the mortal threat of a pandemic over 100 years ago in India

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This memoir explores life under the mortal threat of a pandemic over 100 years ago

Shanta Gokhale's translation of Lakshmibai Tilak’s autobiography includes the writer’s experience of the 1896 Bombay plague.

Gayathri Prabhu Published June 26, 2020

"I thought if Yama had a kingdom anywhere it had to be here. The place was terrifying, the night was terrifying, the surroundings were terrifying and the state of my heart was terrifying."

This kingdom of the dead, described as terrifying in every way, was the quarantine centre at Ahmednagar in Maharashtra at around 1900. The writer is Lakshmibai Tilak (1868-1936) whose remarkable autobiography Smritichitre (first published in Marathi in 1934) is accessible again thanks to an empathetic translation by Shanta Gokhale. Lakshmibai and her husband (the poet Narayan Waman Tilak) spent 18 days in this camp with their little daughter who had just been diagnosed with the bubonic plague.

The bubonic plague came to India in 1896 and lasted till around 1921, during which time an estimated 10 million people died in the country. The colonial administration responded with controversial and wide-ranging public health measures that were strongly resisted and debated by the native population. Lakshmibai’s writings record several experiences that readers in 2020 will be able to relate to — mandatory testing, quarantine, collective anxiety and grief, and chronic uncertainty.

Sustained outbreaks of virulent illness were not unusual for the colonial administration — cholera and malaria were among diseases that caused death in large numbers. But the bubonic plague at the turn of the 20th century was different in two aspects. First, it arrived not long after the emergence and acceptance of the germ theory of disease, so there was a clear identification of bacteria as the source of illness. Secondly, the nature of the spread of this pandemic (bacteria transmitted by fleas that live on rats) made it a disease of certain environments that impacted Indians more than Europeans (who had the means and access to better living conditions).

Historian David Arnold argues that the impact of these two aspects on the perception of the colonial authorities, and the nature of the sanitary and medical measures deployed against the bubonic plague (perceived by Indians as socially invasive), provoked an "unparalleled" and "profound crisis for Western medicine and for the power of the colonial state".

The outbreak

The initial outbreak of the bubonic plague coincided with a time of unparalleled and profound crisis in Lakshmibai’s personal sphere as well. She was 27 years old, and her husband had just converted to Christianity (in February 1895) causing a furore in their Chitpavan Brahmin community. It was a hard trial for the young woman who had already endured a difficult life — she had been married at the age of eleven, endured ill treatment at the hands of her father-in-law, suffered the assaults of a temperamental husband and mourned the deaths of two children in infancy.

But far from being a tale of woe, Lakshmibai’s autobiography reveals a feisty and outspoken temperament with the gift of wry humour. The suffering is nonetheless a part of her life script, especially when her husband becomes a Christian. It was the unthinkable horror for Lakshmibai’s orthodox family and they separate her (and her young son Dattu) from Narayan Tilak for nearly five years. This period of separation is testimony to the deep love and trust that she had shared with her husband despite his misdemeanours.

The couple is reunited when Lakshmibai decides to return to her husband (despite the fierce objection of the community) while continuing to maintain her Brahmin identity (and purity rituals). Living and traveling with her husband, Lakshmibai starts to question the ideas of purity that she has inherited. In due course, Lakshmibai asks to be baptised as well. She now has a second child and names her Tara. All these events in the Tilak household take place while the country is grappling with the vicissitudes of plague and famine.

Running away

Lakshmibai records her first awareness of proximity to plague with characteristic humour. "Although no Brahmins came to eject us from our home, Lord Ganapati, the remover of obstacles was very much with us. He ordered his vehicle, the Rat, to arrange for our eviction." The family notices two rats come out to eat the ritual offerings to the gods. "Ahmednagar rats are not scared of anyone, we said to ourselves and got up." But then the rats spin around and fall dead.

The rats are sent for testing and found to have plague. The family moves to Rahuri and later to Mahabaleshwar by bullock-cart, after doing a ten-day quarantine in a hut. Lakshmibai recollects these experiences in a matter-of-fact manner. Plague or not, the business of life (jobs, family responsibilities, personal aspirations) cannot come to a halt. The family soon returns to Ahmednagar.

Lakshmibai writes of her keen interest in home remedies and native medications. Her desire to "study something that would help me in difficult times and also be useful to others" motivates her to undertake and clear a three-month training as a nurse. At this point, Ahmednagar is experiencing another sudden outbreak.

Inoculation was newly available at that time but several people, including her husband were against it. He forbids it for their children and sends their son to Rahuri. Lakshmibai decides to get the inoculation and has to deal with the discomfort of a swollen arm. Rats re-appear in her house and her daughter develops a high fever. The doctor takes one look at Tara and announces it to be plague.

"Tara’s screams reached fever pitch. There was no money for carts and no manservant to fetch them […] the news of Tara’s plague had got around. Nobody dared enter our house." Lakshmibai manages to get back some money she had lent in the past and arranges for a bullock-cart even though no driver was willing to ferry a plague patient. They finally leave for the quarantine centre in the pitch-dark of the night.

It is winter and they are freezing. At the centre they have only icy water and dry jowar bhakri to eat. Their first night at the camp is the night of the dead that Lakshmibai describes. "We were surrounded by the sick. They screamed and beat on the tin walls. At times, a patient would climb on to a wall and jump with a loud thud into the neighbouring room. The floors of the cottages had not been levelled. When you walked, pebbles bit into the soles of our feet. There was no food in our stomachs and no sleep in our eyes."

A poignant episode

Lakshmibai tells us that only 10 per cent of plague victims survived. Everyone shared the same glass of medicine and thermometer in the quarantine camp, but she kept a separate set for her daughter. After fourteen tormenting days amidst ill and dying people, the Tilaks are told by the doctors to prepare for their child’s inevitable death. This is one of the most poignant sections of her autobiography.

Lakshmibai plasters Tara from chest to stomach with a poultice of flax seed flour that she cooks on the stove, and then coaxes the child to swallow warm castor oil with milk and sugar. She writes:

"I placed the stove by her feet. I wrapped her up in a blanket. Then I said to her, 'Now you are free to die. I didn’t want to feel I had left anything undone.' I shut the door, left her alone in the room and walked far away into the jungle. When I saw I was completely alone, I shouted out to god, 'My lord, please let this child live. She is not my child. She is yours. You gave her to me. I only nurtured her. If it is your will, You will take her. But if she recovers, I will stay here to care for other patients.' Then I let myself go. I howled."

When Lakshmibai returns to her child’s room, her heart is filled with fear and she has to force herself to open the door. To her surprise, Tara speaks to her. The doctors are astonished by Tara’s recovery and the family is able to leave the camp after 18 days.

This experience convinces Lakshmibai and her husband to return to serve plague victims languishing in quarantine. They live in a hut inside the camp and work hard at various tasks, including sorting out irregularities in the camp provisions, tending to personal needs of patients, sweeping the camp, and lifting corpses onto carts.

This deep awareness of service and reflection is woven through Smritichitre, a sparkling record of an unconventional, eventful and courageous life. Lakshmibai Tilak began writing a biography of her husband (requested by her son) but it soon turned into an autobiography that took seven years to write and was published in four parts from 1934 to 1936.

In the hands of an intuitive translator like Shanta Gokhale, we are able to get a sense of the pace, wit and warm tonalities of Lakshmibai’s inimitable voice. Though the bubonic plague only appears in a few chapters of the sprawling autobiography, to read Smritichitre today is to have a better understanding of how pandemics shape communities, and how individuals forge ahead with erratic hope.

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The header image shows a segregation camp in Bombay. — Clifton & Co, c 1903.

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This article originally appeared on Scroll.in and has been reproduced with permission.

   

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Why Make in India matters 🇮🇳

 

Mercury as treatment_‘One night with Venus, a lifetime with Mercury’.

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The history of syphilis part two: Treatments, cures and legislation

Published:

For over four hundred years after its dramatic appearance in Europe in 1495, there was no cure for syphilis and treatments were both few and largely ineffective. 

Treating syphilis

Syphilis was such a deeply unpleasant disease that many were prepared to endure harsh treatments in the hope of achieving some relief from it. 

Guaiacum, also known as ‘Holy Wood’, was probably the first significant treatment. Preparations made from this plants’ resinous gum acted as purgatives – inducing sweating, vomiting, diarrhoea and urination. It was hailed as a ‘blood cleanser’, flushing the sickness out of the body. For many years large amounts of the drug were shipped into Europe from South America, but it gradually fell out of favour as it became clear that ultimately, it just didn’t work!  Its place was taken by the substance that would dominate the treatment of syphilis for centuries – mercury. 

Science Museum Group

Earthenware drug jar for guaiacum wood, Spain, 1730-1770.
Science Museum Group

“One night with Venus, a lifetime with Mercury.”

The pioneering Swiss physician Paracelus (1493-1541) was advocating mercury as early as 1530 and it was already used to treat other diseases – including leprosy.  As mercury use increased, different methods for administering it emerged. It could be applied to the skin as an ointment, swallowed as a pills, drunk as an elixir or even injected in solution. Fumigation therapies also became popular, during which syphilitic patients might sit in an enclosed space exposed to mercury vapours for days at a time. One method even involved the patient sitting atop a commode beneath which a block of cinnabar (a naturally occurring mix of mercury and sulphur) was placed on a hot iron. Either way, such treatments were often expensive and thereby restricted to the few who could afford them. A disease that may have been caught during a brief sexual liaison could result in months, even years of such treatment regimens – hence the popular phrase ‘One night with Venus, a lifetime with Mercury’.

Like guaiacum, mercury prompted bodily reactions that might suggest disease was being purged out of it. Again, patients would  sweat profusely and produce excessive amounts of saliva and urine. But with no modern clinical studies of this historic treatment, any positive effects of mercury are hard to assess. Some historians think that it may occasionally have halted the disease in the first stage and sometimes reduced the impacts of the deadly third stage. However, it seems more likely that any of the ‘cures’ associated with mercury treatment were largely down to the natural dormant phases of the disease. Mercury is also highly toxic, so could cause dreadful side effects. These included organ failure, nerve damage, tooth loss and severe skin ulcers. Numerous patients died as a result of the mercury treatment they were receiving rather than the disease itself. Despite such risks, mercury would remain a popular treatment for syphilis from the 16th century, through to the 19th and even into the early decades of the 20th.

One night with Venus a lifetime with mercury Gallery

‘The Martyrdom of Mercury’ – syphilitic patients shown undergoing various mercury-based treatments, London, 1709.

© Wellcome Collection

Earthenware drug jar for mercury pills, Italy, 1731-1770.

Science Museum Group Collection

Science Museum Group Collection

Syphilis in the Victorian era

By the mid-Victorian period, the health and behaviours of citizens and the consequences these could have on wider society were subject to growing interest and intervention. Both to those in authority and those campaigning for social reforms. In the UK, syphilis remained a serious ongoing health crisis in the eyes of the medical community, but one that continued to be viewed as symbolic of a wider ongoing moral crisis. One that was closely associated with another great ‘social evil’ – prostitution. The two were certainly linked, but any public blame for the spread of syphilis tended to be one-sided. Where there was sympathy, it was largely with the male clients rather than the predominantly poor, working-class women who had often turned to prostitution to make ends meet.

© Wellcome Collection.

Young woman with syphilis, 1898. © Wellcome Collection.
© Wellcome Collection. Image source for Young woman with syphilis, 1898. © Wellcome Collection.

Medical statistics on the number of syphilis cases across the population further raised the alarm. However, it was the impact of syphilis and other sexually transmitted infections (STIs) on the British armed forces that was of most concern. So much so, that it prompted one of the most notorious pieces of Victorian legislation. Authorities had become convinced of the need for action, for what they described as the ‘sanitary supervision of common prostitutes’.  Not only subjected to moral judgement, they wanted these women to be subjected to official control and regulation. 

© Wellcome Collection

Two men are approached by a prostitute, depicted as a clothed skeleton holding a painted mask, France, 1830.
© Wellcome Collection Image source for Two men are approached by a prostitute, depicted as a clothed skeleton holding a painted mask, France, 1830.

The Contagious Diseases Acts

The Contagious Disease Act of 1864 aimed to control soldiers’ and sailors’ relationships with prostitutes as a way of reducing levels of STIs. But under the Act, the powers of which were extended in the following years, women were the sole target. It allowed for the registration, arrest and invasive medical examination of any woman suspected of being a prostitute. If found to be carrying syphilis or other venereal diseases they would also be confined to special medical institutions – known as ‘lock’ hospitals – sometimes for many months. Those refusing to be examined faced up to six months hard labour in prison. The Act required no such compliance by any men.

The legislation became a focus of protest for social reformers, but also ordinary members of the general public outraged by the draconian ways it treated women. After several years of campaigning, the Acts were finally repealed in 1886, by which time public disapproval was shifting more towards the often affluent men who were continuing to exploit impoverished women.

Wikipedia Commons

Poster advertising a public meeting in Wigan to promote the repeal of the Contagious Diseases Act, 1881.
Wikipedia Commons Image source for Poster advertising a public meeting in Wigan to promote the repeal of the Contagious Diseases Act, 1881.

New understanding and new treatments

The decades from the 1880s through to the 1930s saw great strides in the scientific understanding of disease. A key moment for syphilis came in 1905 with the identification of the bacteria responsible by German scientists Fritz Schaudinn and Erich Hoffmann. The following year, an antibody test for diagnosing syphilis was developed by another German – August Paul von Wassermann. Although results from the Wassermann Test could be ambiguous, from the late 1930s many US states introduced regulations requiring couples applying for a marriage licence to take the test. A licence would only be issued if both were syphilis-free. Not until the 1970s did such laws begin to be repealed and only in 2012 did the last state, Mississippi, no longer required these premarital blood tests. Today, they still remain in place in several countries around the world.

With better understanding of the disease came more effective treatments. Arsphenamine, a drug originally known as ‘compound 606’, was first created in 1907 in the laboratories of Paul Ehrlich. Two years later, one of Ehrlich’s research team – the Japanese scientist Sahachiro Hata – observed its anti-syphilitic properties. By 1910, it was being marketed as Salvarsan, effectively the first real cure for the disease.

Ehrlich believed it fulfilled his concept of the ‘magic bullet’ – a drug that could kill specific micro-organisms without harming the body itself. Not that Salvarsan couldn’t have some pretty nasty side effects, such as liver damage, headaches and vomiting. It was also quite an unstable drug, which medical staff found difficult to prepare. And while effective against the early stages of syphilis, for those in the final tertiary stage its impact was limited. Despite such limitations it remained the treatment of choices until the 1940s

New Treatments

Test tube for Wassermann test in wooden case, British, early 20th century 

Science Museum Group

Poster reminding Americans to be examined for sexually transmitted diseases before marriage, c1944.

Wellcome collection

Science Museum Group Collection

Science Museum Group Collection

Three life-size wax legs showing stages in the successful treatment of ulcers caused by secondary stage syphilis with Salvarsan, probably made in Germany, 1910-1920 

Science Museum Group

‘A Cause of Military Inefficiency’

The repeal of the Victorian Contagious Diseases Acts was celebrated by many, but the stated reason for their introduction remained a problem. Syphilis and other venereal diseases – such as gonorrhoea – continued to be a drain on military resources. And despite the arrival of more effective treatments, across the fighting nations it was a major cause of missing manpower in both the First and Second World Wars.

Booklet, "A cause of Military Inefficiency", on venereal disease, issued to First World War troops

Science Museum Group Collection More information about Booklet, "A cause of Military Inefficiency", on venereal disease, issued to First World War troops

Between 1914-1918, there were over 400,000 hospital admissions from the British Army for venereal diseases, including syphilis. It’s been estimated that around 5% of all those who served in Britain’s forces during the war became infected – taking each of them away from their duties for potentially several weeks at a time. Syphilis was the most serious venereal infection, but if treated early with Salvarsan its harmful effects might be limited. As such, men were not so much punished for contracting it, but rather for concealing they had it.

During both wars the realities behind the high levels of infections in the military could not be ignored. But be it through dire warnings of the moral and physical consequences of a lack of self-control, the rollout of health education programmes and early treatment centres, fines and imprisonment or the provision of licensed brothels and free condoms, military authorities trod an inconsistent path when confronting the issue.

Science Museum Group Collection © The Board of Trustees of the Science Museum CC-BY-NC-SA 4.0

Calomel tablets in wrapping paper, German military issue, 1917. Calomel (Mercurous chloride) was used to treat a number of illnesses, including syphilis, from the 1800s onwards. During the First World War it was mainly used as an antiseptic and laxative during the, but given the high rates of venereal diseases in the military it proved useful in that context too.

The arrival of Penicillin

The development of penicillin during the Second World War had a dramatic impact on the syphilis story. By 1947 it was the standard treatment and a highly effective cure, with the antibiotic reducing case numbers in the UK by 90% within ten years. But it was the withholding of this cure that was central to a clinical study that became a byword for racist and unethical experimentation. The Tuskegee Syphilis Study ran from 1932 to 1972 and involved nearly 400 impoverished African-American men living in the US State of Alabama. The men had been diagnosed with latent syphilis, meaning they had the infection but were yet to show obvious symptoms. The purpose of the study was to follow the effects of the disease when left untreated. Not that the men were ever informed that they had syphilis, they were simply told they had ‘bad blood’. 

For taking part, the men got free meals and medical treatment for minor ailments at Tuskegee University’s clinic. Although any treatments for their ‘bad blood’ were actually placebos or mineral supplements, even after the arrival of penicillin. Nothing was to interfere with the research, and it was even ensured that men drafted for Second World War service stayed at home to remain part of the study instead.

Science Museum Group

Glass ampoule of penicillin powder, United States, 1942-1943.
Science Museum Group

Following a public outcry, the study was finally ended in 1972. In the course of four decades, over a 100 men had died of the disease or related complications while 40 wives had been infected and over a dozen children born with congenital syphilis. Barely 70 of the original participants were still alive. They eventually received some financial compensation and in 1997, then US President Bill Clinton finally gave an official apology, declaring that “what the United States government did was shameful”.

Wikipedia Commons

Researcher drawing blood from a patient as part of the Tuskegee Syphilis Study.
Wikipedia Commons Image source for Black and white image of doctor drawing blood from a patient as part of a syphilis study

The persistence of syphilis

Wellcome Collection

Information card handed out in nightclubs promoting syphilis testing and treatment, France, 2000s.
Wellcome Collection Image source for Sexual health poster in french waring people about syphilis and to be cautious.

The ‘Great Pox’ and mercury ‘cures’ may seem like ancient history as cases of syphilis are considerably fewer now than in pre-penicillin days. But across much of the world those numbers have been on the rise again. Globally, over 7 million new cases were reported in 2020, and in 2023 the UK recorded its highest levels for 75 years. Penicillin remains an effective cure, but there seem to be a range of factors contributing to this ongoing increase.

The disruption to general health services and in particular to STI prevention resources during the COVID-19 pandemic is believed to have had a major impact. Likewise, inequalities in testing access, language barriers and the traditional stigma associated with syphilis may also explain the far higher rates in minority and immigrant groups, who often live in the most impoverished urban areas. Women in such communities are particularly vulnerable and cases of congenital syphilis in their children have also increased significantly.

Inevitably, personal behaviours are still central to the global status of syphilis. For example, researchers have recorded sharp rises in cases amongst men who have sex with men. They propose this has much to do with a reduction in condom use, which for many years has been a key form of protection against human immunodeficiency virus (HIV), the virus that can cause another STI – AIDS. A result of HIV increasingly being seen as a manageable, chronic condition rather than the untreatable disease it once was. Similarly, recent research in Japan has suggested a direct link between rising syphilis cases and the increased use of dating apps by young heterosexual men and women.

Today syphilis can be cured, but it hasn’t gone away.

More Stories

The history of Syphilis Part One: cause and symptoms

In 1495 a syphilis epidemic swept across Europe. Before there were effective treatments, the symptoms and progress of syphilis could be both gruesome and terrifying.

Preventing infection: lessons from the past

While the search for new antibiotic drugs continues, scientists and medics are taking inspiration from past treatments and approaches to limit infection. 

Bubonic plague: the first pandemic

The impact of the bubonic plague epidemics of the past still echo across the centuries, reminding us of the devastation that disease can inflict on communities.

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