NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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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 con-
sulted 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 Governor-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
* Not printed.
10
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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
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
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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
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.
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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
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
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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, bub 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
in quarantine the whole of the Bombay Presidency owing to
the outbreak of plague within it, against the rest of India. In
paragraph 8 (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
78
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 serve 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
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.
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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 desti-
nation 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 rail-
way 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
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
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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 FOR THE GENERAL
GUIDANCE OF 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
the death occurred, and by posting trustworthy subordinates,
either members of the Police force or of the Revenue Depart-
ment, at all burying and burning grounds, noting similar
information, These subordinates, not being connected with
the municipality, will afford valuable aid in checking the
returns, and they will assist the Municipal authorities in
arriving at correct results.
5. In villages, the Pátils must submit weekly returns of
deaths in each village, within their respective jurisdiction, to
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the Mámlatdár,* who will forward them to the Collector of the
district, after noting on each any peculiarity in the incidence
of the deaths, the mortality for the corresponding week during
the past three years, and explaining, if he can, any excess.
When the Mámlatdár is not satisfied as to the cause of any
excessive or unusual mortality, he should cause special en-
quiries to be made, and, if necessary, call in the assistance of
the nearest medical subordinate.
6. The Pátils should also be required to give notice at the
police station of the arrival in their villages of any persons
from an infected locality. The names of such persons should
be entered in a register at the police station, and they should
be kept outside the village under observation for ten days and
on no account allowed to sleep within the village site. The
cause of the death of any person who has recently been in an
infected locality should be investigated. In villages remote
from a police station the police Pátil should discharge these
duties, but the Revenue Pátil and the Kulkarni † should be
held equally responsible.
7. The returns referred to in paragraphs 4 and 5 will
show, both in towns and villages, any unusual mortality over
the average of previous years, and also the occurrence of two
or more deaths in one house or localised area when immediate
special enquiry is necessary.
8. For the discovery of cases of sickness it will be
necessary to obtain the assistance of the more respectable
residents in each quarter, street or group of houses. In any
doubtful case of sickness they could obtain the services of
the medical subordinate attached to the dispensary, or a
hospital assistant may be specially deputed to aid the resi-
dents in the work of detection.
9. It should be made obligatory under the Epidemic
Diseases Act for the occupier of each room or house in an
infected town to notify all cases of sickness and death,
occurring in the room or house occupied by him, and for
every medical practitioner practising in such a town to report
all cases of sickness and death coming to his knowledge in
the practice of his profession.
10. When there is reason to believe that cases of plague
are occurring in a town or are likely to occur, owing to its
proximity to an infected area, the town should be divided
into quarters or divisions of a size convenient for effective
supervision, and each quarter should be placed, as far as
* i.e., the Tahsildar.
† i.e., the Karnain.
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