NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
APP, II.]
Previous history of plague in India.
93
family, and Punagir of Mauza Maghera was a caste-brother of Tejgir.
Punagir visited Tejgir on the 13th September while the latter was ill
of the fever, and returning to his home five miles away on the further
side of the Pangra river, was seriously ill the next, and died the follow-
ing day.
The inhabitants of Barkuri, separated by a spur of a hill from
Surkali, vacated their village on the 22nd July on account of a great
mortality among rats and mice, and an outbreak of mahamari was
thus in all probability averted.
21. In 1894 five persons died of the disease at Ira, patti Chaprakot,
Garhwal, between the 5th and 8th January, and there were two more
seizures, and between the 3rd and 4th May a girl and a boy were
reported to have died of the disease at Gadoli, patti Daijuli, pargana
Chandpur, but Dr. Giles was of opinion that these deaths might have
been due to famine fever.
22. A description of a Kumaon hamlet and the terrible effect
among the people, and of the calamity which often befalls many a
household on the outbreak of the plague, may be best given in the
words of one who personally observed the scenes and recorded his
experiences of the extended outbreak in 1876-77.
" Bait and Bintola are two adjoining hamlets situated rather low
down in a valley about four miles north-east of Almora.
"The houses are well built of stone, with solid roofs of thick hill
slate. They are arranged in short terraces on the hillside, in accord-
ance with the following ground plan, Bintola being lower placed than
Balt. In the plan each square represents a house, and the figure, the
number of deaths which occurred in the family inhabiting the house :—
94
Previous history of plague in India.
[ APP. II.
"The people of Balt and Bintola were friends; they had inter-
married, and relatives of many families lived part in Bintola and part
in Balt ; and the two villages might be considered one."
Mahamari first appeared in Bintola early in November 1876, in the
person of a child of the padhan or headman of the village. The child
died on the third day after it sickened, and while it was sick two other
children of the same family were taken ill and also died. In the two
houses which formed the homestead of the padhan, before the
sickness commenced, there resided a family of fourteen persons in all.
Of these fourteen persons, thirteen died at intervals during Novem-
ber and December, all with the same symptoms of disease, commencing
with shivering, quickly followed by intense fever, ending in delirium,
insensibility and death on the third or fourth day.
In the terrace of three houses adjoining the padhan's home, three
families resided containing a total of fourteen persons. The women
of these families helped to nurse the sick of the padhan's family, and
during November and December twelve of these fourteen persons
died of the same form of disease.
At first the sick were nursed and died in the houses, afterwards the
sick were nursed and died in temporary huts outside the village, and all
the bodies were buried after death. In all, thirty-one cases of the
disease occurred during November, December and January, and 27
persons died. The four persons who recovered presented themselves
to me on the 24th January for examination. All had the same appear-
ance of extreme debility with emaciation, and one had a small bubo
in the left axilla, which appeared on the sixth clay of his illness seven
clays ago, and is now soon likely to suppurate, being hot and tender.
Bubo was noticed both in the axilla and inguinal regions in some
other of the later cases, but in none of those who died quickly at the
first outset of the disease. And it was only after the bubos were
seen that the people knew they were suffering from an outbreak of
gola, the name given by the hill people to the disease. No appear-
ance of bubo occurring in the first rapidly fatal cases, the people
thought the disease was sanjar, a form of continued fever common
amongst the hill people and frequently fatal, but believed to be less
contagious, and therefore less dreaded than gola.
From the time the people vacated the site to live in temporary
huts or in caves on the hillside, only one death occurred, as will be
hereafter described.
In Balt the first case occurred in the person of a -woman named
Bani, who had gone to the padhan's house at Bintola to assist in nurs-
ing the sick children there. She resided and died in one house of a
terrace of seven in the upper part of Balt ; next, her daughter died ;
then four persons died in the adjoining house ; then her husband died,
and the disease spread through the terrace; so that deaths occurred
APP. II. ]
Previous history of plague in India.
95
in every house excepting one, which was untenanted. In all, 13
persons died in the terrace during December, and then, as at Bintola,
the people of the villages vacated their houses so soon as " gola" or
bubo was noticed as a symptom of the disease in those who lived
beyond the fifth day. Indeed, deaths from gola being reported, the
civil authorities directed the people to vacate their houses, and they
located themselves in huts of grass and branches on the hillside. All
remained well until, a great fall of snow occurring on the 14th of
January, the people returned to their homes ; and during the succeed-
ing five days, four more deaths occurred in the houses of the terrace
previously effected. The people, seeing this return of sickness, fled
at once to the hillside, leaving the sick who died unattended in the
houses.
The local conditions at Balt and Bintola were as follows :—" Both
villages were uninhabited, the former inhabitants scattered in families
miserably lodged in huts or caves far off ; the village cattle roaming and
feeding amidst the young wheat of the cultivated terraces around and
below the villages. The torn remains of thirteen cows, calves or bul-
locks, and five goats, scattered in different places, witnessing to the
truth of the local statement that, from dread of the disease, no one dare
venture on to the site to house the cattle as night approached, and
that consequently leopards and hyenas were devouring the flocks.
"The houses were double storied, one room below and one above,
close, unventilated tenements. The lower room was used as a cow-
house, the upper room for family occupation. In the lower room,
about five feet high, it had been customary to lodge from four to
eight head of cattle or goats at night, and, indeed, in some instances
as many as the room had standing place for ; the only opening being
the small doorway of entrance, tight closed and barred at night.
These rooms were seen to be littered for about a foot in depth with
decaying straw and much manure, moistened by the fluid excretion
of cattle, and the entrance way on each side, and the stone platform
facing the lower storey, were piled with heaps of manure, which had
been drawn out of the lower room as necessity required, and there
left for eventual removal to the land in the ploughing season. The
upper room was noticed to be roughly divided by wooden slabs into
a front and back portion ; the former used as the family sleeping
place, the latter as a granary. The doorway, and in some instances
a round hole in the front, and a small round hole for the exit of smoke
through the roof of the house, all commonly closed at night, being the
only openings. The floor was made of thin wood, with pretty numer-
ous cracks, so that the warmth generated by the cattle below could
reach to the sleeping people above, afterwards locally described as a
beneficial arrangement,
96
Previous history of plague in India.
[ APP. IL
"Upon the stone platform facing the terrace above mentioned lay
the broken remains of the four persons who had last died, their limbs
and skulls torn and scattered by jackals.
"As regards the site generally, and the precincts of the villages
nothing naturally insanitary could be seen. With the exception of a
grove of pine trees at one place, the sharply sloping surface was clear
of excessive vegetation everywhere. A mountain stream of bright
water flowing between the village sites furnished an ample supply of
good water for domestic purposes. Above the village sites all was
clear, open rocky ground ; around and below the sites almost all the
surface had, by the patient industry of many years, been fashioned
into narrow terraced fields, spreading down in green steps of young
wheat and barley to the margin of the rocky stream flowing in the
very bottom of the valley."
Alam is another village of about 12 houses, high placed in the
precipitous mountainside above the Gori river. To reach it from the
Gori valley side, the river, a boiling flood of snow water, has to be
crossed by means of a cradle sliding on a rope, the apparatus being
temporarily provided for the use of the visitor.
The houses are placed on the mountainside in the following
order :—
ALAM.
Alain was inspected on the 12th of May 1877. In all, eight
deaths in two families occurred here from gola disease, the following
being the history of the outbreak: —
"The disease commenced in the padhan's family with the illness of
the padhan's brother, who came home ill with fever from a shooting
excursion on the 4th of March, and died on the 7th, swelling
appearing in his groin before he died. In this family the wife of
another brother and her child died during the period between the
7th and 23rd of March, and in both cases bubo appeared as a symp-
tom.
APP. II. ]
Previous history of plague in India,
97
"The man who first died lay sick, was visited several times by a
man who had recently come from Askot to settle with his family in
three attached houses, highest placed of any in the village. This
Askot man was taken ill on the 11th and died on the l6th of March, a
swelling appearing in his armpit before he died. He died in his
house attended by his wife, who buried his body just outside the house
door. Three days after he died his wife was taken ill, and died after
four days' illness ; and her body was left in the house unburied. The
five remaining members of the family, four boys and one girl, fled to a
neighbouring hut, where they lived together for a few days, the eldest,
a boy of 14, acting as head of the family and providing food for the
rest. This boy feeling himself ill, returned into the house alone and
died, his body also remaining in the house. Four children remained,
the eldest, a girl of nine named Danuli, and her three brothers aged,
respectively, 7, 5 and 1½ years. Danuli worked for and fed them all
for a few days, and during this period the boy of 7, wishing to take
honey from a hive in the house, entered it with burning straw or wood
to drive the bees away. Either from carelessness, or as the result
of fright at seeing the dead bodies, he set the house on fire ; and
all three tenements were burnt down. A few days after the house,
was burnt down, the boy of seven was taken ill and died in the hut ;
and his death was followed by that of the boy of 1½, after an inter-
val of some days. So that Danuli and one brother only were left.
"Before reaching the village on the 12th of May, I had been in-
formed that possibly children might be found there abandoned. The
village was found empty and desolate, and Danuli and her brother
were found near the place of temporary abode outside the village,
the former, a bright-eyed little girl dressed in an old petticoat, the
latter a little urchin wrapped in a piece of old blanket. These
children had lost their parents by the 20th of March, and from that
date had been thrown on their own resources, except for a few days
while the elder brother lived, for no person of the village would
approach them.
"The girl Danuli recounted, in disjointed sentences, her experi-
ences of the past eight weeks. Explained how her father, mother
and big brother had died ; how all the people ran away out of sight ;
how the house had been burnt ; how her brother of seven had died
and his body been carried away by jackals in the night time ; how
she had buried her little brother of 1½, taking the body in a basket
and digging a trench for it with a pick ; and lastly, how she had
been left only with the remaining brother, husking and cooking rice
for both every day, leading her brother clown to a stream to drink
and sleeping with her arms about him every night. Even now that
b 13
98
Previous history of plague in India.
[ APP. II.
so long a period had elapsed since the last person had died, no
native person present would approach these children, who sat hand-
in-hand, apart, as the girl told her pathetic tale of suffering and
endurance.
" The two children were taken down the mountainside to a stream
in which they were washed, their clothing was burnt, and they were
re-clothed and provided with blankets. Afterwards they were passed
in the cradle across the Gori, and given in charge of their grandfather,
who was much moved at sight of the children and promised to care
for them in his village on the mountain opposite Alam."
Such is the history of many a household during the occurrence
of the plague, which exists to this day in British Garhwal and
Kumaun.
23. The ever-recurring recrudescence of the plague in this por-
tion of the Himalayas may be ascribed to the ingemination of a
specific poison, and its spread by fomites and other means through
neglect to destroy articles, etc., likely to convey and retain infection
for long periods and to the imperfect burial of the dead in epidemic
and at other times. The accidental uncovering of a grave, distur-
bance of soil, etc., or the unearthing of a long neglected or hidden
household article, may undoubtedly let free the specific poison just
as the special communicable poison of scarlatina, small-pox, etc., may
be wrapped up in a dirty rag or other article for years.
24. The cause of the disease, however, is still obscure. It has
been ascribed by Dr. Watson to the eating of diseased brain, espe-
cially to the use of "mandua" (Elusine cor ácana), and the fact that
the rats and mice have access to grain stores and die of the disease
often prior to the outbreak among the people seems to have con-
firmed him in his belief, strengthened by the supposed fact that a
quantity of diseased mandua sent from an infected village to be
ground at a water-mill caused the death of all rats about the mill.
Others have ascribed the disease to the use of chua (Amaranthus
frumentaceus], and it is where this grain is chiefly used or forms the
staple food of the people that the disease first breaks out. However,
Doctors Francis and Pearson have pointed out that the villagers on
abandoning an infected village take their supplies of grain with
them, and that the pestilence is usually stayed although the food-
supply is the same as when the people occupied the infected local-
ity.
Doctors Francis and Pearson fully investigated the point and
satisfied themselves that Doctor Watson's supposition could not be
supported by properly authenticated facts.
APP, II. ]
Previous history of plague in India.
99
25. Light has lately been thrown on the etiology of the disease by
investigations into the occurrence of the recent epidemic at Hong-
kong. The confirmation of the fact that a special organism exists in
the blood and tissues of those affected by the disease seems to indi-
cate that a special bacillus is the cause of plague. The demonstration
of its abundance in the inguinal glands of the affected and of the
rapidly fatal effect of the inoculation of the micro-organism (an
encapsuled dipplococcus, difficult to strain by the usual reagents but
easy to cultivate on gélose) on rats, mice and guinea-pigs would seem
to point to a definite conclusion. It only remains for us in the North-
Western Provinces on the next appearance of the disease in the
Himalayan hill tracts to confirm such conclusions, by demonstrating
the presence or non-presence of the newly-discovered bacillus in con-
nection with the disease as it occurs among the people of British
Garhwal and Kumaun.
26. Mahamari has been fostered by the uncleanly and filthy
habits of the people of the hill tracts who house cattle, sheep, goats,
and other animals on the ground-floors of their unventilated houses
and allow accumulations of sewage, refuse and litter in the immediate
vicinity. They also defile and pollute the neighbourhood of the
village in defiance of all sanitary law, and in their helplessness
permit refuse and noxious weeds to fill the air with rank odours,
adding to the foul emanations that penetrate every nook and corner
of the overcrowded impure dwelling which forms a nursery of
zymotic disease and is the birthplace of the pestilence.
27. The remedial and preventative measures, as embodied in
the rules for the prevention of Mahamari, comprise—
(1) The housing of all cattle, goats, sheep, etc., in the sheds at
a distance of not less than 50 feet from the village, the
sheds being located below the village if possible,
(2) Attention to the ventilation of houses and the prevention of
overcrowding by the distribution of families in different
rooms.
(3) The prevention of nuisances in or near the village.
(4) The clearances of accumulated filth, manure heaps and rank
vegetation from within and around the dwelling-houses.
(5) The preservation of the water-supply from pollution and con-
tamination.
(6) The evacuation of infected houses and of the village on the
death of rats or mice in observable numbers or on the
occurrence of the disease among the people,
100
Previous history of plague in Indict.
[App. II.
(7) The destruction by burning of bedding, clothing of the in-
fected and the proper cremation of the dead of the disease ;
and
(8) The destruction by fire of the house, together with any
article likely to convey or retain infections in which a
death from Mahamari has occurred.
28. Continued immunity from Mahamari in an epidemic form makes
the rising generation, as Sir Henry Ramsay wrote in 1882, under-
estimate the danger " arising from the continued presence of this
preventible diseased"
It is still necessary to emphasize the need for increased watchful-
ness and for maintaining the strictest sanitary precautions to prevent
the disease from assuming undue proportions in the hill tracts,
Otherwise its incidence might even yet prove disastrously fatal
among the overcrowded communities of our hill sanitaria, within a
few miles only of the locality of the ever-recurring pestilence.
DR. STIVEN'S REPORT.
No. 5.
(Indian Annals of Medical Science, No. III, October 1854)
As one of the leading objects of the conductors of the "Annals "
is to record the progress of epidemic disease in India, we return to
the deeply interesting subject of Mahamari, upon which an article
appeared in our last number. The present contribution to its history,
although brief, is highly important, in announcing the fact of its
having extended from the hilly regions to the plains. We are in-
debted for this addition to our knowledge of this mysterious disease
to Dr. Stiven, Civil Assistant Surgeon of Muradabad, whose official
report upon the subject has been published, and from which we
proceed to extract all that is likely to interest our distant readers, but
more especially those points which refer to the contagious transmis-
sion of the malady.
In the paper on Mahamari in our last number, it will be remem-
bered that its history was brought down to the close of 1852, at which
time, after a year of unexampled fatality, it was still existent in
Kumaon and Garhwal. In February, 1853, we find it committing
great devastation in Rampore, and in a milder form in Kasheepore,
both situated in Rohilcund, an extensive plain adjoining the Kumaon
hills continuing for a brief period only. As we consider, however,
the progress of epidemic disease from place to place as constituting
APP. II. ]
Previous history of plague in India.
101
one of its most interesting characteristics, we shall give the descrip-
tion in Dr. Stiven's own words :—
"In accordance with the instructions contained in his letter, I at
once proceeded to Kasheepore and ordered the Thanadar to make
strict inquiries through the medium of the chowkidars and burkan-
dazes, as to the localities in which the sickness prevailed, and that
when this was clone, I would proceed with him and visit all the
infected houses.
"In the meantime Mr. Wilson arrived from his camp in the neigh-
bourhood, and afforded me every assistance in his power, accompany-
ing me through all the streets of the town. We saw a few cases of
sickness, three of which were fever, in two of these swellings of the
glands to a slight extent was observable, in one those of the right
groin were affected, in the other those of the right armpit ; in conse-
quence of not having seen any more cases, either during my stay
at Kasheepore or having received any intimation of others having
occurred afterwards, I gave the following opinion in my report sent
in then.
" There was nothing to show that these swellings were so connected
wich the disease as to lead to the supposition that the cases were in
the least analogous to Mahamari, as reported.
"Further experience has led me to form an opposite opinion from
the one then expressed, and I now firmly believe that these two cases
of supposed fever were cases of "Mahamari" modified by the
diluted nature of the infection (if I may be allowed to use such an
expression), and that the "vis medicatrix naturae" was sufficient to
overcome the disease in the absence of all medical treatment. I need
not recapitulate what I then wrote in regard to the filth of the town,
etc. ; it is sufficient to say that measures were taken to cleanse it and
its environs, and that no other cases were heard of in 1853.
"I may, however, add that the Thanadar did not report the circum-
stance of sickness being prevalent in sufficient time, in fact until it
had all but ceased to exist.
" If I had known of it at once, it is very likely that I would have
seen cases of pure " Mahamari" and might have been able to have
traced the disease to Chilkeea—a very important mart for hill produce,
and where the Kasheepore buniahs are in the constant habit of
going to barter their goods for these articles brought down by the
paharis, causing, of course, intimate intercourse with each other.
" I might thus have been able to show that contagion was the " prima
causa " of its breaking out, and that it was propagated by the filthy
state of the whole town.
" In the appendix, my report of Kasheepore sickness will be found,