NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
344
Measures in the Bombay Presidency and Sind. [App. Ví.
was the removal of sick persons from the city into the surrounding
villages. I believe that this practice did much to lower the general
mortality of the city, and it certainly accounts to a great extent for
the exceptional lowness of the mortality from causes other than plague
during the period from 21st April to 20th May. Accepting 2,901 as
the total plague mortality of the city,—and I think the figure is well
within the mark,—we find that the plague claimed 24 per mille of the
registered population as victims.
10. In tracing the progress of the epidemic it has to be firmly
borne in mind that till the latter part of April our record of plague
attacks and plague deaths was very incomplete. Evidence of its rise
and fall must, therefore, be looked for in the variations in the total
mortality, and in this connection we ask attention to the abstract of
Appendix 38, which has already been given. From the last column of
that abstract it will be seen that the recorded mortality rose steadily
from the first period of December to the first period of March with
only one interruption, and that there was a continuous decline in all
subsequent periods. In connection with this it must be explained
that before the plague operations came under European control the
death registration was carried on very irregularly by the municipal
staff. On the last day of each month a number of deaths were brought
on to the register, which had been reported by the municipal subordi-
nates and policemen, some of which had occurred weeks before. Further,
deaths were not registered at all on days when the Municipal Office was
closed, deaths which should have been registered on such days being
brought to account subsequently. It is owing to these two causes
combined that the registered mortality was lower in the first period of
January than in the last period of December. I see no reason to believe
that there was any real interruption in the increase in the mortality
between the first period of December and the first period of March.
Up to the middle of January that increase was assisted by a continuous
increase in the population of the city. From the beginning of Feb-
ruary it went on concurrently with a decrease in the population. The
mortality from all causes reached its highest point on 10th March,
when a fall set in,
11. It will be seen from the abstract that the total mortality in the
second period of March was smaller than in the first period of that month
by 98. This decrease is chiefly due to the fact that it got known in the
city that house-to-house inspection by the military would commence on
I3th March. During the few days before that date, thousands of people
including many sick left Poona, which naturally had its effect on the
mortality within city limits. The increase in the number of removals
APP. VI. ] Measures in the Bombay Presidency and Sind.
345
to hospital which began, when the military search parties started work,
cannot have had much effect on the mortality as early as 2oth March,
The small decrease in the mortality that occurred in the third period
of March is, in our opinion, due to the plan of campaign beginning to
take effect on the epidemic. After the end of March the decrease in
the mortality was rapid, and by the end of April the plague was no
longer of the dimensions of a severe outbreak. By 19th May, when
the house-to-house inspection was brought to a close, the disease may
be said to have become sporadic.
Poona Suburban Municipality.
12. The population within Poona Suburban Municipal limits, accord-
ing to the census of 1891, is 6,706, exclusive of passengers enumerat-
ed at the railway station. The area is 3.75 square miles, and 1,788
persons per square mile, represents the density of population. A
statement of the daily plague attacks, plague deaths and total mortal-
ity from 2nd October 1896 to 20th May 1897 will be found in Appen-
dix 41. The monthly mortality during the period of the epidemic
is contrasted with the mortality in previous years in Appendix 42.
Particulars of the extent to which the various castes and nationalities
were attacked is given in Appendix 43.
13. The following summary of Appendix 41 contains particulars of
the plague and general mortality in each month of the epidemic :—
Month.
October
...
•..
November
December
January
February
...
March
.,,
April
May 1st to20th
TOTAL
PLAGUE ATTACKS.
Imported.
6
1
45
89
57
20
32
5
255
Local.
...
...
...
4
8
7
1
20
Total.
6
z
45
89
61
28
39
6
275
Plague
deaths.
6
...
33
55
35
16
17
2
164
Total
mortality.
47
34
83
107
66
66
66
34
503
b44
346
Measures in the Bombay Presidency and Sind. [APP. Vi,
The first cases of plague occurred on 2nd October and were imported
from Bombay. No local case occurred till 21st February, and the
disease never took a firm hold of the suburban municipal area.
The
reasons of this probably were the absence of overcrowding and the
comparatively good sanitary condition of the majority of the houses
within suburban limits. Mr. Plunkett noticed that the majority of
indigenous cases occurred in damp areas and near irrigation channels.
14. The bulk of the imported cases were those of persons found at
Poona railway station to be suffering from plague. It is worthy of
note that up to the end of February all the imported cases, 198 in
number, came from Bombay. From Appendix 42 it will be gathered
that the death-rate in ordinary seasons is extremely high in proportion
to the population. This is due to the fact that the Sassoon Hospital ;
which is the general hospital for the whole of Poona, is situated within
suburban limits. The abnormally high mortality that has prevailed
since December 1896 is in great measure accounted for by the inclu-
sion in the returns of imported plague cases which proved fatal. It is
not believed that any considerable number of plague deaths have been
registered as due to other causes in suburban limits.
O
Poona Cantonment.
15. The population of Poona Cantonment, according to the census
of 1891, is 35)O94. The area is 4.25 square miles, and 8,257 persons
per square mile, represents the density of population. A statement of
the daily plague attacks, plague deaths and total mortality from 1st
December 1896 to 20th May 1897 will be found in Appendix 44.
The monthly mortality during the period of the epidemic is contrasted
with the mortality in the corresponding months of previous years
in Appendix 45. Particulars of the extent to which the various castes
and nationalities were attacked is given in Appendix 46. The following
summary of Appendix 44 contains particulars of the plague and general
mortality in each month of the epidemic: —
Month.
December
..
January
..
•••
February
..
March
Aprill ...
..
May 1st to 20th
..
TOTAL
PLAGUE ATTACKS.
Imported.
...
3
2
9
1 1
...
25
s
Local.
...
5
63
75
20
163
Total.
...
3
7
72
86
20
:S8
Plague
deaths.
...
4
44
64
18
130
Total
mortality.
36
57
67
97
107 -
47
411
APP. VI. ] Measures in the Bombay Presidency and Sind.
347
16. In addition to the cases shown above one imported plague case
occurred on November I2th and proved fatal. Including this case the
total recorded plague mortality within cantonment limits was 131. No
local case of plague is known to have occurred before 9th February
1897, and it was only in the month of March and April, after the
adjoining parts of Poona City had become badly affected, that the can-
tonment suffered at all severely from the epidemic. The greater part
of the Poona Cantonment is occupied by military lines and bungalows,
where a filth disease like plague would not be expected to gain a
footing. The bazar portions of the cantonment are, however, thickly
populated, and it is there that the majority of the indigenous cases of
plague occurred.
Death Registration arrangements.
17. The registration of all deaths that occurred was a point to which
the Plague Committee attached the utmost importance, The subject
was one which had not received the attention it deserved in Poona City
up to the time of the appointment of the Plague Committee, and the
bye-law relating to the giving of information of deaths by the people
had not been enforced by the Poona City Municipality. In practice
information of the occurrence of deaths used to be collected by
the road-sweepers who were paid a quarter of an anna for every death
reported at the Municipal Office. The ward mukadams and inspectors
had orders to check the information so obtained, and police con-
stables on duty in the city had orders to collect information about
domestic occurrences to serve as a check on that collected by municipal
agency. During the five years 1891-92 to 1895-96 the registered mortal-
ity had been at the rate of 27 per mille on the census population of
1891, and it is likely that about one quarter of the deaths occurred
used to escape registration.
18. Nos. 17, 18 and 19 of the rules published in Government
Notification No l272/765-P of 9th March 1897 gave the Plague Committee
power to enforce more accurate registration of deaths than had hitherto
taken place. From the time the military operations commenced,
registration clerks were kept on duty from 6 A.M. to 10 P.M. daily
within city suburban and cantonment limits to register deaths of which
information was given under rule 17 and to grant certificates of registry.
At the same time mukadams were posted at the principal burning and
burial grounds with orders to collect death registry certificates from
funeral parties, and to hand over a member of the funeral party to the
police if no certificate was forthcoming. Instructions were given to
all policemen on duty to examine the certificates of all funeral parties-
which passed them and to detain a member of the party when no certi-
ficate was forthcoming in order that inquiries might be made as to
348
Measures in the Bombay Presidency and Sind. [ APP. VI.
where the death had taken place. The arrangements made were duly
notified to the public,
19. The startling decrease which took place in the mortality of
Poona City during the month of April led the Committee to entertain
a doubt whether deaths were not escaping registration. Accordingly,
with a view of increasing the efficiency of the death registration
arrange m ents, a British officer was placed in charge of them from
April 26th. The actual work of death registration was entrusted to
native officers, and the mukadams stationed at the burial and burning
grounds were replaced by men from the native infantry. Sowars
were told off to inspect daily the smaller burial-grounds where it was
not wor th while maintaining permanent posts. I am confident that
since these changes have been made very few deaths have escaped
registration, while the number that went unregistered before April
26th was probably inconsiderable. The arrangements made for veri-
fying the addresses at which deaths occurred have been noticed in
describing the work of the fumigation parties.
20. In suburban and cantonment limits, where the death-rate
never reached the height it did in the city, arrangements for the
medical examination of corpses of persons who died in places other
than hospital were made at an early stage of the operations. This had
the effect of keeping down the number of houses which had to
be disinfected and their inmates segregated, since when the examina-
tion showed that death was not due to plague disinfection and segre-
gations were inapplicable.
21. In the city, owing to the calls upon the time of the medical
officers employed, a system of medical examination of corpses was
not introduced till May 19th, when the work of the search parties
stopped. Since that date it has been performed by Surgeon-Captain
Beveridge, and has had the effect of saving the public from much
inconvenience. A copy of the notification which was issued regard-
ing the medical inspection of corpses is given in Appendix 47.
22. By this system of inspection of dead bodies by a medical man,
combined with efficient death registration arrangements, it is improbable
that any considerable number of deaths from plague can escape the
notice of the authorities, and the enforcement of disinfection and segre-
gation in all doubtful cases which it renders possible should go far to
prevent a recrudescence of the epidemic.
XII.—INSPECTION OF IN-COMERS AND OUT-GOERS,
This subject may conveniently be dealt with under two heads-
inspection at railway stations and inspection on roads.
APP. VI. ] Measures in the Bombay Presidency and Sind.
349
Inspection at Railway Stations.
2. In consequence of the appearance of plague in Bombay, the
Managing Committee of the Poona Suburban Municipality resolved, on
the 29th September 1896, to post a medical man at the Poona railway
station to watch passengers arriving from Bombay by railway and to
send any found to be suffering from plague to the shed provided for
the purpose in the Sassoon Hospital compound, A medical man was
accordingly posted at Poona station from 3oth September 1896 with
two peons to work under him. He was instructed by the then Deputy
Sanitary Commissioner Surgeon-Major Street as to how he should
examine persons suspected to be suffering from plague, and directed
to advise them to go to the Sassoon Hospital, and in the case of
their refusing to do so to ascertain their destination and communicate
it to the authorities concerned.
3. On 28th December the inspecting staff was increased to two
medical men and four peons, who met all the passenger trains arriving
from Bombay. On January 31st the inspecting staff was authorised to
compel sufferers from the plague to go to the Plague Hospital. From
February 2oth the inspecting staff was required to watch persons
leaving by rail as well as those arriving. From January 16th a cart
was specially engaged for the conveyance of sick persons from
the station to the hospital, and stretchers were provided to carry
patients from the platform to the cart.
4. On March I5th a European Assistant Surgeon was deputed by
Government for passenger inspection duty at Poona station. On
March 21st the two municipal medical men were withdrawn and their
duties taken up by four hospital assistants appointed by Govern-
ment. On April 5th a second European Assistant Surgeon and three
additional hospital assistants were detailed for duty. Thus the pre-
sent strength of the inspecting staff at the Poona station is two Assist-
ant Surgeons and seven hospital assistants appointed by Government
and four peons supplied by the Poona Suburban Municipality.
5. At first the inspection chiefly consisted in watching third class
passengers as they passed the ticket-collectors at the exits. Later
on it was arranged with the railway authorities to require all third
class passengers to pass into a compartment specially allotted in the
third class waiting-room, where they were inspected by medical
officers, while one medical man watched the exit for first and second
class passengers.
6. Subsequently the work was carried out as follows :—
Half an hour before the departure of a train outgoing third class
passengers were collected in the third class waiting-room
and made to pass through in single file after being examined.
350
Measures in the Bombay Presidency and Sind. [APP. VI.
All persons suspected to be suffering from fever were detained,
their temperatures were taken, and they were finally examined
for plague in a small partitioned room. First and second class
passengers were examined after they had taken their seats in
their carriages. For the examination of arriving passengers
two hospital assistants were placed at the exit door for third-
class passengers, and an Assistant Surgeon at the exit for first
and second class passengers. Each passenger_was examined
as he passed through. Those found to be suffering from
plague were sent to the General Plague Hospital. Observa-
tion cases were sent to the Sassoon Hospital up to April
22nd and subsequently to the General Plague Hospital.
7. The Southern Maratha Railway Company posted one medical
man at Poona station on 29th October 1896, and another on 22nd
March 1897, to examine outgoing passengers by their line. These
two medical men made their inspection on the overbridge leading to
the Southern. Maratha Railway platform.
8. The number of real and suspected plague cases reported to
have been discovered by the inspecting staffs is given below :—
By Municipal medical men
By Government medical staff
By Southern Maratha Railway medical men
TOTAL
481
155
163
799
9. Details as to the number detected on each day are given in
Appendices 48, 49, 50.
It may be noted that many of the cases reported to have been
found are not traceable on any hospital register, and appear not to
have been admitted to hospital. This applies particularly to the
cases found by the Southern Maratha Railway medical men.
10. I may mention here that the officers of the various railway
departments and the railway police have done all they can to faci-
litate the inspection of passengers. The inspection work has been
controlled by Surgeon-Major Street, while Mr. Plunkett has taken a
leading part in making the arrangements it entailed.
11. Under instructions from the Collector of Poona a medical man
with two peons was posted at Kirkee railway station from 28th
January 1897 to prevent persons affected with plague from alighting
there and proceeding to Poona by road. On February 20th orders
were given to watch outgoing as well as in-coming passengers. Seven
suspected cases were discovered at Kirkee station. The staft was
withdrawn on May 23rd.
APP. VI. ] Measures in the Bombay Presidency and Sind.
351
12. It may be mentioned that by Government Resolution No. I-B.
of 4th March 1897, Government suspended the booking of third class
passengers from Poona and neighbouring stations except in the case
of persons who had obtained written permits from the District Magis-
trate of Poona or myself. The restriction was, however, withdrawn a
few days later.
Inspection on Roads.
13. On 28th January a medical man was posted by the Collector
at the Harris Bridge near Dapuri to inspect persons arriving by road
and prevent any found to be suffering from plague from entering Poona,
He was transferred to Poona City for other duty on March I3th,
Three suspected cases of plague were discovered at this post.
14. After the work of the troops in the city commenced it was
found that sufferers from the plague were removed from Poona by
night in considerable numbers. Accordingly, on the night of the 29th
March, cavalry picquets were placed on all the principal roads leading
from the city to prevent the surreptitious removal of sick persons. On
the 7th April native infantry picquets were stationed at Sowar's Gate
and Lukdi Pul for the same purpose. These cavalry and infantry
picquets were kept on till search operations by the military ceased.
The picquets had orders to detain all sick persons found by them and
to send them to the General Plague Hospital for examination. In the
event of a corpse of a person being removed without a certificate of
the registry of his death, they were required to detain one of the
bearers in order that the necessary inquiries might be made.
15. The number of plague cases and corpses found by the picquets
in the course of the operations amounted to 103 and 23 respectively.
Particulars of the numbers found on each day are given in Appendix
51. The work of the picquets was of value both as checking the
removal of the sick from Poona and as leading to the detection of
plague cases,
XIII.—INOCULATION.
At an early stage of the operations it was thought desirable that
the efficacy of inoculations against plague with Professor Haffkine's
prophylactic lymph should be tested at Poona. A supply of lymph
was accordingly obtained from Bombay, but it was found that none
of the medical officers employed on plague duty had leisure to attend
to the inoculations. The assistance of Surgeon-Colonel Edge, Princi-
pal Medical Officer, Poona District, was solicited in the matter, with
the result that Surgeon-Lieutenant Dove, A M.S., was sent to be
trained in Professor Haffkine's laboratory and was subsequently sent
down to Poona to carry on inoculation.
352
Measures in the Bombay Presidency and Sind. [ APP. VI.
2. The work was commenced on March 25th under the personal
direction of Professor Haffkine. From March 27th it was continued
by Surgeon-Lieutenant Dove. Inoculations were carried on within
Poona suburban limits at His Highness Aga Khan's Bungalow,
which was kindly lent for the purpose, and at the Dinsha Maneckji
Petit Dispensary in Poona Cantonment. It was not thought neces-
sary to arrange for inoculations in the city as my inquiries led me to
believe that few of the inhabitants would volunteer to be inoculated.
Surgeon-Lieutenant Dove continued the inoculation work till May
13th, when, as a few people were coming forward to be inoculated, his
services were replaced at the disposal of the Army Medical Depart-
ment and the work was made over to the Civil Surgeon.
3. Appendix 52 shows the numbers and nationalities of the per-
sons who were inoculated each week. In all, up to May 20th, 1,361
inoculations were carried out.
4. The officers in charge of the various plague hospitals were
instructed to note whether any cases of plague occurred among persons
who had been inoculated. No such cases have been reported, which
is evidence in favour of the efficacy of Professor Haffkine's lymph.
It has to be remembered, however, that the inoculations were not
commenced till after the epidemic had passed its highest point, that
a large proportion of the persons inoculated did not live in a highly
infected locality, and that most of them did not belong to the classes
that have been the chief sufferers from the plague in Poona.
XIV.—THE TROOPS EMPLOYED.
The troops employed on the operations against the plague were
drawn from the following corps :—
Royal Artillery.
Royal Horse Artillery.
Durham Light Infantry.
Royal Irish Rifles.
2nd Bombay Lancers.
Bombay Sappers and Miners.
2nd Bombay Grenadiers.
14th Bombay Infantry.
19th Bombay Infantry.
28th Bombay Pioneers.
Men were also taken from the Commissariat and Transport
Departments and the Army Medical Staff. The number of troops
employed at different periods of the operations is shown in Appendix
53. It will be seen that the greatest number of troops was employed
from March 2oth to May 5th, when the total number of British and
native troops on plague duty was 1,112. After May 5th, as the opera-
tions were contracted, the number of troops employed was gradually
reduced till on June ist it stood at 124.
2. The troops on plague duty were up to May 19th encamped at
Parvati near the Sinhgad road with the exception of those who were