NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Plate No III
Involution forms from a 4 days old culture
on Agar Agar Carbol Fuchsin X 1200
Plate No IV
Involution forms from a 4 days old culture
on Agar Agar
Gentian Violet X 800
Plate No. V
Plague Bacilli in chains from a 2 days'
old growth in bouillon.
Plate VI
Haffkines "Stalactite growth"
LITHO GOVT PHOTOZINCO OFFICE, POONA 1900.
Plate VII
"The Snowfall."
LITHO GOVT PHOTOZINCO OFFICE POONA 1900.
Plate VIII
Growth of Plague on Agar -
Agar,
Ground Glass Appearance
Natural Size.
Drawn
by
Gouveya
Litho: Govt Photozinco: Office, Poona 1900
224
[CHAP. III., PT. Π.
On the analogy of similar diseases we presume that persons suffering from plague infect
their clothes, beds and other room surronndings. Hence for these latter we employ various
methods of disinfection and we draw our conclusions as to the particular disinfectant to be
used—its form and its strength—from the laboratory experiments which have been per-
formed in this connection.
With regard to the presence of the piague-bacillus in air—in water or in the soil—it is
impossible at present to make any assertion whatsoever with the insufficient dala which we
possess. Hitherto all attempts (many of which have been made by Dr. Gibson, Lieut,
Liston, and others) to isolate the plague-bacillus from the soil have failed.
Plate IX
Single old Colony on Agar
6 or 8 times natural size
N.B. The yellow appearance of the above is largely due to the
colour of the subjacent agar jelly.
Drawn by Gouveya
Litho:
Govt
Photozinco:
Office, Poona 1900.
Plate X
B. Pestis to show appearance of large colonies.
Natural size Agar growth.
Drawn by Gouveya
Litho:
Govt:
Photozinco
Office,
Poona,
1900
132
[CHAP. IV.
available for plague duty rendered it impossible to detail one to each district. As a matter
of fact, only 5 such Doctors in all were employed, viz., Doctors Thomas, Parsons, Haydon,
Dalai, and Lewis, the latter being the only one present during the epidemic of 1898-99.
The following table which gives the approximate dates of the beginning of the main
outbreaks in each district or ward is taken from the Municipal Commissioner's Report :—
22nd November 1898—2nd Nagpada.
29th
„
,, —Fort North, Dongri, Kumbharwada, Mahim.
6th December „ —Market, Kharatalao, Byculla.
13th
„
,, —Mandvi, Dhobitalao, Mazagon, Parel, Worli.
27th
„
„ —Umarkhari, Bhuleshwar, Fanaswadi, Kamatipura, Tardeo,
1st Nagpada, Sion.
3rd January 1899—Middle and Lower Colaba, Khetwadi, Girgaum, Tarwari,
Sewri.
10th „
„ —Chukla, Mahalaxmi.
24th „
,,
—Chowpatti.
31st
„
„ —Walkeshwar.
7th February „ —Esplanade.
The poorer classes suffered most severely in this epidemic.
Camps.
The great difficulty experienced with regard to health camps was that of space. Thir-
teen standing camps were taken over from the Plague Com-
mittee ; of these, 8 were retained either wholly or in part ; all
the rest were demolished. Towards the close of 1898 a generous grant of one lakh by the
Government of India for expenditure on camps greatly assisted the solution of the difficulty.
In addition to the 8 camps abovementioned which were retained, over 20 more were
established, the distribution of which is fully given in the Municipal Commissioner's report,
and the cost of which was roughly Rs. 60,000.
These numerous camps in and about the City have undoubtedly been of the greatest
service, furthering the evacuation of infected houses and localities, minimizing the incon-
venience arising from such evacuation to the inmates, permitting of greater accommodation
to the evacuated population and conducing generally to health.
The
Discretional
Relief
Fund.
As the Discretional Relief Fund has been dealt with in a separate chapter by itself,
and as full details of \ill\ working in Bombay are given in
Chapter VI. of the Municipal Commissioner's report, com-
ment on it here would be superfluous.
Hospitals. The hospitals in Bombay City which were either expressly set apart for, or, in addition
to their ordinary patients, took in, the victims of plague
number between 80 and 40, As a whole, they were well
appointed, well managed, and successful. Chief amongst them must be mentioned the
Arthur Road Hospital. This hospital is a permanent institution, and has been constantly
open since plague began in 1896. It has a staff of over 100 all told, of whom 2 Medical
Officers, 10 English Nurses, 6 local Nurses and 4 Hospital Assistants, form the superior
BOMBAY TOWN AND ISLAND.]
133
staff. The largest number of admissions was made in the week ending 11th March 1899,
when 113 plague patients were admitted ; and on any one day, on the 10th March 1899, on
which day 25 plague patients were admitted. The total number of deaths during the year
in this hospital was 1,508, of which 1,161 were due to plague.
The following table, taken from the Municipal Commissioner's report gives the
admissions from all causes with the deaths and recoveries for the year :—
Plague
Relapsing Fever
Cholera
Small-pox ...
Chicken-pox
Measles
Whooping Cough
· ·
· ·
.* .
...
...
...
Observation and other Diseases
Total
· ·
...
...
··
...
Admissions.
1,470
1,436
4
73
12
40
1
216
3,252
Deaths.
1,161
311
2
6
...
3
...
26
1,509
Recoveries.
309
1,125
2
66
12
37
1
191
1,743
Percentage
of
Mortality.
78.97
21.65
50.00
8 · 49
100.00
7.50
100.00
11.57
46.37
This hospital may be taken as the model on which the other hospitals cither did or
endeavoured to work. Dr. N. Chowksey was in charge of it throughout. Full details of
all the hospitals are given in the Municipal Commissioner's report, Part VI. Lt.-Col. J.
S. Wilkius, D. S. O., I. M. S., was in charge of all these hospitals from October 1898 to
May 1899.
A chart showing the total mortality week by week for the three plague years is given
overleaf.
BOMBAY CITY
Population 806,144.
Chart of The Weekly Total Mortality from Sept. 1896 to Nov. 1899.
NOTES * * During this interval 400 000 people - about half the population, fled from the City
An exodus, though an a much smaller scale also took place about the same time during the two following years
135
CHAPTER V.
SEA INSPECTION.
One of the most important measures adopted for the prevention of the spread of plague was
the Medical Inspection of sea-going passengers and crews. In Bombay City both the
export and import of plague infection had to be guarded against : export, first, when plague
declared itself in Bombay, and import, afterwards, when Bombay itself being practically free
from plague, people from other infected parts began to pour into the City. It will be con-
venient, therefore, to review the measures adopted for the prevention of exportation of plague
eparately from those instituted for the prevention of importation.
Outward Inspection.
For twelve years before the advent of the present plague epidemic in India, a perfect
system of inspection of vessels, passengers and crews bound for Aden, Red Sea ports, Europe
viá the Canal, Persian Gulf and Mauritius, was in existence in Bombay for the detection of
passengers or crews suffering from infectious or contagious disease.
In January 1897 it became clear that a panic-stricken population was fleeing from
the City by all available routes, and was spreading plague to the inland towns as well as to
the ports in the Bombay Presidency, more especially to those near the City. It was there-
fore absolutely necessary that all crews and passengers, leaving Bombay by sea, should be
thoroughly and systematically examined, and all that was necessary was to extend the
system mentioned in paragraph 2 to all crews and passengers on vessels and native craft
leaving for any place or port viâ the Bombay Harbour.
On the 6th February 1897, therefore, rules were promulgated under the Epidemic
Diseases Act (III. of 1897), which precluded the delivery of a Port clearance to any vessel
without the production of the Port Health Officer's bill of health, certifying that the " master
or person in charge, officers, crew and passengers (if any) of such vessel were free from any
dangerous epidemic disease." Inspections had now to be simultaneously conducted at different
centres in a very large harbour, at various places along an extensive foreshore and within
wet docks, where tidal conditions had to be reckoned with. The prompt and successful
carrying out of the enormous quantity of work involved the organization of a large staff of
reliable and energetic Medical Officers and Subordinates.
The extended system of sea inspection came into force on the 6th of February 1897, and
the following staff was made available for the work :—
Port Health Staff.
One Port Health Officer.
One Additional Port Health Officer.
Three Commissioned Medical Officers.
Three Assistant Surgeons.
One Hospital Assistant.
One Lady Doctor, and the services of a second as occasion required.
SEA INSPECTION.]
139
"When the process of elimination was completed, the suspects were transferred to the
Plague Committee's Observation Camps, and detained there for periods varying from 3 to 5
and 8 days, according as they had come originally from uninfected, moderately and heavily
infected places. Actual plague cases were sent in ambulances to a plague hospital."
Such as it was then, such the inspection has remained up to the present time.
The extent of area from which passengers were examined was increased in August
1898, and Hongkong, Madagascar and Jeddha were added to the list ; on the other hand,
people arriving from non-infected and lightly infected ports on the coast were exempted from
inspection from time to time. So also were changes made in the staff, especially when impor-
ation of plague into Bombay City was not a matter of much con sequence, owing to an epide-
mic in the City, or when the whole of the inspections, outward and inward, were conducted by
the Port Health Staff alone.
Pilgrims returning from Jeddha were isolated in the pilgrim shed until their kit was
thoroughly disinfected, after which they were sent direct to their final destination and were
not allowed to have any unnecessary communication with the City.
The following statement compares the number of arrivals inspected during the three
epidemics :—
Period.
April and May 1897 ...
June 1897 to May 1898
June 1898 to May 1899
...
...
Total
...
...
Number of vessels
inspected.
Number of persons
examined.
Number of persons
segregated.
Square-
rigged.
422
1,447
522
2,391
Native
Graft.
8,072
39,959
830
48,861
Passengers
167,173
270,023
83,135
520,331
Crew.
62,911
310,271
35,356
408,538
Passengers.
5,324
39,841
281
45,446
Crew.
42
5
47
The Plague Committee's Staff were dispensed with on the 21st April 1898, and
the Customs Medical Staff were taken over by the Port Health Officer on 28th January 1899.
Since the latter date the Port Health Staff have been responsible for all Medical Inspec
tions in the Harbour.
During the period covered by this review, the total number of vessels, including
native craft, examined was 379,850. They had 3,131,049 crew and passengers, and among
them were discovered 409 cases of plague, including the cases found on the Harbour craft.
The sea medical inspection was, from the importance and magnitude of the in-
terests involved by the spread of plague out of India, a source of the greatest anxiety to
Government. But events have proved that no department of plague administration has been
better managed ; and the thoroughness and successful conduct of the operations as
a whole has commanded warm admiration.
RAILWAY INSPECTION.]
143
List of Local
Stations on
G. I. P.
Linc.
Kurla.
Mahim River
Sion.
Matunga.
Parel.
Currey Rd.
Chinch-
poogli.
Byculla.
Masjid.
Victoria.
Terininus.
List of Local
Stations on
B. B. &
C. I. Line.
Santa Cruz
Bandra.
Mahim River
Mahim.
Dadar.
Elph. Road.
Parel.
Maha-
lakshmi.
Grant
Road.
Possible methods of evasion.
G. 1. P.
(IV) Passengers could alight at Thana and
walk to Bhandup, Ghat-Cooper or
Kurla, and book to Bombay.
B. B. & C. I.
(IV) There is no station on the B. B. & C. I.
Railway corresponding to Thana.
G.I. P.
(V) Passengers could book from the G. I.
P. to the B. B. & C. I. line at Dadar
and thus slip into Bombay.
B. B. &. 0. I.
(V) Passengers could book from the B. B.
& C. I. to the G. I. P. line at Dadar
and thus slip into Bombay.
G. I. P.
(VI) Passengers could book from stations
north of Kalvan to stations between
Kalyan and Thana or between Thana
and Sion and change into local trains
at Kalyan or Thana and thus slip
into Bombay.
B. B. & C. I.
(VI) Passengers could book from stations
north of Virar to stations youth and
change into a local train at Virai
and thus slip into Bombay.
G. I. P.
(VII) Passengers could alight at Thana
und walk to Sion Causeway.
B. B. &. C. I.
(VII) Passengers could alight at Virar
and walk to Bandra Causeway.
Steps taken to prevent evasion by
these methods.
(IV) The Company would not stop book-
ing from these stations, but pro-
mised to report if the booking be-
came heavier so that steps could
be taken later.
(IV) No steps necessary.
(V) The Company stopped this.
(V) The Company stopped this.
(VI) The Company stopped booking
from stations north of Kalyan to
Diva, Demauli, Mumbra, Bhandup
and Ghat-Cooper.
(VI) The Company stopped such book-
ing.
(VII) This was obviated by instituting
a system of detention of Causeway
passengers.
Local, through, barrier, frontier and mofussil inspections with disinfection
Observation Camps, and other regulations to prevent infected or probably infected people
from travelling, remained in force till after the middle of the year 1898, modified by local
indications from time to time ; as, however, there seemed little prospect of a speedy
termination of the epidemic, and as it was considered that many of the regulations in force,
such as detention and others, which practically close the channels of daily business, etc.,
were inexpedient as permanent features of plague administration, a modified system, known
as the Surveillance System, was introduced in October 1898, which is laid down and
described in Government Resolution No. 5772—5864-p. of 17th October 1898. The chief
features of this new system were—
(a) systematic and careful medical examination of each traveller ;
(b) careful disinfection of suspicious articles ;
(c.) correct ascertainment and record of the locution of travellers after they have been
permitted to enter a town ;
(d) special regulations for travellers who could not be depended upon to give a trust-
worthy account of their residence and movements, or were suspicious, whether by
reason of their appearance or symptoms, or the dirty condition of their clothes or
effects.
144
[CHAP. VI·
On the 4th November 1898, Captain W. E. Jennings, I. M. S., was appointed
Supervising Medical Officer, Railway Medical Inspection, to susperintend the working of
the new system in the Presidency proper. His duties, detailed at length in Government
Resolution No. 6130—6228-p., dated the 8th November 1898, were briefly as follows, viz :—
(i) To report from time to time at what places medical examination should, in his
opinion, be conducted and at what places discontinued ;
(ii) to be responsible for the efficiency of the examination at each place, for the
arrangements for the comfort of the public, and generally for carrying ont the
provisions of Government Resolution No. 5772—5864-p., dated the 17th October
1898;
(iii) to keep a list of infected stations for the purpose of special plague-marking of
railway tickets ; and
(iv) to inspect Surveillance Registers at Railway stations.
It was of course intended that the decision regarding the stations at which from
time to time examination should be held would depend on the course of the plague, and at
the time when the new arrangements came into force, the state of plague in the Presidency
necessitated the establishment of inspection and disinfection posts as follows :—
B. B. & C. I. Railway.
Palghar — Up and Down trains.
* Anand — Down trains.
Dhond and Manmad Railway.
* Manmad — Up and Down trains.
G. T. P. Railway — (Calcutta Line).
Kalyan — Down trains.
* Manmad — do.
* Bhusawal — do.
G. T. P. Railway— (Madras Live).
Kalyan — Down trains.
* Poona — Up and Down trains.
* Sholápur— Down trains.
Southern Maratha Railway.
* Poona — Up and Down trains.
Sátará Road — Down trains.
Belgaum —
do.
* Hubli—
do.
* Bagalkot — Up and Down trains.
Londa — All passengers alighting from the
Southern Maratha Railway and all
those travelling westward from Londa.
Under the revised system, local inspections for the protection of Bombay against
Sálsetto and vice versâ were abolished, and Government decided to include the Islands of
Sálsette and Bombay (which were both infected at the time) as one District, from which the
conveyance of infection should be prevented by careful examination of through trains
at selected places—Kalyán and Pálghar on the G. I. P. and B. B. & C. I. Railway lines,
respectively, being the first two.
Note.—At the stations marked with an asterisk there was steam disinfecting apparatns, except at Bhusawal and
Bagalkot, where disinfection was carried out by other means. The clothing, bedding and baggage of persons coming,
or suspected of coming, from a plague-strickeu neighbourhood, who were believed to be likely to convey infection,
either from having lived with people among whom plague had been prevalent, or from the dirty condition of their
clothing or baggage, were, at the discretion of the Medical Officer, liable to disinfection.
Note.—In the 14-30 daily Fast Poona Train, Poona passengers, who are locked into separate compartments, are
not examined at Kalyan but at Poona.
RAILWAY INSPECTION.]
345
During the month of January 1899, barrier inspection of all departures from
Broach Station was instituted on the B. B. & C. I. line, and in March 1899 an inspection
and disinfection post was instituted at Dohad on the Godhra-Rutlám line for the protection
of Rájputána and Central India, and also a barrier inspection of all arrivals at Wathar on
the Southern Maratha line for the protection of Wai, Panchgani and Máhábleshwar.
Since the 1st of May 1899 the following arrangements have been in force, viz. :—
I.—B. B. & C. I. Railway.
i. Dohad—Inspection of passengers and local departures in down trains, and of passen-
gers alighting from up and down trains. Disinfection by boiling.
ii. Bordi—Inspection of local departures in down trains.
iii. Anas—Inspection of local departures in down trains.
iv. Anand—Inspection of passengers in down trains from Bombay, of local departures
in down trains, and of arrivals and through passengers in up trains on the Godhra-Rutlám
line. Disinfection by steam.
v. Broach—Barrier inspection of local departures and arrivals. Disinfection by boiling.
vi. Pálghar—Inspection of passengers and local departures in down trains.
II.—G. I. P. Railway.
i. Kalyán—Inspection of passengers and local departures in all down trains from
Bombay.
ii. Poona—Inspection of passengers and local departures in all down trains from
Bombay except the Madras Mail which is inspected at Sholápur. Inspection of all arrivals
and through passengers in up trains on the Southern Maratha Railway. Disinfection by
steam.
iii. Sholápur—Barrier inspection of all arrivals by up and down trains, inspection of
all through passengers and local departures in the down Madras Mail and in all up trains.
Disinfection by steam.
iv. Manmad—Inspection of all passengers alighting from down trains, from Bombay
and Dhond.
v. Bhusáwal—Inspection of all passengers and local departures in down trains. Dis-
infection by boiling pending the starting of steam disinfection.
III.—S. M. Railway.
i. Wáthár—Inspection of arrivals in down trains.
ii. Sátára Road—Inspection of all passengers and local departures in up and down
trains.
iii. Londa—Inspection of arrivals in up and down trains and through and local depar-
tures in trains towards Goa.
iv. Hubli—Inspection of all passengers and local departures in up and down trains.
Disinfection by steam.
v. Bagalkot—Inspection of all passengers and local departures in up and down trains.
Disinfection by boiling.
37
[CHAP. VI.
Though railway inspections have been in force for more than two years, yet
the plague has spread. But, the area and duration of its prevalence considered, its dissemi-
nation has been very gradual : and there can be little doubt that it has been largely
checked by this measure. The following causes have combined to discount its utility :—
(a) The impossibility, when the measures would have been most useful, of obtain-
ing sufficient staff on account of the large demand made on the Medical Depart-
ment for Plague, Famine, Cholera, and Frontier Campaigns, all at the same time,
and the consequent delegation of inspection work to temporary medical subordinates ;
who, though doubtless equally zealous, were yet less qualified.
(b) Evasion by travellers, i.e., alighting before arrival at, and walking past
inspection-station ; booking to intermediate non-infected stations, &c.
(c) The conveyance of infection by road.
(d) The impossibility of detecting cases in the incubation stage.
On the other hand there is much to demónstrate the value of the system as a
preventive measure. Statistics go to illustrate that it is a powerful deterrent against
those travelling, who are actually suffering from plague, and also against those travelling,
who are probably infected : for out of many hundreds of thousands of passengers
examined, only an infinitesimal number were found to be actually suffering from plague,
and, out of many thousands detained for observation, a comparatively small number
developed plague. It is almost certain that all actual plague cases, and all those who
have commenced to sicken for plague, are detected, and only those incubating for
plague escape.
The inspection establishments were made up of officers of the following classes,
viz., Commissioned Medical Officers, English Doctors and Lady Nurses, Government Assistant
Surgeons and Hospital Assistants, Indian Medical graduates and native practitioners, medi-
cal students, Indian trained nurses and female inspectors specially instructed to assist in
inspection work, and clerical, police and menial staff.
The following statement gives in a tabular form the period during which the
Revised Regulations were in force, the number of passengers detained, the number o£
plague cases detected (and of deaths among them), the numbers of those disinfected and
subjected to the clinical thermometer test, and the total expenditure at each station up to
the week ending 2nd June 1899. It also contrasts in a general way the comparative effi-
ciency of the Revised Regulations and the Detention Camp system (which was in force
during the epidemic of 1897-98).
A comparison of the tables brings out the fact that under the Detention Camp
system at 12 stations during an average period of 5 . 14 months each, out of 131,074, people
detained (for ten days), 201 cases of plague were detected, and the total cost was
over Rs. 3,85,000. Under the Revised Regulations at 14 stations during an average period
of 5 . 7 months each, out of 19,302 people detained (for observation only), 413 cases of
plague were detected, and the total cost was under Rs. 1,03,030, including cost of monsoon
shelters for 1899.