NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
ÀPP. IX. ]
spread of infection by sea.
337
prevented from sailing in any vessel under this rule shall be dis-
infected on shore in such manner as the Port Health Officer directs
before such baggage and personal effects are permitted on board
any vessel.
Rule III.—After the master or person in charge of the vessel
has obtained a bill-of-health or certificate under the provisions of
these rules, no person or cargo or goods of any kind shall be embark-
ed or disembarked before the vessel leaves the port of Bombay,
unless such vessel is again inspected by the Port Health Officer
and another bill-of-health or certificate obtained from such officer by
the master or person in charge of the vessel.
Rule IV.—No port clearance shall be delivered to any vessel
unless and until the master or person in charge thereof shall produce
the bill-of-health or certificate to be obtained as aforesaid, and it
shall be the duty of customs officers to refuse delivery of the port
clearance until such master or person in charge shall produce such
bill-of-health or certificate and such bill-of-health or certificate comes
within the provisions of rule V.
Rule V.—Vessels not leaving port before 6 A.M. of the day follow-
ing the medical inspection may not leave without re-inspection.
Rule VI.—The medical inspection of vessels and passengers shall
be carried out between sunrise and sunset.
Rule VII.—The Government of Bombay may appoint any person
or persons by name or by virtue of office, Health Officer or Health
Officers of the port for the purpose of these rules as regards any
class or classes of vessels and may cancel any such appointment.
Rule VIII.—Should the Port Health Officer prevent the embarka-
tion or sailing of any persons under these rules, such person or
persons may be kept under observation in duly appointed places
until free from any suspicious signs or symptoms of plague, and
actual plague cases may be removed to such hospitals as are
appointed for the purpose.
Rule IX.—Disobedience of any of the above rules I, II, III, IV,
V, and VIII will subject the offender, and all persons aiding and
abetting him to a prosecution under Indian Penal Code.
B.—ÎNWARD.
In exercise of the power conferred by Act III of 1897, His Excel-
lency the Governor in Council is pleased, with the previous sanction
of the Governor General in Council to make the following rules and
to publish the same for general information. These rules have effect
43
338
Measures io prevent the
[ APP. IX.
from
in the port of Bombay as a
temporary measure—
I.—The commander of every vessel, including buggalows or
other native craft arriving at Bombay from
shall,
before entering harbour, hoist a yellow flag ; or shall, if
entering port at night time, show the quarantine light sig-
nals, viz., 3 lights, red, white and red at the main. He shall
indicate by signal the port from which the vessel has
come, and shall keep such flag and signals hoisted until
permitted to take them down as hereinafter provided.
The pilot on going alongside a vessel from
shall direct the flag or lights prescribed above to be
hoisted, if this has not already been done.
II.—Such commander shall not without first having obtained
permission, as hereinafter provided allow any communi-
cation except orally, with the shore or with any vessel or
board excepting with the boat supplying pilots, and in
that case communication shall be limited to receiving on
board the pilot, his servant and baggage.
III.—On such arrival being signalled the Health Officer of the
port shall as soon as possible go alongside the vessel
and ascertain by enquiry from the commander, and by
careful individual medical examination of the passengers
and crew, whether any person on board is suffering or
has during the voyage suffered from plague, or whether
any death has occurred during the voyage from unknown
or suspicious causes. If the Health Officer of the port
is satisfied by such enquiry and examination that no per-
son on board is suffering, or during the voyage has suffer-
ed, from plague, and that no death from unknown or sus-
picious causes has occurred during the voyage, and that
the vessel has been ten clear days out from
pratique shall be given at once, subject to the directions
of the Health Officer of the port as to what, if any, proce-
dure of disinfection shall be carried out. Should ten clear
days not have elapsed between the date of the vessel's
departure from
and its arrival at Bombay, it will be within the discretion of
the Health Officer of the port (to refuse pratique until ten
339
APP. IX. ]
spread of infection by sea.
clear days have elapsed since the vessel's departure from
or until all persons on board have been subjected to me-
dical supervision at an appointed place during such
period as will complete ten clays from the date of the
vessel's departure from
For the purposes of this rule the Health Officer of the port may
domaud a declaration on oath from the medical officer or in his
absence from the commander that there has been no case of plague
on the ship since her departure from
IV.—If, as the result of the enquiry and examination made under
rule III, the Health Officer of the port shall have
reason to believe or suspect that at the time the vessel
arrives in the harbour any person is suffering, or during
the voyage has suffered, from plague, or that any suspici-
ous death has occurred, he shall direct that such person,
together with all his or her baggage and personal effects
other than such contaminated or infected articles as the
Health Officer of the port directs to be destroyed, be
removed to such place as is appointed for the purpose,
there to remain until permitted to leave by the medical
officer in charge of such place. After such removal the
Health Officer of the port may direct the commander to
take the vessel to such quarantine anchorage as is
appointed for the purpose, there to remain for a period
of ten days, and he may direct that whilst at the aforesaid
anchorage all communication, except such as is herein-
after provided,' between such vessels and the shore or
other vessels or boats in the harbour, shall be prohibited.
Under this rule the period of quarantine for vessels
which on arrival are found free from cases of plague,
but on which a suspicious death has occurred during the
voyage should be limited to ten days from the date of
such suspicious death.
V.—If, during the period, a vessel is at the quarantine anchorage
aforesaid any case or cases of plague should occur on
board, the said vessel shall remain in quarantine for a
period of ten days from the termination of the last case
either by death, recovery, or removal from the vessel, and
be subject to all the prohibitions provided in rules III
and IV.
340
Measures to prevent the
[ APP. IX.
VI.—When any vessel has been placed in quarantine as aforesaid,
the Port Health Officer may direct that so many of the
passengers and crew as may not be suffering from illness,
and whose services may not be required on board, the
vessel shall be removed to such place as may be appoint-
ed for the purpose there to remain for such time as will
complete a period of ten days either from the date of
departure from
or from the date of the occurrence of the last plague case, and
under such directions as the Port Health Officer may lay
down as to disinfection of the personal effects of the said
passengers and crew. After such removal the vessel and
the effects of such persons as have remained on it shall
be disinfected in such manner as shall be laid down by
the Port Health Officer.
VII.—Any mails, baggage or cargo which may be brought by
any vessel so arriving shall be landed under such pre-
cautions as to the Health Officer may seem necessary to
prevent the spread of the disease.
VIII.—It will be the duty of the Port Officer to facilitate the
conveyance to all persons in quarantine of such supplies
of provisions, stores, and other articles as may be
required.
IX.—All vessels arriving at Bombay, which may have communi-
cated with vessels coming from—shall be subjected to
the same rules as vessels arriving at Bombay from
No. 591 of 1897
Note by Surgeon-Major MacCartie on Government of India letter
No. 1623, Home Department^ dated ist June 1897 (Sanitary).
In order to bring the rules now in force at Bombay against the
export and import of plague within the lines laid down by the Venice
Sanitary Conference, two sets of rules must be considered :—
I.—Those to be enforced as regards departures by sea.
II.—Those against arrivals by sea.
I.—Departures.
2. The two points of difference between the Bombay rules at
present in force and the Venice Regulations are—
(a) Venice rules insist on medical inspection on shore before
embarkation of each person sailing on a vessel : whereas
341
APP, IX. 1
spread of infection by sea.
the Bombay rules permit of inspection on shore or on
boardship as the case may be.
(b) Inspection on shore of contaminated or suspected articles is
compulsory under the Venice rules and is not mentioned
in the Bombay rules. A third point of difference is the
wish of the Government of India expressed in paragraph
5 of their letter No. 1623 of 1st June, that the attendants
and relatives of infected cases should be prevented from
embarking.
3. The order to inspect on shore each person sailing on the ship
would seem to include crews as well as passengers, and if that is the
intention, its inclusion in the Bombay rules will be difficult, if not
impossible, for the following reasons :—
A very large number of vessels do not enter the docks. They
load and unload in the stream and their crews therefore live on board,
but communicate freely with the shore either by visits to the town or
by contact with shore people who load or unload the vessels. If these
crews have to be brought on shore for inspection, great expense,
trouble, and delay will be thrown on shipowners with no compensating
advantage, for, if any member of them is found at the inspection of
shore to be suffering from plague, he must be considered to have
already infected the ship he has come from.
The largest P. and O. vessels always sail from the stream and
have crews numbering from 300 to 340 men. All these have free
communication with the city for many days before departure from
Bombay. Are they to be brought on shore for examination on the
day of sailing, as would seem to be intended by the rules of the
Venice Conference, and if so, what sanitary object has been attained
by a transfer from ship to shore at great expense, inconvenience and
delay to the owners, and at considerable risk to the ships thus
deprived of their crews ?
The same objections apply though in a lesser degree to such
vessels as sail direct from the wet docks, Although the question of
expense may not arise, there is a maximum of inconvenience and no
apparent compensating sanitary advantage.
5. How important is this crew question will be seen from the
return of persons inspected prior to their departure from Bombay by
sea during the months of April and May last, the only two months for
which the returns have as yet been made out. In April 80,008
persons were inspected, of whom 42,141 were crews. In May 81,398,
of whom 44,797 were crews.
It is thus evident that the crews of vessels have been even more
numerous than the passengers, and that the transfer of an average of
342
Measures to prevent the
[ APP. IX,
over forty-three thousand a month to shore for inspection would have
been impracticable, and as regards any sanitary object, such as the
prevention of infection on a departing vessel, useless.
6, It is to be hoped then that the expression " every person sailing
in the vessel must be examined on shore" which occurs in paragraph
5 of Government of India letter No. 1623 of 1st June 1897, will not
be held to include the crews of vessels.
7. On the other hand, the inspection of all passengers on shore
will be possible, although extremely difficult and very expensive as
will be seen from the following remarks.
In accordance with the Venice Regulations, Bombay, as long as
indigenous cases of plague occur there, will be bound to inspect all
outgoing persons ; but it is the opinion of many medical men of
standing that plague will, as cholera had done, become endemic in
Bombay. There is therefore a possibility if not a probability of the
Local Government having to provide an inspecting staff to prevent
the export of plague cases, commensurate with the enormous human
traffic between Bombay and other ports.
To estimate what staff is necessary for this purpose is of course
impossible until it is known whether the regulations as to inspection
refer only to vessels bound for Europe, or are to apply as at present,
to all persons leaving Bombay by sea for anywhere. If the latter,
then a staff sufficient to inspect some 80,000 people a month will be
necessary. Such a staff has been in existence since the 6th Feb-
ruary, and consists of—
1 Port Health Officer,
I Additional Port Health Officer,
3 Commissioned Medical Officers,
3 Assistant Surgeons,
1 Hospital Assistant,
2 Lady Doctors,
and services of one other Lady Doctor on at least two days of each
week, and in addition to the above, three qualified medical officers
who worked under the supervision of the Customs Department, chiefly
in connection with the inspection of small native sailing craft.
The above staff was really too small, and the work was only
satisfactorily done by working at a pressure which is only possible
for a limited time, which left absolutely no margin for sickness or
accident, and necessitated hours of duty lasting on too many occasions
from 5-30 A.M. to 7 and at times 8 P.M. with a very brief interval
for breakfast, whilst it was found necessary on English mail days to
supplement that staff by enlisting the services of at least two and
sometimes four of the Professors of the Grant Medical College.
343
ÁPP. IX. l
spread of infection by sea.
The necessity for a large staff is not merely because so large a
number of persons have to be inspected, or because vessels sail at
all hours and from different anchorages or berths in a large harbour,
but also because plague is a disease which compels a most rigid
inspection of all persons who present themselves for examination.
Its main and chiefest signs are fever and bubos, and accordingly
any man with fever or with bubos becomes an object of suspicion, has
to have his temperature taken and be examined practically naked.
During the inspection of departing passengers by sea in February,
March, April and May, the numbers placed on one side for temper-
ature observation ranged from 20 to 25 per cent., and as many as a
dozen thermometers were in use at the same time.
8. Therefore as long as plague exists, the Local Government will
require a very large staff to examine outgoing vessels, for, even if
there are but few cases of plague in the city, every one departing
from Bombay must be looked upon as a possible plague case, and
will have to be most rigidly examined ; for no Port Health Officer
can be expected to sign a bill-of-health which certifies to the
absence of plague from amongst crew and passengers, unless he is
satisfied that all that is humanly possible has been done to ensure
that the bill-of-health is an honest one.
9. It becomes, then, important to consider how the inspection of
outgoing persons from Bombay can be managed without the Local
Government having to undergo a very heavy expenditure ; and, as I
submit, the expense of an inspecting staff will, if all persons are to be
examined on shore, as directed in paragraph 5 of Government of India
letter No. 1623 of 1st June, be so great as to practically be prohibi-
tive.
10. In discussing the question of shore inspection, the starting
points of steamers must be remembered. Vessels sail from-—
(1) Berths alongside banders or docks harbour walls.
(2) From the wet dock.
(3) From the stream or open harbour.
As regards class (1) there is no difficulty. The passengers of this
class are even now examined on shore in sheds belonging to the Port
Trust, and specially arranged for the purpose, and are then passed
direct into their vessel, and these passengers are those most likely to
be infected, being those who travel by Shepherd's steamers and the
British India boats bound to Kathiawar, Cutch and Karachi.
As regards classes (2) and (3), the difficulties and expense of
inspection on shore at once become manifest, even if the passengers
only are considered.
344
Measures to prevent the
[ APP. IX.
They are—
(a) Increased staff necessary.
(b) Considerable outlay required to erect suitable buildings with
separate compartments for the inspection of men and
women, and retiring rooms for the more private examina-
tion always necessary in plague inspections.
(c) The difficulty of controlling the movements of passengers
after inspection.
(d) An increase of staff will be necessary more especially in the
case of vessels sailing from the stream, because in addi-
tion to the inspection of passengers on shore, the vessels
and crews (if it is permitted to examine the latter on
board) must also be inspected, and even if the crews are
not to be inspected on board, the vessels must still be
examined, and their sanitary condition enquired into.
The importance of this sanitary examination of vessels
cannot well be exaggerated, and has always been admit-
ted here and given a prominent place in the Government
bills-of-health.
If passengers may be examined on board, then vessel, crew and
passengers can all be examined in one place and by the same staff.
It follows that more men and more time will be required if the ship
has to be examined at one time and the passengers at another.
(b) Outlay for erection of buildings. Two such buildings will be
necessary, one for passengers embarking on vessels of class
(2) placed at some central position of the wet docks and
a second situated at, say, Ballard pier, for passengers em-
barking in vessels of class (3). The necessity for these
buildings disappears if passengers may be allowed to
embark before inspection.
(c) Difficulty of control of passengers after inspection. This is
very apparent in connection with vessels leaving the wet
docks and the stream. Vessels sail from the docks
according to tidal conditions both by day and night, and
some of them carry from five to six hundred native pas-
sengers. Such a vessel may be timed to leave her berth
at 4 A.M. Her passengers can be inspected on previous
evening on shore. They have then to be escorted to
their vessel, and, on boarding it find that all the ship's
water closets are closed, as they are by rule.
This compels to resort to the dock latrines. Who is to prevent
them, when they have left their ship for this purpose, from visiting
city ? After they have been inspected on shore, who is to guarantee
345
APP. IX. ]
spread of infection by sea.
that those inspected are those who ultimately sail in the vessels ?
Under a system which permits inspection on board the passengers
would be embarked at sunset, the vessel would leave dock at 4 A.M. and
anchor in the stream, where at 6 A.M., her passengers would be
inspected, and the vessel sail away immediately the examination was
over.
The same difficulty, but more intensified, exists in the cases of
vessels lying in the stream. Who is to control the passengers
between Ballard pier and vessels lying all over the harbour and often
several miles from Ballard pier ?
This difficulty of control of passengers may be got over by a
sufficiently large police force, and special barges on which to convey
persons to the various ships, but native sepoys are sometimes ineffi-
cient, and not always beyond the reach of bribery.
11. The difficulty and expense of compulsory shore inspection
will of course be much lessened if the rules of the Venice Sanitary
Conference are held to apply only to vessels leaving Bombay for
European ports, but they will exist even then to a very appreciable
extent.
12. It now remains to show that the system at present in force
in Bombay, which permits of inspection on boardship or on shore as
the conditions demand, has not been attended with any ill conse-
quences and has, as regards the prevention of the export of plague
to other countries, worked satisfactorily. Since 6th February, 1897,
when the Government order for the inspection of all vessels leaving
Bombay came into force, only one plague case as far as is known got
away from Bombay by sea, viz., that by the S.S. Dilwara hired
transport. Before that date two plague cases occurred in the pil-
grim vessel Pékin after departure from Bombay. In both those cases
passengers were inspected on shore prior to embarkation, and in the
Dilwara instance had the inspection of passengers been made on
board at the time when the Port Health staff visited the vessel for
examination of the ship and its crew, the plague case which had been
inspected two days previously on shore might possibly have been
discovered. The arrangements for the medical examination of pas-
sengers by troopships are made by the military authorities, the Port
Health staff only inspecting crews and vessels. The Dilwara and
Pékin were therefore infected vessels, and the latter vessel carried
over 1,000 of perhaps the most insanitary and dirty people, who
travel by sea, pilgrims—yet the disease did not catch on, nor did
the passengers on board these very crowded vessels suffer in health
from the fact that plague cases were amongst them, During the
inspection on boardship from February up to date, many persons
c 44
346
Measures to prevent the
[ App. IX.
have been removed from outwardbound vessels as suspicious cases.
Some of these developed plague after removal, but in no instance did
the disease appear amongst those who remained on the vessels.
They sailed away and no more plague occurred from which it would
seem that the circumstances of a sea voyage are inimical to the
plague microbe : and that people affected by manifest plague, or in
whom the disease is incubating, may be on boardship without danger
to the rest of the passengers, unless, indeed, the number of infected
ones is very great. The compulsory inspection on shore then does
not seem to be an absolute sanitary necessity, whilst it has been
shown that it can only be carried out by a system which will neces-
sitate a very large expenditure of time and money.
13. (B) Disinfection on shore of contaminated or suspected arti-
cles. This can be carried out under the Bombay system. An infected
case on board a vessel may be removed with all his baggage, as
now is done to an observation camp, before leaving which kit can be
and is now disinfected : and the vessel or parts of it where the case
lay can be also dealt with.
14. The rules marked A (outward) drawn up in consultation with
the Commissioner of Customs, and forwarded by him to Government,
accordingly, are worded so as to permit of inspection on boardship as
well as on shore, whilst in other respects they are adjusted to meet the
requirements of paragraph 5 of Government of India letter No. 1623
of 1st June. They also provide for the segregation of actual plague
and suspicious cases in plague hospitals and observation camps re-
spectively and for disinfection of vessels and baggage.
An opening has been left in rule I, so that it can be made appli-
cable to all vessels leaving Bombay for anywhere or to vessels bound
for certain ports only, e.g., Europe, Africa, etc.
II.
15. The rules marked B (inward) have been drawn up according
to the instructions laid down in paragraph 12 of Government of India
letter No. 1623 of 1st June, 1897, and it is proposed that they should
be applicable to vessels arriving at Bombay from any infected port,
Indian or foreign. Under them certain places for quarantine camps
outside the city will be required, and it should be noted that no such
places at present exist which are suitable for the purpose : whilst the
Plague Committee's segregation camps inside the city are temporary
and will not provide accommodation for from 600 to 800 people, which
must be considered insufficient when it is borne in mind that one pil-
grim ship alone, the Pekin, may arrive from an infected port such as
Jeddah with more than 1,000 passengers.