NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
2
THE STAMPING OUT OF
of stamping out could be as successfully applied to the extirpation of
small-pox among us as it has been applied to the extirpation of
rinderpest; but of course with great differences. The rinderpest has
been stamped out by killing all the animals laboring under the
disease; and in many instances all those animals of the same flock
which had been exposed to the contagion of it, but which were not
yet attacked by the malady. The mission, however, of the human
physician is ever to save life, never to destroy it."
"And yet in accordance with this leading and divine principle, we
could, in my opinion, as surely and as swiftly stamp out small-pox
as rinderpest has been stamped out. For all that appears necessary
for the purpose is simply the methodic temporary seclusion, segrega-
tion, or quarantine, of those affected with small-pox, until they have
completely passed through the disease and lost the power of infecting
and injuring others; the poleaxe was the chief and leading measure
required to stamp out rinderpest. ISOLATION is the chief and leading
measure required to stamp out small-pox."
Mortality from
small-pox in
Calcutta
2. In a special report on the Presidency vaccine establishment
I laid before the Bengal Government in 1865 a table of the deaths
from small-pox which had taken place in Calcutta since the year 1832.
From this it can be seen that small-pox exists in Calcutta every year,
and that in the thirty-four years included in the table it had assumed
epidemic proportions on seven occasions. On each of these occasions
the loss of life has been so terrific as to make one shrink from dwell-
ing on it. The figures have already been published in the Calcutta
Gazette of the 17th January 1866. This figured statement seems
to have attracted but little attention. It is difficult to appreciate
the full significance of abstract figures; perhaps with the aid of
illustration I may be more fortunate in drawing public attention to
the subject. To exemplify in what degree a small-pox epidemic
means death, let me take as an extreme instance what occurred in
the last small-pox epidemic.
During February
and March 1865,
exceeded that in
England for a
year.
3. In the months of February and March 1865, 2,957 people
died of small-pox in the town of Calcutta,—in other words, close
on 3,000 persons perished in these two months. In these two solitary
months more people died of small-pox in this one city, than usually
die of this disease in every city, town, village, and hamlet in the
whole of England during a year.
SMALL-POX IN CALCUTTA.
3
Comparison
with naval ac-
tions.
4. The fearful carnage on board a ship of war during a naval
engagement is one easy of comprehension. Naval appliances for
wholesale slaughter are very perfect; with the enemy collected
together in individual ships, every condition is secured to render
destruction on a large scale very easy. When you search through
history for an example of a large fleet having so suffered as to serve
as a parallel for the death-rate from small-pox in Calcutta during the
year 1865, not the most remote approach to such an illustration can
be found in the whole annals of our naval warfare. By com-
bining together any number of our most noted and bloody actions
at sea, if you take only the killed into the account, it is difficult to
secure such an illustration. To get over this difficulty if every
wounded English sailor is added to the list of those killed, and you
make a list of naval engagements, as of those at St. Vincent, Camper-
down, the Nile, Trafalgar, Algiers, and Navarino, the total sum
of killed and wounded combined may be compared against the loss
of lives from small-pox in Calcutta in the-one year referred to. Even
then, however, the illustration falls considerably short of the full
number required.
Comparison
with wars on
land.
5. Again, the science of war ashore is by no means defective
in its means for destroying human life; let us take an example of
a war extending over a considerable period, and seek by having such
an instance in mind to appreciate the terrible loss of life from small-
pox. If we fix on a period of four years, the last years of the
Peninsular war will furnish the example. During this eventful period,
8,899 British soldiers were killed in action or died of their wounds.
If to the deaths from small-pox in the year 1865 just alluded to, we
add those which took place in another year (1850), we get a total
of 9,415.
Here we find that in this one city, 516 people died of this
disease in two years, over and above the total numbers that the whole
of the armies of Great Britain lost while engaged with a powerful
enemy for double that time. Small-pox killed more people in Calcutta
in two years, than all the shot, shell, and grape of the Artillery, all
the sabres of the Cavalry, and all the bullets and bayonets of the
Infantry could destroy, when used against large armies of English
soldiers for four years.
Comparison
with accidents
in civil life.
6. Come now to civil life : accidents here occur which every now
and again startle society from some horrible sacrifice of human life.
4.
THE STAMPING OUT OF
But analogy here completely fails to furnish even a remote equivalent
catastrophe for the one with which I wish to compare it.
Take all the Railway accidents in India, add to them all those
from falling buildings crushing their occupants in their ruins, throw
into the account all explosions from gunpowder, and every accident
that has caused a single death, and you cannot get numerals, expressing
a sufficiently large number of deaths, to compare against the thousands
of deaths which have steadily continued to take place in Calcutta for
as long a time as any record can be procured.
I have before me a tabulated statement of deaths from small-pox
in Calcutta extending back to the year 1832. As no real illustration
can be found to give an idea of the immense loss of life, let an impos-
sible one be invented for the purpose. Boiler explosions every now and
then occur, and when a few succeed one another at short intervals,
they are much talked about. Suppose a series of boilers bursting every
week, and let each of them kill fourteen persons, and you get a series of
deaths, which if extended over a long number of years, would repre-
sent very nearly the fatal nature of small-pox in Calcutta. The table
which I published included thirty-four years; the average weekly rate
of mortality closely approaches to fourteen deaths. Fourteen people
have been dying week after week from small-pox whose lives could easily
have been saved. Had such a mortality been taking place for thirty-four
years, as the result of boiler explosions, means would have been found
to put a stop to it. The whole machinery of legislation would have
been put in motion to avert such a terrible series of catastrophes,
and nothing would have been considered too stringent as a legal
enactment to prevent such an unheard of succession of fatal accidents.
It is to guard against a precisely similar amount of loss of life that
the " stamping out" of small-pox in Calcutta is a necessity. Only a
slight amount of legislative assistance is required to allow this to be
effectively done.
SECTION II.
POSSIBILITY OF STAMPING OUT SMALL-POX.
Purely contagi-
ous nature of
small-pox.
7. It is a fact known to all who engage themselves with such affairs
that this mortality can be effectively put a stop to. In the language
of those who write on such subjects it is called a preventible mortality.
Small-pox is one of those diseases which propagates itself solely by
SMALL-POX IN CALCUTTA.
5
contagion. Where no contagion exists, no small-pox will be found.
No case of small-pox can be originated from any combination of cir-
cumstances; it can only arise from a germ derived from a previously
existing case of the disease.
As soon would a student of Natural History believe that an
elephant, or a banian tree, had sprung into existence without parentage,
as the natural historian of disease, of the present day, would credit
the assertion that a case of small-pox had been generated de novo.
Three factors
necessary to
allow of small-
pox becoming
epidemic.
8. To allow of small-pox spreading there are three conditions
essentially necessary—
1st.—Certain atmospheric and general states which favor the spread
of small-pox.
2nd.—The existence of persons susceptible of receiving the con-
tagion.
3rd.—The presence of persons or things capable of communicating
the contagion.
Theory of pre-
vention.
Remove one or other of these effectively, and no extension of
the disease can take place.
Atmospheric
and hygienic
conditions
affecting small-
pox.
9. During the prevalence of certain states of the atmosphere small-
pox cannot exist. While the Simoom lasts, the germs of small-pox
feel the influence of its poisoned breath and die, and Egypt for the
time is free from this and every similar form of pestilence. The
Harmattan scorches and dries up the elements of small-pox contagion,
and renders them as harmless as similarly desiccated white of egg.
During the hot winds of the North-West Provinces, small-pox
is either entirely or in great part incapable of propagating itself.
In Bengal it receives a check in April, and in May and June it
spreads under great disadvantages. If Calcutta is ever well-drained
and clean, and if attention be directed to prevent over-crowding,
small-pox may possibly, in obedience to certain of the laws controlling
the febrile exanthemata, find the conditions less favorable to its
spread. We cannot so affect the climate or so modify the hygienic
conditions of the city as to make small-pox incapable of existing,
and therefore, with the object of attaining this end, we have to
place our reliance on controlling the other conditions under which only
an epidemic of small-pox is a possibility.
6
THE STAMPING OUT OF
Facility of
prevention.
10. Fortunately with regard to Calcutta at least, the carrying
out of both of these requisites, to an extent capable of restraining the
ravages of this disease to a minimum, is easily within our reach,
provided the legislature will render legal the necessary restrictive
measures. None of these enactments will fall heavily on individuals,
nor, if judiciously and vigorously worked, will their incidence affect
vexatiously any large numbers.
SECTION III.
REMOVAL OF THE SUSCEPTIBILITY OF RECEIVING THE DISEASE.
Repeated attacks
of small-pox rare.
11. A large and extended experience over all the world, has shown
that those who have once suffered from an attack of the disease, are
but little susceptible to the contagion of small-pox, and but rarely
undergo a second or third attack. It is also known, that those who
have been artificially caused to go through the disease by means of
inoculation with the small-pox virus, or by means of vaccination,
possess the same immunity when exposed to the contagion of small-
pox.
Present Vaccine
Establishment
capable of
protecting
Calcutta.
12. A Vaccine Establishment exists in Calcutta, and if the
Government of Bengal sanctions a slight alteration of a defect in the
working of the Department, the necessity for which I pointed out in
1865 and again in 1867, in consequence of its interfering most
seriously with the efficiency of its operations, there is every reason
to believe that it is capable of affording Calcutta all the protection
against small-pox which, under the present state of Native feeling
on the subject, and in the absence of vaccination being made compul-
sory, is capable of being provided for the city and suburbs.
In working it,
two objects held
in view.
13. In working this establishment two great objects are held
in view—1st, to bring the whole population of the city, as far as
possible, under the protective influence of vaccination; 2nd, to vacci-
nate around every case of small-pox which occurs, and thus to throw
an insusceptible zone of human beings as a protection around each
centre of contagion, with the object of robbing the focus of its power
of spreading the disease.
General
vaccination.
14. Difficulties, which it would take pages even to enumerate,
render it impossible that Calcutta can ever be thoroughly protected
by vaccination, till a compulsory law has been passed. In my previous
SMALL-POX IN CALCUTTA.
7
public writings on this subject, I have expressed my intention of
moving the legislature at some future time to pass such an Act. But
I have stated, also, that for the present, I am not prepared to press for
such a law, till all other means of having the people protected have
been fairly pushed with energy and determination. Such a law is an
inevitable necessity; but the people must first be educated by watch
ing vaccination and learning about it, up to the standard of receiving
such an act as by no means entailing serious hardship. Thus to
accomplish the first of these objects I do not for the present ask for
any special assistance from the Commissioner of Police.
Vaccination
round cases of
small-pox.
15. With regard to the second, however, it is different, and
without some assistance the object can be but very imperfectly
attained. To vaccinate round a case of small-pox, pre-supposes that
the occurrence of the case shall have become known. Experience has
shown that the means at the disposal of the Vaccine Establishment to
provide itself with this knowledge are most imperfect. Cases of
small-pox occur of which nothing is heard; while others are brought
to notice after so long an existence of the disease, that protective
measures are only had resort to, at a time that much preventible
mischief has taken place.
Early notifi-
cation of the
occurrence of
small-pox.
16. To enable the vaccinators to carry out this part of my
instructions with any measure of success, it will be necessary that
they be provided with the information that a case of small-pox
exists in a given locality. The simplest way to effect this object
seems to be, that it shall be rendered imperative that each case
be notified at the nearest Police station, and that the Inspector
of Police fill up and forward a printed form, detailing the name
and residence of the person affected, to the Superintendent of Vacci-
nation of the division of the town in which the case occurs. Several
reasons might be adduced why the report should be forwarded through
this channel; and no further Police assistance is desired, provided
the notice of the occurrence of small-pox has been given early.
The assistance asked under this head is very moderate. I will now
mention a few instances in which I have been able to stop small-pox
from spreading, by removing the susceptibility to the disease of those
residing round it, in order to prevent objections being raised to the
necessary powers being granted. With results so marked and
striking, accruing every year from a systematic following out of the
principle of depriving those surrounding small-pox cases of their
8
THE STAMPING OUT OF
susceptibility of receiving the contagion, I trust no difficulty will
be experienced in having it rendered compulsory to give early notifi-
cation of each case of small-pox as it occurs, and providing for the
imposition of a heavy penalty on the head of the house in every
case in which he has failed to give (or cause to be given) the necessary
information to the Police.
SECTION IV.
INSTANCES OF SMALL-POX BEING "STAMPED OUT" BY REMOVING THE
SUSCEPTIBILITY TO CONTAGION OF THOSE AROUND.
Stamping out
In Calcutta.
17. In Calcutta, small-pox attacking a family has been in so
very many instances prevented from spreading to the other members
by vaccinating or re-vaccinating all in the house that no note is kept
of such instances. Strangers bringing it to the town have also been
prevented from spreading it in the same way.
Thus in December last a man arrived in Calcutta from Benares.
He was suffering from the initiatory fever of small-pox, and on the
second day after he reached Calcutta, the eruption appeared He pos-
sessed no protection against small-pox, the disease was confluent, and
he died of it. He remained for three days in one house and was then
removed into another. Vaccination was performed in both of these
houses, and in the neighbourhood of each, and not a single other case
of small pox occurred.
Again in January a man came to Calcutta from Ramkistopore,
a village on the other side of the Hooghly. He, too, was laboring
under the initiatory fever of small-pox, and the eruption came out
in due time. The unprotected persons in his house, and immediately
around it, were vaccinated, and he communicated the disease to no one.
So also in the next month, a woman arrived from the Jehanabad
district, and stated that inoculation was being extensively practised
in the village in which she had been residing. Small-pox attacked
her soon after reaching Calcutta, the contagion having been received
at her previous residence. She was prevented from being a source of
danger to those around, by all coming within her influence being
deprived of their receptive power, and again no one caught small-pox
from her,
SMALL-POX IN CALCUTTA.
9
I know of other cases which have this year been imported into
Calcutta and its immediate neighbourhood, but by being so dealt with
have been rendered harmless.
Stamping out
at Sanki¬
beriah.
18. To strengthen my case, let me also briefly describe two
instances in which small-pox has been " stamped out" within com-
paratively short distances of Calcutta during this year and the last.
To begin with what took place this year. At the commencement of
the hot weather of 1867 small-pox originated about forty-eight miles
south of Calcutta, in the Diamond Harbour sub-division, owing to
inoculation having been practised. Sankiberiah was its head quarters,
the epidemic involving a large number of the surrounding villages.
Early in 1868 vaccinators were sent there with orders to stop the
epidemic at once. After January, with two exceptions, not a case
occurred in the villages which had been thus invaded.
Owing to a fair, the disease was carried to a village at some
distance. This village and all surrounding ones were vaccinated, and
the conflagration again died out for want of fuel.
Seven thousand seven hundred and twenty-one people were
successfully vaccinated by the gang of vaccinators sent to Sankiberiah,
and the prompt and instant check to small-pox fully verified all my
previous experience in regard to the facility of successfully stamping
out the disease in this way.
Stamping o
at Sookchur.
19. So also in January 1867, small-pox broke out at Sookchur,
about ten miles north of Calcutta, and the disease showed itself to be
of a very malignant type.
Eight vaccinators rapidly protected fourteen hundred indivi-
duals in the neighbourhood of the outbreak. Those in whom the
disease was incubating at the time of the vaccinators' arrival, were
the only ones seized with small-pox, except two persons, both of whom
died, and these would not consent on any terms to be vaccinated.
SECTION V.
GUARDING AGAINST THE DIFFUSION OF CONTAGION BY AFFECTED PERSONS.
Isolation of
affected per
20. The third element necessary to the spread of small-pox
I stated to be the existence of persons or of things capable of com-
municating the contagion. In a practical argument it may be accepted
B
10
THE STAMPING OUT OF
that those only laboring under the disease, the clothing and conveyances
used by them, or in general terms whatever has come into contact
with their bodies, possesses the power of conveying to others an attack
of the disease.
No restrictions of any sort are placed on those who thus for the
time being are gifted with the most fatal powers of communicating
disease and death to all who come within their influence. It is
open to any one with small-pox to act in such a way that he may
be the means of causing the death of hundreds of his fellow-beings.
Cases have come within my own knowledge where individuals, insen-
sible to the entreaties of those around, and deaf to the remonstrances
of medical men, have refused to go to the small-pox hospital, or take
other steps to avoid doing the infinite mischief which was sure to
follow on their remaining in their own overcrowded dwellings and
localities. In a city such as this, where small-pox is met with every
year, it is very difficult to estimate the exact prejudicial influence
exercised by individual cases of small-pox. But under other circum-
stances the results can be estimated with startling facility.
Illustration of
danger from the
mischief caused
by the Ditto.
21. In his recent address to the Social Science Association,
Sir James Simpson recounts an instance which will convince every
one on this point:—
" In the narrative of the circumnavigation of the globe by the
Austrian frigate Novara, in 1857—59, it is mentioned that in 1854
the English barque Delta arrived at Roankiddi Harbour, in the Island
of Puynipet, with one of the crew affected with small-pox. There
was some demur about supplying the infected ship with provisions,
or allowing its crew to land for that purpose. In the silence of the
night, the Captain of the Delta deposited the sick man on the shore
with all his property, and at day-break made off under full sail.
The sick sailor was carefully nursed and tended by the inhabitants
of the Island, and recovered. But the Islanders were sadly repaid for
their humanity and charity; for the small-pox speedily broke out
with frightful violence among them; and almost every native was
attacked. Of 5,000 inhabitants, forming the whole population of
the Island, 3,000 succumbed to the virulence of the malady; and
many of those that escaped with life showed upon their faces and
bodies very visible traces of the effects of the disease. Of 30
white settlers, who had all previously been vaccinated, only one was