NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
APP. I. ]
its causes and characteristics.
37
A detailed report on the inoculated, classified according to races
and occupation, will be sent in later on.
2. The following occurrences of plague took place amongst the
inoculated in Bombay.
1.—Fatal Cases.
1. Sorabjee Naorojee Daruwalla, Parsee, male, 20 years, report-
ed to have developed plague within about 12 hours after inoculation,
but likely to have been already unwell when inoculated ; died on the
fourth day.
2. Luxman Shivram Kharkar, Hindu, male, 35 years, pleader from
Thana, came for inoculation after feeling first plague like symptoms
inoculated on the 2oth March 1897 ; died on 21st night.
II.—Attacks ending in Recovery.
1. Kondem Dussara, daughter of Surgeon Major Dimmock's
coachman, Hindu, 11 years, attacked with plague 12 days after ino-
culation ; recovered.
2. Aboo Chima, Surgeon-Major Dimmock's dhobi, attacked with
plague 17 days after inoculation; recovered.
3. Gulam Hussein Mahamad, Mahomedan, male, 37 years,
developed gland and fever on fourth day after inoculation ; symptoms
disappeared within a week.
4. Girzai, Hindu, female, 25 years, contracted plague 6 days after
inoculation ; recovered in a few days.
5. Jokhan Pubber, Hindu, male servant of Brigade-Surgeon-
Lieutenant-Colonel Arnott, attacked with plague next day after
inoculation and sent to hospital ; recovered.
6. Ganoo, Hindu, male, 20 years, a mali of Surgeon-Lieutenant-
Colonel Hatch, attacked 12 days after inoculation ; recovered.
7. Narayan Munglia, Koloe, Hindu, male, 8 years, from Mora,
attacked 17 days after inoculation; improved from the next day;
recovered.
8. Toolja Munglia, Hindu, female, 25 years, from Mora, attacked
a fortnight after inoculation ; improved from third day ; recovered.
9. Mr. Naronha, Christian, 291/2 years, Assistant Superintendent,
Public Works Department, Bombay, attacked one month after inocu-
lation. Fever came down on the fourth day of the attack and patient
recovered.
10. Jeevraj Poonja, Khoja, Mahomedan, male, 30 years, attacked
on the day of inoculation ; recovered.
38
Description of Plague :
[ APP. I.
11. Eduljee Hormusjee Jamoola, Farsee, male, n years, of Mora,
attacked 15 days after inoculation; improved after two days' illness ;
bubo disappeared after a week.
12. Ardesir Jijibhoy, Farsee, male, 10 years, attacked on the
fifth day after inoculation ; recovered.
13. Pherozsha Burjorji, Mistri, Farsee, male, 20 years, reported
to have had two attacks of plague before inoculation, one severe, the
second milder. Third attack followed five weeks after inoculation ;
fever disappeared after one day, gland remaining for several days
longer ; patient recovered.
14. Ahilya Anant, Hindu, female, 7 years, from Sion, developed
gland and fever three months after inoculation ; improved from next
day ; recovered.
15. Ardesir Pestonji Baria, Farsee, male, 48 years, from Mora,
attacked one month after inoculation ; improved and recovered after
three days' illness.
16. Raoji Bhana, Hindu, male, 16 years, -attacked 16 days after ino-
culation ; sent to the Charing Road Hospital in fever with a swollen
gland. Fever disappeared in four days, gland lasted longer, but
gradually disappeared.
III.—A case of deat h from cause other than plague following soon
after inoculation.
Anant Bhikaji Paranjpe, Brahmin, 40 years, teacher from Bandra-
got, an attack of hemiplegia two days after inoculation and died on
eleventh day. The result of the medical investigation was to the
effect that the attack was unconnected with plague, nor with the
inoculation.
Summary.
Amongst the 7,905 persons inoculated in Bombay during the
epidemic, and who all came from the most threatened localities and
houses, there were (besides the occurrences in the Byculla House of
Correction described apart) —
(a] two persons who were already unwell at the time of inocu-
lation, and who developed unmistakable plague within the
next 12 hours ; they eventually succumbed ;
(b) and 16 persons who were attacked more than 12 -hours
after inoculation, and all recovered.
These results are in perfect conformity with those observed in
the Byculla Jail mentioned above. No other casualties of plague
amongst the inoculated have been reported, though a large number
of physicians watched the results with eager interest and many
with great readiness for criticism.
APP. I. ]
its causes and characteristics.
39
I am specially confident with regard to the number of fatal cases
reported, whereas in the number of cases with recovery there may
have been neglect in reporting some of them, as a large proportion
of the cases were exceedingly mild. The increase, however, in the
number of cases ending in recovery would put in a still more satis-
factory light the small case mortality amongst the inoculated—a
problem which was particularly aimed at in the plan of preventive
inoculation worked out for the plague, as contrasted with the ino-
culations against cholera.
In the latter case no reduction in the proportion of deaths to
cases could be established in any of the outbreaks where inocu-
lation was applied, though a reduction in the absolute mortality was
- unmistakably observed in all the most important cases of observa-
tion.
The result of the inoculations against plague, as far as known
for the present, would therefore justify the adoption of a similar
modification in the plan of all the future methods of preventive
treatment, including the inoculations against enteric, intended to be
introduced now amongst the troops in India.
(c) Finally, there was one case only where, for a short time.
a question arose whether the plague inoculation did
not do any harm. The case appeared, however, to be
in no connection with plague nor with the inoculation,
as the disease, an attack of hemiplegia, has not been
observed either in plague or in any other of the inocu-
lated individuals.
No. 15.
Dated Hardwar, the 20th November 1897.
From—MONS. W. M. HAFFKINE, d.E.,
To—The Secretary to the Government of India, Home Department.
I have the honour to submit a report, by Surgeon-Major Lyons
and myself, on the epidemic of plague in Lower Damaun and on the
effect of preventive inoculation there.
The delay in forwarding this report was due to the fact that,
while the observations collected in Daman were being studied and
classified, two epidemics occurred, one after another, in Lanowlie and
in Kirkee, in conditions which permitted of making a very accurate
investigation on the effect of inoculation. I decided to delay the pre-
paration of the present report, and to take immediate advantage of
the two outbreaks, for repeating the experiments made in Daman
4Ò
Description of Plague :
[ APP. I.
and verifying, for a second and for a third time, the results obtained
in the former place.
In both epidemics just referred to, as will be seen from the reports
to follow, the results were slightly below those obtained in Daman,
which was due to my having been unable, while away in the affected
districts, to renew the stock of lymph stored up in Bombay, and to my
having had to use material of (gradually) inferior quality, when the
stronger was exhausted. The effect differed, however, inconsider-
ably, and represented, in Daman, as will be seen from the adjoined
report, a reduction of 89.2 per cent, of the plague mortality, in
Lanowlie a reduction of 85.7 per cent., and in Kirkee of 77.9 per
cent.
2. I beg, Sir, to point out, in the submitted report, the following
features : the great readiness and spontaneity with which the popula-
tion came forward for inoculation, without any pressure being brought
to bear upon them, except that of the dreaded disease ; the rapidity
with which the effect of the treatment was perceived and appreciated,
and the fact that one assistant, deputed to the place, was able to
inoculate, in a few days, large numbers of people, the inhabitants
providing all the necessary accommodation and help. When com-
pared with the circumstances connected with the attempts at destroy-
ing the bacilli of plague in villages and in big towns, and at keeping
the sick and the healthy away from each other, and from the infected
localities, the method of combating the epidemic by inoculation pre-
sents inestimable facilities.
3. I shall submit my full reports on the operations in Lanowlie and
Kirkee—in order to confirm the conviction which imposes itself on
studying the Daman epidemic—as early as my present absence from
my office, and the time required for compiling the documents, will
allow me. In view, however, of the great urgency of the case, I
believe it opportune to consider, from the present, the possibility of
Government deciding to introduce preventive inoculation as a means
of combating the plague, on lines similar to vaccination,—combining
this method, in the commencement, with other measures, but assign-
ing to it, in the programme, a very important part. I give, therefore
below a brief sketch of the organisation necessary for that :—
(a) The staff sufficient for securing a supply of lymph for
India would consist of—
one Commissioned Medical Officer, as a permanent assistant,
who will be trained to carry out and supervise all the
Laboratory preparations connected with the plague
prophylactic ;
one Military Assistant Surgeon ;
APP. 1 ]
its causes and characteristics.
41
one Apothecary ;
one Clerk ;
two Laboratory boys ;
one peon for packing and despatching of parcels ; and
one Hamal.
I suppose, of course, that the above staff will be free from any
work connected with the actual inoculations, or from any investiga-
tion duty, and will devote undividedly their whole time to the manu-
facturing of lymph.
(b) The raw materials necessary for the preparation of one
hundred doses of lymph cost below Re, 1.
(c) In case the Laboratory remains in Bombay, a house for its
accommodation, containing 30 rooms, provided with gas
and water, with an extensive compound and several out-
houses and stables, is placed at our disposal, free of
charge, by His Highness Aga Khan, in a suitable locality
of Bombay. If the Laboratory is located elsewhere, ac-
commodation will be required of ten rooms, for the pre-
paration and storing up of the plague prophylactic , and of
another half dozen rooms for carrying on investigation
work.
(d) The actual inoculation should be carried on by the flying
columns, or parties at present engaged in combating the
plague in the affected districts, and which, with regard to
the inoculations, should be subject to the same regula-
tions as are in force for vaccination against small-pox.
It is desirable that, in the beginning, in every new place,
the inoculations should be started by a Commissioned
Medical Officer, whom I shall guide personally in his first
set of operations, and whose duty it should be to keep
my office informed on the effect produced upon the epi-
demic. Afterwards, and very soon, the operations will
be entrusted to an Assistant Surgeon or a Hospital
Assistant.
4. I propose, unless you advise me to the contrary, to remain in
Hardwar for the time necessary for ascertaining whether the disease
contracted by the monkeys, and which caused only an insignificant
mortality among them, is the same as the bubonic plague in men ; and
to return to Bombay after that,
b 6
42
Description of Plague :
[ APP. I.
No. 16.
Joint Report on the Epidemic of Plague in Lower Damaun, Portu-
guese India, and on the effect of Preventive Inoculation there,
by M. Haffkine and Surgeon-Major Lyons.
The plague prophylactic referred to in the present report has been
described by Mons. W. M. Haffkine in the " British Medical Journal,"
May 1897, and in the " Indian Medical Gazette," June 1897.
The facts reported here have been collected by Professors Koch
and Gaffky, the heads of the German Scientific Mission to Bombay,
and Mons. Haffkine, on a visit to Damaun on the 2oth and 21st
May last ; at the end of the same month a house-to-house visitation
at Damaun was undertaken and carried out, at Mons. Haffkine's
request, by Surgeon-Major Lyons, President of the Bubonic Plague
Research Committee, in order to complete, by exact details, the
information gathered on the first visit.
At the German Scientists and Mons. Haffkine's inquiry at Damaun,
their informants were—
His Excellency Colonel J. P. Kuchenbuck Villar, Governor of
Damaun ;
Mr. Judge, Assistant Collector, Salt and Revenue Department,
in charge of the Preventive Police and the Plague Operations
on the Damaun Frontier ;
Shet Sorabjee Manockjee Damaunwalla, head of the Parsee
Community, assisted by his Secretary ;
Dr. Virgilio Poiares, Physician in charge of the Plague Hos-
pital ;
Dr. Proença, Health Officer ;
Dr. Pinto, in charge of the Plague Operations in Damaun Town ;
and
Dr. Da Cunha, L.R.C.P. (Edinburgh), '
Dr. Moniz, L.M.S,, and
Dr. Fernandez,
Medical Practitioners
of Damaun.
The Medical Officers abovementioned were assembled, on the 20th
May 1897, by His Excellency the Governor, who was also present,
and to whom we are indebted for affording every facility for making
the enquiry complete. The general information given below, in the
preliminary part of this report, was reported at this meeting and was
supplemented by documents from the respective offices.
43
APP. I. ]
its causes and characteristics.
The history of the Damaun epidemic appears to be as follows:—
The town of Damaun is divided by a river into two parts : Lower
Damaun, the largest business part of the town ; and the Fort, or Upper
Damaun, where the Government house and the Government offices are
situated. The plague attacked almost exclusively three of the villages
which make part of Lower Damaun, namely, Lower Damaun proper,
having, in ordinary times, a population of 5,000 inhabitants ; Katheria,
the property, of Shet Sorabjee Damaunwalla, with a population of
4,700; and Khadiwadi, with a population of 1,200. This part of the
town was in active business communication with the Bombay Presi-
dency, and is densely populated, the inhabitants living in small houses
crowded together. The Fort was cut off by a cordon from Lower
Damaun as soon as the epidemic began to increase in proportion, and
had only some 1/2 dozen imported cases.
The first attacks came to notice in February last, and occurred
amongst new arrivals from Bulsar, a neighbouring town which was
badly affected at the time, and amongst sailors from Karrachee
arriving at Damaun by sea, in native crafts. Before the end of the
same month local cases began to appear among the fishermen, who
have their busti close to the river, where crafts are moored, behind
the Damaun Municipal School. In the last days of the month a
hurried exodus of people began from Lower Damaun, increasing daily
as the epidemic gained in intensity, until, on the 23rd of March, the
Governor placed a cordon along the river, and stopped communication
between the Lower and Upper parts of the town ; while a week later,
on the 3oth March, the Bombay Government, on their part, closed
British territory to the inhabitants of Damaun. By this time, it was
estimated, over 2,000 people had quitted the place.
The worst period of the epidemic corresponded to the month
following the closing of the Damaun frontiers. The climax was
reached in the middle of April, when the daily number of deaths
remained stationary for about 8 days and then began to decline. The
largest number of deaths which occurred in one day was 80.
Up to the 25th of April the daily mortality, which was closely
watched by the Parsee Community who kept peons on the burial and
burning grounds, was recorded officially from the information given
by the inhabitants coming to the Registration Office to declare cases
of deaths in their families. On the 25th April, the Governor placed a
guard of his own on the burial and burning grounds, and on that day,
though the number of deaths reported by the inhabitants was II, the
number of bodies disposed of in the presence of the guard was 34.
From the above date the Governor's guard was kept permanently on
44
Description of Plague ;
[ APP. I,
the grounds, and the official information became complete. The
following is the number of bodies registered by this means from the
25th April up to the date of investigation :—
25th April 1897
26th
,,
...
27th
,,
28th
„
29th
„
30th
»
1st May 1897
2nd
„
3rd
„
4th
„
5th
„
6th
„
7th
8th
9th
„
l0th
„
...
11th
„
12th
„
I3th
I4th
„
I5th
l6th
„
17th
„
18th
„
19th
„
25 days.
34
31
21
49
41
58
41
22
29
47
33
31
31
33
18
24
27
15
13
17
13
20
6
8
13
675 deaths,
Thus, during the 25 days preceding our visit, i.e., between the
25th April and 19th May 1897, at a time when the population was
considerably thinned by desertion and death, and when the mortality
had dropped to 8 and 6 a day, the total number of bodies disposed
of was 675, giving an average 0f 25 deaths a day. His Excellency
the Governor and the medical gentlemen present at the meeting
stated that they would be well within the real figure if they estimated
the number of deaths which occurred in the fully populated town,
in the first period and during the height of the epidemic, i.e., up to
the time of placing the guard, at an average of 30 a day, counting
from the 1st March and neglecting the mortality before that date.
This estimate gives a total of 2,325 deaths as having occurred in
Damaun from the beginning of the epidemic up to the time of the
Scientific Committee's visit. Of this number, 2,093 deaths were
afterwards authenticated in the particular families where they had
APP. I, ]
its causes and characteristics.
45
taken place, during a house-to-house enquiry instituted by Shet
Sorabjee Damaunwalla, the owner of Katheria.*
As the immunity of the inoculated in Damaun will be estimated
from a comparison with the mortality in the uninoculated population,
it is essential, in order to avoid the possibility of exaggerating the
power of inoculation, to take for guidance the lowest figure admis-
sible as representing the real death-rate in the place. In the follow-
ing calculations, therefore, the number of deaths from plague which
occurred in Damaun from the commencement of the epidemic up to
the visit of the Scientific Committee is accepted as 2,093, which is
the number authenticated by an enquiry in each of the affected
families. This figure gives an average daily mortality from the
commencement of the epidemic up to the time of placing guards on
the burial and burning grounds, as being close upon 26 deaths a day.
From the 21st of May up to the end of the same month, that is to
say, up to the date when Surgeon-Major Lyons concluded the addi-
tional inquiry, of which the details are given below, there occurred 96
deaths more, giving a total of 2,189 deaths from plague which took
place in Damaun during the period under observation.
In this number of deaths there were 24 in those inoculated, per-
sonally observed by the Medical Officers of the place ; plus a small
number of others of which they knew, but which they had not seen
personally. 15 deaths of the 24 were reported by Dr. Moniz, who was
said to have treated the largest number of plague patients in the
place ; 4 by Dr. Poiares, who also saw 4 other cases which recover-
ed; 3 cases by Dr. Proença, all of whom recovered (these had been
seen also by Dr. DaCunha) ; 3 deaths were known to Dr. DaCunha.
* The number of deaths from plague which took place during the whole epidemic
up to the end of July, and a record of which could bo obtained by an enquiry in the
households, was 2,352 and was distributed amongst the different castes inhabiting
Damaun as follows :-
Parsees
.,
Brahmins
Parbhus
Shrawaks
Banias
Lohanas
..
Gujrathi Goldsmiths
Daxini Goldsmiths
Hindu Barbers
...
Khatris
Coppersmiths
Machis
Carpenters
...
Mussalmans
Golas
Chhipas
Tailors
6
.,. 26
4
11
...
23
4
... 15
... 80
... 27
... 87
11
... 600
... 104
... 440
... 106
... 23
... 48
Ghatis
Potters
Portuguese
Bandarees
B hayas
...
Bhateli
Dhobis
Mochis
Kolis
Boras
Khojas
Lohars
Mangelas
Hindoo Low Castes
Castes unknown ...
TOTAL
21
16
...
34
22
5
1
16
23
19
5
4
13
7
351
200
... 2,352
46
Description of Plague :
[ APP. I.
and 2 to Dr. Pinto (in addition to one mentioned by Dr. Moniz which
Dr. Pinto had seen with him).
Considering the small extent of the town, the limited number of
inhabitants, and the number of Medical Officers who were looking
O
after the place, it appeared probable that not many attacks among
the inoculated escaped their notice, as such attacks usually excite
much comment amongst the inhabitants, and attract general atten-
tion. Indeed, the gentlemen present at the meeting seemed to
know between them every place in the town where inoculated
people lived, and every house which had suffered from plague or
happened to have escaped. As has been mentioned already, they
stated at the time that there was a small number of inoculated attack-
ed whom they did not, see, but of whom, they informed us, a record
existed in the office of Shet Sorabjee Damaunwalla, where, during
the plague, a dispensary was opened for distributing gratuitous
medicines to the affected population.
It was on the initiative of that Parsee gentleman that the inocu-
o
lations were introduced, He had a personal knowledge of the
people who were inoculated, and kept a watch over the effect of the
operation, collecting, with the help of his office establishment, a
large number of details in this connection.
From his information it appeared that the total number of deaths
amongst the inoculated was under 40, each of the cases being known
to him ; that amongst those inoculated in a first series of inoculation,
done in March last, a smaller proportion got affected and died than
amongst those done a month later ; and that in a series of inoculations
carried out by the Physician in charge of the Damaun Plague Hos-
pital, with lympy supplied from our Bombay Laboratory, the number
of attacks was larger than amongst those inoculated by Dr. Kalapesi,
Dr. Haffkine's assistant, sent from the Laboratory. These details
were found afterwards, in the course of the close investigation carried
out by us, to be scrupulously correct.
Mr. Sorabjee had also a guard of his own kept on the burial and
burning grounds, watching the course of the mortality, and his
information concurred with the statements recorded above. The
number of people inoculated up to the time of the Scientific Com-
mittee's visit was 1,645 : over four times that number remained
uninoculated. The latter had lost from plague close upon one-third
of their number, and, he considered, there could be no doubt that the
inoculated exhibited a most striking degree of immunity.
The effects of inoculation were closely watched by the inhabitants,
as will be seen from the following observations which they brought to
our notice,