NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. II.]
its causes and characteristics.
63
earlier preventive inoculations. This protective power is damaged by
all the most powerfully acting agencies, such as boiling heat ; and in
order to kill the bacteria with certainty without destroying the protec-
tive power, the most advantageous process was found to be the treat-
ment of the cultivation for one hour with a temperature of 65°C. The
immunity does not appear at once, but after a certain interval (from
about the 5th to the 7th day) ; and it is not so high a degree as that
which is attained by infection with living cultivations. Experiments
with regard to its duration could not be made, as they would have re-
quired many months. From the experiments described, and others
which of course in many points require repetition and testing, it can
in the meantime be deduced, that, for future immunisation with dead
cultivations, cultivations of undiminished virulence, which have been
killed in the way described, are to be used. The height of the natural
immunity, such as is attained by going through an attack of plague,
can in the meantime only be reached by subsequent inoculations with
living plague bacilli. "
Comments of the
German
Commission
on inoculation
in Daman.
The German Commission also investigated the effect of preventive
inoculation in Daman, and their conclusions were on the whole
favourable :—
" Haffkine's preventive inoculations were carried out in the case
of about 1,400 persons in Daman. A protective action of the proce-
dure was undoubtedly recognisable ; though the protection was ap-
parently only a limited one, because among the inoculated not a few
cases of plague occurred (with, however, remarkably mild course), and,
as can be proved, in about 20 cases ended fatally."
Experiments by
the Russian
Commission or
monkeys.
The members of the Russian Commission stated the following
conclusions from experiments conducted on monkeys :—
" L'immunité donnée par l'inoculation préventive de 10 c.c. du
sérum de Yersin ou de 5 c.c. de la lymphe de Haffkine, ne dure pas
au delá de 10 ou 14 jours ;
" L'immunité résultant de l'inoculation préventive, faite avec des
cultures sur gélose chauffées à 60° centigrades, ne se produit pas avant
sept jours, mais cette immunité se prolonge pendant plus longtemps.
Un singe inoculé par ce procédé, et infecté 21 jours après l'inocula-
tion, ne montra aucun symptôme de peste. "
Comments of the
Egyptian
Commission.
Both Dr. Rogers and Dr. Bitter pronounce conclusions which
are on the whole unfavourable to the Haffkine method of treatment.
They are summed up in the following passage from Dr. Rogers'
report:—
" There is always the danger that the enthusiastic advocate for
preventive inoculations, more particularly if he only have a laboratory
64
Description of Plague : its causes and
characteristics.
[ CHAP. II.
and not a medical and sanitary education, should view with indiffer-
ence if not actually oppose the application of practical sanitary
measures, relying on a method for dealing with disease which from
the laboratory point of view is perhaps conclusive.
"The individual who dreads contracting the disease, if he believes
in preventive inoculation, will probably have recourse to it, but he must
not imagine that it is always so simple an operation as it is sometimes
described.
" It may be followed by serious and painful symptoms lasting for
three or four days.
"The efficacy of preventive inoculations against plague remains
yet to be proved.
" The fact that so many thousands of the population of Bombay
have been inoculated since the end of January and have not con-
tracted the disease proves nothing. These same people were presum-
ably exposed to infection from August to the end of January, without
being inoculated and without contracting the disease, which almost
as soon as the inoculations were begun, commenced to be on the
wane.
" Nor are the figures of the House of Detention, Bombay, to which
so much importance has been attached, in any way conclusive. If
even the efficacy of preventive inoculation in individual cases be fully
established, its practical application would probably be limited to
• groups of the population, such as schools, regiments or prisons. The
most ardent advocates of the system would hardly pretend that it
could replace general sanitary measures, while the protection of an
entire community, such as the population of the city of Cairo, would be
practically impossible. "
CHAPTER III,
GENERAL HISTORY AND GEOGRAPHICAL
DISTRIBUTION.
The plague in
remote antiquity
and in classical
times.
The Justinian
plague,
* The history of the plague may be followed into remote antiquity,
and, with a certain measure of certainty, even as far as the end of the
third or beginning of the second century of the pre-Christian era. In
one of Oribasius' medical extracts from Rufus of Ephesus, a contempor-
ary of the Emperor Trajan (98—117)1 the plague boils are described,
and allusion made to their occurrence in epidemic form in Lybia,
Egypt, and Syria. The first accurate historical record which exists
is that of the great pestilence which spread over the Roman Empire
in the sixth century, during the reign of the Emperor Justinian. The
pandemic is estimated to have lasted from fifty to sixty years, and it
wrought frightful devastation wherever it appeared.
Plague in
mediaeval times.
The Black
Death.
This outbreak gave the plague a firm hold over Europe, which
latsed for more than a thousand years. The history of the pestilence
after the Justinian plague is very vague until the episode of the Black
Death) the great pandemic of the fourteenth century. Contemporary
writers place the origin of this outbreak in India or China, whence
it is said to have spread over the countries of Asia Minor to the north
coast of Africa and Europe. No part of the then known world escaped
the ravages of the pestilence ; even distant Greenland was depopulated.
According to Hecker's estimate, 25 millions of human beings suc-
cumbed in Europe, or about a quarter of its population at that time.
* This account up to the description of plague in China is mainly derived from the
Chapter on Plague in Volume I o£ Hirsch's Handbook of Geographical and Historical
Pathology,
9
66
General history and geographical distribution. [ CHAP. III.
Plague in the
fifteenth to
seventeenth
centuries.
Retreat from the
west and centre
of Europe.
Extinction in
Europe.
Throughout the fifteenth and sixteenth centuries and during the first
two-thirds of the seventeenth century the plague continued to appear
frequently over wide areas of the continent and islands of Europe. In
the last thirty years of the seventeenth century the plague was observed
: to be gradually retreating, and only twice after the beginning of the
eighteenth century did it become at all widely diffused in the western
and central regions of the continent. From the middle of the eighteenth
century only the south-eastern parts were a permanent seat of the
disease ; from there it frequently made excursions northwards, but
hardly ever got beyond the Balkan Peninsula and the countries imme-
diately adjoining. Since the beginning of the present century it is
only in the region last mentioned that plague has been epidemic from
time to time ; on the last occasion in 1814 ; and, excepting the slight
epidemic of the winter of 1878-79 in the Government of Astrakhan,
it then vanished completely from the soil of Europe.
Last outbreak in
England.
The Plague of
London.
Last outbreaks
in France and
Germany.
The Plague of
Marseilles.
In England the last great epidemic was that of the plague of
London of 1665-66. *The number of reported plague deaths in
the Metropolis in 1665 was 68,596, but the actual number was
probably greater. In the year 1665 and still more in the year 1666,
plague epidemics raged with varying degrees of severity in a number
of provincial towns, which were probably infected from London. In
France the last outbreak occurred at Marseilles in 1720 and spread
thence through Provence. The epidemic in Marseilles was one
of the worst recorded in history. In Germany also the disease
appeared for the last time early in the eighteenth century.
Turkey, the
starting point of
plague in
Europe.
As the area of the plague in Europe became narrower, and the
channels of its diffusion became more clearly marked, the more decid-
edly did Turkey stand revealed as almost the sole point of depar-
ture in Europe for every inroad of the pestilence. Even in some of
the great epidemics of plague in the seventeenth century, it was pos-
sible to follow the track of the disease from the east, towards the north-
ern, western, and central parts of the continent. That route was still
more decided in the two severe epidemics at the beginning of the
eighteenth century mentioned above ; and it was very obvious in subse-
quent times down to the extinction of the plague in Europe, about the
year 1840, that is to say, within the period when the disease existed no-
where out of Turkey, except in the countries of the Lower Danube
and Southern Russia.
* Creighton's History of Epidemics in Britain.
CHAP. III.]
General history and geographical distribution.
67
Plague in Africa.
Egypt, the
starting point.
Extinction of
plague in Africa
except on the
Tripoli Coast.
The part that was played by Turkey in disseminating the plague
in Europe was played by Lower Egypt in the case of Africa.
But
in Africa the area of the disease was much more confined than in
Europe, and it never spread beyond the belt of Northern States—
Tripoli, Tunis, Algiers, and sometimes as far as Morocco. In Egypt
itself the plague never extended above the first cataract of the Nile.
The last epidemic of plague occurred in Egypt in 1843-44, in Tunis
in 1836-37 and in Morocco in 1818-19. Since then Africa has been
entirely free from plague except for two outbreaks that occurred on
the Tripoli Coast in 1859 and in 1874. This portion of the country
appears to have formed a new plague centre.
Old plague
centres of
Western Asia.
In the western portion of Asia the principal plague centres up to the
end of the first half of the present century were Syria and Asia Minor,
and to a lesser extent Armenia and Caucasia. In Syria thirteen out-
breaks were recorded between 1773 and 1841, and in Asia Minor
there are reports of twelve outbreaks between 1771 and 1839. The
history of the plague in Caucasia is wanting in reliable information,
but the disease seems to have been prevalent between 1798 and 1818.
In Armenia there were seven outbreaks from the beginning of the
present century up to the year 1841. Since the outbreak of 1841
there has been no re-appearance of plague in these old centres of the
disease.
Plague centres
in Western Asia
during the
second-half of
the nineteenth
century.
Their place has, however, been taken by Arabia, Persia, and
Mesopotamia, where previous to 1850 outbreaks of plague had been
of rare occurrence. In Arabia epidemics occurred in 1815 and 1832;
from that time onwards there was no outbreak until 1853, when an
epidemic which arose in the mountainous district of Assir spread
over the greater part of the country. Another widespread epidemic
took place in 1874 and extended to within few days' march
of Mecca, and there was a third epidemic in 1879. In the month
of June 1897 the disease again broke out at Jeddah amongst the
pilgrims from Hadramaut in the south of Arabia, and extended to the
inhabitants of the town. Careful precautions were adopted and the
epidemic was quickly stamped out. There is an account of an out-
break in Persia in 1571 and thence onwards epidemics occurred at rare
intervals in the north-western portions of the country. There was a
long interval free from plague between 1835 and 1863. In this latter
year a severe epidemic broke out which was followed by other severe
outbreaks in 1870, 1876, and 1877. In 1892 the plague spread from
Persia into Turkestan, In Mesopotamia an outbreak occurred (at
68 General history and geographical distribution.
[ CHAP. III.
Bagdad) in 1596 and there were three outbreaks between 1750 and
1842. An interval then occurred, with occasional isolated cases, which"
lasted to 1866 when a small local epidemic broke out in the marshy
level of Hindieh on the west of the Euphrates. Six years afterwards
(1873) plague re-appeared in the same locality and grew to an epi-
demic which lasted five years and overran the greater part of the
country in wider and wider diffusion. In 1876 it appeared in Bag-
clad, and Hirsch considers that the estimate of 20,000 deaths in
that place is probably much too small. In 1881 plague broke out
again in Kerbela, Nejef and the neighbourhood.
Plague in further
Asia.
Until recently it was commonly accepted that Persia was the
eastern limit of the area of plague on Asiatic soil, and that during
the last five centuries, at any rate, it had never penetrated beyond this
limit. Recent experience has, however, shown the existence of plague
centres in India and China which, even before the recent outbreaks
in the Bombay Presidency and Houg-kong, excited the great interest
of scientific investigators.
India.
The first trustworthy information of the occurrence of plague in
India dates from the year 1812, when an epidemic broke out in Cutch
and spread into Gujarat and Sind. In 1828-29 a disease absolutely
like the Pali plague is reported to have been prevalent at Hansi in the
district of Hissar in the Punjab. In 1836 another epidemic broke out at
Pali in the Marwar State of Rajputana, and spread over a considerable
area causing great loss of life. Along with these isolated outbreaks there
exists an endemic centre of plague on the southern slopes of the Hima-
layas in the districts of British Garhwal and Kumaun. The existence
of this centre can be traced back with certainty to the year 1823, and
it has ever since been the scene of outbreaks of varying degrees of
severity. A more detailed account of plague in India is given in the
next chapter.
China.
Yunnan.
In China the seat of the pestilence lies in the mountain valleys of
Yunnan, a province situated on the borders of Upper Burma. The
history of the disease in Yunnan is very obscure. It does not appear
to have attracted notice before the virulent outbreak that occurred in
1871-73, at the time of the great Muhammadan rebellion, but some
Chinese authorities allege that it existed from earlier times in the
district of Ta-li-Fu in the extreme west of the province. The theory
is sometimes put forward that the disease was imported from the
endemic centre of Garhwal and Kumaun through either Thibet or
CHAP, III. ] General history and geographical distribution.
69
Mengtsz.
Pakhoi,
Canton.
Hong-kong.
Upper Burma. *For over thirty years, at any rate, the pestilence has
re-appeared year by year in different portions of the province of
Yunnan at epochs varying for different districts, but as a rule regular
for each locality. From the highlands the malady has extended to the
elevated plain in the south of the province, and it now appears every
year in the town and district of Mengtsz in the south of the province \
of Yunnan. Here the first cases occur regularly in May, at the season
of the rice planting, and are said to be heralded by mortality among rats
and pigs. As a rule, the epidemic does not last more than three or four
months, and at its height twenty to thirty deaths are recorded a day.
In the north of Yunnan the disease prevails chiefly in the winter. From
Yunnan the pestilence has extended to the neighbouring provinces of
Kwei-Chan and Kwangsi, and to the further province of Kwangtung,
in which Canton is situated. At various intervals epidemics occur
in these three provinces, but the disease does not remain permanently
in the low regions of Kwangsi and Kwangtung. In 1882 a severe
epidemic broke out in the seaport town of Pakhoi, south of the
Kwangsi Province, where Dr. Rennie, writing in 1894, stated that
the disease has been known for the last thirty years. He considered
that the disease reached Pakhoi overland through the province of
Kwangsi. In 1891 plague broke out in Kao-chao, the prefecture
adjoining Lien-chou, in which Pakhoi is situated ; according to the
Chinese, it had spread northwards from that place. In the spring of
1894 it prevailed in severe epidemic form in localities between Kao-
chao and Canton, and in March 1894 it broke out in Canton itself,
having apparently travelled overland from Pakhoi. Dr. Rennie
estimated that by the middle of June 40,000 people had died of the
disease in Canton, and it is stated that not less than 100,100† per-
sons in all died during the epidemic. In May 1894 the disease broke
out in Hong-kong, reached a virulent height in the hot season and
died away in September. The cases gradually rose up to 60 to 70 a
day, and even to upwards of 90, and on one day to 109. About 2,550
persons perished before the epidemic died away. In January 1896
there was a recrudescence, the cases becoming more frequent in
February and March, until in April and May the disease again
assumed an epidemic character : 729 cases occurred up to the 5th
May. In June, July, and August it gradually subsided. The second
* Dr. J.L. Michoud's Report on the health of Mengtsz for the year ending the both
April 1894, and Dr. Alexander Rennie's Report on the plague prevailing in Canton
during the spring and summer of 1894.—(China Imperial Maritime Customs Medical
Reports, 1894, Special Series, No. 2.)
† Paper by A. G. Viegos, L.M.S., published in the Indian Lancet of the 16th
February 1897.
7°G eneral history and geographical distribution.
[CHAP. III.
epidemic was less virulent than the first. The infection was probably
brought from Canton on boardship in the ordinary intercourse of
commerce.*
Annual report by the Governor of Hong-kong (Sir William Robinson) for the year
1894.
Report by Sir William Robinson on the 1896 epidemic in Hong-kong, dated the
6th May 1896.
Report on the Epidemic of Bubonic Plague at Hong-kong in the year 1896, by Staff
Surgeon Wilm of the Imperial German Navy.
Article in the Lancet of the 4th April 1896.
CHAPTER IV.
PREVIOUS HISTORY OF PLAGUE IN INDIA.
Notices of Pestilence in early Indian History.
Virulent plague
epidemics have
occurred in India
in former years.
The present Bombay epidemic has excited a special interest and a
special anxiety owing to its having broken out in the Indian port in
closest and most constant communication with Europe, and owing to
the large area over which it has spread. But the summary given
in the last chapter shows that the visitation is not the first of the kind
that has been experienced in the west of India.
Possibility that
the Black Death
emanated from
India.
Pestilence in
India in the
fourteenth and
fifteenth
centuries.
Notice of
pestilence in the
sixteenth
century.
The belief of contemporary writers that the Black Death origin-
ated in India or China has already been noticed, as well as the fact that
the pulmonary form of the disease, which has been a marked charac-
teristic of the present and previous plague epidemics in India, was
equally a marked feature of the Black Death. Only *two direct refer-
ences have, however, been traced which may point to the existence of
plague in the west of India in the fourteenth and fifteenth centuries.
The first is from Ibn Batuta, who notices that Muhammad Tughlak's
army in Ma'bar (1325-1351) mostly perished of pestilence, and that at
the end of the century (1399), after Timur left, the districts through
which he had passed were visited by pestilence. The second relates to
the year 1443, when pestilence caused such loss of life in the army of
Sultan Ahmad I. that, leaving many of the dead unburied, he retired to
Gujarat. Ferishta calls this disease ta'un, and speaks of it as very
unusual in India. The famine† of 1590 to 1594 was followed by a
pestilence that, besides hamlets and villages, depopulated whole cities.
It must remain a matter of conjecture whether these outbreaks
of virulent pestilence were epidemics of true plague.
Outbreak of
1618.
Twice m the seventeenth century the district of Ahmedabad in the
Bombay Presidency was visited by severe epidemics of pestilence
which were probably outbreaks of plague. The Bombay Gazetteer‡
gives the following description of the first of these epidemics, which
appears to have been very widespread :—
" The disease that raged in Ahmedabad in 1618 began in the
Punjab in 1611. It is called the plague, wába or wába-o-tá'aun, and
the works of the Hindus ara said to have no mention of such a disease.
It was thought to be connected with the comet of 1612. From the
* Bombay Gazetteer, Volume IV, p. 218.
† Bombay Gazetteer, Volume IV, p. 219.
‡ Volume. IV, Chapter XII.
72
Previous history of plague in India.
[CHAP. IV.
Punjab it spread through Lahore, through the Doab to Delhi, and
north to Kashmir, No place in Hindustan was free from its ravages.
Lulling at times, it continued to lay waste the country for eight years.
About the same time in Kandahar the land was overrun by mice,
and mice and plague seem to have had some close connexion. A
mouse would rush out of its hole as if mad, and striking itself against
the doors and walls of the house, would die. Then the plague was in
the house. If the people at once fled they might be saved ; if they
stayed, the whole village was swept away. "
Outbreak of
1683 to 1689.
With reference to the second outbreak, which occurred during
the period 1683 to 1689, the Gazetteer* makes the following remarks :
" For several years before 1689 the plague, taun and wába, was
again in Ahmedabad, and lasted for seven or eight years. The
visible marks were swellings as big as a grape or banana behind
the ears, under the arms, and in the groin, and redness round the
pupils of the eyes." Hirsch repeats the following quotation made by
Macpherson ('Annals of Cholera,' London, 1872, 112) from an Indian
Chronicle which apparently refers to this epidemic : " A fever had
prevailed for some years both in the Deccan and in Gujarat. It con-
sisted of a slight swelling under the ears, or in the armpit or groin,
attended with inflamed eyes and severe fever. It generally proved
fatal in a few hours. " Hirsch remarks that this description is sug-
gestive of plague.
Eighteenth cen-
tury.
It is stated in the Ahmedabad Gazetteer that during the eighteenth
century, though none of the symptoms of the disease are described,
there would seem to have been several outbreaks of a most deadly
form of fever. In 1718, a year of famine, great numbers died of
sickness ; in 1770, another famine year, "on account of the unwhole-
someness of the atmosphere, thousands of people died of fever in two or
three days, so that no one could be found to bury them." Fearful
disease is said to have accompanied the 1790 famine.
The Epidemic in Western India in 1812 to 1821.
Gujarat epidemic
of 1812 to 1821.
Origin in Cutch.
Description of
Cutch.
This is the first undoubted plague epidemic in India of which
there is an authentic and trustworthy account. The disease broke
out in the Island of Cutch in 1812, and spreading thence over
Kathiawar, part of the district of Ahmedabad, the Radhanpur State,
and the southern portion of Sind, ravaged the country for a period of
ten years. Cutch† is a native State of Gujarat situated to the south of
Sind, from which it is separated by the Ran of Cutch. The capital is
Bhuj, where the Chief or Rao resides. The whole territory of Cutch
* Volume IV, Chapter XII.
† See Map in Volume IV, page I,