NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
46
Description of Plague :
[ CHAP. II.
Experience
of
previous epide-
mics.
Hong-kong.
The experience of previous epidemics was similar to that des-
cribed above.
Staff Surgeon Wilm, in describing the Hong-kong plague of 1896,
lays stress on the immunity enjoyed by the persons, and especially by
the Europeans, occupied in cleaning and disinfecting houses, in trans-
porting dead bodies and plague patients and in attending on the sick.
He argues from these facts that contact with patients suffering from
plague and with the bodies of those who have died of the disease, was
not dangerous, provided that care was taken to avoid being soiled by
the evacuations of the patient, and also to thoroughly disinfect the
hands. He draws the further conclusion that the plague infection is
not contained in the air and is not therefore taken into the system
by the lungs, for had this mode of infection been possible, many
engaged in disinfecting houses and treating the sick would have died.
It has been seen that this latter deduction is not entirely correct.
There can be no doubt that infection is taken through the lungs
in the case of persons living in ill-ventilated dwellings.
Dr. Cantlie lays special stress on the fact that the immunity
enjoyed by the European doctors and nurses at Hong-kong was
shared by the Chinese students of the College of Medicine, who were
in constant contact with the sick.
Pali
outbreak
(Rajputana) in
1836.
Dr. Rennie in his report on the Pali plague of 1836 made
the following interesting remarks :— " I feel no hesitation in profess-
ing my belief that a man in sound health, provided he continue to
breathe pure air, might safely keep his hand a whole day in contact
with one suffering under the Pali or Moradabad fever, but if he
sat within the same hut and inhaled the same tainted atmosphere half
the time, he would probably be seized with similar illness. None of
the medical officers or their native assistants, who handled patients
affected with the Pali disease and felt their pulses for days and
weeks, have suffered. "
Observations
recorded by
Cabiadis during
the outbreak at
Hillah and
Bagdad in
1876-77.
Hirsch quotes a series of observations of similar purport to those
mentioned above recorded by Cabiadis on the mode of diffusion of
plague in the outbreak at Hillah and Bagdad which occurred in 1876-77.
"Persons occupying the same dwelling with a plague patient, and
avoiding all contact with him or his belongings for fear of infection,
usually take the disease, whereas very few cases of sickness occur
among those living in houses free from the plague, although they visit
the sick and come boldly into contact with them, remaining however
only a short time in the sick-room. All the physicians, surgeons, and
assistants who paid visits every day to many hundreds of the plague-
stricken in that epidemic remained well, with the exception of one
assistant, although the Surgeons and the assistants, who opened
CHAP. II. ]
its' causes and characteristics.
47
abscesses and dressed and bound up wounds were obliged to spend
much time—more than the physicians—in the immediate proximity of
the sick or in the closest contact with them. "
Health Camps.
Lastly, the experience gained in the health and segregation camps
and especially those at Poona, in Sind and at Khandraoni shows
that the disease can be at once checked by removing the in-
habitants of an infected locality to a carefully supervised camp in
the open, especially if their clothes are disinfected at the time of
their exodus. With the infected locality the disease is left behind,
and if the place is thoroughly cleansed and disinfected the infection
will be found to have vanished when the inmates return to their
dwellings. Full details on this subject will be given in later chap-
'ters.
Plague
com-
monly
spread
from place to
place by persons
infected with the
disease.
Practically the common way in which the pestilence is spread
from place to place is by persons infected with the disease and their
personal effects. Persons in whom the seeds of the malady already
exist move from one place to another, and the disease may not perhaps
develop in them until they have arrived at their destination. Here,
if they are not watched, and if local insanitary conditions and uncleanly
habits favour the spread of the disease, they infect their immediate
attendants and friends from whom the disease spreads in widening
circles. The following remarks recorded by Dr. Rennie with regard
to the Pali plague afford an interesting illustration :—
Infection carried
by fugitives
during the Pali
plague.
" Most of those who escaped the malady evinced from an early
period their conviction of its infectious character by deserting the
town (Pali) and seeking refuge in the neighbouring villages. The
neighbours of these fugitives entertaining similar dread of infection,
often refused them shelter. Yet many of the persons who left Pali
in this manner finally got admission into the houses of their friends,
and wherever they took up their residence the fever shortly after-
wards appeared. "
Typical in-
stance at Khand-
raoni in Gwalior
during the Bom-
bay epidemic.
The history of the epidemic in the Bombay Presidency affords
further abundant illustration of the manner in which the malady was
spread by individuals. The outbreak in the village of Khand-
raoni affords perhaps the most typical and well-defined instance that
occurred of the diffusion of the disease in this manner. Khand-
raoni is a small village situated in the Gwalior State and distant
about twenty miles from Jhansi. The population, in July 1896, was
558. For some years past several of the inhabitants of Khandraoni
had been in the habit of going to Bombay and taking service there,
revisiting their village at intervals ; among these were two Brahmins,
Bindraban and Khoobi, the former being one of the headmen of
48
Description of Plague :
t CHAP. IL
the village. These two Brahmins came from Bombay to Khandraoni
in January 1897, at a time when the epidemic was virulent in Bom-
bay. They travelled straight from one place to the other and arrived
at Khandraoni on the 9th of the month. On leaving Bombay Bindra-
ban was suffering from fever and Khoobi attended him on the way,
bringing him to Jhansi by rail and from there, in a country cart, to
Khandraoni, where he died five days after his arrival. Two days after
Bindraban's death, Khoobi fell ill and died in three days, and almost a
week after his death a native doctor of the village who attended the
two Brahmins was attacked with fever and died, and at the same time
a second native doctor, who came from another place to treat the
first doctor, also succumbed to the disease. The plague then gradually
spread amongst the inhabitants of the village, and by the 18th March,
59 seizures had occurred, of which 47 had proved fatal.
Infection spread
by animals.
Rats.
Having investigated the manner of the spread of infection by
persons suffering from plague and their surroundings, the next point
for consideration is the danger of infection from animals. It will
have been gathered from the account of plague in animals that the
principal danger is to be apprehended from rats. Authorities differ
somewhat as to the extent of this danger, but it is certainly not so
common a cause of infection as the sick person and his surroundings.
Staff Surgeon Wilm in his note on the Hong-kong plague states
that infection can be carried by animals, especially rats and mice.
It has been stated above that the German Commission formed the
conclusion that by means of rats plague germs can be introduced
from one house to another and conveyed to man. General Gatacre
stated that " amongst other sources of the spread of disease through-
out the epidemic, the influence of rats has been shown in many
extraordinary ways. Grain depots are often the first centres in the
spread of the plague, the infection having been imported into
the colony of rats that haunt the depôts, spreads amongst them,
and they die in large numbers. In this way the grain and
grainbags are infected and become sources of conveyance of the
disease to human beings. The Committee (i.e.) the Bombay Plague
Committee) have, during disinfection; invariably treated these places
where rats have been known to die as plague infected localities."
This no doubt was a wise and necessary precaution, but it is open
to doubt whether General Gatacre does not attach too great an
importance to the part played by rats. . Mr. Snow, the Municipal
Commissioner of the City of Bombay and Dr. McCabe Dallas also lay
great stress on the danger of the spread of infection by rats. On
the other hand, Dr. Bitter considers that rats are of very minor
-importance as agents in the dissemination of the disease, and Dr.
CHAP. IL ]
¿is causes and characteristics.
49
Rogers, another Member of the Egyptian Commission, holds the same
view.
Monkeys, pigs
and domestic
animals.
Recent experience at Kankhal would seem to show that there is a
possibility of plague being spread by monkeys, and experience in Hong-
kong points to the possibility of infection being carried by pigs.
Apart from these animals there does not appear to be reason to appre-
hend that danger exists of plague being spread by animals. The
remarks made in a previous section of this chapter on the non-
susceptibility to plague of the domestic animals are of great import-
ance in this connection.
Food-stuffs.
Next, with regard to food-stuffs. It is generally admitted that the 1
infection of plague may be caught through the medium of infected
food, the infection being received through the tonsils or the alimentary
canal. But both laboratory experiments and general experience tend
to show that this danger is much less than the danger arising from the
sick and their surroundings. In the first place, food-stuffs are not very
likely to be contaminated by the dejecta or morbid products of plague
patients (excepting the infection of grain by rats), in the second place,
experiments tend to show that food-stuffs do not form a medium
favourable to the life of the plague bacillus, and in the third place,
grain is usually cooked before being eaten. Again, the special forms
of the disease which can most reasonably be attributed to infection
by food are rare. Lastly, there is no evidence to show that during
the present epidemic the plague was in any case spread from one
place to another by infected grain or other food-stuffs. During the
epidemic in Sind considerable quantities of grain were imported from
the infected area into other localities without in any case spreading
infection. At the same time it must be stated that careful precautions
were taken to prevent the export of any grain likely to be infected.
That some danger does exist cannot be denied, and the precautions
adopted in Sind were necessary and fully justified. This matter is
further discussed in Chapter XII.
General articles
of commerce.
The degree of danger to be attributed to the spread of infection
by general articles of commerce is naturally a matter of the first inter-
est and has been keenly discussed. Formerly very great importance
was attached to this method of diffusion, and in consequence stringent
regulations were imposed by ' healthy against infected countries.
Hirsch makes the following remarks on the subject :—
Remarks made
by Hirsch.
" There can be no doubt of the diffusion of the morbid poison by
goods ; and this is another of the points on which there is incontrovert-
ible evidence from the sixteenth and seventeenth centuries. Proofs
7
50
Description of Plague :
[CHAP. IL
are also given by Kanold from the epidemic of 1709-10 in Prussia,
by Autrichan from the plague of 1720 in Toulon, by Desgeuettes,
Puguet, and other French Army Surgeons, from the epidemics of
1798 and 1799 in Egypt and Syria, by Bulard from the epidemic of
1834·35 in Egypt, and by Ségur-Dupeyron from observations made
in the quarantine stations of Venice (1793 and 1818) ; and Syria
(1832, 1834, 1837) ; and the last mentioned are so convincing that
even the Paris Academy of Medicine, which maintained a very scep-
tical attitude towards the doctrine of the communicability of plague,
could not but admit their importance. "
Modern
research shows
that the danger
is not great.
Remarks by Dr.
Bitter.
Modern research, however, tends to show that the danger is more
restricted and less important than was formerly held to be the case.
As in the case of food-stuffs, there are not many ordinary articles
of commerce which are likely to be contaminated by the dejecta
or morbid products derived from the sick, and it would appear that
ordinary commercial articles do not form media favourable to the
lite of the bacillus. It has been said that clothing and bedding and
other such articles contaminated by the sick and kept in a moist
condition away from the disinfecting action of the atmosphere can
probably retain the power of infection for a considerable period. Such
articles, whether carried as merchandise or as the baggage of travel-
lers, are rightly regarded everywhere with great suspicion. For
similar reasons rags from an infected locality must always be re-
garded as dangerous. But it seems doubtful whether the danger
goes much beyond this. Dr. Bitter has recorded the following
important remarks on this subject :—
" Les marchandises du grand commerce, telles que coton, blé, tissus
neufs, cuirs, provenant d'un pays infecté de la peste, n'offrent qu'un
danger tout à fait secondaire. D'un côté, elles ont relativement très
peu de chances d'être contaminées, et de l'autre côté, par leur nature,
elles ne sont pas bien aptes à conserver longtemps vivant le bacille, et
le mode de leur emploi ne les met pas souvent dans ce contact in-
time avec l'homme qui semble nécessaire pour l'infection. Nous
nous trouvons du reste, ici, vis-à-vis d'un fait qui s'observe également
pour d'autres maladies épidémiques, tel que le choléra. Nous n'avons
pas d'exemple qu'une telle épidémie ait été importée dans un pays
par des marchandises de commerce proprement dites.
" Le seul article du gros commerce qui mérite une attention sérieuse,
ce sont les chiffons, qui offrent le même danger que les vêtements,
linges, tapis, etc. Il ne peut y avoir de doute que parmi les chiffons
ramassés dans une ville ou un pays où règne la peste, il n'y en ait une
quantité considérable qui soit contaminée,"
CHAP. II. ]
its causes and characteristics.
51
Articles classed
as susceptible in
the Venice
Sanitary
Convention of
1897.
The following is a list of the articles of merchandise classed as .
susceptible by the Venice Sanitary Convention of 1897 :—
1. Used linen, clothing, personal effects and bedding.
2. Rags, not excepting rags compressed by hydraulic force which
are carried as merchandise in bales.
3. Old sacking, carpets and old embroidery.
4. Rawhides, untanned and fresh skins.
5. Animal refuse, claws, hoofs, horsehair, hair of animals gene-
rally, raw silk and wool.
6. Human hair.
The articles named in the first three numbers in this list were
included in it as likely to have been in contact with sick persons.
The more important articles named in the fourth and fifth numbers
were included in the list for fear they might be derived from animals
that had suffered from plague. Recent investigation on the degree
of susceptibility of different classes of animals to plague shows that
this precaution may be unnecessary.
There is no evidence to show that a single case of plague has
been occasioned by merchandise imported from the infected portions
of India, although large quantities of wool and other commodities
have been exported from Bombay to England and other countries
since the beginning of the epidemic.
Other possible
sources of
infection.
Other possible sources of infection must be regarded as of minor
importance to those already described. It may be taken as proved that
the microbe does not travel about for considerable distances in the air
or in dust, etc., and that healthy persons cannot carry the seeds of
contagion with them except in the form of clothes, rags, etc., impreg-
nated with infectious matter. The water-supply is said to be a
possible source of danger, and no doubt should be the subject of careful
precaution. Staff Surgeon Wilm lays stress upon this possible source
of infection. General Gatacre gives an instance in which a stagnant
pool of filthy water is believed to have fostered the spread of infection
in a village in the Island of Bombay (see Chapter VII). But it has been
seen that under ordinary conditions the bacillus appears to die rapidly
in water. The drains are also regarded by some persons as a prob-
able means of spreading infection, although, according to Dr. Bitter, it
is not likely that the bacillus can exist for long in sewers. At the
same time a careful attention to drainage is a precaution which should
certainly be adopted, and constant flushing of sewers with a solution
of corrosive sublimate is said to have had a beneficial effect in the
Mandvi quarter of Bombay. Both Dr. Bitter and Mr. Hankin are
inclined to think that graveyards containing plague corpses are not
52
Description of Plague :
[CHAP. II.
likely to be a source of danger, but the knowledge on this point is not
sufficiently certain to make careful precaution with respect to grave-
yards in crowded portions of cities unnecessary.
Influence of Climate and other Natural Conditions.
Moderate
warmth and
dampness favour
the development
of plague.
Experience of
former
epidemics.
Moderate warmth in conjunction with dampness seem to be the
most favourable conditions for the development of plague. In the cooler
parts of the East and formerly in Europe, the epidemics occurred
mostly in summer. In middle Egypt, particularly in Cairo, the
epidemic used to cease in the height of summer at the time of the
excessive dry heat : an epidemic never commenced at that time of the
year. In Mesopotamia it appears mostly in the temperate season,
and becomes dormant during the hot weather. By severe cold the
spread of the disease seems to be restricted, but nevertheless epi-
demics have occurred during the severe cold of winter (at Moscow
in 1771, at Astrakhan in 1878-79), as well as, during great summer
heat—(Scheube.)
Hong-kong.
Staff Surgeon Wilm recorded the following observations on
climatic influence over the course of the Hong-kong plague :—
"Both in 1894 and in 1896 the epidemic broke out at the end of
the cool season, which was damp though free from rain. It began in
May in 1894, in April in 1896. In the latter year isolated cases came
under observation from January to March, and these occurred chiefly
in the western part of the town inhabited by the Chinese. In both
years the epidemic reached its height in the early months of the hot
season in May and June, and then suddenly subsided. From these
facts the only conclusion to be drawn is that the plague in Hong-kong
thrives better in a damp, moderately cool tropical climate than in a
hot one. But in this connexion we must not forget that in the cool
season the houses of the Chinese are much more overcrowded than
in the hot season. "
Climatic
influence on the
course of the
epidemic in the
Bombay
Presidency and
Sind.
The course of the epidemic in the Bombay Presidency points to
the conclusion that the dry heat of an Indian summer is less favour-
able to the development of the disease than the climate of the cooler
and damper months. In the city of Bombay the existence of the
disease was discovered during the warm damp weather that followed
the abnormally early close of the autumn rains. The epidemic
reached its height in the cool season— in the month of February—
and then steadily declined, until towards the end of June only
CHAP. II. ]
its causes and characteristics.
53
First period
the epidemic.
occasional cases occurred. In Thana district the epidemic began in
December, in Peona city early in January, and in Surat and Kolaba
districts early in February. In Thana and Poona the epidemic
culminated about the end of March, in Surat in the beginning of
April, and in Kolaba about the end of April. In all these localities it
had almost disappeared by the middle of June. In Sind, where
the infection was probably brought from Bombay, the outbreak
occurred later than in the Bombay Presidency proper and was also
shorter lived. In Karachi the epidemic broke out in the second-
half of December and attained its greatest virulence early in
February. Throughout February and March the epidemic continued
to be very severe ; the number of cases then quickly fell. In Hyder-
abad city the disease began early in March and was at its worst in
the first-half of April ; with the end of May the epidemic practically
died out. The epidemic in Sukkur began in February, culminated
early in April and was over by the end of May. The last place in
which a serious outbreak occurred during the first period of epidemic
was Mandvi in the Cutch State. The outbreak began in April and
became virulent in May. Towards the end of May it declined in
violence and throughout June the fall in the number of cases con-
tinued ; in July they numbered on an average about one a day,
and in August the epidemic disappeared, having, however, in the
meantime spread to other places in the neighbourhood.
The recrudes-
cence.
The recrudescence in the districts of the Presidency proper, which
afterwards attained such serious dimensions, began about the middle of
July in Baroda territory and in the districts of Poona, Satara, and Surat.
In the early part of the cold weather it rapidly spread and increased in
violence.
General remarks.
Broadly in 1896 the epidemic began at the end of the rainy
season, increased in virulence until the middle or end of the cold
weather and rapidly declined during the hot weather months. In
the present year the recrudescence began in the latter part of the
rainy season and spread in the cold season.
Overcrowding
in the cold
season.
The crowding of the people into their homes during the cold
season must exert an unfavourable influence apart from the mere
climatic change.
Varied climatic
conditions in
which plague can
exist.
The description of the climate of the Bombay Presidency and
Sind which is given in Chapter V illustrates the very different climatic
conditions under which the plague can exist. It was equally fatal in
Sind with its arid climate and extreme variations of heat and cold,
in the moist and equable Konkan which receives the full force of the