NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
363
APP. VI.] Measures in the Bombay Presidency and Sind.
Municipality was, on 31 st idem, called to this letter, and the immense
value of isolation, and a copy of it was also despatched to all district
officers. It was requested that daily reports might be submitted for
any place where plague might unfortunately appear, and " isolation
should be everywhere promptly enforced."
Cleaning and dis-
infecting.
Caste hospitals.
On the 1st January, 1897, the Acting Commissioner received a
copy of a letter addressed by the Deputy Sanitary Commissioner to
the Sanitary Commissioner, Bombay, giving a full account of the
state of affairs up to December 3oth. As far as local conditions
allowed, cleaning and disinfection were being efficiently and
energetically carried out by the municipal executive. Suitable houses
in the town had been set apart as caste hospitals, which would provide
for patients who did not possess spacious and well ventilated private
dwellings of their own, Surgeon-Captain Arnim added—
Opposition.
"There is a marked opposition among the Municipal Com-
missioners and the inhabitants of the town to the complete isolation
which the removal of the sick to the Lyari isolation sheds would
necessitate ; indeed, there is reason to believe that, at present at least,
the feeling among the townspeople would not admit of the segregation
of all cases at the Lyari sheds."
All were working with energy and system. His inquiries had
failed to trace the disease to any source outside Karachi. The Deputy
Sanitary Commissioner thought that, most probably, the disease had
been prevalent in the town previous to the date upon which attention
was drawn to the first two cases.
Notice of plague
cases.
On the 1st January, a copy of the Deputy Sanitary Commissioner's
letter was sent to the Collector of Karachi, stating that, with a trifling
exception, the Acting Commissioner saw nothing to object to in the
Municipal resolutions, but it should be incumbent on householders to
give notice of plague cases.
Visit of the
Acting Com-
missioner.
In giving sanction to the Municipal resolutions, the Acting Com-
missioner judged it advisable to proceed immediately to Karachi to
ascertain how far the Municipality were in a position to carry them
into effect, and particularly in what attitude the Municipality stood
towards the Muhammadan population. He arrived in Karachi early on
the morning of the 3rd January, and at once called upon the Principal
Medical Officer, and Surgeon-Colonel Bainbridge kindly consented to
accompany the Acting Commissioner on a tour of inspection through
the native city. Mr. Giles, the Collector of Karachi, Surgeon-
Lieutenant-Colonel Henderson, the Civil Surgeon, Surgeon-Captain
Arnim, the Deputy Sanitary Commissioner, Dr. Kaka, the Health
364
Measures in the Bombay Presidency and Sind. [ APP. VI.
Disinfection.
Caste hospitals
empty.
Legal.
Compulsory
segregation of
the sick
considered
inadvisable,
Officer, and others were of the party. It was gratifying to
observe that Surgeon-Captain Arnim's description of Municipal
energy was even less than the facts warranted. The disinfection
of rooms in which deaths occurred was most thorough, and to Dr.
Kaka is due the very high credit of the free use of perchloride of
mercury as a disinfecting agent from the commencement of opera-
tions. In those early days, the saturation of houses and the watering
of streets was excessive, but that was almost immediately remedied
and one of the popular complaints of that morning was removed.
The buildings called caste hospitals were empty. It was clear to
every one that they could only be filled up by compulsion. A meet-
ing was convened at Government House on the afternoon of the
4th, at which the Collector, the medical officers named and the
municipal executive, including Mr. Tahilram, the President, and Mr.
Strachan, the Engineer and Secretary, were present. The Acting
Commissioner had consulted these officers. The Collector considered
that section 73 of the District Municipal Act was inadequate to deal with
the disease and there was no provision of law to render compulsory
notification of plague legal. The Honourable Mr. James, in a letter
of 30th November, 1896, had expressed a similar opinion that, under
section 73, compulsory segregation of the sick would be unauthorised.
The Principal Medical Officer, the Collector of Karachi and the Pre-
sident of the Municipality, as also Mr. Strachan and Dr. Kaka were
of opinion that no segregation of sick was possible without compul-
sion, and that in the present state of the public mind compulsion
would not be the best way of meeting the epidemic. In fact, it
would be the worst possible means to adopt. As a scientific method,
the Civil Surgeon and the Deputy Sanitary Commissioner advocated
segregation but considered compulsion necessary, and that it would
be met by opposition.
Difficulties,
The Acting Commissioner reviewed the position with great care,
chiefly in view of the fact that there were, according to the last
census over 51,000 Muhammadans to some 42,000 Hindus, that the
former had probably still further increased the disparity of numbers
in the interval, and that it was practically a Hindu Municipality who
would have the task of enforcing rules in the teeth of the Muhamma-
dan majority, a majority composed largely of a fanatical congeries of
tribes and nations, not one of whom had listened to the proposal for
caste hospitals, nor was there a Muhammadan hospital in existence.
Asked how the Municipality proposed to carry out their rules, the
reply was "The Police." And the Acting Commissioner silently
resolved that, if the Municipality were to pass rules hateful to both
Hindu and Muhammadan, at once retire to the back ground, and leave
APP. VI.] Measures in the Bombay Presidency and Sind.
365
the police to fight with the people he would prefer the rules should
be his own, the personality his own, and before attempting to drive
a crowd of terrified and panic-stricken people, he would be quite
sure he could treat the sick when they were segregated. He had
seen the effect in cholera and famine of crowding numbers without
carefully prepared arrangement, and determined to meet Hindu with
Hindu and Muhammadan with Muhammadan, and, if possible, to win
the confidence of both before resorting to compulsion.
Abandonment o£
compulsory
segregation.
On the 4th January, immediately after the meeting, the Collector
was informed that the Acting Commissioner was unable to sanction
the compulsory removal clause as it stood. The clause, read with
the directions, left a door of escape for the rich and none for the poor,
and these would ignorantly and fanatically resist compulsion. Gov-
ernment were informed that the fear of this impending compulsory
seizure of the sick had already produced something like panic :
medical aid was being rejected, sickness was concealed, and the
population hostile Surgeon-Colonel Bainbridge had concurred that
it would be inadvisable to resort to compulsion. The segregation
must be effectual, or it must be abandoned as impracticable. The
Municipal President and the Engineer and Secretary had warned that
a reign of terror would certainly follow resort to force, and better
results were to be expected from conciliation. It came to this—either
sick people must be dragged from their homes by force and opposi-
tion be met by force, or else this terror of compulsory removal must
be allayed and sympathy and conciliation take its place. The success
of segregation depended upon the population being more or less
consenting, not opposed, to the remedy. The Muhammadans, for
example, would not even set a house apart. A Muhammadan medical
officer would greatly strengthen the Municipality, and an effort would
be made to render the hospitals, if possible, popular.
District
Inspectors.
A valuable suggestion from Surgeon-Lieutenant-Colonel Clarkson ,
was placed before the meeting, and accepted by the Municipality,
that the town should be divided into districts and a medical officer be
appointed to each, to see every case of suspected plague before
removal, and an Inspector, whose duty it would be to find
out the cases. The Municipality immediately appointed Inspectors,
and these men proved most useful in securing correct and early infor-
mation.
Success of the
system of
treating the
people.
The Collector writes in paragraph 24 of his report that he is
still firmly convinced that the policy adopted at the time was
the right policy, that, to a very considerable extent, it had the
immediate effect aimed at ; the people readily opened their
houses to visitation and disinfection, while the same conciliatory
366
Measures in the Bombay Presidency and Sind. [ APP. VI.
policy continued led the people, who had unanimously rejected
both treatment and segregation, to accept both.
The Acting Commissioner returned to his camp, confident in
leaving the Collector at the head of affairs, and hopeful that,
now a breathing space had been obtained to exhibit the real
sympathy felt by Government towards the suffering, the measures
taken at Karachi would not be the signal for terror and panic,
should plague spread in Sind, but would make it practicable to
adopt greater stringency in other places.
Lady Doctor.
Trans-Lyari
Muhammadan
opposition.
The Collector had one or two meetings with the Muhammadans,
and promised them a lady doctor and Muhammadan doctors.
Miss Duggan, a fully qualified doctor, was appointed by the Muni-
cipality on the 8th January for pardah ladies. The Muhammadans
generally acquiesced in the measures sanctioned, but when the
disease crossed the Lyari into their quarter, as it did on January
10th, opposition was shown on the 18th, when the Health Officer
wished to disinfect a house and to burn down a hut. The Collector
went in person, acted with firmness and tact, sentenced the chief
offenders, and enforced compliance. This was the only instance in
Sind of obstinate resistance to authority, and it proceeded from
the fisher class, who on previous occasions of epidemics bad been
difficult to manage.
Flight.
Establishment of
cordon.
Evacuation and
health camps.
From the 1st January the disease suddenly increased. On
the 1st, the number of cases rose to 10, on the 7th to 20, and on
the 14th to 34. On the recommendation of the Collector, the
District Superintendent of Police abandoned his tour and devoted
himself to organising the police arrangements. The infected quarter
was being deserted. Most fled by rail and ship ; many to houses
of friends, or to houses rented in other parts of Karachi. To inter-
cept the local migration, the Collector, with the aid of the General
Officer Commanding, established a police and military cordon
between the city on one side and the Sadar Bazar and the Canton-
ments on the other. This cordon was valuable in checking the
general influx that would have taken place. The formation of
health camps was the subject of much demi-official correspondence.
Mr. Strachan, the Engineer and Secretary, lent himself with his
usual energy and capacity to the erection of huts on a site across
the Lyari, but remote from the Muhammadan settlements, while
Mr. Tahilram, the President, and the Collector were persistent in
their efforts to persuade the Nasarpuris, a sect of well-to-do
Hindus, occupying good houses in the Old Town, to move into
the camp, For these people to live in mat huts was a degradation-
367
APP. VI. ] Measures in the Bombay Presidency and Sind.
from which they shrank. Eventually, they agreed to move, but
only on their own conditions. These were wisely agreed to. To
get the Old Town quarter completely evacuated and set an example
that would silence prejudice were the objects in view. At this
stage, compulsion would have scattered the population like sheep,
and distrust of the authorities would have been spread through
the land.
t Nasarpuri
r Camp,
The increasing daily death-rate caused the Acting Commissioner
to hurry through some necessary business, and he relinquished the
rest of his tour on the 23rd January. He arrived in Karachi to
find the first health camp just occupied by some 2,000 Nasarpuris,
The camp did Mr. Strachan very great credit. It was well laid out,
with water-pipes and bathing, platforms ; in fact the Municipality
had spared no expense to make the camp attractive and convince
the people that the desire was to save, not to kill. As an instance
of the feeling at the time, a few days later, a party would not
enter ready-made huts, saying the huts might be poisoned, but they
accepted new materials and made their own huts. It was not then
known that plague affects the heart, and the sudden deaths of
people, not apparently very severely ill, gave ignorant imagination
its opportunity. On the 26th January Surgeon-General Cleghorn,
C.S.I., the Sanitary Commissioner with the Government of India,
arrived to examine the measures taken. He was unfortunately obliged
to leave next evening, recalled to attend the Venice Convention ;
but his visit was mcst beneficial in encouraging the efforts that were
being made to get people out of infected houses. The following
suggestions were made by Dr. Cleghorn :-—
Dr. Cleghorn's
5uggestions.
(a) That Dr. Arnim should be placed in charge of the differ-
ent camps, in which the population would
require
careful supervision.
(b) That a house evacuated should not be re-occupied until
its interior had been thoroughly cleansed, disinfected
and whitewashed, and that these measures should be
extended as widely as possible.
(c) That permission to re-occupy a place not fit for habitation
should be refused.
(d) That overcrowding should be prevented.
(e) That a commissioned medical officer should inspect rail-
way passenger traffic from Karachi.
The sequel proved that the first suggestion 'would have
established the success of the Nasarpuri Health Camp experiment.
368
Measures in the Bombay Presidency and Sind, [ APP. VI.
Other camps, however, have conclusively proved what immediate
results follow a camp managed as Dr. Cleghorn suggested under
medical supervision. The disease was attacking new quarters, and
it required the whole strength of the officers available, and Dr. Arnim
was soon engaged with many others in a hand-to-hand struggle with
the pestilence at its worst.
On the 1st, 2nd and 3rd February there was a sudden ac-
Climax of the
disease.
Decline.
Week ending 10th December 1896 ...
„
17th
„
„
24th
„
„
...
„
31st
„
„
„
7th January 1897
„
14th
,,
„
...
2ISt
,,
„
28th
„
„
4th February 1897
11th „
,
18th
„
,
25th
„
4th March 1897
nth
„
,
18th
„
,
25th
„
,
1st April 1897
8th „
1 5th »
.
22nd ,,
29th „
„
26th May 1897
I3th „
„
20th „
,
27th „
3rd June 1897
10th
„
,
1 7th
,
24th „
Total
plague
deaths.
1
9
21
28
103
159
200
181
295
262
239
217
197
207
189
188
192
172
115
127
86
65
52
23
20
29
7
i
2
cession of plague cases.
From the 28th January
the daily figures had been
rising, but on these three
days, the number rose to
59, 49 and 56, respec-
tively,—a record never
subsequently reached. In
fact the epidemic in the
first week in February
attained its climax, and
thereafter, though the out-
breaks in new quarters
partially obscured the fact,
the disease gradually abat-
ed, as the marginally noted
figures, taken from Dr.
Kaka's reports, show. Or,
taken by months, the mor'
tality was as follows, re-
collecting that February is
the shortest month :—
Monthly
Statistics.
In December 1896
...
In January 1897
In February „
...
In March
„
In April
„
In May
„
In June
,,
In July
„
59 deaths from
743
995
864
538
167
23
9
plague.
Exodus.
The movements of the population corresponded with these
figures. The exodus by road, and specially to encampments or
villages in the neighbourhood, was considerable, but figures are not
available. The numbers entering and leaving Karachi by rail and
369
APP. VI. ] Measures in the Bombay Presidency and Sind.
sea are known, and the net difference between arrivals and departures
is as follows :-—
Population of 1891.
In December 1896-98, 195
In January 1897
In February ,,
In March
„
In April
„
In May
„
In June
,,
Net difference
between arrivals
and departures.
—3,223
— 11,047
-9,40F
—4,232
+ 1,951
+5,733
+4,405
Remaining
population.
94,972
83,925
74,464
70,233
72,183
77,916
82,321
leaving a net loss at the end of June of nearly 16,000 people. The
full table is given in the Appendix B. As already stated, the figures
for 1801 are much below the true population.
Railway inspec-
tion and watch
in municipalities.
In his final suggestion burgeon-General Cleghorn called attention
to the necessity of more effectual control over this exodus. As early as
the first week in January, a few days after his return to Karachi, Mr.
Giles addressed the Principal Medical Officer, pointing out that the
arrangements at the Karachi departure platforms were not stringent
enough. On the 8th, the Acting Commissioner wrote that the
Government of India seemed very anxious that it should be made
impossible for any one ill with bubonic fever to get away from
Karachi. With this object, 4 European Travelling Inspectors,
engaged by the Collector to travel as far as Dadu station with each
train, had been sanctioned, and suggestions for strengthening the
medical inspection were invited from the Principal "Medical Officer.
On the same date, the 8th, a letter was received from the Deputy
Sanitary Commissioner, Sind Registration District, forwarding copy
of a letter addressed to district officers, based on instructions received
from the Sanitary Commissioner, Bombay, as to the necessity of
watching the arrival of trains at stations and intercepting any sick
persons. On the 4th, Government had inquired by wire what arrange-
ments were proposed, on the 6th the Manager, North-Western
Railway, telegraphed that the Punjab Government had taken precau-
tions at Khanpur, Shershah and Raewind. From a letter received
from the same source on the 9th, it appeared that the Manager, by
request of the Director-General of Railways, had on the 31st Decem-
ber, 1896, wired to the Principal Medical Officer to order inspection
b 47
370
Measures in the Bombay Presidency and Sind. [ APP. VI.
of passengers at principal stations in conjunction with the civil
authorities. Accordingly, on the 10th, the Acting Commissioner
issued detailed directions to all district officers in continuation of
previous correspondence, informing them that the Principal Medical
Officer had in consultation with the North-Western Railway issued
instructions to the Civil Surgeons and Hospital Assistants for medical
inspection of travellers at Karachi and all principal railway stations
in Sind. These arrangements required to be supplemented by watch-
fulness on the part of Revenue and Police officers. Each district
officer should make himself acquainted with the arrangements made
for his district, and, if in any way defective, he should at once take
necessary action. Any remissness or inability on the part of the
hospital assistants to inspect or attend the arrival of trains should
be promptly brought to notice of the officer to whom they were
subordinate, The object now was, if possible, to prevent the disease
spreading. All municipalities should be called on to take steps for
their protection, and any suspicious case entering a town should be
promptly reported to the medical officer. Attention was invited to
the railway rules dealing with infectious cases, and it was pointed
out that the sick man's relations or friends travelling with him should
also be kept under observation. Great care would have to be exer-
cised that sick did not alight at wayside stations with the intention of
avoiding medical inspection and getting to their destination by road,
The Railway Police and officials were asked to assist in preventing
this. At main stations, two sheds should be provided, one for
sick and one for relatives, Communication with the town should
be prevented, and everything done for making the detenus as
comfortable for the days of their enforced residence as circumstances
would permit. For this end each hospital assistant should be allowed
a small permanent advance from Municipal or Local funds.
Magisterial and Police officers should be reponsible for enforcement
of segregation. The Principal Medical Officer had been asked to
arrange for examination by an experienced medical officer of persons
detained on suspicion. The utmost consideration should be shown
to all sufferers, and persons should not be forcibly examined for
glandular swellings, but if suspicious detained. Females should in
no case be subjected to any bodily examination, and the strictest
attention should be paid to their customs and prejudices.
In forwarding a copy of the circular to Government, the Acting
Commissioner observed that these measures appeared the least
stringent that could be of any use to check spread of infection, and,
if the law did not justify them, he hoped steps might be taken to
371
APP. VI. ] Measures in the Bombay Presidency and Sind.
legalise the action taken. Government approved the measures, and
this was communicated to all officers on the 6th February,
On the 23rd January, the Acting Commissioner was able to
reply to Government that the inspection of all passengers before
leaving the Karachi city and cantonment stations and at one or
two places en route, specially at Dadu and Sukkur, was careful and
thorough. A European Inspector travelled as far as Dadu. At every
station passengers alighting were examined by a medical officer
and at all principal stations isolation sheds were ready. Nearly
every Municipality had provided itself with rules under section 73 oí
the District Municipal Act, and all had been active in cleaning up.
Segregation was to be insisted upon up-country. The immediate
evacuation of an infected house and the camping out of the
inmates, and similar evacuation by the entire community of an infected
quarter, coupled with systematic house-cleaning and whitewashing
and burning of all rags and rubbish under European supervision
were means likely to prove effectual. A copy of this report was
forwarded to all District Officers and the Principal Medical Officer.
Principal
Inspection
Stations.
The Manager, North-Western Railway, had suggested Dadu and
Ruk stations for the principal medical examination of trains.
Ruk
was impracticable, as no adequate supervision could be exercised.
At Dadu the trains arrived by day light. The Principal Medical
Officer was, on the 10th January, asked to arrange for medical
inspection of all passengers in the train on arrival at Dadu in the
manner suggested by the Manager, and enquiry was made whether
careful medical inspection of persons leaving Hyderabad railway
station by the new Rohri-Kotri line had been arranged, as it seemed
probable that persons would utilise that route to evade Dadu. The
Acting Commissioner further suggested the desirability of placing
a Commissioned Medical officer on special duty to supervise medical
inspections at the Karachi stations, and on the railway generally.
The Principal Medical Officer replied that, on the 12th January, he
had telegraphed to the Surgeon-General, Bombay, for a Commis-
sioned officer. On the 26th January, a very full report was received
from the Principal Medical Officer, detailing the arrangements he
had made. Surgeon-Lieutenant-Colonel
Henderson, the Civil
Surgeon, Karachi, reported that, from the evening of the 13th
December, 1896, inspections were being held at Karachi. There was
inspection of all passengers leaving Karachi by both up-mails, first
at the city station by a Hospital Assistant and afterwards at the
cantonment station by the Railway Apothecary. The Civil Surgeon
had on several occasions been present, and the Principal Medical