NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
SMALL-POX IN CALCUTTA.
11
attacked. In the gigantic naval fight of Trafalgar, one of the greatest
battles ever fought at sea, between 1,600 and 1,700 of the British
sailors fell. Thus, the one infected sailor, cruelly left by the ship
Delta upon the shores of Puynipet, destroyed nearly twice as many
human lives as were destroyed by all the artillery and musketry fired
by the French fleet at Trafalgar."
Necessity for
legislation.
22. There are few law-makers who, had they possessed the
power of legislating so as to prevent the loss of these 3,000 lives,
would not gladly have exerted their functions to prevent this sailor
from becoming such a wholesale destroyer of human life. There are
few restrictions, which in such a case as this, would be considered too
great an interference with the liberty of the subject. In Calcutta, it is
precisely a similar amount of mortality which I point out as pre-
ventible, only the death-rate I have chosen as my example extends over
two months alone; the heavy mortality both before and after this period
not being now dwelt upon. In Calcutta, it is true we can hardly hope to
trace an epidemic to the influence of a single case. If we were so
fortunately situated in this respect, as only to expect one sailor capable
of spreading small-pox, to be left with us in any single year, it might
be long before it was deemed requisite to ask for legislative protection.
The case is different, however, when every railway, road, river, canal,
and creek may any day introduce the disease among us.
Vaccination
along all routes
of communica-
tion.
23. Already the attention of the Bengal Government has been
called to the fact that this city lies extremely open to invasions of
small-pox, owing to the circumstance that the country around has
never been protected by vaccination. For this reason local outbreaks
of the disease in the vicinity are extremely frequent, and any one of
these, places Calcutta in danger. Efforts are being now systematically
carried on, with the view of protecting all the lines of communication,
leaving for future years those districts which are more isolated in their
position, and therefore less liable to influence Calcutta in this way,
or to receive small-pox from it in times of epidemic visitation. One
case has been quoted as an instance in which small-pox was brought
from Benares within the last few months. Since that case occurred a
Sikh soldier's wife also brought the disease with her from the same place.
She was effectually isolated, and did not spread the disease. In both
of these instances the scourge was brought to us by rail from a greater
distance than 500 miles.
12
THE STAMPING OUT OF
It only requires time and observation to be able to record such
cases being brought from double or treble the distance of Benares.
It can hardly be hoped that the protective influence of vaccination
will be carried to such distances within the life-time of those in Calcutta,
whose interests are now affected, and some simple, yet effective, measure
is urgently required, in the meantime, to guard against our periodic
epidemics.
Principle of such
a law not new.
24. Such an enforced temporary seclusion has its evident parallel
in the removal of dangerous lunatics to an asylum or of those suffer-
ing from contagious disorders to a lock-hospital; for both of which
Indian law already provides. It is but a short step to apply such a
principle to those who are dangerous to others while they suffer from
small-pox; while the danger to be guarded against is far greater than
either of those against which the law already provides.
Isolation at sea.
25. There are very many recorded examples of the effective
security which can be attained to by the isolation of those affected
with small-pox. For obvious reasons, those occurring at sea are the
most striking. Sir James Simpson relates that a shipful of Chinese, who
were unprotected, were saved from the ravages of small-pox, which was
brought on board by a European passenger, by the judicious
seclusion of the affected person. Another very striking illustration is
recorded by Dr. Currie, in which eight cases of small-pox appeared on
board a Guineaman shortly after she had left the African Coast. Those
affected were confined to the main-top, some twenty feet above the
deck, none of the other passengers or crew took the disease.
Comparative
facility of such
quarantine
ashore.
26. If judicious police regulations can effect so much among the
crowded population of an emigrant or passenger ship, how much more
easily can protection be provided for, under the more favorable circum-
stances at our disposal ashore.
What we require is legal authority to enforce isolation of those
affected with the disease, and also restrictive measures to prevent them
from touching anything while they are ill which is liable to be made
use of by others.
Absence of all
restrictions in
Calcutta, .
27. At present those covered with small-pox are allowed to sit or
lie in the public streets. Even in our broadest thoroughfares, such a
practice is most reprehensible, and when it takes place in a narrow lane
SMALL-POX IN CALCUTTA.
13
or crooked alley, the danger is much greater. During the last small-pox
epidemic, I have very many times, while wandering about the infected
localities, been appealed to for charity by beggars who were covered
with small-pox crusts, and therefore possessed the power of conveying
the disease in a very high degree; and I have seen children similarly
situated as regards contagion, constituting the centre of a group of
sympathising companions, who were quietly playing round them. I
have seen the healthy child, as yet unprotected, being lulled to rest by
its father, in close contact with the body of its mother, who was too near
her death from small-pox, to care for anything on earth. It was a daily
occurrence to see children, as yet free from the disease, made to sleep
with those who had the disease in a bad form: and many are the
instances in which I witnessed the firm protective power of vaccination
under such circumstances. At almost any hour of the day there could
be seen in the same confined hut those dying of small-pox, those more
recently attacked, and those who had not yet got the disease.
SECTION VI.
LEGAL ENACTMENT TO COMPEL ISOLATION.
Seclusion to be
enforced.
28. To guard against such a wholesale neglect of precaution,
nothing short of legislative interference will avail.
In private
houses.
29. Those affected by small pox must be compelled by law to keep
themselves separate. If their circumstances are such that they can do
so at their own homes, such an indulgence may in most cases be allowed,
on the production of medical evidence, in writing, to the effect that they
are able to keep up an effective seclusion.
In hospital.
30. In the case of those who, from limited means, are unable to
comply with the necessary requirements, arrangements should be made
to provide, at the cost of the community to be protected, for their
isolation; and powers must be asked for to make it compulsory for such
persons to accept the provision thus made for them.
Classification of
patients.
31. In making such isolation in places set apart for the purpose
incumbent, it will be obviously right to make such a restriction fall as
lightly as possible on those subjected to it. With this end in view,
special reserved accommodation should be set apart in the small-pox
hospital about to be built, to enable those who can afford to pay for it, to
keep themselves separate from the public wards. Not only might a few
14
THE STAMPING OUT OF
absolutely private wards be provided, but also a few small wards capable
of holding three or four patients. These would allow for the classification
of the patients to a certain degree, and with a graduated scale of pay-
ments, would prove a boon to those who, though they could not afford
the expense of strictly private accommodation for themselves, would
value being saved from a compulsory association with those less for-
tunate in life than they were.
Relations and
private
attendants.
32. Those of the sufferers who desired it, might have the consolation
of being cared for by a relation or private attendant, in every case where
the expense for food could be defrayed from private sources. Those
who entered the hospital without the disease, however, would have to
comply with the regulations of the hospital as regards previous protection
from variola, and compulsory residence till legally discharged. Such a
concession would tend to lessen the evils-attendant on the admission of
visitors to the hospital. Probably if a law existed to make such seclusion
compulsory, in most cases where the necessity for it existed, those
affected would comply with the law on any medical man advising them
to this effect.
Means for
enforcing com-
pliance.
33. Provision will require to be made for the case of those who will
not otherwise provide for their own isolation, or resort to the small-pox
hospital. One of the simplest ways of doing this would be to provide
that any Justice of the Peace or Magistrate could sign an order for
removal to the hospital, on a certificate for its necessity which was signed
by two medical men who had seen the patient. The Commissioner of
Police might also have such a power of action, on the certificate of the
Superintendent of Vaccination for that division of the town in which
the patient resides, countersigned by the Superintendent General of
Vaccination. The Superintendents of Vaccination are always medical
men, and before signing such a certificate would have seen the person
affected. The counter-signature of the Superintendent General of
Vaccination might involve only a knowledge of the case, derived
from the vaccinators, or others, by whom it might have been brought to
notice.
SECTION VII.
PRECAUTIONS WITH REGARD TO FOMITES AND OTHER CARRIERS OF
CONTAGION.
Infected rooms,
clothing, and
bedding.
34. Another element which serves to propagate small-pox, will
also require careful regulation,—whatever has come into contact with
SMALL-POX IN CALCUTTA.
15
the bodies of those suffering from certain stages of the disease, may
become the vehicle of disseminating the scourge.
All the bedding and clothing made use of by those labouring under
the disease, or by those in close attendance on them, should be burned,
or thoroughly disinfected, and the rooms which they have occupied while
so affected should be purified in such way as the knowledge of the day
should point out as the most effectual.
For the latter purpose, after thorough cleaning and ventilation, if
the apartment were for some time kept filled with the fumes of
burning sulphur, and subsequently white-washed, the most prominent
indication would be fulfilled.
Any clothing or bedding worth preservation, after being boiled in
water to remove impurities as far as possible, should be exposed to dry
heat in special chambers, or thoroughly fumigated with sulphur. As in
some continental hospitals, such disinfecting chambers might be provided
at the small-pox hospital, so that patients and their friends might have
their clothes disinfected before leaving the hospital; while the public
might also be allowed the privilege of the gratuitous disinfection of
private clothing.
Public convey-
ance.
35. During the last epidemic I had to address the then Commis-
sioner of Police on the subject of the public conveyances being used by
those suffering from small-pox, and pointed out the necessity for the pro-
vision of special conveyances for such a purpose. The restrictions then
imposed worked well, and might now be made to take a more permanent
form.
Dangerous occu-
pations.
36. The exercising of trades by those convalescent from small-pox,
or in buildings where small-pox exists, calls for special prohibition.
I have seen in a washing establishment three small-pox cases being
attended to by those engaged in getting up the clothes, and I have seen
sheets, which might next day lie upon the beds of those liable to small-
pox, used as screens to protect the sufferers labouring under this disease
from the clouds of flies hovering over them.
I have also seen loaves of bread being handled by those capable of
spreading the disease, and others have seen tailors and dressmakers
endanger-public safety by sending out infected garments, which have led
to the death of those who wore them.
All of these, and similar infringements, of well known precautions,
which are liable to endanger public health, call for special measures to
guard against the possibility of their occurrence, for the future.
REPORT
ON THE
OUTBREAK OF SMALL-POX
AT
SANKIBERIAH, THANNAH SULTANPORE,
STAMPED OUT
BY EXTENSIVE VACCINE OPERATIONS.
BY
T. EDMONDSTON CHARLES, M.D., M. R. C. P. LOND.,
SUPERINTENDENT GENERAL OF VACCINATION.
INDEX.
PARA.
Position of Sankiberiah
...
...
...
...
...
Origin of the Epidemic ... ... ... ... ...
Progress of the disease ... ... ... ... ...
Extent and mortality
...
...
...
...
...
Actual condition when Vaccination began ... ... ...
Commencement of Vaccination ... ... ... ...
Progress of Vaccination; Small-pox stamped out ... ... ...
Farther extension of Vaccination ... ... ... ...
Detail of Arrangements ... ... ... ...
Small-pox reported at Ramjannagur ... ... ... ...
Origin of this outbreak ... ... ... ...
Extent which outbreak had reached ... ... ... ...
Vaccination and cessation of Small-pox ... ... ... ...
Varicella at Ghateshara ... ... ... ... ...
Total number vaccinated and results ... ... ... ...
Inspection by the Superintendent of Vaccination ... ... ...
The Superintendent deputed to Sankiberiah ... ... ...
Reliable nature of the above report ... ... ...
Amount of successful cases not overstated ... ... ...
Nominal cost of these Vaccinations
... ... ... ...
Nominal cost of each Vaccination
...
...
...
...
...
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
REPORT
ON THE
OUTBREAK OF SMALL-POX AT SANKIBERIAH,
THANNAH SULTANPORE.
Position of
Sankiberiah.
Sankiberiah is a village, forty-eight miles south of Calcutta, in the
Diamond Harbour Sub-division. Although this village was the head-
quarters of the epidemic, it extended in a severe form to several neigh-
bouring villages; in the following report the operations recorded were
not confined to the one village of Sankiberiah, but extended to all local-
ities in which small-pox was to be found in the surrounding country.
Origin of the
Epidemic.
2. At the end of March 1867 a number of the inhabitants of the
village of Bhajna were inoculated. The exact number cannot now be
ascertained, though two hundred may be stated as a close approximation.
A considerable proportion of the inoculations seems to have com-
municated the disease in a severe form, and eight persons died during
the following month in consequence of the small-pox thus artificially
engrafted on them. There was no small-pox in the neighbourhood at
the time that inoculation was practised in this village, and the very com-
mon practice of inoculating all the unprotected portion of the inhabi-
tants was not followed. In particular, the inhabitants of Baniaparah, a
suburb or continuation of Bhajna, first put off the day of inoculation for
a short time, and then being alarmed at the results of the inoculation
already practised refused to have inoculation performed. This remark
applies also in a less degree to some of the inhabitants of Bhajna proper.
In the month of April natural small-pox was communicated to several of
these unprotected individuals, and the disease, originating in this way,
was spread from person to person; apparently, however, it did not extend
out of their village during the whole of May.
Progross of the-
disease.
3. In June the contagion was conveyed beyond the limits of
Bhajna, and during this and the following three months was slowly
disseminated among the surrounding villages. Up till the end of Sep-
tember the following villages had been infected—Baniaparah, Pakoor-
tollah, Ramchundernugger, Tetooliah, Mudhoosoodunpore, Shibnugger
and Sankiberiah. This last village is only a mile from Bhajna, where
2
OUTBREAK OF
the disease followed on inoculation. Most of the cases of small-pox
occurred in four of these villages, which might be included in a circle
the diameter of which was four miles. The disease was put a stop to in
these villages in the end of January by extensive vaccination. The last
two cases of small-pox which occurred appeared on the 2nd and 5th of
February 1868.
Extent and
mortality.
4. Up to this time it had attached one hundred and forty-nine
persons, of whom thirty-five had died. Of those included in the
number attacked, seven had just been vaccinated, three of whom
got the initiatory fever of small-pox on the fourth day. It so happened
that none of these seven cases were fatal. It must also be noted
that six of the deaths among these cases of small-pox were violent
ones which took place during the cyclone on the 1st November 1867.
Two of these persons who so died seem to have been moribund at the
time of the accident, and in the other four the disease had assumed a
virulent type, and was so far advanced, as to render it impossible for those
affected, to move away from the danger with which they were threatened.
Actual condition
when Vaccination
began.
5. On the arrival of the Head Vaccinator he reported having seen
thirty-seven cases of small-pox, seven of the cases being in such a condi-
tion as to render recovery hopeless. The population of the villages
referred to were in an excited state, in consequence of the events which
had occurred, and alarmed at the steady progress the disease was making
among them. No vaccination had ever been practised among them, but
as they were an extremely poor and ignorant population, and fully appre-
ciated their present danger from small-pox, they listened readily to the
promises of safety made to them, if they would accept the English pro-
phylactic, and they allowed themselves to be vaccinated in numbers.
Commeneement
of Vaccination.
6. Romanauth Ghosal, one of the Head Vaccinators, belonging to
the Vaccine Establishment, was deputed to stamp out this outbreak. He
left Calcutta on the 17th January and reached Sankiberiah on the 21st.
On his way he picked up a boy of twelve, from the nearest centre of vac-
cine operations, who had been previously vaccinated, and whose services
had been entertained for this duty. The means of communication in
this part of the country are so defective, that this boy could not be
returned to his own village for seventeen days. On the 22nd, ten
persons, not immediately exposed to small-pox, were persuaded to allow
themselves to be vaccinated, with the view of their providing a reliable
lymph supply in case of subsequent vaccinations proving not readily
SMALL-POX, &C.
3
available for the purpose, should small-pox supervene during the course
of the vaccination. On the 23rd he began to vaccinate in the houses
where small-pox existed, and on this and succeeding days fifty-three
individuals were vaccinated from the boy to whom the disease had been
communicated by six points of insertion; sixty-three persons in all were
thus vaccinated from the vaccinifer the vaccinators had brought with
them. Every one of these persons was successfully vaccinated, not even
a single doubtful case having been met with.
Progress of
Vaccination.
7. As these cases became ready to supply lymph, very extensive
vaccination was practised from them, so that up to the 31st January
eight hundred and fifty seven individuals had been operated on. Among
this number, there were only four failures and two doubtful cases. Up
till the 7th February nine hundred and seventy-three more were vaccina-
ted, among which number, there were two failures and three doubtful
cases. On the 7th February the four villages in which the disease had
been worst were reported absolutely safe. Small-pox had been stamped
out.
Further exten-
sion of Vaccina-
tion.
8. The safety of vaccination, the fact of its practice being so
free from all distress, and the prompt way in which small-pox had ceased
under extensive vaccination, was acknowledged by every one in the neigh-
bourhood ; and dozens of people from the surrounding villages had flocked
to the vaccinators for protection. On the 12th February it was reported
that twelve villages round Sankiberiah had been thoroughly protected
by vaccination, and that there was not a single case of small-pox in the
neighbourhood. In spite of this absence of small-pox, however, the
people showed considerable willingness to take vaccination, and village
after village continued to be dealt with, as long as the weather remained
so cool as to render the operation advisable.
Detail of
Arrangements.
9. Romanath Ghosal, the Head Vaccinator, had at first only one
vaccinator under his orders. At once on his arrival he reported the
exact state of matters which he found, and the outbreak being of such
large proportions, two additional vaccinators were sent to him, who joined
him on the 12th February, and later on in the same month other two
vaccinators joined him; so that during March and April he had five men
under his superintendence.
Small-pox
reported at Ram-
jannagur.
10. On the 12th February a report was received from the Zemin-
dar at Dehi Gungadhurpore that small-pox had broken out in one of his
villages. This village is situated to the north-west of Sankiberiah at a
4
OUTBREAK OF
distance of eight miles. Reports of the success of the vaccine operations
had reached him, and he invited the vaccinators to work on his estate, beg-
ging in particular, that they would come at once to the relief of the
village in which small-pox already existed.
Origin of this
out-break.
11. In the beginning of February three cases of small-pox occur-
red at Ramjannagur. There was not much direct communication between
this village and those in which small-pox existed. However, a market
took place twice a week both at Koolpee and at Gungadhurpore, the
former of which is quite close to Ramjannagur, and the latter to Bhajna,
where the Sankiberiah outbreak originated. Both of these markets are
numerously attended; the people of Ramjannagur going close to the
first centre of infection, and those from the infected villages coming also
close to the second centre of infection. In this way four times a week
abundant facilities were afforded for small-pox to spread from one place
to another, though the actual individuals who transmitted the contagion
cannot now be traced.
Extent which
out-break had
reached.
12. The disease was confined to one house; one of the grown-up
male members having been first affected, seems to have communicated
it to his wife, and she again to a boy of fourteen, on whom the disease
had reached the eleventh day at the time the vaccinators arrived.
Vaccination and
cessation of
Small-pox.
13. Two vaccinators, each provided with a child from whom to
vaccinate, were deputed to work in Ramjannagur. This village was
a small one, and only sixty-three unprotected individuals were found in it
and were all vaccinated on the same day. On previous years inoculation
had been practised in this village; but this year, hearing of the success
of vaccination eight miles off, the ryots moved the landowner to
apply to our vaccinators for their aid. About twenty-five villages round
this one were vaccinated, and no more cases of small-pox occurred either
in Ramjannagur or the neighbourhood.
Varicella at
Ghateshara.
14. At the village of Ghateshara several cases of varicella occur-
red, and the people thinking that it was variola, took fright and sent to
Sankiberiah, a distance of fourteen miles, for vaccinators. It was ex-
plained to them that vaccination did not protect against chicken-pox,
but as the vaccinators were there, advantage was taken of the circum-
stance to protect this village and five surrounding ones against small-pox.
Total number
vaccinated and
results.
15. Thetotalnumber vaccinated by RomanathGhosal and the division
of vaccinators under his orders amounted to seven thousand seven hundred
and twenty-one, of which seven thousand six hundred and sixty-nine were