NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
[CHAP. IV.]
Previous history of plague in India.
81
High mortality.
the dead. All the fuel was burned and though houses were pulled
down to supply logs, many bodies hud to be left half consumed, Half
of the people of Ahmedabad, perhaps about 50,000 souls, are said to
have perished. "*
Importance of
the history of the
Gujarat
epidemic.
Details of the outbreaks in Sind and Radhanpur are not asccr-
tainable, and the above description therefore closes the account
of the 1812—1821 epidemic, Its history is most important,
not only because of the light that it throws on the disease, but
because it affords an Indian example of the pertinacity with which
plague will persist and the virulence with which it will prevail
if left to work its way unchecked amidst insanitary surroundings.
Plague-like
disease in the
Punjab in
1028-29.
The Pali Plague.
The Pali Outbreak of 1836-37.
Hirsch notices a statement by Colonel Skinner that in 1828-29
a disoase with glandular swellings absolutely like plague prevailed
with malignancy at Hansi (Hissar district of the Punjab) in the
province of Delhi. But the outbreak next following the Gujarat
epidemic, of which there is a detailed and authentic account, is the
epidemic that occurred in Rajputana in the years 1836-37 and
which is usually known as the " Pali Plague." Dr. Forbes, one of
the medical officers who investigated the disease, was informed by an
intelligent Guru † of the Jains that, although new to his generation,
the maladv had formerly committed great ravages in Marwar.
Dr. Ranken's
report on the
Pali plague.
An interesting account of this epidemic was written by Dr. James
Ranken, Officiating Secretary to the Calcutta Medical Board, and ]
published by order of the Government of India in 1838. The follow-
ing description is mainly derived from this report and its appendices.
Dr. Ranken did not himself visit the scene of the epidemic, but
compiled his report from documents written by the medical and other
officers who were on the spot. Differing from the doctors who saw
the disease, Dr. Ranken did not believe it to be the plague of history,
but his arguments to this effect are inconclusive, and the clinical and
epidemological accounts of the outbreak show beyond doubt that it
was one of true plague.
Description of
Marwar,
Mewar, and
M envara.
The scene of the Raj putaña epidemic was the country lying on
either side of that portion of the Aravulli hills which forms the
district of Merwara, under British administration.
To the west and north of the range of hills lies the state of Marwar
or Jodhpur, and to. the east and south the state of Mewar or Udaipur.
Marwar forms the south-eastern portion of the Rajputana desert
* Bombay Gazetteer, Volume IV, Chapter XII. | † Spiritual guide.
I I
CHAP. IV.]
Previous history of plague in India.
83
cases of disease have been observed by the Bombay Medical Officers,
appearing either sporadically or partially epidemic, the symptoms of
which closely assimilated those of the true plague ; and, I believe,
that only the supposed impossibility of the existence of that disease
in India prevented those cases being declared such.
" It appears that in those instances the disorder broke out and
subsided, and again appeared at different periods. From which I
conclude that the disease, at each time of its appearance, was freshly
imported, either by land or sea, in bales of merchandise containing
the fomites of the plague ; which disease, after breaking out, was in
those cases soon arrested in its progress by the occurrence of great
heat and an arid atmosphere, and a probably small population to
act on. It would seem very likely that, had the plague never
reached Pali, the disease might still have appeared sporadically
to the westward, and yet never have from its insignificance been
ackowledged as such. From the great increase of land transport
via Pali, it is not at all to be wondered at that goods infected
with the fomites of plague at last reached that place ; it is
rather a matter for admiration that such had not occurred before,
under the absence of every precaution. It is equally evident
that for a long series of years goods may be imported from even
infected quarters, and yet not contain the fomites of the plague ;
but, at length, one infected package arriving may do all the mischief.
That the plague was thus introduced into Pali I have not a doubt,
especially from the circumstances of the disease not having appeared
at intermediate towns, between Pali and the coast ; from which it
would seem probable that the package containing the fomites was
at once conveyed unopened from the vessel it came in to Pali where
it spread the pestilence ; more particularly as it is a well known fact
that the period that unopened goods will retain the fomites of plague
is almost unlimited, though the time the human frame will retain the
hidden seeds of the disorder is not beyond eight or ten days : hence
it seems evident that the contagion reached Pali retained in bales of
merchandise and was not introduced by men infected with the
malady."
Flight of the
inhabitants of
Pali.
" In the course of five or six weeks from its first appearance, the
disease having committed great ravages, and the daily mortality
being still on the increase, all ranks of the townspeople became so
much alarmed that they began in considerable numbers to abandon
alike their homes, occupation, and property, and to seek refuge in
Jodhpur, Sujit, Khairwali, and other towns and villages within a circle
of twenty to thirty miles round Pali. The wealthier members of
the community were the first to emigrate ; others soon followed their
84
Previous history of plague in India.
[CHAP. IV,
example, and to such an extent that (with the exception of the Chip-
pahs) only the very poorest remained in the outskirts of this once
rich and thriving town." Almost all the long narrow streets and
alleys were left tenantless, every shop was shut, and, according to
Assistant Surgeon Maclean, who visited the town at this period, and
from whose account the above description is taken, not more than a
thousand persons, mostly of the very poorest class, were left in the
place. The Assistant Surgeon continues his account of the flight
as follows :—
The disease
spread by the
refugees,
" Of the thousands of persons who quitted Pali * * * some
were at the time labouring under disease, others fell sick on the
road or immediately after they had reached their destined places of
refuge. For a short period after their arrival in the various towns
in which they had taken up their temporary abodes, the sickness
which they had brought in their train adhered to the refugees, with-
out attacking the inhabitants of those towns. But this state of things
did not long continue. The classes with which the refugees had
the most intimate communication (bannias* for instance) speedily
began to feel the effects of the Pali scourge, and now there is
not a town or village, to which the refugees resorted in any consi-
derable numbers, which is not become a fresh focus of contagion
and in which the original malady does not rage with fearful vigour. "
Progress of the
plague in Marwar
and Mewar.
Extinction in
the spring of
1838.
In September the epidemic extended to Sujit, a town containing
six thousand souls, and by October it reached Jodhpur, the capital
of Marwar (about fifty-two miles in a direct line from the hills), and
spread over the intervening towns and villages. It next affected the
single village of Dewair in the M envara hill district, where it destroyed
four hundred persons. Passing over the hilly tract it attacked Deo-
ghar in Mewar, on the east border of the hills, and skirting the
hills towards the north-east, it extended fifty miles by Lusani Thana
and Bednore to Jalia and Ranghar in the district of Ajmere. At the
same time it extended over the southern portion of the open Mewar
country. These events occurred in January to March 1837, In
April 1837 the sickness was announced in Bhilwava and Hamirgarh
in the extreme east of the Mewar plain, towards the direction of
the British cantonment of Neemuch. In all thirty-two villages in
Mewar were attacked by the epidemic. The hot season of 1837
was unusually mild, but nevertheless the hot weather and winds were
found to have a beneficial effect in checking the progress of the disease.
Towards the end of 1837 the epidemic broke out again in
Pali, and it did not die out until the spring of 1838. No accurate-
estimate was made of the total mortality. Dr. Irvine states that
* Retail
vendors.
CHAP. IV. ]
Previous history of plague in India.
85
Mortality.
thousands died in Jodhpur, and Assistant Surgeon Maclean believed
that the assertion of the Marwaris that a hundred thousand persons
perished of the plague in their country was not very far wide of the
truth. He estimated that when the epidemic had reached a virulent
stage, not less than three-quarters of the sick died.
Contemporane-
ous yellow fever
in Rohilkhand.
Dr. Guthrie on
the Rohilkhand
fever.
Dr. Ranken states that at the same time that the plague raged
in Rajputana, common remittent and intermittent fevers prevailed in
Jilwara and Jaipur, and Rohilkhand was ravaged by an infectious and '
deadly epidemic resembling yellow fever. Hirsch remarks that it was
stated by Dr. Guthrie that, while the plague was at Pali, there was a
pestilence observed over the whole country round Bareilly (Rohil-
khand), which had precisely the same characters. The appendix to Dr.
Ranken's report contains a note by Dr. Guthrie (Civil Surgeon) on the
subject oí the Bareilly fever. The symptoms he describes seem to be
those of relapsing fever rather than plague, and are in some respects
widely different from the ordinary symptoms of plague. In only one
instance did Dr. Guthrie observe any enlargement of the glands, but
occasionally the illness was marked by severe pains in the throat
and chest, with cough and expectoration. Dr. Guthrie's note is re-
printed in Appendix II.
Symptoms.
Bubonic and
pulmonary
forms.
Description by
Assistant Sur-
geon Maclean.
The symptoms observed in the Pali epidemic were similar to those
of other plague epidemics in India. The disease was commonly of
the bubonic form, but the pulmonary variety was also sufficiently
well marked to excite special attention. The following is che account
given by Assistant Surgeon Maclean, who saw numerous cases of the
malady :—
"The attack is generally sudden, without previous feeling of
indisposition ; the patient is seized with rigor, usually slight headache,
pains of the loins, nausea, etc.; the skin soon becomes hot and dry,
and the pulse frequent, generally soft and easily compressible, seldom
full and bounding and rarely or never hard. I counted a great many
pulses; they were ail frequent, often 130, 140, 150. This might
in some measure be attributed to the exertion necessarily made by
the patients while being carried to the doors of their houses from the
interior. In many cases, however, where the patient was not moved
at all, I found the pulse equally frequent Tongue usually covered
with a white or light brown fur. Sometimes it was nearly clean,
chiefly where the disease was of recent date. Vomiting did not
appear to be common at any period of the disease. I saw, however,
a few cases in which there was much irritability of the stomach,
manifested by frequent and distressing retching. Bowels generally
bound in the early stages of the disease, abdomen rather tumid and
hard, and almost always free from pain on pressure ; considerable
86
Previous history of plague in India,
[ CHAP. IV.
thirst, Eyes commonly heavy and hazy ; often bloodshot. Counte-
nance in all the severer cases expressive of much anxiety and suffer-
ing. Respiration generally easy, excepting in patients having
inflammation of the lungs as the prominent feature of their malady.
" Buboes appear in the groins, armpits and neck (usually on the
left side), sometimes almost simultaneously with the fever, but
more commonly in the course of the first or second day—rarely so
late as the third or fourth. They are at first of small size, moveable,
and always acutely painful to the touch. In some few cases they
increase rapidly in bulk, suppurate, and discharge pus alone, or
mixed with shreds of dead cellular membrane. In by far the
greater number of instances, however, they do not become larger
than a walnut, and show no disposition to suppurate. The groins
are the situations in which the buboes appear most frequently.
" Sometimes there is one in each groin, sometimes in one groin
and one axilla, sometimes in one or both axilla and neck, in one or
both groins and neck, or in the neck alone. Suppuration and even
rapid increase of size without suppuration have been remarked by
the Pali people to be favourable symptoms. In persons who recover
from the disease, the buboes most frequently disappear gradually of
their own accord. I saw one man, however, in whom a bubo, in the
left groin, had attained a great size, and was likely to prove very
troublesome. It extended from the pubis to near the anterior sup-
erior spinous process of the ilium, and was hard and painful. In
this patient the fever had ceased four days before I saw him. In this
disease a remission of the febrile symptoms, more or less marked,
takes place towards morning, the remission being of longer or shorter
duration according to the mildness or severity of the malady in each
individual case. In the worst cases there is no perceptible remission.
In some the disease was so mild that the patients walked without
assistance from their houses to the place where I was standing, had
their buboes, pulses, etc., examined, swallowed their medicine and
walked home again. In others, again, syncope followed any attempt
to raise them from their charpoys. The head is but rarely affected
in the early stages of the disease. Most of the persons I saw
answered questions readily and distinctly. In fatal cases the patients
become comatose some hours before death.
" In a small proportion of cases inflammation of the lungs comes
on, on the first or second day of the disease. The patient complains
of acute pain of one or other side or behind the sternum ; great
difficulty of breathing ; short dry cough; usually on the second or
third day a small quantity (rarely more than half an ounce) of florid
blood, in small coagula, is expectorated. In such cases buboes are
CHAP. IV. 1
Previous history of plague in India.
87
not commonly observed, though they do occasionally coexist with
the inflammation of the lungs. The mortality has been so great
among those in whom the lungs were affected that a person now,
on seeing blood in his sputum, gives himself up for lost. "
Infection carried
from place to
place.
Epidemic
fostered by dirty
and insanitary
conditions of
life.
It has been stated above that the origin of the Pali outbreak is
not known though it is surmised that it may, have been imported-
from the Gujarat ports. The history of the epidemic shows that
the infection was carried from place to place. All the author-
ities are agreed that the spread and virulence of the epidemic was
largely fostered by dirty and insanitary conditions of life, as Dr.
Ranken puts it, "under the influence of an atmosphere accidentally
more impure than ordinary, in foul and ill-ventilated huts, amidst
the privations of the poorer classes in Manvar and Meywar."
In Chapter II a quotation has been given showing the insanitary
condition of a typical Rajputana village of the time. The following
general remarks recorded by Dr. Ranken are to the same purport :—
Insanitary
condition of
Rajputana.
" The people of the North-Western Provinces of British India,
and of Marwar more especially, are to be considered in varying
stages of transition from anarchy and want to comparative plenty
and order. They have advanced within reach of many improve-
ments in the physical conditions of society, but having made no
corresponding acquisitions in intelligence, their minds retain the
impress of former barbarity and misrule, and are. yet unable to turn
the advantages of a better system to account. Hence animal
instinct predominating over foresight and enterprize, population has
augmented faster than increasing agriculture and commerce have
extended. The hut, or one of the same dimensions, which was the
unwholesome den of four persons, for example, fifty years ago, now
shelters six human beings within a space barely sufficient for the
accommodation of one. These miserable habitations are often
enclosed by an outer screen or wall, for the double purpose of confining
the cattle and secluding females from the public gaze. Glass to let in
light or apertures to admit fresh air being unknown, the door, in order
to keep out heat at one season and cold at another, is generally shut.
The poor feel most at home in such dark places with their children
lying round them on the floor, too much like hogs in a sty amidst their
Jitter. The sense of insecurity for life and property which deterred
their ancestors from living near the fields which they cultivated, in
farms, houses and cottages scattered over the face of the country,
owing to hereditary habits of thinking, still perceptible to this day
under the very cannon of Fort William, makes the peasantry every-
where accumulate their hovels within the narrowest limits, and the
88
Previous history of plague in India.
[CHAP. IV.
consequence is that each dirty village, unventilated, and over-
crowded with man and beast, exhibiting every sort of nastiness, is
a focus of disease. "
Mortality
greater in large
than in small
villages.
Assistant Surgeon Maclean remarked that in large, irregular?
closely built villages the mortality was greater than in the smaller
ones. The smaller villages were for the most part as filthy as the
larger ones; but their small size alone, particularly when coupled with
an open situation, was of signal advantage to the inhabitants, by allow-
ing the pure air to penetrate more freely into the recesses and corners
in which the native sick were commonly lodged.
Land quarantine
and preventive
cordons.
Dr. Ranken's
opinion on the
subject of land
quarantine.
An endeavour was made to prevent the spread of infection by
the imposition of rigid land quarantine. The preventivo lines and
cordons that were established are shown in the map in Volume IV,
page 2. To protect the Bombay frontier a cordon line was
drawn between Balmir and Bhinmali to the south of the infected
portion of Marwar. A similar line was established along the north
of the Mewar territory from Luluah on the western slope of
the hills to Sawar on the Bañas River, and another along the
south of the infected part of Mewar. Captain Dixon, Superin-
tendent of Merwara, established a cordon along both sides of the
hill district. Preventive lines and strict quarantine were also
established around Ajmere, Neemuch, and Nasirabad. A thousand
armed horsemen patrolled the cordon lines established for the pro-
tection of the North-Western Provinces. The Princes of Jodhpur and
Udaipur were requested to prevent the spread of the disease by
blockading the places belonging to them in which it prevailed, but it is
believed that they did little in this direction. Dr. Ranken considered
that quarantine and sanitary cordons lessened the chances of infection
by intercepting persons with the disease in their constitution who
might otherwise have taken refuge in some hovel in uninfected territory
where the sickness was likely to break out and spread, He was in
favour of the blockade of infected places provided accommodation
were increased within the infected area to allow of proper sanitary
arrangements being made for the infected population, but he believed
that it was not possible to render preventive lines embracing long
frontiers really effectual, and he was of opinion that suppression
of communication between neighbouring districts was a measure
calculated to spread infection by causing famine and disease.
" The suspension of the internal trade of conterminous districts," saya
Dr. Ranken, " depriving the farmer of a market for his produce, the
merchant of the use of his capital, and consequently the labourer of
employment, diminishes or takes away that supply, in the continuance
CHAP. IV.]
Previous history of plague in India.
89
of which the improvident and pennyless mass of the people depend
to-day for subsistence to-morrow. Nothing, in short, appears to me more
calculated than an efficient cordon to assist famine, disease, and with
the concomitance of an impure atmosphere, the very infectious or conta-
gious fever which it is intended to eradicate. The combined coercion,
restraint and oppression subversive of the functions of society, which
the system of quarantine involves, are inferior only to the horrors of
plague when it actually prevails."
Dr. Ranken attributed the
comparative immunity of Merwara and the escape of the civil and
military stations in British territory to their superior sanitary con-
dition rather than to quarantine and preventive linos.
Breach of the
Merwara
cordon.
The Merwara cordon did not prevent the infection from invading :
the hill tract. It was broken on the western line, and a village in Mer-
wara (Dewair) was attacked by the malady, which did not, however,
spread to other parts of the district. In the neighbourhood of Dewair
there was a much frequented pass, connecting Marwar and Mewar
territory. It was discovered that certain people of the Dewair district,
who gained their subsistence by acting as guides to travellers cross-
ing the Merwara hills, were (after Captain Dixon had closed the
main road) in the habit of conducting travellers into and through the
Merwara districts by bye-paths and during the night when discovery
was difficult or impossible.
Dr. Ranken's
advocacy of
sanitary reform.
Advice with
regard, to
Calcutta.
The measure in which Dr. Ranken had the greatest confidence
was sanitary improvement, both in the condition of towns and
villages and in the condition of the people themselves. " The most
comprehensive injunction that can perhaps be given on this subject,"
he states, " of paramount importance to public health, is to pre-
vent the contamination and promote the circulation of the at-
mosphere, and to let no water stagnate on the surface of the
ground * * *. If earnestly acted on, a great change for the
better must soon appear. It is very possible for an active magistrate
to get the streets cleaned of rubbish, dung-hills and other filth ;
dead walls, fences, jungle and planted trees removed from the areas
and outskirts of the place; and to make the inhabitants drain or
fill up puddles. The benefit derivable from such obvious and practi-
cable means would far exceed the expectation of those to whom the
subject is new." In especial he earnestly advised the Government
" to begin the amelioration of the country by making Calcutta, the
capital, a model by which other stations may be improved in a
manner which shall render them, less sickly at all times, and compara-
tively safe from the occasional irruption of diseases resembling
plague."
12