NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
APP. I. ]
its causes and characteristics.
47
There were altogether 306 Parsees in Lower Damaun, including
males, females, and children. Of these, 276 were inoculated twice,
and one once, all the particulars being given in our inoculation
register. The names and particulars of the 29 who remained unino-
culated were supplied to us on the spot. The attacks and casualties
from plague which occurred in the two groups after the introduction
of inoculation are given below. No deaths from any other cause
occurred in the community from the beginning of the epidemic:—
Occurrences of plague amongst the 277
inoculated Parsees.
(1) Jerbai, wife of Manekji Bacha, age
35, belonging to a well-to-do
family; was five months pregnant ;
inoculated once on 17th April 1897,
in the right arm. For about 24
hours before, she had fever and
pain in the groin, but this was not
known at the time of inoculation.
Developed characteristic plague
in the evening of the day of ino-
culation had an abortion on 20th
morning, died same day.
(2) Seven other Parsees inoculated were
attacked, respectively, three days,
one week, twelve days, a fortnight,
one month, one month and five
weeks after inoculation, but all
these recovered.
Occurrences of plague amongst the 29
uninoculated Parsees.
(1) Nanabhai Jivajee, male, age 60,
belonging to a well-to-do family,
where all the other members (14 in
number), except himself, were ino-
culated. Attacked on 16th April
1897 ; bubo in left groin ; died
on 2oth.
(2) Merbai, daughter of Bairamjee, age
20 years, of a well-to-do family,
where eight members were ino-
culated
and four, including
Merbai, were not inoculated ;
attacked about same time as
Nanabhai Jivajee; bubo in right
groin; died on 20th April.
(3) Ratanbai Ratanjee, female, age 35,
of a well-to-do family ; attacked
and died in the first days of May
1897, having had fever and a
bubo.
(4) An old woman, Avabai, widow of
Rustomjee, age about 75 years,
of a well-to-do family, where four-
teen others were inoculated, Ava-
bai and Gulbai, her daughter-in-
law, being the only uninoculated.
Avabai got attacked on 11th May,
developed bubo two days later,
died on the 13th.
Thus in the 29 uninoculated Parsees there were 4 deaths from
plague, or a mortality of I3.8 per cent., while in the 277 inoculated
there were 8 attacks with only 1death, the one who died being a
woman attacked before inoculation, and the mortality thus produced
in the inoculated being 0.36 per cent., or 38.3 times lower than in the
uninoculated,
4 8
Description of Plague ¡
[ APP. I.
Another significant instance, in a limited number of people, was
furnished by the servants belonging to Shet Sorabjee's house and to
his garden. There are 50 servants in the house where he lives and
about 150 in his garden, half a mile distant from the house. Round
the garden the epidemic was raging violently. Of the whole number
of servants one, a deformed individual, remained uninoculated, all the
others were inoculated twice. Plague appeared among the servants
on the 16th May when the only person uninoculated was attacked
and succumbed on the 19th ; the total number of inoculated lost also
one, a child of 4 years.
The other instances given were in isolated families and referred
to smaller numbers of people.
The German Commissioners completed this part of the inquiry by
collecting information as to the soil of Upper and Lower Damaun,
the hydrographie and climatic conditions obtaining in both, their
comparative hygienic circumstances, etc. The facts supplied on these
points were of an approximate character. The Committee returned
to Bombay on the morning of the 22nd May.
Surgeon-Major Lyons went to Lower Damaun on the 26th May
1897, the object of his visit being to find out accurately, by a minute
inquiry in each house, the number of deaths which occurred amongst
those inoculated. For this purpose he divided the town into 4 sec-
tions, and during 4 days, between the 26th and 30th May 1897, visited
all the houses, section by section. And as a number of dwellings had
been vacated and the inhabitants encamped in the fields outside the
town, Dr. Lyons visited them in their encampments and collected
information from all of them. The frontier around the town being
closed and guarded by a British and a Portuguese cordon, the condi-
tions for collecting the necessary information were particularly
complete.
In this manner Dr. Lyons collected the history of 33 deaths and 54
attacks with recovery which had occurred in the inoculated up to
the 19th May (the time of the Scientific Committee's visit), and of 3
deaths* and I attack with recovery which occurred between that date
and the 31st of May inclusive.
In the appendix are reproduced 88 "Investigation sheets"t filled
up by Dr. Lyons during the house-to-house visitation, as well as one
sent afterwards by His Excellency the Governor. Each of the
investigation sheets contains particulars of a house where inoculated
* In this number of 3 deaths is included one additional, in the person of Ghopal
Bicaria, 9 years, communicated by Dr. Fernandez through H. E. the Governor of
Damaun.
t Not printeds
ÁPP. I. ]
its causes and characteristics.
49
people lived, and where cases of plague had occurred, either among
the inoculated or the uninoculated members of the family. These
sheets, therefore, do not make mention of the inoculated households
where no cases of plague occurred, nor of any of the attacked houses
where there were no inoculated persons,
Comparative Analysis of the Mortality from Plague in Lower
Damaun, in the inoculated and uninoculated, between the 26th
March and the end of May 1897.
The inoculations in Damaun were done in four series :
First Series.—Between the 23rd and 26th March 1897, 846 per-
sons were inoculated by Dr. R. M. Kalapesi, who was sent from the
Laboratory, and between the 4th and 7th April, 171 persons by the
Portuguese Physician in charge of the Plague Hospital in Damaun,
Dr. Virgilio Poiares, who was supplied with material also from the
Bombay Laboratory. The lymph used by Drs. Kalapesi and Poiares
on that occasion, as will be described later on, was prepared from a
strong virus, and produced a high febrile reaction when injected in
the prescribed small standard doses. The operations of these two
gentlemen differed in that Dr. Poiares gave doses much weaker than
those given by Dr. Kalapesi, as is shown by the detailed records of
their operations. It will be observed from the results given below
that, though Dr. Poiares' patients appear to have given a considerable
reduction of mortality when compared with the rest of the population,
the results from his small doses were lower than those obtained from
the same material given in larger doses.
Second Series.—A few weeks after the first series, the demand
for further inoculations coming from Damaun became exceedingly
persistent, as was the case, after an interval, in the six other places
where inoculations were performed,—in Bombay, Mora, Damaun,
Poona, Balsar and Tarapore ; and though the Laboratory had run
short of strong material, Dr. Kalapesi was deputed again, with a
much weaker lymph than that used on the first occasion, as will be
detailed later on. Between the 17th and 27th April, i.e., about a
month after his first visit, he performed 529 fresh inoculations, and
between the 24th April and 2nd May 1897, 99 more were done by Dr.
Poiares with a similar material obtained for him from the Bombay
Laboratory by the Bombay Portuguese Consulate. The lymph used
on this occasion, even when injected in doses 2 to 3 times larger than
the standard ones, failed to produce marked rise of temperature,
though it caused considerable local reaction. As will be seen below,
both Dr. Kalapesi's and Dr. Poiares' operations, on this occasion, gave
a smaller lowering of mortality than those perviously performed,
though they had both been working with increased doses,
67
50
Description of Plague :
[ APP, I.
Third Series.—Between the 21st and 23rd of May Dr. Kalapesi
inoculated 362 persons with a similarly weak lymph, while Dr. Da-
Cunha, another Portuguese Physician, who had been working in
Damaun with Dr. Kalapesi, inoculated 190 persons with the same
material.
Fourth Series.—Lastly, in August last, Dr. DaCunha inoculated
over 100 persons with material supplied to him from the Bombay
Laboratory.
Thus, altogether 2,297 persons were inoculated in Lower Da-
maun.
The visit of the Scientific Committee coincided with the time
of the third series of inoculation, and Dr. Lyons' investigation ex-
tended to twelve days later, when the worst part of the epidemic was
over, and the daily mortality had come down to below a dozen a day.
The present analysis refers, therefore, to the occurrence of attacks
and deaths amongst the 2,197 inoculated on the first three occasions,
and is divided into three periods of observation, the first correspond-
ing to the interval between the first and second series of inoculations,
the second to the interval between the second and third series, and
the third to the interval between the third series and the end of the
month of May 1897, when the investigation was concluded.
First Period (between the First and Second Series of Inoculations).
At the time when the first series of inoculations was completed,
the 26th March 1897, tne total number of inhabitants in the affected
villages of Damaun, namely, 10,900, had been reduced by 670, who
had died of plague before that time, and by about 2,000 who had left
the place before the closing of the frontiers.
Of the 8,230 remaining, 846 were inoculated by Dr. Kalapesi
and 171 by Dr. Poiares in their first series of inoculations, while 7,213
remained uninoculated,
From that time up to the time when the second series of inocula-
tions was completed, i.e., the 23rd of April, the following were the
occurrences in the respective groups of people :—
(a) Amongst the 846 inoculated by Dr. Kalapesi, there were
17 cases with 3 deaths. (Total mortality, 0.4 percent. ;
case mortality, i.e., percentage of deaths to attacks,
I7.6 per cent.)
(b) Amongst the 171 inoculated by Dr. Poiares, there were
6 cases with 3 deaths. (Total mortality, 1.8 per cent. ;
case mortality, 50 per cent.)
APP. I. ]
its causes and characteristics.
5l
(c] Amongst the 7,213 uninoculated, there were 719 deaths.*
(Total mortality, 9.9 per cent.)
It will be seen that, if the 1,017 inoculated had exhibited the
same susceptibility for plague as the uninoculated, and had had the
same mortality of 9.9 percent., the number of deaths amongst them
would have been 101 instead of 6, a difference of 94.1 per cent.
Second Period (between the Second Series of inoculation and the
Third Series, or the time of the Scientific Committee's visit).
By the time when the second series of inoculations was completed,
the number of those inoculated by Dr. Kalapesi had decreased by the
3 deaths mentioned above, and increased by 529 newly inoculated,
giving a total of 1,372.
The number of inoculated by Dr. Poiares had decreased by 3
deaths, and increased by 99 newly inoculated, giving a total of 267.
The number of uninoculated had decreased by 716 deaths and
by the 628 newly inoculated, leaving a total of 5,869 uninoculated.
From the time of the second series of inoculations up to the time
of the Scientific Committee's visit, viz., 19th of May last, the following
were the occurrences in the three groups :—
(a) Amongst the 1,372 inoculated by Dr. Kalapesi, there were
52 cases with 18 deaths. (Total mortality, 1.3 per cent. ;
case mortality, 34.6 per cent.)
(b) Amongst the 267 inoculated by Dr. Poiares, there were
12 cases with 9 deaths. (Total mortality, 3.3 per cent. ;
case mortality, 75 percent.)
(c) Amongst the 5,869 uninoculated, there were 674 deaths.
(Total mortality, 11.5 per cent.)
It will be observed that if during the second period of observa-
tion the 1,639 inoculated had had the same mortality as the 5,869
uninoculated, they should have lost 188 instead of 27, which repre-
sents a difference of 85.6 per cent.
Third Period (between the Third Series of inoculations and the his
end of May, or the time when Surgeon-Major Lyons concluded
investigation).
At the time of the Scientific Committee's visit to Damaun, the
number of inoculated by Dr. Kalapesi had decreased by 18 deaths,
and increased by 552 inoculated by him and Dr. DaCunha, giving a
total of 1,906.
* As a matter of fact, much more than that, the figure 716 deaths, 9.9 per cent
implying that during the initial three weeks of the epidemic, before the introduction of
inoculation and during the first period of four weeks after the inoculations, the worst
period in the whole epidemic, the mortality was uniformly 26 deaths a day, which, of
course, was not the case.
52
Description of Plague :
[ APP. I.
The number of inoculated by Dr. Poiares had decreased by 9
deaths, leaving a total of 258 inoculated.
The number of uninoculated had decreased by 674 deaths and by
552 who got themselves inoculated, leaving 4,643 uninoculated.
During the 12 days which elapsed till Dr, Lyons completed his
investigation, these groups produced—•
(a) The 1,906 inoculated by Dr. Kalapesi, 1 case with 1 death.
(Mortality 0.05 per cent.)
(b) The 258 inoculated by Dr. Poiares, 3 cases with 2 deaths.
(Mortality 0.8 per cent.)
(c) The 4,643 uninoculated—93 deaths, (Mortality 2 per cent.)
Calculating upon the death-rate amongst the uninoculated, the
2,164 inoculated should have had 43 deaths instead of the 3, which
is a difference of 93 per cent.
During the three periods of observation put together, between the
26th March and the end of May, 6,033 uninoculated had 1,482 deaths
(24.6 per cent.), while 2,197 inoculated had 36 deaths (1.6 per cent.).
Calculating upon the death-rate among the uninoculated we have
seen that the inoculated should have had altogether 332 deaths
instead of 36. This represents a difference in mortality of 89.2 per
cent.
Considering the large proportion in which the number of inocula-
ted stands to the rest of the population (2,197 to 6,033), it is evident-
ly impossible that the inoculated repersented the upper, or any other
particular, class of the population possessing a degree of personal or
local immunity much different from that of the rest of the population
and to which their reduced death-rate could be ascribed.
This view is confirmed by the following comparison of the morta-
lity which occurred in the inoculated and uninoculated persons belong-
ing to the same families, who lived therefore under absolutely iden-
tical conditions of life.
In a large number of households the whole of the members of the
family were inoculated, leaving none for comparison as regards suscep-
tibility to the disease. This circumstance rendered it necessary to com-
pare the whole inoculated population with the whole of the uninoculated
population, as has been done above. However, in 62 of the inoculated
families in which cases occurred, there were 124 persons who remain-
ed uninoculated, while the number of inoculated in these families was
250. A comparison between this fraction of the inoculated popula-
tion with their uninoculated relatives shows the following result :
124 uninoculated had 54 cases (43.5 percent.) with 37 deaths (29.8
per cent., case mortality 68.5 percent.).
APP. I. ]
its causes and characteristics.
53
250 inoculated had 50 cases (20 per cent.) with 20 deaths (8 per
cent., case mortality 40 per cent.).
The inoculated households lived, therefore, under no specially im-
mune conditions, as the mortality among their uninoculated members,
29.8per cent., was 5.2 per cent., higher than the mortality in the gene-
ral uninoculated population. This must invariably be the case, as only
people from badly-affected or particularly-threatened localities pre-
sent themselves for inoculation. It will be noticed also that this
small number of 124 uninoculated had a mortality higher by I death
than the total mortality sustained by the 2,197 inoculated inhabitants
of Damaun ; and that a comparison between the inoculated and
uninoculated members of these families shows that if the 250 inocu-
lated had exhibited the same susceptibility as their 124 uninoculated
relatives, they should have had 75 deaths instead of 20, a difference
of 73.3 per cent. *
A similar conclusion is arrived at on comparing the mortality in
the Parsee community quoted above, and which shows that the in-
oculated members gave a reduction of 97.4 per cent, of deaths when
compared with the uninoculated of the same community.
It has been mentioned that the lymph used in Damaun in the first
series of inoculations was of an active stock, prepared from a highly
virulent microbe, and produced a brisk febrile reaction when used in
relatively small doses. Owing to the great pressure of work during
the epidemic, no method for keeping up the strength of the plague
bacilli has been worked out, and the microbe from which the plague
lymph was manufactured was allowed to gradually sink in virulence
till it became almost harmless when inoculated into rodents. It was
lymph thus weakened that was used in the subsequent inoculations.
A comparison between the first and second series of inoculations+
done with the strong and with the weak vaccines, respectively, shows
*As far as the small numbers from which the figure 73.3 per cent, is obtained permit of
drawing conclusions, the comparison between this figure and 89.2 per cent, by which
the mortality in the total inoculated population differed from the mortality in the total
uninoculated, would seem to indicate that the presence of uninoculated members in a
family reduces the safety of the inoculated, and that, like in small-pox vaccination, the
duty of the individual is to be inoculated for the safety of his neighbours in the
community.
t The third series, done shortly before the conclusion of the observations, is left out
of this comparison, only one death having occurred amongst those inoculated on the
third occasion (see attached Rolls).
54
Description of Plagué :
[ App. I.
a difference in result in direct correspondence with the difference in
the material used, as will be seen from the following table :—
1,017 inoculated on the first occasion had 49 cases (4.8 per cent.)
with 15 deaths (1.5 per cent., case mortality 30.6 per cent.).
628 inoculated on the second occasion had 41 cases (6.5 per cent.)
with 20 deaths (3.2 per cent., case mortality 48.8 per cent.).
The total mortality and the percentage of deaths to cases amongst
the inoculated on the second occasion, though they were exposed to
the risk of infection during the milder period of the epidemic, was,
respectively, 2.2 and 1.6 times higher than amongst those inoculated
on the first occasion,
Also as mentioned already, Dr. Poiares in his operations used doses
considerably lower than those given by Dr. Kalapesi. The difference
in the results of these two groups of operations corresponded again
to the difference in the method employed, as is seen below:—
Amongst the 1,924 inoculated by Dr. Kaiapesi, there were
70 cases (3.6 per cent.) with 22 deaths (1.1 per cent.,
case mortality 31.4 per cent.).
Amongst the 270 inoculated by Dr. Poiares, there were 21
cases (7.8 per cent.) with 14 deaths (5.2 per cent.,
case mortality 66.7 per cent.).
Thus amongst the inoculated with reduced doses, small though
their death-rate (5.2 per cent.) was when compared with the death-
rate in the uninoculated population (24.6 per cent.), the total morta-
lity was 4.5 times and the case mortality 2.1 times higher than that
amongst the inoculated with larger doses.
This variation of the results, answering faithfully to the variation
in the strength of the lymph and in the doses given, shows the direct
connection of cause and effect in the two series of facts, and makes
it probable that it will be in our power to improve upon the results
obtained in Damaun.
It also indicates, when the actual figures are examined, that the
plague prophylactic has a greater influence upon the number of deaths
than upon the number of attacks. This result repeated itself in all
the observations collected up to the present on the plague inoculation,
and seems to stand in a comprehensible connection with the plan
followed in working it out. If this surmise is correct, it will be in our
will to effect a further reduction in the number of attacks by corres-
pondingly modifying the composition of the plague prophylactic.
APP. ï. ]
its causes and characteristics.
55
The above satisfactory results were obtained in one of the most
virulent outbreaks that have been observed in India in the present
epidemic, and during the 9 weeks which corresponded to the highest
stage of that outbreak.
The question as to the final duration of the effect of the plague
inoculation remains unsolved, but loses its urgent interest in view of
the above results.
No. 17.
No. 2713, dated Calcutta, the 22nd December 1897.
From—J. P. HEWETT, Esq., C.I.E., Secretary to the Government of
India, Home Department,
To—The Secretary to the Government of Bombay, General Department.
I am directed to forward, for the information of the Governor in
Council, the accompanying copy of a letter, dated the 2oth November
1897, from Mons. W. M. Haffkine, in which he suggests a system for
preventive inoculation against plague on an extensive scale. M.
Haffkine has been instructed to address the Government of Bombay
on the subject of his proposals. The result of the inoculations per-
formed at Damaun, described in the joint report prepared by M.
Haffkine and Surgeon-Major Lyons, appears to the Government of
India to be distinctly encouraging, and they have no doubt that the
Government of Bombay will afford M. Haffkine all practicable assist-
ance in making a further trial of his system in the localities in the
Bombay Presidency, which are at present infected with plague.
No. 18.
No. 2714, dated Calcutta, the 22nd December 1897.
From—J. P. HEWETT, Esq., C.I.E., Secretary to the Government of
India, Home Department,
To—Mons. W. M. HAFFKINE, Hardwar.
I am directed to acknowledge the receipt of your letter, dated the
2oth November 1897, forwarding a joint report prepared by Surgeon-
Major Lyons and yourself on the epidemic of plague in Lower Damaun,
and on the result of preventive inoculation performed there.
The Government of India have, I am to say, read your report with
the greatest interest, and consider the results of the inoculation
experiments in Damaun to be distinctly encouraging.
56 Description of Plagué : its causes and characteristics. [ ÁPP. Ï.
2, I am to request that you will address the Government of Bom-
bay with regard to your suggestion that a system should be organized
for carrying out preventive inoculation against plague on an exten-
sive scale. That Government, to which a copy of your letter of 20th
November has been sent, will no doubt afford you all practicable
assistance in making a further trial of your system in the localities
at present infected with plague.
APPENDIX II.
PREVIOUS HISTORY OF PLAGUE IN INDIA.
PAPER
Nos.
1-22
3.
4-5
CONTENTS
The plague epidemic in Kathiawar—
1. Report by Dr. Gilder
2. Report by Dr. Whyte
Pali Plague. — Description of the fever prevail-
ing at Bareilly in 1836-37, by Mr. H Guthrie,
Civil Surgeon .
.
.
.
.
.
Mahamari —
4. Dr. Hulcheson's note
.
.
.
.
.
5. Dr. Stiven's report .
.
.
.
.
.
PAGES
59-64
64—80
80—82
82 — 100
l00- 106
b 8