NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
173
The present Medical Officer took charge of the Hospital on 28th July 1898.
The Hospital was then chiefly used for detaining and keeping under observa-
tion cases of fever sent from the various bunders by the Port Health authorities.
The numbers of plague admissions were then comparatively few, but they gradually
swelled with the increase of plague in the City.
In February 1899, the Health Officer of the Port opened a special camp for
his " Bunder cases " on the site of the old Modikhana Camp, and ceased sending
them to this Hospital. This helped much to increase our accommodation for plague
cases.
In March 1899, accommodation was further augmented by opening two extra
wards.
The largest number of patients under treatment in this Hospital was 135 on
the 12th March 1899.
Staff.
During the height of the epidemic, the following staff was employed :—
1 Medical Officer.
4 Lady Nurses.
2 Local Trained Nurses.
2 Hospital Assistants.
1 Clerk.
1 Compounder.
1 Muccadum of Ward boys.
13 Ward boys.
4 Ayahs.
2 Cooks.
3 Dhobies.
1 Limewasher Muccadum.
9 Coolies.
4 Ramosis.
11 Mehtars.
4 Mehtranis
In addition to this, the following staff was employed for the Modikhana Steam
Sterilizer worked in connection with this Hospital :—
1 Engineer.
1 Fireman.
4 Coolies.
During the period under report, the following Lady Nurses worked in this
Hospital :—Miss Green, Miss Truman, Miss Harris, Miss Fry, Miss Scott, Miss
Riley, and Miss Hale. To these ladies, to the Hospital Assistants, and to the staff in
general, the Medical Officer offers his best thanks for their cheerful co-operation and
valuable assistance rendered during the time.
Hospital.
2. The Hospital consists of following sheds :—
7 Wards.
1 Office.
1 Dispensary.
1 Resident Hospital Assistant's
quarters with kitchen.
1 Hospital kitchen.
1 Godown for food, stores, &c.
1 Mortuary.
1 Store-room for lime.
2 Sheds for Servants' quarters.
1 Shed for Mehtars.
1 Contact shed and kitchen.
1 Shed latrines.
In addition to these, there are four other godowns, one shed for Dhobies' bhuthee and
a sentry box.
Sisters'
quarters.
In January 1899, quarters for Nurses were put up adjoining the Hospital
compound, with accommodation for three Sisters, their servants, and a kitchen.
During the height of the epidemic the extra Sister was provided with a tent pitched
close by.
179
Phlyctenules.
Pustules or phlyctenules were noticed in 10 cases, and had a distinctive
appearance; in the beginning a small vesicle was noticed which showed nmbilication
and contained a clear fluid which afterwards became greyish and purulent. A zone
of inflammation invariably surrounded the base which was hard and painful. The
vesicle gradually enlarged, and if the patient survived, it sloughed away, leaving a
deep punched out ulcer, very slow to heal.
Alimentary
Symptoms.
Alimentary System.—-There was generally intense thirst, dryness of the
tongue, sordes, and foul breath. The tongne coated brown or even black, dry,
sometimes cracked, and sometimes the papilloe unusually prominent. But there was
nothing characteristic about the appearances of the tongue in plague.
In cases of buboes in the cervical region accompanied with much surrounding
infiltration there was dysphagia.
Vomiting:.
In some cases there was vomiting, sometimes incessant, so that patients were
not able to retain anything. The vomited matter might be :—
1. Simple Mucus.
?. Medicines, &c., and curdled milk.
3. Bilious matter.
4. Coffee grounds.
5. Bloo.1.
Sometimes tho vomit was very offensive.
The abdomen was generally found to be distended, either from dilatation of
the stomach, Intestinal flatus or from distension of the bladder.
On palpation it was sometimes tender all over. In the cases of deep-seated
pelvic buboes, they could be easily felt upon deep pressure in the iliac regions.
Generally there was constipation, sometimes diarrhoea, occasionally foeted.
In some cases there was melœna.
The presence of ascarides lumbricoides was almost a constant occorrence.
Liver and
Spleen.
The liver was sometimes found enlarged. The spleen was often found to
extend beyond the costal arch.
Circulatory
Symptoms.
The Circulatory System,—The characteristic want of tone in the pulse has-
been previously described.
Heart.
Heart's sounds were often noticed to be muffled. Dilatation of the heart
was not detected.
Hœmorrhages.
Various haemorrhages were noticed: epistaxis, haemorrhages into con-
janciivce, bleeding from the throat, haemoptysis, hcematemesis, and also melœna.
There were no cases of hcematuria nor haemorrhages into the skin.
Respiratory
Symptoms.
Pulmonary
Lesions.
Respiratory System.—Hiccough was sometimes noticed. The respirations
were hurried, generally above 30 per minute, and in grave cases with pulmonary
complications, short, irregular and gasping. Congestion of the pulmonary tissue or
of the bronchioles or a catarrhal condition of them was noticed in a majority of case.
This secondary pneumonic condition was noted in 19 cases out of 28 cases treated
by the Indian Plague Commission with M. Koux's serum, an analysis of which
will be given in the form of an appendix.
A description of primary pneumonic plague will be given subsequently.
Nervous
Symptoms.
Nervous System.—-Besides the symptoms of drowsiness and delirium and the
characteristic manner of speech, mentioned above, various other nervous phenomena
were noticed. Delirium was rapidly followed by great prostration and coma.
180
Headache was more or less a constant symptom and so also sleeplessness.
In a few cases a peculiar fibrillar trembling of muscles was noticed.
Generally there was marked muscular atrophy, and sometimes spasmodic
muscular contractions of extremities, sometimes spasms resembling tetanus.
Picking at bed clothes was noticed in severe cases, and in a few cases con-
vulsions preceded death.
Urine.
Urinary System.—Unfortunately, owing to pressure of work, no special
observations were made with regard to this system. Retention of urine was a
common symptom, but suppression was never met with. There appeared to be no
diminution as regards the quantity of urine excreted.
Complications.
The various complications met with have been described above under the
various systems, and, in addition to these, acute conjunctivitis, ulcerative keratitis
and hypopyon have been constantly noticed.
Aphasia was met with, and in one case the patient remained aphasic for nearly
one month after the subsidence of all the acute symptoms.
Pregnancy complicated plague in six cases. Abortion followed in every case.
There were no recoveries.
Secondary abscesses were met with in a large number of cases, and in one
case eight such abscesses were opened.
In some cases the pus from suppurated buboes showed a tendency to travel
along the areolar tissue in long directions.
Sequelae.
The sequel of plague were noticed to be, firstly, a very protracted period of
convalescence, the result of asthenia following the extreme prostration from the action
of the toxines of plague on the tissues. The ulcerations resulting from the suppura-
tion of buboes, or from sloughing away of dead tissue of buboes or plague phlyctenules,
showed no tendency to rapid healing.
Two cases developed phthisis during convalescence and died of exhaustion.
Dementia was observed in one case.
Clinical
Varieties.
For Clinical purposes three varieties of plague were recognised :—
(1). Bubonic.
(2). Septicoemia or non-bubonic
(3). Pneumonic.
Bubonic
Plague.
The bubonic variety was accompanied by the presence of bubo which confirms
the diagnosis of the disease.
Non-bubonic
Plague.
In the second variety all the typical symptoms of plague were present, but no
bubo could be detected externally. This so called septicoemic or non-bubonic type
was met with in 294 cases. The absence of buboes showed that the infection was
not through the ordinary lymphatic channels. The terra " Septicaemia" is
misleading, for every case of plague is a septicoemia, and there is no reason, therefore
why this term should be applied to non-bubonic cases in particular.
Pneumonic
Plague.
The third clinical variety is pneumonic plague. In a certain number of cases
all the usual symptoms of plague are present, but no bubo, showing that the
infection is not through the lymphatic system. There are, however, on physical
examination certain inflammatory lesions invariably found in the lungs ; and the
sputum is found by bacteriological examination to be swarming with plague. It
is inferred from this that in these cases the primary infection is through the
respiratory tract.
182
All the ward attendants had special instructions that under no circumstances
was an acute case to be allowed to sit up. All violently delirious patients were
properly secured by tying them down to their cots by means of " clove-hitch" knots
Medical
Treatment.
Immediately on admission, plague patients were put on the following
mixture :—
R—Liq. Strych
M. v.
Spt. Ammon. Aron.
...
5p
Spt. Etheris. Nitrosi
...
3 p
Aq. Mentha pip. ad
§ i
every 4 hours j along with this, they received from 4 to 6 ounces of rum during
24 hours, also a hypodermic injection of liquor strychninse B. P. m.v. was given
as a routine practice, three times daily, or every 4 hours in collapsed cases,
For nourishment they received milk and conjee regularly during the day
and night, and also egg flip every morning and evening. Delirious patients were
fed by means of nutrient enemata.
Treatment
of Bubo.
In some cases recovery took place even when absolutely no local treatment
was applied to the bubo.
Generally when buboes were extremely painful, an application of glycerine
and belladonna seemed to alleviate the pain.
The routine treatment for buboes was as follows:—A thick pad of absorbent
cotton was soaked in 1 in 40 carbolic solution, and kept over the bubo by means of
a bandage. This compress was renewed every 4 hours.
When a bubo showed signs of suppuration, poultices were sometimes used to
hasten the process.
When actual suppuration had taken place in the buboes, they were freely
laid open to facilitate the escape of sloughed tissue. The cavity was afterwards
stuffed with strips of lint and iodofbrm and allowed to heal from the bottom.
This procedure also prevented the pus from burrowing deeper, so that very seldom
did a bubo need to be incised twice.
Treatment
of Symptoms.
The various symptoms and complications arising during the course of the
illness were treated as follows :—
Pyre.via.—If the temperature was above 103° F. Ice bag on the head, in
over 105° F. cold sponging. Coal tar antipyretics were never used.
For delirium, ice bag on the head ; in a few cases blisters were tried. The
usual treatment was the following mixture :—
R—Ammon. Brom.
...
...
...
... 3 p
Spt. Amraon. Aromat
mxx
Liq. Strych
... mij
Aq. Menth. pip. ad
§ i
It was repeated after two hours if necessary.
In violent cases where immediate effect was desired, the hypodermic
injection of 1/6 to 1/4 gr. of morphia, combined with 2 to 3 minims of liq. strychnine,
had sometimes good effect.
The phlyctenule was treated with carbolic compresses, until it showed no
signs of further spread of the inflammation at the base and until a distinct line
of demarcation was formed. Poultices were then substituted, the slough was
dusted over with iodoform, and finally the sloughed mass was removed by the knife
or scissors. The ulcer left xvas dressed in the same way as the buboes.
183
Vomiting was treated by giving milk and medicines iced and by pieces of
ice to suck by the mouth. Sometimes calomel gr. ij and santonine gr. j had a
marked effect in checking it. Brandy was substituted for rum. Mustard plaster
over the pit of the stomach. In very severe cases 1/e to 1/4 gr. of morphia was
bypodermically injected over the epigastrium with good result.
For thirst, soda water and ice to suck.
For headache, saline purgatives, ice bag on the head and bromide
draught.
Constipation was relieved by means of calomel gr. V, aperients or enemata.
Diarrhoea was checked by astringents.
In meloena, calcium chloride gr. x to xv, 4 hourly, was tried with marked
benefit.
The heart's action waa mainly sustained by the hypodermic use of Strychnine
as mentioned before.
Hoemorrhages were treated with full doses of calcium chloride.
Where pulmonary complications were present, cotton wool or flannel jackets
were ordered and the following mixture, 4 hourly, was given:—
R—Vini Ipecac
...
m xv
Spt. Ammon. Arom.
...
5 i
Tinct. Scillac
m xv
Liq. Strychninse
m
j j g
Aq.
ad
B i
also injection of Strychnine as above, every four hours.
Sleeplessness was treated with a Bromide draught combined with half an
ounce of rum.
Distension of the bladder, was relieved by hot fomentations, or failing this
by means of a catheter.
Oorneal ulcerations were treated with constant use of Boracic Acid drop,
and compresses of Boracid Acid solution. No eyes were lost.
Special
treatments,
Stapbylococcns
In 6 cases a small quantity of pus was injected into the buboes. In one the
bubo, a left parotid one, suppurated and the patient made a good recovery. All
;he remaining cases died.
Rouse's
Serum.
28 cases were treated by Roux's serum. The cases have been fully described
in the appendix.
Conclusion.
The Medical Officer cannot but conclude this report without expressing his
deep obligation to Col. Wilkius, I. M. S., D. S. 0., the Special Medical Officer in
charge of Plague Operations, for his guidance and ever valuable advice.
The work of Prof. Miiller and the Rev. Mr. Grey, who had charge of the
" Discretional Relief Fund," was gratefully appreciated by the patients, and their
gifts of fruit, biscuits and toys were much enjoyed.
To the Rev. Father George, S.J., many thanks are due for his keen interest
and for his exertions in securing plants and flowers for the hospital; and to Mrs.
Nevin for her numerous presents of clothing for little children.
D. A. TURKHUD, M.B.O.M.,
Chief Medical Officer,
Modikhana Hospital.
184
TABLE Ij—-Total admissions during tJie year.
—
Months.
June
1898
J^y
„
August
„
September „
October
„
November „
December „
January 1899
February „
March
„
April
„
May
„
Total ...
Plague.
1
• • •
22
65
55
48
71
213
284
330
124
54
1,262
Relapsing
Fever.
1
3
5
15
6
30
19
11
7
6
4
107
Observation
Cases including
all General
Diseases.
3
5
15
20
10
12
29
77
99
128
52
47
497
Total.
5
5
40
90
80
61
130
309
394
465
182
105
1,866
The largest number of weekly admissions was 140 for the week ending
March 3rd, 1899, and the largest number of daily admissions were 21 on 2nd March
1899, 4th March 1899 and 6th March 1899, respectively.
The largest number of daily deaths was 17 on 3rd March 1899, 5th March
1899 and 13th March 1899, respectively.
Besides the admissions given above in Table I, 2,193 Bandar passengers
were sent to this hospital for observation by the Port Health Authorities, as follows :—
Bandar Cases.
Months.
June
1898
Jniy
„
August
,
September „
January 1899
Total
Number.
130
83
161
302
811
383
586
237
2,193
During the year under report 194 contacts were admitted into this hospital,
out of which 6 developed Plague.
185
Total Weekly deaths and percentage of deaths to admissions.
Week.
Ending
5
3
,,
,,
,
})
}
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,,
1}
,,
,,
,,
5)
,,
11
,,
,,
,
,,
,,
,,
,,
,,
,,
,,
)}
,,
,,
,,
,,
,,
,,
,,
,,
,,
,,
,,
,,
2nd June 1898
9th „
16th „
23rd „
80th „
7th July
14th „
21st „
28th ..
,,
4th August
11th „
18th „
25th „
1st September
8th
„
15th „
22nd „
29th „
6th October
13th „
20th „
27th „
3rd November
10th „
17th „
24th „
1st December
8th
„
15th „
22nd „
29th „
,,
•••
•••
„ ••
...
...
„ •..
...
...
„ ...
...
...
„ ...
...
...
„ ...
...
...
j •••
•••
•••
,,
•••
-••
•••
.. ...
...
...
„ ...
...
...
„ ...
...
...
„ ...
...
..
.a.
...
...
J
••
"•
•••
„
"••
•••
,, ...
...
...
„
...
...
...
„
...
...
„
...
...
...
"•
„
...
...
...
J
••
••
•••
,,
...
...
...
„
...
...
...
••
•"
••
It
•
•'•
•••
„
•••
•••
„
...
...
„
...
...
...
5th January 1899
12th „
19th „
26th „
2nd February
10th „
17th
„
24th „
3rd March
10th „
17th „
24th
31st „
7th April
14th „
21st „
28th „
5th May
12th „
19th „
26th „
31st „
„
...
...
...
l
•••
•"
..•
„
...
...
...
,,
...
...
...
„
...
...
...
|
••
•••
U
...
...
...
„
...
„
•••
•••
••
„
•
•••
•••
,,
,, ...
...
...
„
...
...
...
,,
...
...
...
„
...
...
...
„
...
...
...
„
...
...
„
...
...
Total
Admissiom.
8
1
......
1
1
4
••••.
2
8
13
14
14
20
20
29
30
18
19
20
23
23
15
17
25
19
22
33
27
41
56
64
92
84
100
59
110
140
114
104
102
85
45
48
37
42
40
41
22
14
5
1,866
Deaths.
3
...••
... ...
••••.
......
......
.. ••••
......
1
3
6
4
5
14
11
15
15
14
11
7
8
14
4
7
9
8
9
15
14
23
43
42
56
62
67
46
67
95
78
73
1
61
52
27
32
23
29
17
21
18
8
3
1,140
Percentage of
deaths to
Admissions.
• • • • •
300-0
•• •••
•
•
......
,
50·0
37·5
46·1
28·5
35·7
70·0
55·0
51·7
50·0
77·7
57·8
35·0
347
608
26·6
41·1
36·0
42·1
40·9
45·4
51·8
56·2
76·7
65·6
60·8
73·8
67·0
77·9
60·9
67·1
68·4
70·1
59·8
61·1
60·0
66·6
62·1
79·0
42·5
51·2
81·8
57·1
60·0
84·3
186
TABLE II.
Admissions.
Plague
Relapsing Fever
Observation & other Diseases.
•
Total ...
1,262
107
497
1,866
Deaths.
1,028
23
89
1,140
Percentage
Recoveries,
of
Mortality
230
86
391
707
81·4
22·5
18·1
• ••1C •
TABLE III.—All' Diseases.
Months.
June
1898
July
„
August
„
September „
October „
November „
December „
January 1899
February tt
March
„
April
„
May
„
Total ...
Total |
admissions.
5
5
40
90
80
61
130
809
394
4'65
182
105
1,866
Died with-
in 24
hours.
...
3
27
20
33
22
78
88
88
30
46
435
Within
48
hours.
...
1
4
13
1
5
28
55
54
21
9
| 191
Total
Deaths.
4
• ••
15
52
47
37
46
207
253
289
116
74
1,140
Total
Recoveries.
15
5
12
27
42
26
48
76
124
156
100
76
707
Percentage
of
Deaths.
80'0
···
37·5
57·7
58·7
60·6
35·3
66·9
64·2
62·1
65·3
70·4
...
TABLE III.—Plague.
Months.
June
1898
July
„
August
H
September „
October „
November } ,
December ,,
January 1899
February ,,
March
„
April
„
May
„
Total ...
Admissions
1
•••
22
65
55
43
71
213
284
330
124
54
1,262
24 hours.
...
' 3
27
20
83
22
78
88
88
30
46
4S5
i
48 hours.
•• •
c • • 1
4
13
1
5
28
55
54
21
9
191
Total
Deaths.
4
•••
14
Recoveries.
• ••
47 i
9
47 •
35
46
12
9
14
180
17
224
269
101
61
...
32
45
44
39
...
Percentage
of
Deaths
4000
...
63·6
72·8
85·4
81·3
64·7
84·5
76·8
81·6
81·4
112·9
...
TABLE III,—Relapsing fever.
Month.
June 1898
,.
July
„
August
„
September „
October „
November,,
December „
January 1899
February „
t
March
„
April
May
,,
Total „,.
Admissions.
1 1
......
3
5
15
6
30
19
11
7
6
4
107
Deatas.
!
8
12
8
3
...
1
22
Recoveries.
1
1
8
14
5
13
20
15
5
5
4
33
Percentage
of
Deaths.
60
63·1
25·4
42·8
•••••
25·0
187
TABLE! IV.—Hindoos.
Males
Females
Children under 12 years
Total Admis-
sions.
1,381
212
97
Deaths.
815
155
i
52
Recoveries. I
514
58
41
Percentage of
Deaths.
61·2
75·0
54·6
TABLE IV.—Mussulmans.
Total Admis-
sions.
Males
;
82
Females
'
10
Deaths.
29
5
Children under 12 year ...
4 |
1
!
Recoveries.
50
2
3
Percentage of
Deaths.
35·3
50·0
25·0
TABLE 1Y.—Christians.
Total Adinis-
sions.
Males
Females
Children under 12 years ...
106
18
8
Deathe.
68
8
5
Recoveries.
33
9
2
Percentage of
Deaths.
85·8
71·5
62·5
TABLE IV.—Jews.
Total Adm is
sions.
Males
1
Females
1
i
Children under 12 years ...'
Deaths.
1
1
Recoveries.
••••••
Percenta ge of
Deaths.
1000
100-0
i
i
TABLE IV.—Parsis.
Males
Females
...
Children under 12 years
Total Admis-
sions.
......
Deaths.
... •••
Recoveries.
1
......
Percentage of
Deaths.
......
188
TABLE IV.
Plague oases among Hindoos at the Modikhana Hospital during the year ending
3lst May 1899.
Females
Children under 12 years
...
Total
Admissions.
862
170
69
Deaths.
725
143
50
Recoveries.
139
29
13
Percentage
of Deaths.
TABLE IV.
Plague cases among Mussulmans al the Modikhana Hospital during the year ending
31st J%;|899.
Males.
Females
Children
Total
Admissions.
41
6
1
Deaths.
25
4
1
Eecoveries.
20
1
Percentage
of Deaths.
TABLE IV.
Plague cases among Christians at the Modikhana Hospital during the year ending
31s/ May 1899.
Males
,„
Females
Children
Total
Admissions.
92
11
8
Deaths.
Eecoveries.
i
65
25
8
1
5
2
Percentage
of Deaths.
TABLE IV.
Plague cases among Jews at the Modikhana Hospital during the year ending
31st May 1899.
Mules...
Females
Total
Admissions.
1
1
Deaths,
1
1
......
Eecoveries.
Percentage
of Deaths.
189
TABLE V.—Table showing the mortality for the year amongst sexes and children.
Total Mortality for
the year.
1,140
Mortality
amongst
the men.
913
Moitality
Mortality
amongst
amongst
children all
women.
under 12 years
of age.
169
58
TABLE VI.—Showing Situation of Buboes.
Situation.
Cervical
Parotid
R. Axillary
L. Axillary
B. Femoral
L. Femoral
B. Inguinal
L. Inguinal°0
ther Situations
No Buboes
Multiple Buboes ...
Total
No. of
cases.
79
17
109
80
56
64
220
213
18
294
67
1,223
Males.
45
10
77
64
45
53
173
167
11
255
58
958
Females.
20
5
25
14
5
4
36
34
4
32
6
185
Children.
,
Mortality Ee-
coveries.
14
50 ,
25
2
7
7
8
6
7
11
12
3
7
3
80
94
70
48
52
180
164
12
266
47
990
9
16
13
5
9
42
59
6
33
13
280
Percent-
age of
Mortality.
61·2
41·1
86·2
81·3
85·7
81·2
90·0
76·9
66·6
90·4
70·1
80·9
Upper Eyelid 1
Cheek 1
Sub-Maxillary 6.
Left Lumbar 1
Palm
1
Sub-Mental 4
Popliteal 1
Pelvis
2
Tochhar 1
TABLE VII.—Pneumonic Plague without Buboes.
Males...
Females
Children
Admitted.
80
6
3
Died.
30
5
3
Kecoveries.
••••••
Percentage.
l00·0
88·3
100·0
190
TABLE VIII.
Table showing cases of secondary plague pneumonia (complicated with
buboes).
This table is drawn from the 28 cases, which were treated with Roux's
serum and which were kept under special observation ; 19 of these were found to be
suffering from secondary pneumonic symptoms.
Males
Females
Children
Oases.
19
Died.
16
•••••
Recovered.
3
Percentage of
Mortality.
84'2
(1) In these cases the bacteriological examinations were carried on by Lieuts.
Douglas and Walton of the I. M. S.
(2) Out of the above 19 cases, 13 were found to be suffering from secondary
pneumonia on the day of their admission, three developed it on the second day, two on
the third day and 1 on the fourth day after admission.
D. A. TURKHAD,
Chief Medical Officer,
Modikhana Hospital.
Notes by the Special Medical Officer.
The interesting Report by Dr. Turkhad is published in fall. The work done
by the hospital and staff is very good.