NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
67
3. He is exempted from being sent to camp if evacuation or segregation is
ordered, but, if Plague occurs in bis house, it will have to be disinfected as usual.
4. The above exemptions do not apply to any one actually suffering from
plague.
5. Para. 2 applies throughout British India ; para. 3 applies in the Bombay
Presidency only.
6. Nothing in the above affects the special Plague regulations for Mahablesh-
war and Matherun.
Difficulties.
During the earlier period of the campaign the principal obstacles
were found at first in an utter want of interest in the subject. Gradu-
ally, as the public were stirred up by the numerous meetings, opposition
followed the lines of (1) disbelief in the protective effect of the
prophylactic ; (2) fear of possible ill consequences either immediately
or after the lapse of months and years ; (3) objections on religious
grounds from the Mussalmans and orthodox Hindus. A considerable
section of the vernacular press took up an attitude strongly opposed
to inoculation, and, though there can be no doubt that these
writings deterred many from protecting themselves, opposition of this
kind is not to be altogether deplored, as criticism, whether honest
or dishonest, always tends to the elucidation of the truth. With the
exception of the Khojas, who, under the healthy influence of their
enlightened leader H. H. the Aga Khan, took more readily than any
other community to inoculation, the Mussulmans as a whole never
budged from their position that inoculation was against religion. They
were not open to reason on the subject and the number of them inoc-
ulated was almost a negligeable quantity. The Bohras, perhaps, would
have taken to it if they had suffered severely from plague. So far as the
orthodox Hindus went, the objection on religious grounds, which at one
time threatened to become a burning question, gradually disappeared.
Several of the leaders of these castes (Brahmins, Jains, Bhatias, Loharuis,
&c.) were inoculated, but no impression was made upon the bulk of them.
Fear of imaginary ill consequences gave place to a keen appreciation of the
real discomforts of the operation, with its supervening malaise and fever,
and disbelief in its protective effect was superseded by a disinclination
to undergo these discomforts for the sake of protection not absolutely
guaranteed, and only promisee! for a limited period. In these objections
there is nothing unscund. and they can only be met by improvements in
the prophylactic fluid.
The choice between evacuation and inoculation was the most powerful
inducement that District Officers were able to use ; and great numbers of
people living in infected houses, who would otherwise have had to go to
camp, accepted inoculation without liking it, and without believing in it,
simply as the lesser of two evils ; but the bulk of those operated upon
consisted of the poor and destitute—the classes most liable to plague—
who voluntarily submitted themselves to the operation for the sake of
the four annas dole and the charitable grant of grain. In especial almost
all the Kathiawari famine refugees w?"e inoculated almost as soon as
they reached the city.
68
The attitude of the Parsees towards inoculation during the year
under report was in curious contrast to that previously adopted by them.
Last year, with the exception perhaps of the Khojas, no community
showed a greater readiness to adopt the treatment : this year the Pancha-
yet spared no pains to keep the Parsee public well-informed and interest-
ed in the subject, but, though there was some promise for a brief period
that they would take to it again, they would, generally speaking, have
nothing to do with it.
Now and again the constant strain of argument was relaxed and
people came forward voluntarily. Here is an extract from Captain Cup-
page's report for the week ending 23rd December 1899 :—
''About 25 persons came of their own accord from Picket Lane near Carnae
" Boad to the office to be inoculated. While writing this report I had a visit from
" Eao Saheb Purshotum Odhowji, who was present when inoculations were being
" performed this morning in Tara Naikin's Wadi. Ninety-eight persons were
" inoculated. He assures me the people came to him—told him tbat they saw for
" themselves how the inoculated were keeping free from Plaguo, and that the fresh
" cases occurring in the Wadi were all either amongst new arrivals or those of the
" inhabitants who had refused inoculation. They actually asked to be inoculated."
In Kumbharwada, too, the people began to see that there was some-
thing in inoculation and one or too chaw Is came forward voluntarily.
Here and there landlords insisted upon their tenants being inoculated,
and in most cases this was due to their appreciation of the fact that, if all
the inmates of a chawl were inoculated, plague was not likely to put in an
appearance, and that even if a few cases did occur they would not be
followed by evacuation of the chawl and loss of rent to themselves.
Precautions
Rotopted.
In order to ensure the adoption of proper precautions the following
circulars were issued :—
Antiseptic and other precautions to be taken by Inoculators
when using Ha/lane's Plague Prophylactic.
1. Any bottle of the prophylactic found to have the seal broken, the cork loose,
or the bottle cracked or broken, is to be sent back to the Laboratory and the con-
tents are not to be used.
2. Exposure of the bottles to day-light is to be avoided as much as possible.
3. Each bottle before opening is to be well shaken, and the contents are to be
well mixed up each time the syringe is filled.
4. In opening the bottle the sealing wax or paraffin is first to be melted over
the flame of the spirit lamp. The forceps are to be sterilized by passing them
several times through the flame of the spirit lamp. The cork is then withdrawn
with the sterilized forceps, both arms of the forceps being pushed in between the
cork and the neck of the bottle on opposite sides to avoid breaking the cork.
5. The syringe before being first used should be kept filled with a 5% solu-
tion of Carbolic Acid for twenty-four hours. Before each batch of inoculations the
syringe should be filled with a 5% solution of Carbolic Acid for one hour. After
ach batch of inoculation the syringe should be washed out several times with a 5%
solution of Carbolic Acid.
72
(2) Collodion should also be applied at the point of inoculation, subsequent
to the operation, for the purpose of sealing the wound made by the
needle,
The utmost care should be taken to see that all the precautions laid down are
carefully complied with.
At a later date the above were supplemented by the following
instructions drawn up at the Laboratory,
Imtructions for the use of the Plague Prophylactic.
1. Parcel to be opened and unpacked carefully. Any bottle found open,
cracked or with the covering of the cork damaged, is to be sent back to the "Labora-
tory without being used. Prolonged exposure of the prophylactic to daylight is to
be avoided.
2. The prophylactic is to be given by injection under the skin. For this
purpose a hypodermic syringe of a suitable size is to be disinfected, in the beginning,
by keeping it filled with a 5 per cent, solution of carbolic acid for 24 hours. After
that, if the syringe is not used for other purposes, it will be sufficient to keep it
filled for one hour before commencing operations. After the completion of each
series of injections the syringe is to be washed out three times with the same anti-
septic solution. The needle should be sterilized by boiling in a test tube before
use, or should it by chance fall on the ground during the operations. Between each
inoculation the needle should bo kept immersed in carbolic lotion (1 to 20),
which may conveniently be contained in the upturned lid of the metal syringe-
case. Syringes may be obtained from the Plague Research Laboratory, Parel,
Bombay.
3. Each bottle before being opened is to be shaken, and the contents well
mixed up each time before being absorbed into the syringe.
4. When opening a bottle a pair of dissecting forceps is to be used, the
branches being heated beforehand in the flame of a spirit lamp, and guarded from
contact with any other unsterilized object.
5. While opening a bottle the mouth of it is passed several times through the
flame of a lamp, and the paraffin melted. The cork is then withdrawn with the
sterilized forceps, both branches of which are shoved in between the cork and the
neck of the bottle, on two opposite sides simultaneously. In the case of bottles
closed with India-rubber stoppers no paraffin or other covering is used. The
stoppers are easily withdrawn by the sterilized forceps. After the bottle is opened
any contact between its mouth and other unsterilized objects is to be avoided j
and, if contact inadvertently occurs, the mouth is to be heated again in the flame
for disinfecting it. The contents, or a part of it, are absorbed into the syringe. The
bottle is to be kept as nearly horizontal as possible during the whole time the cort
is out. Leaning the neck of the bottle against the edge of the box-lid will be found
convenient.
6. For an adult man, in average state of health, the standard dose is 2ĉ
ubic centimeters (15 minims counting for 1 c. c.). This is to be injected under
the skin of the back of the upper arm, preferably the left one, avoiding as carefully
as possible the muscles or the big vessels by entering the needle in a sloping direc-
tion (never at right angles),
73
The following table shows at .a glance the proper doses to he given to persons
in good health : —
If the dose marked on the bottle is—
Below 2 years
From 2 to 5 years
„ 6 toll ()
„ 12 to 15 „
„ 16 to 50 „
2'5c i .c.
then give
0-5
I'D
1-5
2-0
2'5
c. c. or 1/5 full dose
c. c. or2/5| „ „
c. c. or 3/5 „ ,
c. c. or4/5 „ „
c. c., full dose
6'c.c.
then give
1 ' G, C.
2 c. c.
3 ' C. C.
4 c. c.
5 ' c. c.
Women of all ages over 12 years should get Q'25 c. c. less than men of
corresponding ages.
Persons over 50 years old should get 0*25 c.c. less for each decade above that
age.
Children stand the treatment well and no fear need be felt in giving these doses.
The symptoms commence as a rule 3 to 5 hours after inoculation, and consist
chiefly of swelling and pain at the seat of inoculation, and of a rise of temperature.
The pain is felt particularly on movement of the part. The fever is accompanied
by general discomfort usual to this condition. No treatment of the symptoms
is required bej'ond applying ice for the relief of headache, if any is felt, and taking
some rest. General symptoms subside after 24 to 36 hours ; the pain at the seat
of inoculation lasts for three or four days, disappearing gradually ; a painless in-
duration remains there for some time longer. It is desirable to produce a rise of
temperature of at least 102° F. If the reaction is less marked, the operation may
be repeated 3 or 4 days later, with the same or an increased dose, according to
the result of the first inoculation. There is no harm in leaving a longer interval
between the two inoculations. Note carefully the instructions on the label of each
bottle and attend to any directions on it for increasing or diminishing the amount to
be administered.
7. No changes in diet or occupation are necessary beyond, if possible, taking
some rest. Bathing in the open air should be avoided for some days. A simple
purgative may be given 24 hours after the inoculation.
8. The prophylactic material is harmless, and can be thrown about without
danger ; but it is liable to get infected. A bottle, once opened, is therefore ?iot to le
corked again, but used up at once, or the rest of the contents thrown away. While
a bottle is open, it should be guarded from insects flying or walking into it, or
dust falling in, vide last sentences of paragraph 5 above. The empty bottles, the
boxes, and, if possible, also the material in -which they were packed, are to be return-
ed to the Laboratory.
9. In properly closed bottles, and when kept in dark and sufficiently cool
places, the prophylactic is likely to retain its power indefinitely.
At the beginning of September the question was raised whether
the inoculation of contacts was desirable, seeing that the disease might
74
already be incubating in them and their attack subsequent to inocu-
lation might be put down to the operation. The opinion of Major
Bannerman was asked and his advice, which was acted upon, was as
follows :—
In reply to your memo. No. P-6441, of 18th instant, I have the honour to advise
that all contacts should be given the chance afforded by inoculation for the follow-
ing reasons :—
(a) From observations made under exact conditions, e. g., in jails, small
villages, etc., it is certain that plague in the incubation stage can be " aborted "
by inoculation, provided the operation has been performed 12—24 hours before the
appearance of symptoms of plague.
(5) It is also proved that inoculation of a person actually suffering from the
fever of plague does not do him any harm, the death-rate among such inoculated
persons being the same as in the non-inoculated.
(e) The argument that the inoculation of contacts should be stopped because
a certain number of such persons will develop plague is not sound. From practical
experience in other parts of India, I know that when the matter is explained to the
people, even the uneducated, they at once see the force of the argument and regard
such plague cases as being unavoidable, and not therefore detracting from the bone-
fits of inoculation. I suppose the Bombay people would not be more backward to
accept this view of the matter than those in other provinces,
It would be a distinct loss, from a humanitarian point of view, to stop the in-
oculation of contacts who have no fever on them at the time.
On the whole the operators did their work carefully and well. With
the exception of a few practitioners of considerable experience, who
were compelled to satisfy the Special Medical Officer of their fitness for
the responsibility, none but qualified medical men were permitted to inocu-
late. Cases occurred from time to time where the pain arid inflammation
at the seat of inoculation, or stiffness of the joint, were prolonged ; but it
would be difficult to assert that this was due to carelessness on the part
of the operators, especially when it is remembered that the ignorant
in spite of warnings constantly rubbed cowdung and other objectionable
stuff upon the seat of inoculation. Abscesses, probably due to this cause,
occasionally occurred. In a few cases prolonged debility following upon
the operation was ascribed to inoculation, and in a few the cessation of
rheumatism, malaria, or other ailments, were thought by the sufferers to
have resulted from the prophylactic treatment; but such instances were
extremely rare and probably mere coincidences.
Abuses.
Two cases were reported by the Port Health Officer where people
anxious to get away by sea obtained inoculation certificates belonging
to others and personated the proper holders in the hope that it would
facilitate their departure. No means existed for checking this practice
except that of examining the thumb-impressions and marks of identifica-
tion upon the certificate. The practice may have been common, but the
above were the only two cases actually reported during the year.
75
The one serious abuse of inoculation, which it. was impossible to
check, was the inclination of some of the destitute Kathiawari refugees
find other beggars to make a profession of inoculation. They would
wander round from station to station getting at each their dole of
four annas and the free gift of grain. The strictest injunctions were
issued to all inoculating officers to examine carefully the arms of persons
coming up for inoculation, to see that they had not been done before,
and very large numbers were constantly being turned away ; but all
traces of the operations disappeared in the majority of cases within a
very brief space, and, careful as the medical officers might be, there is no
doubt that several thousands must be deducted from the total number of
operations performed to arrive at the actual number of people protected.
On one occasion Captain Lock collected some 50 men who had been
inoculated, some 15 fcim.es each : one of them confessing to as many as
30 operations. In a few of these cases it was possible to detect as many
as four indurations, but in the majority of cases one, or at the most two,
could be found. None of these people seemed to be in the least affected
by their repeated doses. The following Circular was issued with a view to
emphasizing the importance of vigilance against this abuse.
CIRCULAR.
It has come to the notice of the Commissioner that in some cases people are
making a profession of inoculation: one man admitted having been inoculated 30
times in order to .secure the four-annas fee and many others had been inoculated 10
to 30 times each.
The Commissioner has, therefore, ordered in modification of this office Circular
No. P-5612 of 25th August 1899—
1. That the certificate to be attached by District Officers or other duly-
authorised persons to bills for fees shall run :—
" Certified that these operations have been performed in my presence, and that
none of the persons operated upon have, so far as I can ascertain, been
inoculated before ivithin the past 6 months. "
2. Compensation up to a maximum of annas four may be paid only to persons
who have not been inoculated before within the previous 6 months.
District Officers are requested to enforce these orders literally and strictly, and
I am directed to say that severe notice will be taken if any Medical Officer exhibits
carelessness in ascertaining whether or not a person has been previously inoculated.
On another occasion Dr. R. V. Patel sent in 18 certificates of some
men he had turned away who had been inoculated some half a dozen
times each. Hundreds of people were constantly being thus turned away
at the various inoculation stations, but as the indurations disappeared
it became impossible to detect whether they had been inoculated before,
and the people themselves, realising that they would not be inoculated
again and get the compensation they hoped for if they admitted having
been treated before, unblushingly denied having ever been operated
on.
78
2. Any practitioner whose assistance is accepted must maintain a careful regis-
ter in the accompanying form, and this register mu&t be open to inspection by fcfye
District Officer.
3. He must also submit to the District Officer direct a weekly return correctly
compiled in the accompanying form.
4. He wilt obtain prophylactic fluid, certificate forms, and other requisites
from the District Officer.
5. Certificate forms must be kept under lock and key. They must never be
signed before they are filled in. The impression of the left thumb of the person
inoculated and at least one mark of identification must always be given.
The eountersignature of the District Officer is not necessary.
6. The District Officer should keep a register of all prophylactic and other
requisites issued to private practitioners, obtaining a receipt for every issue.
7. It is impossible to place Municipal Funds at the disposal of private practi-
tioners, for the payment of compensation to persons inoculated.
Protection.
One of the most striking cases of the protective value of inoculation,
during the year, occurred at, house No. 201, Cattle Lines, Pilot Bandar,
Colaba. There were 61 people living here and of these 24 were inocu-
lated. The persons inoculated were mostly women and children, the
men being generally away at work at the time of the medical officer's
visits. In the month of February, the house was violently attacked by
plague, 20 cases occurred altogether, and of these 19 were among the
37 tininoculated (a. percentage of 51*3), and only one among the inocu-
lated, a percentage of 4'2. The facts of this ease were reported to
Mr. Haffkine and a detailed investigation was instituted by him. Of the
19 uninoculated cases 12 died and 7 recovered, while the one inoculat-
ed case recovered. In another case—that of the Marine Battalion—of
775 persons, all but 75 had been inoculated when plague broke out.
Six cases occurred, and of these 3 were among the uninoculated and
3 among the inoculated. The percentage of attacks amongst the unin-
oculated was, therefore, 4'00 ; among the inoculated 0'42. The facts of
this case were also reported to Mr, Haffkine.
Thanks chiefly to the enthusiasm and energy of Mr. N. N. Gazdar 7
a great number of the inhabitants of Frere Road and adjoining streets
were inoculated. The densely-crowded chawls of this locality suffered
severely from plague in past years, but escaped comparatively lightly
during the year under repon, and the District Officer is unable to assign
any reason for this, except inoculation.
From several examples of the good effects of inoculation in B. "Ward,
the case of house No. 31-33, Jail Road (North), may be selected. It is
a dirty insanitary building, inhabited by Mhars. It had a bad plague
record from 1898, and between 1st May 1899 and 30th December 1899
there were 22 deaths there, of which 4 were plague and 7 suspicious.
The majority of the inmates were inoculated on the latter date.
Between 5th Januarv 1000 and 28th Mav 1900 42 deaths occurred in