NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
182
'The following is a short account of a morning's 'house-to-house
visitation in the Mahometan quarter of the 2nd Nagpada District, which
was personally conducted by the Committee assisted by Brrgade-Surgeon-
Lieutenant-Colonel Wier, the Chief Medical Officer of the Staff, on
March 24th.
Late on the evening, of the 23rd the Police Commissioner was asked to cord on
early on the morning of the 24th the district bounded by Bellasis Road, Parel Road,
Grant Road, and Duncan Road. 'This was done, and at 7a.m. several companies
from the 8th, 17th, 21st, and 22nd Regiments of the Bombay Light Infantry and a
company of the Dublin Fusiliers were marched up and distributed at convenient points
within the area above mentioned.
The Committee—
General Gatacre,
P. H. Snow, Esq.,
Surg -Major Dimmock, and
C. C. James, Esq.—
assembled at 8 a.m. at Messrs. Treacher's Shop, where they were met by the Commis-
sioner of Police, the Deputy Commissioner of Police, and Brigade-Surgeon-Lieutenant-
Colonel Weir. The Lady Doctors present were—
Also —
Mrs. Pechey Phipson.
Mrs. Slater.
Dr. Bernard, R.N.
Dr. Basset-Smith, R.N.
Dr. Sorabji Cawasji.
Miss Benson.
Miss Brennan.
Dr. Godinljo.
Dr. Pettigrew.
Dr. Kapadia.
The parties divided into two—the one under Brigade-Surgeon-Lieutenant-Colonel
Weir, and the other under Mr. James.
Mr. James party took Tank Street and Kazipura Street, Brigade-Surgeon-Lieut-
enant Colonel Weir's party took the east side of the Duncan Road as far as Kazipura
Street. Many chawls in Tank Street were inspected and proved to be of the dirtiest
character; among these was one occupied by several hundred Seedis (Negroes); in one
of the rooms a Seedi aged about eighteen was found suffering from plague. After the
doctors had certified to the disease, arrangements were made to fetch one of the new-
ambulances and, as there appeared to be considerable excitement among the Seedi
men and women, to draft in some armed police and military sepoys. The Commis
sioner of Police and his Deputy,who were present, deemed it desirable that the King
of the Seedis should be sent for to help to quell the excitement, which appeared to
be growing. On his arrival, he did exceedingly good work in helping to remove the
patient. It was evident that, without his help and without an armed force, it would
have been imppssible to remove this patient.
The inspection of chawls then
proceeded, but no other plague cases were found. The total work done by this party
was one plague patient found and three suspicious cases.
A most careful inspection of each house in Duncan Road was made by Dr. Weir's
party, who altogether examined 23 premises including very large chawls, some of
which were occupied by over 300 people.
Two cases of plague, both Mahomedans, were found and removed in ambulances
to the nearest hospital. It would have been impossible, unless supported as this party
was, to have removed the patients; while Brigade-Surgeon-Lieutenant-Colonel Weir
was posting the Police sepoys, large crowds collected in the streets, but they gradually
drew back after the Military came up.
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The new ambulances gave the greatest satisfaction, and the - patients appeal-oil
pleased to be put into them. From one house a patient was removed with great
difficulty through having to he carried down a staircase in a blanket. As each patient
was removed, the place in which he lived was disinfected.
Some of the houses inspected were so dark inside that lamps were indispensable.
Disinfection.
As soon as a plague patient was removed the Disinfecting
Inspector or his Sub-Inspector came on the scene with a supply of
perchloride of mercury, hot lime and other disinfectants, with pumps,
mops, brushes, buckets, tubs, &c.
All rags, bedding and clothes belonging to the patient, as well
as articles likely to have been infected and of little value, were removed
and immediately burned in the street ; the disinfection then proceeded
and was carried out as laid down in the following rules for the Inform-
ation of District Medical Officers :—
(a) All rags, bedding, clothes, etc., belonging to persons affected,
as well as all kutchra found in infected places, to be care-
fully removed and immediately burned.
(b) The infected place shall then be washed down thoroughly
with a solution of perchloride of mercury in the proportion
of 4 oz. to 30 gals. of clean water in a wooden tub or
bucket, a mop being used for all parts within reach, and a
wooden hand-pump for all parts beyond reach. In the
use of perchloride of mercury, it must be remembered
that it is a virulent poison. In dissolving it, a little com-
mon salt should be used.
(c) For the general treatment of the building the measures
hitherto adopted by the Health Department will continue
as usual.
(d) Sub-Divisional Medical Officers will see that this work is
thoroughly done, as the checking of the spread of the
disease depends upon it.
(e) Immediately on the drying up of the disinfected place, lime-
washing with quicklime laid on hot should proceed.
(f) Re-occupation of places so treated not to be permitted with-
out the sanction of the District Medical Officer.
(g) Disinfect the moree, nahani, privies and traps, scraping
such places as are likely to retain filth.
(h) Open out the roofs so as to admit light and air thoroughly.
The above rules not being deemed sufficient, the Committee early
in April considered it advisable to supplement them with a further and
more complete set, a copy of which is given below :—
" The Committee have noticed on occasions, when house-to-house
visitation has been proceeding, that sufficient care is not taken in regard
to the disinfection of rooms and bouses from which plague cases have
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been removed. The Committee, therefore, lay down a few simple
directions in regard to this matter.
1. Immediately a patient is removed from a room, the disin-
fecting staff should be ready and brought into operation.
2. All rags, bedding, clothing of the patient and kutchra
generally should be carefully lifted up and removed and
burned outside the building. In placing the articles out-
side, they should be carefully laid down so as not to raise
dust.
3. No brushing of walls or floor should take place ; this is a most
dangerous proceeding and is calculated to spread infection.
4. The first work in all instances is to flood the floor with a
solution of perchloride of mercury not weaker than 1 in
1,000, the junctions of floor and walls and all corners
should then be mopped with the solution, as well as the
wall, as far as the mop will reach, and above this a small
hand-pump should be used ; the floor, if made of earth,
should then be dug up to a depth of 4 inches.
5. All furniture that can be dealt with should be likewise
disinfected with, perchloride of mercury solution, either
wich a pump, or with a cloth dipped in perchloride
solution.
6. After the above work has been thoroughly done and the
solution has dried, quicklime in a hot state, and in as
strong a solution as possible, should be laid on all the
walls, floor and ceiling.
7. In the event of the whole house requiring disinfection, the
privies should be attended to first, not forgetting the
shafts, then the staircases and corridors should be operated
upon ; lastly the rooms in order, first by washing every
part with perchloride of mercury solution and laying on
the quicklime as described in paras. Nos. 4. and 6.
8. All nahanis and nahani pipes should be carefully disinfected
by flooding them with perchloride of mercury solution,
and, when necessary, they should be altogether removed
and replaced with new ones at the cost of the owner of
the premises."
In the case of the poor, a small money grant was made them
as compensation for articles destroyed. Property, the destruction of
which would inflict great loss on the owners, was moved out into
the road and left there exposed to the sun and air for three days, a
guard being placed over it. The contents of shops and godowns in
which cases of plague occurred were treated in a similar manner.
Besides the actual disinfection and limewashing of the inside
of the houses affected with plague, a steam flushing engine was
obtained and the outside of the premises were thoroughly washed down,
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and the gullies and drains and nahani· traps well flushed with disin-
fectants. Where 4 or more cases had occurred in one house, the place
was vacated and was not re-occupied until the District Medical Officer
was satisfied that it was free frorh infection. Where the house was in
such an unsatisfactory sanitary condition as to be unfit for human habi-
tation it was vacated, condemned by a Sanitary Board and marked
with the letters U. H. H.* Huts for accommodation of people who
were thus turned out of their houses had already been erected in
different quarters of the City by the Municipality.
Thus, not only were plague cases discovered by means of house-
to-house visitation, and the infection of the disease controlled and
prevented from spreading, but the dark, evil-smelling, ill-ventilated,
ill-drained, over-crowded lanes and alleys of Bombay were explored and
thoroughly cleansed.
The above describes the disinfection of merely individual
dwellings or rooms, but beyond this large disinfecting operations were
undertaken in whole localities both before or after the Committee was
appointed. At one time not less than 5,000 extra coolies were engaged
on this work alone. In Kamatipura a special gang of some 400 coolies
worked on lime-washing and other cleansing works throughout part of
December 1396 and the whole of January. Every house was lime-washed
to the number of 1,344, and something over 100 tons of fresh hot lime
were expended on the work. Dropping plague cases had been occurring
in Kamatipura since the end of September, but it was not until the
latter end of November that they became indigenous, and during this
period the Health Department had been giving the district a thorough
cleansing. Plan No. 8 is a chart shewing on a scale of 10 days to one
inch and 10 deaths to one inch the deaths that occurred in the district
on each day. From that chart it will be seen that until November
cases were probably imported from other parts of the City and were not
indigenous, and if Plan No. 2 is referred to, it will be noticed that
Kamatipura was epidemic in October, agreeing with Plan No. 8.
Group Nos. 1 and 2 are considered indigenous, while group No. 3
is considered to be epidemic.
During December and January the population of the district fell
to one-half.
The disinfecting operations were completed about the 10th of
February, after which date it will be seen that plague practically left
the district, and though cases occurred, it is clear that the disinfecting
operations brought about much good. Kamatipura is by virtue of its
low-lying position naturally unhealthy, and its houses are mostly dark,
damp and without ventilation, and most of them have been built on
reclaimed ground ; a more suitable place for the growth and spread of
disease could hardly be found.
Unfit for human habitation.
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186
In Daji Purbhoo's Wadi at Gharupdeo -in Tarwari, there are
some 90 houses containing a population of some 2,000 persons. The
houses are mostly (a wretched class of chawls) of kutcha construction,
ark, damp, with deficient ventilation and the surroundings very insanitary.
Most of the sewage of the place soaks into the ground. The
first recorded cases occurred on January 1st, the 2nd on the 6th,
and from that date onwards until the 14th February, 21 cases occurred ;
by that date all the inhabitants had left the Wadi. The usual cleansing
operations were carried out, all the houses being mostly thoroughly
lime-washed, and those in which cases had occurred, treated with
perchloride of mercury. The water was cut off in all the dwellings and
stand-pipes with taps erected from which open drains were constructed,
and all kutchra collected and burned.
The cleansing operations commenced on January 28th and occupied
two days and were most thoroughly done.
After the 29th of January the following cases occurred : 30th,
1 case ; 31st, 2 ; Feb. 2nd, 2 ; 3rd, 3 ; 4th, 1 ; 5th, 1 ; 7th, 1 ; 9th, 1 ;
10th, 1 ; 12th, 2 ; 13th, 3 ; 14th, 1.
This would appear to point out the fact that when the surround-
ings are hopelessly insanitary and where buildings are overcrowded
as they were in this Wadi, and have little or no plinth, and the rooms
contain no means of ventilation, except the door, sanitary operations
have little or no effect in stopping the disease, and that the only certain
treatment is segregation of the people and demolition of the buildings.
In Amba Wadi which is in the Mazagon District, there are
about 200 houses containing a probable population of 1,800. The houses
are many of them pucca built, rooms fairly dry, and light with ventila-
tion. The first case of the disease here occurred as in Daji Purbhoo's
Wadi on January 1st, another case was not reported until January 13th
and then 4 are reported : 13th 1, 14th 1, 15th 2. There was then an
interval of 10 days, the next case occurring on the 23th and 2 on the 29th.
On January 21st disinfecting operations commenced and were
completed on February 4th, from that date practically no cases occurred
although many houses remained occupied,
It is interesting to note in regard to the above three districts
that the virulence of the disease did not seem to be affected, as might
naturally be supposed, by the sanitary character of the houses or neigh-
bourhood, but it will be observed that in districts where the houses were
fairly sanitary and free from excessive overcrowding, cleansing opera-
tions showed distinctly beneficial results, while in the districts where
the houses were abnormally insanitary and overcrowded, similar efforts
were rewarded with little success.
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In connection with the above it may be interesting to note the
density of population in a few districts in the City :—
District.
Kamatipura ... ...
Dhobi Talao
...
...
Kumbar Wada ... ...
Khara Talao ... ...
Bhuleshwar... ...
Area in
Acres.
66
97
46
41
75
Population.
29,203
29,945
32,209
27,033
38,361
Density
per Acre.
441-5
407-7
699-3
649-3
506
in all of which districts plague raged with more or less virulence at
various times. In comparing this with the City of London it may be
mentioned that the greatest density of that town is probably not more
than 222 persons per acre.
Plans Nos. 11 and 11a show the progress of the disease in Worli
Koliwada. The events which accompanied the course of the disease in
this village are exceedingly interesting. Worli Koliwada is an isolated
village on a peninsula in the north of the Island ; it is inhabited almost
entirely by Kolis (fishermen). The number of houses in the village is
936, and the normal population is 5,493. The character of the disease
was marked by extraordinary virulence, over 90 per cent. of the
persons attacked dying, often after a few hours' iUness only.
The houses are mostly kutcha-built with cadjan roofs, which are
in many cases brought down so low as to render the inside very dark.
The streets are exceedingly narrow. There is no artificial drainage, but
good natural drainage exists from west to east ; the whole village is
open to the sea-breeze on two sides. During the months of October and
November 1896 there is no record of any case of plague having been
present in the village ; the first case being reported on December 1st.
The villagers were fully alive to the dangers of the disease and
of its getting into the village, and they took extraordinary precautions.
The three patels, headmen of the village, agreed among themselves as
far back as October to prevent strangers entering the village, by placing
watchmen at the entrances, and to allow no persons to proceed from the
village to any affected part of Bombay ; they even went so far as to
object to the usual Municipal coolies visiting the village for cleansing
purposes. But all this was of no avail, as a Koli (named Roza Maria
Creado), resident of the village, died on December 1st. No further deaths
occurred till December 11th.
Plan No. 11 is on a horizontal scale of four days to one inch and
a vertical scale of four deaths to one inch.
It will be seen that the deaths have been grouped Nos. 1, 2, & 3.
On plan No. 11a the deaths have been shown in the houses in
which they occurred by circles colored in the respective colors of the
groups (either 1, 2 or 3) which they represent.
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Group No. 1. which contains only one case, is shown by a red
circle on house No. 6, in which the woman lived and died.
Group No. 2 contains four persons ; they are shown on their
respective houses by yellow circles.
Group No. 3.—All the persons in this group are shown by green
circles encircling red spots.
By grouping the disease as on plan No. 11 and plotting on
No. 11a the cases· in their individual houses, it has been sought to throw
some light on the way in which the disease spreads.
There is no doubt that the village of Woli was at the time of the
outbreak of plague in a fit state to receive and propagate the germs of
the disease on account of the drainage of generations having soaked
into the ground on which the village stands, combined with the con-
tinual wastage of an ample water-supply.
No. 1 case, as shown on the plan, died in house No. 6 on 1st
December. There does not appear to be any connection between No. 1
case and the first death in No. 2 group which occurred on the 11th
December, but it is probable that No. 1 case in some way spread the
infection to some one in group No. 3, who lived in his vicinity, by some
means other than personal. In glancing at No. 2 group, it will be seen
in house No. 535 that two members of the group died and that two of
group No. 3 were affected and died in the same house, which points to
the strong probability of personal infection. In house No. 534, too, three
deaths occurred of aeighbours who lived in close proximity to three
members of No. 2 group. In glancing further at plan No. 11α, it will
be seen that in almost all cases the disease forms itself into groups. But
the chief characteristic of the disease in this village was its virulence
and the extraordinary short period in which it became epidemic. Usually
several warnings take place. first, sporadic imported cases exist per-
haps for a month, then a few indigenous cases occur and there is a
small outbreak, and then comes a lull in the disease, but in this instance
it was not so. Group No. 1 was an indigenous case and the first in the
village so far as is known. Group No. 2 consisted also of indigenous
cases ; and then group No. 3 commenced with three cases on December
18th, after which the whole village quickly became affected.
As regards the disinfecting operations : on 20th of January a
gang of 270 coolies were sent to the village ; they disinfected all affected
tenements ; limewashed all houses and removed all roofs in the village ;
cutchra was burnt ; the water was cut off from the houses, and standpipes
with drainage to the foreshore substituted, the whole work being com-
pleted as shown on Plan No. 11a on the 29th of January. By this date,
with the exception of some 176 of the inhabitants, all had left the village.
Many went to live in surrounding fishing villages, only it is feared to
infect them. Some 250 went by road to the Karli Caves at Lanowli,
189
where several cases of mild type took place after they had arrived, and
all recovered. Some 400 encamped near Worli village. Among these
no fresh cases occurred after the ten days' incubation period, although
these persons daily went to the village to get grain which was stored in
the village granaries. During the epidemic 139 cases occurred in the
village, nearly all of which proved fatal. On re-occupation of the
village in March, no further indigenous cases occurred. It will be seen
here that the course of the disease was most distinctly south to north.
From enquiries made in the village, it has not been possible to ascertain
that the advent of the disease was marked by any great mortality among
rats, such as is almost invariably the case.
Plans. Nos. 12 and 12a are, respectively, a chart shewing the
deaths which took place in the village of Sewree Koliwada, and a site
plan of the village itself.
The progress of the disease in this place has considerable interest
attaching to it.
Sewree Koliwada is a village in the north-east of the Island,
containing a population of some 600 Kolies (fishermen) inhabiting about
150 houses.
The first case reported in the village occurred on the 12th of
December, but it was not until January that the disease became epidemic.
The disease here, as in Worli, was marked with great virulence, nearly
every case being fatal.
Disinfecting operations were carried on all through December
and January in individual affected houses, but had little or no effect on
the spread of the disease. On the 27th of January these operations were
extended, and some 200 coolies were placed on the work ; they disin-
fected and lime-washed all and every house ; rags and kutchra were
burned ; all roofs were opened for ventilation ; and the place generally
had a thorough cleansing. This work lasted five days, and the spread of
the disease was checked. But, at the back of the village, there was in
December and January a long and narrow shallow pool of water. This
pool was daily largely used by the male population of the village for
ablutionary purposes in connection with defecation. Professor Hankin
in his researches at this village about the 24th January discovered the
plague bacilli in large numbers in this water. Upon this being known,
the pool was thoroughly disinfected with carbolic acid on or about the
27th January, and the whole field, which was littered with human excre-
ment, was cleaned up. It is possible that in this incident lies the crux of
the situation. Disinfecting operations apparently up to January 27th had
very little effect on the spread of the disease, and it may be conjectured
that its spread was fostered and maintained by the daily use of the water
in the pool, especially when we know that most of those affected were
males.
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