NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
110
Extent and course of the plague
[ CHAP. V.
the remainder spread over twenty-two of the thirty-two quarters into
which the city is divided. The actual number of cases which occur-
red during the week was, it is known, much greater than the number
reported. Bearing in mind the slow rate at which the infection of
plague spreads during the early period of an epidemic, it is certain
that the disease must have been in existence for a considerable time
before the cases could have become so numerous and so widely
diffused.
Cause of the
outbreak.
The immediate cause of the outbreak must remain a matter of con-
jecture. It would seem probable that the infection was introduced
by sea, since it is most unlikely that the disease could have been
carried overland from the small endemic centre in the Himalayas,
or that it could have been introduced from beyond the border by any
land route. It has been seen that an endemic plague centre exists
on either side of the Indian Peninsula—to the west in Mesopo-
tamia and to the east in China. In so far as is known, there was no
unusual prevalence of plague in Mesopotamia at the time of the out-
break in Bombay. But on the west the second or 1896 outbreak in
Hong-kong had not died out when Bombay became infected. The
probability would therefore seem to point to China rather than to
Mesopotamia as the source whence the infection was derived. In
connection with this question it is interesting to note that Staff
Surgeon Wilm, whilst eulogising the general arrangements made
in Hong-kong to stamp out the epidemic, remarked that too little
attention was paid to the water-borne traffic. And in India
quarantine was not imposed against Hong-kong during the 1896
epidemic at that place, although it was imposed during the more
important epidemic of 1894 and withdrawn when that epidemic
ceased. Intimation of the recrudescence in 1896 was not sent to the
Government of India, and it would appear that in Egypt also quaran-
tine was not imposed. It is therefore quite possible that undetected
cases of plague may have arrived from Hong-kong.
Abnormal
climatic condi-
tions.
The outbreak of plague in Bombay occurred at a time oí unusual
climatic conditions. The early cessation of the monsoon of 1896 is
notorious in connection with the widespread famine which resulted
in India. Dr. Weir has given the following account of the pheno-
menon as it affected the City of Bombay :—
" The mean annual temperature of the year was 80 7, the second
highest on record in the last 51 years. The total fall of rain amounted
to 87 6 inches, being 15 inches above the average. But the distri-
bution of the rainfall was abnormal, for, instead of being distributed
over four months, it was distributed over a much shorter period—a
CHAP, V. ]
in the Bombay Presidency.
111
ittle over six weeks—and, instead of being succeeded by the great
atmospheric disturbances designated elephantas, the monsoon cur-
rents ceased in less than two months, and the thunderstorms which
we look forward to as announcing the end of the rainy season were
absent. The rainfall in June was 28 inches, or 8 inches above the
average, and the rainfall in July amounted to 36 4 or 11 7 inches over
the average. In August the rainfall amounted to 20 8 inches, giving
an excess of 7½ inches over the average. The rainfall, therefore, was
abnormal in its duration and in its distribution. It must be remem-
bered that the sanitary effects of the annual rainfall on the public
health are as marked as are the aberrations of the rainfall on agricul-
ture. The heavy rainfall in 1896, as we remember, flooded with
sewage the low-lying portions of the city, through which the polluted
streams rushed in swirling currents, leaving banks of mud and sludge
behind to ferment or slowly dry; and, moreover, the sewage flowed
from the sewers on to the streets after each heavy downpour and
rushed up the traps and flowed on to the low-lying ground. Unfor-
tunately, in the beginning of the monsoon, a serious obstruction
occurred on the Worli foreshore, in the outfall channel of the sewage-
D
The stoppage took place during a great storm, and it was impossible
to send men down in the heavy seas to remove the obstruction.
Although the monsoon practically ceased in the middle of August, the
shady sides of the streets in crowded portions of the city remained
damp long afterwards. I find a note in the last week of August
drawing attention to it. In September only 1 6 inches of rain fell
being 10 inches lower than the average. This was the most abnormal
month of an abnormal year yet recorded (even in the famine years of
1876-77, the September rainfall was not less than 4 inches) ; and an
abnormal September was followed by an abnormal October, dry and
warm. "
Outbreak in
Mandvi.
Statistics, charts,
and maps.
The disease was first discovered in the Mandvi quarter of the
ward of the same name, in the heart of the crowded portion of the
city where local conditions greatly favoured its growth. The subse-
quent progress of the epidemic is illustrated by the statements given
in Appendix III. The statements show-—
(a) Total reported plague seizures and deaths in the city, week
by week.
(b) Total weekly mortality of the city compared with the
average weekly mortality of the corresponding period of
the preceding five years.
(c) Total reported plague seizures in each quarter and ward.
112
Extent and course of the plague
[ CHAP, V.
(d) Reported plague seizures in the different wards of the city
week by week.
(e) Reported plague seizures in the different quarters into
which the wards are subdivided, week by week.
The charts on pages 21 to 23 of Volume IV illustrate the course
of the plague in the city and in its different wards. On page 6 of
Volume IV is a map showing the incidence of the mortality in the
different quarters of the city.
Inaccuracy in
reporting.
In examining the statements it has to be remembered that they
probably do not show much more than one-half of the actual number
of cases, and that the reporting was much less accurate in the begin-
ning than at the end of the period. Whilst therefore the statements
are of great use in illustrating the comparative virulence of the disease
in the different quarters, and the general course of its rise and fall, they
must not be taken as furnishing anything approaching to an exact
statement of the cases that occurred.
Monthly seizures.
The following was the total number of seizures reported month
by month :—
October
1896
November "
December ,
January I 97
February
March
April
May
June
July
August
406
339
1,664
2,374
3,172
2.495
1,418
448
186
62
124
General course
of the epidemic.
In October 1896, the number of reported seizures fluctuated con-
siderably, but the epidemic did not show any tendency to increase.
In the first-half of November there was also no increase and the hope
was encouraged that the epidemic would soon die out. But in the
second-half of November the increase began. In the beginning of
December there was a large rise which continued progressively until
the end of the month. Throughout January the high figure was main-
tained, and a further rise occurred at the end of that month. February
saw the height of the epidemic, the following being the figures for
the four weeks of the month :—
Period.
First week
...
Second „
Third
„
Fourth „
Reported
seizures.
717
870
822
763
Excess of total mortality
from all causes over
corresponding figures for
preceding five years.
1,375
1,166
1,116
945
CHAP, V. ]
in the Bombay Presidency.
113
Flight of the
population.
During March the disease began rapidly to decline, and the epi-
demic waned steadily throughout April, May, June and the first-half of
July. The period from the 1st to the 15th July showed a total of only
15 isolated cases. From the middle of July began the recrudescence,
Those among the population who could leave the city endeavoured
to save themselves by flight. In Mr. Snow's report the following
estimate is given of the exodus :—
In October 1896
In November and December 1896
In January 1897
...
In February 1897 ...
TOTAL
about 20,000
„ 171,500
„
187,400
„
19,100
„ 398,000
Mr. Snow gives the following account of the exodus :—
" The outward flow began in October, and the smallness of its
dimensions up to the end of that month may be ascribed to the fact
that the disease was for a long time confined principally to one
locality. The exodus increased through November and December,
and reached its highest point in January, after which it rapidly sub-
sided, and during March and April there was a steady stream back to
Bombay. The appearance of plague in the various cities of refuge
to which the people fled had probably great influence in checking the
emigration from Bombay and the horrible mortality in some of those
places must have gone far to persuade them of the advisability of
returning to their ordinary avocations.
" The population of Bombay at the census of 1891 was 821,764,
and, taking into consideration the rate of increase between 1881 and
1891, we may assume that in 1896 the total number of persons in
Bombay was about 846,000. Taking the exodus at, roughly, 4 lakhs,
we shall not be far wrong in estimating that at the beginning of Febru-
ary it was reduced to something like 4½ lakhs.
" While the panic was at its height and the exodus in full flow, the
scenes at the railway stations were striking—a motley crowd of natives
of every caste and creed pressing and shouting for tickets, and then,
as the train steamed in, a hurrying anxious throng, old and young
alike, tottering under enormous bundles of household goods. As special
after special left the stations, the relics of the disappointed crowd
sooner than miss the next opportunity would quietly settle down to
sleep on the platforms. The busy scenes at the station stood out in
marked contrast to the quietness of Bombay ; whole streets of shops
were closed, business was paralysed and the desolate emptiness of
15
114
Extent and course of the plague
[ CHAP. V.
thoroughfares ordinarily teeming with life was most remarkable and
continued throughout the months of December and January, when the
population had been reduced to its lowest figure. "
Course of the
epidemic in differ-
ent wards.
Until the end of September the disease appears to have been
mainly confined to the Mandvi quarter of the ward of the same name, but
from the beginning of October cases were reported from many parts of
the city. Speaking generally, the plague travelled from east to west
and then north, throwing out branches to the south. In the Mandvi
Ward itself the disease persisted with fluctuations until the beginning
of May, when it rapidly declined. The worst periods appear to have
been the beginning of October and the month of April. In Bhulesh-
war the cases began to increase in number at the end of November,
and the disease was virulent throughout December, January and the
first-half of February, a sudden drop then occurred in the number of
cases, after which the decline of the epidemic was gradual and steady.
In the Fort Ward the main period of the epidemic was from the begin-
ning of December to the end of April, January and February being
the worst months. The disease was never virulent in this ward.
The end of December to the beginning of April was the main period
of the epidemic in Girgaum ; it was specially virulent in February.
In Byculla the epidemic was strongly marked from the middle of
December to the middle of April, and the number of cases was
extremely high during the second-half of December and the whole of
January, February and March. The epidemics in the Parel and
Mahim Wards in the north of the island were almost synchronous ;
they were extremely violent, but also short lived. The main period
was from the end of January to the middle of April. From this point
the decline was unusually rapid, and before the end of May the
disease had practically died out in both wards.
Manner in which
the infection
spread.
It was noticed that the first onset of the disease was rarely
rapid in any locality. Isolated, imported and, perhaps, endemic
cases occurred from time to time, followed by one or more small
groups of endemic cases. Then the disease having obtained a
footing in the locality began to spread and soon increased with
rapidity and virulence until the place became thoroughly infected. It
was also noticed that infection appeared to spread from house to house,
neighbouring houses forming groups in which many cases occurred.
The infection was hardly ever found at all evenly distributed over the
locality.
Comparison of
the intensity of
the epidemic in
different wards.
Comparing the wards one with another, it will be seen that in com-
parison with its population the Mahim Ward in the north of the island
suffered most, the number of reported seizures amounting to 38 per
CHAP. V. ]
in the Bombay Presidency.
one thousand of the population according to the 1891 census. Parel,
the other ward in the north of the island, also suffered severely, the
number of seizures per one thousand of the population being :8. By-
culla Ward was next worst to Mahim, the per thousand figure being
22 : the figures for the other wards were—
Girgaum
...
...
...
...
Fort
...
...
...
...
Mandvi
Bhuleshwar
...
...
...
...
16
13
10
It is remarkable that the wards forming the main body of the city
show the smallest number of reported seizures in proportion to the
number of inhabitants. The two wards in the north of the island owe
their heavy mortality to virulent outbreaks in small and insanitary
villages and suburbs. The extensive flight of the inhabitants also
interferes to some extent with the deduction to be drawn from the
figures. The population figures used in the statements are taken
from the census return of 1891, but the actual population after the
flight had set in was, it has been seen, reduced to a far lower figure,
and the flight may have been more extensivein some localities than in
others. The wealthier inhabitants of the city would be able to leave
much more easily than the poor fishermen, living in the villages in
the north of the island.
Localities chiefly
affected.
The incidence of the disease varied greatly in different quarters of
the same ward. In Mahim Ward the figures were—
Mahim quarter
Worli
61 seizures per 1,000 of the population.
21
,,
,,
,,
The exceedingly high totals in this ward were due to virulent
outbreaks in dirty and insanitary fishing villages. An account of
these outbreaks and the measures taken to suppress them is given in
Chapter VII. In Parcl Ward the number of seizures per one thousand
of the population in the different quarters was as follows :—
Siwri
...
...
...
...
,.,
Sion
Parel
31
20
14
Again, an insanitary fishing village (Siwri) shows the largest
number of cases.
In Byculla the figures were—
Mazagon ...
,,.
,.,
,,.
...
Kamathipura
...
...
...
First Nagpada
...
...
...
...
Tardeo ...
...
...
Byculla ...
Tanvadi ...
..,
...
...
...
Second Nagpada
...
.,.
...
,,,
29
25
24
23
21
IS
10
116
Extent and course of the plague
[ CHAP. V,
Mazagon includes a portion of the docks ; Kamathipura and Nag-
pada form the north part of the main body of the native town.
In Girgaum Ward the disease was severest in Mahalakshmi (32
per mille), and next in Walkeshwar (21 per mille) in which Malabar
Hill is situated.
In the Mandvi and Bhuleshwar Wards (which form the greater
portion of the main body of the town), the incidence of the disease,
according to the figures based on reported seizures and the population
of 1891, was much lower. The per thousand figures vary from 21 in
Mandvi quarter to 4 in Chakla.
In the Fort Ward the total number of cases was small; but the
quarter of Upper Colaba shows a per thousand figure of 24.
Statistics, charts,
and maps.
The Bombay Presidency Proper.
The extent and course of the first period of the epidemic in
the Bombay Presidency proper is illustrated by the following
statements in Appendix III :—
(a) Weekly statement of reported seizures in districts and
Native States.
(b) Weekly statement showing both seizures and deaths.
(c) Weekly statement distinguishing between imported and
indigenous cases.
(d) Weekly statements showing the principal localities in dis-
tricts and Native States in which the disease was endemic.
The charts in Volume IV, pages 24 and 25, illustrate the course of
the disease in the districts and Native States where the epidemic
was most severe. The maps on pages 3 to 5 of Volume IV illustrate
the incidence of the epidemic, and show the principal localities in
which the disease prevailed. The statements, charts, and maps cover
the period from the beginning of the outbreak up to the end of
August 1897, that is to say, up to the time when the recrudescence
had begun to gain ground.
Geographical
distribution of
the disease.
Geographically the epidemic may be divided into four divisions,
The first and most important is, that which extended along the
Konkan Coast from the Surat to the Ratnagiri districts, and in-
cludes the town and island of Bombay, the districts of Surat,
Thana and Kolaba, the Navsari division of the Baroda State, the
Janjira State, the small Portuguese possession of Daman and the
northern portion of the Ratnagiri district. The second group of
infected localities forms a line running north and south along the
CHAP. V. ]
in the Bombay Presidency.
117
west and centre of the Deccan districts. It includes the districts
of Nasik, Poona, Satara, Ahmednagar, and the northern portion
of the Kolhapur State. Khandesh and the eastern portion of the
Deccan districts escaped altogether or show only very few indigen-
ous cases. The southern districts of Sholapur, Kaladgi, Dharwar,
Belgaum, and Kanara, the southern portion of the Kolhapur State,
and the Portuguese possession of Goa remained practically free from
plague. The third division extends over the whole of Gujarat, north
of Surat district, excluding Cutch, which forms the fourth division.
Indigenous cases occurred at a number of places scattered widely
over Gujarat, the only serious outbreak was at Palanpur. There was
a very virulent epidemic in Cutch.
The Konkan
Coast the chief
seat of the
epidemic.
Apart from Poona and Cutch, the first division is the only one in
which the districts show a number of reported cases in excess of
one per one thousand of the population according to the census of
1891. The figures are—
Number of reported cases
Thana district
...
... ...
Janjira State
...
... ...
Surat district
...
...
,.,
Kolaba district
...
...
...
Navsati division (Baroda territory)
...
per 100,000 of the
population.
550
351
331
261
176
Thana.
Kolaba.
Daman.
In Thana district indigenous cases occurred in 60 places, and
more than 100 such cases in 11 places. The disease was worst at
Bandra, Bhiwindi, Bassein, and Kurla, all near the city of Bombay.
In the Surat district also indigenous cases occurred in 53 places. The
epidemic also was worst at Bulsar on the sea coast, and was also bad
at Mugod and Rander. In the Kolaba district the disease was
worst at Revdanda and Alibag. It spread to 2g other places. This
division of the epidemic includes also a virulent outbreak at the small
Portuguese possession of Daman between the Thana and Surat
districts. The plague was worst in the portion of the territory known
as Little Daman, and it is said that here more than one-third of
the population perished.
Poona City.
In the second division the city of Poona was the principal seat
of, the disease. Here the reported number of cases up to the 27th
August amounted to 2,543, or 16 per thousand of the population, and
the actual number of cases is known to have been much greater.
The late Mr. Rand, who was in charge of plague operations in the
city, estimated on the basis of total mortality from all causes that the
number of deaths from plague were certainly not less than 2,900
in the city itself (excluding the cantonment and suburbs), giving
118
Extent and course of the plague
[ CHAP. V.
Poona district.
Satara.
a death-rate of 24 per thousand. In Poona district the number of
reported cases amounted to 1,186. The disease was worst in Kirkee
cantonment and the small station of Lonavla, and it extended to ten
other places. In Satara district very few cases occurred during the
first period of the epidemic. The cases in this district belong to the
period of the recrudescence and will be noticed later on. In Nasik
and Ahmednagar districts there were few indigenous cases.
Palanpur.
In the third division the outbreak at Palanpur was the most
important incident. Here there were 167 indigenous cases mainly at
Palanpur itself. The number of indigenous cases in Ahmedabad,
Baroda territory, and other places in the third division was small.
Mandvi.
In Cutch (the fourth division) the outbreak began with an epi-
demic at Mandvi, which was one of the werst that occurred. The
number of reported indigenous cases was 4,359, or more than 11 per
cent. of the population, and it is known that large numbers had been
attacked before the existence of the epidemic was brought to the
notice of the authorities. From Mandvi the disease spread to a number
of villages in the State, and for several months caused considerable
mortality.
Course of the
epidemic.
In the months of October and November, 1896, isolated imported
cases were detected from time to time at different places in the pre-
sidency, but it was not until December that the epidemic began to
show a marked tendency to spread. The imported cases were at first
most numerous in the Ahmedabad district, but here they failed to
occasion any diffusion of the malady. Only 27 indigenous cases
were reported in all : they occurred between the middle of February
and the end of the first week in May. Satara district in the Deccan
was one of the localities in which indigenous cases appeared at
an early stage, but here also the infection did not spread. Only 88
indigenous cases were reported during the first period of the epidemic,
mostly in November and February. It is remarkable that Satara
should have escaped so easily during the first period of the epidemic
and yet have been the source of an outbreak of extreme violence
during the recrudescence.
Thana.
Turning to the districts of the first division, it will be seen that
Thana became infected in the month of December, and that the number
of cases rose rapidly during January, February and March. The
last part of March and first part of April included the worst period
and the highest number of indigenous cases (389) was recorded dur-
ing the week ending the 2nd April. In the beginning of May the
number of cases decreased quickly and the fall was rapid throughout
May and June. By the end of June the epidemic had for the time died
out. In Surat and Kolaba districts the beginning oí the epidemic