Cholera and its treatment by preventive inoculation in the Darbhanga Jail1

During a recent severe epidemic in the town of Darbhanga, cholera broke out in the jail. At first limited to an isolated case, the disease became established in a few days – not by the occurrence of several cases in one particular barrack or ward, but by single scattered cases being furnished by every building in occupation. The cause of the first case was distinctly traced; the affected prisoner, contrary to strict orders on the point, had drunk water from the jail tank, which, on a previous occasion, twenty months ago, had given rise to a mild outbreak of cholera. This water was examined by Surgeon-Captain Green during the recent epidemic and was found teeming with comma bacilli. No connection could be traced between this case and the subsequent ones; there was no possible chance of propagation by contact in cases 1 and 2, 2 and 3, or 1 and 3; these prisoners were as far apart, as they could be, occupying different wards at night, and being in no way associated during the day. Case no. 1 had been employed in the outside garden; No 2 had been making string in the B class yard, and No. 3 had been an inside mehter in the A class. Case No. 1 occurred on the 31 March, No. 2 on the 3, and No. 3 on the 6 of April. On the evening of the last-named day a fourth case occurred from ward No. 3, in the B class barracks, and here, again, no connection could be established between that and the previous cases. After this the admissions for cholera became numerous, there being one on the 7, another on the 8, and two on the 9. There were thus eight cases up to the 9 of April; and, of these, the first seven had occurred in as many different wards in the jail. This seemed to clearly indicate not a general contamination of the food or the drinking water, but a dissemination of the poison by some agency in such a manner as to infect separate individuals or localised spots; and this dissemination, as Dr. Macrae of Gaya suggested not long ago, might have been caused by flies which, having come in contact with a cholera evacuation, happened, subsequently, to alight either on a plate of food or a vessel of water, contaminating it. As so many of the buildings had furnished cases, it seemed probable that there might be a general outburst of the disease at any moment, so it was decided to evacuate the jail, and, on the 10 April, 172 prisoners were moved into camp twelve miles away, 53 being left behind, these being the sick in the jail hospital, the patients in the cholera huts, with their attendants, the old and infirm and a few cooks and sweepers. Three fresh cases occurred in camp on the 10, and one in the jail; on the 11, at 2 and 4 AM., respectively, two further cases were reported in camp, the total number up to date having been 14, of which 10 had proved fatal. At 7.30AM., on the 11, Professor Haffkine and Dr. Green arrived at the camp and proceeded to make arrangements to inoculate such as were willing to submit to the operation. The prisoners were spoken to on the subject and seemed to be pleased with the idea, the word tika, which was familiar to them from its association with small-pox (inoculation), appearing to appeal to them. They were, accordingly, arranged sitting in four rows facing the tent, in front of which Dr. Haffkine was about to commence operations. I was the first subject to be inoculated and, after me, the Jailor, Assistant Jailor, Hospital Assistant and three warders. The first prisoner in the front rank was next brought up and submitted cheerfully, after which every alternate man was taken, so that no selection of cases was made until one-half of the total number were inoculated. As each man was finished with, he was taken to a place away from his original position, and, at the conclusion of the operations, there were two distinct bodies of prisoners, the inoculated and the uninoculated, numbering 83 and 81, respectively, and, subsequently, three more were added to the former list, one being an attendant on cholera cases, and two being patients with diarrhœa. Those who had not been inoculated were far from pleased at having been passed over; and, to our 1 Brown EH. Cholera and its treatment by preventive inoculation in the Darbhanga Jail. Indian Medical Gazette, July 1896. 247-250 Published by Oxford University Press on behalf of the International Epidemiological Association