NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
4
August 10th, shewed a serious increase of general sickliness, much
of which was probably due to Plague either ignorantly or intentionally
concealed. During the month of August cases were noted in which
enteric fever, remittent fever, and pneumonia passed into Plague. It is
therefore probable that a considerable share of the cases returned during
late July and early August under lung diseases and fevers should be
assigned to Plague.
Relief works.
From the beginning of August complaints were general, and to some
extent well-founded, that the city was infested with numbers of starved
idlers whose feeble condition, predisposing to Plague, was a menace to
public health. How far it was necessary or advisable to open special
relief works was a somewhat difficult question. If liberal pay were offered
and no task were exacted, crowds of indigents would be attracted, to the
disturbance of the labour-market. As the extent of the distress was
doubtful, and as the question of opening Municipal or State relief works
was not easily determined, a subscription was started and a sum of
Rs. 9,422 collected. The Secretary of the Indian Famine Charitable
Relief Fund placed a further sum of Rs. 10,000 at the disposal of the
Committee. Relief works consisting of filling in low land on the Ripon
and Clark Roads, and of breaking stone into road-metal, were opened on
the 3rd August. The merest subsistence rates, namely, three aunas a
day for men, two annas for women, and one and a half annas for
children were paid ; and by the close of the month 10,755 persons, of
whom 8,770 were men, 1,952 women, and 33 children, had received
relief. The enforcing of a labour test and the giving of a mere subsistence
wage prevented the daily gathering of a rabble of loafers and avoided
the evil of tempting the destitute from famine-stricken districts
into Bombay.
Inward Qua-
rantine—Sea.
As there was reason to believe that the spread of Plague in
different parts of the city was due to the importation of cases
by sea from Cutch and the South Konkan ports, and by land from
the Deccan, attention was given to the completion of arrangements for
inspecting and detaining new-comers. The serious outbreak of Plague
in Mandvi (Cutch), which started in May 1897 and continued with great
severity till July, was not a source of danger to Bombay till after the
middle of August when, at the close of the stormy season, naviga-
tion opened and numbers of passengers, chiefly Hindu traders of
the Bhatia, Lohana and Jain classes, began to arrive in Bombay.
Though the epidemic was practically over in Mandvi, Plague
was still active in the neighbouring villages. Cases of Plague
5
occurred on board of some of the steamers, and suspicious cases
were detected at the medical examination in Bombay. To guard the
city against re-infection, it was necessary to open camps in which
arrivals from Cutch and Karachi might be detained for a period of
10 days. Narielwadi Hospital was enlarged, and made into a Detention
Camp. The local Bhatias, Jains, and Lohanas, to whom most of the
immigrants belonged, made special arrangements for the camp comforts
of members of their own communities ; and the principle of a guarantee
by certain leading members of each community, allowing under an
adapted form the concession of surveillance accepted by the Venice
Convention, together with the safeguard of photographing all who
were passed out on surveillance, worked well. Care was taken that all
clothes were spread in the sun. People of these classes have large
quantities of clothes, among them many quilts and padded coverlets.
How far the heat of the sun is enough to sterilise germs in heavily
padded articles of clothing and bedding is doubtful. The use of the
steam sterilisers which have since been obtained would have improved
the original arrangements.
One difficulty in managing the camp was that the inmates, as a rule,
were rich and tempted the camp staff to connive at breaches of the rules.
On the whole, however, surveillance worked well, but required to be kept
in check by the circular of the 20th October 1897.
Regulations for the management of Segregation Camps are given in
the Appendix.
As large numbers of sickly and ill-nourished people were arriving
from the Konkan by boat, it became necessary to detain them also. The
hospital at Wari Bunder was through the kindness of the Hon'ble
Mr. Hughes enlarged so as to include the Port Trust Hospital, and was
made into a Segregation Camp to hold about 1,500 inmates.
Movements of
the people.
AUGUST...
Arrivals—
Kail
Road
Sea
Departures—
Kail
Road ...
Sea
... 113,646
... 98,258
... 18,252
... 130,105
... 98,258
... 17,017
225,156
240,380
Excess.
15,224
Rainfall.
6
SEPTEMBER.
The September rainfall was both abundant and timely. Of a total
of 20.4.9 inches, 2.06 fell during the first week, 7.83 during the second,
3.40 during the third, and 7.20 during the fourth.
Sickness and
mortality.
In the beginning of September (4th), though the public health was
slightly improved, the total death-rate was still 50 per cent. above the
normal. The second week (11th) showed a rise in the total mortality
from 814 to 838, due partly to an increase in fever, partly to large
Plague figures in Byculla, Parel, Mandvi, and Kamathipura. The third
week showed a further rise in the total deaths from 838 to 876. The
fourth week showed a slight decline.
In the beginning of the month the sections of the city where the
death-rate was highest were (on the basis of a yearly rate per thousand)
Second Nagpada 140.82, Tardeo 82.19, Parel 77.80, Kamathipura 73.00,
and Byculla 61.43. Later, in all the divisions of the city where in 1896
Plague had been epidemic, the death-rate was especially high. The last
week (25th) showed a slight decline, but, according to the returns, a
spread of Plague, chiefly in isolated cases, over fourteen out of the
thirty-two districts of the city.
The outbreak of Plague in Mandvi occurred chiefly in large well-
built houses, to few of which on the score either of want of light or air
could objection be taken. Some of the houses in which cases occurred
had been attacked during the cold-weather epidemic. In many cases,
probably in the majority, the attacks took place in houses which had
escaped during the previous epidemic. In other districts the houses
attacked were, as a rule, inferior chawls and tenements in which
insanitary conditions and want of light and air were notable.
During the first week of September a severe outbreak of relapsing
fever occurred. Ten cases were sent to Arthur Road Hospital, where
before the end of the month more than 25 cases were under treatment.
As in a considerable proportion of cases Plague was mixed with
relapsing fever, the precautions of disinfection and isolation adopted in
the case of Plague were extended to relapsing cases.
During September, while in Bombay the number of Plague cases
was only 181, and of recorded Plague deaths 136, in the mofussil the
corresponding totals were 3,886 cases and 2,888 deaths.
Relief works.
The demand for relief, in spite of the labour test and the subsistence
wage, continued to increase. But the result was satisfactory. Of the
7
crowd of idlers and beggars who attracted the public eye, the daily-
average number on the works was above 500.
During the month 10,702 men, 2,411 women and 1,920 children—
a total of 15,033—received relief.
Staff.
Towards the close of September, in consequence of the increased
mortality, Kamathipura, Tardeo, and Nagpada were put under a special
organization under the charge of Surg.-Lieut. Walton, I.M.S. It was
admitted that the supervising staff should have been at the same
time strengthened in other affected parts. But in consequence of the
drain of officers to the Frontier, and also of the outbreaks of Plague in
Poona, Karhad in Satara, and Sholapur, no officers, were available.
Inward Qua-
rantine—Sea.
Towards the end of September, in consequence of the large number
of arrivals from the Plague-infected districts of Satara and Poona,
through Ratnagiri ports, quarantine was imposed on all arrivals from
those ports. The pressure on Wari Bunder Camp was for a time
excessive. It was relieved by the use on emergency of the pilgrim
sheds at Malet Bunder, and on one or two occasions the pressure had to
be lightened and room made for new-comers by allowing inmates of
more than five days' standing to leave the camp. Still the pilgrim
sheds were unsuited for ordinary arrivals, and reducing the term
of detention proved an unsatisfactory device. It was accordingly deter-
mined to open a fresh Segregation Camp at Modikhana on open ground
convenient to the bunders. The details of this camp, which is the
most complete camp built by the Committee, are given in the chapter
on camps. It has accommodation for 2,500 inmates.
Movements of
the people.
SEPTEMBER
Arrivals—
Rail
Road
...
Sea
Departures—
Rail
Road
Sea
• • •
• • •
• • •
... 123,526
... 120,968
... 45,825
... 150,885
... 117,153
... 27,100
290,319 7
295,138
Excess.
4,819
Rainfall.
OCTOBER.
The rainfall in October was short and ended before the middle of
the month. Of a total of 2.62 inches, 2.52 inches fell during the first
week and 10 cents during the second. After the middle of October no
rain fell.
Sickness and
mortality.
During the first half of October both the total death-rate and
the recorded Plague deaths showed a decrease. This was followed,
8
during the second half of the month, by a considerable increase
in recorded Plague. The cases, except in Kamathipura and Mandvi,
were few compared with September, but the totals show an increase
from 181 to 327, and in recorded Plague deaths from 136 to 223,
Meanwhile, the mofussil epidemic of Plague spread with marked rapi-
dity, the totals rising from 3,886 cases and 2,888 deaths in September
to 6,970 cases and 5,021 deaths in October.
Relief works.
Compared with September, the numbers on relief works showed
a slight increase from 15,033 to 17,925, of whom 11,855 were men,
5,574 women, and 596 children.
Inward Qua-
rantine—Land.
The severity of the outbreaks of Plague at Surat, the continuance
in Poona and Satara, and the specially fatal epidemic in Sholapur during
the second half of September, convinced the Committee of the necessity
of enforcing detention on arrivals both by rail and by road. The Cham-
ber of Commerce was consulted. On October 1st, that body expressed
their disapproval of the Committee's proposed extension of detention
to land as well as to sea travellers, mainly on the ground of the damage
which quarantine would inflict on the trade of Bombay by preventing
the resort to it of up-country buyers. The Chamber was of opinion
that increased police supervision might keep out many weak and
emaciated arrivals; that a more effectual medical inspection would
suffice ; and that if necessary a camp for the weakly and suspicious
might be started at Kalyan.
To this the Committee replied that the imposition of a few days'
detention was not likely to cause such interference with trade as the
Chamber dreaded; that practically a quarantine had been in force in
Bombay for months, both against Karachi and Cutch ; and that in the
case of Calcutta strict land quarantine had not caused the evil effects
described by the Chamber.
The Committee further argued that land or at least rail quarantine
was more necessary than sea quarantine, as the length of time spent
on a railway journey is generally less than on a sea voyage, and
therefore in the case of arrivals by sea. the chance of Plague showing
itself before or on arrival was greater than in the case of passengers
by rail; that since Plague does not show itself until after a period of
incubation, no medical inspection on arrival can remove the risk of im-
portation of Plague from infected areas ; that Detention Camps at
Kalyan and Bandora would be costly and difficult to manage from
Bombay ; and that it was doubtful whether Municipal funds could be
spent outside of municipal limits..
9
Moreover it was urged that the existing system of lodging the
healthy in camps in the city and of moving suspicious cases at once to
Plague Hospitals appeared to be the best system ; that a local adaptation
of the system of surveillance sanctioned by the Venice Convention
secured the required complement to inspection and prevented quarantine
becoming too costly and burdensome as surveillance set free, after a
delay of 24 hours, all arrivals pressed for time ; and lastly, that the
practice of photographing persons allowed out on surveillance pre-
vented the risk of personation, and their attendance at the camp for
medical inspection on the second and fourth day after being let out on sur-
veillance minimised the risk of their carrying infection.
The Municipal Commissioner however (October 9th) demurred to
the scheme, both on the ground of cost and that it was unlikely to
produce any practical results.
On the 14th October, to prevent infected arrivals from Sholapur,
orders were issued that railway passengers with Sholapur tickets should
be strictly examined and that all third class passengers from Sholapur
should be detained at Sion and sent in carts to the Narielwadi Camp.
On the 19th a telegram from Government ordered that booking of
third class railway passengers from Surat and its neighbourhood to
Bombay should be stopped. But the orders were evaded (1) by pas-
sengers booking second class, and (2) by passengers travelling down the
line from Surat, and taking tickets for Bombay from Broach or other
uninfected stations.
On the 5th November an important memorandum on the necessity
of establishing quarantine for railway passengers was received from the
Surgeon-General, and on the same day the Chairman of the Plague Com-
mittee reported to Government that since the 8th October Bombay had
suffered from the continuous daily importation of cases of Plague, chiefly
from Poona and Satara. The medical officers in charge of the Arthur
Road and Hindu Hospitals reported that more than half their patients
came from outside Bombay. Within the month 40 cases with serious
symptoms had been sent to hospital from the Wari Bunder Camp. And, as
shown in the margin, during the four months end-
ing with October of a total of 479 Plague cases
73 were recorded as imported. With this evi-
dence in view, the Committee held it proved that
unless supplemented by quarantine on arrival in
Bombay, all booking restrictions and up-country
arrangements were incomplete remedies.
PLAGUE CASES
Month.
July
August
September...
October
Imported
10
9
25
29
73
Total.
52
65
155
207
479
10
On the 12th of November, with the evidence of the Committee's
letter before them, the Chamber of Commerce gave their unanimous
approval to the imposition of quarantine on all arrivals, pronouncing that
" no consideration of trade should be allowed to stand in the way of the
" benefits which the medical authorities and the Committee anticipated to
" be likely to accrue from the imposition of quarantine." On the 14th
November Government telegraphed powers to enforce quarantine, and
arrangements were introduced on the 19th November. How much
vigilance was required to work this detention with success is shown by
the sixteen different ways of entering Bombay described by Surgeon-
Captain Jennings, I.M.S. (letter No. 996-R. of 25th November 1897),
who was in charge of the arrangements (vide page 39).
Movements of
the people.
OCTOBER,.
Arrivals—
Bail
Road
Sea
Departures—
Rail
Road
Sea
122,047
124,011
... 36,241
282,299
124,776
127,766
35,945
288,487
Excess.
6,188
NOVEMBER.
Rainfall.
No rain fell in November.
Sickness and
mortality.
The first week of November ( 6th ) showed a rise from 250 to
253 in the recorded cases of fever. Plague with a recorded weekly
total of 442 was holding its own in Mandvi. Kamathipura was
markedly unhealthy. The second week (13th) showed a fall in
fever, and a spread in Plague to Umarkhadi and Colaba. The
decline in total deaths continued during the third week (20th).
The fourth week (27th) showed a further decline in fever, but a rise in
recorded Plague from 47 to 66, and a spread into the North Fort. Un-
like Bombay the mofussil returns show in November a notable
increase of Plague, from 6,970 cases and 5,021 deaths in October to 7,631
cases and 5,864 deaths in November.
Relief works.
The demand for relief showed a considerable fall, from 17,925 in
October to 7,992, of whom 4,859 were men and 3,133 were women.
11
Towards the end of November no fresh applicants were taken on, and
at its close relief ceased.
Movements of
the people.
NOVEMBER
Arrivals—
Bail
Road
...
.
Sea
Departures—
Rail
Road
Sea
88,649
106,113
38,122
108,024
105,581
31,699
232,884
245,304
Excess.
12,420
DECEMBER.
Sickness and
mortality.
The first week of December (4th) showed no increase in Plague and
a decline in fever. The second week (11th) showed a rather serious
rise in fever (123 to 170) and a slight increase in Plague cases, but no
spread in area. The third week (18th) showed a general increase in
disease.* Plague was spreading into the centre and the west of the
city. Certain of the cases shown as respiratory complaints were
probably due to Plague, Sickness was serious among the Jains—
a term under which the Health Returns loosely include the bulk of
Hindu traders. The fourth, week (25th) showed a fall in fever, but a
rise both in the intensity and in the area of Plague. During the last
five weeks of the year the recorded deaths from Plague rose from 66
to 200. The details for the four weeks of December are :—
Week ending—
December 7th
„
14th
21st
„
28th
January
4th
Total Deaths.
706
785
835
975
1,061
Recorded
Plague Deaths.
83
95
158
200
302
It is worthy of remark that while the Bombay returns show an
increase in cases from 331 in*. November to 868 in December, and in
deaths from 225 to 583, the mofussil returns show a fall in cases from
7,631 to 5,420, and in deaths from 5,864 to 4,825.
Segregation off
Contacts.
In early December the arrival of infected persons in Bombay, and in
many attacks an increase of virulence and infectiousness, made it
probable that at an early date the Plague would develop into an
epidemic. To prepare for an increase in disease, two measures received
* This week is generally considered to be the date of the commencement of the second
Bombay epidemic.
12
the consideration of the Committee. These were the separation of
Contacts, of the sick man's family, and the vacating of infected or un-
wholesome houses, with the removal of the inmates to Health Camps.
As regards the segregation of Contacts, no question of the use-
fulness of the measure could arise. At the same time it was certain
to be unpopular. It seemed doubtful how far it could be enforced
without risk of serious dissatisfaction. Especial caution also was required
since the strict enforcement of the segregation system was likely to add
to the temptation to hide cases.
During the former epidemic nothing was done towards segregating
the infected beyond encouraging or requiring one, or at most two,
members of the family to accompany and attend the patient in hospital.
When a room or a house was emptied for cleaning, the inmates were
allowed to find fresh lodging where they pleased, So long as the
type of plague was not highly infectious, this laxity may have caused
comparatively little harm. But the city was still nearly full (containing
perhaps 800,000) and the number of highly infectious pneumonia
cases imported and local, was considerable and was increasing.
On December 2nd the rules for Contact segregation, printed in
the Appendix were issued. These rules provided that in large chawls,
unless several attacks took place, it would not usually be neces-
sary to segregate the inmates of more than two or three rooms. In
the case of large private houses Contacts might be segregated either
in another part of the same house or in an out-building in the same
enclosure. Provision was also made that, when Plague Officers
admitted its fitness, Contacts might be isolated in a Private Segregation
Camp ; that cases occurring in an eating-house would not necessitate
the other inmates being made Contacts ; and that leniency should be
shown to goldsmiths, handloom-weavers and other craftsmen who work
in their houses. The detention of Contacts was to be limited to ten days
and might be reduced to seven, and a modified system of surveillance was
sanctioned.
Segregation
Gamps.
In Public Segregation Camps the inmates were to be supplied
with rations, and the bread-winner, whether man or woman, was to be
allowed to go to work, provided he spent the night in the camp. The
Wari Bunder Camp was set apart for Contacts. Particular care was paid
to the disinfecting of their clothes and other articles; at first by washing
and sunning, and later, when a stove was available, by passing them
13
through the steam steriliser. Surgeon Knapp, R. N., who was in charge
of the "Wari Bunder Camp, arranged the yard outside of the camp, in the
centre of which stood the steriliser and round it separate bathing-places
and sheds for men and women, where they were washed and clad in
camp clothes while their own clothes and other kit were being sterilised.
The considerable numbers of persons attacked after entering the camp
proved the value of these measures. To prevent suspicious Contacts
mixing with the other inmates, they were moved into an isolated
section of the camp and remained there until either Plague developed,
when they were removed from camp to a Plague Hospital, or until the
fever abated and they were allowed to pass into the body of the camp.
In spite of these concessions the Contact system has proved difficult
to work. The greatest number of Contacts at any time was 1,061 on
March 7. Even after adding the number sent to hospital as attendants,
this falls far short of the total number of Contacts which the average
daily Plague cases in January and February should have yielded.
Health Camps.
The second leading measure adopted by the Committee to meet
the probable increase of Plague was the emptying of infected and
unwholesome houses and the planting of the inmates in Health Camps.
A Health Camp for 1,000 inmates was opened at Foras Road at the
expense of Rao Saheb Ellapa Balaram : the Segregation Camp at
Byculla Bridge was improved ; and huts were built on the open
Agripada Estate to the north of the Byculla Camp.
The action taken by Government made it plain that, if Plague made
way in Bombay, its people would be prevented from leaving, and the
virulence of the disease and the death-rate might rise much higher
than in the previous epidemic.
The moving therefore of large numbers of people from infected and
unwholesome houses into Health Camps was a measure to which the
Committee attached the greatest importance. The fierceness of the
second epidemic in Poona, and of the outbreak in Sholapur, showed how
comparatively light the death-rate in the first epidemic in Bombay
might be considered.
In December the city was full, but the total population at the time
is uncertain. Calculations, varying from 750,000 to 800,000, may
bo taken as a fair estimate. If the death-rate could be kept within
moderate limits, panic might be averted, and the trade of the city might
be saved from dislocation. On the other hand, if the people carne