NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
380
Measzires in the Bombay Presidency and Sind. [ APP. VI.
The first fortnight of February was a time of earnest battling
with a foe that literally walked in the darkness. His Excellency the
Governor on the 11th flashed a message that cheered all. thanking all
O
'
O
for the determined efforts to fight the plague, and that His Excellency
was watching with closest interest.
Spread of the
disease beyond
Karachi.
While this battle with pestilence was being fought in Karachi,
cleanliness against dirt, light against darkness, fresh air against foul,
scattering against overcrowding, and a free use of disinfectants, there
were signs of coming trouble in other places. For a time, the hope
prevailed that, with rigorous segregation, the germs would not
thrive in the dry climate of Sind. Nor was this hope altogether
fallacious.
Hyderabad,
Kotri and Tatla
On the 27th January a circular was issued, inviting attention
to deaths from plague increasing up-country, and notably at Hyder-
abad, Kotri and Tatta. So far no local cases had occurred, but it was
essential to prevent any person suspected of plague entering a town,
and isolation, segregation and disinfection, with provision of huts
and health camps, were recommended. Surgeon-General Cleghorn,
through the Deputy Sanitary Commissioner, pointed out the extreme
importance of compulsorily removing the healthy persons from an
infected house, and the letter was forwarded on the 29th to all
district officers. The Sanitary Commissioner, Surgeon-Major Clark-
son, in a letter, dated 4th February, urged the removal of the
sick person from the house in all cases. The circular of the 27th
had stated that, if it could be done, it was better to remove the sick
persons, and that all the clothes and bedding, including the wearing
apparel actually worn, of the family should be disinfected. These
directions to District officers appeared to leave them full power of
action, and were therefore not modified.
Karachi
District.
From first to last, there occurred in the Karachi District, outside
Karachi, no more than 238 cases and 178 deaths. Of these, only 53
and 41 were local cases and deaths. The disease only took root in
Tatta.
Tatta, with which its railway station, Jungshahi, must be included,
and in Kotri. Tatta is a town of about 10,000 inhabitants,
about 13 miles from Jungshahi. It is a favourite resort of the upper
classes of Karachi, and is on the main route to Cutch. From the
middle of December to the week ending the 19th February, 31 cases
and 21 deaths, all imported, had occurred in Tatta. The influx then
appears to have ceased, and no more deaths were reported till plague
broke out locally in the week ending the 26th March. Thereafter,
the outbreak was local, and practically ceased early in May. That
the epidemic was kept out of the town so long was due to the
APP. VI.] Measures in the Bombay Presidency and Sind.
381
Jungshahi.
unsparing and well-directed efforts of the Assistant Collector, Mr.
M. D. Mackenzie. To that officer is also due the credit of starting
the first observation camp. Persons were medically inspected at
Jungshahi, and not allowed to hire conveyances for Tatta unless
certified as healthy, On arrival at Tatta, they were taken to the
camp and not allowed into the town. Cases were consequently hidden
away in Jungshahi, and about the third week in February a sharp little
local outbreak was the result, There is only a population of some 200.
Mr. Mackenzie at once appeared on the scene, adopted energetic
Evacuation and
disinfection.
measures of evacuation and thorough disinfection, and there were no
more cases. The local cases in Tatta began, as stated, towards the
Tatta
end or March and, though never exceeding 4 or 5 a week, caused grave
anxiety for five weeks. Mr. J. P. Vaughan, I.C.S., succeeded Mr.
Mackenzie on the 23rd April, when the disease bid fair to seize the
town in earnest,
FATAL LOCAL CASES.
Week ending 26th March
...
...
„
„ 9th April
...
...
„
,, 16th „
„
„ 23rd )}
.6.
>.
„
„ 30th »
„ 7th May
„
„ I4th „
Cases.
. 2
.
I
• 4
• 5
,. 4
. 2
. 1
Deaths.
2
I
3
3
5
3
1
Mr. Vaughan, having had no plague experience, was first taught by
the Collector in Karachi and then sent to Tatta with Surgeon-Major
Baker, a trained gang of disinfectors under a selected Supervisor, and
a nurse. The above figures depict the rapidity and thoroughness of
their work, as in the week ending the 3oth April the number of cases
went down instead of going up.
Kotri.
Kotri is on the Indus and is the railway station for Hyderabad,
from which place it is separated by the river and a couple of miles
of road. It is a small town of about 8,000 inhabitants, and on Mr.
Brayson, the Deputy Collector in charge, devolved the difficult duty
of protecting the place. As in Tatta, up to the third week in Febru-
ary, dropping cases came in from Karachi, deterred probably by the
medical examination on the steam ferry from going to Hyderabad.
Commencement
of outbreak.
Then there was a lull, and not till the week ending the 26th March
did the first local case show itself at the same time with cases
imported from Hyderabad, where the disease had just broken out
Staff.
virulently. Mr. Brayson made Kotri his head-quarters and, well
assisted by Assistant Surgeon McMullen of the North-Western
Railway, defended his charge from the simultaneous incursion
from Karachi and Hyderabad, and, by enforcing sergregation in
huts, got rid of the local cases for 17.
382
Measures in the Bombay Presidency and Sind. [ App. VI.
Epidemic
Diseases Act.
With the passing of the Epidemic Diseases Act had come increa-
sed powers. Sanction to the following measures, which were all
already in operation under Municipal rules, was solicited by telegram
on the gth and granted by Government on the nth February :—
Powers.
The Commissioner and District and Sub-divisional Magistrates
were empowered to act or to empower any person by name to act as
follows :—
(a) Enter or break open any house or room, day or night,
disinfect, limewash, collect and burn rags, rubbish, pull
down, burn, open walls or roofs, burn suspected bedding,
clothing and other articles, and disinfect persons or their
property,
(b) Order persons or classes of person to leave certain place
for another, or prohibit leaving given area, prohibit com-
munication between certain areas, probibit entrance of
persons within prescribed area, make regulations for
inspection of travellers, by land or water and, if necess-
ary, their detention and segregation, and destruction of
suspected articles-,
(c) Direct that any place for supply or preparation or storing
of food be closed, or the food removed, if so permitted.
(d) Direct compulsory notification of sickness or death from
any cause.
(e) Value and pay compensation for all bedding, clothing, etc.,
or temporary huts destroyed, and after summary inquiry
of any valuable article or house.
00 To give notice to house holders or occupiers within 48
hours to limewash and clean their premises or specified
parts, and to burn or collect dirt, rags and rubbish for
cartage.
The Commissioner was also empowered to delegate the follow-
jng powers to any person by name :—
(a) Remove any person suffering or suspected to be suffering
from plague, or likely to have contracted the disease, to
any place ; detain him till permitted leave.
(b) Prohibit re-occupation of any house without permission,
(e) Regulate removal, burial or burning of corpses and
general conduct of funerals.
(d) Prohibit import or export of specified articles.
(e) Determine in what manner and by whom any expenses,
including compensation, be defrayed.
APP. VI. ] Measures in the Bombay Presidency and Sind.
383
Lastly the Commissioner might make subsidiary rules to carry
out any of the above powers, and might require any Municipality to
act in any of the above ways in such manner as the Commissioner
might prescribe and to employ such establishment as deemed neces-
sary.
These powers were so very wide that on the 17th February a
circular was issued, desiring that every officer and subordinate should
recollect that exceptional powers carry with them increased respon-
sibility, and the powers must be used with consideration, tact and
judgment, and only be put in force when and so far as the necessity
for preventing spread of the disease required.
Hyderabad
District»
On the 19th January, the Collector of Hyderabad, Mr. C. G.
Dodgson, I.C.S., had reported the arrangements made for cleaning
Hyderabad town and other large towns in his district, and for medi-
cal examination and detention on the steam ferry across the Indus
and at principal railway stations. On the 5th February, the first*
local cases in Sind, outside Karachi, were reported by the Assistant
Collector, Mr. N. B. Divatia, of the Hala subdivision of the Hyder-
abad District to have occurred and Tando Alahyar, a Railway station
and Municipal town of over 4,000 people. Five such cases had
occurred during the last fortnight of January, and four had proved
fatal. The Collector of Hyderabad was asked to report whether segre-
gation of the healthy found in the infected house and isolation of the
sick had been rigorously enforced, and whether disinfection was
thorough. These, being the first local cases, caused anxiety. The
reply received was that a man arrived in Tando Alahyar from Kara-
chi on the 10th January and died of plague on the 12th, His two
sons, who had not been to Karachi and who lived with him, fell ill,
and they died on the 19th. In an adjoining house, practically all
one building, two persons, who had also neither left the town were
Tando Alahyar.
attacked and died on the 26th. Mr. Divatia went to Tando Alahyar
on the 7th February, and found that clothing and bedding had been
burned and houses disinfected. On his arrival, he introduced segre-
gation, and the Collector's commendation of his work was borne out
by the fact that, though Tando Alahyar continued to be a source
of anxiety till after the middle of April, yet cases were only on one
occasion in excess of one a week, and the total cases and deaths
did not exceed 18 and 15, respectively—a testimony to Mr. Divatia's
prompt enforcement of orders. There was no other local outbreak
in the Hyderabad District.
Hyderabad town.
On the 17th February, inquiry was requested as to the accuracy
of the returns from Hyderabad town that all cases occurring were
* A cabe at Tatta in January was considered doubtful.
384
Measures in the Bombay Presidency and Sind. [ APP. VI.
imported. At that date, 33 cases and 28 deaths had been so describ-
ed as under :—
Week ending 8th January
,.,
»
»
15th
„
„
„
22nd
„
...
„
„
29th
„
„
„
5th February
...
„
„
1 2th
„
»
»
19th
„
Cases.
2
9
5
3
3
6
5
Deaths.
2
8
5
2
3
5
3
On the 10th February, the Collector had been asked to give up
his tour and make Hyderabad his head quarters, which he did
immediately, reaching Hyderabad on the 17th. With the exception
of a flying visit to Tando Alahyar on the 27th and 28th, Mr. Dodgson
remained at Hyderabad till his health obliged him to take furlough.
On arrival Mr. DoHgson found much municipal activity, though the
measures he had urged during a visit paid to Hyderabad at the end of
January had not progressed so rapidly as he had hoped.
House to house
inspection.
Divisions of the
town.
European officers
The President of the Municipality is Mr. Hiranand, who, like
Mr. Tahilram in Karachi, stuck to his post, and evinced a true ap-
preciation of the gravity of the visitation and the necessity of active
and cordial co-operation on the part of the people. The disease was
new, and the measures must be new. At the end of January, house-
to-house inspection was commenced by Municipal officers, and in
the middle of February the town was divided into 10 divisions, each
of which was placed, at the suggestion of Surgeon-Major R. Baker,
the Civil Surgeon, in charge of a European officer, the military office, s
Subdivisional
Officers.
cordially volunteering to assist. Lach divisional officer had working
under him one or two subdivisional officers, who were mostly Muni-
cipal Commissioners. The efforts of these officers, were directed to
Cleaning.
cleaning and limewashing the 12,000 houses that composed the town.
In passing it may be remarked that this work, as in Karachi, was
most carefully executed.
Cases at first
treated in
own houses.
In a letter received from the Civil Surgeon on the 9th February,
Surgeon-Major Baker remarked that the cases were as a rule treated
in their own houses and, after the case ended, the house, bedding, etc.,
were dealt with. The attention of the Collector was drawn to this
remark. If the Municipality wished to escape the scourge, they must
at the very beginning isolate the sick and segregate the family and
attendants. If this could not be done by taking the whole family,
including the sick person, to sheds outside the town, then the healthy
APP. VI, ] Measures in the Bombay Presidency and Sind.
385
members must be made to vacate, leaving only necessary attendance,
No persons arriving from Karachi should be allowed to enter the
town till they have been under observation for 10 days. A copy of
these instructions was sent for guidance to the Collector of Shikar-
pur and to the Deputy Commissioners.
Segregation
enforced.
Mr. Dodgson acted with energy. He insisted on the Municipality :
making house-to-house inspection a reality, and stated that, where '
the sick person was not too ill to be moved, the removal to sheds
would be enforced. He explained that detention against arrivals
from Karachi had already been discussed with the Civil Surgeon and
the President, but owing to the subterfuges that would be restored
to after a day or two, it would be impracticable to recognise a
person as hailing from Karachi.
Later on at Shikarpur this diffi-
culty was met by stopping everybody, but at this period of the epide-
mic the authorities had enough discontent to deal with inside the
town.
Evacuation.
On the 23rd of February, Mr. Dodgson proceeded to take action
himself, and with the assistance of Mr. Hiranand, the President, he
caused the evacuation of about 100 families from a group of houses
where cases had been increasing.
On the 17th February, Surgeon-
Major Baker had noted that the interval in one case of 18 days after
arrival from Karachi was a questionable " imported " case. On the
26th, or three days after the commotion occasioned by the evacuation,
the first two local cases occurred, though not reported till the 28th.
During the week ending the 20th February, there were no cases,
local or imported.
Then began the plague, though at first, as in
Karachi; very slowly :—•
For week ending 5th March
,,,
»
1 2th
»,
,.,
Cases.
3
7
Deaths.
2
7
Disinfection and
evacuation.
When the local cases began Mr. Dodgson found that a large
family of goldsmiths had allowed 3 deaths to take place in their house
before the news spread.
He reported that all the houses had been
disinfected and cleaned, the plaster scraped off walls and floors, and
the roofs taken off. All the inmates were promptly removed to
camps outside the town, with the exception of two native ladies, and
all the neighbouring houses to each infected house were vacated.
Gangs of coolies were placed under the divisional officers, and depots
for lime and disinfectants established in convenient spots.
Watching roads
from infected
places,
On the 19th February a copy of a telegram was received from
Government urging the importance of watching roads leading from
infected places. These instructions were on the 20th sent to all
b49
386
Measures in the Bombay Presidency and Sind. [ APP. VI.
District officers, with the suggestion that police should be stationed
under a responsible officer at suitable points to stop and send for
examination by a medical officer any one with severe fever trying to
enter the town. The Collector of Karachi was asked to take steps
at, say, a distance of a day's journey from Karachi on the main
road to detain any sick or suspicious persons attempting to leave
Karachi.
Sukkur,
On the 17th February, a report was received from the Civil Sur-
geon, Sukkur, Surgeon-Major Corkery, stating that a case of plague
was reported on the 12th idem, and in the face of great opposition he
had removed the patient, a girl of 10 years old, accompanied by her
Compulsory
Segregation of
first case.
mother and brother, to the sheds prepared for such cases. Dr.
Corkery disinfected the house. This was the first case of plague
reported from Sukkur, and the first case of forcible removal of a
patient anywhere. The result is significant. Ominous silence fol-
lowed, and soon it appeared that the people of all ranks had banded
themselves together with one accord to defeat the authorities. On
the 26th February, Dr. Corkery reported that, besides the one case
which he saw and removed, a few suspicious fatal cases had occurred
which were not brought to notice and which the relatives had palmed
off as deaths from natural causes. A very large number of the popu-
Flight.
lation immediately deserted Sukkur. There was a rush of the healthy
to Shikarpur, but the measures there and in other big towns were more
or less dreaded, and the bulk of those who had sick in their families—
and there appear to have been many—fled to the neighbouring villages.
The country is well cultivated in that part of Sind, and villages are
pretty close together. A day or two after the removal of the girl,
the sister-in-law of a Municipal Commissioner took the disease and
was immediately secreted in a village 5 miles off, where she died
poor creature, " possessed of the devil," as her brother-in-law pleaded.
How many perished in these villages before their condition was
known and help could reach them it is difficult to say, but in the
Sukkur Taluka the excess of reported deaths over the normal was
436. The fugitives also crossed over to the left bank of the, Indus
and infected Rohri and the villages in its neighbourhood. Some
10,000 people are said to have thus suddenly decamped.
Detection of
concealed cases.
Surgeon-Major Corkery set himself to find out the truth. He
traced one family to Rohri, where 4 deaths occurred. Spies were
placed over a suspected lane in New Sukkur. A sick man was caught
as he was being placed in a boat with a temperature of 105, and deliri-
ous. This was on the 25th. Next day, the 26th February, the same
date on which the first two local cases occurred at Hyderabad, a
APP. VI. ] Measures in the Bombay Presidency and Sind.
387
search was made in the lane. One dead boy and two sick were found
and these were removed to the isolation sheds, and the other inmates
to the health camp. There was only slight opposition. Clothing
and bedding were burnt, and the houses fumigated and locked. It is
to be regretted that the Municipal Commissioners of Sukkur lent no
assistance.
Early period of
the Sukkur
epidemic.
The Collector of Sbikarpur, Colonel Mayhew, was asked to go
to Sukkur, his head quarters. He had already been there, and anti-
cipated the request. Sukkur, like Karachi, shows no imported cases.
All were local, and though Karachi people went to Sukkur, none
were traced to have died of plague. By the 12th February, when the
girl was discovered, chere must have been a good many sick in Suk-
kur to give rise to the panic that followed her removal. In the neigh-
bouring town of Shikarpur, plague measures aroused no panic, because
the towns people had no sick in their households. The early figures
for Sukkur are—
For week ending I2th February
...
„
19th
„
26th
„
5th March
„
12th
„
Cases.
... I
... o
... 4
... 6
... 14
Deaths.
0
I
l
8
9
Railway and road
inspection.
On the 3rd March it was evident that plague had broken out at
Hyderabad as well as at Sukkur, and a telegram was despatched to
both Collectors, pointing out that, local plague cases having occurred,
migration of the population would commence, and medical inspection
of all departures by rail should be arranged, and at exits by road
plague authorities should be stationed to detain sick and suspected for
medical examination, and no plague case be permitted to depart. A
second chain of inspecting stations should be made at suitable points
at 10 to 15 miles distant, and evcry effort made to prevent sick
persons travelling. Any sick found to be detained in hospital. On
the 4th March, the measures to be adopted were recapitulated for the
guidance of the Collectors and to strengthen their hands. Private
hospitals \Vere the alternative to forcible removal, but always a dis-
cretion was left.
Watching 1 the
roads from
Hyderabad.
The Collector of Hyderabad reported that 16 medical students
were being placed on the main roads leading from Hyderabad, assist-
ed by police. Nice huts were erected for them, and it thence for-
ward became very difficult for any sick person to get away. The
Hyderabad-Rohri railway station and the steam ferry across the
Indus were carefully watched for departing families. The burial and
burning grounds were under close supervision, and no concealment
388
Measures in the Bombay Presidency and Sind. [ App. VI
was now possible. The exodas of healthy persons was most desir-
able, the town being overcrowded. The Collector of Shikarpur reported
that he had established cordons, but the rush had taken place
and guarding the roads was of little use. It was pointed out that
this was true enough, but as each new street got infected some would
still try to escape the measures being- taken, and this must be checked.
The arrangements for examination of passengers leaving the railway
station were also detailed,
Special danger of
the outbreak at
Sukkur.
Sukkur and Rohri are prnctically one place, connected by the
Lansdowne Bridge over the Indus, and with railway lines to Hyder-
abad to Karachi, to the Punjab, and to Shikarpur and Baluchistan.
A more dangerous spot for an outbreak of plague could hardly be
named, and with the large important town of Shikarpur, teeming
with Karachi, Hyderabad and Sukkur fugitives, and having business
connections all over India and as far as Bokhara in Central Asia,
situated within 75 miles of Sukkur the progress of the epidemic was
watched with the keenest anxiety, and the resources of the province
were strained to check its apparently resistless march northwards.
Assistance of a
special
Commissioned
Medical Officer.
The Principal Medical Officer was asked to permit Surgeon-
Major Baker to visit Sukkur and assist Surgeon-Major Corkery in
making a thorough house-to-house inspection. Surgeon-Major Baker
arrived at Sukkur on the 8th March, and under date of 12th idem
reported that he had found two plague cases in the isolation camp
and 20 persons in the health camp, one of whom had just developed
plague. Old Sukkur, where the wealthier portion of the community
Flight from New
Sukkur.
lived, and which was separated from New Sukkur by the European
and railway quarters, was not deserted to any appreciable extent, but
three-fourths of the inhabitants of New Sukkur had left for the sur-
rounding villages.
Increase of the
staff.
On the 10th March, Mr. W. H. Lucas, I.C.S., who had just
been relieved at Jacobabad by Mr. M. D. Mackenzie, was put in
orders as Personal Assistant to the Collector of Shikarpur, as no
extra establishment had yet been sent there and Mr. Cadell had
been taken for Karachi. But the Collector did not then see the
necessity, and Mr. Lucas was directed to proceed to Karachi to ac-
quaint himself with plague administration there.
On the 23rd Surgeon-Major Baker, having been placed on
special duty, visited Shikarpur and with the Collector inspected the
arrangements there.
Precautionary
measures at
Shikarpur.
Surgeon-Captain C. Milne, I.M.S., had been deputed to
Shikarpur on the 19th March owing to the occurrence of imported
cases, of which to the date of his arrival 14 cases had occurred, and