NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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Great care had to be exercised in searching holes and corners of
houses to avoid overlooking hidden cases. Lofts, privies, and unoccupied
rooms were favourite places for the sick to be stowed away in during the
search ; but many instances of greater ingenuity in concealment were
brought to light, such as covering the patients with clothing, locking
them in cupboards or chests, and placing them under beds.
Military
cordons.
When in the beginning of January Plague began to get out of hand,
and the systematic hiding of the sick made the ordinary house-
to-house search fruitless in sections of the worst infected parts of the
city, where the death-rate was high and the cases taken to hospital were
few, it was considered advisable to cordon the areas with troops at an
early hour of the morning, and after making arrangements for the pass-
ing out of such of the healthy as were anxious to go to their work to have
all the houses searched.
It is to be admitted that these 'cordoned' searches were not so
fruitful of cases as they should have been. It is difficult to keep secret
the area fco be cordoned. It is difficult to baffle the people's determina-
tion that the sick shall not be found out. Whether through secret com-
munications from house to house, or by passing them across gullies, it is
beyond question that on several occasions badly infected cordoned areas
were carefully searched and disproportionately few cases discovered.
Contacts.
The first line of resistance having been broken by the removal of
undoubted Plague cases to the safe environment of a hospital, it remains to
deal with those persons who have lived in the same room or house with
the patient, and who have been in such close association with him that
it is highly probable some of them will develop Plague before long.
These persons are designated "contacts." They with their clothes,
bedding, and movable property are sources of incalculable danger to
other persons both near and far. If left alone they may develop the
disease in their already infected houses, and so intensify the existing
conditions of infection ; they may scatter and develop the disease in
fresh quarters of the city, or they may carry infection on their persons
or with their belongings to their next place of refuge, provided the
conditions for the development of the virus are favourable there.
Contacts are therefore treated on the same lines as Plague
cases, and are removed with all their belongings to a Contact Camp
where they pass through a complete process of disinfection, which is
applied fco their persons, clothes and movable property, after which they
enter the Contact Camp, If Plague cases appear among them, these
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are again removed to a hospital and the same measures for elimination
and disinfection are again applied to those who have been closely asso-
ciated with them, and who are therefore designated Re-contacts. This
process is again repeated until it is found that Plague has actually
been dispelled—a result which is usually attained within the first week,
the majority of Plague cases amongst Contacts occurring within the first
four days.
Disinfection.
Having thus disposed of the evident sources of infection,
an attack on the next line of resistance follows, namely, on the infected
room or house, and this is done by the several agencies of fire
disinfection, limewashing, ventilation, and exposure to sunlight and air.
In a crowded city the application of fire, the only certain agent for
the complete destruction of infective matter, is applicable to only a
limited extent. For general purposes we have therefore to rely upon
chemical disinfectants. A collation of the several authorities who have
reported on their experience and treatment of Plague, shows that of
some six or seven proposed disinfectants Perchloride of Mercury com-
mands by far the widest use.
The Committee have therefore continued to rely upon Perchloride
of Mercury as the most effective and powerful disinfectant they could use
for treating houses.
A note on this subject will be found in the Appendix.
The work of disinfecting, chiefly with perchloride, is as a rule begun
immediately after a case is removed. On the following or on an early
subsequent day, the disinfecting is completed by limewashing. From
July till the close of December, special officers with separate staffs were
employed solely in disinfecting, in January, when it became possible to
strengthen the district staff and subdivide charges, each District
Plague Officer was again given entire control of all Plague measures in
his district. This arrangement worked with remarkable success in South
C Ward, where, amongst the men of the Durham Light Infantry, Major
Ross possessed trained disinfectors. In other districts also the system
worked well.
So far the disinfecting seems to have been thorough. Since dis-
infected dwellings have been re-occupied, few cases of Plague are known
to have occurred in disinfected rooms. Disinfection however cannot pre-
vent fresh infection from outside. Rats or men may re-infect a thoroughly
disinfected house. Still, the results support the view that, apart from
actual re-introduction of the disease, disinfection is a valuable protection
against a fresh outbreak of Plague.
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Limewashing.
Limewashing in advance of the Plague was practised during the
first epidemic. The arrival of infected persons and kit from other parts of
the city may in many cases negative the good results of this precaution.
Still, when in February Plague repeated its former progress northward,
it seemed necessary to carry out disinfecting operations in advance of the
disease. Towards the middle of this month a special body of limewash-
ers and disinfectors under Mr. Atkinson passed through the whole north
of the Island, except a small section of Mahim, and cleansed the houses.
For a time the result seemed satisfactory. But during April the progress
of the disease over most of the north of the Island throws doubt on the
success of the operation.
It is most important that all water sources be closely inspected, not
only in already infected districts, but throughout the entire neighbour-
hood. Water connections of which any suspicion are entertained should
be cut off pending investigation, and a general inspection of all water
connections should be at once directed.
Systematic limewashing of all premises evidently in need of it,
even when there is no infection ; a regular inspection of latrines, drains
and wells ; the removal of kutchra, and the free use of a flushing engine,
are operations the timely introduction and regular performance of which
will prove a great protection against the spread of the disease, if not
against its outbreak. It is therefore incumbent upon the Health Depart-
ment of an infected city to prosecute such sanitary measures with
redoubled energy, shoulder to shoulder with the special operations of the
Plague Authorities. Some of the Medical Officers have raised a
scientific question, as to whether limewashing is advisable in Plague-
infected quarters, because the bacillus developes in alkaline solutions ;
but it must be remembered that hot slaked lime is a caustic solution
and that limewashing is only used after other means of disinfection, and is
invaluable for sweetening and brightening up the rooms. No evidence
is forthcoming to substantiate the doubts above referred to, except the
statement that two or three limewashing coolies have contracted Plague.
Disinfecting
Staff.
All disinfecting operations were carried out by a special disinfecting
staff, and the standard section of the staff is a squad consisting of—
100 Coolies, 4 Muccadums, 1 Mistry and 2 Store Clerks,
working under the direction of a European Inspector.
The staff of each district was organised according to the require-
ments of the District Officers,
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Later on, when the stress of the epidemic was great, this work was
largely carried out in most of the districts by a departmental arrange-
ment. In B Ward the original system has been maintained throughout.
The staff were distributed on the two branches of work—disinfecting
proper and cleansing houses, and limewashing:.
Disinfecting
Classes.
In Government Resolution No. 5603/3592-P of 14th October 1897, Govern-
ment ordered Collectors of Districts to select certain men to proceed to
Bombay, Poona, Surat, and Ahmedabad to receive instruction in dis-
infecting clothing, building, &c. In forwarding the orders of Government
to the Chairman, the Surgeon-General stated that he thought these men
should be taught also to prepare the different standard solutions of
disinfectants. These men were accordingly sent at first to the District
Medical Officers for instruction, but as those officers found it impossible
to give sufficient time and attention to the matter, it was decided to
start a special class, and the Municipal Commissioner was asked to lend
the services of Mr. T. G. B. Atkinson, Chief Inspector of Roads, to give
instruction in disinfection as he had had an extensive and practical
experience of this work both in Bombay and the Mofussil. This was
kindly arranged by the Municipal Commissioner, and intimation was sent
to Government that the Committee was ready to give instructions at once.
Statement showing the Districts which sent out men to learn
Disinfection Work.
1.
2.
3.
4.
5.
6.
Districts,
Khandesh
Ratnagiri
Thana
Kolaba
Nasik
Bombay —
Public Works Department ...
High Court
Collector of Bombay
Number of men.
85
42
50
20
1
8
1
49
5
Total ... 261
Vacation of
Houses.
When many cases of Plague occur in a house, a large chawl, or in a
group of crowded dwellings, or when the conditions of such dwellings are
so insanitary as to invite outbreak of Plague, the complete vacation of
such dwellings, and the removal of the inhabitants together with their
property to a Health Camp, after the Contacts have been set apart, is a
most effective mode of attack on the epidemic.
Such tenements, of all sizes, lay spread throughout the whole City
from Colaba and Fort to Parel, and even in Malabar Hill, in every stage of
dirt and decay. Kamathipura, a notoriously evil district, both in the first
and in the recent epidemic, shared with Tardeo, Dongri and Bhuleshwar,
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the worst proportion of pestilential dwellings, and the greater part of
notices to vacate within 24 hours had been served in these districts.
Accordingly (4th January 1898) a new organisation, dealing solely
with the removal of tenants from badly infected houses under the
orders of the Plague Committee, was set on foot under Captain Betham,
8th B. I., and Lieuts. Mason, Mansergh, and Henderson, R.N., and
Mr. T. Jenkins, R.N.
In preparation for the reception oí Evicts, camps were formed for the
several wards—at Elphinstone Bridge, Byculla, and Connaught Road,
Foras Road (Rao Saheb Ellapa Ballaram's), the Kennedy Sea-face, and
to the south of the Goculdas Tejpal Hospital. The houses especially to
be vacated were those which held many cases last year, and which
continued to supply them this year, and to these the attention of
the vacating officers was addressed. Under the rules of vacating,
persons evicted and removed to the Evicts' Camps were detained for
14 days ; after which they were permitted to return to their old
houses, if fit for habitation, or to proceed elsewhere.
The erection of Private Camps by persons and firms employing
large numbers of employés was encouraged as much as possible, and
camps of this nature to accommodate 28,000 people were built.
The Public Health Camps constructed or in progress, would have
accommodated 30,500, and allowing for an average stay in camp of 14
days, if the active operations for eviction begun on the 1st of March had
not been disturbed by the riots of the 9th March, a total of over 150,000
people would have been passed through the public health camps before
the earliest possible fall of rain.
The following account of the system employed in the vacating
of houses is contributed by Lieutenant G. W. Mason, R.N., whose ser-
vices in this matter have been of especial value.
" In every ward in Bombay a record is kept of the number of
deaths and cases of Plague which have occurred in every house in that
particular ward.
" On reference to this record, should it be apparent to the District
Medical Officer that a house is in an insanitary condition, he communicates
with the District Plague Officer, who, with the approval of the Plague
Committee, informs me that the house in question is to be vacated.
" On receipt of this information I at once make arrangements with
the Officer Commanding 8th Bombay Infantry, and with the District
Superintendent of Police, to have a sufficient number of men at a
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rendezvous (conveniently near the situation of the house to be vacated)
at 7 o'clock the next morning.
" On arrival at the house I post a certain number of men in position
to prevent the inmates from escaping, for, if they did so, the efforts to
limit the infection would be ineffectual.
" The Police sepoys next procure bullock carts, and then the Military
sepoys are sent into the houses to assist the inmates in packing up and
removing their furniture.
" Previous to this I myself have sent for the landlord, gone round
with him and explained the reason for vacating the house, expressly
impressing on the inmates the fact that there will be no quarantine, and
that no restriction will be placed on their liberty to come and go from
the camp to which they will be temporarily sent.
" The people are then removed to one of the camps erected for the
purpose of receiving evicted persons, in charge of a Military guard, and
their numbers are checked by the Camp Master.
" The houses are then thoroughly disinfected and limewashed, and
the tiles removed from the roofs.
" After a sufficient period of time has elapsed (in the District Medical
Officer's opinion), the people are taken back to their old houses.
" During the period I have been engaged on this work, I have
evicted over 8,500 people and have never (with the exception of some
cases among the Jullahas) met with the least opposition ; my object
having always been to carry out the work with the maximum of
despatch and the minimum of friction."
Ventilation
and improve-
ment of houses
for re-occupa-
tion.
When a house was vacated, it was at once surveyed with the
object of improving its sanitary condition, so that when the poor inhabit-
ants had finished their time in the Health Camp, they might return to
a thoroughly disinfected, cleansed, well-ventilated and healthy dwelling.
The first operation undertaken in each house was generally the opening
up of the ends of passages so as to allow of air passing freely through
them. This generally involved the demolition of a room at each end of
each passage. Openings about 3 ft. by 3 ft. were made in passage
floors and grated over, allowing an upward draught of air from one floor
to another, and the roof-cover of the top passage was either provided
with side ventilation or with small circular ventilators. In each room an
open grating was inserted above the doorway ; windows were enlarged
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where necessary, and, wherever possible, latrines were separated from
the house by an air space made by cutting walls or floors. After
these structural alterations had been completed, the houses were
whitewashed and cleansed.
The Committee however accepted the position that the improvement
of houses rested in the first place with the Municipality. Whatever their
legal powers, the Committee held that it was in practice undesirable that
they should deal with dwellings which, however ill-kept and insanitary,
had remained free from Plague. The Committee held that in the case of
houses in which Plague had occurred either in the 1897 or in the 1S98
epidemic, their power extended to declaring the tenement unfit for
human habitation. Many houses, whose actual defects in the supply
of light and air made the letters U. H. H. a true description, were given
a last chance. This concession was not more in the interest of the
landlord than of the people, as if any considerable number of evil
houses is labelled U. H. H., then so soon as conditions favour an
influx of labour, the dwellings fit for human use must become more over-
crowded than ever.
The probability also that, when the work of the Improvement
Trust begins, a large number of tenements will be cleared away, made the
Committee unwilling, except as a last resort, to label a house unfit
for use. The advisability therefore of removing partitions, cutting
lateral and vertical openings for light and air, &c., was pointed out to
the landlords as the last chance for many unwholesome houses. In
Nowrojee Hill Street, Dongri, where hardly a house escaped Plague,
either in the first or second epidemic, the changes pointed out by the
Committee were, with few exceptions, made by the landlords, and the
improved houses are again occupied.
Though in Dongri this arrangement succeeded, it was evident that to
place the whole burden of the changes on the landlords must entail great
delay. To provide for the rapid completion of necessary changes on a large
scale the Committee secured the services of a company of Sappers under
Captain Swayne, R.E., Executive Engineer, Military Works.
Progress
however was almost immediately stopped by the Municipality who
raised the question whether, under the epidemic rules, the Plague
Committee had authority to carry out or sanction house improvement.
The Municipality held that all such changes belonged to them as they
had passed rules, without conformity to which no Plague-stricken or
otherwise unwholesome house could escape destruction. The matter has
been referred to the decision of Government, Meanwhile the Plague
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Committee heave been forced to abandon their scheme for improving an
appreciable share of Plague-stricken houses.
One measure for letting light and air into unwholesome houses has
been carried out on a large scale—the untiling of roofs. In certain cases
to give them a chance of escaping the verdict U. H. H., very un-
wholesome or Plague-stricken houses have had the whole roof stripped
and the worn and probably infected tiles destroyed. As a rule, enough
light and air are let in if a strip 3 ft. in breadth of the tiles be removed
from ridge to eave and stored on the roof. This treatment is of un-
doubted advantage in one-storeyed tenements. In high houses, unless
Plague has been specially fatal in the attics, which is not uncommon,
no greab result can be expected from the stripping of tiles.
House
cleaning.
Even with the greatest care and expedition only a small propor-
tion of the people whose dwellings urgently require disinfection and
cleansing can be moved into camp. For the rest, that is, for the mass
of poorer townspeople, some treatment, less complete and satisfactory
than a fortnight in camp, must be provided. Dwellings, slightly infected
and the construction of which is fairly sanitary, need not be kept empty
beyond the time required for actual disinfection. The inmates of such
dwellings should be sent to one of the Ward Camps. They should
undergo on admission washing both of themselves and of the clothes in
actual wear ; the rest of their clothes and the bedding should be
sterilised by steam, and if no case of Plague occurs they should be
returned to their houses at the end of five days.
One class of houses remains—dwellings not situated in thorough-
fares, of fair construction, which, though they have been free from
Plague, are in an unclean and unwholesome condition. In the case of
these dwellings, now that the cold season is over, it seems sufficient
to clean out the house, to disinfect or simply to limewash every part
of it, leaving the lodgers and their kit to spend out-of-doors the one, or
at most, the two nights required for the house-cleaning. Rags should
be burned. If it seems necessary, all padded clothing and bedding
should be packed in sacks and sent to the nearest steam steriliser.
During the house-cleaning the people should be made to bathe and
lay out their wearing clothes in the sun.
Results.
It may be admitted that the results of the Committee's efforts have
fallen short of the objects they hoped to secure. The total deaths rose
from 3,794 in December to 6,886 in January and to 8,316 in February,
and, in spite of several temporary lulls, leached a total of 9,210 in March.
The pressure of the special measures required and enforced to check
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this grievous mortality roused a feeling of unrest which, if not the cause,
was at least the excuse for a riot. This may be admitted. Still the
efforts of the Plague Staff to withstand the force of the epidemic com-
mand respect.
That during the six weeks before the middle of March on an
average 2,951 houses were daily searched and 106 Plague cases
daily discovered and taken to hospital ; that on an average 100 deaths out
of a daily recorded Plague mortality of 195 took place in hospital, that 88
Contacts were daily placed under surveillance in camp and about 200 (as
attendants on their friends) in hospital; and that 161 infected dwellings
were disinfected and 78 were vacated, the bulk of them being large
buildings, is a remarkable record.
It may be urged that though the measures were sensible and
the amount of labour expended in enforcing them was creditable,
they were carried out in a manner so harsh that discontent ending
in riot was the natural outcome. In reply it is to be noticed
that no considerable amount of formulated or even of genuine
grievance against the Plague Committee and its measures has been
brought forward either at the time of the riot or since. Among
over a thousand limewashers picked off the street at day wages, a
rough element is inevitable. Yet only one band disgraced itself
by horseplay and extortion. In emptying over 3,200 houses in six
weeks, entire freedom from breakage and damage to property was
impossible. Instances of misconduct under several heads may be
admitted. At the same time the rarity of such instances seems to
follow from the almost complete absence of complaint, though every
opportunity to complain has for weeks been offered to the whole
population of Bombay.
It may be held that the comparatively few and, as a rule, easily
explained complaints which this opportunity has brought to light
show a high standard of conduct not only among the disciplined
soldiers and sailors on Plague duty, but among the temporary Plague
Staff, and at once reflect credit on the men employed and on the officers
who controlled them. That a staff over 2,000 strong, more than half of
them day-labourers or employed by the month, should for nearly a year
carry out on so large a scale duties almost all of them unpopular, and
that at the end charges of misconduct should have been so singularly
few, may be considered honourable to all employed and a legitimate
cause of satisfaction to Government.