NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
22
[CHAP. I., ΡT. III.
I.
Major Ross writes from Poona :—
" The effect of health-camping was almost magical. Of upwards of 4,000 people taken from
the worst infected areas, only one undoubted plague case* occurred after they had returned to
their houses ; in that instance the woman who was attacked was only six days in Camp, and
was taken ill the evening of the day she left."
II.
Colonel Fawcett, R.A.M.C., writes from the same place :—
"Owing to the prevalence of Plague in the Wanowrie Bazaar a second Health Camp was
established early in December, about 200 paces from that bazaar. It was capable of containing
about 400 people, and was arranged and managed in a similar manner to the Camp at the Lall
Bagh. As soon as possible after it was ready, the whole of the inhabitants of the Wanowrie
Bazaar were moved into Camp. Plague had been rife among these people, and the course of
the epidemic was but little modified by the removal of the sick and segregation of contacts.
Form the date of the removal of the last family to Camp, not a single indigenous case arose
among these people, nor did one occur among them after their return to the bazaar.
"It may be well to relate an incident that, at the time, made a profound impression both
on plague-workers and on the surrounding people.
" When the bazaar people were sent to the Health Camp a small row of huts was overlooked
and the inmates left undisturbed. Amongst these (i. e., those who had been thus left behind
in their 5 cases, 3 fatal, occurred within 24 hours ; the remainder
were then segregated
without delay. This object-lesson proved of great value, and was not forgotten by the people."
III.
In the District of Khandesh is a village of some 300 souls called Kanaswadi. The first
case of plague in this village occurred on the 5th October 1897. It was imported. No more
cases occurred till the week ending 4th November 1897. During this week one indigenous
case occurred. During the week ending 18th November 3 cases occurred, and the following
week one case. The epidemic now mounted rapidly : for during the week ending 2nd December
there were 5 cases, and during the week ending 9th December 14 cases. The village was
emptied on the 5th December, and from the 9th December plague absolutely ceased, for there
was not another case. The following chart shows the gradual increase and sudden
cessation :—
CHART OF EPIDEMIC IN KANASWADI
Population
about
300
* This was the only case sub-equent to evacuation.
EVACUATION.]
25
XI
Shrigonda in the Ahmednagar District affords yet another instance :—
" It soon became apparent, however, that plague could not be altogether checked unless
all communication ceased with the infected town ; and all our energies were directed
towards this end. Gradually by the grant of some aid partly from plague and partly from
charitable funds, weavers and other artisans were persuaded to erect their workshops outside
the village. A site was also chosen and fitted up for the weekly bazár. There a large
camp or market was erected and all the merchants and shopkeepers induced to open their
shops and offices in that camp. In this way by the end of January the town had been
quite emptied and all communication forbidden ....
By the 15th January 1898
plague had practically disappeared."
The tailing off of an epidemic with one or two cases weekly after complete evacuation,
as is shown in a great many cases, is easily explained by these stealthy visits of people to
their infected houses, and under such circumstances is just what might be expected. It is
unfortunately a state of affairs which it is difficult if not impossible to prevent. Such cases
might be quoted by the score, and it is reasonable to infer that, where an epidemic shows a
similar feature, this secret visiting of houses has been practised, though, perhaps, not detected.
A direct comparison between the incidence of the disease on an infected population
which has partly vacated, and partly remained behind in the town, is afforded by Mándvi
Town in Cutch, the figures for which are given below. The long tailing off is just what might
have been expected, seeing that there must have been communication between the inhabitants
of the camp and the town. The following statement shows the number of cases occurring
outside and inside the town respectively :—
On the 1st May 1898 there were
(
in
Camp
35,000
(in
the Town
...
... 5,000
6th May
13th ,,
20th „
27th „
3rd June
10th
„
17th
„
24th „
1st July
8th „
15th „
22nd „
29th ,,
5th August
12th „
19th „
26th ,,
2nd September
Week ending
1898
Totals for 4 months...
NUMBER OF INDIGENOUS CASES IN
Health Camp
(35,000).
14
20
14
30
19
16
15
8
6
13
9
10
10
9
3
3
7
...
206
Town
(5,000).
30
22
50
51
36
30
43
20
12
20
29
26
23
28
19
35
29
22
525
REMARKS.
9 in Salaya. †
1
do.
3 do.
6 do.
9
do.
8 do.
9 do.
9
do.
24
do.
17
do.
9 do.
and 7 cases
in Post Offices hitherto
immune.
104 cases in Salaya.
* Collector of Ahmednagar's No. 9286 of 10th Sept. 1898,
† Salaya is a suburb of Mándvi.
7
26
[CHAP. I., ΡT. III.
These results may be compared thus :—
Locality.
Outside the town *
Inside the town
Salaya
Population.
35,000
5,000
Period.
4 months ...
4 months ...
2½ months ...
Number of Cases.
206
421
104
REMARKS.
Excluding Salaya.
* Includes houses outside the town.
In other words, a population INSIDE the town of 5,000 had more than double the number
of the cases of a population seven times as large OUTSIDE the town.
It must be remembered also that the figures for those outside the town include those
for all the houses outside the town, and for all such people as paid undetected visits to the
town and afterwards displayed plague symptoms in Camp.
B.—Opinions.
Those who have had a large experience of plague measures and their results, whether
Europeans or Natives, whether Civil, Medical, Military, or unofficial, are practically
unanimous as to the value and efficacy of evacuation: even the people themselves, as
represented by the more influential of them, who have actually done plague work, and by
those again who have learnt the lessons from previous epidemics, show, both by words and
actions, that their belief in the value of evacuation is as strong as that of the other classes
above mentioned.
Although such evidence is in many cases unsupported by figures, still it carries its own
weight in the fact that it is the result of what these people have seen for themselves : not
in one or two parts of the Presidency only, but in every locality and every quarter of it.
An occasional dissentient voice is heard, e. g., Mr. V. A. Patwardhan's, from Poona:—
" Wholesale evacuation is highly objectionable, especially in the monsoon and cold
weather. If the persons who come into contact with the sick persons leave the house, that is
quite sufficient."
Mr. B. C. Sathe's, from the same place :—
" People showed great aversion to leaving their houses. The chief causes of this were :—
1. Want of safety as regards property left at home.
2. Danger of living in far-off lonely places, especially with children and females.
3. Want of sufficient money to make the habitations in open plains as comfort-
able as are suited to the habits of the people.
4. In the case of the poor classes living on daily labour, the distant residence told
very much on their gains."
And perhaps Ráo Bahádur B. R. Heblikar's from Sátára, Assistant Surgeon J. V. Mas-
carenhas' from Dhárwár, and one or two others.
(3) Influence of evacuation on trade, and on the lives, occupations, and minds of the
people—
As evacuation is nothing more or less than " camping out " for a few weeks, it does not in
small villages affect to any considerable extent the large majority of the inhabitants, who
are probably peasants, or do peasants' work of one kind or another. It inconveniences the
weavers, bannias, shop-keepers, and such classes as under ordinary circumstances never leave
their houses. But this is no great matter, as the shops and trade are small, and in most cases
can be continued just as well outside as inside the village.
EVACUATION.]
27
In the case of large towns, however, matters are different, and a larger and larger number
of well-to-do inhabitants find their business seriously interfered with by this enforced
abandonment of their houses. The larger the town and population the more acutely is the
inconvenience felt : until in very large towns, such as Karachi, Poona, etc., it becomes
practically impossible.
The sanctioning of caste camps and hospitals did away with objections on such grounds
as caste and rank : and the enforcement of the measure does not now affect the minds of the
people. This is shown by the attitude of the people themselves: for, considering the
universality of its adoption, complaints have been exceedingly rare.
But these drawbacks will be noticed later on.
(4) and (7).—Cost of Evacuation.—
The cost of evacuation varies with the class of people to be turned out.
As a rule, its cost is now nominal, the people being simply told to make their own
arrangements, and, except in the case of the very poor, to build their own huts, or erect their
own sheds, outside the town.
The cost, again, must be in some sort proportionate to the size of the town, and in the
case of a large town like Sholapur, doubtless the expense is considerable. In Jalgaon,
however, a town of some 14,000, the expense was nominal : and Major Anderson, I. M. S.,
states that in Dharwar District the expense was practically nil.*
The following note by Mr. Morison, † formerly Collector there, shows the actual cost at
Sholapur, where arrangements were made to house everybody. The estimates which follow
are, however, very rough ; and they merely indicate what has actually been achieved. They
are obviously unsuited, not to say impracticable, in the rains, and the accommodation provided
in the smaller and cheaper huts was, to say the least, scanty : —
" For housing the people our unit was a triangular shelter (as per margin), made of
gunny bags stretched over bamboos, open at front, closed at
back, floor area 8' X 8', giving accommodation to a family of 5.
Cost of each shelter.
Rs.
a. p.
10 gunny bags at Es, 18 per 100
...
1 13 0
10 bamboos at Rs. 8 per 100
...
0 13 0
Mooram floor, 6 in. high ...
...
0
40
Serving establishment and sundries ...
0
60
Total ...
340
" Suppose a town of 60,000 is to be evacuated ; of the total population at least 30,000
will either run away or erect their own huts and shelters, if sites are given them and
proper arrangements made for police protection, etc., the cost of hutting the remaining
30,000 will be—
6,000 huts at Rs. 3-4-0 each
...
...
... Es. 19,500
Twelve latrine enclosures for males and females with trenches
at Rs. 200 each
...
...
...
... „ 2,400
Water-supply
...
...
...
... „
2,000
Huts for police guards, etc.
...
...
... „
1,000
Total ... Rs. 24,900
* Report ou the Navalgund and Nargund Talukas in his charge.
† Letter dated 3rd March 1899.
28
[CHAP. I., ΡT. III.
i.e., a rate of 13 annas per individual housed or 6½ annas per head of total population
for the actual hutting, presuming that open ground is available free of charge for camps.
No provision is made for shops, bazárs, etc., as the people arrange these themselves if sites
are pointed out.
" If superior huts with small side walls (as shown in sketch in margin) are provided,
the cost would be Re. 1-2-0 per individual housed or
9 annas per head of total population.
For superintendence, I think—
1 Staff Corps Officer ... Rs. 600} for one
2 Assistants at Rs. 150 each 300} month.
Total .... 900
would suffice for evacuating a town of 20,000 inhabitants. I mean for the arrangement of
camps in connection with evacuation.
" In brief, my estimate is as follows :—
Per 1,000 of total population.
Inferior huts.
Superior
huts.
Rs. 406, say Rs. 425.
Rs.
562, say Rs. 600.
Plus Rs. 900 for each 20,000 of total population. "
The maximum and minimum cost of evacuating a town of, say, 20,000, may then be
roughly estimated as follows :—
Maximum.
Shed for complete population at 13 annas per head, deducting
half population for flight, private arrangements, etc. ... Rs. 8,100 roughly.
Staff Corps Officer and Staff
...
....
... „
900
Say ... Rs. 9,000
Minimum.
Sheds for 750 indigents (the rest making their own arrange-
ments)
...
...
...
...
... Rs. 304 roughly.
Staff Corps Officer and Staff
...
...
... „ 900
Say ... Rs. 1,250
This cannot be considered, due regard being had to the population, an expensive
measure.
It must be remembered, however, that these calculations are made for suitable conditions,
and could not apply in the monsoon and rainy season.
Nor does it require a special staff or organization ; for it can be carried out in villages
and small towns by the village officials on the spot ; and, as in every other measure, much
will depend on their trustworthiness. In large towns a small staff of police, with a responsible
officer of some standing, is necessary : but such towns are few.
The real difficulty lies in the maintenance of strict segregation after the people have
vacated the town, the prevention of clandestine visits to the empty houses, and the flight to
neighbouring villages.
For the effective adoption of such measures some responsible and trustworthy officer
(with a competent and vigilant police force) is necessary.
EVACUATION.]
29
But in this connection there is a hopeful sign in the gradual comprehension by the people
of uninfected villages and towns themselves, who are at length beginning to realize their own
danger in harbouring such fugitives, and consequently to deny to such fugitives entrance into
their towns and villages. On the intelligent co-operation of the people, then, depends to a
very large extent the necessity for Government organizations to prevent dissemination in
the manner just described ; and it is hoped that this co-operation will become ever more
efficient and valuable as the masses comprehend the salient characteristics of the disease.
(5) and (6).—The sphere of evacuation; and the duration of its effect.—
The sphere of evacuation is only limited by the size and population of the town or
village emptied ; and extends, moreover, not merely to the protection of such population, but
to the complete eradication of infection in the village itself : provided that the measure has
been allowed sufficient time to do its work.
The duration of its effect, though uncertain, appears to be more or less permanent ; the
cases where a town or village, which has once been completely evacuated for a sufficient
length of time, has afterwards suffered from a recrudescence—as distinguished from a re-
infection—if any such exist, being exceedingly rare.
The disadvantages and drawbacks attributed to evacuation are :—
(i.) Danger to person and property from dacoity.
(ii.) Injury to health from exposure.
(iii.) Impossibility of efficient death registration.
(iv.) The hardships it imposes on certain of the poorer classes.
Careful inquiries have been instituted on the first two points, with the following result :—
(i.) Evacuation and Crime.
That the vacating of a town leaves the houses empty, and increases the risk of robbery,
cannot be denied. This difficulty has been partially met by police guards and patrols, and
by carefully securing the doors so as to prevent ingress except by force.
Dacoities on the people in the fields also occur, but are not numerous, and seldom serious.
From reports received by Collectors it would seem, therefore, that the complete evacuation of
villages does to a small extent in some districts tend to increase dacoity and robbery. In
other districts, on the other hand, the increase is insignificant. Ahmednagar may be cited as
an instance of such a district, and Mr. C, Hudson, I. C. S., the Collector, submits an interest-
ing report on the point :—*
"The following offences were committed during the years 1897 and 1898 in this district
at places which were evacuated on account of plague :—
Dacoity
Robbery
House-breaking thefts
...
...
...
...
...
Simple thefts
...
...
...
...
..
...
. .
Receiving stolen property
...
...
...
1
2
18
7
3
31
2. The cases were distributed over Nagar City and the villages of Bhingar, Savedi,
Máliváda, Shrigonda, and Rájur. Nineteen cases were disposed of by being brought to trial,
* No. 968 of 1st February 1899.
8
36
[CHAP. I., ΡT. IV.
many improvements have since been introduced in its manufacture, the principles as therein
laid down remain unaltered. The first trial of the prophylactic on a plague-stricken community
was made in the Bombay House of Correction at Byculla. Plague broke out there on the-
23rd of January 1897, 9 attacks with 5 deaths occurring between that date and the 29th of
the same month. On the 30th of January, 6 more cases, of which 2 proved fatal, occurred. In
the afternoon of that day inoculation was offered to the prisoners, and about half the population
of the Jail volunteered. Three of the inoculated developed plague the same evening, and all of
these died. These cases manifestly had plague in their systems already—in fact, one actually
had a visible bubo at the time of inoculation—and are therefore excluded from the following
table of results obtained in the two groups of "inoculated" and " uninoculated": —
172 Uninoculated
...
147 Inoculated
Cases.
12
2
Deaths.
6
...
This result, having become known, naturally encouraged the inhabitants of Bombay City
to apply for inoculation in large numbers, and during the course of the season of plague
prevalence, ί. e., up to October 1897, altogether 8,142 persons were operated on. The following
table shows that the inoculated persons belonged to all castes and ages :—
Sex and Age distribution.
Adult males
„ females
Children of 10 years and under ...
Unclassified
5,259
1,668
1,079
136
Race distribution.
Parsis
Brahmins ...
Kshatriyas
Vaisyas
Sudras
Other Hindu Castes
Mahomedans
Europeans
Native Christians ...
Jews
Japanese ...
Unclassified
3,414
298
486
219
805
339
1,478
467
414
84
2
136
In this early period in the introduction of inoculation it is probable that all cases of
plague appearing among those inoculated were promptly reported to the Laboratory staff, as
the whole medical profession in Bombay were watching its effect with the keenest interest.
The following list of attacks and deaths among the 8,142 inoculated persons may
therefore probably be taken as fairly accurate. 20 cases of undoubted plague and one
doubtful one were thus reported and investigated by officers of the Laboratory. Of these
4 died (including the doubtful case) and 17 recovered. Two of these were ascertained
to have had the signs of the disease on them at the time of inoculation, and therefore
may be left out of account, as the inoculation does not profess to be curative in this
sense.
Inoculation has been introduced at various places on a large scale with striking success.
The cases in which accurate records of such inoculation have been kept have been arranged,
in chronological order, and are given seriatim below :—
I. Mora.— In the middle of March 1897, in the village of Mora to the south of
Bombay Harbour, in Uran Municipality, with a population of about 1,000 inhabitants, 419
were inoculated. Only 7 of these were attacked by plague, and all recovered. In the
uninoculated portion of the population, according to information furnished by the local Parsis,
26 cases occurred, of whom 24 died.
INOCULATION.]
37
2. Damaun.—This town, situated in Portuguese territory to the north of Bombay, and
in constant communication with it by sea, was affected in February 1897. Its population
was originally 10,900, but at the end of March had been reduced by flight and plague to 8,230.
Λ cordon was now drawn round it by this Government, and inoculation was begun there on
the 23rd March 1897 : three series of inoculations being performed between the following-
dates :—
23rd to 26th March,
17th April to 2nd May,
21st and 23rd May.
The total number inoculated during these three periods was 2,197; and a "searching
investigation of the results obtained was made by Major Lyons, I. M. S., who visited every
house where a plague case occurred.
The results classified by periods were as follows :—
NOTE.—In the following tables the total numbers shown as inoculated arc progressive : i. e., the numbers for
the second period include those for the first period : and those for the third period include the numbers for both
first and second periods. The deaths also amongst the inoculated have been deducted in each case.
1st Period,
23rd March to 16th April.
Operators.
Dr. Kalapesi
Dr. Poiares
Total ...
Numbers.
846
171
1,017
INOCULATED.
Cases.
17
6
23
Deaths.
3
3
6
Percentage
of
Mortality.
0.4
1.8
0.58
NOT INOCULATED.
Numbers.
7,213
Deaths.
716"
Percentage
of Mortality.
9.9
* Number of cases not known.
Dr. Poiares used the same vaccine as Dr. Kalapesi, but gave smaller doses, so his results
were not so good. If the 1,017 inoculated had suffered in the same proportion as the unino-
culatedjthey should have had 101 deaths, instead of 6—a difference of 94.0 per cent.
2nd Period,
17th April to 2nd May.
Operators.
Dr. Kalapesi ...
Dr. Poiares ...
Total ...
Numbers.
1,372
267
1,639
INOCULATED.
Cases.
52
12
64
Deaths.
18
9
27
Percentage
of
Mortality.
1.3
3.3
1.6
NOT INOCULATED.
Numbers.
5,869
Deaths.
674*
Percentage
of Mortality.
11.5
* Number of cases not known.
The vaccine used for the second series was much weaker than that previously employed, as
the Laboratory was unable, in this initial stage, to meet the increasing demands which arose
on all hands. The results obtained were therefore less effective.
If the inoculated had suffered in the same proportion as the uninoculated, they should
have had 188 deaths, instead of 27—a difference of 85 per cent.
10
38
[CHAP. i., ΡT. IV.
3rd Period,
22nd to 31st May.
Operators.
Dr. Kalapesi ...
Dr. Poiares
Total ...
Numbers.
1,906
258
2,164
INOCULATED.
Cases.
1
3
4
Deaths.
1
2
3
Percentage
of
Mortality,
0.05
0.8
0.14
NOT INOCULATED.
Numbers.
4,643
Deaths.
93
Percentage
of Mortality.
2.0
If the inoculated had suffered in the same proportion as the uninoculated, they should have
had 43 deaths, instead of 3—a difference of 93 per cent. ·
Taking the period as a whole, the following is the result obtained :—
2,197 inoculated had 36 deaths, or 1.6 % of mortality.
6,033 not inoculated had 1,482 deaths, or 24.6 % of mortality.
As a large number of families in Damaun were entirely inoculated, and so had no
uninoculated individuals living with them for comparison, it was found necessary to compare
the whole inoculated population with all those not inoculated remaining in the town. But if
those houses be singled out in which only a portion of the inhabitants had been inoculated,
the following result is obtained. In 62 houses there were living 250 inoculated, and also 124
not inoculated :—
Inoculated
Not Inoculated ...
Numbers.
250
124
Cases.
50
54
Deaths.
20
37
Percentage of
Mortality.
8.0
29.8
If the 250 inoculated had suffered to the same extent as the 124 uninoculated, they
should have had 75 deaths, instead of 20—a difference of 73.3 per cent.
From the above it would appear that uninoculated individuals living in the same houses
as those inoculated are a source of danger to them, and therefore inoculated people are advised
to see that those in immediate contact with them (i. e., family and servants) are likewise
operated on. It is just as much a duty to the public to be inoculated during plague-
prevalence as to be vaccinated when small-pox appears in the neighbourhood.
A striking illustration of the effect produced by the inoculation of an entire community is
afforded by the history of this epidemic among the Parsi inhabitants of Damaun. The Parsi
community of Lower Damaun numbered 306. Of these, 277 were inoculated and 29 were
not.
The following shows the attacks and deaths in the two groups. No death from any
other cause than plague occurred in this community during the epidemic :—
Inoculated
Not Inoculated
Numbers.
277
29
Cases.
8
4
Deaths.
1
4
Percentage of
Mortality.
0.36
13.8
If the inoculated, who were living in precisely the same social conditions as the uninoculated,
had leen affected in the same proportion, they should have had 33 deaths instead of only one.