NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
357
APPENDIX A.
The official year for the compiling for the Annual Plague Eeturns for the previ-
ous 12 months ends on the 31st May 1899.
All returns for the 12 months will therefore be made up to the above date.
To facilitate the compiling of the returns I have thought it advisable to have a
uniform method of Tables and Headings, and I hope that all Medical Officers will
adhere as much as possible to these so as to avoid confusion.
In making observation regarding the symptoms and other developments of the
disease I want Medical Officers to state facts and to give reasons for statements made.
This is more particalarly required in Pneumonic Plague where the physical signs of
the disease should be given as well as Bacteriological examination where made, and
combined with charts, &c.
With regard to Pneumonic Plague, I am aware that only a very few examina-
tions have been mode bacteriogically and I think that it would be better to include as
Pneumonic Plague all cases of Lung Disease uncomplicated with Buboes, which have
died within say 3 days of the development of the disease. This, I think, would cover
nearly all cases of Pneiimonic Plague.
1. Report on the
Plague Hospital, Bombay,
from the
..
to
2. A history of the foundation of the hospital and when opened ; names of
Committee, Medicol Officers, List of Medical Staff, viz., Nurses, Hospital Assistants,
Ward BoySj &c., &c. Donations to the hospital might also be given.
3. Give a description of the hospital buildings, the numbers of wards
and how occupied, dispensary, servants' quarters, contact sheds and number occupy-
ing the same.
4. Conservancy.—Information regarding the latrines and system of conservancy
employed, number of seats, method of disposal of sewage. Also state the method
of disinfection of clothes by sweepers previous to washing by dhobies. Any
suggestions ?
5. Water-supply whence derived.
6. Disinfection of wards and other buildings. Method employed and class of
disinfectants used. If the clothes were disinfected by the steam disinfector, state
how often the clothes were sent, and how were they sent to the disinfecting station
and how long were they kept there.
7. Method adopted regarding the disposal of the dead. A description of the
mortuary. How were pauper patients who died disposed of ?
8. Inoculation by Haffkine's serum. Were any of the cases admitted previ-
ously inoculated, and, if so, please give full particulars of the number of cases and the
sexes, age, &c., and mortality. Give the names of the patients and date of inoculation,,
and date of attack by plague.
9. Sickness and mortality amongst the staff of the hospital. Full particulars,
regarding the nature of the illness, the source of contagion, whether the patient lived
on the premises or outside, whether the patient recovered or died.
358
10. The following tables are to be filled in correctly : —
TABLE I.—Total admissions during the year.
Months.
Plague.
Eelapsing Fever.
Observation Oases, includ-
ing all General
Diseases.
TOTAL.
The Arthur Road Hospital will supply, in addition to this, tables for Small-pox,
Chicken-pox, Measles, &c.
11. The largest number of admissions during any week and on any particular
day will be given.
12. Please state the total number of deaths during the year
Total
number of deaths from plague
Total weekly deaths and percentage of
deaths to admissions. Largest number of deaths during any particular day.
TABLE H.
Plague
Relapsing Fever
Observation and Other Dis-
eases
Total ...
Admissions.
Deaths.
Eecoveries.
Percentage
of Mortality.
TABLE III.
Months.
Total Ad-
missions.
Died with-
in 24
Hours.
Died with-
in 48
Hours.
Total
Deaths.
Total
Recoveries.
Percentage of
Deaths.
The above table is also to be made out separately for Plague and also for Eelaps-
ing Fever, except that in Relapsing Fever the deaths within 24 and 48 hours are to
be omitted.
TABLE IV.
Males
...
Females
Children (under 12 years) ...
Total
admissions.
Deaths.
Eecoveries.
Percentage of
Deaths.
The above table is required separately for each caste, viz., Hindus, Mahome-
dans, Parsis, Christians, Jews, Eurasians, &c.
359
TABLE V.—Table showing the Mortality for the Year amongst Sexes and Children.
Total Mortality for the
Year.
Mortality amongst
Men.
Mortality amongst
Women.
Mortality amongst
Children, Call under 1 2
Years of Age).
TABLE VI.— Table showing the Situation of Buboes*
Situation.
Cervical
Parotid
K. Axillary.
L.
„
R. Femoral
L. „
Total No.
of Gases.
Males.
i
R. Inguinal
..
)
L.
„
* Other Situations ..
No Buboes
Multiple Buboes ..
Females. Mortality. Recoveries. Percentage
of mortality.
* Please state at root where these were situated, vis., on calf of leg, pophteal space, (arms, trunk,
scalp, &c.
TABLE VII.—Table showing Pneumonic Plague (without Buboes).
Admitted.
Died.
Eecovered.
Pe Moy. °£
Males
Females
...
Children
i
Vide instruction on page 357 regarding this disease.
TABLE VIII.—Table fhowing Cases of Secondary Plague Pneumonia
( complicated with Buboes).
Males
Females
Children
Admitted.
Died.
l
Eecovered.
Percentage of
Mortality.
1. In filling in the above tables, Medical Officers are particularly requested to
state facts, reasons for diagnosis, whether bacteriological examination was made or not,
and by whom.
2. In Table VIII state when the pneumonia supervened.
Notes on the symptoms, character and treatment of the disease.
Period of incubation.—What you have observed on this point and the reasons for
your statements.
Symptoms on the disease developing itself or the onset of the disease.
Fever.—The temperatures observed on admission and the course of the disease,
giving typical charts of an acute case ending in recovery ; of a mild case ending in
recovery, any observations regarding the temperatures—the maximum, the mini-
munij &c.
363
extreme infectiousness of this form of plague. The face should be kept averted as
much as possible -when examining and attending to the patients. The sputum of
such patients is virulently infective, and should be at once disinfected (burnt if pos-
sible). Attendants should wash with disinfectants after attending the patient,
especially before eating.
I examined the hospital records of these patients under English treatment
for the last fortnight, and they showed—
Plague Deaths, Bubonic
69
Do.
Pneumonic...
...
... 17
The recoveries in each olasa are 12 and 6, respectively. This last figure is loo
high, and probably includes some recoveries from simple pneumonia.
One small dead rat was found in the dispensary, subsequently to my first visit.
I do not attach any importance to this.
I have, &c.,
F. MAITLAND GIBSON.
APPENDIX C-
Report on the Steam Bath Treatment of Plague
cases at the Mahratta Hospital by
Lieut. H. J. R. Twigg, I.M.S.
In this report, brevity has been aimed at throughout, and to attain that end para-
graphs existing in rough copies have been freely omitted.
The text must not be regarded as the most important part : the charts on the
other hand have been somewhat elaborated, and a careful study thereof with occa-
sional references to the text should suffice for a .clear idea of the results obtained. In
addition, the charts give further information not directly bearing upon the Steam Treat-
ment but interesting as regards the incidence of plague during the last outbreak in
Bombay.
It was not possible upon administrative grounds to take alternative cases for the
Bath treatment: had such a plan been carried out, the process of comparing results
would have consisted of mere simple arithmetic.
Certain cases were allotted for Steam Treatment in addition to the treatment in use
in the ward in which the particular case was, but although the permission to give cases
Steam Baths was freely and generously granted by the Medical staff at the Mahratta
Hospital, nevertheless much care had to be exercised to maintain a fair selection of
cases. I think it can be truthfully said that the cases were allotted in as fair a
manner as could possibly be followed. Allowances have been made in this Report for
all departures from an exactly equal distribution. The only condition which at times
deterred me from giving a case a bath was feebleness of pulse, but pulmonary com-
plications I considered no centra-indication at all. Late in March, I rejected many
cases with feeble pulses, nevertheless the mortality continued very high,
The charts have been divided up into three groups A, B, and C, of very unequal
size and importance. Group A, expresses actual results. Group B likewise ex-
presses results, but the interpretation of these results is a fit matter for discussion.
Group 0 is a small and miscellaneous group introducing factors which modify the
results of group A. The remaining part of the report contains a brief summary of
parts A, B and C. [ N. B.—Owing to the large number of charts in the General
Report, the Chart of Parts II and I] 1 in this Report on steam treatment have not
been published."]
365
(c) A similar state of affairs on a smaller scale obtains as regards the
bath during the end of February.
(d) The greater uniformity and avoidance of extremes obtaining during
March when the numbers were high.
Hence these daily charts have been supplemented by others which summarize
the former into weekly groups corresponding in time with the weekly returns fur-
nished to the Municipality by the various Bombay Plague Hospitals. By this method
o sufficiently large number of cases is guaranteed.
III. The third portion of Group A consists of the next four charts as follows:—
Chart A-6 is a weekly summary of percentages of recoveries of all cases.
Chart A-7
bath cases.
Chart A-8
,
native cases.
Chart A-9
'' other method" cases.
In each Chart the first and last observations should be disregarded, for the first
refers to one day only, namely, 1st January 1899, and the last refers to an incomplete
week.
The principal points to be noted are :—
(a) In A-6 the general high mortality especially in February and
middle of March.
(6) In A-7 the apparent success of the Bath in B, C, & G, and the real
comparative success in I, J, K, L.
(c) The success in C, the want of success in H, and the later success in
J in A-8.
(d) In A-9 the Chart is characterized by uniform excessive mortality.
jflote.—Especially F when the mortality was practically 100 per cent.
IV. The last or fourth part of Group A here follows.
The Chart A-10 is of the utmost importance, as it expresses the actual results of
the different treatments along with the number of cases upon which the observations
are based.
The chief points are as follow;—
(a] The red line in the Bath cases from January 1st to the next period should
not appear, inasmuch as on the 1st January no Bath case was taken, and
during the whole of the next week there were only three cases; an in-
sufficient number on which to base any conclusion. It should also be
noted that the Native cases were here successful, but only nine occurred.
(5) The remarks about the smallness of numbers apply to the periods B and C
in the Bath cases. During I, J, K, and L, the Bath results are much
more uniform and trustworthy.
A stage has now been reached when the question of results can be discussed.
The Charts presented have shewn—
(a) The incidence of daily admissions for all treatments.
(6) The incidence of daily admissions for each treatment with daily re-
coveries.
(c) The daily percentage of recoveries for all and for separate treatments.
(d) A weekly summary of the above.
(<?) A comparative Chart showing weekly results and total results.
371
failures, and while the Non-bath methods have not been curative, the bath method can
certainly, in my opinion, claim to have been more alleviative than its competitors.
As to what would have been its results had the cold bath been rigidly enforced, I will
not say. In the words of the Medical Officer at the Maratha Hospital " whatever
cases may have recovered here, have recovered by means of processes not brought
about by us but have got well of themselves."
In conclusion I must thank the Medical Officers and staff at the Maratha Hospital
for their assistance ; also Mr. Moos for his Chart relating to meteorological factors,
and Mr. Leslie I must thank for two reasons; firstly, for providing me with an
excellent opportunity for studying plague, and secondly for providing me with a really
excellent assistant, quite indefatigable in work and always willing—Mr. Hate upon
whose shoulders fell more than a fair share of the work in this investigation. But
the Report is wholly my own and for it I alone am responsible. Its delayed comple-
tion has been due to occupation elsewhere and temporary indisposition.
APPENDIX D-
Appendix to the Report of the Modikhana Plague
Hospital, Bombay, for 1898-1899.
General
Remarks
Report of Cases treated with Roua's Serum.
The Indian Plague Commission brought along with them a large quantity of
anti-plague serum prepared in the Institute Pasteur in Paris under the direction
of M. Roux, with the intention of trying its efficacy on a large scale.
The first trial of the serum was conducted at Bangalore.
During the months of January and February 1899, the Modikhana Hospital was
selected for a further trial, and the close proximity of the hospital to the Municipal
Laboratory, where the Members of the Commission were engaged in carrying on
research work in plague, was found to be a great advantage to them.
The treatment was carried out by Lieutenants Walton and Douglas of the Indian
Medical Service, who were assisting the Plague Commission in their Laboratory
work, and the cases were watched from time to time by Professor Wright and
Dr. Riiffer. A detailed account of the action and results of the serum on the cases
tried in the Modikhana Hospital, and of its action on lower animals will appear in
the Report of the Indian Plague Commission.
The following brief sketch is only intended to give a little idea of the manner
in which the treatment was carried out.
Number and
Selection of
Cases-
There were altogether twenty-eight cases of acute plague treated with Roux's
Serum. These cases were not specially selected for treatment, but every alternate
case as it was admitted into the acute plague ward, was taken for serum treatment,
the remaining cases forming the " Controls." This arrangement was thought to
be better adapted for comparing the result of the serum treatment with that of the
routine treatment as carried on in the hospital.
Of the 28 cases treated with serum—
10 were brought into the hospital on the 2nd dav.
6
5
2
1
..
..
j..
5J
..
5
3'
5J
..
..
..
..
..
3rd „
4th „
6th „
8th „
In 4 remaining cases the duration was unknown.
372
Mode of
treatment.
The injections were generally given deep into the cellular ti'ssue of the-
anterior abdominal wall, sometimes in the interscapular region, and in a few casea
intravenously. In all cases tlie strictest antiseptic precautions were taken; the
syringe and the skin being carefully sterilized. In not a single case were local
abscesses formed at the seats of injections.
The injections were given twice daily. The first dose was-, with only a few
exceptions, 40 cubic centimetres, all the subsequent doses being 20 cubic centimetres
each.
The total amount of serum injected varied from 40 cubic centimetres
upwards, and the largest amount injected into a single individual was 235 cubic
centimetres, (Serial No. 9) who however died. In the case of Rama Narayen (Serial
No. 17) who was ultimately discharged cured, 220 cubic centimetres of serum-
were injected.
In all of these cases the ordinary routine treatment for plague, viz., stimulants
and strychnine injections, was allowed to be carried on simultaneously with the-
serum.
Effects on
Symptoms.
The injections, as I have said before, were given both intracellularly, as well a i
intravenously, and without any accidents. In general, it may be said, that there waa
no effect observed as the result of the injections. The temperature, pulse, and
respirations were in no way afi'ected, and the serum, even when injected in the-
proximity of a bubo, did not appear to influence it in any manner. It produced
no beneficial effect upon the delirium. The intravenous injections apparently created
no influence on the pneumonic condition.
It may be mentioned at the same time, however, that there were certainly
no ill-effects observed to be arising from the injection and use of the serum. No
irritation or urticaria was produced at or around the seats of injection.
Result.
Of the 28 cases treated, 5 recovered and the remaining 23 died, thus giving a
mortality of 82'1 per cent. Out of an equal number of " Controls " there were 3 re-
coveries and 25 deaths, mortality percentage being S9'9. Thus the percentage of
recoveries from the serum treatment does not show any striking results as compared
with those obtained from the ordinary treatment.
The result, therefore, was unsatisfactory and disappointing, especially as in
Laboratory experiments Roux's Serum had shown a decided antagonising action to
the toxines of plague.
Of the five recoveries, in the case of Dhondoo Trimbuek, the bubo gradually
subsided, in the remaining four the buboes suppurated and had to be incised.
A tabular list is herewith appended giving details of the cases treated ; also Charts
showing four hourly temperature, pnlsp, respirations, the amount of serum injected
and the time of injection.
D. A. TURKHUD,
Chief Medical Officer, Mcdikhana Hospiial.
373
Analysis of Cases treated with Route's Serum in the Modikhana Hospital Bombay.
ferial
No.
1
2
3
4
5
G
7
8
9
10
11
12
13
14
15
]6
17
18
19
20
21
32
23
24
25
2S
27
38
' Begister
No.
1654
1656
1669
1671
1680
1688
1697
1700
1708
1712
1716
1720
1723
1730
1738
1743
1746
1747
1762
17BB
1775
1773
1763
1783
1786
1788
1805
1684
1
Name.
Gopal Janu
Dhondoo Trlmbak ..
Purshotum Jng:
Pandia Mabadoo ..
..
Viithu Nathu
Janu Paya
Tatvadas Bamnath . .
Sukhlabram Maugroo
Gulam Imamdla
J. Fernandes
DaJiBabatt
Luximan Bama
Mahadoo Kondoo ..
1
Baghoo Gungaji
Dhondoo Sadoo
..
..
MangJuga
'
BamaNarayen
..
Dhondoo Deojl
i
DhondoBhamji
..
..'
Mania Vlthoo
NarayenOoma
KalooPurbat
BapnHaibata
SukeaKama
Sukharam Krisb.ua . .
Prayag Ganeshe
..
..
Bamjee Bsghoo
. .
• •
i
Caste.
Hindoo
j>
ji
»
>)
j)
it
Mahomedan.
Christian.
Hindoo
i)
i>
5J
11
JJ
JT
W
)J
ij
1)
J)
jj
1)
9)
a
»
Eex.
Male.
jj
ji
JJ
))
l)
!>
11
»t
1)
}J
)>
JJ
JJ
))
))
JJ
J»
)(
5j
JJ
JJ
Jj
1J
jj
JJ
11
»
Age
years.
28
23
35
28
28
40
45
30
18
40
30
35 j
30 J
i
30 '
22 !
25
29
2-1 .
(
30 !
25 :
14
25
40 .'
24
12
30
25
25
1
Date of Admission.
28th January 1899 . .
28th
do.
29th
do.
29th
do.
30th
do.
30th
do.
1st February 1899
Jst
do.
2nd
do.
2tul
do.
2nd
do.
3rd
do.
3rd
do.
3rd
do.
4th
do.
4th
do.
5th
do.
5th
do.
6th
d3.
6th
do.
7th
do.
6th
do.
Cth
do.
7th
do.
8th
do.
8th
do.
9th
do.
.
15th
do.
Day of
Illness.
2nd
6th
3rd
3rd
2nd
2nd
3rd
2nd
2nd
','.
8th
4th
3rd
4th
2nd
...
2nd
3rd
..!
4th
2nd
2nd
6th
..!
2nd
..1
4th
..j
2nd
.J
4th
.J
2nd .1
3rd
..1
2nd . '
Bubo.
1
B. Femoral..
L. Axilla . .
L. Inguinal
B Axilla ..
L. Inguinal
B. Femoral..
L. Inguinal..
L. inguinal..
B. Axilla ..
J,. Inguinal..
B. Inguinal
B, Inguinal
. .
B. SubinaxHlary .
B. Femoral..
B. Inguinal
B, Inguinal
L. Femoral
..
B. Axilla
B. Axilla
B. Femoral
L. Groin
B. Axilla
L. Axilla
L. Axilla
L. Axilla
B. Inguinal
..
B. Inguinal
. .
B. Femoral
Complications.
Violent Delirium ..
..
Secondary Pneumonia
. .
Do.
do.
....
Secondary Pneumonia
Do.
do.
Do.
do.
Do.
do.
Do.
do.
Do.
do.
. . ••
Secondary Pneumonia Dis-
phagia.
Secondary Pneumonia
....
Secondary Pneumonia •
Much infiltration around
bubo.
Secondary pneumonia
Do.
do.
Do.
do.
....
Secondary Pneumonia
..
Do.
do.
Do.
do.
Do.
do.
Do.
do .
Total Serum injected.
160 C. 0. M.
..
188
„
140
..
.
88
£
..
..
60
„
..
..
60
..
..
40
„
..Died..
140
',
.
..
235
„
100
„
140
"
.
..
40
',
.
..
100
„
.
..
40
„
135
„
..
..
115
..
..
220
..
..
150
"
..
..
80
„
..
..
140
„
..
..
80
"
..
..
80
"
120
„
.
..
80
„
40
.
..
80
"
.
..
40
„
.
135
„
.
..
Result.
Died 1st February 1899 .
Discharged, 6th March 1899
Died 2nd February 1899 .
Died 30th January 1899 .
Died 1st February 1899. .
Died 31st January 1899 .
2nd February 1899
Discharged 17th March 1898
Died 6th February 1899 . -
Died 4th
do.
Discharged 23rd Mar. 1899.
Died 3rd February 1899 ..
Do. 6th
do.
Do. 3rd
do.
Do. 7th
do
Discharged, 15th March 1899
Do.
23rd
do.
Died 8th February 1899 . .
Do. 7th
do.
Do. 9th
do.
Do. 8th
do.
Do. 8th
do.
Do. 10th
do.
Do. 9th
do.
Do. 8th
do.
..
Do. 9th
do.
..
Do. 9th
do.
..
Do. 19th
do.
Bemarks.
Bubo subsidefl.
Bubo suppurated.
Do.
do.
Do.
do.
Do.
do.
I). A. TURKHUD,
Chief Medical Officer•,
Modikhana Hospital.
376
2. I beg to forward to the Commissioner memorandum giving briefly my
opinion on the different subjects on which I have been requested to express my
views.
3. Further explanations can be given by my Assistant, Dr. Galeotti, Lecturer
at the University of Florence, and by myself by letter, if the Commission find
it necessary.
4. The aim of my coming to Bombay has been to, pay a visit to the labora-
tory arranged by my Assistants, Drs. Galeotti and Polverini, and to have personal
information of the arrangements for the preparation of the curative serum.
5. I am very pleased to be able to express to the Commissioner that I have
found the work of Drs. Galeotti and Polverini completely satisfactory in every re-
gard, and I should be very glad if the Plague Commission would pay a visit to this
Laboratory and examine the operations for the preparation of the serum and
the experiments for the immunisation of horses and other animals.
6. Now, it will be seen from the several works published by myself and Dr.
Galeotti in different scientific papers that we had in our researches, the object of
extracting from the plague bacilli a very active substance of known constitution able
to induce in the animals in which this substance has been injected, a strong local and
general reaction, by means of which the serum of the blood of these animals attain
specific bactericidal and antitoxic properties.
7. Our experiments were in the beginning performed 011 animals (rabbits,
rats, guinea-pigs, monkejs) and later on [? on human beings] (July and August
1897) in Bombay and Poona with a serum prepared in Florence. With this serum
we treated 30 patients in different stages of disease, and of these 24 recovered.
8. In February 1898, I was charged by the Municipality of Bombay to prepare
serum in my Laboratory at Florence, and to send it here for the treatment of the
plague patients in the hospitals of this town.
9. Every time, before the sending out of the serum, I tested its preventive and
curative power on rats, injecting them in the peritoneal cavity with a small quantity
of a very virulent plague culture.
10. I did not determine the minimum curative doses, because I think that such
determinations have no conclusive value, it being impossible to have a standard of the
strength of the injected virus.
11. I can only say with certitude, that 1/3 or ½ C.C. of serum was able to save a
white rat of 100 grains weight, if the serum was injected under the skin 2 or 3 hours
after the intraperitoneal infection with cultures able to kill rats in 12 to 18 hours.
12. These experiments show that the serum of the No. 4 , horse was the most
active, and that of the No. 1 horse was the weakest.
13. The results are in accordance with the experiments made with the same
serums on plague patients.
14. With these experiments the Plague Commission have been acquainted by
Dr. Galeotti and by other witnesses who had occasion to examine the treated cases
and it would be useless to report these results.
15. Now I have found the horses treated by Dr. Galeotti in good condition, and
I hope they will give an active serum.