Dr. Viegas appears to have been the first physician to recognize the existence of the plague in the city. In a paper read before the Grant Medical Society on November 24, 1896, he discussed the possible and probable avenues by which the disease had found its way into the town. He stated that sugar and dates had been mentioned as means by which the plague was imported, but, if this had been the case, he thought it strange that the infection had not been conveyed from Bagdad and Bassorah, inasmuch as these articles come almost exclusively from those places. Again, it was thought possible that the clothes of the sick or of the dead from the plague in China might have been brought over to Bombay, but Dr. Viegas was unable to find any evidence in support of this theory. It had also been claimed that rats sick with the plague had come by ship from Hong Kong, and had infected the rats about the docks in Bombay. This theory, Dr. Viegas held, was not supported by any facts. In short, Dr. Viegas found some objection to every theory that had been proposed, and leaves us in doubt as to his own views concerning the avenue by which the plague reached Bombay. He is quite confident, however, that the filthiness of the city is to blame for the rapidity with which the disease spread.
In a report by Lieutenant-Colonel Weir on the plague in Bombay a statement is made that the disease was imported from Suez. Early in September, 1896, four very suspicious deaths were reported, but, as none of these had been attended by medical men, no definite conclusion could be reached concerning them. The first case was reported by Dr. Viegas late in September, 1896. The patient was a native who had not been out of the city for months. The first case reported among Europeans occurred on November 12, 1896. During the winter of 1896 and 1897 the disease prevailed most alarmingly, and reached its highest mortality during the week ending February 9, 1897, when the deaths from all causes in Bombay numbered 1,891. During the summer of 1897 the disease declined, and led to the belief that the measures that had been put in operation would prove successful. This hope, however, was not realized, and during the winter of 1897 and 1898 there was a recrudescence of the disease. During the summer of 1898 the disease again abated, to appear with renewed strength during the winter of 1898 and 1899. During the last week in March, 1899, the total number of deaths from all causes in Bombay reached 2,408, and the deaths from plague alone numbered more than 250 a day. It will be seen from these figures that the plague still rages with undiminished virulence in the capital of western British India. The abatement of the disease during the summer months and its increased severity during the colder season are not directly due to the effects of temperature. In the warm season many of the natives sleep out of doors, while during the colder weather they crowd into small, unventilated, filthy rooms. It is the opinion of practically all observers at Bombay that the recrudescence of the disease during the winter is due to this overcrowding.
Since the plague has prevailed at Bombay for nearly three years, it may be well to inquire concerning its probable continuance at that place. In making this inquiry we may learn something of the sanitary condition of the city and the habits of its inhabitants. Bombay is the metropolis of western India, and is situated on a long, narrow island running almost north and south. The city is located near the southern end of this island, with its harbor to the east and its sewage outfall to the west. Its population of about nine hundred thousand is a very mixed one, consisting of Hindoos of different castes, of Mohammedans, of Eurasians, and of Europeans. Differences in race, in religion, and in caste make it exceedingly difficult to carry out sanitary measures and to look after the sick. The mean temperature is about 79° F., and the relative humidity seventy-seven per cent. A considerable portion of the island is below high-water level, and consequently the sewage must be removed by means of pumps. The mean maximum temperature of the ground eleven feet below the surface is 84.9° F., and the mean minimum temperature is 80.9° F. It will be seen from these figures that organic matter must undergo rapid decomposition both on the surface and in the sewers. The water supply, which is said to be excellent, is so carelessly drawn upon by the natives that, although sufficiently abundant if used properly, it sometimes becomes scant. It not infrequently happens that the sewers will not carry the volume of water turned into them. For this reason, together with the tropical rains, the soil often becomes water-logged. Indeed, the surface in some sections of the city may be, not inappropriately, compared with a fermenting muck-heap. Besides the fixed population, there is a constant current of people flowing to and fro between the island and the mainland. When there is any opportunity for the employment of a large number of unskilled laborers, hundreds and thousands from the surrounding country pour into the city. These people know nothing of sanitary appliances, they lodge in the most densely crowded parts of the city, and often a dozen of them will hire a single room, not more than ten feet square, in which they eat and sleep. It is said that seventy per cent of the inhabitants of Bombay live in "chawls." These are tenement buildings of from five to seven stories high, built on the "flat" system. A narrow hall, at the end of which is a latrine, runs through each story, and from this doors open into rooms eight by twelve feet in area. In one of these houses from five hundred to eight hundred people live. These buildings are crowded together, with only narrow, dark alleys between. Into these alleys the inhabitants of the houses on both sides throw all kinds of refuse. In many parts of the city fecal matter is deposited in boxes or baskets, and these, when filled, are carried on the heads of scavengers to certain designated places and the contents dumped into the sewers. It may be of interest to note, in passing, that these scavengers seem to be largely immune to the plague and all other infectious diseases.
This is a brief description of the sanitary condition of the city into which the bubonic plague found its way nearly three years ago. How long is it likely to remain? Before attempting to answer this question we might ask what means have been employed to eradicate the disease. On October 6, 1896, the municipal health commissioner issued an order to the effect that all cases of the plague were to be segregated, their houses disinfected, by force if necessary, and their sick to be taken to the hospital. Health inspectors visited all parts of the city, and carefully went through the great tenement houses looking for those sick with the plague. When such were found they were immediately sent to a hospital. Later, four camps were prepared, with facilities for accommodating about twenty thousand people. An attempt was made to transfer all the residents from a certain section of the city to these camps, and detain them there while their residences were being disinfected. After this had been done these people were allowed to return to their homes, and another twenty thousand were taken to the camps. This attempt, however, was never fully carried out. A high-caste Hindoo prefers death at any time to association with one of inferior caste. Every attempt at segregation of the sick led to more or less disturbance; and finally, in March, 1898, serious riots resulted. These were begun by Mohammedans, who followed a medical officer to the hospital and burned the building and hospital supplies. A plague inspector and three English soldiers were stoned to death. Since the riots attempts at segregation of the sick have been practically abandoned. Numerous hospitals have been provided, in order that those differing in religion or in caste might be cared for at different places. Under certain restrictions those sick with the plague are allowed to remain in their homes. It will be seen from these statements that it is not probable that the plague will be driven by human agency out of Bombay. The Hindoos believe that when the plague finds its way into a city it will remain for six years. The probabilities are that this belief will be strengthened by the history of the present epidemic in Bombay. Nothing short of an extensive conflagration, destroying a large part of the city, can thoroughly disinfect this place, in which the plague has already dwelt for nearly three years. I think, therefore, that we must conclude that it is quite certain that for several years yet Bombay will remain an infected city.
When the plague was first announced at Bombay a large number of its inhabitants, estimated at about three hundred thousand, left the city. There can be but little doubt that with these the germs of the plague were carried into the surrounding country. From Bombay the disease has spread out in every direction, until it has found its way into nearly every part of India. To-day the three large commercial cities of British India—Bombay, Calcutta, and Madras—are all infected. The manner of the introduction of the disease into Calcutta is somewhat uncertain, several different accounts being given as authentic. Dr. Cantlie says on this point: "The first case dealt with and reported upon in Calcutta gives an interesting history. The patient, a lad seventeen years old, came from Bombay, where evidently he had been exposed to infection, as his sister, who accompanied him, had seen several cases of plague in Bombay. Fifteen days before leaving Bombay he had noticed swelling first in one groin and then in the other, but never felt ill until his arrival in Calcutta, on September 24th. He was seen and carefully examined in Calcutta by honest observers, and a diplobacterium identical with the Kitasato bacillus was found in his blood. Not only so, but the clinical symptoms of plague were most manifest."
Another authority would have it that the plague was brought to Calcutta from Hong Kong by a British regiment which had been engaged in cleansing infected houses at Hong Kong. On this point Dr. Simpson makes the following statement: "In January, 1895, the regiment went to Calcutta, and this disease was first diagnosed as syphilis, then as malarial fever with bubo, and finally the cause was declared to be unknown. In June, 1896, one of the medical officers of the regiment was attacked with fever, and the glands of the neck, axilla, and groin were all enlarged. A goodly number of similar cases were met with in the town; moreover, the rats became sick, and the grain stores swarmed with diseased and dead rats. In spite of opposite evidence, it was well-nigh certain that plague in a sporadic form had been in Calcutta since 1895 or 1896."
The bacillus of the plague has undoubtedly found Calcutta quite as well prepared for its reception as Bombay. In discussing a medical report on the sanitary condition of Calcutta, the Pioneer Mail makes the following statement: "London, with its population of over 4,000,000, has about 36,000 people to the square mile. In the thirteen wards of Calcutta there are only four below this figure; the remainder have from 46,000 to 144,000 per square mile, three wards containing actually over 100,000. Colootolah is most densely populated; the houses are literally crammed with people. One case is quoted where 250 persons were living in a space that should accommodate only 50. In a hut seven feet in length, breadth, and height five men were found, and several instances are given where similar conditions obtained. In our barracks 600 cubic feet per man is the minimum space allowed. In these bastis the space runs from 157 to 49 cubic feet. This would be bad enough if everything were clean and sweet in and about the huts, but, as the medical board puts the case, 'here we find an allowance per head going as low as practically one thirtieth of that given in barracks, and no ventilation, with filth ad libitum both in the room and in its surroundings, to say nothing of the filthy persons of its occupants, the sewage in the adjacent drains, and the accumulated filth in the neighboring latrines; and to this may be added the fact that the subsoil on which the huts are built is soaked through and through with sewage matters and littered with garbage and filth of all kinds.' The narrow gullies which give access to these huts are in keeping with the general character of the bastis, and we may well wonder that epidemic disease is not always present."
The probabilities are that the plague will continue in Bombay, Calcutta, and Madras until it dies out from want of susceptible material. It is not at all likely, with the conditions in these cities, such as have already been described, that sanitary measures sufficiently energetic to destroy the bacillus will be resorted to. For some years to come these cities are likely to harbor the infection, and will remain, as they are now, nurseries for the disease.