinion differente, mais d'apres tout ce qui a ete constate k Bombay, tant par les autres observateurs que par moi, je me crois autorise de dire que I'infection par voie intestinale n'a joue k Bombay aucun role, ou au nioins un role tout a fait secondaire. " II n'est pas bien probable que dans deux epidemics de la meme maladie, sevissant dans difTerents endroits, le mode principal d'infec- tion puisse etre tellement different commeil le serait, si Ton admettait que tant les observations faites a Bombay que celles rapportees de Hong-kong par Wilm, soient exactes. Infection in the " Mais il existe une autre voie d 'entree bien souvent frequentee par '""gs- le bacille de la peste, c'est I'infection par inhalation ou mieux par as- piration dans les poumons. Dans ces cas la, la localisation pri- maire se trouve dans les poumons sous la forme de foyers pneumoniques dissemines. D'apres ce que nous avons vu plus haut, ces foyers constituent reellement la premiere lesion, et II ne peut pas exister le moindre doute que I'infection ne dolve reellement son origine a I'entree directe des bacilles specifiques dans les poumons." Intestinal With regard to Dr. Bitter's observations about intestinal infec- infection. ^.^^ .^ ^^^ ^^^^ stated above that the gastro-endemic form of plague, though rare, did exist in Bombay as a primary type. Chap. II. ] its cattses and characteristics, 35 Messrs. Wyssokowltz and Zabolotny of the Russian Commission Exp'-riments of came to a similar conclusion with regard to infection by '^i'^^'^t in- pjf '^"^^^^^.^^ oculation, as will be seen from the following quotation : — ■ sion with regard to inf-ction ,, T^ e • ■ 1 , • •! ^ -J TTf- M 1 A, through the " Ln iaisant les autopsies, il elait diincile de reconn?iitre par .i^jn^ quelles voies le virus avait penetresoit dans les glandes, soit dans les poumons. Presque dans tons les cas on ne trouvait ni lesions locales de la peau, ni modifications des vaisseaux lymphatiques (lympliangites). Et cependant, on devait supposer la penetration du virus par la peau : il etait necessaire de prouver cette proposition. Nous avons trouve des arguments en sa faveur dans les experiences faites sur les singes. En effet, des experiences preliminaires sur les singes nous ont montre que ces animaux sont trfes sensibles au virus de la peste "D'aprSs nos experiences, nous sommes persuades que les singes prennent tou jours la peste apres qu'on les a infectes. Nous avons fait quelques experiences avec des doses trfes minimes de bacilles, au moyen d'une simple piqCire faite avec une epingle chargee de virus. Tousles singes (5) infectes de cette fagon k lapaume de la main sont morts, apr^s 3 a 7 jours, avec des bubons et tons les autres symptomes de la peste, mais dans ce cas on n'observait, ni pendant le cours de la maladie, ni ^ I'autopsie, aucune alteration sensible a. la place de T introduction du virus, k la paume de la main. *' Chez un singe infecte au pied dans les memes conditions par une piqure d'epingle, la mort n'est survenue qu'apr^s un temps plus long (10 jours) avec des bubons inguinaux et retroperitoneaux tres mani- festes, absolument comme chez I'homme, mais toujours sans lesions locales au point d'inoculation. " Les resultats de ces experiences sont tres interessants parce qu'ils ne laissent pas de doute sur ce point que, chez Thomme, I'infection par la peau pent se developper sans qu'il y ait aucune lesion apparente au point d' introduction du virus." Among the medical officers of the Government who studied the Dr. McCabe plague, Dr. McCabe Dallas (Grant Road Hospital, Bomba}-) discusses ^fl^T '''^ the mode by which the bacilli gain an entrance into the system a.ud infection. produce the disease. He states that the current conclusions are th*at the infection occurs through wounds, abrasions, or other openings of the skin or mucous membrane, through the lungs or by way of the alimentary canal. He explains the theory of these conclusions m somewhat the same way as Dr. Bitter, but states that there are objections, the chief among which he appears to consider the difficulty, 36 Description of Plague : [Chap, IJ. Dr. Wilkins on the mode of infection. Infection by the skin. mentioned by Wilm and combattedby Dr. Bitter and the members of the Russian Commission, of believing that the germ can in the majority of cases enter the system through a discontinuity of the skin. Surgeon-Lieutenant-Colonel J. S. Wilkins, who was in charge of the operations against plague at Cutch-Mandvi, made the following interesting remarks, in which he states a view in many ways similar to that put forward by Dr. Bitter : — " There are several means of conveyance : — ■ 1. By the air, producing the very common and fatal form of primary plague pneumonia. 2. By the food or drink [acute plague dysentery). 3. By the skin. " I am inclined to think that the latter method is far commoner than is generally supposed, especially amongst cases affected with buboes. Out of the following 260 cases » . , it has been found that there were— No buboes... ... ... ... t.. 94 Right inguinal „!,„■ ... ... ... fo Left „ ... ... ... ... 58 Right axillar})- ... ... ,„ ... 19 Left „ ... ... ... ... II Submaxillary ... ... ... ... 7 Cervical ... ... ... ... ... 1 Supratrochlear ... Parotid Multiple ... ... " From the above it will be seen that by far the largest number of buboes affected the groin. The explanation of this appears to be that the large majority of Cutchees wear no protection to the feet, and it is perfectly easy to understand that, under these circumstances, ever so slight an abrasion of the superficial epithelium (an unavoid- able occurrence in a barefooted race) would provide a mode of entrance to the bacillus followed by an inflammatory condition of the nearest glands. " The same principle applies equally to other parts of the body. The next largest number to the inguinal are the axillary, the right axillary nearly double the left, because the right hand is not only used more than the left, but is almost exclusively used in eating. •*The submaxillary becomes infected by the entrance of the bacillus through a carious tooth, the supratrochlear from the hand, and the Chap. II. ] Us causes and characteristics. 37 parotid through Stenson's Duct. The cases fairly illustrate the frequency of direct inoculation, which in the present state of our knowlcdsfe should come under the old head of contagion." The Plague and Animals. Plague differs from other infectious diseases, such as typhus, ty- Plague attacks phoid and cholera, in that it is not confined to man but also attacks animals, certain classes of animals. The occurrence of a marked mortality among rats either anterior Rats, to or coincident with plague epidemics is a well-known phenomenon that has been observed from distant times and in many lands. It has been a marked characteristic of plague visitations in India including the present epidemic. An examination of the bodies shows buboes similar to those which exist in man, and bacteriological investigations in Hong-kong and India have demonstrated the existence in large quantities of the plague microbe in the bubo and in various portions of the organism of the dead animals. There Is no doubt that rats are in a high degree susceptible to plague. Inoculation with bubonic pus causes certain death, not only to rats, but also to other small rodents, such as mice and guinea-pigs. Mice die after one to three days, and guinea-pigs after two to five days. Numerous bacilli are found In the lymphatic glands, the spleen, the liver and the blood. Inoculations from cultivated bacilli are also successful. The following were the conclusions of the German Commission on the subject of plague in rats : — '' A rat which had become Infected while in a state of freedom Observations of contained in Its body a verv great number of plague bacilli : and *^® German 11 1 1 ' 1 111 Plague altogether, as later researches proved, rats showed themselves in a Commission on high degree sensitive to plague Infection. Simple Inoculation with P^^^ue m rats, the smallest quantities of a cultivation, or contact of the external mucous membranes with a cultivation, or feeding with the smallest quantities of a plague bacillus cultivation was enough to produce in- variably fatal plague. Since it is known that these animals in a state of freedom are accustomed to gnaw the bodies of their companions dead of plague, it is easy to understand that the pestilence must spread very quickly among them and destroy the whole rat-population of a place, and that by means of rats the plague germs can be Intro* duced from one home into another and conveyed to men." Remarks of the Technical Committee of the Veiiica S initary Convention on plague among domestic animals. Experience of present plague shows that susceptibility of domestic animals is very slight. M. Haffkine's experiments. ^8 Description of Plague: [ CflAP. W, The Report of the Technical Committee of the Venice Sanitary Conference of 1897, after dealing with the small rodents, discusses the case of the domestic animals in the following terms : — " D'autres especes encores vivant au voisinage de I'homme, "k I'etat domestique, leschiens, les pores, les buffles, les moutons, les chevres, etc., peuvent 6tre atteintes d'apres certains observateurs. Jusqu'icr cependant, aucune preuve directe n'a ete fournie de la communaute d'origine de la peste.et de certaines epizooties, qui out, parfois regne simultanement." The Government of Bombay consulted their expert advisers with ar view to ascertain what danger existed of domestic animals being attacked by plague. The investigation was made specially with a view to determine whether any risk of infection was to be apprehended from animal lymph prepared within plague areas. The result was distinctly unfavourable to the hypothesis that domestic animals are under ordinary conditions susceptible to plague. The Government of Bombay summed up the conclusions in the following passage : — " It is in fact very doubtful whether cattle are susceptible to plague,, at all events to anything like the same degree as human beings. There has been no record of any disease or deaths among cattle in the many places where the epidemic has raged in the Bombay Presi- dency which could be attributed to plague ; and, as will be seen from Dr. Lowson's report, in Cutch-Mandvi inquiry has shown that cattle remained perfectly healthy while the plague was at its worst in that town. The so-called cases of plague in cattle have, at least in one instance, been pronounced by competent veterinary opinion as rin- derpest. Dr. Lowson reports that he carried out experiments in Hong-kong in conjunction with the Colonial Veterinary Surgeon, in which it was proved that cattle, after direct inoculation with pure culture of plague bacilli, did not develop plague, and, with the excep- tion of temporary fever and refusal of food, remained healthy. More- over plague bacilli could not be found microscopically or bacteriologi- cally in their blood, nor were there any signs of plague, such as enlarged glands, along the chain of lymphatics from the spot where the inocula- tion was made. M. 'Haffkine's experiments in Bombay, like Dr. Lowson's in Hong-kong, tend to prove the immunity of cattle generally from plague. JVl. Haffkine injected hypodermically horses, goats, cows and sheep with considerable doses of virulent plague cultures. The operation caused an attack of fever from which they all, except the goats, recovered In a short time with perhaps local swelling and suppuration at the seat of inoculation. The goats alone, without developing any acute disease, lost condition, gradually wasted away, and after a considerable time many of them succumbed. He further Chap. II. ] Hs causes and characteristics. 39 states that one of the cows gave birth to a calf during the period she was operated on, and both cow and calf remained healthy. Finally, M. Haffkine considers that his experiments show that no spontaneous plague infection, which in nature can only take place with much smaller doses of virus than those used by him on horses, cows, goats and sheep, is likely to affect these animals ; and the Surgeon-General concurs in this opinion. " The researches of the German Plague Commission were equally Resr^arches of satisfactory. The following is a summary of their conclusions : — piLgue " Pigeons, fowls, geese, and pigs were treated with injections of Commission, virulent, concentrated suspensions of plague bacilli, and the pigs were also in part fed with rats dead of plague ; but none of them showed any reaction whatever. Injected or inoculated dogs gave almost no reaction. Of two dogs fed with pure cultivations, one remained well, the other became slightly ill, but no plague bacilli were found in the swollen glands. Injected and inoculated cats had short fever. In one case a local abscess formed, but the pus was sterile. Somewhat more sensi- tive to inoculation or injection were sheep and goats ; in the case of the former the abscess-pus contained numerous plague bacilli ; In the case of the latter, none. Cows reacted with high fever and severe local appearances ; In this case also the abscess-pus was free from plague bacilli. Horses showed less reaction. All the animals experi- mented on that showed signs of illness have completely recovered. It is to be noted that In these experiments with animals the exhibition of the Infection was far more intense than obtains under natural conditions. " The experience of the Himalayan plague In Kumaun and Garhwal Confirmatory affords further evidence that domestic animals are not susceptible to Kumaun and the disease. In the Himalayan villages cattle and men are crow^ded Garhwal. together in Ill-ventllated tenements. The cattle with the people are thus subjected to conditions peculiarly favourable to the action of plague infection. Notwithstanding this, Br. Rennle, who investigated the Himalayan plague in 1850, expressly remarked that the natives were all agreed that there had been no particular disorder or mortal- ity among their cattl«, but that the disease was preceded or accom- I panied by a great mortality among the rats in their houses. Monkeys, on the other hand, were found to be extremely sensitive Monkeys, to plague, and both the German and the Russian Commissions used monkeys for their experiments on the effect of preventive and curative Inoculation. The members of the German Commission discovered that the grey monkeys were far more sensitive than the brown mon- keys. It is believed that some monkeys died of plague during a slight Insects. 40 Description of Plague : [ Chap. IL epidemic that prevailed at Kankhal near Hardwar in the North- Western Provinces. The German Commission observed that flies taken off the body of 3 rat and inoculated into a guinea-pig, infected it with plague. The possibility of infection being carried by flies and other insects has been noticed in some previous epidemics. Primary danger is in the sick person and his surroundings. Danger greatly enhanced by insanitary and overcrowded surroundings. Hirsch's remarks on connection between plague and defective hygiene. Mode of Dissemination. The facts narrated in the preceding sections regarding the dissem- ination of the bacilli from the sick, the behaviour of the bacillus in nature, the mode in which the infection enters the system, and plague among animals, lead up to the all-important subject of the manner in which the disease is disseminated. In the first place it will have become evident that the primary danger exists in the sick person and his surroundings, his clothing and bedding and other objects that may have been in contact with him, and the room in which he has resided. The general characteristics of the bacillus and in especial its apparent rapid loss of vitality in air and sunlight, and its power of thriving in the filthy media suited to it will have further indicated that the danger from these primary sources of infection must be infinitely greater in insanitary, ill-ventilated and overcrowded surroundings than in a wholesome and clean environ- ment. In this fact lies the answer to the question to what extent the disease is infectious. In dirty, ill-ventilated and confined places the poison may attain to an extraordinary virulence, and has produced results which are recorded in some of the most appalling chapters of the history of mankind. But in more healthy and airy habitations the bacillus fails to find the conditions essential to its life and is at once robbed of its devastating power. Modern scientific research has disclosed the reason for this phenomenon, but the fact itself has been notorious for ages. Plague has always been recognised as intimately connected with poverty and filth, and in Europe, as the sanitary con- ditions of life became better, the disease, which once raged with irresistible violence, was observed to recede gradually but surely from the continent, Hirsch lays the greatest stress on this aspect of the question. He remarks as follows :— " There is no point in the etiology of plague about which obser- vers in all times and at every place have been so entirely in agreement, as that the origin and diffusion of the disease are closely connected Chap. II. ] ^^^ causes and chafarteristics. 41 with the injurious influences of a defective hygiene^ and paiticularly with domestic misery. Almost all the authorities on epidemics of plague in Europe during past centuries point to the accumulation of filth in the houses and in the streets, to defective disposal of fsecal matter, and other animal excreta, to overcrowding and insufficient ventilation of dwellings, and the like, as a real means of fostering the pestilence; they all urge the removal of these noxious influences as the most important principle of prophylaxis, and they all remark that the reason why the plague has mostly, and sometimes exclusively, attacked the poorer part of the population, is that among them the defects of social wellbeing are most felt. " The same tale is told by those who have observed the disease in Later Egypt, Syria, Asia Minor, Turkey in Europe, Persia, Mesopotamia, °„^cTuding?b'ose and China, and India is not in the least an exception to the rule. made in fndia Dr. Whyte in his interesting account of the plague in Gujarat effect! ^ ^^"^ in the early part of the present century states in the most impressive manner his belief that the disease was in the highest degree fostered by insanitary conditions and that it might be combated by removing the people from these conditions into healthy surroundings. Dr. Ranken's report on the Pali plague of 1836 mentions particu- Insanitary larly the dirty and insanitary condition of the Raiputana villages. He condition of the r ■, c 1 1 towns and quotes several extracts from the accounts or the local medical officers, villages which of which the following will serve as an instance : — ^^''t,*K^ scene of ° the rah plague. " The town,^ like most others in Marwar, is abundantly filthy, the cattle being either the actual inmates of a number of the houses, or pent in folds as close to them as possible. The collection of nuisances that this order of things gives rise to may readily be conceived nor can we suppose the effect to be otherwise than injurious as regards the health of the inhabitants. Indeed, the most studied art could hardly devise a more effectual plan for rendering their nuisances every way offensive than that universally prevailing among the people of Marwar and Meywar. I mean the plan of running immensely dry hedges, composed of the branches of prickly shrubs, bushes, etc. not only round the town, as a defensive outwork, but into every crevice and corner where there may be possibility of egress or ingress either to man or animal. "" In his account of the endemic plague in Garhwal and Kumaun insanitary {Mahamari) Dr. Hutcheson gives the following general description of condition of the the insanitary condition of the country .— ' tl'n'r^^CyL " Mahamari has been fostered by the uncleanly and filthy habits of enTmic! the people of the hill tracts, who house cattle, sheep, goats and other * Sumari. 42 Description of Plague t [ Chap. II. animals on the ground floors of their unventilated houses and allow accumulations of sewage, refuse and litter in the immediate vicinity. They also defile and, pollute the neighbourhood of the village in defi- ance of all sanitary law, and in their helplessness permit refuse and noxious weeds to fill the air with rank odours, adding to the foul emanation that penetrates every nook and corner of the overcrowded impure dwelling which forms a nursery of zymotic disease, and is the birthplace of the pestilence. " The inhabitants of these Himalayan tracts have become so impressed with the fact that the disease is fostered in their villages that it is their common practice to flee to the open when an outbreak occurs, thus, no doubt, saving many of their lives. The 5ame ]esson The history of the present epidemic given in subsequent chapters taught by the q£ ^|^jg report teaches the same lesson. It will be shown how the disease present " epidemic. broke out in a quarter of the city of Bombay where the overcrowded, dirty and ill-ventilated tenements presented conditions the most favourable for the growth of plague, and how it seized with irresisti- ble violence on dirty and insanitary towns, such as Sukkur and Mandvi. Incidence of In a memorandum signed in the middle of January 1897 by some of Bomba ' Cit ^^^ principal European and native medical practitioners of the city greatly due to of Bombay and members of the Special Plague Research Committee local conditions, ^ppoj^^^ed by the Government of Bombay, the opinion was stated that the disease then prevailing in the city was, under certain con- \ ditions, only slightly contagious or infectious, and that the facts observed in connection with individual cases and those associated with the general progress of the disease, warranted the conclusion that its incidence was greatly due to local conditions. Remarks by General Gatacre, recorded the following remarks :— General Gatacre. " These and many other points taken In connection with the insanitary conditions in which the poorer, and in some particulars, even the wealthy, classes live, make the suppression of the epidemic in India a very diflicult matter. " It must be remembered that in all large oriental cities a very large proportion of the population are very poor and cannot afford to pay the rent of a really sanitary building ; they therefore are forced to live in miserable shanties, dark, low, small, and built on insanitary sites, without plinth, added to which, with a view to bringing the cost of this habitation to the lowest point, 16 or 20 persons will sleep, eat and cook in a space hardly sufficient for the requirements of four. " Chap. II.] its causes and characteristics. 43 Surgeon-Captain Thomson (Parel Hospital, Bomljay) observed Dr. Thomsoti that " fatigue, destitution, filth, poverty and overcrowding seemed to be the chief predisposing factors, and the horribly filthy condition of the person and clothing of most patients were indescribable. " Dr. McCabe Dallas (Grant Road Hospital, Bombay) made the Dr. McCabe following remarks in describing the outbreak of the plague: — chvT ^ ^™ ^^ " There were the necessary heat and moisture present to encourage its culture, helped by the requisite material within the houses, which, in most instances, were overcrowded, ill-ventilated, deficient in light, and inhabited by a class of persons who are generally opposed to the benefits of sanitation. " In subsequent chapters other instances will be given of the foster- Other instances ing influence exerted by insanitary conditions, and indeed the exam- fubseq'u"ent pies might be multiplied without number, but enough has been said to chapters, show that it has been fully recognised in the present as in previous epidemics of plague that insanitary and filthy conditions play the chief part in fostering the spread of infection. Important instances are also not wanting in the history of the Instances present epidemic with regard to the reverse aspect of the question, healthy^ ' serving to show how the existence of healthy conditions destroys the conditions virulence of infection. In the first case there is the marked immunity viruierice of enjoyed by Europeans. On this point Dr. Bitter has recorded the infection. following interesting remarks : — " D'un autre cote, le nombre d'Europeens atteints de la peste Immunity pendant I'epidemie, a ete minime. II y a eu en tout jusqu'a la fin Eur°op^eans. du mois d'avril, 40 cas parmi une population de plus de 10,000. II faut m6me considerer qu'une partie de ces cas est survenue chez des personnes pauvres, qui habitaient les quartiers indigenes. On ne pourrait gu^re expliquer ce fait, en admettant que la race europeenne ait une predisposition moindre pour la peste. On recontre des cas aussi graves et aussi rapidement mortels parmi les Europeens que parmi les indigenes. II est vrai que les Europeens attaques ont donne une mortalite considerablement plus faible que les indigenes, mais cela est certainment du au fait que les cas legers qui sont suivis de guerison, chez les indigenes, echappent tres souvent a I'observation. La seule explication raisonnable que Ton pourrait donner pour Timmunite relative des Europeens, c'est que par leurs habitudes de vie, ils sont mieux proteges contre rinfection. Du reste, je ne connais pas d'exemple que dans une famille europeenne de classe aisee il y ait eu plusieurs cas de peste. " Next there is the important evidence of the non-infectious character Non-in'ectious of the disease in hospitals, and the comparative immunity enjoved by character of the the attendants on the sick and the persons, both European and native, hospYuls" 44 Description of Plague : [Chap. II. engaged in the work of disinfection and other such operations, whose sanitary conditions were carefully supervised. General Gatacre re- marks as follows :-^ Gere^ScXacre " ^^ '^ ^" interesting and highly satisfactory fact that remarkably few of the officers or employes engaged on plague work, and especially on disinfection, suffered from the disease. Of the coolies working within the city of Bombay who caught plague, only three or four are recorded ; of the gangs sent to Cutch-Mandvi, five developed plague in the place itself and died, and three after they returned to Bombay while under observation. Of those sent to Colaba district, none are recorded as having taken the disease. But it is to be regretted that Dr. Desai, the Medical Officer in charge of the Hindu Hospital, and Dr. Dooda, in charge of the Dariastan Hospital, succumbed to the disease, while in the execution of their duty. " At Cutch-Mandvi, Nurse Home died after only a few days' ill- ness, as did also Sister Elizabeth (Fille de la Croix) who nursed at the Government Hospital at Mahim. Two hospital assistants — one at the Jamsetjee Bunder and one at the Mahim Hospital — caught the disease; the former died and the latter recovered. Three military ward orderlies are recorded as having died of the disease contracted while engaged on hospital work. " It will be observed that the above number of casualties represent a very small proportion of the percentage of the total number of employes, and in that light the result of the precautions taken to prevent infection amongst the staff must be regarded as satisfactory. " Parel Hospital, Surgeon-Captain Thomson recorded the following observations :— Bombay. '^ That the disease is not infectious in hospitals is a well-estab- lished fact from experience in the Parel Hospital. In upwards o^ 240 instances the friends of the patients attended their sick, and in 20 instances scarcely ever left the bedside, and in not a single instance did the disease spread to the friends. Out of more than 140 attendants on the sick belonging to the hospital staff, from time to time, only one sweeper w^as attacked ; and he had been constantly helping in the post-mortem room and had a very mild attack wath small axilliaiy bubo. Temperature 100° F. at highest. He resumed his duties on the fifth day afterwards. In three cases amongst hospital orderlies other and special sources of contagion existed, very likely to lead to direct inoculation, and are therefore not considered instances of spread of the disease from mere attendence on the sick. One nurse belonging to another hospital, whose case is given in de- tail, was admitted. Chap. II.] its causes and characteristics. 45 " The conclusion drawn is that one of the safest places during an epidemic is the ward of a sanitary plague hospital, something more than mere exposure to contagion being necessary to develop the disease — most probably overcrowding, destitution, deficient cubic space, ventilation, and sunlight, and a filthy and general insanitary condition of person, clothing, habitation, and its surroundings. " Further specific proof of the non-contagiousness of plague in hospital was furnished by one instance in which a mother ill with the disease suckled her infant and it escaped ; by one instance in which an infant with plague was nourished on the mother's milk and she was not attacked ; and by one instance in which a brother slept in the same bed with his stricken brother and did not contract the disease from him. •" The following extract is from Dr. McCabe Dallas' report :— q^^^^ ^^^^ ''Those most closely associated with the disease, as the working J^'^'"'^^'' ^°™' staff, from the medical officers down to the coolies, considering their numbers, enjoyed comparative immunity from infection. Of about 400 people — men, women, and children — who either visited their sick friends or remained constantly by their bedsides, together with the cases under observation, in not a single instance did any of these persons contract the plague. But one of the ward-orderlies doing duty in the hospital became affected through direct contagion in consequence of drinking the remnants of stimulants left in feeding- cups by patients who did not consume the whole contents, and most probably after some cup had been in contact with the mouth of a plague pneumonic case. " In the report on plague in Sind Mr. Wingate remarked as follows •— „ . Hospitals m "At Sukkur, as elsewhere, the sick were accommodated in some ^^"'^• of the best buildings in the town, the schools having been placed freely at disposal by the educational inspector, and the best comforts and nourishment that could be procured were provided, while the nursing was that of the motherly Sisters of the Lady Aitchison Hospital, Lahore, generously spared and eager for the service. assisted by the Zenana Mission ladies. ***** 4f '' While the sick were thus accommodated, usually in the centre of the towns, instead of being banished to some dreaded lazaretto, it was remarkable that the plague hospital attendants and guards^ and even the relatives of the sick, enjoyed almost complete immunity! One of these nurses. Miss Home, in Karachi, besides Sister Isabel at Rohri, took the disease, but she also recovered. Under proper management, the disease seemed paralysed and innocuous. " 46 Description of Plague : [ Chap. 11. Experience _ of The experience of previous epidemics was similar to that des- previous epide- •, i i mics. cnbed above. Hong-kong. Staff Surgeon Wihri, in describing the Hong-kong plague of 1896^ lays stress on the immunity enjoyed by the persons, and especially by the Europeans, occupied in cleaning and disinfecting houses, in trans- porting dead bodies and plague patients and in attending on the sick. He argues from these facts that contact vs^ith patients suffering from plague and with the bodies of those who have died of the disease, was not dangerous, provided that care was taken to avoid being soiled by the evacuations of the patient, and also to thoroughly disinfect the hands. He draws the further conclusion that the plague infection is not contained in the air and is not therefore taken into the system by the lungs, for had this mode of infection been possible, many engaged in disinfecting houses and treating the sick would have died. It has been seen that this latter deduction is not entirely correct. There can be no doubt that infection is taken through the lungs in the case of persons living in ill-ventilated dwellings. Dr. Cantlie lays special stress on the fact that the immunity enjoyed by the European doctors and nurses at Hong-kong was shared by the Chinese students of the College of Medicine, who were in constant contact with the sick. „ ,. ., , Dr. Rennie in his report on the Pali plasfue of 1836 made Fall outbreak ... r cs ^ (Rajputana) in the following interesting remarks : — '' I feel no hesitation in profess- "^ ' ing my belief that a man in sound health, provided he continue to breathe pure air, might safely keep his hand a whole day in contact with one suffering under the Pali or Moradabad fever, but if he sat within the same hut and inhaled the same tainted atmosphere half the time, he would probably be seized with similar illness. None of the medical officers or their native assistants, who handled patients^ affected with the Pali disease and felt their pulses for days and weeks, have suffered. " _, ^. Hirsch quotes a series of observations of similar purport to those Observations . ^ , . ^ '■ _ ^ recorded by mentioned above recorded by Cabiadis on the mode of diffusion of the^'ou'tbrerk af P^^g^^ in the Outbreak at Hillah and Bagdad which occurred in 1876-77. Hillah and "Persous Occupying the same dwelling with a plague patient, and avoiding all contact with him or his belongings for fear of infection,, usually take the disease, whereas very few cases of sickness occur among those living in houses free from the plague, although they visit the sick and come boldly into contact with them, remaining however only a short time in the sick-room. All the physicians, surgeons, and assistants who paid visits every day to many hundreds of the plague- stricken in that epidemic remained well, with the exception of one assistant, although the Surgeons and the assistants, who opened Bagdad in 1876-77 Chap. II. ] Us causes and characteristics. 47 abscesses and dressed and bound up wounds were obliged to spend much time — more than the physicians — in the immediate proximity of the sick or in the closest contact with them. " Lastly, the experience gained in the health and segregation camps Health Camps. and especially those at Poona, in Sind and at Khandraoni shows that the disease can be at once checked by removing the in- habitants of an infected locality to a carefully supervised camp in the open, especially if their clothes are disinfected at the time of their exodus. With the infected locality the disease is left behind, and if the place is thoroughly cleansed and disinfected the infection will be found to have vanished when the inmates return to their dwellings. Full details on this subject will be given in later chap- ters. Practically the common way in which the pestilence is spread piacrue com- from place to place is by persons infected with the disease and their monly spread personal effects. Persons in whom the seeds of the malady already place by persons exist move from one place to another, and the disease may not perhaps '"footed with the develop in them until they have arrived at their destination. Here, if they are not watched, and if local insanitary conditions and uncleanly habits favour the spread of the disease, they infect their immediate attendants and friends from whom the disease spreads in widening circles. The following remarks recorded by Dr. Rennie with regard to the Pali plague afford an interesting illustration :— » " Most of those who escaped the malady evinced from an early Infection carried period their conviction of its infectious character by desertino- the ^J '>g'tives ^ during the ran town (Pah) and seekmg refuge m the neighbouring villages. The plague. neighbours of these fugitives entertaipxing similar dread of infection, often refused them shelter. Yet many of the persons who left Pali in this manner finally got admission into the houses of their friends, and wherever they took tip their residence the fever shortly after- wards appeared. " The history of the epidemic in the Bombay Presidency affords Typical in- further abundant illustration of the manner in which the malady was JlonHn GwaUof spread by individuals. The outbreak in the village of Khand- during the Bom- raoni affords perhaps the most typical and well-defined instance that ^^ ^^' ^'^"^' occurred of the diffusion of the disease in this manner. Khand- raoni is a small village situated in the Gwalior State and distant about twenty miles from Jhansi. The population, in July 1896, wasi 558. For some years past several of the inhabitants of Khandraoni had been in the habit of going to Bombay and taking service there, revisiting their village at intervals ; among these were two Brahmins, Bindraban and Khoobi, the former being one of the headmen of 11 Infection spread by animals. Rats. 48 Description of Plague: [ Chap. II. the village. These two Brahmins came from Bombay to Khandraoni in January 1897, at a time when the epidemic was virulent in Bom- bay. They tra;velled straight from one place to the other and arrived at Khandraoni on the 9th of the month. On leaving Bombay Bindra- ban was suffering from fever and Khoobi attended him on the way, bringing him to Jhansi by rail and from there, in a country cart^ to Khandraoni, where he died five days after his arrival. Two days after Bindraban's death, Khoobi fell ill and died In three days, and almost a week after his death a native doctor of the village who attended the two Brahmins was attacked with fever and died, and at the same time a second native doctor, who came from another place to treat the first doctor, also succumbed to the disease. The plague then gradually spread amongst the inhabitants of the village, and by the i8th March, 59 seizures had occurred, of which 47 had proved fatal. Having investigated the manner of the spread of infection by persons suffering from plague and their surroundings, the next point for consideration is the danger of infection from animals. It will have been gathered from the account of plague in animals that the principal danger is to be apprehended from rats. Authorities differ I somewhat as to the extent of this danger, but it is certainly not so common a cause of infection as the sick person and his surroundings. Staff Surgeon Wilm in his note on the Hong-kong plague states that infection can be carried by animals, especially rats and mice. It has been stated above that the German Commission formed the conclusion that by means of rats plague germs can be introduced from one house to another and conveyed to man. General Gatacre stated that "amongst other sources of the spread of disease through- out the epidemic, the influence of rats has been shown in many extraordinary ways. Grain depots are often the first centres in the spread of the plague, the infection having been imported into the colony of rats that haunt the depots, spreads amongst them, and they die in large numbers. In this way the grain and grainbags are infected and become sources of conveyance of the disease to human beings. The Committee (z>., the Bombay Plague Committee) have, during disinfection; invariably treated these places where rats have been known to die as plague infected localities." This no doubt was a wise and necessai'y precaution, but it is open to doubt whether General Gatacre does not attach too great an importance to the part played by rats. Mr. Snow, the Municipal Commissioner of the City of Bombay and Dr. McCabe Dallas also lay great stress on the danger of the spread of infection by rats. On the other hand. Dr. Bitter considers that rats are of very minor importance as agents in the dissemination of the disease, and Dr. Chap. II. ] iis causes and characteristics. 49 Rogers, another Member of the Egyptian Commission, holds the same View. Recent experience at Kankhal would seem to show that there is a Monk'>ys, pi^s possibility of plague being spread by monkeys, and experience in Hong- anj'j^Jg"^'*^"*^'*^ kong points to the possibility of infection being carried by pigs. Apart from these animals there does not appear to be reason to appre- hend that danger exists of plague being spread by animals. 'J he remarks made in a previous section of this chapter on the non- susceptibility to plague of the domestic animals are of great import- ance in this connection. Next, with regard to food-stuffs. It is generally admitted that the Focd-stuffs. infection of plague may be caught through the medium of infected food, the infection being received through the tonsils or the alimen':ary canal. But both laboratory experiments and general experience tend to show that this danger is much less than the danger arising from the sick and their surroundings. In the first place, food-stuffs are not very- likely to be contaminated by the dejecta or morbid products of plague patients (excepting the infection of grain by rats), in the second place, experiments tend to show that food-stuffs do not form a medium favourable to the life of the plague bacillus, and in the third place, grain is usually cooked before being eaten. Again, the special forms of the disease which can most reasonably be attributed to infection by food are rare. Lastly, there is no evidence to show that during the pr'esent epidemic the plague was in any case spread from one place to another by infected grain or other food-stuffs. During the epidemic in Sind considerable quantities of grain were imported from the infected area into other localities without in any case spreading infection. At the same time it must be stated that careful precautions were taken to prevent the export of any grain likely to be infected. That some danger does exist cannot be denied, and the precautions adopted in Sind were necessary and fully justified. This matter is further discussed in Chapter XII. The degree of danger to be attributed to the spread of infection General a-tides by general articles of commerce is naturally a matter of the first inter- °^ commerce, est and has been keenly discussed. Formerly very great importance was attached to this method of diffusion, and in consequence stringent regulations were imposed by healthy against infected countries. Hirsch makes the following remarks on the subject : — "There can be no doubt of the diffusion of the morbid poison by Remarks made goods ; and this is another of the points on which there is incontrovert- ^^ hirsch. ibie evidence from the sixteenth and seventeenth centuries. Proofs So Description of Plagiie : [Chap. II. are also given by Kanold from the epidemic of 1709-10 in Prussia, by Autrichan from the plague of 1720 in Toulon, by Desgeuetles, Puguet, and other, French y^rmy Surgeons, from the epidemics of 1798 and 1799 in Egypt and Syria, by Bulard from the epidemic of ^ 834-35 in Egypt, and by Segur-Dupeyron from observations made in the quarantine stations of Venice (1793 and 1818) ; and Syria (1832, 1834, 1837); ^^^ ^^s ^^^^ mentioned are so convincing that even the Paris Academy of Medicine, which maintained a very scep- tical attitude towards the doctrine of the communicability of plague, could not but admit their importance, " jviodern Modern research, however, tends to show that the danger is more research shows restricted and less important than was formerly held to be the case. that the danger ... is not great. As in the case of lood-stufts, there are not many ordmary articles of commerce which are likely to be contaminated by the dejecta or morbid products derived from the sick, and it would appear that ordinary commercial articles do not form media favourable to the lite of the bacillus. It has been said that clothing and bedding and other such articles contaminated by the sick and kept in a moist condition away from the disinfecting action of the atmosphere can probably retain the power of infection for a considerable period. Such articles, whether carried as merchandise or as the baggage of travel- lers, are rightly regarded everywhere with great suspicion. For similar reasons rags from an infected locality must always be re- garded as dangerous. But it seems doubtful whether the danger Remarks by Dr. gocs much beyond this. Dr. Bitter has recorded the following Bitter. important remarks on this subject: — " Les marchandises du grand commerce, telles quecoton, ble, tissus neufs, cuirs, provenant d'un pa^^s infecte de la peste, n'offrent qu'un danger tout a fait secondaire. D'un cote, elles ont relativement tr^s peu de chances d'etre contaminees, et de I'autre cute, par leur nature, elles ne sont pas bien aptes a conserver longtemps vivant le bacille, et le mode de leur emploi ne les met pas souvent dans ce contact in. time avec I'homme qui semble necessaire pour I'infection, Nous nous trouvons du reste, ici, vis-a-vis d'un fait qui s'observe egalement pour d'autres maladies epidemiques, tel que le cholera. Nous n'avons pas d'exemple qu'une telle epidemic ait ete importee dans un pays par des marchandises de commerce proprement dites, " Le seul article du gros commerce qui merite une attention serieuse, ce sont les chiffons, qui offrent le meme danger que les vetements, linges, tapis, etc. II ne pent y avoir de doute que parmi les chiffons ramasses dans une ville ou un pays ou regne la peste, il n'y en ait une quantite considerable qui soit contaminee." CiIAP. II. ] its causes and characterislics. 51 The following is a list of the articles of merchandise classed as Articles classed susceptible by the Venice Sanitary Convention of 1^97 : — ■ th^i^ Venice '^'" 1. Used linen, clothing, personal effects and bedding. Sanitary Convention of 2. Rags, not excepting rags compressed by hydraulic force which 1897. are carried as merchandise in bales. 3. Old sacking, carpets and old embroidery. 4. Rawhides, untanned and fresh skins. 5. Animal refuse, claws, hoofs, horsehair, hair of animals gene- rally, raw silk and wool. 6. Human hair. The articles named in the first three numbers in this list were included in it as likely to have been in contact with sick persons. The more important articles named in the fourth and fifth numbers were included in the list for fear they might be derived from animals that had suffered from plague. Recent investigation on the degree of susceptibility of different classes of animals to plague shows that this precaution may be unnecessary. There is no evidence to show that a single case of plague has been occasioned by merchandise imported from the infected portions of India, although large quantities of wool and other commodities have been exported from Bombay to England and other countries since the beginning of the epidemic. Other possible sources of infection must be regarded as of minor Other possible importance to those already described. It may be taken as proved that fnfectloti. the microbe does not travel about for considerable distances in the air or in dust, etc., and that healthy persons cannot carry the seeds of contagion with them except in the form of clothes, rags, etc., impreg- nated with infectious matter. The water-supply is said to be a possible source of danger, and no doubt should be the subject of careful precaution. Staff Surgeon VVilm lays stress upon this possible source of infection. General Gatacre gives an instance in which a stagnant pool of filthy water is believed to have fostered the spread of infection in a village in the Island of Bombay (see Chapter VII). But it has been seen that under ordinary conditions the bacillus appears to die rapidiv in water. The drains are also regarded by some persons as a prob- able means of spreading infection, although, according to Dr. Bitter, it is not likely that the bacillus can exist for long in sewers. At the same time a careful attention to drainage is a precaution which should certainly be adopted, and constant flushing of sewers with a solution of corrosive sublimate is said to have had a beneficial effect in the Mandvi quarter of Bombay. Both Dr. Bitter and Mr. Hankin are inclined to think that graveyards containing plague corpses are not 52 Description of Plagiie : [ Chap. II. likelv to be as">ii^ce of danger, but the knowleHge on this pouit is not sufficiently certain to make careful precaution with respect to grave- yards in crowded portions of cities unnecessary. Influence of Climate and other Natural Conditions. Moderate Moderate warmth in conjunction with dampness seem to be the dan"pnlsTtavour "lost favourable condiiions for the development of plague. In the cooler the development parts of the East and formerly in Europe, the epidemics occurred Experience of mostly in summer. In middle Egypt, particularly in Cairo, the former epidemic used to cease in the height of summer at the time of the epidemics. ^ . , . i i • r , excessive dry heat : an epidemic never commenced at that time of the year. In Mesopotamia it appears mostly in the temperate season, and becomes dormant during the hot weather. By severe cold the spread of the disease seems to be restricted, but nevertheless epi- demics have occurred during tl.e severe cold of winter (at Moscow in K771, at Astrakhan in 1878-79), as well as during great summer heat.' — (Scheube.) Hong-kong. Staff Surgeon Wilm recorded the following observations or climatic influence over the course of the Hong-kong plague : — "Both in 1894 and in i8>^6 the epidemic broke out at the end of the cool season, which was damp though free from rain. It began in May in 1894, in April in 1896. In the latter year isolated cases came under observation from January to March, and these occurred chiefly in the western part of the town inhabited by the Chinese. In both years the epidemic reached its height in the early months of the hot season in May and June, and then suddenly subsided. From these facts the only conclusion to be drawn is that the plague in Hong-kong thrives better in a damp, moderately cool tropical climate than in a hot one. But in this connexion we must not forget that in the cool season the houses of the Chinese are much more overcrowded than in the hot season. " Climatic The cour'^e of the epidemic in the Bombay Presidency points to influence on the j,|,g conclusioo that the dry heat of an Indian summer is less favour- ccurse or the -^ . epidemic in the able to Hie development r.f ihe disease than tiie climate of the cooler Pre'^i^Ync and ^"^ damper months. In the city of Bombay the existence of the Sind. disease was discovered during the warm damp weather that followed the abnormally early close of the autumn rains. The epidemic reached its height in the cool season — in the month of February — and then steadily declined, until towards the end of June only Chap. II. ] its causes and characteristics. 53 occasional cases occurred. In Thana district the epidemic began in First period December, in Poona city early in January, and in Surat and Kolaba ^ '''^' districts early in February. In Thana and Poona the epidemic culminated about the end of March, in Surat in the beginning of April, and in Kolaba about the end of April. In all these localities it had almost disappeared by the middle of June. In Sind, where the infection was probably brought from Bombay, the outbreak occurred later than in the Bombay Presidency proper and was also shorter lived. In Karachi the epidemic broke out in the second- half of December and attained its greatest virulence early in February. Throughout February and March the epidemic continued to be very severe ; the number of cases then quickly fell. In Hyder- abad city the disease began early in March and was at its worst in the first-half of April ; with the end of May the epidemic practically died out. The epidemic in Sukkur began in February, culminated early in April and was over by the end of May. The last place in which a serious outbreak occurred during the first period of epidemic was Mandvi in the Cutch State. The outbreak began in April and became virulent in May. Towards the end of May it declined in violence and throughout June the fall in the number of cases con- tinued ; in July they numbered on an average about one a day, and in August the epidemic disappeared, having, however, in the meantime spread to other places in the neighbourhood. The recrudescence in the districts of the Presidency proper, w^hich j^e recrudes- afterwards attained such serious dimensions, began about the middle of cence. July in Baroda territory and in the districts of Poona, Satara, and Surat. In the early part of the cold weather it rapidly spread and increased in violence. Broadly in i8g6 the epidemic began at the end of the rainy General remarks, season, increased in virulence until the middle or end of the cold weather and rapidly declined during the hot weather months. In the present year the recrudescence began in the latter part of the rainy season and spread in the cold season. The crowding of the people into their homes during the cold Overcrowding season must exert an unfavourable influence apart from the mere '" ^^" "^^'"^ climatic change. The description of the climate of the Bombay Presidency and Varied climatic Sind which is given in Chapter V illustrates the very different climatic conditions in J..' J 1 • ■!_ i.1 1 • . T, 11 /- , . which pia?ue can conditions under which the plague can exist. It was equally fatal m exist. Sind with its arid climate and extreme variations of heat and cold, in the moist and equable Konkan \\hich receives the full force of the 54 Description of Plague : Statement and chart. Altitude and geological characteristics have no influence on piague. [ Chap. II. monsoon torrents, and in the comparatively dry uplands of the Deccan. But in all these places the hottest part of the year succeeded, com- pletely or for the time, in subjugating the epidemic. A comparison of the course of the plague in different localities with the variations in temperature during the epidemic is given in a statement in Appendix III, and illustrates the above remarks. The chart in Volume IV, page 26, affords a further illustration. Scheube states that neither the geological character of the ground nor its altitude has any effect on the initiation of the disease. It is unnecessary to elaborate this remark. The history and geographical account of plague given in subsequent chapters will make its truth at once evident. General course of plague epidemics. Origin and Course of Plague Epidemics. Origin of plague ^t was formerly a subject of frequent contention whether plague epidemics. ^^^ \\zx^ an autochthonous origin or v/hether an epidemic must in all cases be started by previously existing germs of the disease. Modern bacteriological research, in demonstrating that plague is due to a specific bacillus, has thrown much light on this vexed question, but it has not been settled beyond doubt whether the pathogenic cell may be derived from an innocent one. Scheube makes the following interesting remarks on the general course of plague epidemics : — " If plague is imported anywhere, for the first three or four weeks isolated cases occur in the neighbourhood of the imported case, and subsequently dissemination of the contagion and a general spread of the disease take place. An epidemic will at times last only a few weeks or months, but may extend over several years. The abate- ment generally comes rapidly, but sporadic cases will still occur at times for years, and the epidemic may break out again without a renewed importation from outside. " Gradual growth. These remarks are entirely in accord with the experience of previ- ous and the present epidemics. The gradual manner in which plague epidemics grow is a natural sequence of the fact that the infection is not carried about in the air, but is in general disseminated amongst the immediate surroundings of the sick, its virulence gradually in- creasing in the fostering element of insanitary surroundings. The phenomenon has been markedly characteristic of the present epidemic in almost all places in which it has raged, 'i'his point will be made Chap. II. ] its causes and characteristics. 55 clear in subsequent chapters. It is practically of great importance in the facility which it affords to stamping out an epidemic at the outset. The long period over which plague epidemics have lasted is a well Duration, known feature of the history of plague in Europe. In India also, at the beginning of the present century, there was a plague epidemic in Gujarat which lasted ten years. The plague centre on the northern slopes of the Himalayas affords Recurrence in an Indian example of the manner in which plague epidemics may occur ^" ^"""^ centres. in a place where the disease is endemic at considerable intervals of time without the introduction of fresh infection from outside. Mild sporadic cases are the main link between successive epidemics. The extent to which the disease may be kept alive for a considerable period in surroundings favourable to the vitality of the bacillas is, it has been seen, a matter about which a final opinion has not yet been expressed. Curative Treatment. Paper by Dr. It is not within the scope of this report to give details of the medical treatment in cases of plague. A paper by Dr. Cantlie on the Cantii treatment of plague, which was circulated to Local Governments, is given in Appendix I. The medical treatment is limited to the treatment of symptoms and Small effect of has proved of little effect in arresting the fatal course of the disease- '"e^'^^' *^''sa*:- T^ • 1 1 ment. Lxpenence has, however, shown that good nursing and healthy sur- Influence of good roundings are of material assistance. Surgeon-Captain Thomson, Parel T^T^^ ^"'^ j ° fc> r ' healthy surround- Hospital, Bombay, remarked as follows : " In the treatment of plasfue, ings. symptoms can be relieved and the chances of favourable termination Bombay°^^ promoted ; but little can be done to shorten its course and ensure recovery .... The success of any treatment depends on early and good nursing, and keeping the patients lying down until the temperature has been normal for at least four days .... Abund- ance of fresh air is of next importance, and in Parel each patient had nearly 2,000 cubic feet of air space and free perflation of air. " The following extract is from Dr. McCabe Dallas' report on the Grant Road Grant Road Hospital, Bombay : — Hospital, Bombay. "As regards the effect of medicine, it cannot be stated wath satis- faction that we possess any standard remedies of certainty. What might seemingly cure one patient is ineffective in another of the same type, and it is questionable, whether the successes shown are not wholly due to scientific nursing and hygienic surroundings of a 56 Description of Plague: rcHAP. II. M. Yersin's curative serum. Inconclusive results. Inconclusive result of experiments by M. Haffkine. superior nature and to personal comfort and healthy ventilation. This, of course, was impossible during the "opposition period" of the epidemic, when a large percentage of patients were permitted to remain where they fell ill, in low, dark, overcrowded, ill-ventilated rooms, without proper food, or probably no food at all, and absolutely unsupported by the administration of alcoholic stimulants. " An important subject on which it is necessary to make a few remarks is the endeavour that was made to utilise bacteriological knowledge by attempting to cure patients by the injection of a therapeutic serum. During the Hong-kong epidemic M. Yersin experimented on the effect of the subcutaneous injection of a curative serum derived from horses immunized by injection of prepared cultivations of the bacillus. A description of this method is given in a paper* by MM. Yersin, Calmette and Borrel. On the outbreak of plague in Bombay M. Yersin visited the city and pursued experiments with serum supplied by the Pasteur Institute of Nha Trang. The result of the experiments was inconclusive and medical opinion in Bombay was unfavourable to the treatment. The serum had to be hastily prepared and was weaker than that used In China in 1896. M. Haffkine also endeavoured to cure patients by the injection of therapeutic serum. At the time of the outbreak of plague he was engaged in investigations connected with anti-cholera inoculation. He was at once deputed to Bombay under the orders of the Govern- ment of India, and was employed there throughout the epidemic. In a letter of the Hthf July he described the result of his experiments. A number of animals having been brought to a high deo-ree of immunity, the effect of serum derived from them was tried on patients in whom the severity of the disease did not leave hope of its yielding to the ordinary treatment. No clear results could be obtained as to the effect of the drug. M. Haffkine then resolved to prepare a large amount of serum, to be tested in the manner adopted In the case of the serum for diphtheria, namely, by its application to a very large number of cases, severe and mild, and by comparing the mortality among these cases with the mortality amongst a similar aroup of patients not treated. For there remained the possibility of the therapeutic serum, without producing a clear effect in every case Influencing to an appreciable extent the general mortality. No decisive results have been reported. There is, however, distinguished authority in favour of the system of injecting a curative serum, and it is possible that better results may be obtained on a future occasion. * Annales de rinstitut Pasteur, 189S, pages 589— 592. | f Append x I. Chap. IL] its causes and characteristics. 57 The following remarks on the subject occur in General Gatacre's Remarks by , Generctl Gatacre. report : — " Despite the apparent failure of the treatment to have an appre- ciably beneficial effect on the disease, the Committee {i.e., tlie Bombay Plague Comntittee) wish to draw attention to the fact that it is based on sound laws of scientific experiment and research, that these have not yet reached the full perfection which it is reason- able to expect, that the serum first used by Dr. Yersin was of feeble immunizing power, and that the subsequent operations of Dr. Yersin at Cutch-Mandvi with anti-toxin serum of a higher standard than that which he used in the first instance in Bombay, were attended with more commendable results. " The opinion of the German Commission was as follows : — Remarks by the . 1 -.1 . 1 1 • German Plague " The experiments* as to cure made with strong serum snowed it Commission. undoubtedly possesses curative properties, though of course this can only be held to apply to the animals on which the experiments were made. Whether a similar curative action can be attained in the case of man must not, as the observations on the similarly sensitive grey monkeys show, be rashly concluded, but must be found out by observations in men sick of the plague. In such cases it seems that up to the present only the older weaker sorts of serum have been used. " The Russian Commission also experimented on monkeys and Experiments of stated the following conclusion : — - the Russian Commission on *' Nos experiences dans cette direction et pour lesquelles nous monkeys, avons employe 90 singes nous ont demontre que : 1°. Le serum de Yersin peut guerir les singes malades lorsque le traitement a ete commence presque deux jours apres Tinfection sous-cutanee, et lorsque les symptomes de la peste sont dej^ tres manifestes, elevation de temperature, bubons, etc ; 2°. Le traitement par le serum n'est plus efficace lorsqu'il est com- mence trop tard, c'est-^-dire 24 heures avant la mort des singes qui servent de controle ; 3°. La quantite indispensable de serum pour obtenir le guerison des singes n'est pas tres grande ; en moyenne, il suffit d'injecter 20 c. c. de serum actif au ^^ ; 4°. Si la quantite de serum injectee est trop faible, ou si le traitement est entrepris trop tard, ou peut parfois obtenir la guerison, mais quelquefols cette guerison n'est qu'apparente : il peut se pro- duire une rechute, qui cause la mort des animaux apres 15 ou 17 jours. " * Made on monkeys. 8 58 Description of Plague : [ Chap. II. Favourable The members of the Russian Committee commented favourably on comments bv the , 1 \t • i_ t. 1. Russian ^hc Ycrsm treatment : — Commission on <« En ce qui concerne le traitement des malades par le serum de the Yersin ,r • j j- 1 1 • treatment. Yersin, nous devons dire que dans plusieurs cas nous avons ete a meme d'observer les effets interessants at frappants de Taction de ce serum. Apr6s I'injection la temperature s'abaisse, la somnolence ou ledelire disparaissent, le malade retrouve le bienetre. En general, !es resultats n^ont pas ete aussi bons que nous I'aurions desire ; ils ont cependant reduit la mortalite a 40 % sur les malades traites. '' Nos experiences nous ont pourtant montre que le serum a une efficacite qui n'est pas douteuse. Cette mortalite encore elevee s'explique pas des causes suivantes : " D'abord les malades n'entrent que tr&s tard dans les hopitaux trois, quatre ou cinq jours apres que la maladie est declaree. *' Ensuite, nous ignorons quelle sera la duree de la maladie qui n'a pas la m6me intensite dans chaque cas. Des malades meurent en 24 heures, d'antres survivent pendant 24 jours. "La troisieme cause est que les hommes montrent des degres tr&s varies de sensibilite k I'infection, Celle-ci est plus uniforme chez les singes. " Dans les cas de pneumonic pesteuse, c'est souvent la presence d'autres bacteries, pneumocoques et streptocoques^ qui explique la difficulte d'obtenir la guerison par le serum, "Nous espeions obtenir de meilleurs resultats avec le serum anti- toxique que le Dr. Roux vient de preparer, celui qui a ete employe jusqu' ici est plus preventif qu'antitoxique. " Quand meme un remede n'aurait sauve que quelques vies, cela serait suffisant pour le fa're remarquer et encourager k i'etudier. 'En realite, le serum de Yersin a sauve un grand nombre d'exis- tences et nous devons tres chaleureusement recommender cette methode de traitement. Le serum reste d'ailleurs jusqu'ici Tunique remade k employer dans le traitement de la peste." Doctor Bitter's opinion Is unfavourable : — " Mais aussi le traitement specifique par I'injection du serum antipestenx de Yersin n'a pas, d'apres ma connalssance, donne des resultats concluants. Au point de vue theorique il y aurait, a mon avis, a faire les remarques suivantes, qui nous demontrent que les statistiques, quant ^ I'efficacite du serum, doivent etre recueillies avec beaucoup de soln. D'abord environ 50 % de tons les cas de peste (sauf les cas pneumoniques) se guerissent par vole naturelle. J Is n'ont done pas besoin d'une injection de serum. Pour les cas qui ont la tendance de finir par septicemic, je crois que I'injection du Unfavourable comments by Dr. Ritier. Chap. II. ] its causes and characteristics. 5q serum doit avolf lieu d^s le debut do la maladie, alors que les bacilles sont encore confines dans le bubon primaire, si Ton vcut avoir une chance d'empecher leur entree dans le sang. Une fois la septicemie etablie, a mon avis on n'aurait qu'une chance inlinie d'arr§ter Tissue fatale mdme en employant un serum tres fort." If Dr. Bitter's view is correct, M. Haffkine's experiments on patients so far advanced in the disease that their recovery under ordinary circumstances v^as hopeless could not have had a successful issue. Preventive Inoculation. A more extensive trial was given to the system of preventive More hi-eful Inoculation worked out by M. Haffkine, and on the whole with ""^^"'^^ ''^ , r , ,, preventive more hopeful results. inoculation. In a report,* dated the i6th January 1897, he described the princi- ^f. Haffkine'<; pie on which the inoculation system is based in the following terms: — description of the ° principle. " In the course of the present researches I have found different media which give rich cultures of the plague bacillus, permitting to cultivate them in abundant and concentrated quantities, "The virulence of these cultures is shown by the fact that i or 2 minims are sufficient to communicate certain death to the larger rodents. "The destruction of th« bacilli in the culture by delicate processes, such as the addition of essence of mustard, of very weak solutions of carbolic acid, or by dessication, or by heat, deprives these cultures of their fatal properties and makes a dose forty to fifty times bigger than the fatal one, quite harmless to the animals. *' But while depriving the cultures of their noxious properties, the above processes leave to them the powers of protecting the system against fatal infection. " Rodents which have had an injection of such cultures (with microbes killed in th-m), when infected five days after the prophylactic .. treatment, stand easily a dose which would be fatal to ten other not | protected animals. " Having established these facts, M. Haffkine caused himself to be ;\j Haffkines inoculated on the 10th January in order to observe the symptoms of 'noc"lation of the operation in man. He suffered pain at the seat of inoculation, a rise of temperature (maximum I02°F.), slight headache and a feeling of faintness. The temperature became normal after 24 hours. * Appendix I, Paper No. 12. ^o Description of Plague : [Chap. II. frTJcuSed up to Subsequently many persons were inoculated both by M. Haffkine the end of May. and by medical officers who were instructed by him. On the 31st of May the Government of Bombay reported that 7,874 persons had been inoculated in Bombay, and 4,352 in other places. 1 he process is still being continued and is being more widely adopted. Experiments in r\ ^\ .1 1^ 1 o •»«■ xt z-^, . , . , the Bycuila Jail, ^"^ ^'^^ '7th hebru.ary 1897, M. Haffkme submitted a report* on Bombay. experiments made with the prophylaoctic serum during an outbreak of plague in the Bycuila Jail at Bombay. Between the 23rd and 29th January nine cases of plague occurred in the jail, of which five proved fatal. The population of the jail at the beginning of the outbreak numbered 345. The prophylactic treatment was applied on the 30th January, 154 out of a total of 337 volunteering to be inoculated. The following is the result recorded by M. Haffkine. In an average daily strength of 173 non-inoculated persons 12 cases occurred, of which 6 proved fatal. In an average daily strength of 148 inoculated persons 2 cases occurred, neither of which was fatal. General result In a report,* dated the 14th July 1897, M. Haffkine summarises t'ions? the general results of the experiments with the prophylactic serum (excluding the Bycuila Jail experiment) as follows : — • " Amongst the 7,905 persons inoculated in Bombay during the epidemic, and who all cam.e from the most threatened localities and homes, there were •?«• * -J^ : — {a) two persons who were already unwell at the time of inoculation, and who developed unmistakeable plague within the next twelve hours; they eventually suc- cumbed ; {b) and sixteen persons, who were attacked more than twelve hours after inoculation, and all recovered." M. Haffkine remarks that he is specially confident with regard to the number of fatal cases reported, whereas in the number of cases which ended in recovery there may have been neglect in reporting, as a large proportion of the cases were exceedingly mild. Any increase in the number of cases ending in recovery would, M. Haffkine observes, put in a still more satisfactory light the small mortality among persons attacked by plague after inoculation. Citcumstances Circumstances militating against the force of the conclusion? to militating ^ derived from these experiments are that the subsequent history against the force , , . r n 1 , 1 , ,1 • 1 • of the conclu- of the persons inoculated is not fully known, and that the inoculation s^*^"^- was to a large extent performed when the plague was on the wane and on classes of persons not the most likely to contract plague. * Appendix I, Chap. II. ] Us causes and characteristics. 6i The result nevertheless may be regarded as hopeful. The experiments were followed by several of the medical officers employed on plague duty in Bombay, and their opinion is distinctly favourable to the system. The objections alluded to above are of less weight in the case of Later report on the extensive and satis'^actory experiments made during the virulent expcnm'ints at plague epidemic at Lower Daman, with regard to which M. Haffkine and Surgeon-Major Lyons made a joint report in November 1897. The investigation into the results of the inoculation was very care- fully carried out, and the circumstances were specially favourable to a complete examination owing to the existence of unusual facilities for ascertaining the subsequent history of the persons inoculated. A careful contrast was also made between the mortality among persons who were and who were not inoculated, living under similar condi- tions and therefore equally liable to infection. The period of observa- tion extended from the 26th March to the end of May and the observations were made with respect to the whole of the inhabitants of the infected part of the place. At intervals 2,197 persons were General results, inoculated and it is estimated that there were 6,033 persons in the place who remained uninoculated. Rather more than a quarter of the inhabitants were thus inoculated. Among the 6,033 uninocu- lated there were 1,482 deaths, giving a mortality of 24-6 per cent., while among the 2,197 inoculated there were 36 deaths, giving a mortality of i 6 per cent. According to these figures the reduction in the rate of mortality was 89*2 per cent. M. Haffkine considers that the result might have been better had not the serum used in some of the experiments been too weak. The report contains the Inoculation in following interesting summary of the results of inoculating- a portion homogeneous '7 T r crroujs of of the members of homogeneous groups of persons living under persons, similar conditions : — " In a large number of households the whole of the members of the family were inoculated, leaving none for comparison as regards sus- ceptibility to the disease. This circumstance rendered it necessary to compare the whole inoculated population with the whole of the uninoculated population, as has been done above. However, in 62 of the inoculated families in which cases occurred, there were 124 persons who remained uninoculated, while the number of inoculated in these families was 250. A comparison between this fraction of the inocu- lated population with their uninoculated relatives shows the following results : — 124 uninoculated had 54 cases (43'5 per cent.) with 37 deaths (29 8 per cent., case mortality 68*5 per cent.), 250 inoculated had 50 cases (20 per cent.), with 20 deaths (8 per cent., case mortality 40 per cent.). 62 Description of Plague : [ Chap. If. "The inoculated households lived, therefore, under no specially immune conditions, as the mortality amons^ their uninoculated mem- bers, 29*8 per cent., was 5"2 per cent, higher than the mortality in the general uninocuiated population. This rnust invariably be the case, as only people from badly-affected or particularly-threatened localities present themselves for inoculation. It v\ill be noticed also that this small number of 124 uninoculated had a mortality higher by I death than the total mortality sustained by the 2,197 inoculated inhabitants of Daman ; and that a comparison between the inoculated and uninoculated members of these families shows that if the 250 inoculated had exhibited the same susceptibility as their 124 unin- oculated relatives, they should have had 75 deaths instead of 20 — a difference of 73*3 per cent. " " A similar conclusion is arrived at on comparing the mortality in the Parsee community .... which shows that the inocu- lated members gave a reduction of 97'4 per cent, of deaths when compared with the uninoculated of the same community." Inoculation in In Mr. Rand's report on plague in Poona, where 1,249 persons- °°°^' were inoculated up to the beginning of May, it is stated that " the officers in charge of the various plague hospitals were instructed to note whether any cases of plague occurred among persons who had been' inoculated. No such cases have been reported, which is evidence in favour of the efficacy of Professor Haffkine's lymph. It has to be remembered, however, that the inoculations were not commenced till after the epidemic had passed its highest pt)int, that a large pro- portion of the persons inoculated did not live in a highly infected locality, and that most of them did not belong to the classes that have been the chief sufferers from the plague in Poona. " Symptoms _ The inoculation frequently results in temporary fever and some after iiiocuation. ^^^^.^^j suffering, but there was only one case where, for a short time, a question arose whether inoculation had caused the death of a person. M. Haffkine reported that a Brahmin got an attack of hemiplegia and died on the eleventh day, but that medical investiga- tion showed that the attack was connected neither with plague nor with the inoculation. Experiments The following are the results of the experiments made by the, made by the German Commission in immunising monkeys : — German ._ . , . . . ... j r n Commission. "For the purpose of artificial immunisation living and tuHy virulent cultivations can be used only in the case of animals that are but little sensitive. It proved necessary to operate with killed cultiva- tions which possess a more or less high degree of protective power, as proved by the experiments performed, as well as by Haffkine's still Chap. II.] its causes and characteristics. 63 earlier preventive inoculations. This protective power is damaged by all the most powerfully acting agencies, such as boiling heat ; and in order to kill the bacteria v\rith certainty without destroying the protec- tive power, the most advantageous process was found to be the treat- ment of the cultivation for one hour with a temperature of 65°C. The immunity does not appear at once, but after a certain interval (from about the 5th to the 7th day) ; and it is not so high a degree as that which is attained by infection with living cultivations. Experiments with regard to its duration could not be made, as they would have re- quired many months. From the experiments described, and others which of course in many points require repetition and testing, it can in the meantime be deduced, that, for future immunisation with dead cultivations, cultivations of undiminished virulence, which have been killed in the way described, are to be used. The height of the natural immunity, such as is attained by going through an attack of plague, csn in the meantime only be reached by subsequent inoculations with living plague bacilli. " The German Commission also investigated the effect of preventive Comments of the inoculation in Daman, and their conclusions were on the whole Commission favourable:— on inoculation ,, TT cfi • » i • • 1 .• .1 . , in Daman. "Hatlkmes preventive inoculations were carried out in the case of about 1,400 persons in Daman. A protective action of the proce- dure was undoubtedly recognisable ; though the protection was ap- parently only a limited one, because among the inoculated not a few cases of plague occurred (with, however, remarkably mild course), and, as can be proved, in about 20 cases ended fatally." The members of the Russian Commission stated the following Experiments by conclusions from experiments conducted on monkeys : — ^'^^ Russian Commission on " L'immunite donnee par I'inoculation preventive de 10 c.c. du monkeys. s6rum de Yersin ou de 5 c.c. de la lymphe de Haffkine, ne dure pas au dela de 10 ou 14 jours ; " L'immunite resultant de Tinoculation preventive, faite avec des cultures sur gelose chauffees a 60° centigrades, ne se produit pas avant sept jours, mais cette immunite se prolonge pendant plus longtemps. Un singe inocule par ce precede, et infecte 21 jours apres I'inocula- tion, ne montra aucun symptome de peste. " Both Dr. Rogers and Dr. Bitter pronounce conclusions which Comments of the are on the whole unfavourable to the Haffkine method of treatment, ^g^^^'.^". rri J ■ ,1 <• 11 . , Ccm.aisiion, Ihey are summed up in the following passage from Dr. Rogers' report: — " There is always the danger that the enthusiastic advocate for preventive inoculations, more particularly if he only have a laboratory 64 Description of Plague : its causes and [ Chap. II, characteristics. and not a medical and sanitary education, should view with indiffer- ence if not actually oppose the application of practical sanitary measures, relying on a method for dealing with disease which from the laboratory point of view is perhaps conclusive. "The individual who dreads contracting the disease, if hebelif'ves in preventive inoculation, will probably have recourse to it, but he must not imagine that it is always so simple an operation as it Js sometimes described. " It may be followed by serious and painful symptoms lasting for three or four days. "The efficacy of preventive inoculations against plague remains yet to be proved. " The fact that so many thousands of the population of Bombay have been inoculated since the end of January and have not con- tracted the disease proves nothing. These same people were presum- ably exposed to infection from August to the end of January, without being inoculated and without contracting the disease, which almost as soon as the inoculations were begun, commenced to be on the wane. " Nor are the figures of the House of Detention, Bombay, to which so much importance has been attached, in any way conclusive. If even the efhcacy of preventive inoculation in individual cases be fully established, its practical application would probably be limited to groups of the population, such as schools, regiments or prisons. The most ardent advocates of the system would hardly pretend that it could replace general sanitary measures, while the protection of an entire community, such as the population of the city of Cairo, would be practically impossible. " CHAPTER III. GENERAL HISTORY AND GEOGRAPHICAL DISTRIBUTION. * The history of the plague may be followed into remote antiquity, The p!?.gue in and, with a certain measure of certainty, even as far as the end of the remote antiquity , . 1 , . . r 1 r 1 /-^i • • T and in classical third or begmnmg ot the second century of the pre-Christian era. In times. one of Oribasius' medical extracts from Rufus of Ephesus, a contempor- ary of the Emperor Trajan (98 — 117)) the plague boils are described, and allusion made to their occurrence in epidemic form in Lybia, Egypt, and Syria. The first accurate historical record which exists The Justinian is that of the great pestilence which spread over the Roman Empire P^^gue. in the sixth century, during the reign of the Emperor Justinian. The pandemic is estimated to have lasted from fifty to sixty years, and it wrought frightful devastation wherever it appeared. This outbreak gave the plague a firm hold over Europe, which piaeue in latsed for more than a thousand years. The history of the pestilence mediavai times. r, . 1 T , • • 1 • -T , . , , The Black after the Justinian plague is very vague until the episode of the Black Death. Death, the great pandemic of the fourteenth century. Contemporary writers place the origin of this outbreak in India or China, whence it is said to have spread over the countries of Asia Minor to the north coast of Africa and Europe. No part of the then known world escaped the ravages of the pestilence ; even distant Greenland was depopulated. According to Hecker's estimate, 25 millions of human beings suc- cumbed in Europe, or about a quarter of its population at that time. * This account up to the description of plague in China is mainly derived from the Chapter on Plagua in Volume I of Hii-sch's Handbook of Geographical and Historical Pathology. 65 General history and geographical distribution, [Chap. III. fifteenth to* ^° Throughout the fifteenth and sixteenth centuries and during the first seventeenth two-thirds of the seventeenth century the plague continued to appear centuries. frequently over wide areas of the continent and islands of Europe. In the last thirty years of the seventeenth century the plague was observed Retreat from the to be gradually retreating, and only twice after the beginning of the of Europe. eighteenth century did it become at all widely diffused in the western and central regions of the continent. From the middle of the eighteenth century only the south-eastern parts were a permanent seat of the disease ; from there it frequently made excursions northwards, but hardly ever got beyond the Balkan Peninsula and the countries imme- diately adjoining. Since the beginning of the present century it is only in the region last mentioned that plague has been epidemic fro-m time to time ; on the last occasion in 1814 ; and, excepting the slight Extinction in epidemic of the winter of 1878-79 in the Government of Astrakhan, "'^°^^* it then vanished completely from the soil of Europe. Last outbreak in In England the last great epidemic was that of the plague of Thfpia<^ueof London of 1665-66. *The number of reported plague deaths in London. ^j^g Metropolis in 1663 was 68,596, but the actual number was probably greater. In the year 1665 and still more in the year 1666^ plague epidemics raged with varying degrees of severity in a number of provincial towns, which were probably infected from London. In Last ouibreaks France the last outbreak occurred at Marseilles in 1720 and spread Germany. thence through Provence. The epidemic in Marseilles was one The Plague of ^f ^j^g worst recorded in history. In Germany also the disease .Marseilles. 1 . -i • 1 i appeared for the last time early m the eighteenth century. Turkey, the As the area of the plague in Europe became narrower, and the starting point of channels of its diffusion became more clearly marked, the more decid- Europe. edly did Turkey stand revealed as almost the sole point of depar- ture in Europe for every inroad of the pestilence. Even in some of the great epidemics of plague in the seventeenth century, it was pos- sible to follow the track of the disease from the east, towards the north- ern, western, and central parts of the continent. That route was still more decided in the two severe epidemics at the beginning of the eiu-hteenth century mentioned above ; audit was very obvious in subse- quent times down to the extinction of the plague in Europe, about the year 1840, that is to say, within the period when the disease existed no- where out of Turkey, except in the countries of the Lower Danube and Southern Russia. * Creighton's History of Epidemics in Britain. Chap. III.] General history and geographical distribution. 67 The part that was played by Turkey in disseminating the plague Plague in Africa, in Europe was played by Lower Egypt in the case of Africa. But ftfrtin^'^oint in Africa the area of the disease was much more confined than in Europe, and it never spread beyond the belt of Northern States- Tripoli, Tunis, Algiers, and sometimes as far as Morocco. In Egypt itself the plague never extended above the first cataract of the Nile. The last epidemic of plague occurred in Egypt in 1843-44, in Tunis in 1836-37 and in Morocco in 1818-19. Since then Africa has been Extinction of entirely free from plague except for two outbreaks that occurred on plague in Africa the Tripoli Coast in 1859 and in 1S74. This portion of the country Xr'ipoli'coaat. appears to have formed a new plague centre. In the western portion of Asia the principal plague centres up to the Old plague centres of Western Asia. end of the first half of the present century were Syria and Asia Minor, ^^"'^"'^^ ^'^ and to a lesser extent Armenia and Caucasia. In Syria thirteen out- breaks were recorded between 1773 and 1841, and In Asia Minor there are reports of twelve outbreaks between 1771 and 1839. The history of the plague in Caucasia is wanting In reliable Information, but the disease seems to have been prevalent between 1798 and 1818. In Armenia there were seven outbreaks from the beginning of the present century up to the year 1841. Since the outbreak of 1841 there has been no re-appearance of plague in these old centres of the disease. Their place has, however, been taken by Arabia, Persia, and Plague centres Mesopotamia, where previous to 1850 outbreaks of plague had been durl^g'the" ^^'* of rare occurrence. In Arabia epidemics occurred in 1815 and 1832 • second-half of from that time onwards there was no outbreak until 1853, w^hen an century!^^^'^'^ epidemic which arose In the mountainous district of Assir spread over the greater part of the country. Another widespread epidemic took place In 1874 and extended to within few days' march of Mecca, and there was a third epidemic in 1879, In the month of June 1897 the disease again broke out at Jeddah amongst the pilgrims from Hadramaut in the south of Arabia, and extended to the inhabitants of the town. Careful precautions were adopted and the epidemic was quickly stamped out. There is an account of an out- break in Persia in 1 57 1 and thence onwards epidemics occurred at rare intervals in the north-western portions of the country. There was a long interval free from plague between 1835 and 1863. In this latter year a severe epidemic broke out which was followed by other severe outbreaks in 1870, 1876, and 1877. In 1892 the plague spread from Persia Into Turkestan. In Mesopotamia an outbreak occurred ^at 68 General history and geographical distribution. [ CuAP. III. Bagdad) in 1596 and there were three outbreaks between 1750 and 1842. An interval then occurred, with occasional isolated cases, which lasted to 1866 when a small local epidemic broke out in the marshy level of Hindieh on the west of the Euphrates. Six years afterwards (1873) plague re-appeared in the same locality and grew to an epi- demic which lasted five years and overran the greater part of the country in wider and wider diffusion. In 1876 it appeared in Bag- dad and Hirsch considers that the estimate of 20,000 deaths in that place is probably much too small. In 1881 plague broke out again in Kerbela, Nejef and the neighbourhood. * Plague in further Until recently It was commonly accepted that Persia was the Asia. eastern limit of the area of plague on Asiatic soil, and that during the last five centuries, at any rate, it had never penetrated beyond this limit. Recent experience has, however, shown the existence of plague centres in India and China which, even before the recent outbreaks in the Bombay Presidency and Hong-kong, excited the great interest of scientific investigators. India. The first trustworthy information of the occurrence of plague in India dates from the year i8i2, when an epidemic broke out in Cutch and spread into Gujarat and Sind. In 1828-29 a disease absolutely like the Pali plague is reported to have been prevalent at Hansi in the district of Hissar in the Punjab. In 1836 another epidemic broke out at Pali in the Marwar State of Rajputana, and spread over a considerable area causing great loss of life. Along with these isolated outbreaks there exists an endemic centre of plague on the southern slopes of the Hima- layas in the districts of British Garhwal and Kumaun. The existence of this centre can be traced back with certainty to the year 1823, and it has ever since been the scene of outbreaks of varying degrees of severity. A more detailed account of plague in India is given in the next chapter. China. In China the seat of the pestilence lies in the mountain valleys of Yunnan, a province situated on the borders of Upper Burma. The Yunnan. history of the disease in Yunnan is very obscure. It does not appear to have attracted notice before the virulent outbreak that occurred in \2>ii-n% at the time of the great Muhammadan rebellion, but som.e Chinese authorities allege that it existed from earlier times in the district of Ta-li-Fu in the extreme west of the province. The theory is sometimes put forward that the disease was imported from the endemic centre of Garhwal and Kumaun through either Thibet or Chap. III.] General history and geographical distribution. 69 Upper Burma, *For over thirty years, at any rate, the pestilence has re-appeared year by year in different portions of the province of Yunnan at epochs varying for different districts, but as a rule regular for each locality. From the highlands the malady has extend ed to the elevated plain in the south of the province, and it now appears every year in the town and district of Mengtsz in the south of the province Mengtsz. of Yunnan. Here the first cases occur regularly in May, at the season of the rice planting, and are said to be heralded by mortality among rats and pigs. As a rule, the epidemic does not last more than three or four months, and at its height twenty to thirty deaths are recorded a day. In the north of Yunnan the disease prevails chiefly in the winter. From Yunnan the pestilence has extended to the neighbouring provinces of Kwei-Chan and Kwangsi, and to the further province of Kwangtung, in which Canton Is situated. At various intervals epidemics occur in these three provinces, but the disease does not remain permanently in the low regions of Kwangsi and Kwangtung. In 1882 a severe epidemic broke out in the seaport town of Pakhoi, south of the Kwangsi Province, where Dr. Rennie, v/riting in 1894, stated that the disease has been known for the last thirty years. He considered that the disease reached Pakhoi overland through the province of Pakhoi. Kwangsi. In 1891 plague broke out in Kao-chao, the prefecture adjoining Lien-chou, in which Pakhoi is situated ; according to the Chinese, it had spread northwards from that place. In the spring of 1894 it prevailed in severe epidemic form in localities between Kao- chao and Canton, and in March 1894 it broke out in Canton itself, having apparently travelled overland from Pakhoi. Dr. Rennie estimated that by the middle of June 40,000 people had died of the disease in Canton, and it is stated that not less than ioo,ooot per- Canton, sons in all died during the epidemic. In May 1894 the disease broke out in Hong-kong, reached a virulent height in the hot season and Hong-kong. died away in September. The cases gradually rose up to 60 to 70 a day, and even to upwards of 90, and on one day to 109. About 2,550 persons perished before the epidemic died away. In January 1896 there was a recrudescence, the cases becoming more frequent in February and March, until in April and May the disease again assumed an epidemic character : 729 cases occurred up to the 5th May. In June, July, and August it gradually subsided. The second ♦ Dr. J.L. Michoud's Report on the heahh of Mengtsz for tie year ending the 30th April 1894, and Dr. Alexander Rennie's Report on the plague prevailing in Canton during the spring and summer of 1894. — (China Imperial Maritime Customs Medical Reports, 1894, Special Series, No. 2.) + Paper by A. G. Viegas, L.M.S., published in the Indian Lancet of the i6th February 1897. 70 General history and geographical distribution. [ Chap, III. epidemic was less virulent than the first. The infection was probably brought from Canton on boardship in the ordinary intercourse of commerce.^ * Annual report by the Governor of Hong-kong (Sir William Robinson) for the year 1894. Report by Sir William Robinson on the 1896 epidemic in Hong-kong, dated the 6th May 1896. Report on the Epidemic of Bubonic Plague at Hong-kong in the year 1896, by Staff Surgeon Wilm of the Imperial German Navy. Article in the Lancet of the 4th April 1896. CHAPTER IV. PREVIOUS HISTORY OF PLAGUE IN INDIA. Notices of Pestilence in early Indian History. The present Bombay epidemic has excited a special interest and a virulent plague special anxiety owing to its havinsr broken out in the Indian port in ep'^iemics have i^ y o o ^ ^ ^ r ^ occurred in India closest and most constant communication with Europe, and owing to in former years. the large area over which it has spread. But the summary given in the last chapter shows that the visitation is not the first of the kind that has been experienced in the west of India. The belief of contemporary writers that the Black Death origin- Possibility that ated in India or China has already been noticed, as well as the fact that emana^ted from the pulmonary form of the disease, which has been a marked charac- India, teristic of the present and previous plague epidemics in India, was equally a marked feature of the Black Death. Only *two direct refer- Pestilence in ences have, however, been traced which may point to the existence of fourteenth ani plague in the west of India in the fourteenth and fifteenth centuries, fifteenth The first is from Ibn Batuta, who notices that Muhammad Tughlak's army in Ma'bar (i 325-1351) mostly perished of pestilence, and that at the end of the century (1399), after Timur left, the districts through which he had passed were visited by pestilence. The second relates to the year 1443, when pestilence caused such loss of life in the army of Sultan Ahmad I. that, leaving many of the dead unburied, he retired to Gujarat. Ferlshta calls this disease fa'un, and speaks of it as very unusual in India. The faminef of 1590 to 1594 was followed by a pestilence that, besides hamlets and villages, depopulated whole cities. »t x- f It must remain a matter of conjecture whether these outbreaks pestilence in the of virulent pestilence were epidemics of true plague. cent^ur'y Twice in the seventeenth century the district of Ahmedabad in the Bombay Presidency was visited by severe epidemics of pestilence which were probably outbreaks of plague. The Bombay Gazetteer! Outbreak o£ gives the following description of the first of these epidemics, which ^^*^" appears to have been very widespread :—' " The disease that raged in Ahmedabad in 1618 began in the Punjab in 161 1. It is called the plague, wdba or wdba-o-taaun, and the works of the Hindus ara said to have no mention of such a disease. It was thought to be connected with the comet of 1612. From the * Bombay Gazetteer, Volume IV, p. 218. t Bombay Gazetteer, Volume IV, p. 2IQ. % Volume. IV, Chapter XII. 72 Previous history of plague in India. [CHAP. IV. Punjab it spread through Lahore^ through the Doab to Delhi, and north to Kashmir. No place in Hindustan was free from its ravages. Lulling at times, it continued to lay waste the country for eight years. About the same time in Kandahar the land was overrun by mice, and mice and plague seem to have had some close connexion. A mouse would rush out of its hole as if mad, and striking itself against the doors and walls of the house, would die. Then the plague was in the house. If the people at once fled they might be saved; if they stayed, the whole village was swept away. " With reference to the second outbreak, which occurred during Outbreak of the period 1683 to i68g, the Gazetteer* makes the following remarks : ^3019- u Pqj. cgyeral years before 1689 the plague, taim and wdba, was again in Ahmedabad, and lasted for seven or eight years. The visible marks were swellings as big as a grape or banana behind the ears, under the arms, and in the groin, and redness round the pupils of the eyes. " Hirsch repeats the following quotation made by Macpherson ('Annals of Cholera/ London, 1872, 112) from an Indian Chronicle which apparently refers to this epidemic : " A fever had prevailed for some years both in the Deccan and in Gujarat. It con- sisted of a slight swelling under the ears, or in the armpit or groin, attended with inflamed eyes and severe fever. It generally proved fatal in a few hours. " Hirsch remarks that this description is sug- gestive of plague. Eighteenth cen- It is stated in the Ahmedabad Gazetteer that during the eighteenth *"''^' century, though none of the symptoms of the disease are described, there would seem to have been several outbreaks of a most deadly form of fever. In 1718, a year of famine, great numbers died of sickness ; in 1770, another famine year, "on account of the unwhole- someness of the atmosphere, thousands of people died of fever in two or three days, so that no one could be found to bury them." Fearfui disease is said to have accompanied the 1790 famine. The Epidemic in Western India in 1812 to 1821. Gujarat epidemic This is the first undoubted plague epidemic in India of which of 1812 to 1821. ti^gj-g is an authentic and trustworthy account. The disease broke OrisininCutch. out in the Island of Cutch in 1812, and spreading thence over Kathiawar, part of the district of Ahmedabad, the Radhanpur State, and the southern portion of Sind, ravaged the country for a period of Description of ten years. Cutchf is a native State of Gujarat situated to the south of ^"^'^''' Sind, from which it is separated by the Ran of Cutch. The capital is Bhuj', where the Chief or Rao resides. The whole territory of Cutch • Volume IV, Chapter XII. \ See Map in Volume IV, page i. Chap. IV. ] Previous hislory of plague in India. 73 is almost entirely cut off from the continent of India, north by the great Ran, east by the little Ran, souih by the Gulf of Cutch, and west by the east or Kosi mouth of the Indus. Though on the whole treeless, barren, and rocky, the aspect of the country is varied by ranges of hills and isolated peaks, by rugged and deeply cut river beds, and by well tilled valleys and tracts of rich pasture land. On the south, behind a high bank of sand that lines the sea-coast, lies a low, fertile, and well cultivated plain from twenty to thirty miles broad. There are no rivers in Cutch, but during the rainy season (July to October) many streams of considerable size flow from the central ranges of hills northwards to the Ran and southwards to the Gulf of Cutch, For the rest of the year the courses of these streams are marked by a succession of detached pools. Lying along the line of the tropic of Cancer, Cutch is almost beyond the rain-bringing influence of the south-west monsoon. The mean average rainfall for the five years 1891-1896 recorded at the difierent registration stations in the island was only 17-60 inches. Along the sea-coast, throughout the year, the climate is agreeable ; and over the whole province, for nearly nine months, it is cool and healthy. But in April and May burning winds and duststorms pre- vail, and again during October and part of November the heat becomes excessive.* The years 1811 and 1812 were marked by a severe famine Account of which extended over the greater portion of Gujarat. At the close ^^^ outbreak in of the year 18 12 plague broke out in Cutch with such virulence that it is said to have destroyed half the people of the country. The following account of the epidemic is taken from Volume V, Chapter XII, of the Bombay Gazetteer : — '* What along with the v/eakened state of the people must have strengthened, if it did not give rise to, this plague, was overcrowding in the towns, where on account of the disorders of the few preceding years, people from the village had sought shelter. For two years the disease abated. Then in May 181 5, the year of the heaviest known rainfall, it broke out with deadly force in Kanthkot in east Cutch, As in Ahmedabad, its symptoms were slight fever followed by great weakness and weariness, and then swellings in the groin and armpits, suppurating in some cases and in others remaining hard lumps. Few stricken with the disease recovered. Most died between the third and ninth day. The plague seemed in the air ; there was nothing to show that it had been brought from outside, or was spread by the touch. It seemed to attack most fiercelv the sluggish and vegetable eaters; Rajputs escaped ^\here Brahmans * Imperial Gazetteer of India, Volume IV, psges 57-64. 10 74 Previous history of plague in India. [Chap. IV, and Vanias died in numbers ; oil-makers were believed to be safe. In Bhuj, care was taken that no one should come from the affected districts. One man died, those with him were turned out, and the house was smoked with brimstone and unroofed. From Kanthkot the disease spread to other parts of Vagad (the eastern territorial division of the State), causing much loss of life in the early months of 1816. In May it crossed to Morvi in Kathiawar, and came back in August to within ten miles of Bhuj." Epidemic in the After 1817 there was no re-appearance of the disease in Cutch. Radh-inpur State . , • ,1 , ,1 t i ^ at • •, 1 • 1 aad Sind. At the same time that the disease spread to Morvi it raged in the Radhanpiir State (lying to the north of Kathiawar and bounded on the west of the Ran of Cutch) and in Sind, occasioning a severe epidemic in the capital of tliis latter State (Hyderabad) in November of the year 1816. Description of Kathiawar * to which the plague spread in the spring of 1816, Kathiawar. . ^ . , ,• 1 i ,, , • , .1 a 1 • r^ is a square peninsula, standing boldly out into the Arabian Sea between the smaller projection of Cutch and the straight line of the Gujarat Coast. It was formed into a political agency under the Government of Bombay in 1822, containing one hundred and eighty-seven separate States. For administrative purposes it is divided into four divisions : Jhalawarin the north-east, Halal in the north-west, Sorath in the south-west, and Gohelvvar in the south-east. Lying midway between the dry deserts of Sind and the moist wooded Konkan, the province of Kathiawar partakes of the nature of both. At the same time it illustrates the transition betweea them by modifi- cations of aspect ranging from the barrenness of the one to the rich- ness of the other. Its shores, differing from the rocky coast line to the north and south of Bombay, resemble the coasts round the head of the Arabian Sea, and inland it shows every variety of scenery, from the arid and sandy tracts of Okhamandal in the west and Jhalawar in the east, covered with cactus and desert bushes, to the well watered forests of Gir in the southern range of hills, from the desolate waste of the Ran to the fertile and well cultivated region of the south; from the salt charged plains of the east and west to the rich seaboard Climate. tracts. The climate of the peninsula is in general pleasant and healthy. January, February, and March are marked by heavy dews and thick fogs, which are not unhealthy. The hot weather begins in April and lasts until the rain falls in the middle of June. The hot wind blows in various degrees in different parts, and is hottest in the south. On the sea-coast it is little felt. The hot weather months (April to June) are the healthiest in the year. There is always a light, cool breeze. The rains generally begin in force at the first c hange m the moon in * See M-tp in Volume IV, pa^e 1. Chap. IV.] Previous history of plague in India. 75 July and are spent by about the end of August. Unlike other parts of Gujarat, the rains are never severe and they grow lighter towards the west. Except that slight fevers prevail in July, no disease is specially prevalent between July and September. From the end of September the climate undergoes a change and becomes unhealthy. In September and October the heat of the sun is acutely felt, though the weather is cloudy. The latter part of November and the whole of December are in all respects like January.* Very interesting accounts have been given of the plague inAcc-untsby Kathiawar by two Medical Officers who visited the country during the M'"J3oinceis period of the epidemic. The first account by Dr. Gilder, Civil Surgeon, is contained in a letter dated the 20th February 1820 to the Bombay Medical Board, and the second by Dr. White, Assistant Sur- geon, is contained in a letter of the 27th March 1820 to the same address. The two letters are reproduced in Appendix II, and the following account is derived from them and from Volume IV, Chapter •XII of the Bombay Gazetteer: — It has been stated above that the plague was introduced in May Commencement 1816 from Cutch to Morvi, the capital of a State of the same name, P^ ^1?'' outbreak I ■ 1 TT 1 1 T • • r I TT , . '" Kathiawar at Situated in the Halal division of the Kathiawar Peninsula on the Morvi. western border of the Jhalawar division. In 1817 the disease travelled to Dholera, a sea-port lying twelve g readtotbe miles up a creek of the Gulf of Cambay and situated In Dhandhuka a Dhandhuka subdivision of the Ahmedabad district lying to the south-east of the Ahmedabrd!^ Jhalawar division of Kathiawar. It was believed that the disease was Introduced Into Dholera, a place of some importance In connection Dholera. with the cotton trade, from Cutch, either by merchants or by the cotton ginners who came annually from Cutch with their wheels to separate cotton from Its seed. In Dholera j^iree people only were attacked, all of whom died ; the disease spread thence over the neighbouring British villao-es of Barlad, Rojka, PIpli, etc., and advanced westwards to Dhandhuka, the head-quarters of the subdivision, and situated near the border of Jhalawar. The epidemic continued in this neighbourhood and amongst villages on the border of the Ran until the close of the year s 81 7, when it gradually decreased without, however, altogether gj disappearing. Isolated cases continued to occur in the Dhandhuka Spread to the subdivision and the neighbouring district of Limbdl in Jhalawar. Jhalawar In April i8ig the epidemic broke out with renewed virulence Kith'iawar. in the village of Barlad, a few miles north-west of Dholera. It rao-ed '^'^" here for two months until the setting In of the monsoon, and forty * Bombay Gazetteer, Volume VIII. jS Previotis history of plague in hidia. [ Chap. IV. families are said to have been annihilated. In the beginning of June the malady spread to Rojka, a village close to Dhandhuka, and nearly- depopulated the place. During the rains of 1819 the malady became diffused over a large tract and manifested equal virulence in different parts of the country without, however, passing the western border of the Jhalawar division. Limbdi. Towards the end of June the disease appeared in the town of Limbdi and made such ravages that the terrified inhabitants after losing fifteen hundred to two thousands of their number deserted the place, leaving their sick and a few persons to perform the rites for the dead. After this emigration the disease abated in Limbdi, but only to break out with increased virulence in other towns and villages of the neighbourhood, some of which are said to have been totally depopu- lated. The misery of the situation was aggravated by the fact that the rains were pouring down in torrents, flooding the country and forcing the inhabitants to crowd together in the infected villages, which rose Extinction in \\\^^ islands from a sheet of water. In 182 1 the epidemic died awa\'. 1821, . Except for the 1816 outbreak in Morvi, the malady does not appear to have been diffused in Kathiawar beyond the limits of the Jhalawar Mortality. division. Of the total mortality no estimate was made, but it must have amounted to a large proportion of the inhabitants of the stricken region. Dr. Gilder and Dr. Whyte agree that the disease Avas ex- tremely fatal and that few recovered. Classes most It is said that persons of the Brahmin, Merchant, Golds m"th, Tailor and Kanbi* castes suffered most, and that the flesh-eating classes largely escaped. Dr. Gilder remarked that when once in any place the malady obtained hold over the members of any particular caste or trade it seldom abated without having made victims of them all. Symptoms. Dr. Gilder gives a detailed clinical account of the disease, derived from native sources, in which he draws a marked distinction between the bubonic and pulmonary types, and gives a descrip- tion of each, which tallies exactly with the description given in earlier and later epidemics. The natives had different names for the two forms of the disease ; the bubonic form they termed Ghant no rogue or " the knotty disease ; " the pulmonary form they distinguished by the appelations Kogla no rogue and Tao no rogue, signifying, respec- tively, "the expectorating disease" and "the fever disease." Pulmonary Dr. Whyte also notices the existence of the two forms, yant-ty, the first ^^^^ states that in all cases the pulmonary form first broke out, to occur. , J • and that the ordinary bubonic plague made its appearance afterwards. He gives the following description of a case of the pulmonary disorder which came under his observation : " In this man the heat of the body " The principal cultivating cast3. Chap. IV. ] Previous history of plague in India. 77 was not much increased nor the pulse greatly acccllorated ; his bowels were not disordered nor did his tongue indicate much febrile irritation. He was able to walk about and converse, answering questions dis- tinctly. No person would have thought him in danger, but there existed, in the patient's mind, a degree of alarm and anxiety altogether dispro- portionate to the apparent symptoms. He had only been attacked that morning. All his consideration seemed absorbed with a pain in his chest. He answered to my questions whether he had not other pain, as in his head, his back or limbs, that these were slightly painful; but he immediately recurred to his chest, dwelling upon that \\ith a look of most painful distress ; and if not questioned about other symp- toms, it seemed as if he would not have mentioned them. He had besides a very slight cough, — so slight that it might easily have escaped unnoticed, — and this was accompanied with a discharge of blood from the mouth. The following day he was delirious, had a burning skin, with a very quick pulse. I searched for but found no buboes. I^e died in the course of the succeeding night, i.e.^ in less than forty-eight hours from the first attack. The characteristic symptoms of this variety are, slight cough, pain of the chest, and haemorrhage from the mouth, attended with fever, but no buboes." Dr. Whyte also gives a descrip- M;id bubonic tion of the mild form of bubonic plague unaccompanied by fever. ^°'^'^* " I saw,''* he states, " a great number who had buboes, without any fever, and was told that upwards of one hundred and twenty had suffered in this way. These people walked about without either alarm or inconvenience, for none had died, and not many of the buboes suppurated. ■" Dr. Whyte's report is divided into two parts. Tn the first part Dr. Whyte's he gives a description of the matters that came under his obser- ''eport. vation in the different places he visited, and in the second part he states his general conclusions. Morvi, in the Halal division, and Wuccaner (Vankaner), Sura (Sara), Moolee (Muli), and Sily (Sayla) in the Jhalawar division were the principal places visited. It was three years since the outbreak at Morvi (1816) when Dr. Whvte ,, 11- TT 1 1 Morvi. made his tour. He stated that the situation and surroundings of Morvi were healthy and not such as predispose to ordinary malarial fevers, but that the whole space within the walls of the town was crowded with houses. The disease prevailed for five months in Morvi, begm- ning in the cold and lasting through the hot months without undergoing any modification on the occurrence of the change of weather. The ac- counts given of the mortality varied greatly. Dr. Whyte considered five hundred deaths to be a probable estimate. He with difficulty procured * At Muli, in the Jhalawar division. yS Previous history of plague in India. [Chap. IV. four recovered patients for examination, and instances this fact to show Local belief tVat how few of those who were attacked recovered. The inhabitants of tie ise^isewas |-|;ie town did not believe the disease to be contaafious, The Thakur not contagious. o or Chief's brother had been in the habit of visiting and looking after the sick^ frequently handling and touching them, and did this with complete immunity. Dr. Whyte inferred that casual intercourse with the sick is unattended with much danger, that it is probable that tlie disease is not readily communicated by the touch, and that it is possible that confinement in the same apartment is in general necessary for its production. The Thakur's palace, containing about Beneficial Qj^g hundred people, escaped completely. It was a large well aired henhhy situation place elevated above the other parts of the town. Equal immunity was and aoode. enjoyed by a Small village situated on the opposite side of the river less than a quarter of a mile away on a very high and exposed situa- tion, although there was daily and hourly communication between Vankaner. the village and the infected town. Vankaner is a large walled . town, seated at the foot of a hill and on the banks of a fine river, distant about eighteen miles from Morvi. Tt is believed that the disease was imported from this latter place. The outbreak lasted The Bohoras, or only fifteen days and was almost solely confined to the Bohoras — a cotton weavers. ^,,, , , ,• ,i r. r^i. sect of Muhammadans whose occupation was the manutacture ot cotton cloth. The number of deaths was estimated at sixty among this community, while not more than four or five among the rest of the inhabitants caught the infection. The Bohoras became so alarmed that they all left the town and went to live upon the mountains in the neighbourhood, leaving onl}/ the sick and their attendants. It is said that the whole of these very soon died. Whenever they heard of a death, the friends of the deceased came down and performed the last offices as speedily as possible, returning again to their abode on the mountains. Some of those who attended the funerals fell ill, but • f at the end of fifteen days after the Bohoras removed to the moun- Suppression or "^^ '-"'^ v.iiv-i ^ j the disease by tains, the disease had entirely disappeared from amongst them. removal to the ^^j^g^ ^-^^jg ^^^s the case they all came down and re-occupied their houses, and they declared that no person was afterwards attacked by the disease. Dr. Whyte remarks " that this is a curious and singular fact affording a rare instance of a measure dictated by fear, and carried into effect without reason or reflection, being attended with complete success." " In fact,'^ he says, " it corresponds very nearly . with what has been recommended to be done by one of our best writers, Dr. Adams, on such an occasion, and is a very good practi- cal illustration of the measures, which with so much care, delibera- tion, and strict induction from the facts before him, he laid down Muli. and'thought likely to be successful." MuH is described as a large and Chap. IV.] Previous history of plague in India. 79 populous town, the inhabitants of which are mostly Rajputs. It was surrounded by an old ruinous wall full of breaches, which were ail carefully stuffed with thorns, and every house had a wall of the same material much higher than a man's head. "No better means could possibly have been adopted," says Dr. Whyte, B^d ventilation. " completely to exclude ventilation, if this had been the sole object of the inhabitants. " At the time of Dr. Whyte's visit, the disease was still prevailing and had already caused about eighty deaths. It was at this place that Dr. Whyte recorded his clinical observations on the pulmonary and mild bubonic forms of the plague which are quoted above. Sayla is a large walled town in the neighbourhood of Sayla. an extensive tank, which supplied it with excellent water. The disease had prevailed for about two and a half months at the time Dr. Whyte paid his visit. At first it had been very severe and o-eneral but latterly it had become more partial in its attacks. Here also the Bohoras were the first and severest sufferers ; one hundred and twenty deaths were said to have occurred, of which sixty were amono-st the Bohoras. In some houses the loss had been very heavy, amounting to five, eight, or nine of the household. Dr. Whyte's report contains a long discussion on the origin of the Dr. Whyte's disease and the way in which it spread. The opinions at which he ^'^^"ssionon the arrived were very similar to those which are held at the present time, spread o^he He believed that the disease spread from place to place by contao-ion disease. (in the broad sense of the term), and especially by fomites, but that fnJec?knInd while it spread with facility In a close and insanitary situation the ''°''*^''®^ ^y ii • 1 , . ' endemic causes, reverse was the case in an open space and where sanitary conditions prevailed. He describes in detailthe endemic causes which fostered the growth Insanitary of the disease in Kathiawar. The inhabitants were to the last deo-rpp ^"^''^'.t'^" ^.f ,,.,,. 1 , , . . t)^'^'- Kathiawar. uncleanly in their persons and habits, political causes had checked industry and agriculture and engendered idleness and want, and these evils had been aggravated by severe famine. It was also the habit of the people to live in crowded, dirty and ill-ventilated walled towns, and in the houses men and cattle (which were usually diseased), were herded together in the most unwholesome manner. The lono- duration and virulence of the outbreak can, under these circumstances, occasion no surprise. In the remedial measures which he suggested, Dr. Whyte was also Remedial in agreement with the opinions that now prevail. " It is cheerino- |-q n^e.nsures reflect," he remarks, " that we have arrived at the knowledge of a Dr^ w'hyte!"^ plan, by which, if its rules are rigidly attended to, we have it in our power speedily to check the progress of this scourge, in any place Sagregition of the injected in the open, and dastriiction of contaminated clothino". Out'breqk in the D handbuka subdivision. Description of the Ahrnedabad District. Quarantine measures. Quirantine ineffectual at Dhandhuka. Pestilence at Ahrnedabad. 80 Previous history of plague in India. [ Chap. IV. where it may be introduced. * * * * These (rules), I need hardly add, are such as would secure cleanliness, and a complete separation of every family where the disease had appeared ; they ought to be com- pelled instantly to depart from the town and live in the open plain, under a temporary encampment, which (if the subject were thought of suffi- cient importance) might be erected at the public expense for the lower orders. It would be well if the clothes of the diseased were to be burned at the public expense likewise. Experience has proved that, if not crowded, in such a situation the disease would not spread, and there can be no doubt the beneficial consequences would soon be a subject of joy and congratulation to every one who had a hand in promoting so benevolent a purpose." Dr. Whyte had little hope that these measures would be adopted in Kathiawar. The outbreak in the Dhandhuka subdivision of the Ahmedabad District which spread from the sea-port of Dholera in 1817 has already been noticed. Dhandhuka forms the southern portion of the main body of the Ahmedabad District. The town of Ahmedabad is situated in the north-east corner of the main portion of the district and is some seventy miles distant from Dhandhuka, It is a flourishing town encircled by a belt of park-like country several miles in depth, and it is situated in the fertile plain of sandy soil which extends through the Daskroi and Dholka subdivisions which form the central portion of the district. The Dhandhuka subdivision lies in a fertile but treeless plain which changes towards the east to bleak, salty flats intersected by marshes. To stop the spread of the disease in the Ahmedabad District, the Collector ordered all heads of villages to allow no one to come from infected villages ; if any one harboured people from a diseased village he and his family were to be turned out. Later on (January 1820) it was found necessary to keep people from going to infected vil- lages to attend their relations' funerals, and village officers were ordered to turn any one out who had visited an infected village. But these harsh and stringent measures were powerless to check the spread of the disease. Notwithstanding the quarantine which was imposed at Dhan- dhuka, the infection found an entry and nearly depopulated the place. And at Ahmedabad itself "a contagion raged with a fury that can scarcely be believed." Of the symptoms of this sickness no details are recorded, but there can be little doubt that it was the same plague that was ravaging the neighbouring parts of the country. It is said that " every house sickened, whole families were carried off, and many a funeral party coming back to the house of mourning found that, in their absence, another member of the family had sickened and died. So thinned were some castes that their women had to help to carry Chap. IV. ] Previous history of plague in India. 8i the dead. All the fuel was burned and though houses were pulled down to supply logs, many bodies had to be left half consumed. Half High mortality. of the people of Ahmedabad, perhaps about 50,000 souls, are said to have perished. "* Details of the outbreaks in Sind and Radhanpur are not ascer- tainable, and the above description therefore closes the account of the 1812 — 1821 epidemic. Its history is most important, importance of not only because of the light that it throws on the disease, but ^''^^'^^'^'■y °^ ^'^^ ■ „ (jujar^t because it affords an Indian example of the pertinacity with which epidemic, plague will persist and the virulence with which it will prevail if left to work its way unchecked amidst insanitary surroundings. The Pali Outbreak of 1836-37. Hirsch notices a statement by Colonel Skinner that in 1828-29 a disease with glandular swellings absolutely like plague prevailed P'ague-like •I !• /.TT •/!!• ^• , ■ . r,i T-. -ix- , disease in the With malignancy at Hansi (Hissar district of the Punjab) m the Punjab in province of Delhi. But the outbreak next following the Gujarat 1^28-29. epidemic, of which there is a detailed and authentic account, is the epidemic that occurred in Rajputana in the years 1836-37 and wdiich is usually known as the " Pali Plague." Dr. Forbes, one of The Pali Plague. the medical officers who investigated the disease, was informed by an intelligent Guruf of the Jains that, although new to his generation, the malady had formerly committed great ravages in Marwar. An interesting account of this epidemic was written by Dr. James Dr. Ranken's Ranken, Officiating Secretary to the Calcutta Medical Board, and pill'pla^ue!'^ published by order of the Government of India in 183S. The follow- ing description is mainly derived from this report and its appendices. Dr. Ranken did not himself visit the scene of the epidemic, but compiled bis report from documents written by the medical and other officers who were on the spot. Differing from the doctors who saw the disease, Dr. Ranken did not believe it to be the plague of history, but his arguments to this effect are inconclusive, and the clinical and epidemological accounts of the outbreak show beyond doubt that it was one of true plague. The scene of the Rajputana epidemic was the country lying on Description of either side of that portion of the Aravulli hills which forms the Mewl^'and district of Merwara, under British administration. Merwara. To the west and north of the range of hills lies the state of Marwar orjodhpur, and to the east and south the state of Mewar or Udaipur. Marw^ar forms the south-eastern portion of the Rajputana desert * Bombay Gazetteer, Volume IV, Chapter XII. | f Spiritual guide. II 82 Previous history of plague in India. [Chap. IV. country. The cultivation is poor and precarious, though certain parts have a better soil than others, and some tracts are comparatively produc- tive. The principal towns in this part of Rajputanaare well built and fairly prosperous, and have for ages managed the traffic across the desert The climate of Mevvar is healthy and not malarial. It is remarkably dry, and the country is altogether free from heavy jungle. The soil is for the most part light and sandy : there are few natural or artificial collections of water, and the periodical ra'uis speedily drain off. The portion of Mewar affected was the fertile open and undu- lating country comprised in the north-east portion of the state. The intervening range of the Aravulli hills forms a narrow strip of territory with mountainous and varied scenery ; the highest peak attains an elevation of 2,855 feet above the sea-level, and the average level of the valleys is 1,800 feet. The country is naturally dry and unproductive, but is rendered comparatively fertile by numerous tanks (formed by embanking gorges or torrents), most of which have been constructed since the introduction of British rule. Outbreak at The disease broke Out in the month of July 1836 at Pali, a con- Pah, Ju;y 1836. giderable towm in Marwar, distant about thirty-five miles as the crow flies from the nearest point of the Aravulli hills. Pali was reckoned the emporium of trade between Central India and the sea-ports of Gujarat, and in 1836 was believed to contain about fifteen to twenty thousand inhabitants. A number of families amounting to about twQ The cloth- thousand persons, called Chipis, who lived by printing the plain affected. "^^ pieces of cloth brought from the coast, were the first affected ; and six hundred and fifty-five of them died. TheBrahmans next, then the Mahajans, or retail merchants, and the inhabitants indiscriminately Virulence of the were taken ill in succession. The outbreak was virulent and it Is 6oicicniic believed that four thousand inhabitants perished, the deaths amount- ing to fifty or sixty a day, " Before the mortality abated, all the wood procurable for burning the dead was expended, and corpses had to be consumed with the shells of cocoanuts, and the butter commonly Origin of the used as food.'" The origin of the disease in Pali is not known. Conjecture that One conjecture that was formed was that the infection was brought it was imported in the bales of cloth imported into Pali from Bhavnagar, Surat, and from the Gujarat J; r t ^ t ^ ^ ports. other western ports. The fact that the persons first attacked belonged to the class who handle this cloth for printing lent some support Dr. Irvine's to this view. Dr. Irvine, who was at the time Surgeon to the believing in Political Agency, Rajputana, has recorded the following interesting this theory. remarks on this subject : — " It appears to me, in the first place, that the plague having pre- viously appeared in obscure parts of India is very nearly proven as a fact ; and history declares that at one period, a most fatal contagious plague desolated the whole country. In various places in Gujarat Chap. IV.] Previous history of plague in India. 83 cases of disease have been observed by the Bombay Medical Officers, appearing either sporadically or partially epidemic, the symptoms of which closely assimilated those of the true plague ; and^ 1 believe, that only the supposed impossibility of the existence of that disease in India prevented those cases being declared such. *' It appears that in those instances the disorder broke out and subsided, and again appeared at different periods. From which I conclude that the disease, at each time of its appearance, was freshly imported, either by land or sea, in bales of merchandise containing the fomites of the plague; which disease, after breaking out, was in those cases soon arrested in its progress by the occurrence of great heat and an arid atmosphere, and a probably small population to act on. It would seem very likely that, had the plague never reached Pali, the disease might still have appeared sporadically to the westward, and yet never have from its insignificance been ackowledged as such. From the great increase of land transport via Pali, it is not at all to be wondered at that goods infected with the fomites of plague at last reached that place ; it is rather a matter for admiration that such had not occurred before, under the absence of every precaution. It is equally evident that for a long series of years goods may be imported from even infected quarters, and yet not contain the fomites of the plague ; but, at length, one infected package arriving may do all the mischief. That the plague was thus introduced into Pali I have not a doubt, especially from the circumstances of the disease not having appeared at intermediate towns, between Pali and the coast ; from which it would seem probable that the package containing the fomites was at once conveyed unopened from the vessel it came in to Pali where it spread the pestilence ; more particularly as it is a well known fact that the period that unopened goods will retain the fomites of plague is almost unlimited, though the time the human frame wnll retain the hidden seeds of the disorder is not beyond eight or ten days : hence it seems evident that the contagion reached Pali retained in bales of merchandise and was not introduced by men infected with the malady," " In the course of five or six weeks from its first appearance, the Flight of the disease having committed great ravages, and the daily mortality ^-'labicants of being still on the increase, all ranks of the townspeople became so much alarmed that they began in considerable numbers to abandon alike their homes, occupation, and property, and to seek refuge in Jodhpur, Sujit, Khairwali, and other towns and villages within a circle of twenty to thirty miles round Pali. The wealthier members of the community were the first to emigrate ; others soon followed their 84 Previous history of plague in India. [ Chap. IV. example, and to such an extent that (with the exception of the Chip- pahs) only the very poorest remained in the outskirts of this once rich and thriving town." Almost all the long narrow streets and alleys were left tenantless, every shop was shut, and, according to Assistant Surgeon Maclean, who visited the town at this period, and from whose account the above description is taken, not more than a thousand persons, mostly of the very poorest class, were left in the place. The Assistant Surgeon continues his account of the flight as follows : — - The disease "Of the thousands of persons who quitted Pali * * ^ some spread by the were at the time labouring under disease, others fell sick on the re ugees. xod^d or immediately after they had reached their destined places of refuge. For a short period after their arrival in the various towns in which they had taken up their temporary abodes, the sickness which they had brought in their train adhered to the refugees, with- out attacking the inhabitants of those towns. But this state of things did not long continue. The classes with which the refugees had the most intimate communication (bannias* for instance) speedily began to feel the effects of the Pali scourge, and now there is not a town or village, to which the refugees resorted in any consi- derable numbers, which is not become a fresh focus of contagion and in which the original malady does not rage with fearful vigour. " Progress of the In September the epidemic extended to Sujit, a town containing plague in Marwar gjjj thousand soiils, and by October it reached Jodhpur, the capital and Mewar. ^ ., . ■,- . ^' r ii i -n \ j of Marwar (about hfty-two miles in a direct line from the hills), and spread over the intervening towns and villages. It next affected the single village of Dewair in the Merwara hill district, where it destroyed four hundred persons. Passing over the hilly tract it attacked Deo- ghar in Mewar, on the east border of the hills, and skirting the hills towards the north-east, .it extended fifty miles by Lusani Thana and Bednore to Jalia and Ranghar in the district of Ajmere. At the same time it extended over the southern portion of the open Mewar country. These events occurred in Januiry to March 1S37. In April 1837 the sickness was announced in Bhilwara and Hamirgarh in the extreme east of the Mewar plain, towards the direcli m of the British cantonment of Neemuch. In all thirty-two villages in Mewar were attacked by the epidemic. The hot season of 1837 was unusually mild, but nevertheless the hot weather and A^inds were found to have a beneficial effect in checking the progress of the disease. Towards the end of 1837 the epidemic broke out again in Extinction in Pali, and it did not die out until the spring of 1838. No accurate 18^8^""° °^ estimate was made of the total mortality. Dr. Irvine states that * Retail vendors. Chap. IV. ] Previous history of plague in India. 85 thousands died in Jodhpur, and Assistant Surgeon Maclean believed Mortality, that the assertion of the Marwaris that a hundred thousand persons perished of the plague in their country was not very far wide of the truth. He estimated that when the epidemic had reached a virulent stage, not less than three-quarters of the sick died. Dr. Ranken states that at the same time that the plague raged in Rajputana, common remittent and intermittent fevers prevailed in Jilwara and Jaipur, and Rohilkhand was ravaged by an infectious and Cont^-mporane- deadly epidemic resembling yellow fever. Hirsch remarks that it was °^ r/Jhiikhand. stated by Dr. Guthrie that, while the plague was at Pali, there was a pestilence observed over the whole country round Bareilly (Rohil- khand), which had precisely the same characters. The appendix to Dr. Ranken's report contains a note by Dr. Guthrie (Civil Surgeon) on the Dr. Guthrie on subject of the Bareilly fever. The symptoms he describes seem to be fever. those of relapsing fever rather than plague, and are in some respects widely different from the ordinary symptoms of plague. In only one instance did Dr. Guthrie observe any enlargement of the glands, but Occasionally the illness was marked by severe pains in the throat find chest, with cough and expectoration. Dr. Guthrie's note is re- printed in Appendix II. The symptoms observed in thfe Pali epidemic were similar to those Symptoms. of other plague epidemics in India. The disease was commonly of Bubonic and the bubonic form, but the pulmonary variety was also sufficiently pu'monary well marked to excite special attention. The following is the account Description by given by Assistant Surgeon Maclean, who saw numerous cases of the Assistant Sur- ^ J ° > geon Maclean. malady : — " The attack is generally sudden, without previous feeling of indisposition ; the patient is seized with rigor, usually slight headache, pains of the loins, nausea, etc.; the skin soon becomes hot and dry, and the pulse frequent, generally soft and easily compressible, seldorii full and bounding and rarely or never hard. I counted a great many pulses; they were all frequent, often 130, 140, 150. This might in some measure be attributed to the exertion necessarily made by the patients while being carried to the doors of their houses from the interior. In many cases, however, where the patient was not moved at all, I found the pulse equally frequent. Tongue usually covered with a white or light brovvn fur. Sometimes it was nearly clean, chiefly where the disease was of recent date. Vomiting did not appear to be common at any period of the disease. I saw, however, a few cases in which there was much irritability of the stomach, Manifested by frequent and distressing retching. Bowels generally -bound in thfe early stages of the disease, abdomen rather tumid and hard, and almost always free from pain on pressure ; considerable 86 Previous history of plague in India. [ Chap. IV. thirst. Eyes commonly heavy and hazy ; often bloodshot. Counte- nance in all the severer cases expressive of much anxirty and suffer- ing. Respiration generally easy, excepting in patients having inflammation of the lungs as the prominent feature of their malady. " Buboes appear in the groins, armpits and neck (usually on the left side), sometimes almost simultaneously with the fever, but more commonly in the course of the first or second day — rarely so late as the third or fourth. They are at first of small size, moveable, and always acutely painful to the touch. In some few cases they increase rapidly in bulk, suppurate, and discharge pus alone, or mixed with shreds of dead cellular membrane. In by far the greater number of instances, however, they do not become larger than a walnut, and show no disposition to suppurate. The groins are the situations in which the buboes appear most frequently. " Sometimes there is one in each groin, sometimes in one groin and one axilla, sometimes in one or both axilla and neck, in one or both groins and neck, or in the neck alone. Suppuration and even rapid increase of size without suppuration hive been remarked by the Pali people to be favourable symptoms. In persons who recover from the disease, the buboes most frequently disappear gradually of their own accord. I saw one man, however, in whom a bubo, in the left groin, had attained a great size, and was likely to prove very troublesome. It extended from the pubis to near the anterior sup- erior spinous process of the ilium, and was hard and painful. In this patient the fever had ceased four days before I saw him. In this disease a remission of the febrile symptoms, more or less marked, takes place towards rnorning, the remission being of longer or shorter duration according to the mildness or severity of the malady in each individual case. In the worst cases there is no perceptible remission. In some the disease was so mild that the patients walked without assistance frorri their houses to the place where I was standing, had their buboes, pulses, etc., examined, swallowed their medicine and walked home again. In others, again, syncope followed any attempt to raise them from their charpoys. The head is but rarely affected in the early stages of the disease. Most of the persons I saw answered questions readily and distinctly. In fatal cases the patients- become comatose some hours before death. " In a small proportion of eases inflammation of the lungs comes on, on the first or second day of the disease. The patient complains of acute pain of one or other side or behind the sternum ; great difficulty of breathing ; short dry cough; usually on the second or third day a small quantity (rarely more than half an ounce) of florid blood, in small coagulaj is expectorated. In such cases buboes are Chap. IV.] Previous history of plague in India. 87 not commonly observed, though they do occasionally coexist with the inflammation of the lungs. The mortality has been so great among those in whom the lungs were affected that a person now, on seeing blood in his sputum, gives himself up for lost. " It has been stated above that the origin of the Pali outbreak is infection carried not known thoutrh it is surmised that it may have been imported ^''°"^ P'^<^^ ^^ ° •' place, from the Gujarat ports. The history of the epidemic shows that the infection was carried from place to place. All the author- ities are agreed that the spread and virulence of the epidemic was Epidemic largely fostered by dirty and insanitary conditions of life, as Dr. fo-.tered by dirty T-^ . ii-n f -liiT ^""^ insHnit,-iry Kanken puts it, "under the influence or an atmosphere accidentally conditions ot more impure than ordinary, in foul and ill-ventilated huts, amidst ''^^• the privations of the poorer classes in Marwar and Meywar." In Chapter II a quotation has been given showing the insanitary condition of a typical Rajputana village of the time. The following general remarks recorded by Dr. Ranken are to the same purport : — "The people of the North-Western Provinces of British India, jpganitary and of Marwar more especially, are to be considered in varying '=°"'^'^'°" °^ ... r , , . , Rajputana. stages of transition from anarchy and want to comparative plenty and order. They have advanced within reach of many improve- ments in tlie physical conditions of society, but having made no corresponding acquisitions in intelligence, their minds retain the impress of former barbarity and misrule, and are yet unable to turn the advantages of a better system to account. Hence animal instinct predominating over foresight and enterprize, population has augmented faster than increasing agriculture and commerce have extended. The hut, or one of the same dimensions, which was the unwholesome den of four persons, for example, fifty years ago, now shelters six human beings within a space barely sufficient for the accommodation of one. These miserable habitations are often enclosed by an outer screen or wall, for the double purpose of confining the cattle and secluding females from the public gaze. Glass to let in light or apertures to admit fresh air being unknown, the door, in order to keep out heat at one season and cold at another, is generalh^ shut. The poor feel most at home in such dark places with their children lying round them on the floor, too much like hogs in a sty amidst their litter. The sense of insecurity for life and property which deterred their ancestors from living near the fields which they cultivated, in farms, houses and cottages scattered over the face of the country, owing to hereditary habits of thinking, still perceptible to this day under the very cannon of Fort William, makes the peasantry every- where accumulate their hovels within the narrowest limits, and the 88 Previous history of plague in India. [Chap. IV. consequence is that each dirty village, unventilated, and over- crowded with man and beast, exhibiting every sort of nastiness, is a focus of disease. " Mortality Assistant Surgeon Maclean remarked that in large, irregular* greater in large closely built villages the mortality was greater than in the smaller than in small t^i ,, .,, r ., , r-i i i villages. ones. 1 he smaller Villages were for the most part as filthy as the larger ones; but their small size alone, particularly when coupled with an open situation, was of signal advantage to the inhabitants, by allow- ing the pure air to penetrate more freely into the recesses and corners in which the native sick were commonly lodged. Land quarantine An endeavour was made to prevent the spread of infection by and preventive ii • •,• c • -j i j -• t-ii ,• t t cordons. ''"^ imposition ot rigid land quarantine. The preventive lines and cordons that were established are shown in the map in Volume IV, page 2. To protect the Bombay frontier a cordon line was drawn between Balmir and Bhinmali to the south of the infected portion of Marwar. A similar line was established along the north of the Mewar territory from Luluah on the western slope of the hills to Sawar on the Banas River, and another along the south of the infected part of Mewar. Captain Dixon, Superin- tendent of Merwara, established a cordon along both sides of the hill district. Preventive lines and strict quarantine were also established around Aj mere, Neemuch, and Nasirabad. A thousand armed horsemen patrolled the cordon lines established for the pro- tection of the North-Western Provinces. The Princes of Jodhpur and Udaipur were requested to prevent the spread of the disease by blockading the places belonging to ihem in which it prevailed, but it is Dr. Ranken's believed that they did little in this direction. Dr. Ranken considered opinion on the \\i2X quarantine and sanitary cordons lessened the chances of infectioa subject ol land . ^ . . , . . , . , quarantine. by intercepting persons with the disease in their constitution who might otherwise have taken refuge in some hovel in uninfected territory where the sickness was likely to break out and spread. He was in favour of the blockade of infected places provided accommodation were increased within the infected area to allow of proper sanitary arrangements being made for the infected population, but he believed that it was not possible to render preventive lines embracing long frontiers really efTectual, and he was of opinion that suppression of communication between neighbouring districts was a measure calculated to spread infection by causing famine and disease. " The suspension of the internal trade of conterminous districts," says Dr. Ranken, " depriving the farmer of a market for his produce, the 7 merchant of the use of his capital, and consequently the labourer of employment, diminishes or takes away that supply, in the continuance Chap. IV. ] Previous history of plague in India. 89 of which the Improvident and pennyless mass of the people depend to-day for subsistence to-morrow. Nothing, in short, appears to me more calculated than an efficient cordon to assist famine, disease, and with the concomitance of an impure atmosphere, the very infectious or conta- gious fever which it is intended to eradicate. The combined coercion, restraint and oppression subversive of the functions of society, which the system of quarantine involves, are inferior only to the horrors of plague when it actually prevails." Dr. Ranken attributed the comparative immunity of Merwara and the escape of the civil and military stations in British territory to their superior sanitary con- dition rather than to quarantine and preventive lines. The Merwara cordon did not prevent the infection from invading Breach of the the hill tract. It was broken on the western line, and avillasre in Mer- '^'^'■^"^'^ . _ ^ cordon. wara (Dewair) was attacked by the malady, which did not, however spread to other parts of the district. In the neighbourhood of Dewair there was a much frequented pass, connecting Marwar and Mewar territory. It was discovered that certain people of the Dewair district, who gained their subsistence by acting as guides to travellers cross- ing the Merwara hills, were (after Captain Dixon had closed the main road) in the habit of conducting travellers into and through the Merwara districts by bye-paths and during the night when discovery was difficult or impossible. The measure in which Dr. Ranken had the greatest confidence Dr. Ranken's was sanitary improvement, both in the condition of towns and ^'^^P"^*^^ °/ .,, ^ . sanitary reform. Villages and in the condition of the people themselves. "The most comprehensive injunction that can perhaps be given on this subject," he states, "of paramount importance to public health, is to pre- vent the contamination and promote the circulation of the at- mosphere, and to let no water stagnate on the surface of the ground * * * |f earnestly acted on, a great change for the better must soon appear. It is very possible for an active magistrate to get the streets cleaned of rubbish, dung-hills and other filth ; dead walls, fences, jungle and planted trees removed from the areas and outskirts of the place; and to make the inhabitants drain or fill up puddles. The benefit derivable from such obvious and practi- cable means would far exceed the expectation of those to whom the subject is new." In especial he earnestly advised the Government Advice with " to begin the amelioration of the country by making Calcutta, the l^^""^* ^° J J ^ ' Calcutta. capital, a model by which other stations may be improved in a manner which shall render them less sickly at all times, and compara- tively safe from the occasional irruption of diseases resemblino- plague.'* 12 9° Previous history of plague in India. [Chap. IV. In describing his experiences at Jalia (south of the Aimere dis- trict) Dr. Irvine stated the measures on which he would rely for com- bating an outbreak of plague — Dr. Irvine's " At JaJia, the healthy portion of the inhabitants were directed to hei"thy should ^ leave the town and encamp around the walls for a time, until the encamp outside plague should entirely subside, the sick alone to remain, to whom I place. would attend : all filth and dirt lying in the streets or about the houses was ordered to be collected and burnt outside the walls: the Cleansing of healthy portion were ordered to wash all their wearing apparel on houses. ^" leaving the town : and when the disease should be diminished, the houses were directed to be new "liped""^ with cow-dung, in the absence of whitewash, ere re-inhabiting them. Had these instructions been fulfilled bo7id fide^ 1 have little doubt that the plague would have been quite arrested at Jalia ; but the apathy of the natives has occasioned them to be altogether evaded or only partially performed. '^ At a later date Dr. Irvine recorded the following remarks about the possibility of combating the disease : — Disease easily " From what I have myself observed of the plague, it appears that eradicated on the '^^ ^ small place where only a few cases occur it is very easy to be occurrence or a ^^ , , i i n i i i • few cases in a eradicated; but, let the malady once take a hrm hold m a large ^'"^"ssi'blTto*^' populous town, to arrest the progress of the scourge will be found in arrest when it India an .impossibility. " obtains a hold on a large town, Mahatnari— the Himalayan Plague.f Endemic plague Along with the plague epidemics that have occasionally visited Himdayal!'^ India, and, in so far as the evidence goes, unconnected with them, there has existed for a long time past an endemic plague centre on the southern slopes of the Himalayas. The bacteriological origin of this disease has not yet been investigated, but its clinical and epidemo- logical history leave little doubt that it is true plague. Garhwal and '^^^^ home of the disease is in the North-Western Provinces Dis- Kumaun. tricts of Kumaun and British Garhwal. The area of the two districts is over 11,000 square miles, and they contain a population of close on 1,000,000 persons, living at elevations from 1,500 to over 11,000 feet above the sea-level, ' i.e., smeared. f Surgeon-Colonel Hutchinson (formerly Sanitary Commissioner of the North- Western Provinces and Oudh) ; Report on Mahamari (Appendix H). Mahamari, or Indian Plague: its origin, progress and eradication; Reports of Drs. Francis and Pearson ; Indian Annals of Medical Science, No. II, April 1854. Mahamari ; Dr. Stiven's Report ; Indian Annals of Medical Science, No. Ill, October 1854 (Appendix II). Chap. IV. ] Previous history of plague in Indict. 91 The first authentic record relates to an outbreak which occurred in 1823 at Kedarnath in British Garhwal. At Kedarnath there is Th-? 1823 outbrf^ak a Kedarnath. a famous shrine much visited by pilgrims. Local tradition asserts that o^t^^^eak at the disease originated in the person of the high priest who, having deviated from the rules prescribed in the sacred writings for the per- formance of the religious ceremony called " Horn," was smitten with this new form of dsease, together with the Brahmanswho assisted at the ofTering. From Kedarnath the disease spread to the villages in religious assignment to the temple, and afterwards to other par- gannas * of Garhwal. During the first-half of the century the general tendency of the disease was to spread from north to south. Since the outbreak of 1823 the malady has prevailed off and on up to the present time. There are records showing that the disease was present in some Subsequent part or other of the two districts in the years 1834, 1835, 1846, i847,°"tt)'^eaks. 1849, 1850, 1851, 1852, 1853, 1854, 1859, i860, 1870, 1875, 1876 1877, 1884, 1886, 1887, 1888, 1891, 1893, 1894 and 1897. Since 1834 the out- breaks have thus been of constant recurrence, except during the period ^ ,, , ' V & r Outbreaks i860 to 1875. Some of the outbreaks spread over a number of villages sometimes and occasioned great loss of life; others were confined to a small area, Jomethnes slight In the outbreak of 1 834-35, the ascertained total of deaths was 633, and 1834-35. in 1851-52, 567 deaths were reported to have occurred in seventy-seven villages. In 1853-54 the epidemic spread to the plains and attacked 1853-54. places in the Bijnor and Moradabad districts and in the Rampore [^^^^ *° "^'^^ State, An article in the Indian Annals of Medical Science, April 1854, on the subject Dr. Stiven's report on the appearance of the disease in the plains is reproduced in Appendix II. He gives some account of the epidemic at Thakurdwara in the north of the Moradabad district, and the manner in which the disease was there introduced by a refugee from a neighbouring infected place. Mahamari was at the same time prevalent at Afzalgarh in the Bijnor district, and at Kasipur in the Tarai in the extreme south of Kumaun, It is stated that about 8,000 persons lost their lives. The period from 1850 to 1854 appears to have been the worst on record. The considerable mortality and the tendency which the disease showed to spread to the plains occasioned much anxiety. The Government of the North-West- ern Provinces sent officers to study the disease and to find means to stop its ravages. In i860 nearly 1,000 deaths occurred. In 1877-78 i860. the epidemic which extended over eiorht par^annas caused 550 deaths, r^'J"'^,. , "^ tot'to vjj Later outbreaks None of the later outbreaks appear to have been widespread or to not severe. have attacked large numbers of persons. It must at first sight occasion surprise that constant outbreaks The disease of plague should occur in villages scattered over the mountainside, °* ^'^^ ^ * A revenue division. 92 Previous history of plague in hidi'a. [ Chap. IV, dirty and open to the pure air of the hills, and supplied with water from the unwholesrme ^ _ '^ ' rr surroundings. mountain streams. Here, as elsewhere, the explanation lies in dirty and insanitary, conditions of life. In another place a description has been given of a typical Garhwal village, with its ill-ventilated houses of which the ground floor is crowded with cattle, and its accumula- tions of filth and refuse. The following passage occurs in a report written by Dr. Rennie, who investigated the disease locally in 1850: — "The filth is everywhere — in their villages, their houses and their persons. It destroys the otherwise pure quality of the air, and main- tains ever round the inhabitants that contaminated atmosphere so favourable to the condensation of infectious emanations. Their dwell- ings are generally low and ill-ventilated, except through their bad con- struction ; and the advantage, to the natives in other parts of India, of living in the open air is lost to the villagers of Garhwal, from the neces- sity of their crowding together for mutual warmth, and shelter against the inclemency of the weather. The food of the majority is bad and insufficient," It is stated in Dr, Stiven's report that the infection of viahamari spread from the house in which the first cases occurred over Thakurdwara, "curiously enough, however, choosing the most populous, crowded, ill-fed and filthiest parts of the Kasba for its development. " In the more healthy quarters of the town, it is stated that only one case occurred, which ended in recovery. Symptoms. f^e symptoms and characteristics of mahamari are identical with those of ordinary plague. The usual symptoms are shivering, quickly followed by intense fever, ending in delirium, insensibility and death on the third or fourth day ; also the characteristic enlarge- ment of lymphatic glands, except in some of the severest cases, where death ensues during the first three days from extreme virulence and shock of the great nerve centres. Virulence of the The disorder is extremely fatal and only a small proportion disorder. ^f ^^ persons attacked recover. Instances are given in which all or nf^arly all the members of a family living together have been attacked and died. In Dr. Ronnie's reports of 1850 it is stated that " the mortality from mahamari is very great, not so much in actual numbers as relatively to the small amount of the population. The recent mortality has been estimated by the civil authorities to be probably twenty-five per cent, on the total population. Recent en- quiries show it to have been even greater; but the statistical details are most defective. In certain places the destruction has been very great, of which an example has been given, of fourteen deaths out of siKteen people in one place. In the village of Sarkote in 1846-47, if the reports of the inhabitants are to be trusted, out of a population of sixty-five in all, forty-three died, two only recovered, and twenty Chap. IV. ] Previous history oj plague in India. 53 escaped without infection." The villagers are terrified at the disease, and it is now their common practice to flee from a village in which Fii^M of the , ^ , 1 -11 • 1 T- • u inhabuants from it has broken out and to camp on the hill-sidcs. lixpenence has i,,fcctf^d shown them that to leave the plague-infected locality is their best villages, chance of escape. Dr. Hutchinson classes the outbreaks into two kinds : spontaneous Soontan-ous . . r 1 J- ^"^^ imported outbreaks and outbreaks caused by the importation of the disease, outbreaks. The outbreaks are frequently associated with, and sometimes pre- ceded by, a great mortality among rats. All the civil and medical offi- Mortality among cers who have observed the disease lay the strongest stress on this marked characteristic. It is said that no other animals have been attacked. An instance is recorded in which the inhabitants of a vil- lage promptly left it on the occurrence of a great mortality among the rats, and thus probably saved themselves from an attack of the pesti- lence. Dr. Hutchinson ascribes the ever-recurring recrudescence of Spontaneous the plague in this portion of the Himalayas to the germination of a°"'^^"^^^ ^ '*^^^ specific poison, and its spread by fomites and other means through neglect to destroy articles, etc., likely to convey and retain infection for long periods, and to the imperfect burial of the dead in epidemic and at other times. Modern research on the general subject of plague points to mild sporadic cases, and the preservation of the bacilli in contaminated articles kept under conditions favourable to the vitality of the microbe, as the probable means whereby the infec- tion is preserved between successive epidemics. Assistant Surgeons Francis and Pearson, who made a local investi- gation of the disease in 1852, drew the following " practical deduc- tions " from their observations : — " First. — Maharnari and plague are identical. Secondly. — The disease is of local origin ; capable of transmis- sion from person to person, and from place to place. Thirdly. — That it is gradually extending itself; and that no sufficient grounds exist for the supposition that it will never be developed in surrounding countries. Fourthly. — That the local circumstances, upon which maharnari depends, should be done away with, and sanitary measures introduced ; in which case, it is probable that the disease will be gradually eradicated, or, at any rate, modified in severity. Fifthly. — That it is likely the disease, if dealt with early, will be found to be curable ; and that the people themselves may use the remedy furnished by authority." The last outbreak, which occurred in the spring of the present Outbreak of 1897 ■year, occasioned particular notice and anxiety as it was contem- *' °'^^'"^''^- poraneous with the worst period of the Bombay plague. The 94 Previous history of plague in India. [ Chap, IV. locality was a small village near Okhimath on the main road of pilgrimage from Hardwar to Kedarnath, and some 2o miles distant from the latter place, which was the scene of the 1823 outbreak. At the commencement of the attack some of the inhabitants, follow- ing the usual practice in such cases, left the village, which was very sniall, remote and inaccessible, and thus escaped infection. Only four or five families remained, most of the members of which died of Preventive the disease. There were 17 deaths in all. As soon as information adopted. '^^^ received by the authorities; the villagers who had not already left were removed and segregated, the houses were burnt and orders were issued that the site, which was water-logged and insanitary, should not be re-occupied. The neighbouring villages were thoroughly Their success, cleaned. These careful precautions were successful, and the infection Closing the did not spread. The direct pilgrim route through Okhimath was kept pilgrim route, closed during the time that the danger of infection was apprehended. Future outbreaks of the disease will require to be met by careful precautions, and the general insanitary condition of the villages is Danger of the deserving of attention. On one occasion, at any rate, the plague is makamari. known to have spread from the hills to the plains and to have occa- sioned considerable loss of life. The experience of the past year, as well as the experience of former outbreaks, shows that the conditions of a large part of India are not unfavourable to the spread of plague, if it once assumes an epidemic form. Hardwar, the great pilgrim centre, is not far from, and is in communication with, the area where the pestilence lurks, and has been attacked by plague dur- ing the present epidemic. Lastly, Dr. Hutchinson points out that the disease might prove disastrously fatal if it spread to the overcrowded communities of the hill sanitaria which exist in the immediate neifrhbourhood. CHAPTER V. EXTENT AND COURSE OF THE PLAGUE IN THE BOMBAY PRESIDENCY. Preliminary Remarks. It will not be necessary to give a very long or detailed descrip- tion of the course and extent of the epidemic in the Bombay Presidency, The statements in Appendix III and the maps and charts in Volume Statistics, iV furnish as clear a picture of the epidemic as any verbal description ^ ^"^t^i^" '"^P" could convey. The statements, charts, and maps include the period from the first outbreak until the end of August; they thus carry the account through the entire period of, the first portion of the epidemic and through the beginning of the recrudescence v^^hich has since attained to such great proportions. The account given in this chapter will deal mainly with the first period of the epidemic, but a few remarks will also be made about the recrudescence. A brief description will first be given of the Bombay Presidency, Description of its physical aspects, climate, political divisions and form of adminis- ^^''^ ^^^^' tration. To those w4io are not familiar with the subject the account will make clearer the description of the epidemic and of the measures taken to combat it which is given in the present and following chapters. Brief description of the Bombay Presidency. The following account of the Bombay Presidency is derived Sources from from Volume III of the Imperial Gazetteer of India, with the excep- ac^ount^s tion of the description of the climate which has been prepared by derived. Mr. W. L. Dallas of the Meteorological Department of the Govern- ment of India. Extent and population. — Bombay, the Western Presidency of Extent and British India, is divided into four revenue divisions and twenty-four P°P"'^''^°°' British districts. It also includes numerous Native States under gS Extent and course of the plague [ Chap, V. the protection of the Government of India. The territory thus composed extends from 13° 53' to 28° 45' north latitude and from 66° 40' to 76° 30' east longitude. The British districts, including Sind, contain a total area of i 25,064 square miles, and a total popula- tion (according to the census of 1891) of 18,857,044 souls ; the Native States under the Bombay Government, excluding Baroda, cover an additional area estimated at 69,045 square miles, with a population of 8,05,298 souls ; grand total area, 194,109 square miles; grand total population, 26,916,342 souls. The State of Baroda, with an area of 8,226 square miles, and a population of 2,415,396 souls, although in direct subordination to the Supreme Government of India, is intricately interlaced with the Bombay British districts, and may, from a geographical point of view, be regarded as forming part of the Bombay Presidency. The Portuguese possessions of Goa, Daman, and Diu, with an aggregate area of about 3,806 square kilometres, and population (1881) of 475,172 sou/s, are also included within its The Capital. geographical limits. The capital of the Presidency, the residence of the Governor, and the head-quarters of all the administrative depart- ments, is Bombay City, situated on an island of the same name on the shore of the Arabian Sea, in 18° 55' ^" north latitude, and 72° 53' 55" east longitude. Physical aspectp. Physical aspects. — The Presidency of Bombay presents on the map the appearance of an irregular strip of land, stretching along the eastern shore of the Arabian Sea, and extending up the lower portion of the Indus Valley. The continuous coast-line is only broken towards the north by the Gulfs of Cambay and Cutch, between which lies the projecting peninsula of Kathiawar. The sea board is generally rockbound and difficult of access, although it contains many little estuaries forming fair-weather ports for vessels engaged - in the coasting trade. North of the Physically, as well as historically, the Bombay Presidency may be roucrhly divided into two distinct portions, the Narbada (Nerbudda) formino- the boundary line. To the north of that river lie the Province of Gujarat, with the peninsulas of Kathiawar and Gulch, and the Province of Sind, to the south the Maratha country, part of the Deccan, the Karnatak, and the Konkan. The former of these tracts is for the most part a low plain of alluvial origin. In Southern Gujarat the valleys of the Tapti and Narbada form sheets of unbroken cultivation. But in Northern Gujarat the soil becomes sandy and the rainfall deficient ; cultivation is largely dependent upon either arti- ficial irrigation or the natural humidity caused by the neighbourhood of the ocean. In Sind (beyond the delta on the east), the surface is a Chap. V. ] in the Bombay Presidency. 97 wide expanse of desert, interrupted only by low cliffs or undulating sand heaps. The geological formation is distinct from that of the rest of the Indian Peninsula, consisting of limestone rocks, continuous with those found in Persia and Arabia. Bombay, south of the Narbada, consists of a level coast strip, South of the rising into an upland country. Mountains furrowed by deep valleys ^^'■'^^"''^• intercept the rain-clouds of the monsoon, and blossom -with tropical vegetation. The geological formation is composed of nearly horizontal strata of basalt and similar rocks, which break into steep terraces and hogbacked ridges, and have produced by their decompo- sition the famous 'black cotton soil,' unsurpassed for its fertility. The Deccan,, the Karnatak, and the Konkan are each marked by special features of their own. The Deccan, including Khandesh dis- trict, is an elevated plateau behind the Western Ghats. It is drained by several large rivers, along whose banks are tracts of great fertility ; but for the rest, the air is dry and the rainfall uncertain. The Karnatak, or country south of the Krishna (Kistna) river, is a plain of lower elevation, and contains wide expanses of black soil under con- tinuous cultivation. The Konkan is the name of the narrow strip of land lying between the base of the Ghats and the sea. As a whole, it is a rugged and difficult country, intersected by numerous creeks, and abounding in isolated peaks and detached ranges of hills. The cultivation consists only of a few rich plots of riceland and groves of cocoanut. The rainfall is excessive. The districts of the Presidency are classified as follows with refer- Districts^ ence to the natural divisions above described :-~ Sind districts. — Karachi (Kurrachee), Hyderabad, Shikarpur, Thar and Parkar, and Upper Sind Frontier, forming the Sind division. Gujarat ^z'^/rzV/j.— Ahmedabad, Kaira, Panch-Mahals, Broach, and Surat. Konlzan districts, — Thana, Bombay city and island, Kolaba, Ratnagiri, and Kanara. Deccan districts. — Khandesh, Nasik, Ahmednagar, Pcona, Sholapur, and Satara. Western Karnatak or Soicth Marat ha districts. — Belgaum, Dharwar, and Kaladgi. Agriculture. — The Avide extent and the varied configuration of Agriculture, the Bombay Presidency permit great variations in agriculture. The two most important food-crops are bdjrd or great millet [Sorghum vulgare) and Jodri or spiked millet {Holcus spicatus), which are especially cultivated in the Deccan. Rice is chiefly grown in the 13 98 Extent and course of the plague [Chap. V. Climate. Sind. lowlands of the Konkan. Wheat is extensively cultivated in parts of Gujarat and in Sind, and barley is grown in the same localities to a smaller extent. The aboriginal tribes mainly support themselves on inferior cereals, such as ndchani {Eleusine cor oc ana) and kodra {Paspahim scrobiculatum), which they plant In patches of culti- vation amid the primeval jungle that clothes the hillsides. Pulses and oil-seeds are cultivated to a considerable extent, and among fibres cotton holds by far the chief place. Cotton, oil-seeds and wheat are the chief staples available for exportation. Climate. — The climate of Bombay differs so greatly in different parts of the Presidency that it is essential, in order to obtain a correct idea of the cllmatological conditions, to split it up into a number of areas or divisions, in each of which the climate and weather may be considered as approximately homogeneous. The divis'ons adopted are as follows : — (i) Sind, (2) Gujarat, (3) the West Coast, and (4) Khandesh and theDeccan. Even within these areas or divisions there are considerable diversities of climate, but, on the whole, the climatic conditions over each division are approximately similar. The great Sind plain is the driest and hottest part of the Bombay Presidency. The aridity, which more or less characterises the whole division, reaches Its highest expression in Upper Sind, and, as will be seen from the following table, the relative humidity, as shown by the records of Jacobabad,* is very low throughout the year : — C '.- « 3 c 1—1 3 J3 a, < ^ § c 3 ►— 1 >> m 3 b/) 3 < S u z S (U 0) Q % % % % % % % % % % % % Humidity 46 39 41 38 36 42 53 5S 55 46 45 45 In. In. In. In. In. In. In. In. In. In. In. In. Rainfall 0'2 0*2 0-3 0'2 01 O" I 1*4 I "4 o'3 ... 0"I O'l The driest month is May, after which the dampness of the sum- mer monsoon begins to influence the climate and the humidity rises * Upper Sind Frontier District. Chap. V. ] tit the Bombay Presidency. 99 to a maximum in August. The humidity is very steady during October, November, December, and January, and then commences to fall to the annual minimum in May. The rainiall is very light through- out. It amounts to one and-a-half inches in each of the months of July and August, but is unimportant in the other months. Like other dry districts, the vicissitudes of temperature are large. The winter cold is great and the summer heat is proverbial, while the daily range is large, especially in the winter. The climate of Lower Sind is slightly damper and less extreme than that of Upper Sind. A strong, steady south-west to west- south-west wind blows from April to September and greatly amelio- rates the climate, though it. brings up very little rain. The driest month is November, when the mean humidity is 56 per cent, and the rainfall only o'l inch. The mean temperature is much more steady than is the case in Upper Sind. The daily range is very small for eight months of the year^ but is considerable in the four winter months. The night temperature has never fallen to 41° in the last eleven years, and though on one occasion a temperature of 11 7-6° has been registered, this was quite exceptional, and 102° to 106° is the highest maximum ordinarily registered in May and June. In Gujarat, including Kathiawar, the climate is less dry than Gujarat, in Sind and less wet than in the Konkan. There is a rapid change in the climate on advancing inland from the coast. At the coast stations the air is damp with a strong westerly wind and a moderate amount of rain. Owing to the constant sea breeze, the climate is equable and the daily range of temperature low (14° on the mean of the year), with an actual temperature ranging during the year from 50° to 100°. On proceeding inland these conditions wholly change, and the climate of Deesa (Palanpur State) is comparable with that of Western Rajputana and Upper Sind. The monsoon has, however, a considerably greater effect at Deesa than it has at Jacobabad, and the air is much damper during June, July, August and September, and much drier in the remaining months. The driest month is April, when the mean humidity is only 28 per cent. There is very little rain from November onward to May, but with the setting in of the monsoon the rainfall increases and is mod- erate in July and August. The mean temperature is high throughout the year and, except in the monsoon months, the daily range is large. In April, May, and June the mean maximum temperature exceeds 100°, and once, in 1886, the thermometer rose to ii8'6°; while in the 100 Extent and course of the plague [ Chap. V. winter months the night temperatures are between 50° and 55°, and on one occasion, in 1880, the thermometer fell to 34°. Konkan Coast. The Konkan Coast, extending from the Gulf of Cambay to Kar- war, has the dampest and most uniform climate of any part of the Peninsula, and the annual mean temperature is nearly the same throughout the whole distance, viz., 79° or 80°. The whole of the Konkan is almost rainless from the latter part of October to the latter half of May. The rainfall all along the west coast is heavy during the monsoon^ which lasts from June to October, but the amount decreases northward ; thus the total is 100 inches at Ratua- giri, 73 inches at Bombay, and 42 inches at Surat. The following table gives the monthly averages of rainfall and humidity for Bombay which may be taken as the representative station for this area: — = ji ■s .a E .Q E e c •—1 Si 3 5. < 2 a 3 < 0. % % % % % % % % % % % % Humidity ... 70 69 73 73 75 82 87 87 86 81 71 70 In. In. In. In. In. Ins, Ins. Ins. Ins. Ins. In. In. Rainfall ... O'l o'S 20-8 247 iS'i 10-8 i-S OS 0-1 The rainfall is practically confined to June, July, August, and September, when there are between 20 and 29 wet days each month The mean humidity is lowest in February and highest in July and August. This distribution of humidity holds for all parts of the coast, from Bombay southward, where the mean humidity is com- paratively high and equable, but in the north, near Surat, humidity averages 62 per cent, for the whole year and remains between 50 per cent, and 60 per cent, from November to May. Similarly with temperature. To the north of Bombay the climate of January and February affords cool nights and moderately cool days^ but to the south of Bombay there is relatively little temperature change in the seasons. The mean temperature ranges from 74° to 85° and the mean maximum from 82' to 50°. The mean daily range is in no month more than 14" and in four months is less than 10°. The mean annual temperature of Surat is also 80", but whereas the temperature of Surat in January is 70° and in May 86°, the corresponding tem- peratures of Bombay are 74° and 85°. The extreme temperatures of Chap. V.] in the Bomhay Presidency. lot the year (?>., the highest and lowest readings recorded) show a greater variation ; thus, at Surat they are respectively 109° and 48° and at Bombay 95° and 61°. This summary shows that while the main features of the climate for the whole region are great moistuie and equable heat, yet in the north these features are less marked than in the south, so that in the neighbourhood of Surat the air is dry, the rainfall light and the range of temperature considerable, relatively to other parts of the coast further to the south. A very rapid change of climate occurs in passing from the coast into The Deccan. the inland parts of the Peninsula. After crossing the crest of the ghats, a journey of 30 or 40 miles brings a change from the torrential rainfall of the hills to the dry rolling plains of the Deccan with its precarious and uncertain rainfall. As a general rule, the climate of Khandesh and the greater part of the Deccan is dry, and during the cold weather and spring months almost rainless. During the monsoon this region is swept by a strong, steady west wind, which only occa- sionally falls off and permits of a light rainfall, but the rainy season is cloudy, cool, and pleasant. The stations of Malegaon, Poona, and Sholapur are representative of this area. At Malegaon the average annual rainfall Is about 25 inches, and of this less than two and-a-half inches are received during the seven months November to May. The heaviest rainfall of the year is In September. The mean annual humidity is only 51 per cent, and the driest month is April, when the humidity is only 28 per cent. Poona lies about 100 miles further co the south and the rainfall on the mean of the year Is four Inches heavier than Malegaon. The general rain- fall conditions are, however, similar and only about two Inches of rain falls between November and April. The wettest month is July. In the cold weather months the humidity is as low as at Malegaon, the driest month being March, but in the monsoon the humidity rises to 79 per cent, and the air from June to September is damp. At Shola- pur the air is drier than either at Malegaon or Poona. The mean humidity is only 26 per cent, in April and even In the rains averages only between 60 per cent, and 70 per cent. The monsoon blows strongly over the district, but brings comparatively little rain. The rainfall is, however, better distributed throughout the year than in the case of Poona or Malegaon, and the months between November and April receive not infrequent thundershowers. The mean annual temperature of Malegaon is 76° ; that of December the coolest month, 66° ; that of May, the warmest, 88°. The lowest temperatures of the year are ordinarily between 36° and 43° ; the highest between 107° and 110°. In the dry months of the year the daily range is about 30° to 35°. Poona has a mean temperature of 78° ; that of General statistics. 10^ Extent and course of the plague [ Chap. V. December and January is 72° ; that of April 86° : the lowest tempera- tures of the year have varied between 40° and 50° and the highest between 100° and iia°, and in the dry months of the year the daily range is 30° to 34°. The mean annual temperature of Sholapur is 79° » that of December, the coolest month, 70° ; and that of May, the hottest month, 89": the lowest temperatures of the year have varied between 42° and 49° and the highest between io8° and 112°. The mean daily range in the dry months is about 32°. The following table shows 'the mean temperature, humidity and rainfall values for the different regions of the Bombay Presidency : — Gujarat Khanpesh SiND. AND KONKAN. AND Kathiawar. Deccan. Month. u 3 s CI. E B ri 4) % 9 be c rj u >, e a ca c u bfl 'e bn S > < _3 Ct. E C cu bfl ni C re 0) 3 "c ■(5 u J' bfl ID > < '■^ 'e 3 JS m bo nj I- 0) > < 6 3 Q. E D c i a _>. T3 a rS < >, ''B 'b 3 (U bfl s ILJ > < in. % ° ° in. % in. % in. % January 61 27 0-4 52 69 27 0*1 46 74 • 4 0*1 70 71 35 0*1 41 February 65 26 0-3 49 71 26 0*1 45 75 13 69 75 34 O'l 35 March 75 25 0-3 54 79 26 0"I 52 79 II 73 82 33 02 30 April 82 24 0*2 53 S4 23 o'l 50 82 II 75 86 32 0-5 28 May £S 23 I 55 88 18 01 60 85 10 0-5 75 87 29 I'2 38 June 92 20 0'2 58 87 13 4-3 69 83 8 20-8 S2 81 20 5" I 63 July 89 17 2-3 66 82 9 8-6 81 Si 8 2'47 S7 78 »5 5'o 72 August 87 16 1-6 68 81 9 5"3 81 Po 7 i5"i 87 77 15 4-8 72 September 85 18 0-6 66 81 13 26 77 £0 8 10-8 86 76 16 6-1 73 October 79 26 01 56 Si 22 I"0 56 81 II 1-8 81 77 22 3'4 58 November 69 29 O'l 51 76 26 o'5 45 So 13 o'5 71 73 27 0-6 49 December 63 28 0'2 53 71 27 01 45 76 14 0"1 70 69 29 o'4 46 Year 78 23 6-2 57 79 20 22'Q 59 So II 74'4 77 78 25 ?7"5 50 Inhabitants. Inhabitants. — The population of the Presidency proper consists mainly of Hindus, divided into the two main ethnical and historical Chap. V. ] in the Bombay Presidency. 103 divisions of Gujarat is, or inhabitants of Gujarat, and Marathas, occupying broadly the southern portion of the Presidency. The inhabit- ants of Gujarat include a somewhat larger Muhammadan element than is found in the Maratha country. In addition there is the Dravidian element represented principally by the Konkanis and Kanarese of the coast. The people of the outlying province of Sind are almost all Muhammadans by religion ; their country was the earliest field of Mussulman conquest in India. Executive Administration. — The government of the Presidency Executive cf Bombay is administered by a Governor and his council. This ™'"'^ ^* '°"" body is the chief executive and legislative authority of the Presidency and consists of the Governor as President, and two members of- the Indian Civil Service. The various departments of the administration are portioned out among the Members of Council. There is also a Legislative Council composed of the Governor and his Executive Council above described, together with four to eight other members nominated by the Governor. Not less than a certain proportion of these additional Legislative Members of the Council must be non- officials, with a view to the representation of the European and Native communities. For administrative purposes the Presidency is divided into four divisions, called the Northern (seven districts), Central (seven districts, including Bombay city and island), and Southern (five dis- tricts), in Bombay Proper, and the Sind division of five districts ; these divisions embrace (including Bombay city and island) 24 districts, each division being placed under the control and superintendence of a Commissioner. The district is the actual unit of administration for both fiscal and judicial purposes. The regulation districts of Bom- bay number 1 7, each under the control of a Magistrate-Collector, who must be a member of the Indian Civil Service. The province of Sind and the Panch-Mahals In Gujarat form seven non-regulation districts, under officers who may be either military officers, members of the Indian Civil Service, or other officers. The city of Bombay is regarded for many purposes as forming a district by itself. Each district is on the average divided into 10 talukas or sub-divlslons, each of which again contains about 100 government villages, or villages of which the revenue has not been alienated by the State. Every village Is, for fiscal and police, as well as social purposes, complete by itself. It has its regular complement of officials, who are usually hereditary, and are remunerated by grants of land held revenue-free. The more Important of these officials are the patel or headman : the talati or kulkarni, who is the clerk and accountant ; the mhar, who Is a kind of a beadle ; and the watchman. Over each taluk or sub-division is set a government officer termed a Mamlatdar ; and on an average about three talukas are 104 Extent and course of the plague [ Chap. V. placed in charge of an Assistant or Deputy Collector. General super- vision is exercised by the Commissioners, as above stated, who are three for the regulation districts and one for Sind. The political relations between the Government and the Native States in connection with the Bombay Presidency are maintained by the presence of an Agent or representative at the principal Native Courts. The position and duty of the Agent varies very considerably, in the different States, being governed by the terms of the original treaties, or by recent sanads or patents. In some instances, as in Cutch, his power is confined to the giving of advice, and to the exercise of a general surveillance. In other cases the Agent is invested with an actual share in the administration ; while States whose rulers are minors, and the number of these is always large, are directly managed by Government officers. The characteristic feature of the Bombay Native States is the excessive number of petty principalities, such as those of the Rajputs and Bhil chieftain?. The peninsula of Kathiawar alone contains no less than 187 separate States, Statement of seizures and deaths. General Remarks on the Plague Epidemic. The following is a statement of the reported plague seizures and deaths in the Bombay Presidency and Goa from the beginning of the outbreak up to the 27th August : — Chap, v.] in the Bombay Presidency. io5 Locality. PopiilaMon according to the census of 1891. Number of plague seizures. Number of seizures per 100,000 persons. Number of plague deaths. Numbtr of deaths per 100,000 persons. Bombay City Mandvi Town (Cutch State) Poena City ... Thana District Janjira State Surat District Kolaba District Navsari Division (Baroda State) ... Cutch State ... Poena District Satara District Ratnacfiii District Palanpur State Ahmedabad District Nasii< District Goa ... ... ... Kolhai'ur State Savantvadi State Kathiawar, including Amreli Divi- sion (Raroda State). Ahmednag'ar District ... Broach District Sholapur District Kadi Division (Baroda State) Khandesh ... Baroda Division (Baroda State) ... Kaira District Bhor State ... Mahikantha State Kanara District Belgaiim District Dharwar Dist.-ict Total for the Bombay Pre- sidency Proper. Karachi City Shikarpur District Hyderabad District Karachi District Upper Sind Frontier District Thar and Parkar District Total for Sind GRAND TOTAL Bombay Presidency Proper. 821,764 i5i,3g-o 904,868 8i,;So 649,989 509.5^4 319,443 520,260 906,410 1,225,989 1,105,926 645,526 921 ,712 843,.S82 t4 2 0,868 9'3,>3t 192,948 2,932,592 SSR,755 34lj490 750,689 1,098,7^2 1,460,851 817,023 871,589 155,6^9 581,56s 4=46,351 1,01,1,261 i,05<,3i4 105,199 015,497 9i'',646 459,681 174,548 298,203 * 1 2,795 4,359 2,543 4,974 287 2, "54 1,329 563 840 1,186 1,179 2,77 167 163 136 62 127 25 2S0 54 19 29 30 33 12 22 2 3 33,755 1.557 11,424 ),s76 550 35' 331 261 176 l6i 131 96 34 26 iS 16 >5 14 13 ■22 '19 *io,Si3 3,853 1,819 3,^57 164 1,632 1,172 456 6;10 826 844 316 06 qB 16 100 24 37 25 24 iS 12 Sind. 4,iSi C96 641 238 4 3 6,o6j 39,«'8 3,974 109 70 52 27,if'3 ^r 3,3 c 499 178 3 4,779 31,943 1,316 io,of,8 ',127 426 201 251 230 «43 123 9« 69 29 16 10 12 12 G 4 4 3 3 I I 3 I ''7 '22 •eg •09 3,23" 76 54 39 * These fi6;ures are the sums of the reported seizures and deaths. It is, however, known that especially during the early period of thtt epidemic ihe reporting of cases was not complete and that the actual number of cases was much greater than the number reported. During the period from the weeK ending the ist September 1896 to the wesk ending the 20th April 1S97 (inclusive) the excess of the total mortality of the city over that of the corresponding period of the previous five years vpas 20,828. .After that penod the reporting was more accurate and the general mortality of the city fi'st sank below the normal and then rose above it, owing to an outbreak of ch lera and other causes. Adding to the figure 20,828 the reported plague deaths from the 21st April up to the 27th August (inclusive}, we obtain a total of 21,614, and this approximates more nearly to the actual number of deaths from plague. It gives a pr portion of above 2,630 deaths per ioo,oco of the population according to the last census. The accuracy cf the calculation is to some extent vit^^ted by the fact that during the wo'St period of the epidemic the population was largely diminish»d by emigration. The M unicipal Commissicner of Bombay icade a calculation nased on total mortality and the esrimated popu a;ion of the city from month to month which gives a total number of 25,82:-! deaths from plague up to the end of July, t Population according to census of i83i, 14 io6 Extent and course of the plague [ Chap. V. Total mortality. This statement gives a total mortality of 31,942. It is certain that the actual mortality must have been considerably higher than this figure. It is explained in the footnote of the statement that the deaths from plague in the City of Bombay were probably not less than from twenty to twenty-five thousand, whilst the number of reported deaths was under eleven thousand. In many smaller places the registration was probably more accurate, but it is known that in some important plague centres, such as Poona and Mandvi, the reporting at the outset was very incomplete, and everywhere many cases must have escaped detection. It is very difficult to express a decided opinion as to what the total mortality has been, but it seems probable that up to the end of August the number of deaths from plague must have amounted to over fifty thousand. the The course of the epidemic will now be described, first, in the City of Bombay; secondly, in the Bombay Presidency proper; and lastly, in Sind. Division of subject. Description ol Bombay City. Bombay City, The City of Bombay is situated on an island lying off the Konkan Coast and is connected by causeways, over which run the Great Indian Peninsula and Bombay, Baroda and Central India lines of railway with the larger Island of Salsette and so continuously with the mainland. The general features of the city and island will be seen from the map given in Volume IV (page 7). The city is divided into seven wards — Fort. Mandvi. Bhuleshwar. Girgaum. Byculla. Parel. Mahim. The quarter known as the Fort lies in the north of the Fort Ward, on a slightly raised strip of land between Back Bay and the harbour. It is the original nucleus round which the town grew up, and is chiefly occupied by public buildings and commercial offices. The most conspicuous line of public buildings is in the Esplanade quarter facing Back Bay. The main portion of the native town lies in the Mandvi and Bhiileshwar Wards, the north-east portion of the Girgaum Ward and the Chap. V. ] in the Bombay Presidency, 107 southern portion of the Byculla Ward. The north of the island com- posing the Parel and Mahim Wards and the northern part of the Byculla Ward is comparatively sparsely populated. The quarters of the Euro- pean residents are chiefly situated on the two spurs at the south of the island, Malabar Hill and Colaba. Notwithstanding the magnificent aspect of the city with its almost unrivalled situation and many hand- some buildings, the conditions of life in the native town are unhealthy and to a high degree favourable to the growth of a disease like plague. Surgeon-Major-General Cleghorn, Sanitary Commissioner with the Government of India, gave the following description of the condition of the native dwellings when the epidemic first broke out : — " The chaivls or tenements may run up to seven stories, and the insanitary tene- unit of construction is a long corridor with rooms opening on either "^e"^^- side. In the corridor, either at one end or in the centre, is situated a water tap with bathing platform, and alongside it a latrine with two or three seats. The whole tenement is built up of a congeries of these corridors and rooms, and contains from 500 to 1,000 individuals. The only space between each tenement is a gully sufficiently wide to admit a sweeper. In most of the corridors and rooms, either from the absence of openings or from the obstruction of the existing ones, there is absolutely no light admitted, and consequently no ventilation. The . Health Officer informed me that he estimated that 70 per cent, of the \ population live in such houses. The corridors, before being taken in hand by the Health Department, were the repositories of filth of all kinds, and it is surprising that the mortality under such conditions has been so small." The following statement shows the population of the different Population. wards according to the census of 1891 : — Fort ... ... ,.. ... ... 64,819 Mandvi ... ... ... ... 152,277 Bhuleshwar ... ... ... ... 206,372 Girgaum ... ... ... ... 93.305 Byculla ... ... .„ ... 180425 Parel ,.. ... ... ... 54.404 Mahim ... ... ,,. ,„ 43,998 Total ,., 795,600 to8 Extent and course of the plague [ Chap. V. Hardly any city in the world presents a greater variety of national types than Bombay. The Muhammadans and Hindus of course pre- dominate in numbers, and the Hindus are considerably more numerous than the Muhammadans. Commencement No certain information has been gathered as to when the outbreak in the City of Bombay commenced, what was the immediate cause of the outbreak, or even in what part of the city the first cases occurred. First public Dr. Viegas, a medical practitioner of Bombay, was the first person to publicly announce that he had detected the existence of cases of bubonic plague ; and the first official intimation was received by the Municipal Commissioner on the 23rd September. On the 29th September the Government of Bombay telegraphed to the Gov- ernment of India that the Surgeon General reported having seen about twenty cases of a mild type of bubonic plague in Bombay. On M H ffklne's ^^^ same day the Government of India directed M. Haffkine to investigation. go to Bombay at once and make a thorough bacteriological enquiry. Diagnosis On the 13th of October M. Haffkine telegraphed that bacteriological examination had demonstrated beyond doubt the identity of the disease. announcement. confirmed. Failure to Several circumstances point to plague having prevailed in diseair*^^ Bombay for some time before its existence was recognised. In Early suspicious August cases of fever with glandular swellings had been attended by several medical practitioners, cases of fever accompanied by pneumonia had been reported to the Executive Health Officer, and a death was actually registered on the 31st August as due to bubonic fever. These circumstances failed to arouse an alarm of plague, as a type of fever with glandular swellings has, it is said, been for years known- in Bombay. Again, it is stated by Mr. Snow, the Municipal Commissioner, that " when plague broke out, several native practi- tioners of the first standing acknowledged that from the end of the hot weather in May onwards they had come across several cases of peculiar fever which entirely puzzled them and usually ended fatally. It does not, however, appear that the bubonic swellings in such cases Avere apparent in a marked degree, and Httle further thought appears to have been giv».n to the matter, which is no wonder considering the various obscure form of plague noticed in the epidemic. " High mortality The extraordinarily high rate of mortality which prevailed in the in the city. (,j|-y ffom the latter part of August onwards also pointed to the existence of some unusual phenomenon. The following statement compares the total mortality from different causes in the City of Bombay during the last week in August and during the month CHAP. V. ] in the Bombay Presidency. 109 of September 1896, with the average mortality during the correa ponding periods of the preceding five years: — C lOLERA. Small-pox. Fevers. Bowel- All OTHF.R Total complaints. ;asks. «■ i i o ^ o-us 0.2 10 ." 10 0.2 u > a. &. So, C ul 1- ^ 0. i, cm . ^^ tr, ° ^0 V ° 'p' »-• > IH <: <: < < < < 1st September 26 8 I 2 165 127 94 S3 343 318 639 SO8 Sth September 20 5 4 2 140 138 57 47 342 312 563 494 iStli September 9 5 nu. 1 >77 107 40 41 354 30S 580 459 22nd September S 12 . I 194 116 34 40 37S 309 613 473 29th September 3 11 i 25s 122 42 33 369 323 671 ^92 The excess occurred chiefly under the heads of " fevers " and "all other diseases ;" the latter head included an unusual number of deaths from diseases of the respiratory organs. Both fevers and dis- orders of the lungs are diseases for which the Indian plague may easily be mistaken. Brigade-Surgeon-Lieutenant-Colonel Weir, the Health Officer of the Municipality, has stated that it should not be assumed that this unusual mortality was due to plague. He points out the remarkable circumstance that the increase in mortality was largely confined to persons not born in Bombay, and he suggests that an influx of strangersMue to a large religious assemblage held at Nasik, near Bombay, may have had an important iufluence on the general mortality. But allowing for the possible contemporaneous existence of other causes, the unusual mortality coupled with the other evidence must still point to the probability of numerous cases of undetected plague. That once plague was discovered it was found to be widely on discovery the diffused through the city is additional evidence of a very important disease found to 1 • , • Ti 1 1 , 11 •■ ^ 1 ,. i 1 . ..be widely diffus- description. It has been stated that the first public declaration ofed. the existence cf plague was made on the 23rd September. The municipal returns record the occurrence of 145 cases of plague during the week ending the 2nd October : 89 in the Mandvi quarter and no Extent and course of the plague Cause of the outbreak. Abnormal climatic condi- tions. [ Chap. V. the remainder spread over twenty-two of the thirty-two quarters into which the city is divided. The actual number of cases which occur- red during the week was, it is kaown^ much greater than the number reported. Bearing in mind the slow rate at which the infection of plague spreads during the early period of an epidemic, it is certain that the disease must have been in existence for a considerable time before the cases could have become so numerous and so widely diffused. The immediate cause of the outbreak must remain a matter of con- jecture. It would seem probable that the infection was introduced by sea, since it is most unlikely that the disease could have been carried overland from the small endemic centre in the Himalayas, or that it could have been introduced from beyond the border by any land route. It has been seen that an endemic plague centre exists on either side of the Indian Peninsula — to the west in Mesopo- tamia and to the east in China. In so far as is known, there was no unusual prevalence of plague in Mesopotamia at the time of the out- break in Bombay. But on the w'est the second or i8g6 outbreak in Hong-kong had not died out when Bombay became infected. The probability would therefore seem to point to China rather than to Mesopotamia as the source whence the infection was derived. In connection with this question it is interesting to note that Staff Surgeon Wilm, whilst eulogising the general arrangements made in Hong-kong to stamp out the epidemic, remarked that too little attention was paid to the water-borne traffic. And in India quarantine was not imposed against Hong-kong during the i8g6 epidemic at that place, although it was imposed during the more important epidemic of 1894 and withdrawn when that epidemic ceased. Intimation of the recrudescence in i8g6 was not sent to the Government of India, and it would appear that in Egypt also quaran- tine was not imposed. It is therefore quite possible that undetected cases of plague may have arrived from Hong-kong. The outbreak of plague in Bombay occurred at a time of unusual climatic conditions. The early cessation of the monsoon of i8g6 is notorious in connection with the widespread famine which resulted in India. Dr. Weir has given the following account of the pheno- menon as it affected the City of Bombay : — " The mean annual temperature of the year was 807, the second highest on record in the last 51 years. The total fall of rain amounted to 87-6 inches, being 15 inches above the average. But the distri- bution of the rainfall was abnormal, for, instead of being distributed over four months, it was distributed over a much shorter period — a Chap. V. ] in the Bombay Presidency. lit ittle over six weeks — and, instead of being succeeded by the great atmospheric disturbances designated elephantas, the monsoon cur- rents ceased in less than two months, and the thunderstorms which we look forward to as announcing the end of the rainy season were absent. The rainfall in June was 28 inches, or 8 inches above the average, and the rainfall in July amounted to 36'4 or 11*7 inches over the average. In August the rainfall amounted to 2o"8 inches, giving an excess of 7I inches over the average. The rainfall, therefore, was abnormal in its duration and in its distribution. It must be remem- bered that the sanitary effects of the annual rainfall on the public health are as marked as are the aberrations of the rainfall on agricul- ture. The heavy rainfall in 1896, as we remember, flooded with sewage the low-lying portions of the city, through which the polluted streams rushed in swirling currents, leaving banks of mud and sludo-e behind to ferment or slowly dry; and, moreover, the sewage flowed from the sewers on to the streets after each heavy downpour and rushed up the traps and flowed on to the low-lying ground. Unfor- tunately, in the beginning of the monsoon, a serious obstruction occurred on the Worli foreshore, in the outfall channel of the sewacrc' The stoppage took place during a great storm, and it was impossible to send men down in the heavy seas to remove the obstruction. Although the monsoon practically ceased in the middle of Auo-ust the shady sides of the streets in crowded portions of the city remained damp long afterwards. I find a note in the last week of August drawing attention to it. In September only i'6 inches of rain fell being 10 inches lower than the average. This was the most abnormal month of an abnormal year yet recorded (even in the famine vears of 1876-77, the September rainfall was not less than 4 inches) ; and an abnormal September w^as followed by an abnormal October, dry and warm." The disease was first discovered in the Mandvi quarter of the Outbreak in ward of the same name, in the heart of the crowded portion of the ^^^"'^vi. city where local conditions greatly favoured its growth. The subse- quent progress of the epidemic is illustrated by the statements p-iven o • in Appendix III. The statements show— and maps." ^^'*'' («) Total reported plague seizures and deaths in the city, week by week. [b) Total weekly mortality of the city compared with the average weekly mortality of the corresponding period of the preceding five years. (c) Total reported plague seizures in each quarter and ward. 112 Extent and course of the plague [ Chap. V. {(1) Reported plague seizures in the different wards of the city Aveek by week. {e) Reported plague seizures in the different quarters into which the wards are subdivided, week by week. The charts on pages 2\ to 23 of Volume IV illustrate the course of the plague in the city and in its different wards. On page 6 of Volume IV is a map showing the incidence of the mortality in the different quarters of the city. Inaccuracy in In examining the statements it has to be remembered that they reporting. probably do not show much more than one-half of the actual number of cases, and that the reporting was much less accurate in the begin- ning than at the end of the period. Whilst therefore the statements are of great use in illustrating the comparative virulence of the disease in the different quarters, and the general course of its rise and fall, they must not be taken as furnishing anything approaching to an exact statement of the cases that occurred. Monthly seizures. '^^° following was the total number of seizures reported month by month : — 406 339 1,664 2,374 3.172 2,495 1,4x8 448 186 62 124 General course ^^ October 1 896, the number of reported seizures fluctuated con- of the epidemic, siderabl}^, but the epidemic did not show any tendency to increase. In the first-half of November there was also no increase and the hope was encouraged that the epidemic would soon die out. But in the second-half of November the increase began. In the beginning of December there was a large rise which continued progressively until the end of the month. Throughout January the high figure was main- tained, and a further rise occurred at the end of that month, February saw the height of the epidemic, the following being the figures for the four weeks of the month : — November December >> ••• January February March 1897 J) ... April May J, ... 5J ••• June July August J> ... JJ ... 5, >•• Period. Reported seizures. Excess gf total mortality fr im all causes over corresponding figures for preceding five years. First week Second „ Third „ " ... Fourth „ 717 870 822 763 1.375 1,166 1,116 945 Chap. V. ] in the Bombay Presidency. 113 During March the disease began rapidly to decline, and the epi- demic waned steadily throughout April, May, June and the first-half of July. The period from the ist to the 15th July showed a total of only 15 isolated cases. From the middle of July began the recrudescence. Those among the population who could leave the city endeavoured Flight of die to save themselves by flight. In Mr. Snow's report the following P°P"'^tion. estimate is given of the exodus :— In October 1896 ... ... ... about 20,000 In November and December 1896 ... „ 171,500 In January 1897 ... ... ... „ 187,400 In February 1897 ... ... ... „ 19,103 Total ... „ 398,000 Mr. Snow gives the following account of the exodus : — '' The outward flow began in October, and the smallness of its dimensions up to the end of that month may be ascribed to the fact that the disease was for a long time confined principally to one locality. The exodus increased through November and December, and reached its highest point in January, after which it rapidly sub- sided, and during March and April there was a steady stream back to Bombay. The appearance of plague in the various cities of refuge to which the people fled had probably great influence in checking the emigration from Bombay and the horrible mortality in some of those places must have gone far to persuade them of the advisability of returning to their ordinary avocations. " The population of Bombay at the census of 1891 was 821,764, and, taking into consideration the rate' of increase between 1881 and 1891, we may assume that in 1896 the total number of persons in Bombay was about 846,000. Taking the exodus at, roughly, 4 lakhs, we shall not be far wrong in estimating that at the beginnino- of Febru- ary it was reduced to something like 4^ lakhs. " While the panic was at its height and the exodus in full flow, the scenes at the railway stations were striking— a motley crowd of natives of every caste and creed pressing and shouting for tickets, and then as the train steamed in, a hurrying anxious throng, old and young alike, tottering under enormous bundles of household goods. As special after special left the stations, the relics of the disappointed crowd sooner than miss the next opportunity would quietly settle down to sleep on the platforms. The busy scenes at the station stood out in marked contrast to the quietness of Bombay ; whole streets of shops were closed, business was paralysed and the desolate emptiness of 15 1 1 4 Extent and course of the plague [ Chap. V. thoroughfares ordinarily teeming with life was most remarkable and continued throughout the months of December and January, when the population had been reduced to its lowest figure. " Course of the Until the end of September the disease appears to have been ^nt'^w'^rd's" ^'^^^' mainly confined to the Mandvi quarter of the ward of the same name, but from the beginning of October cases were reported from many parts of the city. Speaking generall}-, the plague travelled from east to west and then north, throwing out branches to the south. In the Mandvi Ward itself the disease persisted with fluctuations until the beginning of May, when it rapidly declined. The worst periods appear to have been the beginning of October and the month of April. In Bhulesh- war the cases began to increase in number at the end of November, and the disease was virulent throughout December, January and the first-half of February, a sudden drop then occurred in the number of cases, after which the decline of the epidemic was gradual and steady. In the Fort Ward the main period of the epidemic was from the begin- ning of December to the end of April, January and February being the worst months. The disease was never virulent in this ward. The end of December to the beginning of April was the main period of the epidemic in Girgaum ; it was specially virulent in February. In Byculla the epidemic was strongly marked from the middle of December to the middle of April, and the number of cases was extremely high during the second-half of December and the whole of January, February and March. The epidemics in the Parel and Mahim Wards in the north of the island were almost synchronous ; they were extremely violent, but also short lived. The main period was from the end of January to the middle of April. From this point the decline was unusually rapid, and before the end of May the disease had practically died out in both wards. . ^. , It was noticed that the first onset of the disease was rarely Manner in which n- v^cvo ^ , , . , , , , i . the infection rapid in any locality. Isolated, imported and, perhaps, endemic spread. ^^^^^ Occurred from time to time, followed by one or more small groups of endemic cases. Then the disease having obtained a footing in the locality began to spread and soon increased with rapidity and virulence until the place became thoroughly infected. It was also noticed that infection appeared to spread from house to house, neighbouring houses forming groups in which many cases occurred. The infection was hardly ever found at all evenly distributed over the locality. Comparison of Comparing the wards one with another, it will be seen that in com- the intensity of ^j-jgon with its population the Mahim Ward in the north of the island differTrlf wTrds!" suffered most, the number of reported seizures amounting to 38 per Chap. V. ] in the Bombay P/esidency. 1 1 5 one thousand of the population according to the 1891 census. Pare), the other ward in the north of the island, also suffered severely, the number of seizures per one thousand of the population being :8. By- culla Ward was next worst to Mahim, the per thousand figure being 22 ; the figures for the other wards were — • Girgaum ,.. ... ... ... 16 Fort „. ... ... .„ 13 Mandvi ... ... ,,, ... II Bhuleshwar ... ... ,., ,., 10 Ifc is remarkable that the wards forming the main body of the city show the smallest number of reported seizures in proportion to the number of inhabitants. The two wards in the north of the island owe their heavy mortality to virulent outbreaks in small and insanitary villages and suburbs. The extensive flight of the inhabitants also interferes to some extent with the deduction to be drawn from the figures. The population figures used in the statements are taken from the census return of i8gr, but the actual population after the flight had set in was, it has been seen, reduced to a far lower figure, and the flight may have been more extensive in some localities than in others. The wealthier inhabitants of the city would be able to leave much more easily than the poor fishermen living in the villages in the north of the island. The incidence of the disease varied greatly in different quarters of Localities chiefly the same ward. In Mahim Ward the figures were — ■ ^ ^^^^ ' Mahim quarter ... 61 seizures per 1,000 of the population. Worli „ ... 21 The exceedingly high totals in this ward were due to virulent outbreaks in dirty and insanitary fishing villages. An account of these outbreaks and the measures taken to suppress them is given in Chapter VII. In Parel Ward the number of seizures per one thousand of the population in the different quarters was as follows : — Siwri ,.. ,,, ... .■•,, ,,, oj Sion ... ... „. ... ,.. 20 Parel ... ,., ... ... ... ja Again, an insanitary fishing village (Siwri) shows the largest number of cases. In Byculla the figures were— Mazaafon „, Kamathipura First N£ Tardeo 29 2^ First Nagpada ... ... ,., .^^ 24 >t« ... ... ... 23 B3'culla ... ... ,„ ... .., 21 Tarwadi ... ... ... ... ... iS Second Nagpada ,„ ... „, ,,, iq ii6 Extent and course of the plague [Chap. V. Mazagon includes a portion of the clocks ; Kamathipura and Nag- pada form the north part of the main body of the native town. In Girgaum Ward the disease was severest in Mahalakshmi (32 per mille), and next in Walkeshwar (21 per mille) in which Malabar Hill is situated. In the Mandvi and Bhuleshvvar Wards (which form the greater portion of the main body of the town), the incidence of the disease, according to the figures based on reported seizures and the population of i8gi, was much lower. The per thousand figures vary from 21 in Mandvi quarter to 4 in Chakla. In the Fort Ward the total number of cases v/as small, but the quarter of Upper Colaba shows a per thousand figure of 24. The Bombay Presidency Proper. Statistics, charts, fhe extent and course of the first period of the epidemic in the Bombay Presidency proper is illustrated by the following statements in Appendix III : — [a) Weekly statement of reported seizures in districts and Native States. {h) Weekly statement showing both seizures and deaths. [c) Weekly statement distinguishing between imported and indigenous cases. {d) Weekly statements showing the principal localities in dis- tricts and Native States in which the disease was endemic. The charts in Volume IV, pages 24 and 25, illustrate the course of the disease in the districts and Native States where the epidemic was most severe. The maps on pages 3 to 5 of Volume IV illustrate the incidence of the epidemic^ and show the principal localities in which the disease prevailed. The statements, charts, and maps cover the period from the beginning of the outbreak up to the end of August 1897, that is to say, up to the time when the recrudescence had begun to gain ground. Geographical Geographically the epidemic may be divided into four divisions, distribution of ^]^g f^j.g|. ^-^^ j^ost important is, that which extended along the Konkan Coast from the Surat to the Ratnagiri districts, and in- cludes the town and island of Bombay, the districts of Surat, Thana and Kolaba, the Navsari division of the Baroda State, the Janjira State, the small Portuguese possession of Daman and the northern portion of the Ratnagiri district. The second group of infected localities forms a line running north and south along the the disease. Chap. V. ] in the Bombay Presidency. wj west and centre of the Deccan districts. It includes the districts of Nasik, Poona, Satara, Ahmednagar, and the northern portion of the Kolhapur State. Khandesh and the eastern portion of the Deccan districts escaped altogether or show only very few indigen- ous cases. The southern districts of Sholapur, Kaladgi, Dharwar, Belgaum, and Kanara, the southern portion of the Kolhapur State, and the Portuguese possession of Goa remained practically free from plague. The third division extends over the whole of Gujarat, north of Surat district, excluding Cutch, which forms the fourth division. Indigenous cases occurred at a number of places scattered widely over Gujarat, the only serious outbreak was at Palanpur. There was a very virulent epidemic in Cutch. Apart from Poona and Cutch, the first division is the only one in The Konkan which the districts show a number of reported cases in excess of seat of the one per one thousand of the population according to the census of ^P'^^°^'^- 1 89 1. The figures are — Number of reported cases per 100,000 of the population, Thana district ... <., ,,, 550 Janjira State ,,. ,„ ,,, 3^1 Surat district ,., ,,. ,,, 331 Kolaba district ... ,,, ,,, 261 Navsari division (Baroda territory) ,., 176 In Thana district Indigenous cases occurred In 60 places, and Thana. more than 100 such cases in 11 places. The disease was Avorst at Bandra, Bhiwindi, Bassein, and Kurla, all near the city of Bombay. In the Surat district also Indigenous cases occurred In 53 places. The epidemic also was worst at Bulsar on the sea coast, and was also bad at Mugod and Rander. In the Kolaba district the disease was Kolaba. worst at Revdanda and Alibag. It spread to 29 other places. This division of the epidemic Includes also a virulent outbreak at the small Portuguese possession of Daman between the Thana and Surat districts. The plague was worst in the portion of the territory known as Little Daman, and it is said that here more than one-third of Daman, the population perished. In the second division the city of Poona was the principal seat Poona City, of the disease. Here the reported number of cases up to the 27th August amounted to 2,543, or 16 per thousand of the population, and the actual number of cases is known to have been much greater. The late Mr. Rand, who was in charge of plague operations In the city, estimated on the basis of total mortality from all causes that the number of deaths from plague were certainly not less than 2,900 in the city itself (excluding the cantonment and suburbs), giving ii8 Extent and course of the plague [ Chap. V. Poona district. Satara. Palanpur. Mandvi. Course ot the epidemic. Thana. a death-rate of 24 per thousand. In Poona district the number of reported cases amounted to 1,186. The disease was worst in Kirkee cantonment and the small station of Lonavia, and it extended to ten other places. In Satara district very few cases occurred during the first period of the epidemic. The cases in this district belong to the period of the recrudescence and will be noticed later on. In Nasik and Ahmednagar districts there were few indigenous cases. In the third division the outbreak at Palanpur was the most important incident. Here there were 167 indigenous cases mainly at Palanpur itself. The number of indigenous cases in Ahmedabad, Baroda territory, and other places in the third division was small. InCutch (the fourth division) the outbreak began with an epi- demic at Mandvi, which was one of the worst that occurred. The number of reported indigenous cases v^as 4,359, or more than 11 per cent, of the population, and it is known that large numbers had been attacked before the existence of the epidemic was brought to the notice of the authorities. From Mandvi the disease spread to a number of villages in the State, and for several months caused considerable mortality. In the months of October and November, i8gf>, isolated imported cases were detected from time to time at different places in the pre- sidency, but it was not until December that the epidemic began to show a marked tendency to spread. The imported cases were at first most numerous in the Ahmedabad district, but here they failed to occasion any diffusion of the malady. Only 27 indigenous cases were reported in all : they occurred between the middle of February and the end of the first week in May. Satara district in the Deccan was one of the localities in which indigenous cases appeared at an early stage, but here also the infection did not spread. Only 88 indigenous cases were reported during the first period of the epidemic, mostly in November and February. It is remarkable that Satara should have escaped so easily during the first period of the epidemic and yet have been the source of an outbreak of extreme violence during the recrudescence. Turning to the districts of the first division, it will be seen that Thana became infected in the month of December, and that the number of cases rose rapidly during January, February and March. The last part of March and first part of April included the worst period and the highest number of indigenous cases (389) was recorded dur- ing the week ending the 2nd April. In the beginning of May the number of cases decreased quickly and the fall was rapid throughout May and June. By the end of June the epidemic had for the time died out. In Surat and Kolaba districts the beginning of the epidemic Chap. V. ] in the Bombay Presidency, 119 was much later ; both districts became Infected in the early part of February. In Surat the disease spread rapidly throughout the latter Surat. part of February and the whole of March, and the first part of April saw the climax. Until April was three parts over the number of cases con- tinued to be very high, but after that the decline was rapid. It lasted through May and the first-half of June. By the middle of that month the first period of the epidemic was over in the district. In Kolaba Kolaba. the epidemic was less severe than in Surat. There was little progress until the last week in March, when the number of cases rose and remained at a comparatively high level until the first week in May. The fall was then steady until the beginning of July. Even durino- that month a few cases continued to occur every week, and with the recrudescence the number again increased. In Janjira State May was the worst month. In the Navsari division of Baroda State Baroda territory. the main period of the epidemic was from the middle of March to the end of the first week in May. In Daman plague began early Daman. in March. The disease spread with great rapidity and virulence until 60 or 70 deaths occurred daily. By the end of May the violence of the epidemic was spent. In the second division Poona City has first to be noticed. The Poona Ciiy. infection appears to have taken hold of the city early in January, it spread steadily throughout January and February, and culmi- nated in the middle of March. The week ending the 26th March showed 345 indigenous cases. The number of cases remained high until the middle of April, and the epidemic then declined rapidly. In Poona district, during the first period of the epidemic, there were never more than occasional indigenous cases. In the Nasikand Ahmednagar Nasikand districts a number of imported cases occurred during the earlier Ahmednagar. months of the epidemic, but indigenous cases resulted in only a few instances. Indigenous cases occurred in Kolhapur State from the middle of February onwards without ever increasing greatly in number. In the third division the Palanpur outbreak is the chief point to Palanpur. notice. The epidemic was short lived, but for a few weeks the number of cases reported was considerable. The period was roughly from the middle of March to the middle of April, after which only a few cases occurred until the recrudescence. In the Kadi and Baroda divisions of the Baroda territory there were only occasional indigenous cases. In Kathiawar indigenous cases began in February and continued Kathiawar. steadily until June. The outbreak at the port of Mandvi in Cutch (fourth division) was Mandvi. not discovered until the middle of April, when the disease had already made great progress. The first week in May showed the enormous 120 Extent and course of the plague [ Chap. V. number of 1,288 cases. From this point the epidemic declined gradually. In the weekending the 4th June the number of cases had fallen to 327, and in the week ending the 2nd July to 44. In August only occasional cases occurred. From Mandvi the infection spread into the interior of Cutch. From February onwards indigenous cases were reported, though at first not in large numbers. The cases were more numerous in May, June and July, and there was a further increasein August and September. In the latter month 522 cases were reported. After September the number of cases again diminished. Sind. Sind was the scene of several violent outbreaks of the disease, but Infected |.]^g period of the epidemic was much shorter than in the Presidency Proper and the infection was much less widely diffused. The epidemic was practically confined to the following places : — ■ Karachi City. Kotri. Karachi district ... ... ... ^ Tatta. [ansfshai. the town. TT J L J J' i. • .. f Hyderabad. Hyderabad district ... ... - [Xando Alahyar. r Sukkur. Shikarpur district ... ... ... j vilkges in ihe Rohri (^and Ubauro Talukas ' The Upper Sind Frontier district, the Thar and Parkar district, and the Khairpur State escaped with hardly a case. Karachi. Karachi stands on a bay of the[lndlan Ocean, at the extreme north- Description of grn end of the Indus delta. The census of 189 1 showed a population of about 105,200; of these nearly 53,000 were Muhammadans and some 44,000 were Hindus. The entrance to the harbour Is between Manora Head and Kiamari Island ; the harbour extends five miles northwards from Manora Head to the narrows of the Lyari River. The Lyari River has a low sandy bed and Is usually not covered by water. On the east bank of this river lies the main body of the city. Immediately on the bank and adjacent to the harbour Is the Old Town, the most densely populated portion of the city. From the Old Town the city extends back into the Market, Napier and other quarters. North and east of the city, and some little distance away from It, is the cantonment, and south- east of the cantonment He the Civil Lines, On the opposite or west bank of the Lyari there Is another quarter of the town known as the Trans-Lyari quarter. It contains twenty settlements of poor Muham- madans of different tribes — fisher people, SIdls, Mekranis, Baluchis, etc., each in their separate village. Twelve of the settlements are Chap. V. ] hi the Bombay Presidency, i2I mostly only reed and plaster huts ; the remaining eight are inferior houses of a permanent type. At the census of 1891 the population of these settlements was numbered at over 22,000, but the population is now estimated to be over 30,000, or one quarter of the present estimated population of Karachi (124,000). There are also villages on Kiamari Island and at Manora, on either side of the harbour. Surgeon-Major-General Cleghorn, who visited the city during the early period of the epidemic, gave the following account of the condi- tion of the main portion of the city : — '' The worst parts of the town are the quarters named Old Town, insanitary Machi Miani, Market, and Bandar, where the greatest mortalitv has condition of the , ' r r ii 1 1 r 1 ' •,. ''"''^'" body of the occurred. 1 he two lormer lace the bed or a dry stream, extending town. backwards until they become contiguous with the other quarters. Many of the houses I visited in the quarters above named were quite unfit for human habitation; there were no openings for the admission of air and light, the rooms were overcrowded, and the inmates lived in complete darkness. The Old Town is the worst in all respects, but the overcrowding in houses and of ground area is common to all." In the report on the plague in Sind Mr. Wingate, who was Acting Commissioner during the period of the epidemic, gives the following description of the beginning of the outbreak :— " On the 1 6th December, while on tour, the Acting Commissioner Beginning of the in Sind received intimation from the Health Officer, through the Collector °"'^''^^^- of Kairachi, of what was reported to be a ' doubtful ' case of plague. A Brahman cook, aged 16 3^ears, resident for nine months in Karachi, stated to have taken ill about the 4th December, was reported on the 8th to the Health Officer to be suffering from bubonic fever. There was high temperature and a bubo. The same evening the patient was re- moved from Rampart Road, Bandar Quarter, to a house in Maoji Street, Rachor Quarter, where next morning he died. Thus early began that removal from place to place which to the last was difficult to deal wath. " The Acting Commissioner directed definite medical inquiry, but on the 1 8th he received the Health Officer's report dated the 12th which left no doubt that the disease had broken out in Karachi, and the facts narrated below "were reported to Government. "An old servant of the firm of Radhakishn Tejbhandas & Co. died on the iith December after, it was said, a 12 days' illness Another servant of the firm, aged 28, also living in the Old Town Quarter, was seen by the Health Officer on the i ith and found to have a tem- perature of 103° and swellings in both groins. In a house close by, in which four persons had died in the course of a few' davs, including 16 122 Extent and course of the plague [ Chap. V. Plague declared epidemic. The epidemic dates from the beginning of December. Spread ol infec- tion. a child seen by the Health Officer on the nth, another child, aged five years, M'as found sick. On the morning of the I2th, the Health Officer took the Deputy Sanitary Commissioner, Sind Registration District, to view the cases. " On the 19th December, at their usual weekly meeting, the Medi- cal Board declared plague epidemic in Karachi. Their report reached the Acting Commissioner on the 22nd, and was the same day communi- cated to Government by telegram, and the Principal Medical Officer was asked for daily reports of attack and deaths. " These facts leave little doubt that, from the beginning of Decem- ber 1896, the disease had got a footing in Karachi. There was nothing in the mortality statistics to indicate the presence of the disease— " - Deaths from ALL CAUSES. Average deaths of s years EiNDlNG l8gS. Week ending Total. Daily aver- age. Total. Daily aver- age. 6th October 1896 83 12 65 9 13th „ 51 7 56 8 20lh „ „ 61 9 58 8 27th „ „ 59 8 58 8 3rd November 1896 ... 54 8 62 9 loth „ „ ... 59 8 65 9 17th „ 72 10 69 10 24th „ „ ... 74 11 67 10 1st December 1896 ... 80 II 70 10 8th „ „ «5 12 81 12 15th ,, „ ... 86 12 82 12 22nd „ M 104 15 102 IS The infection first spread in the insanitary and overcrowded quarter of the Old Town, and for some time it was confined to that quarter. But by the end of January it had spread into the Napier and Market quarters and thence it attacked other quarters of the city. In the Trans-Lyari Quarter the cases began to multiply in the beginning of February. The outbreaks at Kiamari and Manora were of later date. Chap. V. ] in the Bombay Presidency. 1^3 Taking the city as a whole, the beginning of January saw a con- January. siderable increase in the number of cases, which continued during the month. From the 28th January the cases again rose considerably and the maximum was reached on the ist, 2nd and 3rd of February, when the number rose to 59, 49 and 56 — a record never subsequently reached. "In fact," says Mr. Wingate, "the epidemic in the first week in Climax during ^ , . 1 . ,.1,1 r, ,1 1 ii ii , . the first week in February attamed its climax, and thereafter, though the outbreaks m February. new quarters partially obscured the fact, the disease gradually abated." Taken by months the reported mortality from plague was as Monthly plagua f ,, mortality, follows:— ■' 59 743 995 864 53S 167 23 9 Throughout February and March the epidemic continued to be severe ; April saw a considerable fall and May an equally large one. Decline. In June the cases were only occasional and in July the epidemic died out. December 1896 January 1897 February March April May June J"iy In Karachi district there were small epidemic outbreaks in Kotri, Karachi district. Tatta and Jangshahi, giving an aggregate of 48 indigenous cases. From Tatta. the middle of December to the week ending the 19th February, 31 imported cases occurred at Tatta. The influx then appears to have ceased, and no more deaths were reported until plague broke out locally in the week ending the 26th March. Thereafter the epidemic was local and practically ceased early In May. Jangshahi is the railway station Jangshahi. for Tatta. It contains a population of only about 200 persons and a sharp local outbreak was easily suppressed by evacuation and disinfec- tion. Kotri is on the Indus and is the railway station for Hyderabad, Kotri. from which it is separated by the river and two miles of road. Up to the third week in February dropping cases came in from Karachi. Then there was a lull, and not till the week ending the 26th March did the first local case show itself, at the same time with cases imported from Hyderabad, where the disease had just broken out virulently. By enforcing segregation in huts the disease was stamped out after the occurrence of 17 cases.* In the Hyderabad district the town of Hyderabad was the scene Hyderabad of an outbreak which was for a short time virulent and occasioned * A fresh outbreak occurred at Kotri in November 1897. 124 Extent and course of the plague [ Chap. 'V. Hyderabad City, a total number of 544 cases. In 1891 the city contained a population of nearly 55, oco,. and at the time the outbreak occurred it was crowded with Karachi refugees and contained, Mr. Wingate estimates, not less than 65,000 people. The town is healthily situated on a hill and in a dry climate. Imported cases from Karachi occurred for some time before the disease broke out locally. The indigenous cases commenced during the week ending the 5th March and for some time the disease made slow progress. Until the beginning of April the number of cases did not exceed 40 a week, but during the week ending the gth of that month the number suddenly rose to 1 17. Next week the number was 119 and then the disease declined almost as rapidly as it had risen. During the week ending the 7th May there were only 37 cases, and by Tando Alahyar. the beginning of June the epidemic had died out. Tando Alahyar was the only other place in the district where the disease became endemic. The epidemic was slight and included only 13 cases. Shikarpur In the Shikarpur district the towns of Sukkur and Rohri, situated ^'^*''"^^" on either bank of the Indus, were the scene of a virulent outbreak of Sukkur. short duration. In Sukkur the first indigenous case occurred in the week ending the 12th February. The figures during the early part of the epidemic were obscured by the concealment of case s, but the epidemic did not gain ground rapidly until the latter part of March. Dur- ing the week ending the 19th March there were 28 cases reported, and during the following weeks the figures w^ere — Week ending 26th March ... ... ... 97 „ „ 2nd April ... ... ... 105 9th „ ... ... ... Ill i6th „ ... ... ... 87 After the i6th April the disease steadily declined, and died out by the end of May. Rohri on the left bank of the river did not become infected until the second half of April. The cases exceeded twenty in only one week and the epidemic declined from the middle of May and disappeared before the end of June. From Sukkur and Rohri the disease . was spread to several villages in the Shikarpur district and was carried ShikSpu'r" ^ nearly as far as. the Punjab border. But the infection did not obtain district. ^ strong hold in any place and the vigorous m.easures adopted quickly stamped out the disease. Mr. Wingate gives the following account of the end of ^the epi- demic :— „ , ,,, "As already stated, the last plague cases' in Hyderabad and End or the ■' , r t -1-1 r r-> 1 • 1 j.i pidemlc. Sukkur occurred on the 2nd of June. Ihe town of Kohn and the whole district of Shikarpur were free of plague by the week Rohri. Chap. V. ] in the Bombay Presidency, 125 ending the 25th June. Plague lingered fitfully in Karachi till the 27tliJuTy, wherT it finally ceased, and the last case was discharged from hospital on the 6th August. In accordance with the terms of the Venice Sanitary Convention of 1897, ten days must elapse from death or discharge of the last case. By Notification No. 4039, dated the 17th August 1897, the City, Cantonments, Harbour of Karachi and the whole Province of Sind were declared free from infection of plague, and on the 5th September there were thanksgiving services in the churches of all denominations at Karachi. " The Recrudescence in the Bombay Presidency. The recrudescence began in the month of July 1897, and from Commencement. August onwards made wide and rapid progress. The following is a statement of the number of cases reported Statistics. from the localities chiefly affected : — In the City of Bombay the rise^ was gradual until the end of Nov- Bombay City, ember, but in December the epidemic rapidly increased in virulence. The districts of the Konkan Coast, which during the first period Konkan Coast, of the epidemic were a principal seat of infection, have, durino- the recrudescence, escaped with comparatively few cases. In Gujarat, Surat district and Palanpur State have again been the scene of epidemics of some magnitude. But the principal seat of infection shifted further east and south and the Deccan districts of Poena, Deccan districts. Surat and Palanpur. Karnatak. Satara. Improvement in December. 126 Extent and course of the plague in the [Chap. V, Bombay Presidency. Satara and Sholapur have suffered most severely. The epidemic has also extended south^yards into the Karnatak and a considerable number of cases have occurred in Belgaum district. The outbreak in Satara district has been of exceptional virulence and has extended over a large number of towns and villages. In November over 4,500 cases were reported, a figure v^'hich was not approached by any district during the first period of the epidemic. Outside the City of Bombay the month of December showed a general improvement in the places most affected. CHAPTER VI. GENERAL ACCOUNT OF PREVENTIVE MEASURES. THE EPIDEMIC DISEASES ACT. General Account of Preventive Measures. In the succeeding chapters of this report an account is given of the measures adopted to combat the plague and to prevent its spread. The following is a brief summary of the measures and the principles on which they were based. The account of the nature and characteristics of the plague given The nature and In Chapter II indicates the lines on Avhich the disease can best be characteristics of li-i-jj T<-LU i-j-Ui. J plague determine combatted and overcome. It has been explained m what manner and the nature of the to what extent plague is infectious ; it has been shown that the excre- pi^eventive f 1 • / r • r ' measures. tions of the sick are among the most dangerous sources of infection ; that plague can be spread by persons suffering from the disease and by contaminated clothes and other articles ; that infection attaches to the houses in which cases have occurred ; that dirty and insanitary conditions favour the growth of the disease to an extent which can hardly be over-estimated ; that the tendency is for some time to elapse between the occurrence of the first isolated cases and the breaking out of violent epidemic; and that once the malady obtains a firm hold of a locality where local conditions favour its growth^ it spreads with a virulence which is almost irresistible. The preventive measures maybe roughly divided into the follow- Classification of ing classes : — ^^^ preventive , , measures. (i) Measures to suppress the disease in plague centres, and to prevent isolated cases establishing a fresh focus of infection. (2) Measures to prevent the spread of infection by persons travelling by land. (3) Measures to prevent the spread of infection by persons travelling by sea. (4) Measures to prevent the spread of infection by merchandise and food-stuf¥s. The following is a summary of the principal measures adopted in Measures plague centres : — adopted in ^ ° plague centres, Arrangements to ascertain the existence of plague cases by compulsory report, registration at burning and burial grounds, 128 General account of preventive measures. [Chap. VI. house-to-house visitation, and other means. (This is a funda- mental measure, for none of the operations can be successful if undetected cases continue to spread infection.) The treatment of plague patients in special hospitals constructed with a view to the segregation of the sick. The disposal of corpses in a manner calcu- lated to prevent their breeding infection. The segregation of persons who have been living with persons suffering from plague. The evacuation of infected buildings and localities, the inmates being accommodated in carefully-supervised health camps. The disinfection and cleansing of houses in which cases of plague have occurred, and the disinfection of contaminated articles, or their destruction if they are of little value. The exposure of insanitary and infected dwellings to light and air. The demolition of insanitary and infected huts. The general disinfection and cleansing of the locality. The general improvement of drainage and other sanitary precautions, such as the abatement of overcrowding. Measures to pre- Tie measures to prevent isolated cases establishing a fresh focus vent isolated £ infection were similar to those described above. They consisted cases spreading •' an epidemic. mainly in the segregation of the sick and of those who had been in contact with them ; the disposal of the corpses in a safe manner ; the disinfection or destruction of contaminated clothing, bedding and other articles ; the disinfection of contaminated conveyances ; the evacuation of the dwellings in which the cases occurred, and their disinfection or destruction ; the evacuation, if necessary, of the locality, and the adoption of general sanitary precautions. Measures to pre- Land quarantine was not imposed to prevent the spread of in- o^"infecdon^by^ fection by pcrsons travelling by land. All persons travelling from persons travelling ii^fected localities, by rail, road, or river, were examined by a ^ ^" * medical officer, who was given a wide discretion to retain under observation, in suitable and isolated shelter, all persons considered to be likely to spread infection by reason of their symptoms, appear- ance or the state of their clothes or personal effects, and persons without a fixed abode and who were not likely to be traceable or to give information of the occurrence of plague cases amongst them. This inspection was in general carried out on departure from the infected locality or area, and on the route or at the place of destination. In=ipection of the The whole of India was protected against the Bombay Presidency raiwaytra c. and Sind by a series of inspection stations on the main lines of railway traffic. Arrangements were also made to keep a watch at their own homes over persons arriving from infected districts. An additional and very necessary precaution was the disinfection of the clothing and baggage of travellers from infected areas, which from its condition or other reasons was deemed to be dangerous. Rules- were also promulgated for the disinfection of railway carriages. Precautions similar to those adopted on the railways were put in force Chap. VI. ] Genenxl nccounl of prevent ive Measures. 129 in the case of travellers by road and by river routes. To prevent the spread of infection by persons travelling by sea, Measures to vessels sailinor from ports in the infected area, and, in the case ofP''^^^"* ,® ^3 J- ' ' _ spread ot vessels sailing for ports out of India, from otlier principal ports in infection by India, were inspected before departure, and any cases of plague ^is- ['jf^J'^^gj"? covered on board were removed. Quarantine vv'as also impressed by sea. against the infected ports at other ports in India, The original rules enforced at the ports of arrival were issued under the Quarantine Act (I of 1870) and were similar to those enforced against Hong- kong in the year 1894. Revis'^d rules were subsequently issued under the Epidemic Diseases Act (III of 1897), based on the regula- tions prescribed by the Venice Sanitary Convention of the 19th March 1897. The rules for the medical inspection of vessels before leaving port were also revised after the issue of the Convention. To prevent the spread of infection by articles likely to cany the Measures to seeds of the disease, the importation of rags, used apparel and bed- P'"'^^'^"'^ , ^ ° ,' ^ ' the spread ding, w^astepaper, and used gunny bags, from the Bombay Presi- of infection by dency and Sind into other parts of India was prohibited, both by ^"^j^^jP^'*^'® land and by sea. Precautions were also taken to pevent the spread of infection by grain and other food-stuffs. The Epidemic Diseases Act. It 'will be convenient at this point to notice the special Act under which the precautionary and remedial measures w^ere framed and enforced. At the end of January, when the plague had, in spite of 5,-2 ^ts leading all precautions, taken a firm hold of Bombay, wdien it had be- "P to the passing • 1 • • T' 1 • 11 -,111 ^ , ^^ t'ls Epidemic come epidemic in Karachi and when it had begun to spread to Diseases Act. Poona, Ahmedabad, and other places, it became evident that the Ordinary provisions of law were not sufficient to enable the local authorities to enforce all the measures necessary to grapple with the emergency, and to prevent, so far as was humanly possible, the ex- tension of the disease to other districts and provinces. Municipal bodies were, it is true, already endowed with extraordinary powers of dealing with disease within their own limits, but these powers were by no means uniform, and only extended to very limited areas. For instance, section 434 of the City of Bombay Municipal Act, 1888, pro- vided for the imposition of such temporary regulations as might be found necessary to prevent the outbreak or spread of disease, and section 334 of the Calcutta Municipal Consolidation Act, 18S8, em- powered the adoption of similar measures in that City. Under the powders conferred by section 25 of the Cantonment.^ Act 1^X111 of 1889), the provisions of sections 434 and 473 of the City 17 i3o General account of preventive measures. [ Chap. VI. of Bombay Municipal Act were, shortly after the commencement of the outbreak, extended to the Cantonments of Poona, Kirki, Ahmed- abad, and Deesa. In a Resolution of the Government of India in the Public Works Department, dated the 23rd October, 1896, bubonic fever was included in the list of infectious and contagious diseases, given in the general railway rules of 1895, thus enabling the measures prescribed in section 71 of the Act for dealing with persons suffering from any such disease to be enforced in the case of plague. But something much more general and wide-reaching was required, and the Government of India determined, having regard to the high mortality resulting from the plague, the persistence of the disease in Bombay and Karachi, the apprehension that it might spread and become epidemic in other places, the injury that was resulting to the trade of the places affected and the country at large, that it was necessary to take special powers by legislation. With this object a Bill "to provide for the better prevention of the spread of dangerous epidemic disease" was introduced in the Council of the Governor General on the 28th January and passed into law as the ^Epi- Passingofthe demic Diseases Act (III of 1897) on the 4th February. In the ■^<^*" discussions in the Legislative Council it was recognized that the urgency of the case made it necessary that the brief enabling Act should receive the force of law with the least possible delay, and that the varied circumstances and emergencies that had arisen and were likely to arise rendered it desirable that the Act should be general in its terms. Provisions of the The Act, which contains only four sections, enables the authorities empowered under it to adopt all precautionary measures that may be deemed necessary. The main provisions are contained in the second section. The first sub-section of that section is based on section 434 of the City of Bombay Municipal Act, and authorizes the Governor General in Council to direct any measures to be taken and any regulations to be prescribed which are deemed necessary to prevent the outbreak or spread of dangerous epidemic disease, and to direct in what manner the expenses incurred shall be defrayed. The second sub-section empowers the Governor General in Council in particular, to take measures and prescribe regulations for [a) the inspection of ships arriving at or leaving port and the detention of the ship or of any one on board, and {b) the inspection of travellers by railway and otherwise, and the segregation of persons suspected of being infected with the disease. The third sub'section empowers the Governor General in Council to declare that all or anv of the Appendix IV. Chap. VI. ] General account of preventive measures. 131 powers conferred by the Act may also be exercised by any Local Government with respect to the territories administered by it, Sec- tion 3 makes disobedience to any regulation or order made under the Act an offence punishable under section 188 of the Indian Penal Code. The intention of the Government of India In passing the Act was Conferring of that regulations for dealing with the epidemic should, subject to Govprnmentsand the general control of the Governor-General in Council, generally be Administrations made by the Local Governments, who, with their greater local know- ledge and experience and with their greater facilities for gauging local opinion and enlisting local sympathy, were in the best position to devise regulations to meet the particular circumstances which had arisen and might arise in the territories under their administration. Accordingly, on the day that the Act received the force of law the Maritime Gov- ernments of Bombay, Madras, Bengal, and Burma were empowered'^ to exercise all the powers conferred by the Act. The Governments of the North-Western Provinces and Oudh, the Punjab and the Central Provinces, whose territories stood in danger of the spread of infection by land, were given powers under the first, or general, sub-section of section 2, and also under the clause of sub-section 2 au thorizing the examination and detention of travellers. In Assam, Coorg, and Baluch- istan, where the danger was more remote, powers were conferred on the Chief Commissioner under this latter sub-section only. At the same time a notification issued applying the Act to all territories in India which are under the administration of the Governor General in Council, but are not part of British India including the Baluchistan Agency and railway lands ; and in a second notification the administrations of these territories were given powers under the clause authorizing the exaijiination and detention of travellers. Other notifications confer- ring powers on Local Governments and Administrations were issued from time to time as occasion arose. On the 12th February powers under the general sub-sections were conferred on the Resident at Hyderabad for the Civil and Military Station of Bangalore, On the i6th February the Chief Commissioner of Ajmere-Merwara was granted powers under the railway inspection clause, and on the 6th March under the general sub-section. On the ist March powers under the general sub-sections were conferred on the Agent to the Governor General in Baluchistan. On the 3rd April powers under the same sub-section were conferred on the Resident at Hyderabad for the Hyderabad Residency Bazaars, the Cantonment of Secunderabad, the stations of the Hyderabad Contingent, and the Hyderabad Assigned Districts. On the 15th of April powers under the same sub-sections were conferred on the Agent to the Governor General in Central India for the Cantonments of Mhow, Neemuch, and Nowgong. * Home Department Notification No, 302 (Sanitary), dated the 4th February 1897, Appendix IV. 132 General account of preventive measures, [ Chap. VI- The series of notifications conferring powers on Local Govern- ments and Admini-strations are given -in Appendix IV. fcSn^Tpb^ue On the nth February the Mysore Government passed a Regula- pnssed in Native tion (II of iSgy) in the same terms as the Epidemic Diseases Act, and subsequently issued rules and orders under it. The Maharajah oi Travancore and the Rajah of Cochin also issued Regulations based on the Act. These Regulations are set forth in Appendix IV. The Baroda Darbar issued a series of well-devised rules for checking the epidemic in Baroda territory. Rules and orders Both the Government of Bombay and other Local Governments GoTernrneiits and Administrations issued a number of rules and orders under the and Administra- powers conferred on them under the Epidemic Diseases Act, for the tions under the ^ i ^- ^1 . • • - 1 -ri Act. purpose or regulatmg the operations against plague, i hese regu- lations are examined and discussed in the portions of this report which deal with the matters to which they refer. As the regulations on different matters are in many instances gathered together in one resolution or notification, the general orders issued by the principal Local Governments, dealing mainly with the means taken to suppress outbreaks, to prevent the occurrence of isolated cases resulting in epi- demics, and to prevent the spread of infection by persons travelling by land, are grouped together in the Appendix IV. The rules and orders issued by the Governments of Bombay, Madras, Bengal, the North- Western Provinces and Oudh, and the Punjab are given at length. Similar rules and orders \vere issued by anumber of other Administra- tions, both within and without British India. These follow the lines of the rules and orders issued by the principal Local Governments, and it is net necessary to reproduce them. The orders issued for the regulation of sea traffic and to meet special circumstances are given in the appendices to the appropriate chapters. In order that each Local Government and Administration might have the advantage of the experience of other Provinces, the Government of India directed each Government to send a copy of all the rules it issued under the Epidemic Diseases Act to every other Government in India. Q , • u • b '^^^ Government of India found it necessary to take action them* the Government selves under the Epidemic Diseases Act in only four classes of cases, of India under ^^^^ orders issued by the Government of India referred to the prohibi- tion of the pilgrimage to Mecca, to the prohibition of emigration from India, to the temporary prohibition of the booking of railway fares to certain localities with a view to prevent the assemblage of large reli- gious gatherings, and to the prohibition of the importation of certain articles likely to carry the seeds of infection from the Bombay Presi- dency to other parts of India. These matters are discussed in later chapters of this report. the Act. CHAPTER VII. MEASURES IN THE CITY OF BOMBAY. In this chapter the measures devised and adopted in the early period of the epidemic will first be noticed and a description will then be given of the system of remedial and preventive operations carried out by the Special Plague Committee, of which General Gatacre was the President. Measures during the early period of the Epidemic. Dr. Viegas, a private medical practitioner of Bombay, discovered Bsginnirg of the cases he believed to be plague about the 26th September ; the Govern- ^P'^^""^- ment of India at once deputed M. Haffkine, the bacteriologist, to Bombay to investigate the disease, which was officially affirmed to be plague on the 2gth September, and this statement was shortly after- wards confirmed by M. Haffkine, It will be remembered that the disease was mild during the month of October, diminished some- ofThJ^ep'idemlc. what in the first half of November, and from December to the end of February spread and increased with the utmost virulence. From the beginning of March the strength of the epidemic gradually declined, until in July only isolated cases occurred. Until the appointment of General Gatacre's Committee on the gth Conduct of of March, the remedial and preventive measures were carried out by the "P"?*.'^"^ by the municipal authorities of the city, within the scope of whose functions au'thorftres. the care of the public health lies. The following brief account of the constitution of the municipal government of the city, and of the speci- al sections of the municipal law dealing with the suppression of infec- tious and epidemic disease, will make it easier to follow the conduct of the operations. The law relating to the municipal government of the City cf The constitution Bombay is contained in the " City of Bombay Municipal Act °^ ^^^ municipal Bombay Act No. Ill of 1888," as amended in some portions by later ^°^^'^'^''"''°'^ Acts of the Bombay Government. The municipal authorities charged with carrying out the provisions of the Act are — (t) a Corporation, (2) a Standing Committee, and (3) a Municipal Commissioner. 134 Measures in the City of Bombay. [ Chap. VII. The Municipal Corporation consists of seventy-two councillors, of Avhom thirty-six are elected at ward elections, sixteen are elected by the Justices of the Peace for the City of Bombay, two are elected by Fel- lows of the University of Bombay, two are elected by the Bombay Chamber of Commerce, and sixteen are appointed by the Local Govern- ment. The general municipal government of the city is vested in this corporation. The standing committee consists of twelve councillors, eight appointed by the corporation and four by the Gov^ernment* This committee transacts the general business of the corporation) and their special functions are indicated in numerous sections of the Act. The Municipal Commissioner for the City of Bombay is an officer appointed by the Government. In him rests the entire exe- cutive power for the purpose of carrying out the provisions of the Municipal Act. He also controls the municipal staff; he is vested with certain special powers by the Act ; and in cases of great emer- gency he is empowered to take what action he considers necessary on his own authority. During the period of the plague epidemic. Mr. Snow was the Municipal Commissioner, Surgeon-Lieutenant-Colonel Weir was the Executive Health Officer, and Mr. Murzban was the Ex- ecutive Engineer. Regulations of The general regulations for the prevention of the spread of dan- the Municipal „ , . , . . ^ r j.i i\t • Act against gerous discase are contamed m sections 421 to 433 ot the Mum- dangerous cipal Act. The following are the main provisions of these sections. Medical practitioners are bound to give information of any cases -of dangerous disease that may come to their cognizance. The Com- missioner may inspect any place in which dangerous disease is said to exist, and may take such measure as he may think fit to prevent its spread. He may prohibit the use for drinking purposes of water likely to cause dangerous disease. He may order the removal of patients to hospital. He may cause buildings to be disinfected and huts and sheds to be destroyed. He may direct the disinfection or destruction of clothing, bedding, or other infected articles. He may provide and maintain conveyances for the carriage of the sick. All persons are also prohibited from trafficking, etc., in contaminated articles, and from letting any infected building or part of a building until it has been properly disinfected. The drivers of public con- veyances are prohibited from carrying infected persons, and the latter are prohibited from using such conveyances. Section 434 of \^ addition to these measures for ordinary occasions section 434 Act.' ""' ^ of the Act empowers the Commissioner, with the sanction of the Local Government, in the event of the city being visited or threatened with an outbreak of dangerous disease, to take such special mea- sures and prescribe such temporary regulations as he may deem Cf^AP. VIl. ] Measures in the City of Bombay, 133 necessary. It will be remembered that the first or general sub-section of section 2 of the Epidemic Diseases Act was based on this section of the City of Bombay Municipal Act. While the nature of the disease was still under discussion the First measures. Government of Bombay directed their principal sanitary and medical adviser, the late Surgeoii-Major-General Cooke, to furnish full in- formation regarding the facts that had been ascertained with regard to the epidemic and to suggest, in consultation with the Municipal Commissioner, further measures with a view to obtain correct information as to the daily progress of the disease, and to prevent its spread. In a letter, dated the 29th September, Surgeon-Major-General Cooke reported to the Local Government that the disease was no doubt plague, that it was of a mild type, and that it had probably ex- isted in the city for over a month. He assured the Government that the Health Department of -the Municipality was acting with the utmost ^^^j^j^ of thp activity in the infected area, and that a large establishment of inspec- Municipal Health tors and labourers was at work under the superintendence of Surgeon- -P^'^'-'^^"^- Lieutenant-Colonel Weir. In the district examined by Dr. Cooke sea- water was pumped all night through the sewers by a powerful centrifugal pump. Fires of tar and sulphur were lighted at the foot of the staircases leading to houses and in the corridors of houses. Limewashing and cleans- ing of walls and lanes were in active progress, fire-engines being employed in the work. In addition to these measures, Dr. Cooke suggested the following further precautions : an increase in the sanitary and medical staff of the Municipality ; arrangements to detect the disease should it occur in suburban municipalities ; the segregation of the sick in hospital ; the disinfection or destruction of the bedding of patients, and of all other bedding found in the house or rooms occupied by the patient ; and more complete arrangements for carting away filth from sewers. Before the end of September the Local Government appointed Committee a committee, of which Mr. Snow was the Chairman, and the Local Govem- raembers of which were chiefly medical officers of the Government i"ent. and private medical practitioners, to consider remedial and sanitary measures. Dr. Cooke attended the meetings of the committee. At the first meeting, which took place at the end of the month, the suggestions made by Dr. Cooke were discussed and Surgeon-Major Manser insisted on the necessity for the complete disinfection of every house in which cases were known to have occurred. He suggested that the inhabitants of such houses should be removed to empty houses or tents on the Port Trust Estate. Mr. Snow pointed out that under the Municipal Act the Municipal Commissioner 13^ Measures in the City of Bombay. [ Chap. VII. would need to apply to the Government for special powers to carry out certain of the suggestions, and a resolution was adopted by the meeting that the" Municipal Commissioner should be requested to Powers conferred apply for such powers.' On the 2nd of October the Local Govern- on the Municipal _ . Commissioner ment Conferred powers on the Commissioner under section 434 of under section j-j^g Municipal Act to take whatever measures were found necessary 434 Of the ^ ^ ^ •' Municipal Act. to prevent the epidemic from spreading. The corporation voted a large grant for the purpose, and a large additional medical staff was employed to carry out the extensive sanitary measures, the adoption of which was advised. Proclamation o£ On the 6th of October the Municipal Commissioner issued a the Municipal , ,. , . r,i ht'-iai. i- Commissioners. proclamatiDu under section 434 of the Municipal Act making pro- vision for the removal to hospital of all plague patients and the dis- infection and evacuation of infected houses. The assistance of the Alarm and police was to be employed where necessary. The popula' e evinced excitement of ^ ^ -^ . •' • r 1 the population, the greatest alarm and excitement at the suggestion for the compul- sory removal of the sick to hospital, and the increase in the epidemic, ciupled with the operations in progress, produced widespread alarm. People fled from the city in large numbers. On the loth of October a number of mill-hands assembled outside the Arthur Road Hospital and threatened its demolition as well asi voilence to the employes. On the afternoon of the 29th October a gang of nearly one thousand armed mill-hands attacked the same hospital, and were dispersed by the police. The incident was a grave indication of the general feel- ing. The large Municipal conservancy staff became affected by the ^ general feeling of unrest and it was feared that a strike might occur among them. Mr. Snow stated that such a strike would have had the most appaling results. " Bombay would, in a few days, have become uninhabitable and left to reek in a mass of sewage, sweepings and pollution, with no one at hand to conduct the daily routine of sanita- tion, much less to adopt a single preventive measure against plague/' Modification q^^ ^j^^ i^th, of October, the Commissioner issued a memorandum of the orders. to the Health Officer stating that as only a few cases of bubonic fever had been reported within the past few days, and as influential peti- tions and representations had been made against the removal of patients to the Arthur Road Hospital, patients should not be removed if they were living in houses where they could be properly attended and isolated in a reasonable degree. Also that every possible consideration should be shown to the caste and prejudices of persons whose houses the Health Department officials had to enter. To allay Explanatory the alarm and the opposition excited by the fear of compulsory segre- proclamation. . r,i-i <■ .^ i i- • ii,i/-^ gation of the sick, a further proclamation was issued by the Commis- sioner on the 30th of the month, in which it was stated that the Chap. VIL ] Measures in the City of Bombay, 137 object of the notification had been misunderstood, as it was principally- intended to meet the event of a large increase of plague. It was further stated that no cases would be removed to hospital which could be properly treated and segregated on the premises, and that in cases which required removal, no action would be taken except upon the cer- tificate of a duly qualified medical practitioner. These orders had the effect of greatly restricting the segregation Extent to which «Df the sick, but it is stated in Mr. Snow's Report on the Plague in T}f'T. "^ ^^® *■ o SICK wuS Bombay that all attempts at isolation were not given up. "The mere enforced, proposal of this measure," says Mr. Snow, " resulted in the majority of the cases being concealed, but when they were detected arrange- ments were invariably made in the patients' own houses to give them the best chance of recovery possible by removing them to the lightest and best ventilated rooms, and every endeavour was made to dissuade all but the few necessary attendants from frequenting that part of the dwelling. At the same time, where circumstances made it absolutely impossible to make any suitable arrangements, or where the patients were paupers or friendless, they were removed to the Municipal Hospital at Arthur Road.'' The following extract from Mr. Snow's report shows the extent Private and to which an endeavour was made to overcome the opposition of the Caste Hospitals, people to the segregation of the sick in hospital by encouraging the establishment of private caste and sect hospitals :— • " As early as October private hospitals for Hindus on these lines were opened in Mandvi and Bhuleshwar, but this effort proved abortive, the unreasoning terror of hospital-life was still in full vigour and extended even to institutions managed entirely by men of their own class. Those from whom co-operation rather than obstruction might have been expected backed up the unreasoning voice of public opinion by the specious argument that hospitals, while unnecessary in themselves, were a source of the utmost danger to their vicinity. In December, however, more successful efforts were made in this direc- tion. A Jain Hospital was erected in the compound of the Arthur Road Institution, a little later Dr. Bahadurji opened a most success- ful and well managed hospital for Parsis in Parel, and on the 28th January a Hindu Hospital, which did excellent service, was opene.d under the efficient management of the Hon'ble Dr. Rhalchandra Krishna. Similarly, the Port Trustees opened a model hospital at Wari Bandar for their employes on the 23rd December, and through the energy of Professor Muller an institution was started at Modikhana for the servants of Europeans on 31st January. It may also be mentioned that a temporary hospital was erected in December by 18 Measures in the City of Bombay. [ Chap. VIl, the Health Department at Narelwadi for the benefit of the people of that locality which was at the time being very severely visited." Increase of -^^^^ opposition to the segregation of the sick continued so strong aocommodation. that up to January tlie Arthur Road Hospital was only, half full. By the end of January the patients had increased in number and the hospital arrangements at Grant Road were extended. The services of the Sisters of the Convent at Mazagon were procurecj as nurses, and quarters were erected for them. The staff of the hospital was augmented and another ward was added to it. The Plague Research Committee. Sanitary measures in November and December. Surgeon-Major- General Clegborn visits Bombay. Memorandum of Bombay medical gentlemen recommending the removal of the inmates of infected houses. The nest step in the operations to be noticed is the formation of the Plague Research Committee. This Committee of experts was appointed to enquire into the nature and history of the diseases, by a resolution of the Government of Bombay of the 13th October. Five scientific experts served on the Committee. Surgeon-Major R. Manser, the President of the Committee, investigated the treatment by drugs ; M. Haffkine undertook the study of the plague microbe itself, its effect on human and animal bodies, and the questions of immunity, protective inoculation, and the use of therapeutic serum ; Mr. E. H, Hankin, the Chemical Examiner and Bacteriologist for the North- Western Provinces and Oudh, another expert in bacteriology, occupied himself with questions connected with the plague bacillus in nature, in water, the soil, food-stuffs and other articles ; Surgeon-Captain L. F. Childe was engaged on the pathologo-anatomical part of the investigation ; and Dr. Nasarvanji Fakir ji, Surveyor, dealt specially with the question of plague epidemic in rats. Throughout November and December the cleansing, disinfec- tion and sanitary measures were pushed on vigorously, without however making headway against the disease, which now began to rapidly increase in violence. At the beginning of January the Government of India directed Surgeon-Major-General Cleghorn to visit Bombay with a view to inform himself fully on the ex- isting state of affairs and to advise on the situation. After making a careful investigation on the spot and holding consultations with the local medical officers and private practitioners, Dr. Cleghorn presented to the Government of India a note dealing with the position and a memorandum on the plague signed by a number of the medical officers cf the Government and principal medical practitioners of the city. The gentlemen who signed the memo- randum were of the opinion that the bubonic plague then pre- vailing in the city was, under certain circumstances, only slightly Chap. VII.] Measures in the City of Bombay. 139 contagious and infectious, and that the facts observed in connection with individual cases and those associated with the general pro- gress of the disease, warranted the conclusion that its incidence was greatly due to local conditions. In other chapters of this report ample illustrations are given to show how completely this opinion was in accordance with the previous experience of plague epide- mics in India and in other countries, and how fully it was justi- fied by the experience subsequently gained in the City of Bombay and elsewhere in the Presidency. The medical gentlemen also expressed an emphatic opinion that the only practical method of dealing with the outbreak and of arresting the progress of the disease was the removal of the inmates from houses in which cases of plague occurred, and the subsequent complete cleansing, disinfecting and sanitary overhauling of the premises. They suggested that suitable huts should be provided, free of rent, for the accommoda- tion of different classes, and they believed that it only required the concurrence and sympathy of the leaders of the different sections of the native community to render the scheme a success. In pointing out the necessity for adopting the course recommended, stress was laid on the fact that the untiring energy displayed in the systematic cleansing and disinfecting of the affected parts of the city had failed to arrest the progress of the disease. In the note which he presented to the Government of India, Dr. Dr. Clegbom's Cleghorn expressed the fullest concurrence with the views of the medital gentlemen who signed the memorandum. He stated that so far as general sanitary precautions went, the municipal authorities were Energy with displavinsf the utmost energy. The whole city was under the inspec- which sanitary i^ J i3 oj J u improvements tion of the Health Department. All latrines, drains and narrow lanes were being were being flushed, houses were, as far as possible, being cleansed, suffici'ellt^toTtay disinfected and whitewashed, and in those parts of the city which the disease, were not drained, surface drains of excellent construction were being made in connection with the house-pipes. The efforts of the Health Department were, however, to a certain extent frustrated by the diffi- culty they found in carrying out their operations in inhabited houses, and this important difficulty the suggestion of the medical gentlemen would overcome. Dr. Cleghorn gave the description, which has been quoted in another place, of the insanitary condition of the tene- ments in which the majority of the poor classes lived, and" he represented that the evacuation and thorough disinfection of these edifices was the only course likely to stay the epidemic. Dr. Weir, who was alive to the importance of this matter, was gradually induc- ing the inhabitants to vacate infected houses, but he required more assistance. The Government of India recommend the proposal to evacuate infected bouses to the Government of Bombay. Sfimmary of the measures adopted presented to the House ci Commons, The position having become worse, the Government of India again recommend the evacuation of infected houses. 140 Measures in the City of Bombay. [ Chap. Vlf' In a letter, dated the 19th January, the Government of India earnestly recommended these suggestions to the Government of Bombay. They stated that in the crisis that had arisen there should be no hesitation in taking the strongest measures to prevent the spread of the epidemic, which was menacing the whole of India, even though they might be distasteful to the people affected. The parti- cular measures advocated in the memorandum, namely, the removal of all persons from infected houses and the thorough disinfection of those houses, appeared to the Government of India to be well calcu lated to check the progress of the disease, and the vigorous action that had been taken to clean and disinfect the infected parts of the city having failed to arrest the progress of the epidemic, the Govern- ment of India considered that the measures advocated in the memo- randum should be adopted, and that temporary accommodation suit- able to the families to be removed should be at once prepared. On the 22nd January the following summary of the measures at that time being carried out in the city was given by Lord George Hamilton in the House of Commons :— ^' The efforts of the Government and of the Corporation, between whom hearty co-operation exists, were devoted to relieving sufferers from the plague, to checking its extension in Bombay and Karachi, and to preventing its spread elsewhere. Hospital space was increa- sed, special plague hospitals were provided for six different sec- tions of the community and are being prepared for two other sections. House-to-house visitation is being carried out under medical super- vision. Every suspected case of plague that is not at once removed to the hospital is isolated as far as practicable. Every house where a plague case has occurred is disinfected, and is, as far as possible, vacated, temporary accommodation being provided elsewhere. In- sanitary houses are pulled down, in others partitions are removed or ventilation introduced. Special sanitary precaution^ and improve- ments have been carried out in the backward parts of Bombay City. A fuller staf^ of doctors and Indian medical men is being organised^ and the Bombay Government will indent on England for a temporary staff of doctors and nurses, if more aid is required. " On the 9th February, the position having in the meantime become much worse, the Government of India telegraphed to the Government of Bombay in continuation of their letter of the 19th January, again impressing on that Government the importance of giving effect to the suggestions contained in the memorandum of the medical gentlemen. The Government of Bombay replied on the loth February that the evacuation of all infected houses and the Chap. VII. ] Measures in the City of Bombay. 141 removal of people to temporary dwellings was deemed impracticable The Government if carried out on a large scale and by force. They stated that all ^^^ fUmcuulesTn that was practicable was being done by persuasion. Vigorous action carrying out was being taken for the demolition of insanitary huts, and regulations a large scale, were about to issue under the Epidemic Diseases Act providing for the evacuation of infected houses, the entry into and cleaning, etc., of deserted houses, the prohibition of the further use of evacuated and deserted houses, the summary abatement of overcrowding and the closing of houses unfit for habitation. House-to-house visitation was being conducted energetically in order to ascertain the existence of plague cases, and houses needing cleaning or unfit for habitation were being marked with a view to the remedy of the defects. The Government of India replied in a telegram dated the 12th that Thp Government they had learnt with regret the opinion of the Government of Bombay °hat"fhe '"'"'''^^'" with regard to the evacuation of infected houses and the removal of experiment the inmates to temporary dwellings. In view of the great gravity of and^that^ "'^ ^ the situation and the manifest importance of rigorous action they temporary desired the Government of Bombay to reconside their decision, should be at They considered that the measures described by the Government of """^^ P'"^^'^^^ Bombay were very useful, but were not calculated to take the place of the removal of the inmates of infected houses to a healthy locality. This course appeared to the Government of India to be the only one left which offered a hope of subduing the epidemic. They again urged that sufficient temporary accommodation should be supplied in a healthy locality. On the same day that this telegram issued the Government of More detailed Bombay sent a letter explaining in greater detail their objections to ^'^P^'^^'^'O". of the proposed evacuation of infected houses on a large scale. These made by the objections were mainly the difficulty in providing temporary accommo- Government of dation for the very large number of people who would be removed from their homes, the opposition to be expected from the inhabitants of the city, and the panic the measure would be likely to occasion amongst them. The Government of Bombay were advised that it would be necessary to provide for the accommodation of about 30,000 persons in camps outside the city, and that this accommodation could scarcely be prepared before the rainy season made it unfit for habitation. The inhabitants of the city also had the greatest fear of their sick or them- selves being removed from their houses. The attempt to enforce removal on a large scale could probably result in great panic. The people would refuse to go to the health camps provided for them, and would flee from the city in thousands, spreading the infection of plague all over the country. 142 Measures in the City of Bombay. [ Chap. VIL The Government of India suggest that the experiment should be made for the worst quarters. Measures adopted by the Government of Bombay to give effect to the wishes of the Government of India. Mr. Snow's remari men. hospitals and segregation accommodation for their brethren, and by explaining to the more ignorant what was really being done and the reasons why it was being done, gradually restored a feeling of confidence. In the second place, the change is to be attributed to the tact. Tact and patience, and unremittinor attention of the Placrue Committee, j^g Patience of the . y . =" . V-. (_^oiijjxiittee. account oi the work of the Committee which was fully recorded in the local newspapers shows how day by day they conferred with the General (^atacre's report. General features of the system. Divisions of the subject. 150 Measures in the City of Bombay, [ Chap. VII. leaders of the various communities, encouraged them in their efforts, helped them to select sites for their hospitals, and assisted them in their attempts to detect all cases of the disease and to provide for those who were attacked by it. General Remarks on the Operations of the Committee. The following description of the work of the Committee is mainly- derived from the interesting report prepared by General Gatacre, The passages marked with inverted commas are extracts from General Gatacre's account. Broadly it may be said that the system followed by the Plague Committee differed from that previously in force in the city by enlist- ing the help of the people themselves to a larger extent, by providing for the more certain detection of cases of the disease, by the removal of all patients to hospital, by the provision of largely increased public and private hospital accommodation, and by the more systematic evacuation for purposes of disinfection of all infected houses or rooms. It will be convenient to describe the operations under the follow-» ing main heads : — (i) Organisation. ' (2) Detection of cases and removal of patients to hospital, (3) Treatment of the sick in hospital. (4) Disposal of corpses. (5) Segregation of persons likely to be infected. (6) Disinfection of houses and articles. (7j General sanitary measures. Organisation. Division of the The first step taken by the Committee was the division of the city into ten ^^^^ j^jj-q ^g^ districts, due regard being had to the density of the population and the number of houses in each. Each of these ten districts was placed in charge of a responsible medical officer, styled District Medical the District Medical Officer of Health. In most of the districts the Officers of officer in charge was a Commissioned Medical Officer of the Indian or iiealtn. ^ Army Medical Service, Chap. VII. ] Measures in the City of Bombay. »5i The following were the main duties of the District Medical Officers. Duties of ihese General superintendence and sanitary supervision of the district ; o'''*^^"* supervision of the working of the district hospitals ; supervision of the work of the search parties ; control of the disinfection of infected areas and buildings ; inspection of segregation camps ; notification to the officer appointed by the Government of all insanitary premises discovered in the district; reporting on the registration of burials and cremations, and supervision of the sanitary condition of cemeteries. The District Medical Officers submitted a daily report to the Plague Committee, narrating the events of the past twenty-four hours, and making any suggestions they had to offer. The ten districts into which the city was divided are shown in The ten districts different colours in the map on page 7 of Volume IV, and the quarters of the city contained in each district are also given. The following is a list of the districts : — Quarters of the city contained in the District. Population. Houses. District No. I. Upper Colaba ... ... 4,335 164 Lower Colaba 13,622 1,194 Total 17,957 1,358 District No. II. Fort, South 3,951 469 Fort, North 32,847 1,195 Esplanade 10,064 458 Total 46,862 2,122 District No. III. Mandvi ... ... .,. ,„ 37,295 1,615 Chakla 32,157 I,0j0 Umarkhadi ... ... ... ... ,., 52,46s 1,734 Dongri 30,317 1,054 Total 153,277 5,483 152 Measures in the City of Bombay. [ Chap. VII. Quarters of the city contained in the District. Population. Houses. District No. IV. Market ,., ... ... ... Bhuleshwar ... ... ... ... ■>. Kharatalao ... ... ... ... Kumbharwada ... ... •.. ••. ••• 44.751 38>363 27.035 32,209 1,724 1,331 720 914 Total 142,358 4,689 District No. V. Dhobitalao ... ... •.. »•• ••• Fanaswadi ... ... •.• •.• ••• Girgaum ... ... •.• «•• Chowpati ... ... •» ... 39,945 24,069 26,999 n,5i2 1,620 1,146 I,2So 902 Total District No. VI. Kamathipura „t w ... ••• First Nagpada ... ..• ... ... Second Nagpada... 102,525 4,948 29,203 11,133 18,768 1,344 245 545 Total District No. VII. Walkeshwar ,„ ... ... «•• Mahalakshmi ... ... ... 59,104 2,134 12,990 17,014 1,365 1,279 Total District No. VIII. Khetwadi ... ... .«• ••• Byculla ... ... •" •" Tardeo ... ... ... ••• ••• 30,004 2,644 28,814 47,403 18,980 1,270 1,307 711 Total District No. IX. Mazagon ... ... ..• «• Tarwadl •>! ... ••• ••• 95,197 3,283 33,640 21,298 1,946 I.IS9 Total District No. X. Parel Siwi M. •" Sion -. ••• ••• •" Worli Mahim ... ... •" ••• •• 54,938 3, '05 28,740 6,063 19,601 25,493 18,505 1,229 8S0 2,318 2,286 2,912 Total 98,402 9,625 Chap. VII. ] Measures in the City of Bombay. 153 The districts were further divided into subdivisions, usually under Subdivision of the charge of an officer selected from the medical practitioners of the city. The inspectors and disinfecting staff already working under the Health Department of the Municipality were, after the introduction of the new organisation, directed by the District Medical Officers, the same plan being adopted with regard to the extra men working under the Drainage Department. The staff was also largely increased. A stai=f. number of Justices of the Peace and other influential gentlemen Justices of the assisted In the work in each subdivision in a manner that has already '^^'^®' been alluded to and will be described in greater detail hereafter. The following is a statement of the total staff of the districts, apart from i-otal statT. the hospital staff, and the lady doctors and other ladies who assisted in the house-to-house visitation, etc. : — Subdivisional medical officers ... ,,, ... 25 Justices of the Peace ... ... ... 115 British non-commissioned officers .,, ... 3 British soldiers ... ... ... ... 10 * Military sepoys ... ,.. ... ,.. 518 * Police sepoys ... ... ... ... 158 Ambulance sepoys ... ... ... ... 35 Inspectors of health, disinfection, etc. ... ... 15 Sub-inspectors ... ... ... ... 133 Clerks ... ... ... ... ... 38 ^Time-keepers ... ... ... ... 17 Watchmen ... ... ... ••• 38 Overseers ... ... ... .„ 62 Labourers ... ... .., ... 2,035 General Gatacre makes the following remarks on the subject of the aid afforded by the military: "Owing to the terrifying effect Aid alTorded by the heavy mortality from plague produced on the lower classes of '^^^ mihiary. natives in Bombay, it was almost Impossible to procure servants of any description to serve in plague hospitals; and when procured tempted by the high rates of wages offered, their stay was most uncertain. It constantly happened that men joining the hospital for duty only remained for a few hours. The constant chano-e in menial staff thus caused gave much extra trouble to the medical officers concerned, and was most detrimental to the well-beino- of the patients. With the sanction of His Excellency Lieutenant-General Sir Charles Nairne, K.C.B., Commanding the Forces, Bombav the services of troops in the Bombay District, both British and * Number of officers no: itaied. 20 »54 Measures in the City of Bombay. [ Chap. VIL Military staff. native, were placed at the disposal of the Bombay Government, and, in response to the call for volunteers, officers and men sent in their names en tnasse. Henceforward wherever and whenever in the presidency assistance was required to assist in house visitation, to work .... in the hospitals as clerks, storekeepers, ward orderlies, dressers, cooks, orderlies, or to draw the spring ambulances, parties of sepoys were detailed for these purposes and placed on permanent duty in the district in which their work lay. " The total number of troops employed in the city was— British, Officers Non-commissioned officers Men British oflBcers ... Native officers Non-commissioned officers Men Native. 4 II 29 537 Native soldiers chiefly employed, Clothing', arms, sanitary pre- cautions. Cordiality between the military staff and the civil population. Native soldiers were employed in preference to English soldiers, " The reason of this was, Jirst, that the European garrison of Bom- bay is small and is very fully occupied with guard and other duties, and secondly, that in works which take the British soldier into native houses there is always a risk owing to his absolute ignorance, in most cases, of the language and habits of natives, of a misunderstand- ing arising which may lead to serious offence being given where none is intended." The Justices also "worked more freely and happily with men of their own race than with European soldiers." The soldiers were clothed in a working dress of blue drill with putties ; they wore no side arms, and, except in the cases of large detachments posted at distant points in No. X District (the large northern district), their rifles were left in regimental charge. Careful precautions were taken to protect the soldiers from infection. They were segregated in tents or huts situated close to their work. A cot was given to each man to keep him off the ground. Clothes were changed on return from plague duty, the working parties were inspected each day by a medical officer, and a set of careful instruc- tions was issued with regard to the sanitary and other precautions to be observed. Eleven deaths from plague occurred among the sepoys. General Gatacre states that it was " gratifying to note the extreme cordiality that existed throughout the whole period during which the troops were employed between the military on duty and the civil population. Every kindness, consideration and civihty were shown to the people by the men ; this was thoroughly appreciated, and the Chap. VII. ] Measures in the City of Bombay. 155 result was the entire absence of complaint; no difficulty was experi- enced by European soldiers or sepoys employed in searching or on disinfection duty. ■" The detailed working of the organisation is explained in Chapter Detailed account VI of General Gatacre's report, which describes the work done in No. °^j''^'°' ^ ^'^' X District. The following statement sliows the general equipment of each Equipment of , ,. . . r ,1" !• . • i. the district. sub-division or the district:^ (i) A temporary plague hospital (the size of which was regu- lated by the number of inhabitants) with quarters for the medical nursing and menial staffs, and also for segregat- ing the relatives of patients. (2) A subdivisional office. (3) A temporary barrack for a military detachment. (4) Conductors of search parties, such as Justices of the Peace, and other gentleman who volunteered for the work of house-to-house visitation. (5) A subdivisional staff, comprising a subdivisional medical officer, a clerk, medical subordinates, nurses, ward- orderlies, military and police sepoys for search work, hospital servants, sanitary staff for disinfecting, workmen for building, demolishing, limewashing, and other purposes, coolies for conveying ambulances, an office peon, and police *ramosees for watch work. (6) Hand ambulances on bicycle-shaped wheels, with india-rubber tyres, and stretchers attached. (7) A locksmith, or bunches of keys, for opening up locked houses. (8) Pails, mops, engines, reels, hand-pumps, and all other appliances and tools necessary for disinfecting, building, demolishing, digging, burning, limew^ashing, etc. (9) A stock of disinfectants, jars for holding solutions, and kettles for holding small quantities. (10) Complete hospital equipment according to a scale drawn up with reference to the size of hospital. (i 1) Arrangements for supplying hospitals with daily provisions, stores^ ice, etc. (12) Arrangements for disposal of unclaimed dead bodies. (13) Arrangements for discharging patients on recovery in as antiseptic condition as possible. * Watchmen, 156 Measures in the City of Bombay. [Chap. VII. Description of the district. Subdivision. Subdivisional statT. (14) The provision of a bullock carriage, when necessary, for conveying the relatives of patients to the hospital segrega- tion ropms. (15) Provision of leather shoes for all servants on plague hospital work who would otherwise be barefooted. The district was in charge of Surgeon-Captain Jennings. It was an extensive but comparatively sparsely populated district, and comprised the whole northern half of the island. It included the quarters of Mahim, Worli, Sion, P.arel, and Siwri, The total popula- tion of these quarters of the city is over 98,000, or about one-eighth of the total population of Bombay, and the number of houses is approx- imately 9,600 or about one-quarter of the total number of houses in Bombay. The district was divided into four subdivisions, namely, Parel, Sion, Mahim, and Worli. Each subdivision was provided with a complete organisation and establishment for the purpose of detect- \xi