NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. XL ] Measures to prevent the spread of infection by sea. 387
General
substance of
rules.
Examination on
board and on
shore.
The regulation then goes on to cite the rules about the grant
of the bill of health; the individual examination of all persons
sailing on board by day at the time of embarkation ; the disembarka-
tion of persons ascertained or believed to be suffering from
plague, together with the attendants and relatives of such persons ;
the disinfection of their effects and of the infected portions of
the vessel ; the mention of the plague case and the precautions in
the bill of health, etc. The rules provide that the medical examina-
tion must be made on shore, except that in the case of vessels
anchored in the Madras roadstead (i.e., outside the enclosed harbour),
and at minor ports, the inspection of the officers and crew may be
conducted on board.
Remarks by the
Government of
India.
Passengers from
infected locali-
ties.
Special case of
Ceylon.
The Government of India stated that the rules appeared to be
in general well adapted to meet the circumstances of the case.
They considered, however, that the Venice Convention having been
commonly accepted and enforced, the retention of the rule pro-
hibiting the embarkation of persons coming recently from an infected
locality was unnecessary. At the same time it was recognized that
the case of Ceylon was peculiar owing to its close proximity to the
Indian mainland, and it was stated that if the Government of
Madras considered that the withdrawal of the rule in the case of
vessels bound for Ceylon would be likely to cause vessels from
Madras ports to be put in quarantine at Colombo, the rule might be
retained in that special case.
Examination on
shore.
It was further pointed out that the rules did not prescribe that
in the event of the examination being made on shore the sick per-
son and his relatives and attendants should not be prevented to
embark.
Application of
the rules to
vessels sailing
for Burma.
Lastly, it was mentioned that although the rules apparently were
to apply to vessels sailing for Burma, this was not stated in the
preamble which purported to confine the operations of the rules to
vessels sailing for ports out of India.
Emigration,
Prohibition of
emigration from
the infected
area.
In March 1897 it was considered desirable, for the protection of
British Colonies and other countries, to prohibit intending emigrants
from the infected area from leaving India. The following notification
was therefore issued by the Government of India on the 6th March:—
" In exercise of the powers conferred by section 2, sub-section
(1) of the Epidemic Diseases, Act (III of 1897), the Governor General
in Council is pleased to direct that no person who has, since the 1st
388 Measures to prevent the spread of infection by sea. [ CHAP. XI.
January 1897, resided or been in, or passed through, the territories
administered by the Governor of Bombay in Council, or the State of
Baroda or the territories of any Native Prince or State under the
suzerainty of Her Majesty exercised through the Governor of Bombay
in Council, shall, until further orders, be permitted to embark on any
ship at any port in British India with the object of proceeding as an
emigrant or as a labourer to any port out of British India."
When Sind became free from plague and Karachi became a
healthy port the prohibition was withdrawn in so far as it applied to
Sind.
CHAPTER XII.
MEASURES TO PREVENT THE SPREAD OF
INFECTION BY MERCHANDISE AND
FOOD-STUFFS.
Orders of the Government of India forbidding the
import of Susceptible Articles from the Infected
Area. .
Objects soiled
with the excreta
of patients, a
dangerous source
of infection.
Objects soiled by the excreta of patients are, it has been stated,
a dangerous source of infection. It was therefore considered neces-
sary to prohibit the import from the infected area into other parts
of India of articles which from their nature or use were likely
to have come into contact with persons suffering from plague. In
Chapter X an account has been given of the measures adopted
to prevent the spread of infection by contaminated articles carried
in the baggage of travellers. In addition orders were from time
to time issued prohibiting the carriage, as merchandise or in any
other form, from the Bombay Presidency and Sind into other parts of
India of articles likely to be contaminated.
Orders
prohibiting the
export of
susceptible
articles from the
Bombay
Presidency and
Sind into other
parts of India.
There is some traffic in rags and second-hand clothing from the
west of India and especially from the port of Bombay. The stoppage of
this trade was an essential precaution, and the Government of India
issued orders, on the 22nd of January, under the Sea Customs Act,
1878, prohibiting the import by sea of rags and second-hand clothing
from Bombay and Karachi to Calcutta, Madras, and Rangoon. On
the 17th February a wider notification was issued by the Government
of India under the Epidemic Diseases Act. It prohibited the bring-
ing of rags, used apparel and bedding (except when carried in the
baggage of travellers), waste paper and used gunny bags, from
all infected ports to any other port in British India. On the 22nd
390
Measures to prevent the spread of
[ CHAP. XII.
March a further notification was issued prohibiting, in general terms,
the bringing of the same articles from the Bombay Presidency and
Sind into any other part of British India. On the 3rd of April the
prohibition was extended to all territories in India which are under
the administration of the Governor General in Council, but do not form
part of British India. Similar prohibitory orders were issued by the
Hyderabad, Kathiawar, Cochin, and Travancore States.
Regulations with respect to Rags, etc., issued by
Local Governments.
Madras.
Bengal.
General North-
Western
Provinces
rule with respect
to the packing of
goods from in-
fected localities.
Some of the Local Governments issued special regulations to
guard against the spread of infection from rags and other suscepti-
ble articles. The Madras rules provide that the President of the
Municipality may disinfect or destroy any collection of rags in rag-
pickers' houses and rag stores, or of second-hand gunny bags import-
ed from any infected locality. The regulations for Calcutta and
other municipalities in Bengal contain a similar rule with respect
to rags, and provide also that no person, except the servants of the
municipality, shall pick up rags or other refuse in the streets or else-
where, and that rags and other refuse shall not be transported except
under conditions prescribed by the Health Officer. Regulations
of the same nature were framed by the Government of the North-
Western Provinces and Oudh. That Government also framed a
general rule with respect to goods consigned from and believed
to have been packed in the infected area. Such goods may be
detained for examination before entry into any municipality or can-
tonment, and the materials used in packing, such as rags, straw,
grass, paper, etc., may be destroyed if they are considered likely to
convey infection.
Treatment of Susceptible Articles in the Venice
Convention.
The question of the treatment of goods from infected countries
was one of the most important matters discussed at the Venice Sani-
tary Conference.
List of "sus-
ceptible " articles
in the Venice
Convention.
The following is the list of articles and goods which the Confer-
ence classed as "susceptible" :—
" 1. Used linen, clothing, personal effects and bedding.
CHAP. XII. ] infection by merchandise and food-stuffs.
391
When these articles are carried as baggage, or in consequence
of a change of abode (household goods) they are subjected to special
treatment.
Soldiers' and sailors' kits, returned to their country, after their
death, should be treated in the same way as the articles named above.
" 2, Rags, not excepting rags compressed by hydraulic force, which
are carried as merchandise in bales.
"3. Old sacking, carpets and old embroidery.
" 4. Raw hides, untanned and fresh skins,
" 5. Animal refuse, claws, hoofs, horsehair, hair of animals gener-
ally, raw silk and wool.
"6. Human hair."
Reasons for
including the
different articles
in the list.
The articles contained in this list fall into two classes. The
articles numbered I, 2 and 3 were included in the list because their
nature or use make it likely that they may have been in contact with
persons suffering from the disease and may therefore have become
contaminated. The articles numbered 4 to 6 were included because
they are derived from man, or from animals which it was considered
possible might be subject to plague infection. It has been stated else-
where the necessity for this precaution is at least doubtful.
Treatment of
susceptible
articles
prescribed
by the Venice
Convention. The
prohibition
against import is
only optional.
The regulations prescribed by the Venice Convention (Chapter
II, section IV) direct that the import of articles included in the sus-
ceptible list may be prohibited by the Government concerned. The
prohibition is optional and it is not compulsory to forbid the entry
of goods or articles of any class. The only articles which must
of necessity be subjected on arrival to any precautionary measures,
such as disinfection, are clothing, bedding and similar articles which
have been actually worn or used, and which are carried as ordinary
baggage, if they have been brought from an infected area, and are
considered by the local sanitary authority as likely to be contaminated.
The disinfection of merchandise may be enforced only if the local
sanitary authority considers it to be contaminated, or if it falls
under any of the heads of the susceptible list. The treatment ac-
corded by the Governments of other countries to goods arriving from
India during the period of the plague is described in the next
chapter.
Reasons why the
Government of
India did not
issue any further
prohibitory
orders with
respect to the
transport of
susceptible
articles.
The Government of India considered that the orders that they had
already issued forbidding the import from the Bombay Presidency
and Sind into other parts of India of used apparel and bedding,
rags, waste paper, and used gunny bags were sufficient to meet the
requirements of the case, and that it was not necessary for the
purpose of protecting the rest of India to prohibit the import from
the infected area of any of the other articles on the susceptible list.
392
Measures to prevent the spread of
[CHAP. XII.
In reciting the obligation imposed on the countries which are parties
to the Venice Convention to confine their pecautionary measures to
goods coming from the infected local area, it is stated in Chapter II,
section III of the Regulations, that this obligation only exists on the
express understanding that the Government of the infected country
takes the necessary measures to prevent the exportation of suscep-
tible articles derived from the infected area, In other words, a
foreign government would be a liberty to decline to receive articles
classed as susceptible coming from a clean port unless measures were
taken in India to prevent the exportation from that port of sus-
ceptible articles coming from the infected area. The orders contained
in the notification issued by the Government of India, in Feb-
ruary and March, alluded to above, only partly fulfil this condition
since they only refer to used apparel and bedding, rags, waste paper,
and used gunny bags. All foreign governments did not, however,
avail themselves of the option of prohibiting the import of all the
articles classed as susceptible even from Bombay itself.
In view of this circumstance and in view of the optional nature of the
regulation, the Government of India did not think it necessary to issue
orders in addition to the orders of February and March, with the
view of prohibiting the exportation from clean ports of articles
included in the "susceptible" list and coming from the Bombay
Presidency and Sind. But the Governments of Madras, Bengal,
and Burma were informed that if, after consulting the mercantile
community, they considered that prohibitive orders should issue with
regard to all or any of the susceptible articles, the Government of
India would be prepared to consider proposals with this object. No
such proposals were made.
Precautionary Measures with regard to Food-stuffs.
Fear that plague
infection might
be brought from
Sind into the
Punjab in grain
or other food-
stuffs.
Early in the month of March when plague broke out in Sukkur
the Government of the Punjab expressed a fear that infection might
be carried from Sind in grain. In ordinary years there is not a large
trade in food grain from Sind to the Punjab. The trade generally
flows the other way, the Punjab sending large quantities of wheat
to Karachi for shipment to Europe. But in the season of 1896-97
the current of trade was reversed, the crops in Sind, where the
inundation was good, having been sufficient to afford relief to the
south-eastern districts of the Punjab which were the scene of scarcity.
To have prohibited the import of grain from Sind would therefore
have entailed serious consequences.
CHAP. XII. ] infection by merchandise and food-stuffs.
393
Grain a possible
source of
infection,
Grain and other food-stuffs are no doubt a possible source of
infection, and in the case of grain the danger is to some extent
increased by the great susceptibility of rats to plague. But the Gov-
ernment of India did not consider that the danger was sufficient to
make it necessary to proh bit the exportation of grain from Sind, and
they believed that whatever danger did exist might be obviated by the
Prohibition of the
export not
considered
necessary.
Careful
precautions
prescribed and
carried out.
adoption of careful precautions. Such precautions were earned out
immediately and with great thoroughness. The Government of India
issued instructions to the effect that measures should be adopted to
obtain immediate information of any plague cases in or near grain
godowns and to prevent the removal of grain open to the suspicion
of being contaminated. The Commissioner in Sind repeated these
instructions to all district officers and likewise directed them to
detain grain in any way suspected and to examine grain godowns for
rats. In Sukkur one case was discovered in a grain godown, and the
grain was removed and burnt.
Orders were subsequently issued prohibiting the exportation of
grain from the infected portions of the city of Karachi. A special
inspecting staff was formed in all infected towns to examine grain
godowns and bakeries, to direct their cleansing, and to cause all
other necessary precautions to be adopted.
In so far as is known no case of plague was occasioned by grain
or other food-stuffs imported from an infected locality.
Precautionary
measures in the
city of Bombay,
The following account of the precautions adopted in the city of
Bombay to prevent the sale of contaminated grain and other food-
stuffs and merchandise is from the report written by Mr. Snow, the
Municipal Commissioner:—
"The condition of the grain godowns on the Port Trust Estate
attracted early attention, as it was found that numerous cases of
plague were occurring in the dwelling-rooms above them. Interference
with these warehouses was a matter which demanded very careful
consideration, but the sanitary interests of the city were all important
and in every instance where a case of plague was known to have
occurred above a godown, the place was closed for twenty days, the
grain and other merchandise were taken out and exposed to the sun
in charge of ramosis,* sulphur was freely burnt inside and outside the
building, and the godowns themselves thoroughly flushed and disin-
fected.
" Similarly, in the case of shops, when a case occurred, no goods
were allowed to be sold till they had been exposed to the sun for at
least a day. The shops were not allowed to be used till they had
* Watchmen.
50
394
Measures to prevent the spread of
[ CHAP. XII.
infection by merchandise and food-stuffs.
been shut up and completely fumigated for three days, and even then
had to be limewashed before they were allowed to be re-occupied.
"Two hundred and twenty-five godowns and one hundred and
thirty-seven shops were treated in this drastic manner. At the same
time large quantities of infected or damaged sweetmeats and other
food preparations were destroyed, and many tons of grain sweepings
were found which had been collected from the streets and gullies for
the purposes of adulterating sound grain. From one godown as much
as 51 cart-loads of these sweepings were taken away and incinerate'd."
CHAPTER XIII.
STAFF.
Preliminary Remarks.
It is desirable, especially with a view to future reference, to say a
few words regarding the large medical and military staffs employed in
the plague operations, and the special remuneration which was granted
to them. The medical staff will first be noticed, then the military
staff, and lastly a few points connected with some kindred subjects.
Medical Staff.
Tabular
statement of
staff,
The following is a tabular statement of the medical officers and
subordinates employed by the Government exclusively on plague duty
and of the manner in which they were recruited :—
PEOVINCE IN WHICH
EMPLOYED.
Bombay
...
...
Madras
Central Provinces
...
North-Western Provinces
Rajputana ...
...
Central India
,
Baluchistan ...
...
Burma
...
TOTAL
WITHDRAWN
FROM MILITARY
DUTY.
11
2
2
9
3
...
27
14
...
5
...
1
...
20
14
...
4
1
1
20
12
1
8
5
1
27
TRANSFERRED
FROM PERMANENT
CIVIL
EMPLOYMENT.
8
...
1
...
3
1
14
...
...
2
...
4
...
6
14
5
4
2
4
7
...
36
...
...
...
...
...
14
...
14
97
11
4
3
13
35
3
1
167
RETIRED
SUB-
ORDI-
NATES.
3
1
1
5
...
2
...
2
SENT
FROM
ENG-
LAND.
3
...
...
3
I
...
...
1
2
I
5
1
1
9
19
396
Staff.
[CHAP. XIII.
Strain on the
Medical Service.
It will be seen from this statement that the staff included 64 Com-
missioned Medical Officers, 66 Assistant Surgeons, and 210 Hospital
Assistants. The strain on the medical services occasioned by the
withdrawal of so large a number of officers from their ordinary duties
was very great and was increased by the fact that some medical
officers and many medical subordinates were at the same time required
for famine duty. An endeavour was made to relieve the strain as
far as possible by the employment of volunteers from the Army
Medical Staff, retired subordinate officers, and private practitioners.
Private
practitioners.
In addition to the private practitioners shown in the statement as
employed exclusively on plague duty, a considerable number of
medical gentlemen in the Bombay Presidency rendered invaluable
assistance by supervising private hospitals, and in other ways.
Staff at the time
of the recru-
descence.
The statement refers to the staff employed during the first outbreak,
i.e., up to the month of July. On the occurrence of the recrudescence
matters were greatly complicated by the large demand for medical
officers and subordinates for the field hospitals on the North-West
Frontier. The difficulty was met as far as possible by economising
civil officers to the utmost degrees by employing more private
practitioners, and by procuring more officers from England.
Excellent work
of the Medical
Staff.
The zeal and devotion displayed by the medical staff in the per-
formance of their duties reflect high credit on the services to which
they belong.
Special
remuneration.
It was recognised that the specially arduous, and to some extent
hazardous, nature of the duties rendered it fitting that officers and
subordinates should be granted some extra remuneration, and that
volunteers could not reasonably be expected to come forward without
the offer of fairly liberal terms.
Account of the
orders granting
special
remuneration.
The following is a brief account of the orders passed with regard
to the remuneration of the different classes of medical officers and
subordinates :—
Commissioned Medical Officers of the Indian Medical Service.—
In Circular letter No. 7-sanitary/640 649, dated the 20th February, Local Gov-
ernments were informed that officers of the Indian Medical Service
deputed on plague duty might be permitted to draw allowances at
the rates laid down for officers deputed to famine work in Article
101 of the Civil Service Regulations. These rates are : (i) if the officer
is transferred from military duty, Rs. 300 a month if the officer's
service is more than five years, and Rs. 200 a month for
officers of less service; (ii) if the officer is withdrawn from civil
employ, Rs. 5 a day. Subsequently it was explained (Circular
CHAP. XIII. ]
Staff.
397
No. 12-Sanitary/1215-1224, dated the 7th April 1897) that, notwithstanding the pro-
visions of Article 101 of the Civil Service Regulations, the allowance
might be drawn by officers deputed to plague duty within the prov-
inces in which they were serving at the time of their deputation.
In Calcutta an allowance of Rs. 150 a month was granted to the
Additional Port Health Officers who performed the arduous work of
examining vessels in addition to their own duties.
Commissioned Medical Officers of the Army Medical
Staff.-In
letter No. 594-Sanitary, dated the 19th February, the Government of
India sanctioned the employment of volunteers from the Army
Medical Staff on a special allowance of Rs. 300 a month in addition
to Indian pay and allowances.
Commissioned Medical Officers sent from England.—Three officers
of the Army Medical Staff and Dr. Lowson of the Colonial Medical
Service, who had had experience of plague in Hong-kong, were sent
to Bombay by the Secretary of State. The salaries of the Army
Medical Staff Officers were fixed by the Secretary of State at £2 a day
in addition to their English pay and allowances, and travelling allow-
ances at the rates laid down in the Indian Regulations. Dr. Lowson's
remuneration was fixed specially.
Uncovenanted Medical Officers.—In January 1898, the Govern-
ment of India sanctioned the grant to Uncovenanted Medical Officers
who, at the time of their deputation to plague duty were dis-
charging the duties of Civil Surgeons, of a special allowance at the
same rate as is admissible to an officer of the Indian Medical Service
in civil employ, i.e., Rs. 5 a day
Applicants for employment in the Uncovenanted Medical Ser-
vice.—The employment of applicants for appointments in the
Uncovenanted Medical Service on a salary of Rs. 350 a month was
sanctioned in a letter to the Director General, Indian Medical
Service, No. 278, dated the 9th April. In a later letter (No.
372, dated the 26th April), the Director General was informed that
the officers selected might be granted travelling allowance to and
from the places to which they were posted at the rates of double
second class fares for journeys by rail, and four annas a mile for
journeys by road.
Civil Assistant Surgeons.—On the 29th March (Circular No.
II-sanitary) the Government of India sanctioned the grant of a deputa-
1154 1160
tion allowance of Rs. 2 a day to Civil Assistant Surgeons employed on
plague duty. At the request of the Government of Bombay, it was