NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
87
Skin over the swellings dry, hot and tender, and œdema marks the differentia-
tion of the individual glands in the groins; no buboes elsewhere; blood cultures
sterile.
On 10th, at 9 a.m., temperature 103.2° F., pulse 144, respiration 48; stupor
deepening into coma present. Very prostrate. Tongue furred. Sordes on lips. No sleep
owing to delirium during the night. Vesicle the size of a pea has broken down into an
ulcer on right loin. Its contents sterile. Pulse very weak, running in character.
Eyes half open, expression vacant, incoherent and delirious. Vertical cephalalgia.
Lethargy. Buboes in both groins, thick and browny and very tender, with consider-
able surrounding oedema. Bowels moved once and urine passed involuntarily in
bed. Vesicle surrounded by red inflamed spots ; mental hebetude marked.
On 10th, at 6 p.m., temperature 103° F., pulse 140, respiration 48; tongue dirty
brown with fungiform papillas prominent. Prostrate and comatose. Sub-sultus
tendinum present. Passed 3 motions involuntarily in bed, very fœtid, thin and
yellowish. Patient continued to grow worse and died at 11 p.m. on 11th May, not
having recovered consciousness during the last 24 hours.
No bacteriological examination of the contents of the inflamed glands could be
obtained.
Plague-like Remittent Fever at first, late appearance of Bubo
and Broncho-Pneumonia.
No. 355, female, aged 22, from Dadar, admitted 12th April 1897, at
11-30 a.m.
Became suddenly ill at 8 a.m. on 11th April with vomiting, headache, chilliness,
and fever, but had no inflamed gland. Her grandmother had died of plague in
the same chawl, and nine or ten (load rats had been found there ; and during the last
month or so nine people had died of plague in the same chawl.
Present state—Patient is a well-nourished young unmarried woman. Slightly
drowsy. Conjunctivæ not injected. Pupils normal, eyes suffused. Tongue coated
with thick white patchy fur at sides. Pulse 112, soft and compressible. Skin
hot and dry. No delirium, slight frontal headache. Restless and drowsy. Dull
and apathetic. Did not sleep last night, was incoherent, and rambling in low
muttering state.
Nothing abnormal in liver, spleen, heart, lungs or abdomen. No rash, wounds,
abrasions or buboes can be found, and she remained in this state up till the 14th at
11 a.m., when temperature 104° F., pulse 120, respiration 32. and a well-defined bubo
can be seen and felt in the left axilla. At 4 p.m. the bubo was larger, harder, size
of walnut or small orange, on the pectoral margin of left axilla, very tender and
well defined.
Patient anœmic with respiration decubitus, restless, drowsy, and slightly delirious.
Tongue with thick yellowish-brown, patchy fur. Skin of body hot and dry,
extremities cool.
Eyes partly closed, mouth wide open. Expression vacant.
Pupils contracted and eyes turned upwards and inwards. No sordes. Abdomen
flaccid. Liver and spleen not felt. Respiration deep, pectoral in type. Feels thirsty,
drowsy, and complains of pain in the left axilla. Patient has not menstruated for the
last seven months. Breath sound, normal.
22
91
soft, full, but remarkably compressible. Bowels constipated, urine passed highco lored
febrile, deficient in chlorides and slightly albuminous. Pupils dilated. Eyes always
open, fixed, and staring. Mouth half open. No buboes discoverable anywhere.
No rash or wounds. Temperature (at this time) 105° F., Pulse 128, Respiration 28.
On the 11th morning—Slept only 1 hour during the night, very delirious and
almost uncontrollable. Cough and expectoration constant ; pain in, right side,
head-ache, and thirst complained of greatly.
Physical signs of pneumonia scattered and not well marked. Finger pricked and
blood examined and bacilli found in it.
Tongue brown and dry. Skin very burningly hot. Perspiring about head and
neck. No buboes found. Eyes markedly injected. Very incoherent. Floccitation
and carphology present and great jactitation.
On 12th no change ; all symptoms aggravated. No buboes ; prostration and
"typhoid state" increased. Expectoration as before, and cough more frequent, if
possible, than previously. Sinks down in bed, is dull, apathetic, and drowsy. At
6 p.m. collapsed and did not rally till 8 p.m. in spite of ether, hot bottles, stimu-
lants and strychnine; and at 11 p.m. was markedly collapsed; Temperature subnormal;
Pulse 148 R. 48. Pulse could hardly be felt, small, very weak and thready ; skin of
body generally and especially of extremities cold, and death ensued at a few minutes
after midnight. No buboes discovered after death externally, but no post mortem
could be obtained to determine the presence or absence of internal buboes.
The blood after death showed myriads of plague bacilli.
92
Statistical and Clinical Record of Work done in the
Grant Road Hospital during the period of its
existence from the 4th of March to the 15th of
June 1897 by Dr. A. McCabe Dallas, L.M., L.R.C.P.
(Dublin).
401 patients were admitted, 27 of whom were not suffering from plague ;
leaving 374 actual cases to be reported on.
This number includes almost every variety of the disease, and for convenient
reference I have classified the admissions under five sets of tables.
Table (a) exhibits the comparative nature of each form of attack together with
mortality.
Table (b) shows how the castes were affected.
Table (c) indicates their occupation.
Table (d)—Mortality returns for age arranged in half decades.
Table (e)—Relative comparison of the sexes.
In table (a) it will be observed that 98 cases were purely of the pneumonie
type, 9 were pneumonic accompanied by buboes in various positions, 2 were of
the carbuncular type, 2 were apparently free from either bubo or pulmonary com-
plications, while the remainder were entirely of the bubonic variety.
It is unnecessary to analyse the seat of those glands most affected, beyond
pointing out that enlargements in the groins and axillas predominated, and from the
early history of plagues, the present epidemic appears to show no exception in this
respect. If we refer to "Russell on Plague" written anterior to 1840, it will be
seen that from 2,700 observations made by him the inguinal eruptions are most
common, being more in the right than the left side, proportionately about 1 to 1
The axillary regions come next in frequency, the right being more often affected
than the left, although the difference is inconsiderable. This practically coincides
with the observations noted in my hospital.
The ages most exposed to risk range between 20 and 40 years in both sexes.
SO years seems the maximum danger point. From youth up to this figure the disease
gradually increases, and having reached its height there, 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 probably 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.
Mortality among females is higher than males.
As regards occupation, no special vocation appears to be singled out. The
major portion of the patients being labourers, the death-rate naturally shows a
greater percentage in this class.
The first clinical question to discuss is that of a proper scientific name for the
disease, which is popularly recognised and understood to mean Plague. In the
101
considerably involved, and in another case. where a patient appeared to be progressing
favourably, a diarrhœa of mucous discharge setting in, death followed, and it was
found that the inflammation from an inguinal bubo, which had extended downwards
and inwards, causing an adhesion with the descending colon, suppurated and dis-
charged its contents into the bowels.
Accompaniments met with in the course of post-mortems but unconnected with the disease.
1 Patient had renal calculi.
1 Phthisis.
1 Cancer of the stomach.
1 Atrophy of the left kidney.
1 Enlarged prostrate gland.
1 Large polypi in colon.
2 Dysenteric ulcerations.
Diagnosis.
This disease can hardly be mistaken for any other form of fever by those who
have had any experience in its treatment.
The character of the fever, the staggering gait, the peculiar aspect of, and pain
in buboes, and the special nature of the tongue prevent the possibility of its being
confused with fever accompanied with any other form of bubo, whether syphilitic
or sympathetic. There is also the expression, appearance of the eyes, and the diffi-
culty in articulation or hesitancy in speech to be remembered, and in pneumonia,
the character of tongue, sputa, and special physical signs in lungs are distinct from
ordinary inflammation.
Prognosis
Is always to be of a guarded nature. The points for a favourable issue are :—When
the bubo rises early and advances to rapid suppuration, or when it is firm and move-
able ; when there is no marked fever, cerebral disturbance, or vomiting ; when the
respirations do not correspond with the smallness of the pulse ; and when there is a moist
skin or even a gentle perspiration, with little restlessness and a fall of pulse concomitant
with a defervescence of temperature, the pupils regaining their normal size from dila-
tation, the conjunctivæ not being injected and the tongue being moist.
Summary.
The disease affects those most often between the ages of 20 and 40 years.
It has two forms—chiefly bubonic and pneumonic, the latter being a more
fatal and infectious type.
It may have a third form where no enlargement of glands can be detected.
That there is a secondary form of pneumonia originating from hypostasis,
which must not be confounded with the primary form, as each has distinct features.
That the pulse does not usually correspond to the temperature nor to the
respiration.
That in all acute cases the bacilli should be present, but in death at a late
period, or immediately after recovery, the bacilli may be absent.
105
is still obscure. Its antizymotic action is well known, especially in preventing
fermentation, and it has the power of arresting molecular processes detrimental
during the hyperpyrexial state. It is an antipyretic capable of considerably reduc-
ing the temperature, and, though accused of disturbing the cardiac centre under
ordinary circumstances, it does not appear to do so in plague. Indeed phenol is a
natural product resulting from the pancreatic ferment on proteids, and as
tympanitis is a common accompaniment in this disease from fermentation, we are
only adding an excess of an item which nature has already provided in our natural
state. It may be pushed in 2 or 3 minim doses every three hours and beyond a
point where it not only discolors the urine greenish, but causes retention. It is the
most reliable drug at our disposal.
Iodine is another valuable medicine which has found favor in the treatment of
plague ; it is a diffusible antiseptic, exerting especial efforts on the glandular or
lymphatic system and is best administered in the form tincture. Even in 5 minim
doses, continued every three or four hours fou a week, it did not act apparently in
breaking clown red corpuseles and causing a bloody condition of the urine. It may
therefore be summed up that the bulk of my cases were treated as follows for the
glandular variety :—
Liq. strych.
Carbolic acid
Tinet. Iodine
Tinet. Digitalis
Aqua ...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
m. 3
m. 2
m. 4
m. δ 1
oz. 1
every three hours.
Hot poultices to bubo. 1 oz. of rum every three hours ; about 2 pints of milk
during the 24 hours, and in every caso where the temperature exceeded 103 an
ice-bag was applied to the head.
At bed-time ½ dr. to 1 dr. of the liq. morph. hyd. B. P. was given and repeated
once if necessary. When a patient was incapable of swallowing from any reason,
everything was administered per rectum.
Pneumonia—
Liq. strych.
Sodii salici
Carbolic acid
Tinet. digitalis
Spt. ætheris
Tine. scillæ
Aqua ..
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
m.
gr.
m
m.
m.
dr.
oz.
3
5
2
4
10
I
1
every three hours.
The whole of the thorax to be kept enveloped in hot linseed poultices. Stimu-
lants, food, &c., as in the other type. There was no use in trying speculative treat-
ment after these two prescriptions showing the best results.
Tympanitis was relieved by hot turpentine stupes or hot linseed poultices
over the whole abdomen, and where constipation was present with tympanitis,
an enema of turpentine, with 15 or 20 oz. of hot water, saturated with
dr. of
tincture of iodine, afforded relief. A slight variation had occasionally to be made
where unforeseen symptoms appeared. A persistent hiccough was best stopped
with a dose of laudanum and the application of a piece of ice on the pit of the
stomach.
106
The atonic diarrhœa which takes place occasionally originates during con
valescence, occupies the lower bowel, and is yielding to enemas composed of
Dover's powder
Bismuth
Bice water, warm
gr. 5
gr. 5
oz. 2
every 3 hours or often.
Or to a draught of
Dilute sulphuric acid
Water
dr.½
oz. 1
every 2 hours.
as a draught according to circumstances proves satisfactory.
Where there was delirium or sleeplessness, hyoscine hypodermically in 1/12 th
or 1/10th grain proved disappointing. Sulphonal is fairly beneficial.
Bromide of potassium and chloral hydr. were satisfactory in less acute cases or
in sleeplessness without delirium.
Opium is well tolerated, but morphia proved the best narcotie in my hands.
Phenacetin, antipytin, and other pyretics of this group are too depressing and
unsuitable.
Any idiosyncrasy with respect to digitalis may- be relieved by substituting
strophanthus. Camphor is unreliable. So is Salol.
Alcohol is borne in large quantities even where patients have been conscious.
12 ounces of Jamiaca rum given within 24 hours produced no intoxication.
Continued hypodermic injections of æther over the cardiac region for heart
failure failed ; this I attribute to the failure being due to toxic paralysis, and not
to temporary or functional fatigue or syncope.
The compound cinnamon mixture so strongly advocated by some medical
men was given a fair trial with no benefit.
In an early case where there was an abrasion on the hand with, an axillary
bubo, the Russian Medical Commission pronounced the attack to be duo to
inoculation.
With this idea they suggested the arm being rolled up from
fingers to neck with lint soaked in a 1-1000 solution of perchloride of mercury
and covered with waterproof sheeting ; the lint to be moistened every third hour.
This was continued for three days. The patient got worse ; the treatment was
abandoned and carbolic acid and iodine mixture substituted. She ultimately
recovered. The theory was to overtake the disease in its lymphatic stage by
causing local absorption of the corrosive sublimate and destroying the bacilli
or toxine.
Nitrate of pilocarpine acted as a powerful and rapid diaphoretic, but otherwise
failed. It was given in 1/10 gr. doses hypodermically.
The ipecac treatment recommended by some medical missionaries in China
produced continual emesis, but did naught else.
Wet packing and immersion in ice contributed towards the reduction of
temperature, but each patient on whom it was practised died. The reduction was
only temporary.
107
Thirst was relieved by ad lib. quantities of soda (not aerated) water and
lemonade, also by acid fruits, such as oranges and limes, which were much
appreciated.
Regular feeding both day and night, and otherwise careful nursing with
comfortable bedding and a change of clothing daily, are essential considerations.
Disinfection.
This consisting in adding perchloride sol. 1-1000 to every excretion, whether
evacuations, urine, vomited matter, or suppurated discharges, and as far as possible
to pulmonary expectoration.
1-1000 sol. of perchloride of mercury and a 5 per cent. solution of carbolic acid
was ever ready in the wards to wash the hands, sponges, or instruments used in
connection with the cases.
Rags or linen squares used as dressings or to wipe up excretions and sputa,
being of no value, were burnt.
Bedding, as sheets, blankets, pillow slips, &c., and clothing were, on being
changed, saturated with a one per cent. solution of perchloride of mercury then ex-
posed in the sun till dry and subsequently washed in the ordinary way by a resident
dhoby.
The general latrines for native employés and convalescents were treated twice
a day with carbolic powder. The evacuations received in an iron vessel with
deep sides to prevent splash were disinfected with a 1-1000 corrosive solution and
every night conveyed to a special nightsoil cart for disposal,
Hospital.
Consisted of three wards, each about 66X33 ft. capable of holding 78 patients,
and on several occasions had nearly their full complement. Originally the wards
were sheds with a good plinth and tiled roof, intended and used for other
infectious diseases ; the walls consisted of matting with a foot opening below and
above, which afforded ample and free ventilation ; the flooring was of earth beaten
down and laid with a layer of lime, and the lime renewed every month. Expert
medical opinion declared the flooring to be proof against the life of plague
bacilli.
A stand-pipe was provided in front for hospital use, and one behind for the
halalcores and dhoby. The surplus water was conveyed into the immediate drain
on the western side.
Segregation huts were erected on the weather side for patients' friends, of
whom a large number availed themselves of this convenience. They were in all
instances supplied with food, if they desired it, or provided with money from the
Pollen Fund, instead, for this purpose.
All persons who died were removed to the mortuary and, pending removal to
the cemetery, were sprinkled over with carbolic powder. On removal, their bodies
were washed with a solution of phenyle and afterwards rolled in a sheet saturated
in a solution of perchloride of mercury.
Where friends provided their own burial arrangements for the dead and dressed
the body in new clothing, the disinfecting sheet was not omitted.
27
108
Where friends desired a private burial for their dead and had no means to
carry out their intentions, money was given them from the Pollen Fund, or they
were assisted with money and new clothing from the Hospital stock.
Caste sympathies and prejudices were always respected, and after the people
found this out and the liberty and freedom allowed between friends and patients,
it created full confidence in every direction.
The outdoor dispensary gave relief to 75 patients suffering from various
ailments. Two reasons interfered with more work being done here : first, the
staff were fully occupied in their primary duties, and, secondly, the native public
appeared doubtful as to the object of the dispensary. They suspected its institution
as a sort of inducement to have their ailments discovered, which might wrongly be
mistaken for plague. But latterly this suspicion was dying out, and an outdoor
dispensary in the same locality is capable of doing a vast amount of good. It is
central and in the midst of a large poor population.
The staff of the Hospital, whose duties were carried on actively both day and
night, consisted of
1 Medical Officer.
2 Hospital Assistants.
1 Compounder.
7 Nurses from the
Roman
Catholic Convents.
10 Ward-boys.
1 Storekeeper.
1 Office peon and dispensary
servant.
9 Sweepers.
2 Brahmin Cooks.
1 Mahomedan Cook.
10 Men belonging to the 17th Bo.
N. I. were trained as ward
orderlies. They performed their
duties most satisfactorily and
evinced thorough obedience and
discipline to all orders.
10 Men belonging to 21st Bo. N. I.
were also trained as ward order-
lies.
Seeing that all the working staff was new to this class of work, which re-
quired incessant care and watchfulness, it is gratifying to note that all the employes
conducted their duties to my entire satisfaction, and Hospital Assistants Prabakar
Bulwant and Sayaji Sewaji (the latter subsequently transferred to Cutch Mandvi)
rendered excellent service.
I cannot write too highly on the devoted and self-sacrificing manner in which
the Sisters of the Roman Catholic Convents performed their arduous work under the
supervision of the Reverend Mother St. Agnes. Having closed their class rooms
purposely to accept this duty of nursing and never having been engaged in a similar
capacity before, their attention and anxiety for the sick deserve great praise.
On the 14th of June these ladies were replaced by Miss Morey, Miss Hale,
and later on by Miss Kendall, Mrs. McGill from the J. J. Hospital, and Miss Ander-
son. The Nurses from England exhibited great aptitude and intelligence, both
medical and surgical, in the discharge of their official functions and are
a credit to the Hospitals where they received their professional education.
Mrs. McGill is a painstaking and careful Nurse, on whom every reliance can be
placed, while Miss Anderson is a capable woman in all details and in this respect
gave every satisfaction.
TABLE A.—Classification of Plague cases in Grant Road Hospital.
Description.
Pneumonia
...
...
...
Pneumonia with bubo in left
parotid gland...
...
...
Pneumonia with buboes in left
parotid, and right and left
inguinal glands
...
...
Pneumonia with bnbo in right
axillary glands
...
...
Pneumonia with bubo in left
axillary glands
...
...
Pneumonia with bubo in right
inguinal
glands...
...
Pneumonia with bobo in left
inguinal glands
...
...
Pneumonia with buboes in
right and left inguinal
glands
...
...
...
Pneumonia with bubo in right
femoral glands
...
...
Pneumonia with bubo in left
femoral glands ...
Bubo in right parotid glands..
Bubo in left parotid glands ...
No. of. cases.
98
1
1
8
3
11
6
2
2
1
10
8
Recovered
26
...
...
5
...
6
3
2
1
...
5
3
Dled.
72
1
1
8
3
5
2
...
1
1
5
6
Description.
Bubo, right and left parotid and
right axillary glands ...
Bubo, right parotid and right
axillary glands
....
...
Bubo, right parotid and left
axillary glands
...
...
Bubo, left parotid and right
axillary glands
...
...
Bubo, left parotid and left
axillary glands
...
...
Bubo, right parotid and right
cervical glands
...
...
Bubo, left parotid and left
cervical glands
...
...
Bubo, left parotid and sub-
inguinal glands
...
...
Bubo, right parotid and right
femoral glands
...
...
Bubo, right and left parotid
and left inguinal glands ...
Bubo, left parotid and left
inguinal glands
...
...
Bubo, right axillary glands ...
No. of cases.
1
1
2
1
1
1
1
1
1
1
1
24
Recovered
1
1
tea
...
1
...
...
...
...
...
9
Dl ed
•......
...
2
1
1
...
1
1
1
1
1
15
Description.
Bubo, left axillary glands ...
Bubo, right and left axillary
glands
...
...
...
Bubo, right axillary and right
supra trochlear glands ...
Bubo, left axillary and left
supra trochlear glands ...
Bubo, right axillary and right
inguinal glands
...
...
Bubo, left axillary and left
inguinal
glands...
...
Bubo, left mammary glands...
Bubo, left lumbar glands
...
Bubo, right lumbar and left
popliteal glands
...
...
Bubo, left inguinal and left
popliteal glands
...
...
Bubo, right inguinal glands...
Bubo, left inguinal glands ...
Bubo, right and left inguinal
glands
...
...
...
No. of cases
18
2
1
1
1
1
1
1
1
65
60
4
RecoveredI
10
9
1
1
...
1
...
...
1
...
28
28
1
Dled
8
...
1
...
1
...
1
1
...
1
37
32
3
Description.
Bubo, right cervical and right
inguinal glands
...
...
Bubo, left supra trochlear and
left inguinal glands
...
Bubo, right femoral glands ...
Bubo, left femoral glands ...
Carbuncle, left inguinal glands...
Without bubo or pneumonic
indications...
....
....
Total number of cases ...
„
„
deaths
...
„
„ recoveries
Mortality ... ... ...
Recoveries ... ... ...
Deaths under 24 hours
...
No. of cases
1
13
2
2
...
...
...
...
...
...
Recovered
1
1
4
2
2
...
...
...
...
...
...
Mortality excluding deaths under 24 hours
Recoveries
„
„
24 "
Dled.
...
...
7
10
...
...
574
225
149
60.16
89.84
84
48.65
51.35