NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
APP. IX. ]
spread of infection by
Sea
3 2 9
established by Article r of Annexure IV of the Paris Convention of
the 3rd April 1894. It should be explained, however, that the mem-
. bers of this Committee will be taken exclusively from the Constanti-
nople Board of Health, and will represent the Powers which have
accepted, or may hereafter accept, the Sanitary Conventions of Venice,
1892, of Dresden, of Paris, and of Venice, 1897.
2. The proper working of the various sanitary establishments,
prescribed by existing rules, is entrusted to the corps of diplomaed
and duly qualified doctors, of disinfecting officers, of experienced sub-
ordinates and of sanitary guards rec-uited from among persons who
have performed military service as officers or non-commissioned
officers, as provided for in Article 2 of Annexure IV of the Paris
Convention,
3. The expenses of the establishment of permanent and temporary
sanitary posts, as contemplated by this Convention, are, as regards the
construction of the buildings, debitable to the Turkish Government.
The Constantinople Board of Health is authorised, in case of emer-
gency, to advance the necessary money from the reserve fund. In
this case, it should supervise the construction of these establishments.
4. The Constantinople Board of Health should also organise with-
out delay, the sanitary establishments at Khanikin, and Kizil Dizé,
near Bayazid, on the Perso-Turkish frontier, out of the funds which
are now placed at its disposal.
5. Articles 4, 5 and 6 of Annexure IV of the Convention of Paris
of 1894 may be utilised for carrying out the present rules.
Powers of the sanitary, marine and quarantine Board of Egypt.
6. The expenses involved in the measures prescribed for in the
rules contained in this Convention may be met by the following
measures, which the Conference recommends, not only to meet the
new requirements at Moses' Wells, but also to defray the cost of the
increase of the staff under the Sanitary Board :—
(1) The prorogration, with the consent of the Powers, of the
Khedival Decree of 2oth December 1896 (fixing the 1st July 1897
as the date for the application of the reduced tariff for lighthouse
dues) until the difference betweeen the receipts of the present tariff
and the reduced tariff has reached the sum of £4,000 (Egyptian),
The sum thus realised will be devoted to extraordinary expenses
(new arrangements at Moses 1 Wells).
(2) For ordinary expenses (increase of staff) an annual payment
by the Egytian Government to the Sanitary Board of a sum of ¿4,000
(Egyptian), which can be deducted in advance from the surplus of
the lighthouse service fund remaining at the disposal of the Govern-
ment.
c 42
33°
Measures to prevent the
[ APP. IX.
From this sum, however, there will be deducted the value of a
supplementary quarantine tax of P. F. 10 (piastres tariff) to be
collected from each pilgrim at El-Tor.
In the event of the Egyptian Government finding difficulty in
meeting its share of the charges, the Powers represented on the
Sanitary Board will arrange with the Khedival Government to ensure
the participation of the latter in the estimated cost.
Rules for outward and inward bound vessels issued
after the Venice Convention.
BOMBAY.
No. 89.
No. 4021, dated Bombay Castle, the 22nd July 1897.
From—J. DEC. ATKINS, Esq., I.C.S., Secretary to the Government of
Bombay, General Department,
To—The Secretary to the Government of India, Home Department.
Letter No. 2915, dated 24th June
1897, with accompaniments, from
the Acting Commissioner of Cus-
toms, Salt, Opium and Abkari.
Letter No. 3070, dated 2nd July
1897, with accompaniments, from
the Acting Commissioner of Cus-
toms, Salt, Opium and Abkari.
With reference to your letter No. 1623, dated the ist June 1897,
I am directed to forward herewith copies
of the papers noted in the margin, and
to solicit the orders of the Government
of India on certain important questions
arising in connection with the contem-
plated alteration of the rules issued by
this Government under the Epidemic Diseases Act, 1897, and Act I
of 1870, so as to bring them in accord with the provision of the
Venice Sanitary Convention of 1897.
2. The draft rules for the port of Bombay, submitted by the Com-
missioner of Customs, Salt, Opium and Abkari, comply with the
requirements of the Venice Convention, except in one particular : they
do not provide that the medical examination of each person sailing
shall be on shore. They are, however, in the opinion of this Govern-
ment, suitable and effective.
3. The most important to other countries, the most difficult to
this Government, of the sanitary measures for ships sailing from
infected ports, is the individual medical inspection of each person sail-
ing. The labour involved in conducting this inspection is immense.
In April and May of this year upwards of 162,000 outgoing persons
were medically examined at the port of Bombay. The efficiency of
the examination was extraordinary. As far as is known, plague was
prevented from entering any ocean-going vessels leaving the port of
Bombay, except the pilgrimship Pékin and transport Dilwara : and
in the case of the latter vessel the Port Health Officer had not been
APP. IX. ]
spread of infection by sea.
331
entrusted with the medical inspection of the class of persons amongst
whom plague appeared. The Governor in Council cannot leave this
particular aspect of the matter without expressing to His Excellency
the Governor General in Council his appreciation of the admirable
work done by Dr. MacCartie and his staff during the past six months ;
and his opinion that by reason of Dr. MacCartie's very wide, probably
unique, experience in the matter, that officer's views on medical
inspection are entitled' to the most earnest consideration. . -
The first point to notice particularly isthat in the case of ordinary
steamers and especially those sailing to European and Colonial ports,
the chief danger of infecting the vessel arises, not from the passen-
gers, but from the crew. There seems to be little room for doubt
that the expression " each person sailing on the ship " used in the
Convention includes the crew. But, however that may be, it is essen-
tial that the crew should be inspected ; unless the lesser source of
danger alone is to be guarded against and the greater left unchecked,
But herein lies the absolute impracticability of inspection on shore.
The reasons are so clearly pointed out in the papers accompanying this
letter that they need no further elaboration, indeed no statement of
reasons is needed to show that in the case of vessels sailing from the
stream, the inspection of the crew cannot be on shore at the time of
embarkation. The fact is patent.
5. This Government therefore are compelled to ask that the Con-
vention should be so modified as to allow of inspection on shore or
on board) as the circumstances of any particular port may render
necessary. The power of suggesting modifications in the Convention
is reserved to the contracting parties. It should, this Government
consider, be exercised in this particular instance for two reasons. The
first I have already fully explained, it is the practical impossibility of a
complete inspection on shore. The second is that there is not neces-
sarily any loss of efficiency involved in an inspection on board. Dr.
MacCartie shows how time after time he had members of the crew cf a
vessel removed for observation, how a certain number eventually de-
veloped plague ; and yet that on the vessels from which they had
been removed no more cases of plague occurred. It seems to be
practically demonstrated that the early stage of plague is not one in
which the disease is communicable by the patient, and consequently
the removal from a vessel of a person suffering at an early stage of the
illness accompanied by the removal of those in attendance on him and
his and their effects is a thorough safeguard to the vessel and those on
board. Even at a more advanced stage effective disinfection of the
portion of the vessel a plague patient has been in contact with, in ad-
dition to the other measures, would secure the vessel and those on
board from danger. As a matter of experience, however, it is found
332
' Measures to prevent the
[ APP. IX.
that cases on boardships are discovered at an early stage. These
considerations taken with the results of the inspection of outgoing
vessels from Bombay throughout the time when plague was at its
worst demonstrate that the Bombay method of inspection is not want-
ing in efficiency and need not be changed.
6. The argument of expense, though important, is not one which
this Government consider it desirable to urge as a ground for modifv-
o
o
j
ing the provisions of the Convention. They rely on the thorough
efficiency of the method practised in Bombay, and on the practica-
bility of that provided by the Convention.
7. The Bombay Government agree with Sir James Campbell that
when plague cases have become very few in Bombay the inspection
rules should be applied to certain classes of vessels only. So long,
however, as Bombay remains an infected port, within the meaning
of that expression as used in the Convention, individual medical
inspection must be made of every person sailing in each vessel pro-
ceeding to any port of a country which is a party to the Convention.
As regards vessels proceeding to other ports whether within or out-
side India, the inspection can be altered or discontinued at will. I
am to enquire whether it is the wish of His Excellency the Governor
General in Council that no such alterations or discontinuance should
be made without previous reference to the Government of India, and
to this enquiry I am to request that, if the Government of India see
no objection, an answer may be sent by telegram ; for it is to be hoped
the time is near when the inspection of vessels proceeding from Bom-
bay may in some cases be relaxed or discontinued.
8. I am to add that Sir James Campbell appears to be in error in
stating (paragraph 10 of his letter No. 3070 of 2nd July 1897) th at
'' under a recent order of the Government of India letter No. 1623,
dated 1st June 1897, the Local Government rules regarding the inspec-
tion of ships are to be adjusted to the Convention rules." It is under-
stood that the order quoted applied only to the assimilation, to the
requirements of the Convention, of the rules for the inspection of
vessels proceeding to ports out of India from Madras and Calcutta.
No. 2915, dated Bombay, the 24th July 1897.
From—SIR JAMES MACNABB CAMPBELL, K.C.I.E., I.C.S., Acting Com-
missioner of Customs, Salt, Opium and Abkari,
To—The Secretary to the Government of Bombay, General Department.
VENICE CONVENTION.
PLAGUE INSPECTION BY SEA.
Outward and Inward.
With the help of Surgeon-Major MacCartie, the Health Officer of
the port by whom the rules have been
drafted, I have the honour, as directed
in your No. 3188 of the gth June 1897,
to furnish the following intormation.
APP. IX. ]
spread of injection by sea.
333
2. To adjust the procedure at Bombay with that laid down in the
Venice Convention, as explained by the Government of India in their
letter No. 1623, dated 1st June 1897, two sets of rules A outwards
and B inwards are required.
3. The details of rules B inwards are taken from the regulations
enforced by Government at Aden and Karachi against arrivals from
plague-infected ports. The means of segregation now available in
Bombay make it possible to provide for the accommodation and treat-
ment of from 600 to 800 infected or suspected arrivals, a total which
is not likely to be reached, except at such times as pilgrims from the
Hedjaz may be returning to Bombay in infected ships. At the same
time it is to be noted that segregation is available only in the city
itself. Bombay at present has no .means of detaining in any quaran-
tine camp outside the city of infected or suspected arrivals.
4. The details of rules A outward are in the main in agreement
with the existing procedure in Bombay. With few exceptions the
arrangements in force since 6th February last can be continued with
such slight modifications as will bring them more exactly in agreement
with the conclusions of the Venice Conference. In drawing up these
rules we have felt uncertain how far it is the intention of Government
to order the inspection of every vessel which leaves Bombay for any
port. It seems necessary to leave it open to Government to decide
that when plague cases in Bombay have become very few these rules
should apply to certain classes of vessels only, say those bound for
Europe.
5. The only important exception to the general conformity is that
while it has been the practice in Bombay to inspect the passengers
and crew of outgoing vessels either on shore or on board, as the other
necessary arrangements regarding the departure of the ship made
possible, the Convention Rules as noted in Government of India No.
623, of 1st June 1897, paragraph 5, contemplate no inspection of out-
going passengers and crews except on shore.
6. An examination of the conditions under which vessels leave
Bombay shows that it is not advisable, that it is not even possible, to
enforce a rule which makes all outgoing medical inspection an inspec-
tion on shore.
7. In Bombay vessels start from one of three places—•
(1) The outer wall of the dock.
(2) The docks.
(3) The stream.
In the case of vessels starting from the outer wall of the dock the
passengers are now, and, since plague inspection was started early in
February 1897, have been, inspected on shore in sheds specially
334
Measures to prevent the
[ APP. IX.
arranged on the dock wall. The crews of those vessels, that is of
vessels that start from outer wall of the dock, are mustered and exa-
mined on board before the passengers are allowed to enter the ship.
In this way only can the stokers, foreman and other members of the
crew who are on duty be inspected without the risk of delay or of
accident. It might be possible to arrange to inspect the crew in
batches on shore, But the annoyance and risk of such a procedure
are clear and the practical merit of the precaution is not apparent
since the crew have been already on board, and if one of them on
inspection is found to be suffering from plague, he must be considered
to have infected the ship. In this connection I would venture to
draw attention to the fact that the inspection of the crew is of more
importance than the inspection of the passengers. Returns show
that of the inspections during April and May 1897 mor e than one
half were inspections of members of crews (86,938 of 161,406). And
it is evident that specially in the case of vessels for Europe, the shore
life and surroundings of the passengers are more wholesome than
those of the crew.
8. The difficulties in the case of No. 2, that is of departures from
the dock, are more serious than in the case of No. i, departures from
the dock wall, since these difficulties affect passengers as well as crew.
Under the rules no inspection can take place at night. The state of
the lading or of the tide not unfrequently compels a vessel to leave
the dock at night. Vessels which in any voyage may have to leave
the dock by night sometimes carry 500 to 600 passengers. If the
passengers and crew have to be inspected on shore a building must
be secured in some central position in the docks with separate rooms
and retiring rooms for men and for women. Even though necessary
quarters are provided a further set of difficulties remain. If the vessel
leaves the dock during the night how can the passengers be controlled.
The docks are about 13/4 miles round. To use the only available
latrines passengers must be allowed to move about the docks. What
is to prevent a passenger taking advantage of this freedom to pay a
visit in the town? Again when the ship starts what security is there
that the passenger who passed sound the evening before is the same
passenger who leaves Bombay ? A strong body of special police might
help to keep irregularities within bounds. Such a force would be
costly and, considering the peculiar characters of the duty, they could
hardly be expected to be markedly efficient. These objections are
urged in the case of passengers who leave the dock by night. The
same objections apply in some details with more, in other details with
less force, in the case of crews who start during the night.
9. In the case of No. 3, departures from the stream, the objections
to a shore inspection either of passengers or of crew are still stronger.
APP. IX. ]
spread of infection by Sea.
335
Separate inspection rooms, perhaps at Ballard pier, would have to be
provided, and to control passengers starting from the stream would
be still more difficult than to control them during a night departure
from the dock. But it is in the case of the crews of the larger vessels
leaving Bombay from the stream that the difficulty of arranging a
shore inspection practically becomes an impossibility. The India or
other large mail steamer in the stream ready to weigh anchor has a
crew of 332 men. That the whole of this mass of men can either in
block or by detachments be sent on shore for medical inspection is a
proposal which, so far as I can judge, is not practicable.
Rules, page 3, paragraph ÍI-I.
1o. I am therefore hopeful that the principle which the Venice
Convention has been pleased to adopt,
namely, that each Government may take
to account local considerations and conditions, may be declared to
include in Bombay such boardship inspection as local circumstances
have proved to be necessary. That in fact the concession of board-
See General Rules, page 3, Note.
ship inspection granted by the Venice
Convention in Batavia to pilgrim
ships may be applied in Bombay to the less rigid treatment required
in the case of ordinary passengers. It may be objected that in
Bombay the concession of boardship inspection is unnecessary, seeing
that all pilgrims are inspected on shore. The reply is that in
Bombay to make the shore inspection of pilgrims possible restrictions
regarding the berth occupied and the hour of sailing have to be enfor-
ced which could not be made applicable to ordinary passenger ships.
11. The chief argument in support of the concession of board-
ship inspection is neither the saving of expenditure nor the smooth-
ing of difficulties. The chief argument in its favour is, since its
introduction in early February, the notable success of the Bombay
system of inspection partly on shore, partly on shipboard. During
the past four months the outward plague inspections by sea have been
February 79,623, March 91,779, April 80,608, and May 81,398. Of
this total of 333,408 inspections in no single case, for the S. S. Dil-
wara was inspected by the military authorities, did plague appear
after any of the vessels left Bombay.
12. With a record so favourable to the local alternative system
I trust Government may be pleased to move the Government of
India to allow the existing port-shore, port boardship inspection to
continue as the sole concession to the local conditions of Bombay
which the experience of several months has shown to be necessary.
With this hope I have the honour to forward a set of rules A, out-
ward, drafted by Surgeon-Major MacCartie, which I consider will carry
out the directions of the Venice Convention, except in as far as in
336
Measures to prevent the
[ APP. IX.
accordance with the existing Bombay practice, they permit inspection
on shore or on boardship according to the circumstances of each case.
13. Along with the general summary contained in this letter of
the grounds for continuing the system in force in Bombay, I have
the honor to submit a memorandum from Dr. MacCartie, stating in
detail the evidence in favour of alternative boardship inspection. All
the considerations on which the Health Officer of the port lays stress
seem to me of practical importance. They form a valuable record
of his special experience of the system of inspection required in
Bombay to guard against the outward and inward spread of plague
by sea.
A.—OUTWARD.
Rule I.—No vessel shall leave the port of Bombay for any of the
following ports.
Until she has been inspected by the Health Officer of the port,
and the master or person in charge of such vessel has obtained a
bill-of-health or certificate from such officer that the master or person
in charge, officer and passenger (if any) of such vessel are free
from plague : provided that, in the case of a vessel that has called
at Bombay from a port outside the continent of India en route for
some other port, and which has on arrival a clean bill-of-health and
has had no communication with Bombay, except through any person
or persons who shall have embarked there, the inspection of such,
vessel by the Health Officer of the port may be limited to the
medical examination of such person or persons so embarked, and
the bill-of-health or certificate required by this rule shall only certify
that such person or persons is or are free from plague, and such,
certificate may be in the form of an endorsement on the bill-of-health
furnished to the vessel at the last port of call prior to arrival at.
Bombay. For the purposes of this proviso the Collector of Customs
and the Port Health Officer are empowered to decide what shall
constitute communication with Bombay.
Rule II.—Should the Health Officer of the port be of opinion
that any person on board of, or about to sail on, any vessel so in-
spected is suffering from plague he shall refuse to give a bill-of-health
or certificate as aforesaid unless and until such person together with
his or her attendants and relatives, and their baggage and personal
effects have been removed from the vessel, and the vessel has been
disinfected in such manner as the Health Officer of the port directs ;
and such removal and disinfection shall be noted on the bill-of-health.
The baggage and effects of such persons as are removed from or