NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
App. I. ]
its causes and characteristics.
27
Stimulation by hypodermic infection of either is a treatment that
gives grateful response, and must be used freely and frequently. The
collapse from plague does not take place at that period of the disease
when organic structures are played out, but it occurs early in the dis-
ease in two or three days, and is therefore more of a functional or
toxic than of an organic nature ; consequently, the use of stimulants,
in whatever form, is more likely to be attended by remedial results
and not by a mere temporary flicker of response.
Internally the form of drug most useful is either a general sti-
mulant, such as ammonia, or a cardiac tonic or specific.
The prescription of every practitioner who treats plague will be
found to be one in which carbonate of ammonia and the tincture or
decoction of cinchona are met with, and with this mixture now given,
now withheld, will be exhibited digitalis, strophanthus, or camphor.
More good is ascribable to ammonia in some form than to any other
known and more specific drug.
Digitalis in infusion, tincture or in leaf, the latter perhaps the
best, seems the one drug called for when the pulse becomes dicrotic
and the nervous stimulation of the heart gives out. In practice, how-
ever, it is unsatisfactory, and seldom can any good results be traced
to its administration. No doubt the slowness of its action is against
it; but, what is still more, positive evidence is against its being con-
sidered a reliable drug in an acute illness like plague.
Strophanthus is in the same category with digitalis.
Camphor in its double action as a direct cardiac stimulant and a
stomachic carminative is useful as an alternative drug. Undoubtedly
the best form is in pill in doses of gr. ii. Camphor may advanta-
geously be used hypoclermically dissolved in sterilised oil.
Caffeine
also is worthy of trial.
Musky in the few cases treated therewith, seems to justify its
•administration, and it is a form of circulatory stimulant which one
welcomes as an addition to one's resources. The musk, as fresh as
can be obtained, may be given in 5-grain doses every six hours as
an expedient.
Strychnine, administered by the mouth or hypodermically, is of the
greatest use. Granted that functional abeyance of the nervous influ-
ence, more especially of the heart, is the essence of the toxic effect
of the plague bacillus, strychnine ought to be a drug of importance in
the treatment. This expectation was borne out in practice, and Dr.
Lowson in his report, and all who have reported on the treatment of
plague, regard strychnine as a most reliable agent in the form of
28
Description of Plague :
[ APP. I,
stimulation required in plague. Liquor strychninae in 5 to 10 minim
doses, given every four hours, is the most convenient form ; but, when
vomiting is present, a hypodermic solution of gr. 1/48 of the sulphate
of strychnine in 10 minims of distilled water is advisable.
Other drugs may be mentioned, but, though useful as a change
and a standbye on occasions, they do not justify more than a passing
notice. Among the more important are quinine when malaria com-
plicates the disease, as evidenced by a large spleen ; aconite in
the early stages, when high fever and a full pulse are present ; chlo-
ride of ammonium asan alternative is occasionally useful.
The inhalation of oxygen (Lowson) is not to be neglected, and
the gas ought to be always at hand and ready for immediate use.
The result of experience gained by local, radical or tentative
treatment of the glands does not lead one to expect much benefit
from them, That abscesses should be opened when they point, or when
fluctuation is perceptible, is of course natural ; but that local reme-
dial steps should be undertaken for the purpose of affecting the
course of the disease by acting on the gland is, from what we know
of the pathology of the disease, scarcely rational. Injection of a
swollen gland when it is accessible, as in the groin, with such sub-
stances as carbolic acid, perchloride of mercury, or a solution of the
perchloride of mercury and iodide of potassium, has perhaps a theo-
retical basis of justification, but practically little good can be ascribed
to it. The latter-mentioned solution may have a higher claim, as in
several cases in which it has been administered, temperature falls and
the patient seems easier. It may be, however, that the mere pricking
of the tense capsule of the gland even by needle punctures may
serve to relieve tension and thereby pain. This leads one to the be-
lief that subcutaneous incision of the gland may be attended with
beneficial results, and it is a method of surgical procedure not without
precedent. Early free incision of the gland is not to be recommended,
nor can excision be in any way justified. The disease is a polyade-
nitis and of so extensive a nature that eradication of infected glands
is an impossibility. A gland, when swollen, red and painful, may be
smeared with glycerine and belladonna, or poulticed to relieve pain,
and, when fluctuation is perceptible, it should be opened, but further
procedure is useless. When pus is evacuated, dusting the wound
with iodoform and insuring thorough drainage are the means by which
the best results are obtainable.
Retention of urine, a frequent concomitant during the delirium
of plague, renders the use of the catheter imperative.
APP.
1.]
its
causes and characteristics.
29
Reports by M. Haffkine on experiments made with
Curative Serum.
No. 10.
Dated Bombay, the 17th February 1897.
From—M. W. M. HAFFKINE,
To—The Secretary to the Government of India, Home Department.
I have the honour to communicate the following information on
-the attempt at curative treatment, which has been made by means of
•the antitoxine at present under preparation here at Sivree during
the outbreak of plague in Byculla Jail.
A patient 'called Ganoo Baloo admitted to the hospital since
three days has Teceived one injection of antitoxine, but died within
eleven hours.
The following patients were selected for treatment immediately
after their admission to the isolation shed, though after some time
has -elapsed since the onset of the disease.
Admissions on the 3oth January 1897.
Of six patients admitted in the morning, the two most serious,
Jeeva Virchand and Syed Jonas Ali, were selected for the antitoxic
injection, the four milder left to the ordinary treatment.
Of the four milder, three have died within two, four and six days.
The two others specially treated have survived.
Admissions on the 31st January 1897.
Of the two cases admitted, the most serious one, Anuah Vishrao,
has been selected for the special injection, the other milder has been
left to the ordinary treatment.
The milder case ended fatally after three days' illness ; Anuah
Vishroa is alive.
Admissions on the 1st February 1897
Of the five cases admitted, the two most serious, Kaloo Bhimsha
and Keshoo Umar, have been selected for the antitoxic injections ;
the three milder left to ordinary treatment.
The two treated cases have ended fatally after six and twelve
days' illness ; of the not treated specially, two died after four and nine
days.
II. Analysing the result in connection with the period elapsed
between the onset of the attack and the beginning of the antitoxic
treatment, it appears that—
out of the six patients treated, four have been taken for the
special injection within twenty-four hours after the attack
and two patients after two and three days' illness.
30
Description of Plague :
[ APP. I.
Of the four patients admitted for treatment within twenty-four
hours, three have survived and one lived for twelve days.
The two admitted three and two days after attack have died
eleven hours and four days after beginning of treatment.
I believe from the above results that there is the possibility of the
antitoxic serum rendering service in the treatment of the disease.
At the present stage of the preparation for producing any marked
effect on the disease, the following restrictions impose themselves :
it is necessary to start the treatment within the first twenty-four hours,
and a large number of repeated injections are required.
The possibility remains that, with the further maturation of the
fluid, its power will increase so as to effect an influence on older
cases and when used in smaller doses.
No serum can as yet be issued for the use of the general public.
No. II.
Dated Bombay, the 14th July 1897.
From—MONS. W. M. HAFFKINE, C.I.E.,
To—The Secretary to the Government of India, Home Department.
I have the honour to forward the following information regarding
the operations pursued by me at the Government Lazaretto at Sivree,
near Bombay. These operations were intended for the trial of an
antitoxic serum treatment in plague, on lines similar to those worked
out in diptheria. The information which had been published about
the beginning of the epidemic here regarding the Amoy experiments
of Dr. Yersin had created the expectation that the principle, which
in diptheria had effected the reduction of mortality to about half of its
usual extent, will give in plague an infinitely higher amount of success,
reducing the case mortality from about go per cent, to 7, It was
in this expectation, and while I was making tentative experiments
in that direction, that I adopted the suggestion made to me by the
Health Department here, to start the manufacturing of antitoxic
serum, which requires long months of preparation, at a large scale at
once.
In a couple of months a considerable number of the treated
animals have been brought to a high degree of immunity, and their
serum, when tried on infected animals, was found to arrest the
development of the disease in them.
At this stage of preparation, and while I had still a limited amount
of serum, I attempted, on several occasions, the application of the
treatment to human patients. I chose for that purpose individuals
APP. I. ]
its causes and characteristics.
31
in whom the severity of the disease did not leave hope of its yielding
to the ordinary treatment, expecting that the drug will manifest its
power by assisting the physician in such cases.
On no stage of my efforts could I obtain any clear results to that
effect.
•I have then resolved to prepare, for the trial of this treatment, a
large amount of serum which would be tested in the same manner
as it was done in the case of diptheria, namely, by its application to
a very large number of cases, severe and mild, and by comparing the
mortality amongst these with the mortality amongst a similar group
of patients not so treated. For there remains the possibility of the
therapeutic serum, without producing a clear effect in every case,
influencing, however, the general mortality to an appreciable extent
similar to the result in diptheria.
The preparation of the antidiptheritic serum requires the treat-
ment of animals for a period from four to six mouths. In the case
of plague Dr. Yersin stated that the preparation takes him about six
months. In Bombay, where in the beginning neither laboratory
accommodation nor the necessary staff was prepared for this kind
of work, and while the largest part of our time was absorbed by
investigation and when the prophylactic treatment was worked out
by its application and trial, the present epidemic was over before the
above plan could be carried out.
I have got now at Sivree a number of animals in a high degree of
immunity. These animals can yield at once an amount of serum
sufficient for many hundreds of patients ; and afterwards this amount
can be obtained from them time after time again, the animals remain-
ing as strong and sound and fit for work as they were before the
'treatment.
Reckoning upon the final expiration of the epidemic, these animals
can be sold off at once.
Should, however, a recrudescence of plague occur during the next
season, and if the serum now accumulated and tried on the plan above
mentioned show any favourable effect, the loss of these animals,
possessing a power which it has taken many months to be created in
them, may have to be regretted.
I am therefore proposing now, in a letter to the Commissioner
'for. the City of Bombay, that the staff at Sivree should be maintained
by the Municipality for another two months. In case the plague does
not re-appear in Bombay and does not develop in any part of India, the
animals should be sold off, and the serum now obtainable from them
stored up.
32
Description of Plague :
[ APP. I.
On the other hand, if the plague has left Bombay definitely, but
still lingers on in the country, I should then address Government
asking them whether they would not take over the Sivree establish-
ment and maintain it at their cost, till the plan of antitoxic treatment
in this disease is given a complete trial.
2. My laboratory on the Malabar Hill is at present engaged in
further investigation of the problem of prophylactic treatment and
in the storing up of the prophylactic material matured during the last
months.
Reports by M. Haffkine and Dr. Lyons on experi-
ments with Prophylactic Serum.
NO. 12.
Dated Bombay, the 16th January 1897.
From—MONS. W. M. HAFFKINE, C.I.E.,
To—The Secretary to the Government of India, Home Department.
I have the honour to communicate the following facts relating to
the possibility of protective inoculation against the plague.
In the course of the present researches I have found different
media which give rich cultures of the plague bacillus, permitting to
cultivate them in abundant and concentrated quantities.
The virulence of these cultures is shown by the fact that 1 or 2
minims are sufficient to communicate certain death to the largest
rodents.
The destruction of the bacilli in the culture by delicate processes,
such like the addition of essence of mustard, of very weak solutions
of carbolic acid, or by desiccation, or by heat, deprives these cul-
tures of their fatal properties, and makes a dose 40 to 50 times
bigger than the fatal one, quite harmless to the animals.
But, while depriving the cultures of their noxious properties, the
above processes leave to them the powers of protecting the system
against fatal infection.
Rodents which have had an injection of such cultures (with
microbes killed in them), when infected five days after the prophy-
lactic treatment, stand easily a dose of virus which would be fatal
to ten other non-protected animals.
Having established these facts, I caused myself to be inoculated
on the 10th of this month to observe the symptoms of the operation
in man.
ÁPP. I. ]
its causes and characteristics.
33
The injection was done in the flanks with 10 cubic centimetres of
a culture in which the microbes were killed by heating during one
hour at a temperature of 70° C.
The symptoms produced consisted in pain at the seat of inocula-
tion and in a rise of temperature. The highest point reached was
102° F., 8 hours after the injection, which was accompanied by slight
headache and feeling of faintness. The temperature got again
normal 24 hours later. The bowels remained normal.
The pain at the seats of inoculation was mostly felt next morning
while getting up from bed. It extended, on the left side, to the
region above the Poupart's ligament and on the right, towards the
axilla, without reaching it.
Since the next day the pain gradually disappeared. A small
nodule remained afterwards at the seat of inoculation, but got rapidly
absorbed. These symptoms show that the operation is perfectly
harmless to men.
These observations made in the laboratory lead to the conclusion
that the inoculation, as described above, will increase the resistance
of man against the disease. But the extent of that protection, and
the modifications to be introduced in the method for the object of
increasing that protection, can be shown only by observation on man
during the epidemic.
The most important facts to be solved by such observations are
the following :—
(1) Which are the doses necessary to produce in man a
marked increase of resistance against the conditions of
infection as they exist in nature?
(2) How many days after the injection is the highest resist-
ance reached ?
(3) How long will the resistance last ?
No. 13.
Dated Bombay, the l0th February 1897.
From—MONS. W. M. HAFFKINE, C.I.E.,
To—The Secretary to the Government of India, Home Department.
In view of the urgency of the case, I have the honour to commu-
nicate the following information concerning the outbreak of plague in
Her Majesty's House of Correction, Byculla, where a considerable
portion of inmates had volunteered to undergo the prophylactic
treatment, and where the first observations on the effect of this
treatment have been collected,
b5
34
Description of Plague :.
[ ÀPP. I.
Between the 23rd and 29th of January last nine cas.es of plague
have occurred in the jail, of which five proved fatal, the population at
the beginning of the outbreak numbering 345 souls.
The prophylactic treatment has been applied on the 3oth January
154 of a total 337 volunteering to be inoculated.
Occurrences on the day of inoculation.
In the forenoon of the day of inoculation six new patients have
been admitted to the hospital suffering from plague ; of these, three
proved fatal.
The inoculations were applied in the afternoon. One of the
inoculated, Keshav Uma Shankar, prisoner No. 672, had at the time
of inoculation a painful gland in the left groin ; two others, Abdool
Karim, No. 1356, and Govind Pandoo, No. 1222, developed painful
glands in the left axilla the same evening. These three cases have
also proved fatal.
On the first day after inoculation there were—
Amongst 177 not inoculated prisoners, two cases, of which one
proved fatal.
Amongst 151 inoculated, one case, who rapidly improved and
recovered.
On the second day after inoculation there were—
Amongst 172 non-inoculated, one case, which proved fatal.
Amongst thé inoculated, nil.
On the third day after inoculation there were—
Amongst 173 non-inoculated, one case, which proved fatal.
Amongst the inoculated, nil.
On the fifth day after inoculation there were—
Amongst 171 non-inoculated, one case, which proved fatal.
Amongst 146 inoculated, nil.
On the sixth day after inoculation there were—
Amongst 169 non-inoculated, one case, which proved fatal.
Amongst the inoculated, nil.
On the seventh day after inoculation there were—
Amongst the 169 non-inoculated, five cases, of which one proved
fatal.
Amongst 146 inoculated, one case, who is-alive.
Since the 6th instant no more cases have occurred in the jail.
APP. I. ]
its causes and characteristics.
35
The following is a tabulated form of occurrences.
Date of occurrences.
2323rd to January 1897
Forenoon before inoculation
Afternoon after inoculation
First day after inoculation, 3 1st January
18
Second day after inoculation, 1st Feb.
ruary 1897.
Third day after inoculation, 2nd Febru-
ary 1897.
Fifth day after inoculation, 4th Febru-
ary 1897.
Sixth day after inoculation, 5th Febru-
ary 1897.
Seventh day after inoculation, 6th Feb-
ruary 1897.
Total after day of inoculation
...
Amongst the non-lculated.
9 cases, 5 fatal
6
.
3 ,•
2 cases, 1 fatal
...
1 case fatal
...
1
,,
,,
•••
1
,,
,,
•••
2 cases,1 fatal
5 ,, 1 ,,
12 cases, 6 fatal, in an
average daily strength
of 173 non-inoculated.
Amongst the inoculated.
3 cases fatal.
1 case
......
... ...
««« ..i
1cases
2 cases in an average
daily strength of
148 inoculated.
The experience gained by the observation in this jail tends to
show—
-
First.—That the injection of 3 ccm, of the prophylactic seems
to be sufficient to effect the desired protection, no
repetition of inoculation being necessary to arrest
the disease during an existing epidemic.
Second.—That the prophylactic is powerless to arrest the symp-
toms of plague already started, or which develop
'
within a few hours, but there is the possibility of its
influencing the disease in the incubation period in
individuals infected three or four days previously.
Third,—That the time necessary for the plague prophylactic to
produce the protective effect is shorter than in any
preventive treatment known, this period being in the
anti-cholera inoculation of four days, in vaccination
against small-pox of seven days, in the inoculation
against anthrax of twelve days, in the inoculation
against rabies of fifteen days, and in the present
treatment, apparently less than one day.
Fourth.—The question remains open as to how long will the
inoculated persons remain proof against the disease,
and therefore, in order to ensure the probability of a
more lasting effect, it is advisable to apply repeated
inoculations with doses higher than the above-men-
tioned.
36
Description of Plague :
[ APP. I.
The above conclusions are temporary and refer only to the teach-
ing of the particular outbreak in question. There remains fully the
possibility of the future experience compelling us to modify the above
conclusions, though the expectation is justifiable that the general
bearing of the results as above detailed will remain unshaken.
A copy of this letter forwarded to the Municipal Commissioner
for the City of Bombay.
No. 14.
Dated Bombay, the I4th July 1897.
From—MONS. W. M. HAFFKINE, C.I.E.,
To—The Secretary to the Government of India, Home Department.
I have the honour to forward herewith a summarised report on the
experiment of preventive inoculation against plague made upon 7,905
persons in Bombay between the 10th of January and 10th of July 1897.
This report does not include the occurrences in Her Majesty's
House of Correction, Byculla, which have been reported,—compara-
tively with the occurrences amongst the non-inoculated present in the
jail during the outbreak,—in my letter, dated Bombay, 15th Feb-
ruary 1897.
A report on the experiment of preventive inoculation against plague
made in Daman upon 2,001 persons between the 23rd of March and
the beginning of June 1897 will be forwarded to you directly after this.
A copy of the present report has been sent to the Municipal
Commissioner for the City of Bombay.
Summarised report on the experiment of Preventive inoculation
against plague made on 7,903 persons in Bombay between the
10th of January and 10th of July 1897.
The following number of persons has been inoculated against the
plague at the different inoculation stations in Bombay :—
At the Petit Laboratory, Jamsetji Jijeebhoy Hospital,")
or by the Medical Officers deputed from there.)
At H. H. Agakhan's Bungalow, Love Lane
At the St. George's Hospital
At the Gokul Das Tejpal Hospital
Inoculations performed at private hours —
By Surgeon-Major Dimmock upon
...
,, Surgeon-Captain Childe
,
,, Dr. McCamce Dallas
,
,, Dr. K, S. Engineer
,
,, Dr. Murphy
,
,, Dr. Kalapesi
,
,, Dr. Trilokekar
,
...
...
...
...
...
...
..
...
Total
... 5,104
... 1,844
... 198
31
46 persons.
136
... 215
70
...
87
148
26
•••
7,905