60
[CΗΑT. I., ΡT. VI.
is so great as these figures would lead us to infer. For instance, General Gatacre's Report
does not cover the whole of the epidemic of 1896-97, but only deals with four months,
during which it was declining ; so that the 58.9 per cent. mortality shown by his figures
would probably have been much higher if a longer period had been reported on.
" The figures, however, do show a larger number of cases admitted to hospital during
1898-99 than in the previous epidemics. This will be readily seen if we compare the aver-
age monthly admissions to hospital. During General Gatacre's time the average monthly
admission rate was 661.5; during the existence of the Plague Committee, 811.4, and dur-
ing the year under report, 850.8.
"It may also be gathered from a comparison of the percentage rates of mortality that
the Medical Service is as helpless as ever as far as the treatment of plague is concerned."
It must bo noted that the foregoing statement gives the case-mortality for hospitals only.
In these it may be reasonably inferred that many lives were saved which would otherwise
have been lost. It may also be reasonably inferred that the case-mortality in untreated
cases is higher: although the case-mortality shown by the officially recorded cases and deaths
in Districts cannot be accepted as an accurate index of the deadliness of plague. Facts and
figures, as far as they are known, or as far as they are available, the accuracy of which has
been attempted, but cannot be asserted, are given : the rest must be left to individual
opinion. For the groat variation in the hospital percentages no satisfactory explanation is
forthcoming. Their accuracy is, moreover, in some cases vitiated by a number of cases
remaining over, the developments of which would naturally affect the results.
Taking into account all these considerations, the case-mortality of plague in hospitals during
the past 3 years may be roughly cstimated to lie between 65 and 75 % ; or still more roughly
at about 70%. But the mortality in pneumonic and septicæmic cases must be placed a good
deal above, and in simple bubonic cases, perhaps, a little below, this estimate.*
No such estimate can even be hazarded of the mortality of plague outside hospitals.
From Panvel and Kambhala, where practically every case proved fatal, to Dharwar and
Sholapur Districts, where the officially recorded case-mortality was over 80% ; and from
these again to Panch Mahals, whore it was only about 70%; and from Panch Mahals again
to Bantwa and other places where it was under 60%, stretches a field of possible percentage
mortalities, in which the true average plague mortality lies ; but the location of the
latter cannot at present be determined.
A comparison of the actual total mortality throughout the Presidency during the
3 plague years, with the average normal mortality of 3 years previous to plague, elicits
curious results. Thus in Ahmedabad District, where there has been little or no plague
the mortality for the 8 plague years is over 12,000 less than in 3 normal previous years ;
in Ahrnednagar, where 1,000 deaths have been reported from plague, the mortality
during the 3 plague years is over 9,000 less than in 3 normal years previous to plague ;
Hyderabad (Sind), Kaira, Surat all show a similar decrease, in spite of a positive plague
mortality. Satara District, in which 20,000 deaths are accredited to plague, shows, neverthe-
less, nearly an average mortality. On the other hand, Sholapur, Shikarpur, Ratnagiri,
Nasik, Kolaba, Kanara and Bijapur Districts return an increased mortality utterly dispro-
portionate to their reported plague, † There are those who assert that, by subtracting the
average mortality during normal years from the actual mortality during plague years, the
true plague mortality can be arrived at. With what limitations, in the face of such
bewildering figures as these, this universality is to be comprehended, who shall inform us?
Δ statement of the actual and average mortality in Districts and Agencies, as far as
it can be ascertained, is attached.
* Compare Dr. Lyons' remarks on page 80.
† This state of affairs seems to support the coutonlion of the varions Sanitary Commissioners throughout India that death regis-
tration outside Municipal areas and in rural districts is still extremely defective in ordinary years.