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cannot be determined not to be plague, as deaths from plague and by disinfecting
the houses in which they occur. It will of course be open to any persons to volun-
tarily submit a dead body to the examination of a medical officer if they wish to
avoid the death being treated as due to plague.
Applying the principles here laid down to Bombay we find that compulsory
notification of sickness has never been enforced, though under the ordinary
provisions of the Municipal Act medical practitioners have been and will continue
to be bound to report plague or any other dangerous disease which may come to
their knowledge.
Official house-to-house visitation was long ago discontinued and will not be
resumed, though it will continue to be the duty of the staff to visit houses that
have been infected with a view to keeping the inmates under observation.
The question of surveillance over arrivals from infected areas is hardly
applicable to Bombay under present conditions and would be exceedingly difficult
to carry into practice.
Paid spies and informers are not now employed and must not be [employed,
nor should rewards be granted for information regarding plague cases unless and
until that is sanctioned by the local Government. Every effort should be made
to secure the co-operation and assistance of volunteers in collecting information
of plague cases which they will continue to do, as now, by making enquiries in
localities where they are known and have influence. They will also continue to be
of the utmost value in explaining to the people the utility of the measures adopted,
and helping to get them carried out without friction.
It is recognised that it is not possible to find all cases of plague during life.
Compulsory examination of dead bodies has never been adopted in Bombay and is
prohibited, but the verification of deaths should continue on the same lines as
heretofore ; and it should be very distinctly understood and explained to the people
that all deaths, the cause of which cannot be determined not to be plague, will be
treated as deaths from plague and the house wherein it occurred disinfected
accordingly.
Still-born deaths from ordinary causes in hospital, deaths certified not to be
due to plague by reliable medical practitioners, are not open to suspicion ; the
people should be encouraged to inform the plague staff of any dangerous illness so
that the Sectional Medical Officers may satisfy themselves whether the disease is
plague, and in the last resort it will always be possible for the people to avoid
disinfection where the death is not due to plague by submitting the dead body for
examination.
The test whether the District Staff are carrying out these principles efficiently
will be found under ordinary conditions in comparing the balance of deaths ascribed
to ordinary causes with the normal mortality of the District.
Removal of Plague Patients to Hospital.—Paras. 24 to 27.
The Commission are of opinion that the strong aversion of the people to
hospital leads to the concealment of cases and in Bombay to the removal of the
plague-stricken from house to house. They do not think that any steps taken to
popularize hospitals will materially affect the attitude of the people, and they
consider that the concealment of cases and their secret removal from house to house
increase not only the number of houses infected but also the uncertainty as to
which houses were actually infected ; on the other hand the policy of permitting
the sick to be treated in their own houses, as in Calcutta and Mysore City, did not
lead to violent outbreaks of plague.
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