10
5. Taking the total it may be pointed out that the proportion of deaths, not
traced in the City, has fallen to less than 5 per cent, of the total number of bodies
disposed of. It used 18 months ago to be often as much as 20 per cent.
6. By dint of constant pressure the proportion of deaths, ascribed to ordinary
causes after enquiry only, is less than 20 per cent, of the total mortality, and of these
a very large number (probably not less than half) occurred among infants, while a
considerable portion of the remainder were small-pox deaths, about which there is
little likelihood of mistake, in the case of which disinfection is invariably resorted to,
7. It will be seen that of the deaths from ordinary causes those that died in
the public hospitals, under the best European Medical treatment, together with
those seen by the Municipal Medical Officers during their last illness and still-
born, actually number more than the total average deaths for the City, and in addi-
tion a number equal lo more than half that average were either examined by Mu-
nicipal Medical Officers after death, or certified by qualified Medical Practitioners
in private practice.
The conclusion is almost irresistible that if the large excess mortality, ascribed
to ordinary causes, is really due to Plague, then it is in a form not diagnosable by
the means ordinarily available.
8. This conclusion is borne out by actual experience—cases are by no means
infrequent where medical men, whether Municipal servants or private practitioners,
uro completely baffled by Plague in its earlier stages ; and are only put on the
right track by the tardy appearance of a bubo, or the sudden collapse of the
patient and even then often remain in uncertainty until convinced by bacteriologi-
cal examination of the blood. The accompanying copy of a report* from Dr. Choksey
in charge of the Municipal Epidemic Diseases Hospital—an officer of the greatest
experience—illustrates the difficulties of diagnosis. His opinion is, it will be
observed, tliat these difficulties increase from year to year. The accompanying
extract from a report * by Dr. Dhargalkar in charge of the Maratha Hospital, is
also of interest from the same point of view. It will be seen that in their anxiety
to be on the safe side the Medical Officers have sent to hospital not only a number
of cases which could not be diagnosed, but also not a few which were eventually
found not to be Plague. If Municipal Medical Officers can be deceived, it is highly
probable that private practitioners, who are often not too anxious to diagnose Plague,
should be deceived, and there is thus little doubt that a certain number of cases
es.cape detection. It is also possible—though there is practically no evidence
forthcoming on the point—that some part of the excessive infant mortality is due to
Plague. If this is so, it must be Plague of a type peculiar to children, and of a type
that has not yet been satisfactorily diagnosed.
9. It is easy to suggest remedies, but difficult to recommend them. Corpse
inspection is unpopular and unsatisfactory, as outward signs of Plague are often not
apparent. The only effective remedy would, in my opinion, be for Government to
lay it down clearly and distinctly thac every death which was not certified by a
Municipal Medical Officer or an authorised private practitioner not to be due to
Plague, should be treated as Pbgue. If the initial unpopularity of such a measure
could be got over, wo should, doubtless in a very short time, have all sickness seen
by qualified Medical men. If it was undoubtedly Plague they would be bound to
report it at once. If ir was doubtful, it would be treated as Plague upon the death
of the patient. The first essential of such a scheme would be a large additional staff
of Medical men and Medical women.
10. It is probable that a few typical Plague cases may be escaping detection,
but the increased number of roadside oases, now being found, indicate not only the
unpopularity of Plague measures, but their efficiency. For the people would hardly,
. Printed below.