NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
375
not to be found in large statistics, from which we learn that the mortality is much
the same for both the periods and scarcely lower than the average. This discrepancy
might be partly accidental and in part due to the inaccuracy of the patients in
stating their age. The later periods show an increased mortality in the right
proportion.
Concerning the patients who were prophylactically injected it will be sufficient
to say that 7 such patients recovered on the serum side and 6 amongst the controls.
We pass now on to the table showing the results according to the days of
illness on admission :—
Day oí illness on
admission.
1st day ...
2nd ,
3rd ,
4th „
5th
6th „
7th „
8th „ ...
...
9th „
10th „ and more
Unknown
Total ...
Number
of
Patients.
18
121
136
79
32
17
4
16
4
19
34
480
Serum Patients.
Died.
11
95
96
55
20
13
2
6
1
5
24
Ü28
Recovered.
7
26
40
24
12
4
2
10
3
14
10
152
Percentage
of
Mortality.
61.11
78.51
70.58
69.62
62.50
76.47
50.00
37.50
25.00
26.31
70 58
68.33
Number
of
Patients.
20
120
100
67
38
25
13
20
4
26
47
|
480
Control Patients.
Died.
18
103
84
57
35
17
7
11
1
9
40
382
Recovered.
2
17
16
10
3
8
6
9
3
17
7
98
Percentage
of
Mortality.
90.00
85.83
84.00
85.07
92.10
68.00
63.84
55.00
25.00
34.61
85.10
79.58
The figures in this table have only a relative value as they are chiefly based
on the statements of the patients or their friends. In general, we may say that they
are more reliable for the earlier days and that the duration of illness is, if anything,
given as too short. Only 4 per cent, of all the patients were admitted on the
first day, and only two amongst twenty recovered on the control side. The statistics
corroborate thus the clinical observation that only the severest cases are brought
to the hospital on the first day. Still the mortality on the serum side is well below
the average. It rises by 17 per cent. for the patients admitted on the second day.
Then a marked falling off for those of the third day, and a steady decline for the
patients of the following days. The mortality amongst the controls is practically
the same on the first 5 days of illness, the excessive mortality on the first and fifth
day being accidental. We have to record here an essential difference of the results.
The curve of mortality of the patients admitted on the first 5 days forms an
angle on the serum side and is a straight line on the control side. It was irrelevant
for the controls on what day they came to the hospital, whereas it made a consider-
able difference whether a patient received the serum treatment on the first day or on
the second day. So long as the necessity of the early treatment is not fully appre-
ciated and acted upon by the public and the medical profession, the results of the
serum treatment will never be as satisfactory as they could be. A famous surgeon
was wont to tell his pupils that if they be called to an incarcerated hernia in day
time they should not allow the sun to set, and if at night not allow the sun to rise,
without having liberated it. Mutatis mutandis that mast be the principle of the
physician in the serum treatment of plague. One hour lost might be a life lost.
376
The next table gives the results according to the manifestation of the disease :—
Manifestation of
Disease.
Single inguinal, fe-
moral, etc.,buboes.
Single Cervical bu-
boes
Single
Axillary
buboes
Contiguous buboes.
Multiple buboes ...
No buboes
Pneumonia
Total
...
Number
of
Patients.
170
52
88
331
32
3
4
480
Serum Patients-
Died.
97
38
64
102
21
2
4
328
Reco-
vered.
73
14
24
29
11
1
...
152
Percentage
of
Mortality.
57-05
7307
72.72
77.86
65.62
66.66
100.00
68.33
Number
of
Patients.
157
46
100
128
20
16
13
480
Control
Died.
122
33
88
99
12
16
12
382
Patients.
Reco-
vered.
35
13
12
29
8
1
98
Percentage
of
Mortality,
77.70
71.73
88.00
77.34
60.00
100.00
92.30
79.58
We note here the considerable reduction of the mortality effected by the
serum in single femoral or inguinal buboes, and also in axillary buboes. It can
be seen from the list of the recovered patients that this reduction was not due to
the distribution of the convalescents, which has materially interfered with the
correctness of the results in cervical and multiple buboes. Here again the serum
has singled out for its action certain patients, viz., those in whom the disease
was localised.
The statistics of the results, according to the temperature on admission, did not
promise much information, and we have substituted a table demonstrating not the
saving of life, but the prolongation of life :—
Died after admission.
Serum patients
Control patients
"Within
12 hours.
12.50%
16.87%
Within
24 hours.
8.95%
12.50%
Within
48 hours.
18.33%
20.65%
Later on.
28.54%
29.58%
The influence of the serum made itself felt even in patients who in the
common course died within 12 hours after admission. Comparing the percentage of
the total deaths within 48 hours after admission we have 191 patients, or 39.79 per
cent., dying under the serum treatment, and 240 or 50 per cent., amongst the controls,
this being the usual percentage of deaths within 48 hours after admission occurring
in our plague hospitals. In 20 per cent., therefore, of those who would have
died within 48 hours after admission life has been prolonged by the serum treat-
ment. The serum patients lived on an average 4.3 days and the controls 3.2 days.
That will reassure those who might still be afraid that in certain cases the serum
might be injurious. Careful observation on nearly 1,000 patients has shown that
it never does harm, either to moribunds or others.
There are no more statistics available, and we can summarise the information
we have gained as follows :—
In general, our anticipations have been justified, the mortality under the serum
treatment following the fluctuations of the death-rate on the control side closely
on a lower level save for being disproportionately lower in :
(1). Patients of the 1st, 3rd, 4th and 5th day of illness.
This is in accordance with the first law of serotherapeutics, that the earlier
the treatment the better the results. It is no contradiction that the patients of
the third and the following days had a lower mortality than those of the second day.
A similar observation was made in the selected patients and it has been commented
378
We turn now to the Modykhana Hospital, where in February last an attempt
was made to treat patients alternately with the serum. Owing to the pressure of
work and the great distance of the hospital from the laboratory at Parel the under-
signed were unable to visit it in order to control the carrying out of the experiments
which was entirely left to the Medical Officer in charge who had received the
necessary instructions. The results are seen from the following table :—
Modikhana Hospital 26th January,
to 27th February 1900.
Serum patients
Control patients
Doubtful cases
Number of
patients.
66
66
43
Died.
54
48
32
Recovered.
12
18
1Í
Percentage of
Mortality.
81.81
72.72
74.41
Although the failure of the serum treatment might have been merely due to
the distribution of the patients, it seemed strange, and stranger still, the large
number of doubtful cases.
A minute investigation elicited the following facts :—
(1). That 21 of the so-called doubtful cases were undoubted cases of bubonic-
plague, with buboes either on admission or developing buboes in the-
hospital and that the greater part of the others were either suffering
from plague pneumonia or showed other undoubted symptoms of
plague. These cases were, for various reasons, some through inadver-
tance excluded from the alternate treatment.
(2). That the serum treatment was neither always begun in proper time nor
continued regularly.
(3). That the doses were insufficient, the average quantity of serum used for
a patient having been 55 c.c. against 100 c.c., as given in the instruc-
tions.
(4). That the total quantity of serum put down as having been injected was
in excess of that actually supplied to the hospital.
It appeared, therefore, that the alternation was frequently and arbitrarily in-
torfered with at the Modikhana Hospital ; that the serum was administered in a
manner and in doses by which curative results could not be expected, and that the
registration of important items was defective. The proofs for these facts and the
conclusions drawn from the facts were submitted to Lieutenant-Colonel J. S. Wilkins,
Special Medical Officer, Plague Operations, who, after examination, concurred in the
opinion that the experiments, as conducted at the Modikhana Hospital, ware value-
loss and not to be included in the statistics of the alternate treatment.
Six patients were treated with the serum at the Parsee Fever Hospital by
Dr. S. Nariman, the Medical Officer in charge of it, two of whom recovered. Eight
patients, treated during the same period without serum, had also two recoveries. Dr.
S. Nariman stated that all the cases were equally severe, and added that from the
few observations he can infer with certainty that the serum treatment prolongs life.
379
Ten patients were treated in private practice and had four recoveries. Except
one, the cases were all of the third or fourth day of illness and all were very severe.
After having rendered a full account of the patients treated during the last offi-
cial year, we shall bring in conclusion the statistics of the serum treatment since
March, 1898, except those of the Modikhana Hospital, and also other records neces-
sary for comparison.
Period.
March 1898 to 31st
of October 1898
and 1st February
to 81st April
1899.
1st of November
1898 to 31st Janu-
ary 1899,
1st of May 1899 to
31st of June 1900
(Junel899 exclud-
ed).
1st of May 1899 )
to 31st of May
1900 (June 1899
excluded).
13th of March 1898
to 31st of June
1900,
Hospitals and
private practice.
Arthur
Road
Hospital.
Maratha Hospital.
Arthur
Road
Hospital.
Maratha Hospital
Arthur
Road
Hospital.
Maratha Hospital
Different hospital
Private practice.
Treatment.
Serum treatment, select-
ed patients.
Ordinary treatment, re-
maining patients.
Ordinary treatment ...
Ordinary treatment, no
serum available.
Ordinary treatment ...
Alternate
treatment,
serum patients.
Alternate
treatment,
control patients.
Ordinary treatment ..
s Serum treatment, partly
selected patients.
Serum treatment, no
selected patients.
Number
of
patients.
380
1,167
3,257
273
557
480
480
2,599
50
42
Died.
234
942
2,636
222
453
328
382
2,104
33
19
Recov-
ered,
146
225
621
51
104
152
98
495
17
23
Percent-
age of
morta-
lity.
61.57
80.71
80.93
81.31
81.32
68.33
79.58
80.95
66.00
45.23
From the table it appears that on the whole 952 patients were treated with
the serum, and that the results have been uniformly in its favour. If we compare
those during the periods of the selection and alternation we find a difference of
7 per cent. Does that prove a diminished efficacy in the second instance ? Not
necessarily so. No direct comparison between the results is possible. The mor-
tality in the alternately treated cases is the average mortality which may be obtain-
ed by the serum treatment, whereas that in the selected cases is a minimum
mortality. A comparison is only possible between the total mortality of the
hospital during the periods of the selection and alternation. This comparison shows
that the total mortality of the hospital was 1.36 per cent. lower during the second
period. From this and from the small difference between the mortality in the
selected cases and in those alternately treated and from the clinical observation,
we are convinced that the treatment as practised during the period of the selec-
tion would not have given a reduction of 11.25 per cent. if the cases had been treat-
ed alternately. This is not due to an improved manufacture, but to the progress
384
Leprosy.
There were only four examinations made for leprosy amongst three patients.
A sample was taken from a tubercle and one from the nasal secretions, both of
which were successful. The latter success was interesting as the existence of leprosy
bacilli in the nasal secretions is a comparatively recent discovery, and further it
has been suggested that this is the usual mode of entrance into the system. The
other cases-were doubtful and did not show the bacillus.
Varice.
24 examinations were made from patients with various other diseases, e.g., a
sailor (M.K.6235) was sent to hospital as plague with an enlarged gland near the left
angle of the jaw due to the " irritation " of a gum boil. This gland was sterile.
Amongst the cases were catarrhal pneumonia, bronchitis, diarrhoea, &c., examined
for various reasons, but generally to clear up any doubt as to their infectious nature.
In the above notes A. E. stands for the Arthur Road Hospital.
M. K. „
,, the Modikhana
„
Mar,
„
„ the Maratha
„
The numbers given are the Hospital numbers of the cases cited.
GEORGE TAYLOR.
APPENDIX No. VI.
FROM
ASSISTANT HOSPITAL VISITOR,
To
SPECIAL MEDICAL OFFICER
TO THE PLAGUE COMMISSIONER,
BOMBAY PRESIDENCY.
Report of Assistant Hospital Visitor, Plague Epidemic, 1899-1900.
1. My duties as the Assistant Hospital Visitor were commenced on December
13th, 1899, and ceased on June 13th, 1900.
The duties consisted in visiting the private plague hospitals.
At these visits there was to be no interference with the treatment of cases, but the
attention was to be confined to the sanitary state of the hospital.
The daily returns sent in by the private plague hospitals were to bo checked.
2. List of private plague hospitals visited—
Parsee, Parel Road.
Do, Supplementary Ward, Frere Road.
H. H. Aga Khan's, Dontad Cross Lane.
Port Trust, Frere Road.
Adamjee Peerbhoy, Queen's Road.
Pathare Prabhu, Charni Gardens.
Khatri, Bapu Khote Street.
Brahmo Kshatrya, Pinjrapole Lane, Bhuleshwar.
Kapole and Lad, Frere Road.
Bhatia, Frere Road.
Thakordwar, Lohana.
Telegu, Kamatipura.
3rd Bhoiwada, Bhuleshwar.
Jain, Pare] Road.
Do. Pinjrapole, Bhuleshwar.
Bene Israel, Victoria Gardens.
Marwari and Futtipura, 2nd Pinjrapole Lane, Bhuleshwar.
Islami Nagdevi, Nagdevi Street.
385
Petit Mills.
Empress Mills, DeLisle Road.
Narielwadi Mahomedan Hospital.,
Cutch Lohana, Clive Road.
Mogul, Baboola Tank.
V.S. Maharajah's Servants, Cathedral Street, Bhuleshwar.
Sarvajanic, Government House Grounds, Parel.
Stewart Strong's, Colaba.
Hindoo Fever, Charni Gardens.
3. When visiting a hospital, its general sanitary condition was considered, while
special attention was bestowed on the following points :—
(a) The condition of the bedding, sheets, blankets and cloths of a
patient.
(b) The cleanliness of floors and walls.
(c) The providing patients with spittoons and encouraging them, through
the hospital assistants and ward-boys, to expectorate into these
instead of promiscuously about on the bedding, floors and walls.
(d) The limiting of the number of visitors to patients with a view to
preventing more than two visitors at a time to each patient,
(e) The calling the attention of the hospital assistants to dressings, &c.,
thrown about the floors or out of the windows.
(f)
The disinfection of bedding sheets and cloths used for the patients
and of other articles likely to spread infection.
4. If there was any cause for complaint, remarks were written in a book kept
at the hospital for the purpose. The remarks thus made were seen by the visiting
physician or managing committee, while at my next visit I was able to refer to my
note and ascertain if that particular matter had been put right.
5. In all cases of continued or gross defect in the management of the
hospital the matter was reported to the Special Medical Officer.
6. Seeing that at these hospitals the patients were, in the great majority of cases,
admitted for a contagious disease, thorough disinfection of all that might be likely to
convey infection was, I considered, the most important point for consideration. When
first I commenced visiting the private plague hospitals, I learnt from answers to
questions I put to the hospital assistants that in many cases somewhat hazy ideas
were held on the subject of disinfection.
In consequence of this, I drew up some suggestions as to methods of disinfection,
and, with the sanction of the Special Medical Officer, had a copy of these sent to each
private plague hospital.
The following are the suggestions which were sent round :—
Very few of the private hospitals made use of the steam disinfectors, the reason
apparently being the difficulty of transport. If each steam sterilizing station were
supplied with a cart that could be sent round to the private plague hospital in its
vicinity and collect from these the things for disinfection, more use might be made of
this method of disinfection.
7. Any suggestion made was in all cases productive of an effort on the part o
the hospital to carry it into effect.
386
8. The following are some remarks about the different hospitals :—
(a) The Empress Mills (DeLisle Road), the Supplementary Parsee
Ward (Frere Road), the Marwari and Futtipura (2nd Pinjrapole
Lane, Buleshwar), require better direct supervision.
(6) There is room for considerable improvement in the Narielwadi
Mahomedan and V. S. Maharajah's Servants' Hospitals.
(c) The following hospitals should be re-opened on new sites :—
Telegu.
Thakordwar Lohana.
Brahmo Kshatrya.
Cutch Lohana.
Aga Khan's.
Islami Nagdevi.
3rd Bhoiwada.
Mogul.
(d) The Bapu Khote and Petit Mills Hospitals I never found containing
patients : the former, I think, ought to re-open on a new site ; the
latter should be an excellent little hospital from its appearance,
(e) The remaining hospitals are, I think, sufficiently suitably situated.
All of them were well managed, but the number of patients treated
at the different hospitals varied considerably.
(f)
Especial praise is, I think, due to the Hindu Fever Hospital, the
Sarvajanic Hospital and the Stewart Strong's Hospital, Colaba.
(g) Three of the Municipal Hospitals were also visited, vis., the Mahim,
the General Mahomedan (Northbrook Gardens) and the Zullai
Sunni (Ripon Road); the last of these was visited twice a week for
the purpose of discharging patients.
9. As regards the advisability of the existence of private plague hospitals,
my opinion is at present the following :—
So long as a community that maintains a private hospital is ready to receive
advice which they are willing and able to efficiently carry into effect, and provided
the hospital be suitably situated, a private plague hospital is a means of checking the
spread of infection and a service to its particular caste or community, for the many
points of infection are brought to a focus, as it were, at one point, and the infection
is here smothered.
When, however, advice given is not, or cannot be, efficiently carried into effect,
the result is the removal of infection from one locality to another without its
being smothered at the latter.
Therefore, encourage the starting and carrying on of such private plague hospitals,
as are both willing and able to efficiently follow the advice given.
10. It remains to be seen whether those living in the vicinity of plague hospitals
are more subject to infection than others not so placed. The part played by rats in
the spreading of plague infection makes one think that such a thing is possible and
even likely. The reports of the various District Plague Officers might throw some
light on this matter.
I have the honor to remain,
Your most obedient Servant,
E. L. HUNT,
At present Inspector of Inoculation,
Formerly Assistant Hospital Visitor.
387
METHODS OF DISINFECTION.
Suggestions to medical officers in charge of private plague hospitals, Bombay.
(Sd.) E. L. HUNT,
Assistant Hospital Visitor.
DISINFECTION.
Clothing and Bedding*
1. All articles of little value, burn.
2. Bedding, Blankets, Clothing, Mattresses, (take out hair or wool or
feathers, and loosen them before disinfecting) in Steam Sterilizer.
1 steam sterilizer at Modikhana.
1
„
„
„ Northbrook Gardens.
1
„
„
„ Narielwadi.
1
„
,,
„ Arthur Road.
3. Failing (2), burn
4. Failing (2) and (3), boil for 1 hour and wash well with soap and water.
5. Failing (2), (3) and (4), soak for 24 hours in any of these
(1) Carbolic acid, 1 in 20.
(2) Izal
„ 1 in 20.
(3) 1/2 ounce perchloride of mercury.
1 ounce of hydrochloric acid in 480 ounces of water.
DISINFECTION.
Rooms and Furniture.
Fresh air and sunlight (open doors and windows and remove tiles if possible).
Lime-wash floors and walls.
Wash furniture with solution of phenyle or chloride of lime (1 in 100).
DISINFECTION.
Excreta and Discharges.
(From bowels, bladder, lungs, abscesses, etc.)
1. Should be well mixed with 1 in 20 carbolic acid and left quarter of an
hour and finally burnt or buried or thrown down closet which should be well
flushed with water.
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