PLAGUE IN INDIA

Otago Daily Times, Issue 18850, 1 May 1923, Page 5

PLAGUE IN INDIA

By R. S. Cbee Brown, Principal College

of Engineering, Poona.

(Written for the Otago Daily Times.)

A few. days ago the cables reported a severe epidemic oi plague in certain districts of India, resulting in heavy loss of me in Delhi and Madras. In Delhi, with its population of about 250,000, the mortality is from 60 to 100 a day, and in Madras, with about double that population, there have been 600 deaths in a week, irom the usual course of such epidemics in the past it may be assumed that the disease will continue to take a similar toll for about a month, and will then gradualy die down owing to natural causes and the mean taken to combat the scourge. An epidemic in the large Indian cities usually extends over about three months, gradually increasing to a maximum and then as slowly diminishing. • It is difficult for those who , ha 1 v ; 0 , n ° l lived in the crowded cities of the East to realise the conditions created when a serious epidemic breaks out, or the anxieties which the annual recurrence of plague casts upon these responsible for the administration. India lives under the constant threat of two great evils—famine and plague. .these are ever present in greater or less degree, and at any lime may assume sonous propoitions in almost any part of the country. It is true that the great wave of influenza which swept round the world in 1918 levied a heavier toll of life than even the hist great attack of plague, but influenza has shown no signs of returning in a serious form, while plague in spite of the most strenuous efforts to limit its destructive effect. In the past Bengal and the Bombay Presidency have been the greatest sufferers from plague, whilq Madras had until quite recently succeeded in almost entirely excluding the disease. The Madras Government no sooner realised the danger which threatened its territory from contact with the plague-stricken areas, than it introduced the most drastic regulations to guard the population of the capital. All passengers by road and rail had to undergo medical examination before entering the city, if they came from infected areas. These precau-* tions proved almost entirely successful, and only an occasional case was reported. It. now appears, however, that the disease, carried presumably. either*by human beings or rats, has broken through the barriers erected against it. The first serious outbreak in' a city unused to the annual visitation which is experienced elsewhere will no doubt tend to throw the population of Madras into a panic similar to that which followed the first outbreak in Bombay Presidency. But fortunately much more is known of the history of the disease tharp in the days .when India lost nearly a pillion peonlo a year, and when tho medical authorities were fighting in the dark.

The writer has had some experience of the disease in the Bombay Presidency, and recently had the opportunity of seeing the work of the Parel Laboratory in the suburbs of Bombay, where this and other diseases are combated by members of the Indian Medical Service.

The population of India is possessed of a large measure of the fatalism which is characteristic of Eastern races, and in most parts had become used in very large measure to the presence of the disease. There are always a few cases here and there throughout the Bombay Presidency, but they fall to a minimum daring the hot months of April and May, when the weather is not only hot, but dry. The monsoon months which follow usually see a slight increase in the disease, and about September or October the cities, like Poona, situated on the plateau of the Deccan, begin to watch anxiously the plague statistics. As soon as a. few deaths occur in a village or city district the neighbourhood becomes almost deserted, the population going out to live in the fields in booths, tents, or corrugated iron shelters. They have learnt through the efforts of the doctors, backed by propaganda carried on by the Educational Department,. that the disease is carried by the rat flea, apd that when deaths from the disease occur, or when infected rats are found, their only safety is a temporary change of residence. A ' great deal of dislocation of industry ano business must necessarily result, but to put off till to-morrow, or till next month, what could be done to-day does not usually trouble the Indian very much. His chief difficulty is in finding accomodation outside the city, even of a temporary nature, for his resources are iimitod; but the warm climate and the certainty of fine weather except for an occasional thunderstorm in October make it possible for him to live an open-air life without much discomfort.

In a great city like Bombay, with-a population of over a_ million, escape from the plague-stricken districts is not so easy, and the danger of a serious epidemic is greater. The people, on the other hand, are somewhat more used to obeying regulations framed for their benefit. As an example of the effect which the threat of plague has upon the activities of public bodies, it may be mentioned that the University of Bombay has on its books? a regulation authorising the Syndicate, which is the executive body of the University, to grant a “plague term” to any college which may find it necessary to close on account of plague. This means that failure to “keep terms” at that college is condoned. One of the annual anxieties of the principal of a college is to decide whether the danger from plague is sufficient to justify closing. The students who come from distant places which do not experience plague are always excessively nervous and anxious to depart when plague appears; there are others who would like a prolonged holiday, and' who are not above bringing a dead and partially decomposed rat into the hostel, to be found “accidentally” by the hamal when he is sweeping out next morning. If the rat has been dead for some time it is impossible to say whether it has died of plague or not, apd there is always the fear that, while panic is being suppressed and work pressed on, the students may bo subjected to a real ‘danger. The writer had this problem to decide last September. The students were held together and work earned on, while each day deaths occurred- nearer and nearer to the hostel. At length the term was cut short by a fortnight, and the students scattered. Two or three days later a girl, daughter of the hamal, died on the premises, and there was cause for satisfaction that the decision to close had been taken in time, though by no means too soon.

The chief moans of prevention and mitigation of the disease are innoculatiop and a campaign against rats. In Bombay the organisation is a wide one. To begin with the rats, the municipality lends out great numbers of rat traps which are sent round the city in hand-carts daily, and collected the following morning. The writer visited Parol Laboratory about 11 a.m., when /the traps were beginning to come in and being stacked in a heap with their unpleasant contents, sometimes as many as six in one trap, wriggling and fighting. The object of bringing the rats to one centre is to feel the pulse of the city daily. All the rats brought in are asphyxiated quickly and painlessly by the'fumes of crude oil; they are then convoyed to a room in which three ex-soldiers deal with every individual rat, the first preparing them for inspection and the other two inspecting each rat at five places for symptoms of the disease. During my yisit plague in the city was at a very low ebb, and only six or eight rats, out of the 18C0 examined daily, showed signs of infection. The 1800 rats dealt ■with were inspected in about 45 minutes by the two inspectors, who are so expert that, though they examine about 20 rats a minute they have never been known to miss an infected rat, though the results of their examinations are often checked by bacteriological methods. 'When an epidemic breaks out the number of rats caught and examined daily increases to between 50C0 ;nd 4000, and of these some hundreds arc infected. Another Dart of the work consists of taking a daily census of rat fleas. The fleas are asphyxiated along with the rats, and the method is to rub the rat over a ■wl ite-topped table, when the fleas fall out and are counted. A percentage of the rats are thus examined daily, and as soon as the census shows an increase in fleas, due to warm and moist weather combined, the medical officers know that plague is likely to increase. The output of serum for innoculation is increased, and propaganda vigorously pursued urge the people to destroy rats and to bo innoculated. The preparation of serum is an elaborate business, and takes about a fortnight. A collar at the laboratory is filled with himdreds of largo glass flasks filled with broth, just plain soup made from goat’s meat and sterilised, in which a “culture of the deadly bacteria is in process of development. The culture may be seen ' growing downwards from the surface of the broth m long threads. Eash flask has been mnoculatod with a preparation prepared from an infected rat. arid when the culture is ripe it is killed by heating and dosed with carbolic acid in order to preserve it the preparation is then made up in small glass tubes for distribution over the country. Checks are applied at every stage to ensure that no foreign bacteria of a typo other than nlague have .found their way into the gerum*, for these might convoy other ailment*.

The dM injected as a preventative of the disease is a largo one. and the effects are unpleasant. The neighborhood of the injection becomes inflamed and sore, and the glands in the armpits and elsewhere become painful, while there is fever and acute headache for two or three days. Innoculation gives immunity for only six months, but a doctor who had himself had the disease informed the writer that it would be worth ■ while to be innocuiated 100 times in order to avoid the disease itself. Europeans ore much less liable to the disease than Indians, and with their better physique are able to shako it off more readily. Europeans are therefore seldom innoculated unless they are in direct contact with the disease. On one. occasion a plague rat vVas found dead on the writer’s drawing room carpet, and he then thought it time to be inoculated, more as an example to encourage the Indian servants to be done than for his own protection. Indians are now innoculated in large numbers, though some unfortunate accidents in the first experiments, which resulted in innoculation giving the cysease instead of preventing it, have loft a rooted suspicion in the minds of many of them.

A further activity of the Parel Laboratory is tho publication of large-scale pictures for the education of the illiterate public. Some of those show the dirty conditions which encourage rats, in contrast with a clean, neatlv-kept Indian home. A panicky man, who stays at home in terror when he hears of .a death nearby, is shown to be liable to tho disease, while the hopeful man who goes singing along the road is much less liable to get it. There is a whole series of pictures, rather melodramatic in style, blit they tell their own tale, and have had a great effect in fortifying the population against the disease. Much has been done, but much remains. Only a few years ago there were 100 deaths a day in Poona, a city of about 150,000 inhabitants. And there are still unsolved mysteries on the scientific side. The disease in India is almost entirely bubonic. But the far more deadly pneumonic type crops up here and there, apparently without any infection other than bubonic, and then disappears as mysteriously as it came.