NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
38
Report of Wari Bunder Hospital.
GOVERNMENT HOSPITAL NO. 8.
This hospital was opened on 26th March 1897, and closed on 18th May 1897.
Received 56 cases in all, of which 28 prove4 fatal. Death=rate, 50 per cent.
Cases
Recovered
Died
...
...
56
28
28
Of these 56 cases the following are the details :—
A.—Death Rate.
Male.
36
fex.
Female.
14
Children.
6
Death-rate
Male.
%
55
Female.
%
Children
%
17
Caste.
Hindus ...
Mahomedans
Native Christians
Jews
...
...
...
...
...
...
...
...
45
7
2
2
B.—Site of Bubo.
Femoral.
15
Inguinal.
10
Cervical.
9
Axillary.
6
Cervical & Inguinal.
4
None.
6
C.—Pneumonic Type—6 cases.
Observations—
There are three principal forms of bubonic plague.
1. Lymphatic, the simplest.
2. Glandular enlargement.
3. Pneumonic.
(1) Lymphatic.—Affection of lymphatic glands, whether femoral, inguinal,
cervical, or axillary.
Here the seat of inoculation is local, due to abrasion (any form of solution of
continuity).
The local condition involves generally—
1. Constitutional disturbance.
2. Fever (101—3).
3. Rapid pulse (120—30).
4. Furred tongue.
5. Constipation.
6.. Headache and pains in back and legs.
7. Tendency to suppuration of bubo, leading to general good recovery.
Or the above symptoms (1, 2, 3, 4) may be accompanied by extreme
(1) Prostration and the tongue (4) be swollen, glazed, indented, and
tremulous.
(2) Albuminuria is present.
(3) Haemorrhage nasal
enteric.
(4) Jaundiced, drawn, and haggard countenance.
(5) Enlarged liver and spleen.
(6) Suffused conjunctive.
(7) Restlessness and insomnia.
(8) Violent delirium.
Generally terminating Fatally.
NOTE.—Enlaigement of cervical glands the more severe type.
(2) Non-lymphatic.—More serious. Corresponds with the lymphatic with
the exception of non-glandular enlargement, as in 1 (2). But the constitutional
disturbance and prognosis are very grave.
39
(8) Pneumonic Type.—Clinically difficult to distinguish from ordinary lobar
pneumonia ; symptoms being very similar.
Extraordinary Sign—Suffusion of conjunctivæ.
Diagnosis—Requiring bacteriological examination.
Prognosis—Bad.
NOTE.—All six cases admitted proved fatal.
Observations on General Treatment—
Free stimulation,
1 (Drugs)—Ammonia carbonate.
Strychnine.
Alcohol, freely.
2 (Diet)— Milk, broth, beef-ten,
3 (Drinks)—Barley water ; lemon water.
Arrowroot and rice conjee.
NOTE.—Mineral waters not to be recommended ; as inflative and impedimental of
heart's action.
4 & 5 (To reduce temperature).—Tepid sponging and ice-pack, bromides and
sulphonal.
6. Suppuration of bubo to be encouraged, but not hasty incision
after suppuration.
7. Careful nursing essential.
Aeute Stage—Acute stage of disease, ten days to three weeks. The first two
weeks to the crisis. In virulent cases, death in 36 hours, or convalescence very
slow, and subject to relapse.
Sequelae of Plague—
1. Aphasia.
2. Hæmiplegia.
3. Local paralysis and twitching.
Disinfeetion of Premises—
1. Free exposure to air and light.
2. Lime-washing, &c.
3. Carbolic acid solution (1 in 40.)
4. Solution perchloride of mercury.
Report of Reay Road Government Hospital.
GOVERNMENT HOSPITAL NO. 10.
Hospital Staff.
Medical Officer in charge, Dr. Britto.
1 Compounder.
2 Nurses.
2 Ayahs.
4 Clerks.
10 Ward-orderlies.
3 Bhistis,
This hospital opened on 1st April 1897 and closed on 4th May 1897 ; received
2.2 plague patients, of whom 8 died.
After 4th May 1897 it became a segregation camp for suspects under Sea-traffic
Inspection.
Cases
Absconded
Recovered
Transferred
Died
...
...
...
...
...
22
—
1
3
10
8
Of the 22 cases treated, the following are the details of two
selected cases which are accompanied by charts :—
CASE A.
Age 25. Hindu.
Patient's state on admission (4th day of illness)—
Temperature
Pulse ...
Respiration...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
106
110
30
Note that pneumonic and cerebral symptoms were developed simultaneously and
independently.
40
CASE B.
Age 25. Hindu.
Patient's state on admission (a transfer from Observation Gamp)—
Temperature
Respiration ...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
106
110
35
with glandular swelling in left groin. In the evening He was seized with epilepsy, and
subsequently became unconscious, in which state he died on the 2nd day after admission
Symptoms.— Urine scanty, passed in small quantities, and-high-coloured. A case
of the nephritic type.
Sion Hospital.
GOVERNMENT HOSPITAL NO. 16.
Sion Hospital was built on the high ground situated east of the village of
Sion Ivoliwada. It contains three wards nominally of 10 beds each, but capable of
holding sixteen beds each if required to do so.
In addition it was provided with the usual out-door accommodation of a two-
section hospital, including temporary nurses' quarters, a sub-divisional office, two
rows of segregation huts for the relations of patients, and a barrack for accommo-
dating a detachment of infantry posted there for the purpose for providing men for
search and causeway guard work ; which incidentally proved useful as a hospital guard.
The Staff consisted of one Medical Officer, two hospital assistants, one clerk,
two nurses, six ward-orderlies, and a menial staff as detailed in the attached tabular
summary. The Sub-divisional Medical Officer of Sion, Bhoiwada, and Sewree also
did duty as Medical Officer of the Hospital in a most satisfactory manner. The
nurses worked zealously and conscientiously throughout. Of the two hospital
assistants, one remained for only a short time, when he was transferred, and the
other, Mr. Purbaram Tooljaram, who did good work eventually, caused much annoy-
ance when first appointed by refusing to reside in or near the hospital. Of the six
ward-orderlies, four remained throughout and worked well, and the other two were
transferred to Worli. Considerable difficulty was experienced in procuring menial
servants, and in retaining them when appointed, owing to the distance from Bombay
and their awe of the plague. The hospital was used for cases and suspects found in
Western Dharavi, Sion, Govari, Matunga, Vadalla, and Sewree and also for cases and
suspects detained by the Medical Inspection staff at the Sion-Coorla Causeway. It was
opened on the 27th of March and closed on the 17th of May 1897. There were 67
admissions, of whom 23 died (11 within 24 hours after admission) and 44 recovered.
Summary of Report on Sion Hospital.
Hospital opened
Hospital closed
Admissions ...
...27-3-97
...17-5-97
... 67
Recoveries ... ...
Deaths ... ...
Transferred convalescents
44
23
...
Staff.
Medical Officer ...
Hospital Assistant
Clerk
...
...
Nurses
...
...
Ward-orderlies
Ramosees ...
...
...
...
...
...
...
1
1
1
2
4
2
Cooks ...
Dhobie ...
Sweepers
Bhisti ...
Peon
Ayah
...
...
...
...
...
...
...
...
...
...
...
...
2
1
6
1
1
1
42
Staff.
Medical Officer ...
Hospital Assistants
Clerk
...
...
Compounder ...
Sisters ... ...
Assistant Nurses
...
...
...
...
...
...
1
2
1
1
3
4
Ward Orderlies ...
Ramosees ...
Cooks
...
...
Dhobie ... ...
Hospital Boy
Sweepers
...
...
...
...
...
...
8
2
3
1
1
7
Worli Hospital.
GOVERNMENT HOSPITAL NO. 18.
Worli Hospital was built on that part of the Worli foreshore known as Cleve-
land Bunder. It contained two wards nominally of ten beds each, but capable of
holding sixteen beds each if required to do so. It was also provided with the usual
outdoor accommodation of a one-section hospital, including temporary quarters for
nurses, a sub-divisional office, a block of rooms for the relatives of patients, and
lines for a small detachment of infantry posted there for the purpose of providing
men for search work, which proved useful as a hospital guard. The Staff
consisted of one Medical-Officer, two nurses, one hospital assistant, one clerk, four
ward orderlies, and the menial staff detailed in the attached tabular summary.
The Medical Officer was Dr. Dordi, who was also Sub-divisional Medical
Officer of Worli Pakhadi. The nurses worked most thoroughly and conscientiously
throughout. Great difficulty was experienced in obtaining and retaining menial
servants on account of their awe of the disease and the distance from Bombay.
One ward orderly, who misbehaved himself and created a disturbance, was sent back
to his regiment. The rest of the staff worked faithfully and zealously and gave
every satisfaction.
The hospital was used for plague cases and suspects from Worli and
Worli Pakhadi. It was opened on the 1st of April and closed on the 20th of May
1897. There were 44 admissions, of whom 21 died (8 within 24 hours after
admission), 11 recovered, and 12 were transferred to the Parel Hospital in a
convalescent condition. It was decided to retain and strengthen this hospital after
closing it, but the decision has since been abandoned, and the hospital is now in
course of demolition. Matting walls and partitions are to be burnt, and the timber,
bamboos, and jowlies retained for such uses as compensating the poor whose huts
have been demolished, strengthening existing structures, and erecting monsoon
shelters elsewhere.
Summary of Report on Worli Hospital.
Hospital opened
Hospital closed
Admissions
Recoveries
Deaths
...
...
...
...
...
Transferred convalescent
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
1-4-97
20-5-97
44
21
11
12
Staff.
Medical Officer ...
Hospital Assistant
Clerk
...
...
Nurses...
...
Ward Orderlies...
...
...
...
...
...
1
1
1
2
4
Ramosees
Cooks ...
Dhobie ...
Sweepers
Peon
...
...
...
...
...
...
...
...
...
2
2
1
3
1
43
Report of Jullaia Mahommedan Hospital.
GOVERNMENT HOSPITAL NO. 19.
This hospital opened on 10th April 1897; closed. Received 50 plague patients,
of whom 22 died.
Hospital Establishment.
Hakim—Din Mahomed Bhaqui.
1 Compounder,
4 Ward-boys,
3 Ayahs, with
a menial staff of 7.
The hospital was conducted under a Hakim, and general supervision was
exercised by Government Medical Officers; Government also defraying all expenses.
The report and accompanying temperature charts sent in contain useful statistics
clearly arranged.
It is impossible owing to the singular character of Hakim's medicines to give
any account of the general treatment adopted. But the rate of mortality is satisfac-
torily low, being 44 or nearly 9 per cent, below the mean rate of all hospitals.
CASES.
Cases
Recoveries...
Deaths
50
28
22
Of the 28 recoveries, the following were the symptoms :—
High fever and vomiting only
Pneumonia ...
...
...
...
...
...
...
...
...
...
19
8
1
Proportion in respect of sex—
Males were 15; Females 12.
Proportion in respect of age—
Under 8 years
...
Between 12—15 years
„
15—20 „
„
20—25 „
... 2
... 3
... 5
... 7
Between 25—30 years...
„
30—35 „ ...
"
40—45 „ ...
...
...
...
6
2
3
Deaths, 22.—Of the 22 deaths, the following were the symptoms :—
Glandular enlargement ...
High fever only... ...
Pneumonia (no enlargement)
...
...
...
...
...
...
...
...
...
...
...
...
18
3
1
Proportion in respect to sex—
Males were 16 ; Females 6.
Proportion of Age.
Under 9 years
Between 10—15 years
„
15—20 „
„
20—25 „
"
2o—30 "
...
...
...
...
...
3
3
2
5
3
Between 30—35 years
„
35—40 „
„
40—45 „
„
45—50 „
„
55—60 „
...
...
...
...
...
0
2
1
2
1
44
Times of Survival in Hospital.
12 hours
36 "
72 "
96 „
...
...
...
...
...
...
...
...
...
...
...
• ••
3
5
6
3
7 days
12 "
14 "
27* „
47* „
...
....
...
...
...
...
...
...
...
...
...
...
...
...
...
1
1
1
1
1
Died of exhaustion from excessive suppuration having survived attack 67 and 73 days.
Time of Survival after Attach.
Died—
2nd day of illness
3rd
„
4th
„
5th
„
6th
„
7th
...
...
...
...
...
...
...
...
...
...
...
...
2
3
8
1
1
1
Died—
8th day of illness
9th
„
32th
„
28th
„
67th
„
73rd
„
...
...
...
...
...
...
...
...
...
...
...
...
1
1
1
1
1
Survival after the fourth day of illness gives a distinct chance of recovery.
Sites of glandular enlargements in the 37 cases in which these were present.
Left Femoral
Eight Femoral
Left Inguinal
Bight Inguinal
Left Axillary
Bight Axillary
Bight Inguinal and
Cervical (right)
...
...
...
...
...
...
...
...
...
...
...
...
...
Right Femoral
...
...
...
...
...
...
...
oral.
...
11
11
6
2
3
1
1
Recovery.
Death ...
Recovery.
Death ...
Recovery.
Death ...
Recovery.
Death ...
Recovery.
Death ...
Recovery.
Death ...
Recovery.
Death ...
Recovery.
Death ...
8
3
5
6
4
2
1
1
0
2
0
3
0
1
1
0
Proportion of cases attacked, in relation to age. Of the 50 cases treated—
5 were between the ages of—
5
10
10
9
2
5
1
2
1
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
2—10
10—15
15—20
20—25
25—30
30—35
35—40
40—45
50—55
55—60
Of these, there were 31 males and 19 females.
Suppuration—
Of 37 cases of enlarged glands, 6 suppurated ... Recovered...
4
(Died
... 2
Of 31 cases in which suppuration did not occur 15 recovered and 16 died.
Charts accompany the report.
45
Statistical Summary of Work done at the Arthur Road
Hospital by Dr. Choksey, Medical Officer in Charge.
GOVERNMENT HOSPITAL NO. 14.
1. The Municipal Hospital at Arthur Road which had been receiving plague
cases since September 1896 came under the Plague Committee's administration on
the 2nd March 1897. The following is a short statistical summary of the work done
at the hospital from 2nd March to 30th June 1897.
2. Grounds and Buildings.—Accommodation for 115 patients existed, and
an additional ward for 35 patients, then under construction, brought up the total
accommodation to 150. Several structural alterations were made in the old sheds
two of which were re-enclosed with new mat-frames and one with deal boarding.
A verandah ran round each building and water connections which were in close
proximity to the wards were removed to convenient places in the compound.
Quarters and kitchens for the Nurses, Hospital Assistants, and Servants were
constructed. The compound was kept scrupulously clean, all vegetation and
undergrowth being constantly removed.
3. Conservancy and Water-supply.—The water-carriage system is in exist-
ence at the hospital ; all excreta, &c., were disposed of through the drains after
thorough disinfection with corrosive sublimate or carbolic acid. The water-supply is
from the Vehar main. Several fresh connections were made to give additional water
facilities to the hospital.
4. Establishment.—The establishment consisted of 1 Chief Medical Officer,
1 Assistant Medical Officer (during March and April), 3 hospital assistants, 1
compounder and clerk (for a part of the period only), 12 ward-boys, 3 ayahs.;
3 cooks, 1 dispensary servant, 4 Police ramosees, 5 sweepers, and 1 mehtrani.
Nursing.—For the first two months the Sisters of All. Saints nursed at the
hospital. From 3 to 5 Sisters devoted their energies to the work, and they were
assisted by two, and at times, three locally trained nurses, whose expenses were
defrayed out of some moneys placed at the disposal of the Chief Medical Officer
by two Hindu gentlemen—Messrs. Dwarkadass Dharamsey and Gordhandass
Khatao. Subsequently English nurses were detailed to work at this hospital.
5. Patients.—On the 1st March 1897 there remained under treatment
98 patients suffering from bubonic plague; of these, 10 belonged to January
admissions and 88 to February admissions. These cases will be accounted for in
the report from September 1896 to February 1897 to be submitted hereafter to the
Municipal Commissioner. The number of patients admitted during March, April,
May, and June were 193, 60, 26, and 42 respectively ; thus making a total of 321 for
four months. The following table shows particulars and details :—
Months,
March.»
,.
April
May
June
Total ...
No. admitted.
193
GO
26
42
321
Died within 24 hours.
54
17
7
2
80
Died within 48 hours.
34
10
1
1
46
Total deaths.
13')
34
10
6
180
Recovered.
63
26
16
36
141
percentage of total mortality.
67.35
56.66
38.46
14.28
56.07
Percentage of
mortality excluding
the deaths with in
first 24 hours.
54.28
39.53
1578
10.00
41.49
11a
46
6. Details of Patients.—The following tables give the detailed particulars
of the various castes and sexes of patients treated, with results :—
Hindus.
—
Males ...
Females
Children,
...
...
...
...
Total
...
...
...
Total
172
50
33
255
Cured.
71
21
17
109
Died.
101
29
16
146
Percentage of
mortality.
58.72
58.00
48.48
57.25
Mussulmans.
—
Males...
Females
Children
...
...
...
...
...
...
Total
...
...
...
...
Total.
24
4
2
30
Cured.
11
3
...
14
Died.
13
1
2
16
Percentage
of
mortality.
54.16
25.00
100.00
53 33
Christians.
Males ...
Females
Children
...
...
...
...
...
...
Total
...
...
...
...
Total.
24
5
2
31
Cured.
10
3
2
15
Died.
14
2
...
16
Percentage
of
mortality.
58.33
40.00
00.00
51.61
Jews or Beni-Israels.
—
Males ...
Females
Children
...
...
...
...
...
...
...
...
...
Total
...
...
...
...
Total.
......
2
2
4
Cured.
.....
1
1
2
Died.
...
1
1
2
Percentage
for
mortality.
......
50.00
50.00
50.00
Parsees.
—
Males
Females
Children
...
...
...
...
...
...
...
...
...
Total
...
...
...
...
Total.
1
......
1
Cured.
1
1
Died.
.....
......
Percentage
of
mortality.
.....
......
.....
48
GOVERNMENT HOSPITAL No. 15.
Statistical and Clinical Record of Work done in the
Parel Hospital (Government House) during the
Period of its Existence from the 9th of February to
the 26th of June 1897 by Surg.-Capt. Thomson, I.M.S.
Parel Plague Hospital was opened on 19th February 1897 and closed
on 26th June 1897. During the period—upwards of four months—630
patients were admitted, and 70 were detained under observation for
periods varying from one to three days, under suspicion of plague.
Total number treated and detained were 700. Of the 630 admitted cases,
97 were suffering from other diseases, 229 were convalescents transferred
from other plague hospitals, and 304 were acute plague cases.
This report is in reference to the 304 cases of undoubted plague that
came under personal observation :—
Admitted...
Recovered
Died
...
...
• • •
...
...
...
General mortality percent.
304
108
196
64.5
Of these 149 were men, 66 women,
and 89 children (53 boys and 36
girls).
European ...
Native Christians
Jews ...
Parsis ...
Mahomedans
Hindus
Total
...
...
...
...
...
...
...
Total.
1
66
4
6
16
211
804
Males.
1
......
38
1
4
14
148
205
Females.
1
28
3
2
2
63
99
Died.
1
44
3
4
8
136
196
Recovered.
.....
22
1
9
8
75
108
Infants.
8
2-5 yrs.
5
5—10
17
10—20
61
20—30
85
30 -40
56
40—50
34
50—60
26
60—70
10
70 & upwards.
2
The youngest patient was aged 10 months ; the eldest 96 years.
ANALYSIS OF MORTALITY.
Period after Admission to Hospital at which Death took
place in 196 Cases.
Moribund
(5 mts.— 22 hrs.)
66
1st
17
2nd
38
3rd
8
4th
24
5th
10
6th
9
7th
5
8 th
6
Days.
10th
3
13th
1
15th
2
16th
1
18th
1
21st
1
22nd
1
28th
1
29th
1
37th
1
49
Mortality.
64.5%
Men.
68.6%
Women.
71%
Children.
52.8%
Boys.
42.-5%
Girls.
64.5%
Situation of Bubo.
Right Axilla
Left Axilla
Right Remoral
Left Femoral
Right Inguinal
Left Inguinal
Eight Cervical
Left Cervical
Eight Parotid
Left Parotid
Multiple ...
No Buboes
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
Total.
47
32
59
31
17
32
8
4
7
1
24
42
Percentage
15.5
10.5
19.6
10.2
5.6
10.5
2.6
1.8
2.3
0.3
7.9
13.8
Males.
30
16
45
18
11
25
7
2
3
1
15
29
Females.
17
16
14
13
6
7
1
2
4
...
9
13
Died.
34
24
33
14
10
21
6
2
5
...
14
33
Re-
covered.
13
8
26
17
7
11
2
2
2
1
30
9
Mortality per
cent.
72.4
75
56
45.2
59
65.6
75
50
71.4
58.3
78.6
R
Right side—150, of which 12 were multiple.
Left side—108, of which 8 were multiple.
Both sides—4, of which 4 were multiple.
In upper part of the body—109, of which 10 were multiple.
In lower part of the body— 149, of which 10 were multiple.
In both upper and lower—4, of which 4 were multiple.
Distribution of Bubo.
Right Axilla ...
Left Axilla ...
Eight Femoral
Left Femoral
Eight Inguinal
Left Inguinal
Eight Cervical
Left Cervical ...
Eight Parotid
Left Parotid ...
Multiple
Ko Buboes
...
...
...
...
...
...
...
...
...
...
...
...
Total
...
...
...
...
...
...
...
...
...
...
...
...
...
Men.
18
9
35
13
5
17
6
1
3
......
13
29
149
Women.
7
14
31
7
2
6
.....
3
.....
6
10
66
Boys.
12
7
10
5
6
8
1
1
......
1
2
......
53
Girls.
10
2
3
6
1
1
2
1
......
3
3
36
Buboes in unusual
situation
:—
Right popliteal and right calf of leg (and left axilla)...
Left popliteal (and left femoral)
Right brachial (and right axilla)
Right forearm ... ...
Scalp ... ... ...
Mammary gland ... ...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
Cases
... 1
... 1
... 1
... 1
... 2
... 3
50
VARIETIES OF-PLAGUE.
Plague cases vary very much in seventy, and some are so mild that
it is only by the appearance of a bubo that one can know the patient is
attacked by this specific disease.
(I) Nervous.—The most common form might be called nervous,from
the presence of delirium, headache, cerebral vomiting, giddiness, sleeplessness,
stupor, coma, and death by cardiac syncope from derangement of the func-
tions of the central nervous system.
(II) Pneumonic.—This form is characterised by broncho-pneumonia
or primary lobar pneumonia, cough, delirium, serous expectoration occa-
sionally tinged yellow with blood, very few physical signs in the chest,
expectoration containing large numbers of specific plague bacilli, absence of
buboes, absence of dyspnoea, and of disturbance of the pulse ; respiration
ratio as in acute pneumonia, slight pain, irregular temperature, early
cardiac failure and death.
In Parel 9 cases of this « variety of plague were diagnosed as primary
plague pneumonia and all of them died.
There were 19 instances of secondary pneumonia, of which 17 died
and 2 recovered, and 4 had double broncho-pneumonia amongst the 17 that
died.
(Ill) Abdominal—This is characterised by early prostration, irregular
remittent temperature, early abdominal distension, delirium, typhoid state
(picking at bed-clothes, sinking down in the bed, involuntary passage of
evacuations), simple diarrhoea of a thin, watery, and very offensive kind,
aspect dull and stricken, absence of eruption, late appearance of bubo, and
death by coma.
PEEDISPOSING CAUSES OF PLAGUE.
Occupation.—Occupation in itself did not predispose to the disease.
Most of the hospital patients were very poor labouring-class people.
Dhobies are said to be particularly exempt from plague ; yet seven were
admitted. 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 was indescribable.
The exciting cause, no doubt, as will be referred to under bacteriology,
was the specific plague bacillus of Kitasato and Yersin.
Contagion.—There can be no doubt of the contagious nature of plague
under certain insanitary conditions. When one case of plague came from
a house, in 25 instances a second succeeding case came from the same
house ; in three instances a third, and in one instance o fourth case.
How the first case arises it is impossible to state. It is remarkable that
many instances of the death of rats in the house, infected room, or neigh-