NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
APP. VII, ]
Measures outside the Bombay Presidency.
7
2. It appears from your letter that the Government of Bengal
has considered the modification of these notifications from two points of
view. In the first place His Honour the Lieutenant-Governor consi-
ders that the experience that has been gained of the plague shows
that the distinction between isolated cases and a well-defined out-
break which was recognised when the Bengal Regulations Nos. 4 and
5 were framed cannot be safely maintained, and that whatever precau-
tions may be authorised by law should be brought into force directly
a single case occurs. It is pointed out that, although the subsequent
Regulations Nos. 6 and 7 of the 22nd March are not based upon this
distinction, they are not as comprehensive as Regulations Nos, 4 and
5, and in respect of segregation they are far more severe.
3. In the second place representations were received by the
Government of Bengal from the Muhammadan community and the
Indian Medical Association on the subject of the regulations, and it
came in various ways to the Lieutenant-Governor's notice that some
alarm had been caused among both Hindus and Muhammadans by
the prospect of the existing plague regulations, especially those
relating to segregation, being brought into force. After considering
the objections taken to the existing rules and consulting the heads of
the native community, the Government of Bengal drew up a new
draft regulation numbered 8, a copy of which is forwarded with your
letter. Rule 31 of this draft deals with the subject of segregation,
and provides that the isolation of the sick may be carried out in, or in
the immediate neighbourhood of, their own homes, if there is suitable
accommodation for such isolation, and if a sum sufficient to meet the
probable expenses of isolation is deposited. Just as the regulation
was ready for publication, Dr. Lowson arrived in Bengal and the
Lieutenant-Governor consulted him on the subject. Dr. Lowson
expressed views strongly adverse to the proposed system of home-
segregation which he considered likely to prove absolutely ineffectual
in the event of even a few cases of plague occurring. His Honour
the Lieutenant-Governor, after discussing the question with Dr.
Lowson, was driven to the conclusion that no system of home-segre-
gation could be successfully worked in Calcutta, and is disposed to
substitute for rule 31 of draft Notification No. 8, the rule set forth
in paragraph 4 of your letter. That rule provides for the compulsory
removal of all persons suffering from, or infected with, plague to a
plague hospital maintained either by the Government or by some
particular caste or class of the community. His Honour the Lieutenant-
Governor submits the question for the orders of the Government of
India with the remark that he is not prepared to adopt a system
which the expert placed at his disposal declares to be fatal in its
resultsand condemned by all experience.
8
Measures outside the Bombay Presidency.
[ APP. VII.
4. I am in the first place to explain that Dr. Lowson is in no
sense the representative of the Government of India. The Govern-
ment of India have never expressed their adherence to his views, nor
have they accredited him to Local Governments with the object of
expressing to them the views of the Government of India. The
Government of Bombay informed the Government of India that Dr.
Lowson's experience had been useful, and suggested that other Local
Governments might wish to avail themselves of it. The Government
of India had no objection and circulated the suggestion. But it was
no part of their intentions that the Local Governments should do more
than consider on its merits any suggestion Dr. Lowson might make,
and the danger of following his advice without giving full considera-
tion to aspects of the question which would not occur to him is illustrat-
ed by the tone of his letter of June 1st, and by his condemnation
of the rules prescribed for the North-Western Provinces and Oudh.
The form of the rules in the North-Western Provinces and Oudh was
dictated by considerations with which Dr. Lowson was absolutely
unfamiliar, and the Government of India can conceive nothing more
dangerous than to rely in a matter of this nature on the advice of a
medical expert who shows himself so little able to appreciate the
position of the Governments in India as to be prepared to entirely
ignore political reasons.
5. The Government of India wish it to be understood that it is for
the Government of Bengal to thoroughly inform itself and finally
advise as to what measures can be safely taken in the matter of
segregation. It has, on the one hand, to consider the danger of the
spread of plague and the question whether and to what extent home-
segregation could be enforced. On the other hand, it must take into
account the state of feeling in the province and the extent to which
political disaffection and disorder are to be apprehended from the
enforcement of a rule rendering every person suspected of suffering
from, or being infected with, plague liable to be sent to hospital.
The Governor General in Council, on the information at present
before him, is disposed to agree that segregation is the best pre-
ventive measure that can be devised, and that if it is to be enforced
in a place like Calcutta segregation in hospital is essential for the
greater part of the population likely to be affected. But His Excellency
in Council considers that in carrying out any measures of segre-
gation due regard should be had, as in the case of Europeans, to the
position in society of those classes of the native community who can be
relied on to take efficient measures with the object of preventing the
spread of infection, and to other considerations of a like nature.
6. There is another respect in which it appears to the Govern-
ment of India that the draft rule set forth in paragraph 4 of your letter
APP, VII, ] Measures outside the Bombay Presidency.
9
should be made more explicit, if it ever becomes necessary to intro-
duce and enforce it. They consider that it should be clearly stated
that the hospitals, whether Government hospitals or private caste
hospitals, should be so arranged as to provide accommodation for the
immediate family of the patients. The percentage of fatal cases
among plague patients is so high that the Government of India cannot
regard it as humane to separate the sufferers from their families and
friends, and the Governor General in Council apprehends that such
enforced separation of relations and friends may be at the bottom of
much of the agitation against the rules requiring segregation, and
that it leads to dangerous concealment of disease.
7. In paragraph 5 of your letter it was stated that three possible
courses appeared to be open, and it was suggested that, if the Govern-
ment of India accepted any one of these courses without material
modification, the orders might be communicated by telegram, In
my telegram No. 1692, dated the 15th instant, it was stated that the
Government of India considered that the third alternative course—to
leave things as they are—was the best. It appeared to the Govern-
ment of India that, if His Honour the Lieutenant-Governor considered
that the modified rule enforcing segregation in hospitals was neces-
sary, it would be unwise to issue the rule in Notification No. 8, per-
mitting home-segregation ; and, on the other hand, that, as the great
diminution of the plague in the Bombay Presidency has made the
danger to Calcutta remote, it is unnecessary at the present juncture
to excite disaffection by publishing a rule which it may never be
necessary to enforce.
At the same time it may be well to have the regulation in readiness
should it ever be required, and the Governor General in Council will
be glad to be favoured with any revised proposals His Honour may
desire to make after he has considered the observations contained in
this letter.
No, 3.
No. I348-T. M., dated Darjeeling, the 1st November 1897.
From—H. H. RISLEY, Esq., C.I.E., Secretary to the Government of
Bengal, Municipal (Medical) Department,
To—The Secretary to the Government of India, Home Department.
I am directed to address you with reference to your letters
No. 1768, dated 30th June 1897, and No. 2281-A., dated the 14th
October 1897, on the subject of the proposed modification of some of
the plague regulations issued by this Government under the Epidemic
Diseases Act, 1897, and the examination of passengers travelling by
railway from infected areas.
c2
10
Measures outside the Bombay Presidency.
[ APP. VII.
2. In paragraphs 5 and 6 of the first letter the Government of
India make certain observations and suggestions as to the general
policy to be followed and the particular measures to be adopted in the
matter of segregation. Paragraph 7 of the same letter explains the
decision of the Government of India (which had already been
communicated by telegram) in respect of the publication of the draft
Regulation No. 8, which was submitted with my letter No. 206-T. M.,
dated the 3rd June 1897. It is further stated that it may be well to have
the regulation in readiness should it ever be required, and that the
Governor General in Council will be glad to be favoured with any
revised proposals the Lieutenant-Governor may desire to make after
considering the observations contained in your letter.
3. In order to give all classes of the native community in Cal-
cutta the fullest opportunity of expressing their views on the question,
representatives of the Bengali Hindus, the Muhammadans, the Jains,
the Marwaris, and the Parsis were invited to meet the Medical Board
on the 2nd September last, for the purpose of discussing informally
the draft rule relating to segregation, which had meanwhile been
amplified so as to include the following concessions:—
(1) that relatives, friends, hakims, and priests of sick persons
should be allowed free access to them during the day-
time ;
(2) that members of the family in attendance on a sick person
should be admitted to hospitals, but should be required
to sleep in suitable accommodation provided in the com-
pound ;
(3) that the hospitals need not be in remote or inconvenient
situations.
4. The entire regulation was laid before the meeting, but the dis-
cussion was confined to the provisions relating to segregation, and
none of the other rules were objected to. The representatives of the
Bengali Hindus pressed for the recognition of home-segregation on
the ground that the social customs of the people of Calcutta differed
greatly from those of the people of Bombay, and the Hon'ble Babu
Surendra Nath Banerjee put forward two suggestions designed to
bring about this result :—
(a) "that the word 'hospital' in the rules should beheld to
mean any place or house, not being merely a room, with
a courtyard, or, if standing apart, without a courtyard,
which has been set apart with the approval of a com-
mittee of three experts, of whom one is the Health Officer
for the reception of plague patients and their attendants
and which is not used as a dwelling-house ;
APP. VII. ]
Measures outside the Bombay Presidency.
11
(b) " that inmates of infected houses should be allowed to remain
under observation ten days in any uninfected houses chosen
by themselves and approved of by medical experts at
their own expense."
5. The Lieutenant-Governor is clearly of opinion that neither of
these proposals can be accepted. Their practical result would be to
introduce home-segregation on a large scale, and to multiply the so-
called "hospitals" to such an extent that no effective control could
be exercised over the intercourse of plague patients and suspects
with uninfected members of the community. At the same time the
Lieutenant-Governor feels much sympathy with the desire of the
upper classes of natives that in guarding against spread of plague in
Calcutta as little violence as possible should be done to their social
traditions and usages, and he is anxious to make every concession that
is consistent with the paramount duty of preventing the spread of the
disease. With this object rule 31 of the draft Regulation (46* of
that now submitted) has been further amended to the following
effect:—
46. Segregation.—(1) If on examination of any person the Health Officer
suspects that such person is suffering from or infected with plague, he may cause
such person to be removed to a hospital, and may arrange for his detention,
dieting and medical treatment therein. He may also cause the other occupants
of the house in which such person resides to be removed to a segregation
camp and to be detained under observation for ten days. In the case of parda-
nashin ladies a lady doctor shall conduct the examination.
(2) When private plague hospitals or segregation camps have been provided
and fully equipped by or for particular castes, classes, joint families, or associations
of families, and the Health Officer, or in Calcutta two members of the Plague
Commission empowered for this purpose by the President, have in writing ap-
proved of the site, plan, furniture and arrangements for medical administration of
such hospitals and camps, sick or suspected persons may, if they so desire and if
accommodation is available, be removed to the private hospital or segregation camp
constructed for the use of the caste, class or family to which they belong, instead of
to a public hospital or camp.
(3) In both public and private camps and hospitals separate and suitable
accommodation shall be provided for females, and in the case of a female who, by
the custom of the country, does not appear in public, her parda shall be strictly
preserved both in removal to the camp or hospital and during her slay there.
(4) The relatives, friends, hakims, and priests of sick persons shall be allowed
free access to them during the daytime, subject only to such precautions as the
Health Officer may consider necessary.
(5) Members of the family of a sick person who are in attendance on him may
also be admitted to the hospital, whether public or private, provided that they
shall sleep in the compound in suitable accommodation provided for the pur-
pose, and not in the hospital itself.
* Appendix IV
12
Measures outside the Bombay Presidency.
[ APP. VII.
Explanation 1.—It is not necessary that hospitals provided in accordance with
this rule should be constructed in remote or inconvenient situations.
Explanation 2.—Persons desirous of taking advantage of clause (2) should at
once communicate with the Plague Commission, and satisfy that body of their
ability to provide adequate hospitals and camps when plague breaks out.
Explanation 3.—Private hospitals and camps may be closed by order of the
Plague Commission, if the Health Officer reports that medical attendance and
segregation are not maintained to his satisfaction, orthat the conditions on which
such camps or hospitals were sanctioned are not complied with.
6. It will be seen that, following the analogy of the second clause *
of rule 12 of Regulation No. 4 of the loth February 1897, which was
based upon a suggestion made by a native gentleman to the Presi-
dent of the Medical Board, the system of caste and class hospitals,
which has worked successfully in Bombay, has been extended under
certain conditions to joint families or associations of families. This
concession will render it possible for the upper classes of the native
community to secure for themselves and their families complete privacy
in the event of their being attacked by plague, and being required,
in the interests of the general public, to submit themselves to segre-
gation ; while at the same time it will enable the Plague Commission
(Medical Board) to see that the privilege is not abused, and to limit
the privilege to the classes referred to in the second clause of para-
graph 5 of your letter of the 30th June. The Lieutenant-Governor
hopes that it will be possible to induce persons intending to take
advantage of clause (2) to come forward in time and communicate with
the Plague Commission, When plague actually breaks out it will be
too late to make any but the simplest arrangements, and persons
who have not organised their private hospitals beforehand will find
themselves compelled to resort to those provided for the general
public,
7. In other respects the draft regulation is based for the most
part upon the corresponding rules in force in the North-Western
Provinces, which have been modified so as to adapt them to the
administrative arrangements of Bengal. The only points which
seem to require special notice are the following :—
(1) Bengal Plague Notification No. 1 of the 10th February 1897
has been cancelled as being ultra vires in that it delegat-
ed to the Medical Board powers which can only be
exercised by Government. The opportunity has also been
*"Provided that when the Medical Board is satisfied that suitable and sufficient
accommodation for the complete segregation of infected and suspected persons and
efficient medical attendance have been provided by an association of families, it may
exempt such families from the provisions of this regulation This exemption may be
withdrawn if the Health Officer reports that medical attendance and segregation are not
maintained to his satisfaction."
APP. VIL]
Measures outside the Bombay Presidency.
3
taken to add to the number of that body with special
reference to the duties assigned to it by rule 46 (2), to define
its functions more precisely, and to change its designation,
which has given rise to some misapprehension, from
" Medical Board " to " Plague Commission."
(2) Provision has been made in rules 4 to 4 and 25 to 28 for
the subsidiary precautions referred to in paragraphs 7 and
8 of your letter of the 14th October 1897. These rules
have been drawn up in consultation with the Inspector-
General of Police, and aim at combining the system
hitherto in force in Bengal with that which has been
adopted in the North-Western Provinces and Central
Provinces. A double check will thus be exercised over
the movements of travellers from infected areas, and to
this the Lieutenant-Governor proposes to add the further
precaution of inspection by an itinerant staff of railway
police whose business will be to test the observance of the
rules by occasional inspections. The arrangements now
proposed appear to the Lieutenant-Governor to be very
complete, and if supplemented (as recommended in my
telegram of the 3oth October ) by the device cf issuing
specially coloured tickets to persons travelling by rail from
infected areas, will enable the medical officers in charge
of the principal inspection stations at Khana, Katihar, and
Khurda to pass many persons whom they might otherwise
be inclined to suspect of having broken a journey which
commenced in an infected area with the object of evading
inspection. The annoyance of unnecessary examination
and possible detention will thus be reduced, and the
medical officers will be enabled to give more time to the
examination of travellers from infected areas.
(3) Rules 23 and 24 and 33 to 38 confer upon the Magistrate of
the district and, in Calcutta, upon the Chairman of the
Corporation extensive powers in respect of appointing
Health Officers and their subordinates, cleansing houses
and premises, abating overcrowding, providing hospitals,
etc. Recent experience has shown that Municipal Com-
missioners in Bengal cannot be trusted to take timely
or vigorous action in respect of these matters. As the
Government of India are aware, it was only by the strong-
est pressure that the Commissioners of Calcutta were
induced to sanction-an adequate establishment for the
removal of the large accumulations of filth brought to
4
Measures outside the Bombay Presidency. [ APP. VII.
notice by the enquiries of the Medical Board ; and at the
present time, if plague were to appear in Calcutta, it would
find the town without a Health Officer capable of dealing
with such an emergency. The case of the adjacent
municipalities is even worse. The Lieutenant-Governor
has now before him a strong representation from the
Chamber of Commerce on the subject of the insanitary
condition of Serampore ; and in most of the smaller
municipalities near Calcutta on either bank of the
Hooghly the state of things is equally bad. The only
remedy is to appoint a Health Officer with a sufficient
staff to put matters right ; but the income of the munici-
palities is small ; they could not afford to pay separate
Health Officers, and jealousy and party spirit are too strong
among them for there to be any chance of their agreeing
to combine to pay a Health Officer, In view of the danger
to Calcutta arising from these insanitary areas, the
Lieutenant. Governor is satisfied that the time has come for
Government to intervene and to empower the Magistrates
of Howrah, Hooghly, and the 24-Parganas to take such
measure as are necessary to enforce reforms. They will be
instructed to proceed with due regard to considerations of
economy ; but however careful they may be, the Lieutenant-
Governor apprehends that it will be necessary to supplement
the resources of the municipalities by borrowing under the
Emergency Loans Act. His Honour trusts that the
Government of India will be able to find the requisite
funds in the event of the Provincial Loans Budget being
exhausted.
8. As regards paragraph 6 of your letter of the I4th October, I am
to say that the wording of paragraph 4 of Mr. Oldham's letter No.
8o6-T. M., of the 21st September 1897, seems to have given rise to
some misapprehension. The intention of that paragraph was to
inquire whether the inspections in other provinces were conducted
on the same lines as that carried on at Khana. At Khana it has at
no time been the practice to detain all passengers coming from
infected areas. Detention under observation has been confined to
persons who were regarded as suspicious by reason of their
appearance, or symptoms, or the dirty condition of their clothes or
effects. It has extended occasionally to persons who could not be
easily traced and who could not be relied upon to give notice of the
occurrence of plague among them, and to emigrants and persons of
the coolie class travelling in large bodies. Since the publication of
APP. VII. ] Measures outside the Bombay Presidency.
15
the Venice Conference, most of the persons detained at Khana on
the grounds detailed above have been kept under observation for a
period of ten days reckoned from the date on which they started
from an infected area. Inquiry was accordingly made in paragraph
4 of Mr. Oldham's letter, whether this precaution was enforced in
other provinces. It was stated, however, in somewhat too general
terms, and should have referred to " all suspected travellers," and not
to all travellers without exception or qualification.
g. I am to request that if the Government of India approve of
the draft rule relating to segregation, and of the general policy on
which the remaining rules are explained in this letter, permission to
publish the entire regulation may be communicated by telegram.
I am to add that if necessity should arise the Lieutenant-Governor will
issue them without waiting for the orders of the Government of India.
H ardwar.
No. 4. NOTIFICATION TEMPORARILY FORBIDDING THE SALE OF
RAILWAY TICKETS TO HARDWAR AND NEIGHBOUR.
ING STATIONS.
Government of India, Home Department Notification No. 1518, dated the "18th
May 1897.
Whereas the Governor General in Council is satisfied that there
is danger of an outbreak of plague if persons assemble at Hardwar to
attend fairs in the present month of May and the ensuing month
of June ;
In exercise of the powers conferred by section 2, sub-section (/),
of the Epidemic Diseases Act (III of 1897), the Governor General in
Council is pleased to direct that no tickets to travel by railway to
Lakhsar, Patri, Jawalapur, and Hardwar shall be sold from the 24th
day of May 1897 to the 12th day of June 1897.
No. 5. REGULATIONS PRESCRIBED BY THE GOVERNMENT OF THE
NORTH-WESTERN PROVINCES AND OUDH FOR DEAL-
ING WITH PLAGUE AT HARDWAR,
Dated the 1st May 1897.
It having been ascertained that bubonic plague exists in Hardwar,
the following measures are prescribed under the Epidemic Diseases
Act (III of 1897) for the purpose of eradicating it. These rules shall