NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
38
Description of Plague:
[ CHAP. 11.
Remarks of the
Technical
Committee of the
Venice Sanitary
Convention on
plague among
domestic
animals.
The Report of the Technical Committee of the Venice Sanitary
Conference of 1897, after dealing with the small rodents, discusses
the case of the domestic animals in the following terms :—
" D'autres espèces encores vivant au voisinage de l'homme, à l'état
domestique, les chiens, les porcs, les buffles, les moutons, les chèvres,
etc., peuvent être atteintes d'après certains observateurs. Jusqu'ici
cependant, aucune preuve directe n'a été fournie de la communauté
d'origine de la peste et de certaines epizootics, qui ont, parfois régné
simultanément."
Experience of
present plague
shows that
susceptibility of
domestic animals
is very slight.
M. Haffkine's
experiments.
The Government of Bombay consulted their expert advisers with a
view to ascertain what danger existed of domestic animals being
attacked by plague. The investigation was made specially with a view
to determine whether any risk of infection was to be apprehended from
animal lymph prepared within plague areas. The result was distinctly
unfavourable to the hypothesis that domestic animals are under ordinary
conditions susceptible to plague, The Government of Bombay summed
up the conclusions in the following passage :—
" It is in fact very doubtful whether cattle are susceptible to plague,
at all events to anything like the same degree as human beings.
There has been no record of any disease or deaths among cattle in
the many places where the epidemic has raged in the Bombay Presi-
dency which could be attributed to plague ; and, as will be seen from
Dr. Lowson's report, in Cutch-Mandvi inquiry has shown that cattle
remained perfectly healthy while the plague was at its worst in that
town. The so-called cases of plague in cattle have, at least in one
instance, been pronounced by competent veterinary opinion as rin-
derpest. Dr. Lowson reports that he carried out experiments in
Hong-kong in conjunction with the Colonial Veterinary Surgeon, in
which it was proved that cattle, after direct inoculation with pure
culture of plague bacilli, did not develop plague, and, with the excep-
tion of temporary fever and refusal of food, remained healthy. More-
over plague bacilli could not be found microscopically or bacteriologi-
cally in their blood, nor were there any signs of plague, such as enlarged
glands, along the chain of lymphatics from the spot where the inocula-
tion was made. M. Haffkine's experiments in Bombay, like Dr.
Lowson's in Hong-kong, tend to prove the immunity of cattle generally
from plague. M. Haffkine injected hypodermically horses, goats,
cows and sheep with considerable doses of virulent plague cultures.
The operation caused an attack of fever from which they all, except
the goats, recovered in a short time with perhaps local swelling and
suppuration at the seat of inoculation. The goats alone, without
developing any acute disease, lost condition, gradually wasted away,
and after a considerable time many of them succumbed. He further
CHAP. II. ]
its causes and characteristics.
39
states that one of the cows gave birth to a calf during the period she
was operated on, and both cow and calf remained healthy. Finally,
M. Haffkine considers that his experiments show that no spontaneous
plague infection, which in nature can only take place with much
smaller doses of virus than those used by him on horses, cows, goats
and sheep, is likely to affect these animals ; and the Surgeon-General
•concurs in this opinion."
Researches of
the German
Plague
Commission.
The researches of the German Plague Commission were equally
satisfactory. The following is a summary of their conclusions :—
" Pigeons, fowls, geese, and pigs were treated with injections of
virulent, concentrated suspensions of plague bacilli, and the pigs were
also in part fed with rats dead of plague ; but none of them showed
any reaction whatever. Injected or inoculated dogs gave almost no
reaction. Of two dogs fed with pure cultivations, one remained well, the
other became slightly ill, but no plague bacilli were found in the swollen
glands. Injected and inoculated cats had short fever. In one case a
local abscess formed, but the pus was sterile. Somewhat more sensi-
tive to inoculation or injection were sheep and goats ; in the case of
the former the abscess-pus contained numerous plague bacilli ; in the
case of the latter, none. Cows reacted with high fever and severe
local appearances ; in this case also the abscess-pus was free from
plague bacilli. Horses showed less reaction. All the animals experi-
mented on that showed signs of illness have completely recovered.
It is to be noted that in these experiments with animals the exhibition
of the infection was far more intense than obtains under natural
conditions. "
Confirmatory
evidence from
Kumaun and
Garhwal.
The experience of the Himalayan plague in Kumaun and Garhwal
affords further evidence that domestic animals are not susceptible to
the disease. In the Himalayan villages cattle and men are crowded
together in ill-ventilated tenements. The cattle with the people are
thus subjected to conditions peculiarly favourable to the action of
plague infection. Notwithstanding this, Dr. Rennie, who investigated
the Himalayan plague in 1850, expressly remarked that the natives
were all agreed that there had been no particular disorder or mortal-
ity among their cattle, but that the disease was preceded or accom-
panied by a great mortality among the rats in their houses.
Monkeys.
Monkeys, on the other hand, were found to be extremely sensitive
to plague, and both the German and the Russian Commissions used
monkeys for their experiments on the effect of preventive and curative
inoculation. The members of the German Commission discovered
that the grey monkeys were far more sensitive than the brown mon-
keys. It is believed that some monkeys died of plague during a slight
40
Description of Plague :
[ CHAP. II.
epidemic that prevailed at Kankhal near Hardwar in the North-
Western Provinces.
Insects.
The German Commission observed that flies taken off the body of a
rat and inoculated into a guinea-pig, infected it with plague. The
possibility of infection being carried by flies and other insects has been
noticed in some previous epidemics.
Mode of Dissemination.
The facts narrated in the preceding sections regarding the dissem-
ination of the bacilli from the sick, the behaviour of the bacillus in
nature, the mode in which the infection enters the system, and
plague among animals, lead up to the all-important subject of the
manner in which the disease is disseminated.
Primary danger
is in the sick
person and his
surroundings.
Danger greatly
enhanced by
insanitary and
overcrowded
surroundings.
In the first place it will have become evident that the primary
danger exists in the sick person and his surroundings, his clothing
and bedding and other objects that may have been in contact with him,
and the room in which he has resided. The general characteristics of
the bacillus and in especial its apparent rapid loss of vitality in air
and sunlight, and its power of thriving in the filthy media suited to it
will have further indicated that the danger from these primary sources
of infection must be infinitely greater in insanitary, ill-ventilated
and overcrowded surroundings than in a wholesome and clean environ-
ment. In this fact lies the answer to the question to what extent
the disease is infectious. In dirty, ill-ventilated and confined places
the poison may attain to an extraordinary virulence, and has produced
results which are recorded in some of the most appalling chapters of
the history of mankind. But in more healthy and airy habitations the
bacillus fails to find the conditions essential to its life and is at once
robbed of its devastating power. Modern scientific research has
disclosed the reason for this phenomenon, but the fact itself has been
notorious for ages. Plague has always been recognised as intimately
connected with poverty and filth, and in Europe, as the sanitary con-
ditions of life became better, the disease, which once raged with
irresistible violence, was observed to recede gradually but surely
from the continent.
Hirsch's remarks
on connection
between plague
and defective
hygiene.
Hirsch lays the greatest stress on this aspect of the question.
He remarks as follows :—
" There is no point in the etiology of plague about which obser-
vers in all times and at every place have been so entirely in agreement,
as that the origin and diffusion of the disease are closely connected
CHAP. II. ]
its causes and characteristics.
41
with the injurious influences of a defective hygiene, and particularly
with domestic misery. Almost all the authorities on epidemics of plague
in Europe during past centuries point to the accumulation of filth in
the houses and in the streets, to defective disposal of faecal matter, and
other animal excreta, to overcrowding and insufficient ventilation of
dwellings, and the like, as a real means of fostering the pestilence;
they all urge the removal of these noxious influences as the most
important principle of prophylaxis, and they all remark that the reason
why the plague has mostly, and sometimes exclusively, attacked the
poorer part of the population, is that among them the defects of social
wellbeing are most felt."
Later
observations
including those
made in India
are to the same
effect.
The same tale is told by those who have observed the disease in
Egypt, Syria, Asia Minor, Turkey in Europe, Persia, Mesopotamia, '
and China, and India is not in the least an exception to the rule.
Dr. Whyte in his interesting account of the plague in Gujarat
in the early part of the present century states in the most impressive
manner his belief that the disease was in the highest degree fostered
by insanitary conditions and that it might be combated by removing
the people from these conditions into healthy surroundings.
Insanitary
condition of the
towns and
villages which
were the scene of
the Pali plague.
Dr. Ranken's report on the Pali plague of 1836 mentions particu-
larly the dirty and insanitary condition of the Rajputana villages. He
quotes several extracts from the accounts of the local medical officers,
of which the following will serve as an instance :—
" The town,* like most others in Manvar, is abundantly filthy, the
cattle being either the actual inmates of a number of the houses, or
pent in folds as close to them as possible. The collection of nuisances
that this order of things gives rise to may readily be conceived
nor can we suppose the effect to be otherwise than injurious as regards
the health of the inhabitants. Indeed, the most studied art could
hardly devise a more effectual plan for rendering their nuisances every
way offensive than that universally prevailing among the people of
Marwar and Meywar. I mean the plan of running immensely dry
hedges, composed of the branches of prickly shrubs, bushes, etc., not
only round the town, as a defensive outwork, but into every crevice
and corner where there may be possibility of egress or ingress either
to man or animal. "
Insanitary
condition of the
villages where
the Himalayan
plague is
endemic.
In his account of the endemic plague in Garhwal and Kumaun
(Mahamari) Dr. Hutcheson gives the following general description of
the insanitary condition of the country :—
" Mahamari has been fostered by the uncleanly and filthy habits of
the people of the hill tracts, who house cattle, sheep, goats and other
* Sumari.
6
42
Description of Plague :
[ CHAP. II.
animals on the ground floors of their unventilated houses and allow
accumulations of sewage, refuse and litter in the immediate vicinity.
They also defile and pollute the neighbourhood of the village in defi-
ance of all sanitary law, and in their helplessness permit refuse and
noxious weeds to fill the air with rank odours, adding to the foul
emanation that penetrates every nook and corner of the overcrowded
impure dwelling which forms a nursery of zymotic disease, and is the
birthplace of the pestilence. "
The inhabitants of these Himalayan tracts have become so impressed
with the fact that the disease is fostered in their villages that it is
their common practice to flee to the open when an outbreak occurs,
thus, no doubt, saving many of their lives.
The same lesson
taught by the
present
epidemic.
The history of the present epidemic given in subsequent chapters
of this report teaches the same lesson. It will be shown how the disease
broke out in a quarter of the city of Bombay where the overcrowded,
dirty and ill-ventilated tenements presented conditions the most
favourable for the growth of plague, and how it seized with irresisti-
ble violence on dirty and insanitary towns, such as Sukkur and
Mandvi.
Incidence of
disease in
Bombay City
greatly due to
local conditions.
In a memorandum signed in the middle of January 1897 by some of
the principal European and native medical practitioners of the city
of Bombay and members of the Special Plague Research Committee
appointed by the Government of Bombay, the opinion was stated
that the disease then prevailing in the city was, under certain con-
ditions, only slightly contagious or infectious, and that the facts
observed in connection with individual cases and those associated
with the general progress of the disease, warranted the conclusion
that its incidence was greatly due to local conditions.
Remarks by
General Gatacre.
General Gatacre, recorded the following remarks :—
" These and many other points taken in connection with the
insanitary conditions in which the poorer, and in some particulars,
even the wealthy, classes live, make the suppression of the epidemic
in India a very difficult matter.
" It must be remembered that in all large oriental cities a very
large proportion of the population are very poor and cannot afford to
pay the rent of a really sanitary building ; they therefore are forced
to live in miserable shanties, dark, low, small, and built on insanitary
sites, without plinth, added to which, with a view to bringing the
cost of this habitation to the lowest point, 16 or 20 persons will sleep,
eat and cook in a space hardly sufficient for the requirements of
four. "
CHAP. II.]
its causes and characteristics.
43
Dr. Thomson
(Bombay City),
Surgeon Captain Thomson (Parel Hospital, Bombay) observed
that " fatigue, destitution, filth, poverty and overcrowding seemed
to be the chief predisposing factors, and the horribly filthy condition
of the person and clothing of most patients were indescribable. "
Dr. McCabe
Dallas (Bombay
City).
Dr. McCabe Dallas (Grant Road Hospital, Bombay) made the
following remarks in describing the outbreak of the plague :—
" There were the necessary heat and moisture present to encourage
its culture, helped by the requisite material within the houses,
which; in most instances, were overcrowded, ill-ventilated, deficient
in light, and inhabited by a class of persons who are generally
opposed to the benefits of sanitation. "
Other instances
given in
subsequent
chapters.
In subsequent chapters other instances will be given of the foster-
ing influence exerted by insanitary conditions, and indeed the exam-
ples might be multiplied without number, but enough has been said to
show that it has been fully recognised in the present as in previous
epidemics of plague that insanitary and filthy conditions play the chief
part in fostering the spread of infection.
Instances
showing that
healthy
conditions
destroy the
virulence of
infection.
Important instances are also not wanting in the history of the
present epidemic with regard to the reverse aspect of the question,
serving to show how the existence of healthy conditions destroys the
virulence of infection. In the first case there is the marked immunity
enjoyed by Europeans. On this point Dr. Bitter has recorded the
following interesting remarks :—
Immunity
enjoyed by
Europeans.
"D'un autre coté, le nombre d'Européens atteints de la peste
pendant l'épidémie, a été minime. Il y à eu en tout jusqu'à la fin
du mois d'avril, 40 cas parmi une population de plus de 10,000. Il
faut même considérer qu'une partie de ces cas est survenue chez
des personnes pauvres, qui habitaient les quartiers indigènes. On
ne pourrait guère expliquer ce fait, en admettant que la race
européenne ait une prédisposition moindre pour la peste. On recontre
des cas aussi graves et aussi rapidement mortels parmi les Européens
que parmi les indigènes. Il est vrai que les Européens attaqués ont
donné une mortalité considérablement plus faible que les indigènes,
mais cela est certainment dû au fait que les cas légers qui sont
suivis de guérison, chez les indigènes, échappent frès souvent à
l'observation. La seule explication raisonnable que l'on pourrait
donner pour l'immunité relative des Européens, c'est que par leurs
habitudes de vie, ils sont mieux protégés contre l'infection. Du
reste, je ne connais pas d'exemple que dans une famille européenne
de classe aisée il y ait eu plusieurs cas de peste. "
Non-infectious
character of the
disease in
hospitals.
Next there is the important evidence of the non-infectious character
of the disease in hospitals, and the comparative immunity enjoyed by '
the attendants on the sick and the persons, both European and native,
44
Description of Plague :
[CHAP. II.
engaged in the work of disinfection and other such operations, whose
sanitary conditions were carefully supervised. General Gatacre re-
marks as follows :—
Remarks by
Genetal Gatacre.
" It is an interesting and highly satisfactory fact that remarkably
few of the officers or employés engaged on plague work, and
especially on disinfection, suffered from the disease. Of the coolies
working within the city of Bombay who caught plague, only three
or four are recorded ; of the gangs sent to Cutch-Mandvi, five
developed plague in the place itself and died, and three after they
returned to Bombay while under observation. Of those sent to
Colaba district, none are recorded as having taken the disease.
But it is to be regretted that Dr. Desai, the Medical Officer in
charge of the Hindu Hospital, and Dr. Dooda, in charge of the
Dariastan Hospital, succumbed to the disease, while in the execution
of their duty.
" At Cutch-Mandvi, Nurse Home died after only a few days' ill-
ness, as did also Sister Elizabeth (Fille de la Croix) who nursed at the
Government Hospital at Mahim. Two hospital assistants—one at
the Jamsetjee Bunder and one at the Mahim Hospital—caught the
disease; the former died and the latter recovered. Three military
ward orderlies are recorded as having died of the disease contracted
while engaged on hospital work.
" It will be observed that the above number of casualties represent
a very small proportion of the percentage of the total number of
employés, and in that light the result of the precautions taken to
prevent infection amongst the staff must be regarded as satisfactory. "
Parel Hospital,
Bombay.
Surgeon-Captain Thomson recorded the following observations :—
" That the disease is not infectious in hospitals is a well-estab-
lished fact from experience in the Parel Hospital. In upwards of
240 instances the friends of the patients attended their sick, and
in 20 instances scarcely ever left the bedside, and in not a single
instance did the disease spread to the friends. Out of more than 140
attendants on the sick belonging to the hospital staff, from time to
time, only one sweeper was attacked ; and he had been constantly
helping in the post-mortem room and had a very mild attack with
small axilliaiy bubo. Temperature 100° F. at highest. He resumed
his duties on the fifth day afterwards. In three cases amongst
hospital orderlies other and special sources of contagion existed, very
likely to lead to direct inoculation, and are therefore not considered
instances of spread of the disease from mere attendence on the sick.
One nurse belonging to another hospital, whose case is given in de-
tail, was admitted.
CHAP. II.]
its causes and characteristics.
45
" The conclusion drawn is that one of the safest places during an
epidemic is the ward of a sanitary plague hospital, something more
than mere exposure to contagion being necessary to develop the
disease—most probably overcrowding, destitution, deficient cubic
space, ventilation, and sunlight, and a filthy and general insanitary
condition of person, clothing, habitation, and its surroundings.
" Further specific proof of the non-contagiousness of plague in
hospital was furnished by one instance in which a mother ill with
the disease suckled her infant and it escaped ; by one instance in
which an infant with plague was nourished on the mother's milk
and she was not attacked ; and by one instance in which a brother
slept in the same bed with his stricken brother and did not contract
the disease from him. "
Grant Road
Hospital, Bom-
bay.
The following extract is from Dr. McCabe Dallas' report :—
" Those most closely associated with the disease, as the working
staff, from the medical officers down to the coolies, considering their
numbers, enjoyed comparative immunity from infection. Of about
400 people—men, women, and children—who either visited their
sick friends or remained constantly by their bedsides, together with
the cases under observation, in not a single instance did any of these
persons contract the plague. But one of the ward-orderlies doing
duty in the hospital became affected through direct contagion in
consequence of drinking the remnants of stimulants left in feeding-
cups by patients who did not consume the whole contents, and most
probably after some cup had been in contact with the mouth of a
plague pneumonic case. "
Hospitals
in
Sind.
In the report on plague in Sind Mr. Wingate remarked as follows :—
" At Sukkur, as elsewhere, the sick were accommodated in some
of the best buildings in the town, the schools having been placed
freely at disposal by the educational inspector, and the best comforts
and nourishment that could be procured were provided, while the
nursing was that of the motherly Sisters of the Lady Aitchison
Hospital, Lahore, generously spared and eager for the service,
assisted by the Zenana Mission ladies.
*
*
*
*
*
*
" While the sick were thus accommodated, usually in the centre
of the towns, instead of being banished to some dreaded lazaretto,
it was remarkable that the plague hospital attendants and guards,
and even the relatives of the sick, enjoyed almost complete immunity.
One of these nurses, Miss Home, in Karachi, besides Sister Isabel
at Rohri, took the disease, but she also recovered. Under proper
management, the disease seemed paralysed and innocuous. "