NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
84
Governments and Administrations have been communicated
as they were issued by the different Local Governments and
Administrations to the Governor-General in Council for
information, and under the orders of His Excellency in Coun-
cil these have been examined on their receipt, and in any
case in which they have been found to be in conflict with the
general principles which have guided the Government in
dealing with the plague the Local Government or Adminis-
tration concerned has been requested to cancel or modify
them. Experience in the working of the rules has been
mainly obtained in the Bombay Presidency to which, with
very few exceptions, plague has been hitherto confined,
and, in view of the fact that the Plague Commission under
Mr. Wingate accompanied by Dr. Cleghorn, Director-General
of the Indian Medical Service, have recently visited all the
infected areas in the Bombay Presidency and, after examining
the arrangements in force in each place, devised a set of rules *
of which the Government of India, subject to the remarks
made in paragraph 11 of this Resolution as to the principles
to be followed by Medical officers in detaining passengers,
approve, the Governor-General in Council proposes to take
the opportunity of communicating these rules to the different
Local Governments and Administrations with the suggestion
that they should be utilized as a model upon which to frame
rules for other Provinces.
2. The Government of India desire to express their con-
currence in the statement contained in Rule 3 of the rules as
to the measures which must be taken to combat an outbreak
of the plague. The essential measures to be taken are (1) the
early recognition of the disease in a locality, (2) the treatment
of the sick in places of segregation, (3) the removal of the
other inhabitants from the infected house, locality or area,
(4) their segregation for a specific period, (5) the disinfection
of their persons, clothing and personal effects, (6) the
disinfection of the houses in the infected locality and
their contents, (7) the improvement of the ventilation of the
houses, the abatement of overcrowding, and the prosecution
of general measures of sanitary reform.
3. One of the main difficulties which have to be contended
with in dealing with the plague is the absence of any efficient
organization for the detection of cases before the outbreak
has attained proportions which make it impossible to suppress
it for a considerable time. Considering the extent to which
* Printed on pages 92 to 102.
85
fever prevails in the country and the ignorance of the agency
responsible for reporting the occurrence and cause of deaths,
it can hardly be expected that every case of plague will be
brought to notice immediately after it has occurred, and it is
very desirable that where there is any reason to suspect the
existence of the disease a regular system for the detection of
suspicious cases of sickness should be devised. Rules 4 and
9 of the Bombay Rules contain directions designed to secure
the detection of the disease by improving the arrangements
for reporting sickness and mortality, and the arrangements
for rural areas described in Rules 5 and 6 have for some time
past been in force in the North-Western Provinces, the
Punjab, the Central Provinces and Bengal. The occurrence
of cases of plague in villages in the neighbourhood of Kankhal
in the Saharanpur district of the North-Western Provinces
has also led the Lieutenant-Governor and Chief Commissioner
to issue orders for the employment of a special organization
for ascertaining whether it has extended to places other than
those in which it has been detected. This organization is
based upon that which was so successfully utilized in distri-
buting relief during the recent famine, and the essence of it
is that a sufficient number of European officers should be
employed to render the powers of search effective and at the
same time prevent the subordinate establishments from abus-
ing their authority. A copy of the orders issued by the Gov-
ernment of the North-Western Provinces and Oudh to the
Commissioner of the Meerut Division is appended * to this
Resolution, and the Governor-General in Council desires to
commend them to the consideration of other Local Govern-
ments and Administrations in case there should at any time be
reason to suspect that plague exists and has not been detected.
For the purpose of supervising work of this nature, young
officers of the Staff Corps will, the Government of India
believe, be found to be a most suitable agency should the
Civil establishments be insufficient, and though it may not be
possible to procure the services of such officers in any num-
bers at the present juncture, the Government of India will
endeavour, should the necessity arise, to procure them from
the Military authorities when the operations at present being
carried out on the North-Western frontier have terminated.
4. Another measure which has been put forward as an
effective means for ascertaining the existence of plague is
the inspection of corpses. The Government of India have
* Not printed.
86
consulted Local Governments and Administrations as to the
question whether corpse inspection is a reliable means of
bringing facts to light and whether the feeling of the people
is opposed to it or not. The Govern or-General in Council
has not yet received all the replies to the reference made upon
this question and it will be dealt with separately later on.
On the information at present before them it appears to the
Government of India to be doubtful whether the measure is
likely to be of great assistance, and they fear that its general
introduction would be repugnant to the feelings of the people.
5. The system prescribed in Rule 10 and the following
rules issued by the Bombay Government for the division of
towns which are infected or liable to infection into quarters
or divisions of a size convenient for effective supervision
meets with the approval of the Government of India, and in
this, as indeed in all the measures taken for the suppression of
the plague, it is essential to secure the supervision of an
European official who will carry the people with him, and see
that their customs and susceptibilities are as far as possible
respected. When search parties are organized to ensure that
all cases of the disease are brought to notice, and this measure
will, it appears to the Government of India, be found to be a
very necessary one at any place where an outbreak occurs,
endeavour should be made to associate respectable native
gentlemen with them, and female medical attendants should
accompany them for the purpose of examining females.
6. When plague actually breaks out the segregation of
the sick and of the persons who have been in immediate con-
tact with them is a fundamental precaution which is essential
to the successful issue of any operations against it. In
devising means to secure this object it is necessary on the
one hand to consider the urgent necessity of preventing
sufferers from plague from spreading the infection among
their neighbours, and on the other hand the great importance
of interfering as little as possible with the customs and the
feelings of the community. The Governor-General in Council
considers that experience has shown that in order that segre-
gation may be efficacious it must be carried out in hospitals
or other suitable places specially appointed for the purpose.
A measure of this nature can hardly be expected not to cause
alarm among a people many of whom regard the privacy of
their houses as sacred, and this feeling can only be allayed if
those affected by it have confidence in the motives of Govern-
ment and believe that it is actuated solely by a desire to stay
the pestilence. The Governor-General in Council has been
87
much impressed by the readiness and docility with which the
people in many of the infected areas have discarded their
prejudices and submitted to removal from their houses, and
His Excellency in Council feels confident that, if the neces-
sity for the measure is carefully explained to them, the
co-operation of leading men obtained as far as possible, and
every consideration shown to the feelings and habits of those
to whom the Regulations have to be applied, this measure will
be accepted without objection by the people of a locality in
which plague has made its appearance. But it appears to
His Excellency in Council that the prospect of such action
being required of them in the event of plague appearing in
their midst may not unreasonably seem distasteful to them so
long as there is no immediate danger of an outbreak, and it
is therefore desirable to, as far as possible, remove any cause
for discontent by encouraging the people themselves to make
arrangements for the establishment of private hospitals and
segregation camps for particular castes, classes, joint families
and associations of families in anticipation of the necessity for
their removal from their own houses arising. The equipment
and administration of such hospitals must be approved by duly
appointed authority. They should be conveniently placed
and it is not necessary that they should be located in remote
situations. They should not, however, be situated in houses
which are actually inhabited or blocks of houses or streets,
for in the event of an outbreak of plague, cases of the disease
might occur in the house or block which it would then be
necessary to completely evacuate. While His Excellency in
Council is strongly of opinion that in carrying out any
measures of segregation 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, it is not, he fears,
possible save in the most exceptional cases (as for instance
that of a house located in a large garden, in which a hospital
or private camp can be located at a distance from the house
actually infected) to permit the residents of an infected house
not to evacuate the area in which it stands. His Excellency
in Council therefore anticipates that in a crowded city there
will be few (if any) houses, which it will be safe to license as
hospitals or for segregation purposes. In public as well as
in private plague hospitals, all possible consideration should
be shown to the feelings of the inmates, and in especial caste
distinctions and the privacy of females who do not appear
in public should be carefully respected, His Excellency in
88
Council also considers that it is neither necessary nor humane
to separate the sufferers from their families and friends, and
all plague hospitals, whether Government hospitals or private
caste hospitals, should therefore be arranged so as to provide
separate accommodation for the immediate family or friends
of the patients. For the public hospitals it will be found
convenient to utilize schools and other public buildings which
are available and suitable.
7. Before leaving the subject of segregation, the Gov-
ernor-General in Council desires to say that, while it has not
yet been shown that inoculation with prophylactic serum such
as has been prepared by Mr. Haffkine, C.I.E., can be relied on
as a means to prevent the spread of plague, the results of the
experiments made are so distinctly encouraging that he is not
without hope that it may be demonstrated that protection may
be ensured by means of prophylactic inoculation. It is desir-
able that every opportunity should be taken to test the
efficacy of inoculation, and the Governor-General in Council
will feel obliged if Local Governments and Administrations,
within whose territories plague now exists or may appear in
the future, will place themselves in communication with
M. Haffkine in order to procure a supply of serum for the use
of persons who desire to have themselves inoculated. No
person should be inoculated except with his express consent.
In the event of the efficacy of inoculation being eventually
established, it will, it appears to the Government of India,
become possible to dispense with segregation in the case
of persons who have undergone the process of inoculation,
Even in this case it will, however, still be necessary to require
the evacuation of infected houses and localities with a view
to their thorough disinfection for the purpose of destroying
the germs of infection.
8. The rules issued by the Bombay Government for the
removal and burning of the clothing of a patient suffering from
plague, for the disinfection of all those removed from the
infected area whether to the camp for suspected persons or to
that for the healthy, and for preventing the re-occupation of
houses in the infected area until a certain time after they have
been evacuated, cleaned and disinfected, appear to the Govern-
ment of India to be full and satisfactory. The Governor-
General in Council desires to impress upon Local Govern-
ments and Administrations the paramount importance of
making efficient arrangements to prevent people from return-
ing to occupy evacuated houses before the time specified, and
of securing that all articles likely to convey infection are
89
without exception removed from infected houses and immedi-
ately destroyed or disinfected.
9. It seems to the Government of India desirable to
express their views upon the subject of quarantine in relation
to the suppression of plague. Her Majesty's Government and
the Government of India have continuously been opposed to
the view that the spread of epidemic disease can be effectively
checked by the imposition of quarantine so as to prevent the
movement of the people to other places from areas in which
epidemic disease prevails. The first reason which has led the
Government of India to this conclusion is that it is impossible
to make any system of land quarantine in India effective. It
could, indeed, be arranged that every traveller by railway
should, on leaving the infected area, be placed in a segrega-
tion camp for a given time, but any attempt to block all the
roads and paths from the infected area must be defeated,
firstly, because the Government has not at its disposal the
necessary establishments to make such a stoppage of the
traffic effective, and, secondly, because the establishments
could not be relied on to carry out the duty. But even could
it be made effective, a system of land quarantine would, in the
opinion of the Government of India, be mischievous in itself
and calculated to foster rather than to suppress an outbreak
of epidemic disease. It is in appearance so easy a remedy
that if adopted it would be apt to distract attention from
those surer and most essential measures which, if plague is
to be suppressed, must be taken at the place where the out-
break occurs. It causes hardship and suffering to the people
who have to be detained, and it affords opportunities of every
kind for bribery, blackmail and extortion to the subordinate
establishments employed to enforce it. The collection in
camp of large bodies of people who have previously been
subject to the risk of plague infection involves danger of an
outbreak of the disease in the camp, and may thus establish
fresh foci for the dissemination of the disease. The views
held by the British Government and the Government of India
on the subject of quarantine were for a long time resisted
on the Continent of Europe, but they have now been accepted
by the European powers, and in the Dresden Conference of
1893, to which the Government of India declined to become
a party for other reasons, the uselessness of land quarantine
was for the first time recognized by them in respect of cholera.
Prior to the assembly at Venice in the spring of 1897 of the
delegates deputed to concert measures to prevent the introduc-
tion and spread of the plague in Europe, the Governor-Gene-
ral in Council had considered and rejected a proposal to place
12
90
in quarantine the whole of the Bombay Presidency owing to
the outbreak of plague within it, against the rest of India. In
paragraph 3 (iii) of the Home Department letter No. 1623—-26,
dated June 1st, 1897,* addressed to the Maritime Governments,
it was noticed that the Venice Convention provided that the
modern principles of disinfection should be substituted for
the obsolete system of land quarantine, but, with a view to
the protection of countries which may find it difficult to thus
protect their borders, each of the Governments who are parties
to the Convention is at liberty to close its frontiers to travel-
lers and merchandise. The Convention also, while condemn-
ing land quarantine in general terms, permits Governments
to reserve to themselves the right to take special measures with
regard to certain classes of people specially—
A.—Gipsies and vagabonds.
B.—Emigrants and persons travelling or crossing the
frontier in large bodies.
10. Proceeding on the principles embodied in the Venice
Convention the Government of India have from time to time
expressed an opinion adverse to the establishment of cordons
designed to keep the population within an infected area and
have declined to agree to the general prohibition of the book-
ing of passengers by railway to or from particular places, or
to the prohibition of the booking of passengers travelling by
a particular class. The detention of the inmates of an infected
locality within the area of infection by means of a cordon
is apt to increase the virulence of the disease, and therefore
also the danger of its dissemination, by fostering the local
conditions which are a main cause of its development. Expe-
rience shows that ordinarily on the outbreak of plague in a
town of which part is infected and part is not, it is desirable,
concurrently with the removal to a segregation camp of the
inmates of the infected localities, to encourage the healthy
population to leave the infected area before the disease
becomes thoroughly diffused through it. But there may be
cases in which the area of infection being small it may be
possible to entirely evacuate it and to place the inmates of it
in isolation at a place in the near neighbourhood. A guard
may unobjectionably be utilized to keep the population under
medical supervision within the healthy area in which it is
determined to isolate them both with the object of prevent-
ing their return to the infected houses and also to minimise
the possibility of infection being carried elsewhere. In such
cases if proper arrangements are made for separate camps for
* Vide page 199,
91
the sick, the suspected, and the healthy, there is little or no
danger of establishing a focus for the dissemination of the
disease, while the control of the guard can be made effective
and malpractices on the part of the subordinate establish-
ments be prevented if European agency is employed on the
spot to supervise such establishments, and to check, by a
system of registering the inmates of the camps, the attempts
which may be made to leave them.
11. In accordance with the principles explained above,
the Government of India have restricted the interference with
the movement of the general public by railway to medical
inspection. In the terms of the Venice Convention medical
intervention is restricted to the inspection of travellers with
a view to the detention of those who show symptoms of
plague and to the care of the sick. The Convention also
dwells on the desirability of keeping under supervision all
travellers from an infected area at their homes for a period of
ten days from the date of their departure from the infected
area. The Government of India approve of the medical
inspection being conducted so as to provide for the detention
in the observation camp provided for this purpose not only of
persons in whom symptoms of plague or suspicious symptoms
are discovered, but of all persons from the infected area who
appear to be suspicious by reason of their appearance, the
dirty condition of their clothes, the fact that they are travel-
ling in gangs or belong to classes which are likely to dissemi-
nate the disease or cannot be traced on arrival at their
destination or depended upon to give information should
plague occur among them after arrival at their destination.
All other persons should be allowed to proceed to their
destination after inspection, and the rules should not, under
any circumstances, exempt from their operation any class
of persons as such, or be limited to persons who travel by
railway by a particular class.
12. While these are the general principles which should
guide the different Local Governments and Administrations in
their control over the movements of the general public travel-
ling by railway from an infected area it may often be advisable
to interpose special checks either on the movement of pilgrims
from an infected area to a place of pilgrimage beyond that
area, or on the movement of pilgrims to a place of pilgrimage
at which plague exists. When plague exists at a place of
pilgrimage it may indeed be generally the most prudent course
as well as the course which will in the end cause least inter-
ference with the people to definitely prohibit the religious fair
92
at which the pilgrims intend to collect. But there may be
special circumstances in which this course may seem to be
inadvisable, and in such cases it appears to the Government of
India that the booking of pilgrims to the place of pilgrimage
or the neighbouring railway stations may be, without objec-
tion, entirely interdicted for the time. Where, on the other
hand, the place of pilgrimage lies outside the infected area
and it is ordinarily visited by pilgrims from the infected area, it
is legitimate and advisable to prohibit for the time the passage
by railway of pilgrims from the infected area to the place of
pilgrimage, and in accordance with these considerations the
Government of India have from time to time, during the out-
break of plague, issued orders prohibiting the sale of tickets
in the Bombay Presidency to pilgrims desirous of visiting
other parts of India.
Enclosure.
INSTRUCTIONS REGARDING PLAGUE ADMINISTRATION ISSUED BY
THE BOMBAY PLAGUE COMMISSION FOE THE GENERAL
GUIDANCE OP DISTRICT AND OTHER OFFICERS.
1. Plague is a disease which is essentially associated with
insanitary conditions in human habitations, the chief of which
are accumulations of filth, overcrowding and the absence of
light and ventilation.
2. It is, in the first instance at least, a disease of locality,
and is mainly conveyed from place to place by individuals in
their person, clothing and personal effects, who have resided
in the infected locality.
3. The essential measures to be taken for preventing the
spread of the disease are its early recognition in a locality,
the removal of the inmates from the infected locality or area,
which, in the first instance, may be only a room or house,
their segregation for a specific period, the disinfection of
their persons, clothing and personal effects and of the houses
with their contents, situated within the infected locality.
4. The first steps to be taken are in connection with the
sickness and mortality. There are, at present, no methods
in actual operation by which these can be accurately ascer-
tained. Infectious diseases are not notified, and the registra-
tion of deaths is imperfect. Means must be adopted to
improve the latter, and check the results by recording in
towns all funerals which pass the octroi posts, noting the
name of the deceased and the locality of the house in which