NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
21
were numerous. Captain Lock remarks on the virulence of the disease
in Borah Bazaar Street in the Fort :—
'* The houses are of good quality—the rooms large and airy—while the majority
" of the occupants were away in Camps. Most of the cases were among the
" servants left in charge ; but my opinion is that the cause of plague was the
" defective drainage and the dampness of the ground floors."
Captain Cuppage, after noticing how often well constructed, and
thoroughly sanitary buildings, apparently became infected through the
unhealthiness of the locality in which they were situated, gives a striking
example of a building, erected on sound principles and kept thoroughly
clean, remaining free from plague while the scourge was raging fiercely
round it :—
" Situated between old and new Sonapur Lanes in the Dhobi Talao Section
" this building shows a clean bill, not having recorded a single case of plague since
" the first outbreak up to date, though placed in the heart of a highly-infected centre."
Contrast with this another example cited by him :—
" A very noticeable feature with reference to this locality (New Hanuman Lane)
" is that, though plague raged in the most virulent form all round it, a small area,
*' known as Angria's Wadi, remained perfectly immune until the month of January,
" notwithstanding the fact that it is most insanitary and thickly populated by a
" caste known as Karwas, and the houses in it are dark, low, damp and densely
" packed."
Captain Stuart, too, after noticing the general tendency of plague
to attack insanitary places, notices various localities which were an
exception to this rule, thus :—
" (1) Goregamker in Girgaum, inhabited by Brahmins—an exceptionally clean
" race—had a good deal of plague. The chaul is clean and well-ventilated. The cases
'' were probably imported, the infection being kept up through concealment.
" (2) Kotachiwadi— Inhabited by Native Christians, who do not mix much with
" those around them, had a good deal of plague. The place looks clean ; and till the
" appearance of rats enjoyed good health. Every house had one or more rats.
" (3) WalJceshwar.—In the servants' quarters plague was discovered, but not
" very much, mostly in Harkness Koad, and Narayen Dabholkar Street,—rats must
" have been the cause, they were found in the latter place. In one bungalow a girl
tl got plague in the servants' quarters just one year after the last case, exactly in the
" same spot, though the former rooms had been razed to the ground, and new quarters
" built with a higher plinth."
And again in a circle formed by nine good houses in Mahaluxmi, 32
cases occurred, and are ascribed by the District Officer to the malevolent
influence of rats.
Influence of
flats,
It is exceedingly difficult to obtain any precise information, either
about the movements of, or the mortality among, rats. A certain propor-
tion of the more enlightened realised that the finding of dead rats upon
their premises indicated the presence of danger, and hurried to give
information to the District Officer with a view to the place being disin-
23
infection, but that is an almost universal opinion in .Bombay: though
occasional instances have been observed where plague infection has been
carried by human beings from one house to another, and sickness in the
second house has been followed by rat mortality.
Dead rats did riot always mean plague among the residents in a
house. In December 1898 large numbers of rats were noticed along the
foreshore of Golaba at dusk, and writing at this time, the District
Officer says :—
" Dead rats have been found in as many as 25 houses. In nearly every house
" they have been found off and on for at least 14 days before the fact was brought
" to notice. Each house \vas disinfected on receipt of information. In five of these
" houses cases of plague occurred."
Endeavours were made to persuade the people to vacate their
houses in all these cases ; where the finding of rats had heen followed by
plague among the residents they went willingly enough ; but when no
one had been attacked with plague, and the rats had stopped dying,
they could not see the necessity of leaving. It is, however, significant
that the mortality in the Fort began to rise from th« beginning of the
month of December. In one case plague broke out simultaneously in
two adjoining houses. In one lived Hindus, in the other Parsees. There
was no intercourse between the residents, and the only point of com-
munity was that dead rats had been found in both houses shortly before.
Instances constantly occurred all over Bombay where dead rats had
been found a few days previously to the residents of a house being attack-
ed with plague, and it was a common incident to find dead rats in cup-
boards or behind boxes when a house was being disinfected on account
of plague, but in this as in most other respects it was difficult to collect
precise information. Lieut. Brackenbury writes regarding B Ward
South :—
" Dead rats in any numbers were never found by the Plague Staff, but there
" can be no doubt that from the middle of March 1899 to the middle of April 1899,
" L e. } during the height of the epidemic in Mandvi, rats were dying in great
(t numbers all over Mandvi. Everybody in the District acknowledged this, bat
" owing to the dread entertained of having their houses disinfected and vacated, each
•" house-owner resolutely denied that rats had died in his house."
In 0 Ward during August and September, when there was a minor
epidemic, reports were constantly being received of the finding of dead
rats, and plague cases usually were reported at the same time or shortly
afterwards. In Bhuleshwar and Khara Talao dead rats were frequently
found in January and February when the epidemic began to rise.
Captain Cuppage writes of the Market and Dhobitalao sections that
rat mortality invariably preceded infection of the various localities. But
places where dead rats were found were very systematically vacated and
disinfected, and perhaps to this may be ascribed the lighter incidence of
the epidemic in this ward during the year under report. From this
ward it is reported that Plague almost always supervened if a house
26
Their standard of living is lower, their food not so good or plenti-
ful, and they are handicapped in the power of resistance to the disease ;
Mussulmans, on the whole, suffered less than Hindus, and had a greater
chance of recovery. The Khojas especially—a well-to-do and cleanly
community—were very lightly touched ; but a considerable proportion of
them have at various times been inoculated. Of high-caste Hindus, those
from Gujarat seem specially liable to the disease. Until, however, the
Health Department Returns are tabulated, any accurate analysis of the
incidence of plague upon particular communities is not possible. The
comparative immunity of Europeans continued. Some officers have
noticed that people living on ground floors and in attics suffered more
than others. This may possibly be due to the greater dampness of the
one, the overcrowding and want of ventilation of the other : more pro-
bably to the fact that rats mostly frequent the ground floor and roof.
Brief compa-
rison of the
epidemic with
that of pre-
vious years.
The mortality chart for Bombay shows how the ascending curve of
mortality was later than in previous years, so that the hot weather was
established by the time it reached its maximum. That maximum, was-
higher than in either 1896-97 or 1897-98, but the high level period lasted
for three weeks only against seven in the first year and six in the second ;
and the decline began at the same time as in 1897-98. The medical
officers in Bombay have noticed that during the year under report the
virulence of the disease, the rapidity of its course in the individual
patient, and the case mortality were greater than ever before ; and the
enlargement of the lymphatic glands, which has attached to plague the
epithet Bubonic, was very slight or altogether absent in a very much
larger proportion of cases. These were general impressions. The hos-
pital statistics found elsewhere give actual facts.
The following notes have been prepared by Mr. C. Carkeet James
Drainage Engineer, on the Plague Charts compiled by him from August
1896 to the end of the third Epidemic in May 1899. The two charts are
given as an appendix to this report :—
" The third Epidemic of Plague having run its course, it is possible to now make?
a comparison of the Charts which shew the progress of the three epidemics. These
charts have been previously described in detail, in the Plague reports of Major-General
Sir W. F. Gatacre and Sir J. M. Campbell, but it will not be out of place to again
give a brief explanatory description of them here under their different headings.
CHART No. 1.
Chart No. 1 shows the mortality from all causes which occurred in the City of
Bombay from August 1st, 1896, to June 30th, 1899, registered concurrently with the
following data :—
Maximum temperature ...
Minimum
„
...
Population ... ...
Humidity ... ...
Daily mortality ... ...
Normal mortality, previous
five years' averages ...
Velocity of wind ... ...
Clouds
...
...
...
Indicated ou the Chart by thick black lines.
„ „
„ „
„ „
„ „
„ „
„ „
by a thin blue line.
by a green line.
by a thick red line.
a thin red line.
a purple line.
a brown line.
30
It cannot be doubted that the measures undertaken in Bombay to combat the
plague have been remarkably successful, and that only 8·61 per cent, of the popula-
tion should have in three years succumbed to the disease is a result which has proba-
bly never been hitherto obtained in the history of the plague. But in working out the
percentage of plague mortality for the three epidemics on actual estimated population
from Chart No. 2, we get the following : —
No.
No.
No.
1
2
3
Epidemic
„
„
4·30
2·43
2·80
These figures are even more remarkable than the figure 8·31 on the assumed
population of 850,000 for the whole period.
In regard to the concluding paragraph, of the above, it should be
pointed out that the figures are based upon chart No. 2, which only
deals with the epidemic months proper. To arrive at a true concep-
tion of the damage done by plague, not only the plague mortality
during the monsoon recrudescences, but all plague deaths throughout
the year should be taken into consideration. The table given at the
begining of this chapter compares the mortality of the past three
years with the average and shows that—
In the first year the mortality was 37·70 per mille above the average.
„ second
third
38-96
33-51
This would make the percentage plague mortality for the three
years—
First
Second
Third
year
year
year
3·77
3·89
3·35
31
CHAPTER III.
Measures adopted.
The discovery
of Plague
cases.
The discovery of plague cases is the basis of all plague administra-
tion. The measures adopted may be perfect, but if a large proportion
of cases escape detection the administration is a failure. For various
reasons it was not thought feasible to render the report of all sickness,
or of all sickness from plague, compulsory upon the public generally in
Bombay. But the majority of plague cases were discovered through
the following agencies :—
1. Eeports from volunteers.
2. Voluntary admissions into hospital.
3. Information from friends and neighbours.
4. Information from private practitioners.
5. Information from the Military Authorities.
6. Roadside cases and miscellaneous.
7. Information secured by the Plague Staff direct, or from Police or
Municipal Subordinates.
8. Information from cemeteries.
The following statement shows for A Ward, B Ward South, C Ward
and D Ward the extent to which these various agencies proved useful.
The figures for D Ward are practically for the whole year ; those for the
other districts do not go back to the beginning of the year : the record
for B Ward South commences in August 1898 and for C Ward in
November 1898 ; for A Ward about the same time :—
Volunteers ... ... ... ...
Voluntary admissions ... ... ...
Friends and neighbours ... ... ...
Private practitioners other than volunteers..
Military ... ... ... ...
Plague, Police and Municipal Staff, Roadside
and Miscellaneous ... ... ...
Cemeteries ... ... ...
Total...
A Ward.
487
222
121
42
91
421
112
1,496
B Ward
South.
350
326
119
37
...
317
155
1,304
C Ward.
1,233
576
99
79
...
405
201
2,593
D Ward.
376
295
134
6
...
908
286
2,005
It will be seen that the volunteers in 0 Ward reported 47 per cent,
of the cases discovered, in A Ward 33 per cent., in B Ward South 27 per
cent., and in D Ward 19 per cent. Of other districts their assistance was
specially valuable in E Ward West and parts of F and G Wards, but the
very large area comprised in these last two Wards had hardly sufficient
volunteers. In the Central District out of 903 attacks, 554 were report-
ed by volunteers and 249 were either reported by relatives or voluntarily
admitted into hospital. The highest proportion of voluntary admissions
to hospital was 25 per cent, in B Ward South, C Ward came next with
33
nient of a Hakini, who continued to attend the case after its removal to
hospital. On being called upon for an explanation of his failure to report
the case he wrote as follows :—
" The plague according to our Unani medical practitioners is attended with high
" fever, delirium and sometimes total insensibility. One of the highest authorities of
" our medical system, Don Henri de Matteis, late physician to the late Begum of
" Bhopal, assigns the above symptoms to the plague in his work."
He then proceeds with an admirable air of indignation to maintain
that his patient had none of these symptoms, and to challenge denial
of his statement. His position was impregnable.
The information supplied by the Military refers entirely to those
portions of A Ward where their co-operation was enlisted, and the District
Officer speaks very highly of the efficient manner in which they searched
out every case of plague occurring in those limits.
The figures show how heavily the work of searching out plague
cases fell upon the staff in D Ward. A certain number of the cases
were roadside. The discovery of the remainder was due partly to the
cordial relations which many of the sectional Medical Officers managed to
establish with the residents in their charges, partly to the careful inspec-
tion of infected and insanitary localities, and partly to the information
picked up by the subordinates of various public departments in the course
of their daily duties. In the earlier part of the year a certain amount of
money was in some parts of the city paid to people who brought news of
plague cases, but this system is open to abuse and was almost entirely
discontinued. Here and there landlords and their agents were induced
to keep the Plague Staff notified of any cases that might occur in their
chawls, but as a rule the dread of evacuation with the possible loss of rent
involved inclined them to keep any sickness secret. Information obtain-
ed from the cemeteries was in one sense most unsatisfactory and in
another supremely important. As evidence that an individual from a
certain house had died of plague it was entirely unreliable, for except in
the few cases when a medical certificate is forthcoming the cemetery
establishment is entirely dependent upon the account given by members
of the funeral party as to the cause of death and for the address where
the deceased had expired. Usually the one object of the funeral party
was to satisfy the cemetery officers that death was not due to plague, and
through ignorance or intention they constantly gave incorrect addresses.
The supreme importance of information from the cemeteries lies in the
fact that the major portion of plague cases terminate fatally, those that
linger long enough to recover are usually brought to light sooner or
later in their residences, those that succumb are invariably included in
the returns from one cemetery or the other. It is a fairly safe conclusion
that all plague cases not otherwise discovered are included, if not identi-
fied, in the daily death returns.
37
accepted without much demur. Houses where such deaths occurred were
watched, lists of the inmates were made, and surprise visits were paid
by a lady nurse with volunteers, and if a plague case or a second suspi-
cious death occurred the inmates were induced to go into a segregation
camp or some other suitable house.
The following statement shows, Ward by Ward, the total mortality
the number of plague and suspicious deaths and the average mortality,
and is an index to the extent to which the staff was able by the
various agencies at its disposal to find the plague cases that occurred:—
Ward.
1
A ... ... ...
B ... ... ...
C ... ... ...
D ... ... ...
E ... ... ...
F and G ... ...
Water Division ...
Non-resident and un-
known
...
...
Total ...
Total Mor-
tality.
2
2,973
10,942
11,540
5,069
15,630
8,220
61
892
55,327
Plague
Deaths.
3
1,103
2,572
3,369
1,826
4,454
2,250
8
225
15,807
Suspicious
Deaths.
i
113
1,081
686
334
994
943
...
...
4,151
Total of
Cols. 3 & 4.
5
1,216
3,653
4,055
2,160
5,448
3,193
8
225
19,958
Balance due
to ordinary
causes.
6
1,757
7,289
7,485
2,909
10,182
5,027
53
667
35,369
Average.
7
1,578
6,002
6,450
2,466
6,669
2,999
70
615
26,849
The above average is taken on a population of 8,50,000. The
recorded plague deaths in the year ending 31st May 1897 and 31st
May 1898, were 11.683 and 16,554. The following table compares the
results of the 3 years :—
Year.
1
189G-97
1897-98
1898-99
Total Mor-
tality.
2
48,496
55,727
55,327
Plague
Deaths.
3
11,683
16,554
15,807
Suspicious
Deaths
4
...
...
4,151
Total of
Cols. 3 & 4.
5
11,688
16,554
19,958
Balance
due to ordi-
nary causes
6
36,813
39,173
35,369
Average
population.
7
7,00,000
7,90,000
8,50,000
Average
deaths on ;
basis of
31-58 per
mille.
8
22,106
24,948
26,849
Undetected
plague
cases, Cols.
6 to 8
9
14,707
14,225
8,520
Considerable improvement has been effected, but there is room for a
great deal more.
Removal of
patients to
Hospital.
As a general rule every suffering plague case was removed to
hospital, a not inconsiderable proportion going voluntarily before the Dis-
trict Officer appeared on the scene, but there were some 900 cases left in
their houses. Of these approximately 150 were cases that might ha ve been
removed, but which the District Officer in the exercise of the discretion
vested in him permitted to be isolated at home. Of the remainder between
50 and 100 were Health Department biggaries who were dealt with by the
Health Department only, and the rest were moribund cases. In the
moribund cases death supervened usually in a few hours and the ordi-
41
Here is another extract :—
" Yesterday, from 6 a.m. to 1 p.m.,I vacated the chawls in the interior of Antoba-
wadi and removed 466 people from them, of whom 240 were sent to the Kennedy
Sea Face Camp, and 226 to the Goouldas Tejpal Camp. This interior of Antoba-
wadi has an old plague history in previous epidemics, in September and October of
this year also plague broke out in it and there occurred 9 cases, 2 deaths and 2 sus-
picious deaths of plague in it. Again within the last week 2 cases of plague were
removed on the 16th December and 2 cases on the 20th December. I propose to
allow re-occupation after 15 days."
Another, dated 11th January 1899, is as follows :—
" I, this morning, vacated 6 chawls in Carnac Cross Road, in which 2 cases of
plague and 1 death, suspicious of plague, had occurred last week. I sent the occu-
pants to Crawford Market Camp. 178 persons were counted into the Camp up to
10 a.m., but there are probably 30 or 40 more to come in. Lt. Anderson, Dr.
Britto and Rao Sahib G. N. Nadkarni and his Committee were present and
assisted in the vacation."
In F and G Wards houses where there had been cases the previous
year were, in a good many instances, evacuated in the year under report
before a case occurred, directly a dead rat was found. Thus at Sion,
Koliwada, Agriwada and Bhandarwada some dead rats were found in
houses where there had been cases the previous year, and immediately with,
the assistance of Mr. A. N. Dalvi the whole place was vacated, and no
plague cases occurred. Similarly the villages of Bhoiwada, Naigauna,
Sevri Koliwada, Worli Koliwada, and Mori Road were evacuated on the
occurrence of the first case or as soon as dead rats were found. The
people were glad to go out, quite early in they ear, and did not return until
they were driven in by the rain. No force had ever to be used on these
occasions, but the assistance of the police was occasionally asked for and
half a dozen constables were sufficient to maintain order, to prevent
pilfering, and to see that none of the evicts bolted to other parts of the
City. Where the people had suffered severely in the previous year and
had been turned out with immense difficulty, it was found during the
year under report that they were quite ready to go as soon as plague
declared itself. The instances from F and G Wards given above are
illustrations, and another example was found in the fishermen of
Mazagaum Koliwada, who undoubtedly were saved from a loss of many
lives by their ready compliance with the advice given them.
The following statement shows, district by district and section by
section, the amount of work done in the direction of removal of the sick
and the removal of contacts and evicts to Camp from the week ending