NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
APP. II.]
Previous history of plague in India.
75
it accordingly either as probably possible or absurd, according to the
degree of credence which you think it deserves.
I am more inclined to believe that the disease was imported into
this country, with which belief that of the people in general coin-
cides, and there appear to me to be a great many facts which power-
fully support it, and which could not satisfactorily be accounted for
in any other way. It is not known to have attacked any two places
simultaneously, however much alike in those local causes which
might have given rise to it ; but after appearing in one town, went
after a little time to the town nearest ; as from Limree to Wudwan,
Sila, and Moollie this year ; or from Morvee to Wuccaneer in 1817,
affecting slightly the intermediate villages. The class of people first
and principally affected both at Sila and Wuccaneer affords an addi-
tional presumption that in these instances the disease was imported,
for it is every way probable that the cotton forms for conveying the
contagion and sudden disappearance of the disease from Wuccancer,
upon the separation of the healthy from the sick part of the people,
cannot be satisfactorily accounted for by any other supposition
than that of imported contagion. If local causes had produced the
disease, why was their operation not evident again after the return
of the Borahs to their houses, for in so short a space no improvement
in their condition could have taken place unless that of a diminution
from their numbers be considered as one under such circumstances.
Again that fact of the disease disappearing and again re-appearing
after the lapse of years cannot be accounted for by local causes.
It is probable that during the period of the disease being absent,
these remained much the same ; but, on the other hand, if we believe
in imported contagion the difficulty is at once removed. If we
consider the nature of fomites, we shall at once understand how it
might be dormant at any length of time, and then, probably, by some
accident, be at once brought into action, for it is well known that
fomites, so far from losing their power by time will, if confined,
acquire a great increase to it. Dr. Parr says that the last time the
plague appeared in the town where he was writing, Exeter, it arose
from a traveller remarking to his companion that formerly he had
been confined by the plague in the room where they were sitting.
"In that corner" said he, "the dressings kept, it is now plastered,
but probably they are there still." With a poker he broke down the
plastering, found the dressing and the disease was soon extensively
disseminated. We may the rather wonder that the disease is so
seldom produced or so seldom conveyed from one country into
another ; this indeed is a mystery which it is impossible to solve.
Quarantine alone (considering the careless manner in which goods
76
Previous history of plague in India.
[ APP. II.
are ventilated) is insufficient to account for the long exemption
which England has enjoyed. In Bombay, where none is practised,
although a constant intercourse is maintained between that part
and the Red Sea, how shall we account for the disease never having
been imported. A Dr. Lind (in the Medical Physical Journal) says
that it has frequently been introduced into Surat from the ports in
the Red Sea, but has never spread "owing to the inhabitants living
in a constant stream of air." Upon what authority this assertion
was made he does not inform us. Quarantine, I am informed, was
enforced by the town of Dundooka this year; notwithstanding which
the disease made its appearance there ; however, as it is probable that
the authority was not sufficient to prevent the introduction of goods,
however easily people from the infected towns might have been
excluded, no inference can fairly be drawn from this single instance.
In the meantime it is certain that the disease has been introduced into
many villages and even towns of a considerable size (than is a large
walled town and otherwise favourable for its progress) without hav-
ing spread. Dr. Rugoel had frequent occasion to remark this cir-
cumstance and without untying seems to have cut the knot by the
gratuitous supposition of a pestilential atmosphere after having
mentioned a variety of instances where the disease was introduced
and yet did not spread. He says it, fomite, without a pestilential
atmosphere, is insufficient for the production of the disease, which
atmosphere approaches by slow, silent and imperceptible degrees, no
human barrier being able to oppose its progress. We ought not,
however, to deceive ourselves ; there is in the above sentence no
discovery of a new cause ; the question is merely stated in different
terms. We are not only ignorant as to the nature of this atmosphere,
but even uncertain as to its existence ; allow it once existence, and
some circumstances attending the history of this disease, which
before were involved in impenetrable mystery, may then be solved in
an instant. We can account for the disease having hitherto being con-
fined to one strip of country, distinguished by a particular name
(Jalliawan I believe), but by no other peculiarity favour the towns or
districts in its immediate neighbourhood. We can then account for it
coming close to the above limits, but never going beyond the pres-
cribed boundary; the pestilential atmosphere has not yet gone beyond
the said limit. In Europe the pestilential atmosphere has for a long
time been confined to the countries of Russia and Spain ; in Asia to
Turkey and Egypt. Until, however, we are acquainted with the
nature of this pestilential atmosphere, we shall remain where we
were. Why is Turkey so subject to plague at the present day,
although when its countries composed the Roman Empire, they were
APP. II, ]
Previous history of plague in India.
77
almost always free from it. Sir John Pringle says the principal reasons
of all this are the frequent ablutions enjoined by the Mahometan
religion, while the neglect of these in Kathiawar has been thought a
principal cause of the inhabitants suffering from a similar disease.
Nothing can shew, more clearly, the danger attending all reasoning
upon limited experience. All of the countries above named agree in
one general circumstance ; and that is that the inhabitants enjoy a
less degree of that internal comfort, contentment, prosperity, peace
of mind, which constitute the sum of human happiness (speaking
generally) than those of the countries which are exempted from the
ravages of this disease. England probably is indebted to her im-
proved condition, in the general diet and manners of the people,
for her long exemptions, and the other countries will be equally safe,
when their internal situation shall be improved.
From all that has been said, I think it will be apparent that
although this disease in a close ill-aired situation is highly contagious, in
an open space it is quite the reverse. It has never remained long in
any except the large and walled towns, where probably more or less
infectious atmosphere always exists ; while the town of Sila suffer-
ed so much, the Dairwan, which was outside the walls, was free.
The Thakoor's house (the only one in the town well aired) at
Morvee afforded safety to a hundred people, while the disease
lasted for five months, in every other part of the town of Moorba,
kept its inhabitants in safety for the same reason, and all the
villages in the district may be said to have been safe, for the disease
never spread generally among their inhabitants ; and, lastly, when
from fear, the sound part of the people even separated the diseased,
the disease which, while the Borahs remained crowded in their dirty
huts within the walls of Wuccaneer, threatened their entire destruc-
tion, was immediately and entirely removed, no doubt can exist that
the disease was propagated by contagion in the house of the
Thakoor's brother in Moolee, where, in one family, nine women and
a boy died from it, or in the house of the Borahs in Morvee, where
seven out of nine people living in a dirty confined house were suc-
cessively attacked by it. I think it very probable, likewise, that the
towns, which yet have been safe, are every day liable, by means of
fomites, to have it introduced among their inhabitants, and that if
unfavourable circumstances concur at its first introduction, it will
spread in any of those towns whether they are placed within or
without the limits of Jaliiawar.
The subject of prevention therefore is one of the utmost import-
ance, and it is cheering to reflect that we have arrived at the
knowledge of a plan by which, if its rules are rigidly attended to, we
78
Previous history of plague in India,
[ APP. II,
have it in our power speedily to check the progress of this scourge,
in any place where it may be introduced, These rules, to be completely
effectual, however, require the aid of a vigilant police, guarded by
sufficient authority; if introduced into this camp to day, I would not be
under the smallest apprehensions of its spreading; unfortunately, how-
ever, the nature of the petty authorities in Kathiawar, combined with the
apathy, indifference and uncleanly habits of the people, their mental
despondence, belief in fatalism, and perhaps the neglect of oily fric-
tions, present very great and perhaps insuperable difficulties to the
proper execution of the necessary rules. Power is divided into so
many minute portions that it dwindles into almost nothing ; and
that little, if the chieftain attempts to enforce it, subjects him to the
risk of losing all his most industrious subjects. These, knowing
very well their own importance, if displeased, immediately threaten
to remove into the territories of some neighbouring lord, thus
rendering their own a slave to their whims, caprices, and pettish
humours. In consequence of this, the Chief, if ever so willing, would
not possess sufficient authority of enforcing the necessary rules.
These, I need hardly add, are such as would secure cleanliness, and
a complete separation of every family where the disease had appear-
ed from the remaining sound population ; they ought to be com-
pelled instantly to depart from the town and live in the open plain
under a temporary encampment which (if the subject were thought of
sufficient importance) might be erected at the public expense for the
lower orders ; it would be well if the clothes of the deceased were to be
burned at the public expense likewise. Experience has proved that,
if not crowded, in such a situation the disease would not spread, and
there can be no doubt the beneficial consequences would even be a
subject of joy and congratulation to every one who had a hand in
promoting so benevolent a purpose.
It would perhaps have been better if I had, at an earlier period,
said what I now intend to do, concerning the nature of this disease
as I have, in many places, been compelled to anticipate, so far as
to speak of it by a name, which I have no hesitation at once assign-
ing to it, viz., Pestis. Doubtless, in former times, all severe and
fatal fevers were too indiscriminately classed under, and handed
down to posterity with this denomination ; on the other hand, it has
been an error of physicians, more frequently, in later times, altogether
to doubt the existence of this disease, until its ravages had fatally
and too surely pronounced its nature. There is something so re-
pulsive in the name of plague, one wishes naturally beget a dis-
belief of its reality ; let us be cautious how we feed a belief, which
may be fraught with such dangerous consequences to hundreds of
ÀPP. II. ]
Previous history of plague in India.
79
our fellow-creatures, but equally free from prejudice either way ;
let us dispassionately call in the aid of nosological definition to guide
us through the difficulty. It is, I believe, allowed that although a
great many more symptoms frequently attend it (and no disease has
varied so much in various epidemics), yet that Cullen's definition
includes all that are strictly pathognomonic : " Typhus máxime con-
tagiosa cum summa debilitate uncerto : morbi die eruptio bubonum
vel anthracum :" all these symptoms are present in the present dis-
ease in almost every case, and are mentioned always by the natives
as distinguishing it. The very name which they have given to the
disease " Ghaut" means literally a bubo. It is indeed true that petechise
and carbuncles, if ever, are but seldom seen, symptoms commonly
attendant on plague, but we may observe that petechias are not
mentioned by Dr. Cullen, and that he mentions carbuncles in an
ambiguous and guarded manner " bubonum vel anthracum," which
by no means implies their constant and necessary presence.
It may be urged, likewise, that in one particular form, above des-
cribed, no bubos are ever observed, but we learn from Dr. Rüssel
the same thing was very common at Aleppo, and he seems to think
that their non-appearance was owing to the rapid termination of
these cases in death, which is extremely probable, for these eruptions
do not come critically on a particular day, but "uncerto morbi die,"
and in the prognosis of this disease, the later they were in appearing,
it has always been observed so much the greater has been the
danger ; and, vice versa) where they come out before the fever the
danger is seldom great. The same thing has always been observed
regarding the yellow colour of the skin in yellow fever ; when the
patient dies very early in the disease, the yellow colour not appear-
ing. Bubos are the grand distinguishing symptoms of the present
disease, and if the patients were to live long enough, would doubt-
less invariably make their appearance. I apprehend, therefore, we
shall be as little justified in refusing it a place under the head of
plague as those authors have been, who have been so eager to class all
malignant or putrid fevers under its name, merely because they were
generally fatal, and bubos were sometimes though rarely and accident-
ally observed to make their appearance in them. " I feel it unneces-
sary to pursue this subject further than just to remark that all the
other symptoms which have been enumerated as frequent in plague
will be found in the different cases of this disease ; and if it were fair
to infer anything from its fatality in this feature, it might justly claim
pre-eminence of most those epidemics of which we have a history. I
was told by the Thakoor's brother at Moolee that some of the women
mentioned above were suddelny taken ill, in the midst of their
Usual avocations, that while conversing, in the middle of a sentence
8o
Previous history of plague in India.
[App. Iî.
they would fall down, blood come from their mouth (not in any great
quantity) and death immediately follow. After allowing a sufficient
portion of this account for exaggeration, enough will still remain
to show how suddenly fatal, sometimes, its attacks have been. The
symptoms in general were such as denoted rather nervous debility, as
convulsive tremors of the muscles, inability to walk or stand after
the first day, delirium or wandering of the mind, and a very weak
pulse, than those which have been supposed to indicate a putrescent
state of the fluids. The stomach and bowels were not remarkably
deranged, there was nofoter of the breath or excretion, no sordes
upon the teeth, and the tongue was only coated with a white fur.
Hemorrhage was the only symptom which could be supposed to arise
from the latter cause. In women with child, abortion followed
attacks of this disease, and a dead child was produced.
I shall avoid the subject of cure, having no facts that could at all
illustrate it. At Moolee I gave a little medicine to two patients who
died, as the others had done before them, notwithstanding which
it evidently prejudiced the mind of the people against me (I believe
they thought me invested with little less than divine power on my first
arrival), and it operated so much in my disfavour at Sila, whither the
news had travelled before me that when I first arrived they obstinate-
ly refused to let me see any of the sick.
Should I have any further opportunities of observing this disease,
I shall communicate to you their result, but at present I am about to
proceed in an opposite direction in company with Captain Barnewall
on a tour to the westward and southward. I shall feel much obliged by
the communication of any information on this subject, which you may
have received in 1817 or since and have the honour to remain, etc.
Pali Plague.
No. 3.
DESCRIPTION OF THE FEVER PREVAILING AT BAREILLY
IN 1836-37, BY MR. H. GUTHRIE, CIVIL SURGEON.
The fever here is much the same as that so well described by
Mr. Spencer at Moradabad. On some occasions its first invasion is
very insidious, and the unfortunate patient scarcely acknowledges
that he is at all unwell ; but, generally speaking, the first paroxysm is
marked by a smart rigor, and this not subsequently repeated is soon
followed by heat and thirst, continuing during the night, and gradually
declining in the morning. There is seldom or never any sweating,
and during the daily remission the thirst continues unabated. The
tongue is verv peculiar, being tremulous and awkwardly protruded.
APP. II. ]
Previous history of plague in India.
81
presenting a red velvety border deeply indented by the teeth, the
upper surface, with the exception of the red border, a quarter of an
inch in breadth, is various, generally quite white : papillœ thickly and
extremely raised, less frequently covered with a dark typhous crust,
and in a few instances it is yellow or mottled by various shades of
red slightly oozing blood, the teeth covered with sordes and the
expression of face indicative of great distress. The patient seems
unwilling to answer questions, or rather that he has not the power of
arranging his thoughts. The brain or sensorium is affected variously,
from slight frontal headache to deep coma: frightful dreams and
delirium, with horrid moaning and tossing of the body from one
position to another. Eyes generally dull, unexpressive and
muddy, now and then streaked with red vessels, and too frequently of
a deep yellow or saffron colour. In the course of a night I have
frequently known the patient lose his sight by absorptive disorganiza-
tion, the cornea merely protruding like the boiled eye of a fish ; if
any discharge, it is a slight serous one. Occasional severe pains in
the throat and chest, with cough and expectoration ; in the protracted
stage, hiccough frequent and most distressing, with painful tension over
the epigastric and hepatic regions. The spleen is seldom or never
affected, abdomen tumid, hard, and sore on pressure : urine scanty,
high-colored, and occasionally tinged with bile. Pains in the lower
extremities severely complained of during the whole course of the
disease, and even during convalescence in the upper it is chiefly felt
in twitchings of the small tendons about the wrists, and quick invo-
luntary movements among the fingers. There is throughout a
ravenous desire for food, the indulgence in which is generally and
immediately fatal ; this bulimia continues up to the moment of dissolu-
tion. It is quite piteous the manner in which they implore food. Dr.
Worrall took compassion on one poor wretch, but the congee, which
is generally not hurtful, reached the stomach, he fell back and
expired.
In most cases the fever is a remittent one, and the paroxysm
daily steals on about dusk, continuing till morning. Many, however,
die in the first paroxysm, completely overpowered, as if the powers
both of body and mind were at once blighted. These paroxysms,
excepting the first, are generally without rigors. If the fever pro-
tracts, it is accompanied with great prostration, active absorption of
the soft parts, leaving merely skin to cover the bones : the skin does
not break as in putrid fevers. The bowels are very easily moved
and often spontaneously. At first the stuols are very black, green,
but from treatment soon become yellow and liquid. The state of the
bowels is very delicate, and if the debility proceeds, a fatal diarrhœa
sets in, which soon debars all hope of a recovery ; the pulse at first is
b n
82
Previous history of plague in India.
[ App. II
140 or 150, or too quick to be counted, generally weak, soft anc
compressible. In only one case have I seen a glandular swelling, anc
that was on the top of the thigh. This disease differs from remittent
fevers in general and common intermittents—in the saffron eye, state
of the tongue, the ravenous desire for food, the latter being hurtful
as also bitters, bark, quinine, etc.,—cold fit in the first paroxysm only
etc.
Into the dark cavern of nature, whence emerge these destructive
and periodical epidemics, not even a scintilla of philosophical light has
been thrown. This fever has, I understand, been dreadfully destruc-
tive in the neighbouring terrai, and one unfortunate village is said no
to have one inhabitant left alive. As the medical officers supply thei:
accounts, it may be found to extend to Marwar, if not to Guzrat.
As to its infectious character here within certain limits, I have m
doubt, but it has laws of its own. When the town was devastated by
it, the convicts had it not among them—but now it is vice versa.
have nothing to say in a brief hurried account like the present to the
questio vexata of contagion; but this I do know and declare that
those tending the sick and breathing their atmosphere night and day
did take the disease, and severely. I will even be hardy enough to
declare what I have seen before when hundreds were in hospital a
Baitool and even at Allahabad with fever of an intermittent type tha
surgical patients and hospital attendants fell easily and frequentl
under the prevailing fever of whatever kind it was, Our epidemical
knowledge is too confined to enable us satisfactorily to define the
dark boundary betwixt general prevalance and ' particular contagion
either in certain districts of a country or among particular classes c
human beings.
Mahamari.
No. 4,
DR. HUTCHESON'S NOTE.
1. The Plague, Pestis séptica, Syrian, Levantine or Egyptian
Plague, the Bubonic Plague of Western China, and Gola or Phutkiya
rog and Mahamari of British Garhwal and Kumaun are doubtless one
and the same disease, which has existed in all probability in the hill
tracts of India and China from time immemorial.
2. The disease, so far as history records, was prevalent in Europe
in the sixth century, B. C., and is said to have spread at this period
over the greater part of the habitable globe ; and since then it has
been recorded in Syria, the Levant, Egypt, and elsewhere. Dale
Ingram published a historical account of the disease as far back as