NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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of them representing one of the two main cliques in the Konkan com-
munity, have little influence. They are merely registrars of marriages
and divorces, and even for the registration of these contracts they do
not possess the exclusive right over the large non-Konkan element in
Bombay.
With all these hindrances the intelligent and faithful help afforded
to Plague measures by certain members of the Sunni Musalman com-
munity, notably by Maulavi Hidayatulla, Khan Bahadur Fazlullab,
Messrs. Kazi Kabiruddin, Hakim Muhammad Dayam and others, in
some cases at personal risk and loss, was highly creditable.
The Mernons, both Kachhis and Hallais (that is, from North-East
Kathiawar) have also suffered severely. There are excellent citizens,
especially among the Kachhi Memons, who have given willing and in-
telligent help. But the communities are broken into cliques and the
leaders have only a limited authority. The Bohoras and Khojahs have
the advantage of strong and enlightened leaders. The Khojahs suffered
severely in November in consequence of infection spread by a well-to-do
family in Umarkhacli, who brought the sickness from Poona. H. H. Aga
Khan enforced the rule of sending the sick to hospitals and advised
inoculation, and the Khojahs on the whole have behaved excellently,
declaring their cases of sickness and sending the sick to hospital.
Mr. Muhammad Ibrahim Hasham Bhalu, the benevolent Khojah
gentleman who opened a Khojah Plague Hospital at Don-Tod Street in
March 1897, also opened a Segregation and Contact House on Khodak
Paidhowni Road, where at his expense the poorer inmates were supplied
with food, Mr. Muhammadbhai also arranged for setting apart a shed
or ward for the Khojahs at the Narielwadi Camp, where at his cost
food was supplied and bedding furnished to all Khojah arrivals from
up-country. Before Mr. Muhammadbhai's private hospital was started, a
Khojah Subscription Hospital was opened near the Victoria Gardens.
This was under the supervision of Mr. Ismail Jan Muhammad, but
owing to its distance from the Khojah quarters of the city, it was not
a success. It was closed on the opening of the Don-Tod Hospital.
Under the Head Mula Saheb and Mr. Adamji Pirbhai and his
sons, Messrs. Muhammadbhai and Abdul Hussein Adamji, the Bohoras,
in spite of their notable fondness for secrecy, have declared their cases
and moved the sick and a large proportion of the contacts to Mr. Adamji
Pirbhai's excellent sanitarium in Queen's Road, which was set apart
as a Plague Hospital and Segregation House. The name of Mr. Hasan
All and his success in persuading his fellow Bohoras to take their sick
56
to hospital will be remembered by all who took part in Plague measures
in Khara Talao and other sections of North 0 Ward.
Parsis.
The Parsis suffered considerably during the second epidemic. A
few stray cases, some of them doubtful, occurred in the Fort and in
Chaupati in August and September 1897. But the Fort remained
healthy till about the middle of January 1898. It was believed that
the Parsis in the Fort were in almost all cases attended by medical
practitioners and that the families or the medical attendants would at
once give information of any case of Plague. This expectation was not
realised. During the latter part of January, the high death-rate in Fort
North attracted notice and several concealed cases were found among
the Parsis. When it was known that search-parties were at work in
Fort North, several sick Parsis were secretly conveyed to houses in the
Marine Streets of the Dhobi Talao district. In consequence of
this disregard of rules the Marine Street Parsis suffered severely.
So soon as the presence of Plague in the Marine Streets could no
longer be concealed, search-parties were at once at work. To avoid these
parties, the Parsis secretly moved their sick to Breach Candy or Girgaum
Road and spread Plague north along Girgaum Back Road, where it worked
severe mischief. How far the Parsi Plague-current was the only element
in this serious evil cannot be determined. That it was the main element is
beyond question. Between the 18th and 24th February, from the Marine
Streets in Dhobi Talao, infected and Plague-stricken Parsis moved
to Nos. 4 to 6, Dhanji Street, the street which runs south from
Mumbadevi Tank. In this large colony of poorer middle-class
Parsis, up to the middle of April, when Plague was dying in the neigh-
bouring sections, fresh cases of a severe type continued to spread terror.
Although the Parsis have, as indicated, on occasions caused the
spread of plague by neglect of established rules and facilitating conceal-
ment, they have shewn foresight and energy in building hospitals and
camps and good sense in using the hospital accommodation, and in will-
ingly turning out of their houses into camp. The Parsi Panchayat Hospital
on Pare] Road, under the management of Dr. Bahadurji, has proved a
success.
When in the end of January the epidemic was most severe among
the Parsis of the North Fort, the Parel Road Parsi Hospital was full. It was
also at an inconvenient distance from the houses of Fort patients. It was
urgent that in order to overcome the Parsi dislike of allowing a patient
to leave his home, a hospital or ward of their own should be at hand. If
a ward easy of access were made available, the friends before moving the
57
patient might visit the ward, and afterwards could easily attend on him.
There was the further urgency of freeing the Fort from Plague.
One of the main hopes cherished by the Committee was to keep
Plague within limits, which would prevent the dislocation, or even
the disturbance of the general trade of the city. No evil could be more
fatal to trade than to allow the spread of Plague in the heart of the
city, where its entire business activity centres.
With these ends in view, an additional ward was built in the
Modikhana Hospital, and under the close personal attention of Mr. N. M.
Wadia, C.I.E., and of Mr. M. M. Murzban, the ward was supplied with
every comfort and was at once filled. This was unfortunately destroyed by
the fire of February 21st. The patients were safely conveyed to the
Seth Sanitarium in the Fort, where, through the kindness of the
Trustees, they were allowed to remain for a few days till arrangements
were made for their comfort in Modikhana Carap. Two of the patients
were taken to the Parsi Hospital on Parel Road. Almost all the rest of
the patients returned to the Modikhana Camp, and about three weeks
later, when the Modikhana Hospital was re-built, by the generosity
of Bai Dinbai Nusserwanji Petit, the Parsi ward for acute cases,
together with wards for observation cases, for convalescents, and
for nursing friends, were all fully occupied, but since then Plague
among the Parsis of the Fort has nearly ceased, and since the beginning
of April the ward has never been full. Still, under the constant personal
care of Messrs. Wadia and Murzban, it has remained a great safety
and comfort.
It was not expected that Parsi families who are accustomed to houses
full of furniture and ornaments, would agree to camp in ordinary huts.
The Panchayat therefore built a costly type of hut, one for each family,
each having two living rooms, a cooking and a bathing room. These
huts on the Kennedy Sea-face were bespoken before they were finished.
With the exception of one case of Plague, the families who moved
into them have enjoyed unbroken health, and many families would
at once move into camp if dwellings of a similar class were available.
Christians.
Goanese,
Christiaus, that is, the mixed descendants of old Portuguese Settlers
either of Goa or of Bombay-Salsette, have suffered severely. They fared
badly during the first epidemic. During the second they fared worse.
In Cavel, in Girgaum, in Dhobi Talao, in Dukar Gully and Burrows'
Lane in Phanaswadi the number of deaths, both among the poorer and
the richer Christians, has been grievous. Among these Christians one
main flow of infection came though the nurses and other servants in the
houses of rich Parsis. Many of these who contracted Plague during the
discharge of their duties had to leave their masters.' houses and died
58
in their own koors or clubs. There were doubtless other sources of
infection, and when human vahans or carriers were guarded against,
Plague rode in on a sick rat.
No one who has seen the working of Plague measures will withhold
respect and admiration from the conduct of the Christians. Whoever the
patient, and however well and dearly cared for at home, if the case
was declared Plague or suspicious, wife, daughter or son were willingly
sent to the hospital and all arrangements for Contacts and for disinfecting
were submitted to without a murmur. At first Christian patients were
sent to the Grant or Arthur Road public hospitals. In March a move-
ment was started by Dr. Da Gama to have a ward set apart for Christians,
so that the last rites might be ceremoniously performed in private. A
ward was allotted in the Narielwadi Hospital which, in spite of the great
decrease of the Plague, has ever since held a few patients. An
arrangement was made to open a Segregation Camp on the grounds of
the Ashburner Bungalow at Mazagon. Huts were built, but the
decline of the disease made their use unnecessary.
Bombay-Salsette
The second Christian community, the Bombay-Salsette Christians,
made proposals regarding a special hospital and segregation house, but
they took no action till the decline of the Plague made special
arrangements unnecessary.
Jews.
The Jews have passed through the Plague fairly unharmed. The
few rich European Jew patients have been received into the European
Plague Hospital ; the poorer Baghdadi Jews have shown a courage and
devotion in seeding their sick to the public hospitals which has earned
the thanks of the Plague Committee. "With a little persuasion the bulk
of the people have conformed to all Plague rules. Apparently their
freedom from concealing cases and their readiness to have infected
places cleansed has benefited them. In late December and early
January, especially in Nagpada near Mastan Tank, many families of
Baghdad Jews suffered. Since the end of January, however severe
the epidemic has been in their neighbourhood, Jewish houses have been
safe. The local Beni-Israels, or Bombay-Konkan Jews, have had a
rather large proportion of cases. They have built an excellent camp-
hospital at the east end of the Connaught Road and have sent their
patients thither with good results. The Beni-Israels stand high in the
rank of communities whose behaviour throughout the Plague has been
honourable and helpful.
Chinese
The small community of Chinese as a precaution built an excellent
hut hospital on Connaught Road ; but as no Plague occurred among the
community, the hospital has not been used.
59
CHAPTER V.
DIRECT METHODS OF COMBATING PLAGUE.
Aims.
The aims set before the Plague Committee were to keep down the
death-rate while preventing panic and trade dislocation, and to lessen
the risk of a third epidemic.
The transference of the Plague-stricken to hospital, followed by
their return as convalescents, and the proved protective effects of house
disinfecting, combined in a great measure to allay panic and mitigate
commercial disaster. It is true that high wages, a certain familiarity with
plague, the difficulty of leaving Bombay, and the knowledge that plague
ruled in the Mofussil as well as in the City, combined to make the mass
of the people unwilling to move. Still it seems reasonable to suppose
that, if the death-rate had risen from the actual maximum of 230 a day
to 1,500, the Sholapur maximum on the Bombay basis of 750,000
people, or to 650, the Poona and the Karachi maximum, or even to 330,
the maximum of the previous Bombay epidemic, no temptation of
wages, no discomforts of detention would have prevented a flight from
Bombay which would have paralysed the trade of the city.
To lessen the risk of a third Plague epidemic in Bombay, in addi-
tion to the removal of the sick, the segregation of the tainted, and the
cleansing of the house, special attention was paid to the construction of
camps as a relief from overcrowding, to the vacation of infected and
unwholesome houses, and to the introduction of an improved provision
of light and air.
Apart from the cleansing of streets, the flushing of gullies,
and the other general preventive measures which were efficiently carried
out by the Health Department, so far as pure Plague operations are con-
cerned the main hope of a low death-rate lies in securing the removal tc
hospital of the sick at the earliest possible stage of the attack. The
means adopted by the Committee to secure the early removal oi
the suffering were—information, simple house-searching, and house-
searching: with cordons.
Information.
At the stage in the development of an epidemic of plague when
cases are few, scattered, and mild, and in places where no law is in force
60
requiring the declaration of sickness, early information of seizures
is at once the least irritating and the most efficacious means of
discovering cases. With patience and discretion valuable information
can be generally obtained not only from the employes of the Plague staffs
but from sepoys and peons, and from anxious or needy neighbours.
And when trust is inspired, much assistance is given by rent-collectors,
medical practitioners, and caste-leaders. Efforts were made to encourage
a system of information which would give knowledge of cases of
Plague before they ended fatally, and before the patient had passed into
a hopeless condition. During the rainy months and till December
in certain parts of the city, notably in C Ward, the efforts to secure
information were highly successful.
The Committee's efforts to remove the sick were hampered by the
concealing of cases. To dissuade relations from hiding their sick,
the influence of members of their community, and the counsel and
orders of their religious and social leaders were in many cases of great
service. The opening of caste or community hospitals, with the attrac-
tions of quiet and privacy, where friends could attend, and where the
chance of recovery was greater than at home, in many cases overcame
the passion for concealment.
Death
registration.
Nevertheless during the past ten months the efforts to conceal
Plague cases and deaths, with the object of escaping house disinfection,
segregation of contacts, and other unavoidable annoyances, have been
very successful and have to a great extent been due to the imperfect
registration of the house of death.
During the past epidemic in a large proportion of daily deaths, per-
haps in one-fourth of the whole, the place of death has not been recorded
in the cemetery returns with sufficient clearness to enable the case to be
traced. To remove this serious flaw in the registration of deaths in
connection with Plague operations, three suggestions have been made :—
(a) To require the notification of sickness.
(b) To enforce corpse-inspection.
(c) To secure the correct address at which death took place.
As regards (a) ;—compulsory notification of sickness is open to the
objection that either every case of sickness must be notified, a require-
ment which would press heavily on the mass of the people, or that, if the
notification is limited to cases of Plague or other epidemic disease, to
secure conviction for default it must be proved that the patients' relatives
were aware of the nature of the complaint.
Asre gards (b) ;—corpse-inspection has been successfully enforced
both in Poona and in Karachi. The objection to its introduction
61
into Bombay is that, if the inspection is made at the cemetery, a false
or a vague address would, for all contact and disinfecting purposes,
make the information secured by the inspection of the body useless.
Even corpse-inspection in the house of death is open to the objection
that in 20 to 30 per cent, of Plague cases none but highly-trained
Medical Officers can tell the cause of death ; and that in Bombay, except
at; a most serious cost, no staff of sufficiently skilled Medical Officers
numerous enough to attend all deaths, at all hours, without undue delay,
can be provided. In so large a city as Bombay the question of delay in
examining the body is serious. Few communities perhaps would
object to the examination of a body immediately after death. On the
other hand, if the inspection be delayed till after the formal laying out
of the dead, serious opposition is to be expected from almost every class
of the population.
As regards (c), to secure correct addresses, the Plague Committee
proposed that no corpse should be removed from the house of death
without a Plague Authority's certificate of the correctness of the
address. To avoid the detention of funerals at the house of death,
large numbers of Plague Authorities, capable of issuing address notes,
had to be provided; and to avoid delay at the cemetery, in the case of
funeral parties who came unprovided with addresses, it was proposed
that a member of the party might be detached to point out to a sepoy
the house of death. Before the macninery was in order, the neces-
sity of ascertaining the cause of death in cases of Plague was again
urged. The heads of communities were summoned to consider the best
means of supplying the required information. It was agreed that no
corpse-inspection should be attempted, and it was arranged that in
cases attended by practitioners the cause of death should be shown, and
that in other cases a note of the place of death would suffice. Notwith-
standing this settlement, a report was circulated that a rule requiring the
inspection of corpses was about to be enforced, and, in spite of explana-
tions, this received ready credence, especially among the lower-class
Musalmans.
In the riot of March 9th, the intention to enforce corpse-inspec-
tion was the main complaint brought against Plague measures. By
the middle of March, the arrangements for securing the record of a
correct address were completed, and the system was introduced. At this
stage the Municipality took exception to the system on the ground that
the detention of any member of a funeral party was likely to cause irrita-
tion, if not disturbance, and that a regiment of police would be
required to enforce the rule. To this objection the Committee replied
62
that, if the proposed system worked, the cases would be rare in which, a
funeral party would arrive at the cemetery without the note of address.
The present position is by no means satisfactory. The handing to
Volunteer Committees of the duty of giving information of cases of
Plague was, to a great extent, justified by the check on their working
which complete registration returns would supply. Without an
adequate cemetery or other registration check, the risk of Plague cases
and deaths remaining unreported must continue to be serious.
Search-parties.
The best source of information, since it is free from the liability o£
abuse, is from a Justice or other respected and trustworthy volunteer who
knows his beat and his people so thoroughly that he at once hears of any
case of suspicious sickness. This ideal form of information is difficult to
secure. Probably only one Justice in Bombay—Mr. James Macdonald,
of the Byculla Schools—has during the past year known every case of
local or of imported sickness in his beat.
As all other sources are imperfect, house-to-house searching, except
when cases of Plague are few and imported, becomes necessary. Well-
conducted searches, where the medical or other officer in charge is
kindly and considerate—and to this kindliness the exceptions are few—
in ordinary circumstances cause little or no annoyance. In nine cases
out of ten, except when a patient has to be hid, the search-party is
a source of amusement rather than of alarm or dislike.
The lampman, the lockman, and the sepoy at times cause crowding
and confusion. Still so long as the disease is not virulent and a weekly
search suffices, no appreciable irritation is caused. During the virulent
stage of an epidemic, when the course of the disease as a rule does
not exceed three days, a half-weekly search is required, and such
repeated intrusions are apt to breed annoyance.
This method however has necessarily been principally relied on for
the detection of cases, and has been in operation from the earliest days
of the Plague Committee's operations. In each district a number of parties
set out each morning about 7 o'clock to search houses in each section
or sub-section. They continued the work till 10 or 10-30 a.m. and
again in the afternoon from 3 o'clock until dark. These parties were
somewhat variously constituted, but in the main consisted of
(1) A qualified Medical man, either European or Native.
(2) A Lady Doctor or Nurse.
(3) A Sub-Inspector.
(4) A locksmith.
(5) Two lampmen.
(6) Two or more Police or Military sepoys.
(7) A hand-lotion carrier.
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If possible, the services of a local Justice of the Peace or volunteer
were obtained to accompany the search-party, but this was often difficult.
In most instances an ambulance accompanied the search-party, or was
kept in readiness at some convenient point. The District Officer and
the officers in charge of sections and sub-sections went round with one
or other of the search-parties.
The method of procedure was for the party to start from the
District Office at 7 a.m., and proceed to the streets which it had been
previously arranged to search. The houses were systematically searched
down both sides of the street, the party dividing into two for the pur-
pose. On entering a house, sepoys were stationed at the doors to
prevent people leaving until the search was completed. Each room
was looked into, and, if necessary, entered, and all the occupants
scrutinised. Any persons looking suspiciously ill were carefully
examined and their temperatures taken. Persons suffering from chronic
disease were granted a certificate by the Medical Officer, the production
of which freed them from examination by subsequent search-parties,
If a room, was locked, the lock was opened by the locksmith, a Police
sepoy being present to witness that nothing was stolen and that the
room was subsequently locked. Locked rooms which had once been
examined were sealed. When the owner returned he went to the Dis-
trict Officer, who sent an Inspector with him to see the seal broken and
the room entered In the houses of Mahomedans, rooms occupied by
women were entered only by the Lady Doctor or Nurse, who examined
the inmates.
When a case was detected, an ambulance was sent for and the
patient was despatched to hospital in charge of a Police sepoy, who took
with him a form filled in by the Medical Officer giving the address, age,
sex, caste, and condition of the patient and the name of the hospital to
which the patient was to be taken. He returned with the ambulance and
brought a receipt from the officer in charge of the hospital. Previous to
the patient's removal the friends were asked to what hospital they
wished to have the patient sent, and, if they showed no preference,
he was removed to the nearest general hospital.
Considerable ingenuity was shown by the people in concealing
and removing cases while the searching was in progress. One of the
objections to this systematic house-visitation was that, on work being
started at one end of a street, the people living further down, seeing
beforehand what was in store for them, took the opportunity of removing
their sick before the party reached their house.