NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
292
Measures to prevent the
[CHAP. X.
Previous
experience in
India.
All experience in India, including that of an attempt that had
recently been made by the Commissioner in Sind to impose quaran-
tine at Sukkur, showed that the imposition of absolute land quaran-
tine was ineffectual. In a previous chapter the failure to protect
the Ahmedabad district by quarantine during the 1812 to 1821
epidemic has been noticed, and also Dr. Ranken's condemnation
against the strict land quarantine imposed during the Pali outbreak
of 1836 and the failure of that quarantine to protect the route through
Merwara. In 1876 a committee was appointed in the Punjab to con-
sider the question of land quarantine against cholera, and reported
that strict land quarantine was impossible in India.
Statement of
objections.
Dresden and
Venice Conven-
tions on the
subject of land
quarantine.
The Government of India were convinced that an endeavour to
quarantine the Bombay Presidency, a large portion of which was
infected when the discussion took place, would be no more efficacious
than previous efforts of a like nature. No extensive cordon in
India can be expected to be proof against attempts to evade it, and
an endeavour to establish a cordon along the great length of the
Bombay frontier could not possibly succeed. Besides being ineffectual
the attempt would be likely to lead to mischievous results. In the
first place, it would distract attention from the important measures of
observation and sanitary improvement. In the second place, it would
occasion an unjustifiable amount of hardship and suffering, and it would
give opportunities for oppression and extortion. In the third place
the aggregation of large bodies of people on the borders of the infected
area under circumstances rendering proper sanitary administration very
difficult or even impossible presents conditions very favourable to the
spread of disease and may occasion serious epidemic outbreaks. The
imposition of land quarantine is also contrary to the accepted prin-
ciples for the treatment of epidemic disease. The Dresden Sanitary
Conference of 1893 was opposed to land quarantine ; and declared
(Chapter V, Annexure 1) that only persons suffering from cholera or
presenting cholera-like symptoms should be detained. That confer-
ence was composed of the delegates of a number of European states
possessing national frontiers, customs lines, and national and trade
interests, all tending to facilitate quarantine regulations, and it
declared against land quarantine under circumstances far more favour-
able to its adoption than those which exist in India. The delegates
of Her Majesty's Government at the Sanitary Conference held at
Venice in February and March 1897 to devise measures to prevent
the spread of plague were instructed to urge the acceptance of the
principles of the Dresden Convention, and in the convention framed
by that conference those principles were re-affirmed. In chapter 1,
sectioa III of the regulations prescribed by the Venice Convention,
it is stated that modern methods of disinfection should be substituted
CHAP. X.]
spread of infection by land.
293
for land quarantine ; and in chapter IT, section V, the rule is laid
down that land quarantine should no longer be enforced, and that
only persons presenting symptoms of plague should be detained.
After prescribing these principles the conference made the conces-
sion, in order to cover the difficulties which were likely to be expe-
rienced by certain Governments in preventing the importation of
plague into their countries by land routes, that during the prevalence
of plague every country had the right to close its land frontiers
either in part or in whole against all traffic.
Objection to the
stoppage of
third class
railway traffic.
The Government of India also considered that the suggestion
to stop third class railway traffic from infected districts could not
be adopted. The precaution could be evaded by breaking the rail-
way by a road journey across the frontier. It would make invidious
distinctions between classes and would cause great inconvenience
and hardship. It would also be ineffective, inasmuch as it would offer
no check to the spread of the disease otherwise than by railway,
and would not prevent the chance of infection being carried by per-
sons choosing to take first or second class tickets. It would also
greatly increase the chance of infection being carried by other means
than the railway. Prevented from travelling by rail the inhabitants
would scatter over the country-side, and find an egress by ways which
would render inspection and control difficult or impossible. The stop-
page of third class railway traffic is, equally with the imposition of
absolute land quarantine, opposed to the principles of the Dresden
Convention of 1893 and the Venice Convention of 1897.
Alternative
precautions
prescribed by the
Government of
India.
Guided by these considerations, the Government of India negatived
the proposals for the imposition of land quarantine and the partial
stoppage of railway traffic, and in the place of these measures pres-
cribed the precautions detailed in the succeeding portions of this
chapter. They stated that all travellers from infected districts
should be inspected by a medical officer, and that any persons deemed
likely to carry infection should be detained under observation in suit-
able segregation shelter and under proper sanitary supervision until
the danger of their spreading infection was past. In determining
whether travellers should be detained or not, inspecting officers were
directed to exercise the widest discretion, and they were instructed
that any person who was at all suspicious either by reason of his
appearance, symptoms or the dirty condition of his clothes or effects
should not be permitted to proceed without being placed under
observation. It was also prescribed that the class of persons, who
when they enter a town can neither be traced nor depended on to
give information of plague, should be treated as suspicious. Similar
instructions were given with regard to persons, such as labourers and
emigrants, who travel in bodies. With these precautions were
2g4
Measures to prevent the
[ CHAP. X.
combined measures for the disinfection of the personal effects of
travellers likely to carry infection, for the supervision at their desti-
nation of travellers from infected districts, and generally for the
detection of plague cases on their occurring in any town or village in
the threatened provinces. The Government of India hoped that these
measures would protect the rest of India against the Bombay Presi-
dency with the least possible amount of interference with intercourse
and without avoidable hardship. The established fact that isolated
cases of plague are not difficult to stamp out if they are at once detected
and due precautions taken, lent additional force to this expectation,
which was on the whole justified by the result.
Proposals of the
Government of
Bombay for the
enforcement of
local land
quarantine.
In a telegram, dated the 17th March, the Government of Bombay,
whilst accepting the decision of the Government of India against the
proposal to impose general quarantine against the Bombay Presi-
dency, urged that land quarantine should be permitted at selected
places within the Presidency. They gave the following reasons.
In accordance with the custom of the country in dealing with
cholera, the inhabitants of healthy villages in the Thana and Surat
districts had already imposed quarantine against villages infected
with plague. In some towns and villages specially liable to infection
limited quarantine had been imposed with good results by District
Magistrates and Political Agents. Quarantine even if not thoroughly
effective checks large movements of people, and persons flying from
an area, where active remedial and disinfecting operations are anti-
cipated, avoid going to a town where quarantine has been imposed.
Quarantine need not be absolute, but it is specially important to
apply it to the class of people, who when they enter a town can
neither be traced nor depended on to give information of plague
among them. Medical inspection, though valuable, does not detect
cases that are only incubating, and the experience of the city of Bom-
bay had shown that cleansing operations cannot check plague, unless
accompanied by measures for the detection of all new cases—a proce-
dure requiring a larger staff than can be supplied in most country
towns. With regard to the stoppage of third class railway traffic,
the Government of Bombay stated that it would not be carried out
except in particular cases and for most cogent reasons. The Govern-
ment of India recognised that the villagers in threatened districts
might and should be allowed to protect themselves by voluntary
action, and that it was desirable to treat as suspicious persons who
on entering a town can neither be traced nor depended upon to give
information of plague among them. They were, however, entirely
averse from the imposition of compulsory quarantine between different
CHAP. X. ]
spread of infection by land.
295
Objections to
local land
quarantine.
local areas. They accordingly replied in a letter, dated the 29th March,
that the general objections against land quarantine, which they con-
sidered to be overwhelming, hold good in the case of the imposition of
quarantine by one local area against another local area, Such quaran-
tine, it was remarked, besides being opposed to the principles which
have been repeatedly affirmed by those who have most studied the sub-
ject, is sure to be ineffectual and to give rise to hardship and oppres-
sion, and may very possibly foster outbreaks of the disease. The only
circumstances under which strict compulsory quarantine is possible and
likely to be effectual is when the outbreak occurs in a small place, the
inhabitants of which can be easily and securely isolated away from
the area of infection, and then the isolation must be most carefully
regulated and controlled and proper sanitary precautions must be
taken. The operations at Khandraoni in the Gwalior State, described in
Chapter IX, were instanced as an example of the successful imposition
of strict segregation on a small scale, Here the circumstances were
exceptionally favourable, inasmuch as the village is small, it was found
easy to isolate the inhabitants outside the area of infection, and a
commissioned medical officer of experience was deputed to the spot,
and the adoption of all possible sanitary precautions and the preven-
tion of oppression and extortion thus secured. The larger the place
and the less complete its isolation, the greater become the difficulties,
and the point is very soon reached when they are insurmountable.
Modification of
the general rules
issued by the
Government of
Bombay on the
subject of land
quarantine.
The revised general rules for the control of remedial and
preventive measures in the Bombay Presidency, issued by the Gov-
ernment of Bombay on the 29th March, contained the following two
rules authorising the imposition of local land quarantine :—
" Rule 26.—District Magistrates are empowered, when they con-
sider it necessary, to impose quarantine at any place or places
against any other place or places."
" Rule 29.—A District Magistrate, with the sanction of the Com-
missioner, is empowered to prohibit inter-cornmunication between
any place and any other places."
At the request of the Government of India the Government of
Bombay cancelled these rules and substituted the following rule
in accordance with the prescribed principles :—
" Rule 29.—Plague authorities specially appointed by a Commis-
sioner for this purpose are authorised to prevent the passage of sus-
picious persons from any town, village or local area, or into any
town, village or local area to which this rule may be applied by the
Commissioner, unless such persons have been detained in a place of
observation for a period prescribed by the Commissioner: and unless,
if arrangements for disinfection of their clothing, baggage, etc., have
296
Measures to prevent the
[ CHAP. X.
been made under the Commissioner's orders, such disinfection has been
effected. Such plague authorities shall have the widest discretion-
ary power, subject to the general or special orders of the Commis-
sioner, to decide what person shall be considered 'suspicious' for
the purposes of this rule. So long as he remains in a place of obser-
vation under this rule, no person shall be allowed to communicate,
except with the permission of the plague authority, with persons
outside the limits of the place. He shall obey such orders as may be
issued by the plague authority for the cleanliness or protection from
infection of the persons, property or quarters of the persons detained."
Rules to control
egress from in-
fected localities
issued by the
Government of
Bombay in Oct-
ber 1897.
[
At the time of the recrudescence the Government of Bombay
appointed a committee of experienced officers to devise, if possible,
further means of preventing people from leaving infected localities
and entering other places until suitable precautions have been taken
with respect to them. The outcome was the issue by the Government
of Bombay, on the 5th October 1897, of a set of rules to control the
egress of persons from infected localities. A copy of these regulations
is given in Appendix VIII. Broadly, the rules are intended to
prohibit persons from travelling from infected localities to other places
without a pass granted by the plague authority appointed for the
purpose, and they provide that if it is considered necessary, the pass
shall not be granted until the person has been disinfected and detained
under observation in an observation camp. The rules further
explain generally the circumstances under which passes may be
granted without previous detention, and permit certain classes of
persons to travel without passes. With regard to the particular case
of railway traffic the rules prohibit booking within fifteen (increased by
a later notification to twenty) miles of the infected locality in the case
of persons who have not (a) a pass, if they come from the infected
locality, or (b) a certificate from the village officer that they have been
residing in the village and have just left it, if they come from a locality
outside the infected area.
Remarks of
the Government
of India.
After a careful consideration of these rules, the Government of
India were constrained to point out that their general tenor was such
as to give an indirect encouragement to land quarantine, and that the
plague authorities charged with working them might easily, unless
their action were carefully supervised, utilise them for the imposition
of such quarantine. Allusion was again made to the grave objections
which had from the outset been taken to the imposition of land quaran-
tine, and it was observed that this view had been endorsed by the
recent Sanitary Conference at Venice, and must be strictly followed
by the authorities in India.
CHAP. X. ]
spread of infection by land.
297
The form of the rules was also considered open to objection
inasmuch as it exempts from their operation certain classes of persons
such, for instance, as Europeans and Government and railway ser-
vants, and, with the sanction of the District Magistrate, their families
and attendants. The Government of India stated that they were
totally opposed to any interference with the ordinary avocations of
persons who are not sick or suspicious, but in their opinion it is wrong
to exempt special classes of persons from the operation of the rules.
The principle which should govern the rules is that they should
apply to all classes, but that detention should be enforced only in the
case of such persons as are, in the exercise of the wide discretion
which should be entrusted to the responsible officer, considered sus-
picious.
Restricting
movement of
people not the
main object.
In addition to the above criticisms the Government of India
stated their conviction that these elaborate rules for the control of the
movement of people from infected localities would be powerless to check
the spread of the disease unless they were accompanied by stringent
measures to suppress the malady within the infected areas. In the
absence of such measures the compulsory detention of the inmates in
infected localities tends to foster the growth of the epidemic, and to
establish plague foci whence the disease may not improbably spread
with even greater virulence than if no measures had been devised to
prevent the egress of the inhabitants. They, therefore, impressed
upon the Government of Bombay that the most important object
to aim at is, not the control of the movement of the people, but the
adoption of such well-devised and stringent measures as will prevent
the occurrence of plague cases from engendering fresh dangerous
plague centres, whence the infection will certainly spread in spite of
all efforts to confine it.
Protection of the
Surat district
against Daman.
Original strict
quarantine.
Cordon of the
Salt guard.
An interesting subject to notice in connection with the dis-
cussion of land quarantine is the treatment of the Portuguese
territory of Daman at the time of the virulent epidemic of plague
which prevailed there from March to June. At ordinary times the
communication between the British villages and those in the terri-
tory of Daman is free and constant, not only by reason of the
contiguity of the villages and the kinship and caste brotherhood of
their inhabitants, but because a large number of persons habitually
go from British into Daman territory to drink the liquor which
is more cheaply bought there than at the shops on the British side of
the frontier. On the 30th of March the Collector of Surat, with the
previous sanction of the Commissioner of the Northern Division,
imposed a strict land quarantine against the whole of Daman terri-
tory by means of a cordon formed by the frontier guard of the
38
298
Measures to prevent the
[CHAP. X.
First relaxations
of the rules.
Salt Department under the control of Mr. Judge, Assistant Collector
of Salt Revenue. When the cordon was first formed it was utilised
to stop almost all communication between Daman and the Pardi
Taluka of the neighbouring British district of Surat. In the latter
part of April the regulations were somewhat relaxed by the Commis-
sioner, with a view to prevent the suffering which their continuance
in the original form would have entailed on the inhabitants of Daman.
The following were the principal modifications made in the original
stringent rules :—
(1) An observation camp was established on the cordon line
on the 9th May, in which people desiring to leave Daman
were kept under observation for ten days before being
allowed to enter British territory.
(2) Exemption was allowed in the case of Portuguese officials and
persons having cogent reason to cross the frontier,
provided they were free from plague.
(3) Authenticated Portuguese subjects and medical men of any
nationality were allowed to enter Daman.
(4) Entry was permitted in the case of goods arriving for
Daman at the Daman road station, and two agents
were appointed for each of the divisions of Big and
Little Daman to remove the goods.
(5) The entry into Daman of grass, grain, firewood, cattle for
slaughter, and mhowra flowers, was permitted by road,
the goods being removed from British to Portuguese
carts at a post on the cordon line.
Writing on the 23rd April Mr. Judge remarked that the people
were panic-stricken, and that were the cordon removed they would
flock over the border into British territory.
Objections taken
by the
Government of
India.
The Government of India considered that even the modified
regulations were more stringent than was proper or necessary, and
that they were opposed to the principles on which preventive mea-
sures should be based. On the 26th May they telegraphed to the
Government of Bombay that the proper course was to institute a sys-
tem of inspection by medical officers who should have authority to
stop all suspicious persons and to detain them under observation. For
this purpose, the Government of India remarked that it was essential
that there should be segregation camps capable of accommodating
suspicious persons of all classes, and enquiry was made whether
sufficient accommodation had in fact been provided. The Govern-
ment of India further stated that they were of opinion that restric-
tions as to the transport of goods should be removed. On the 17th
of June the Government of Bombay forwarded a memorandum drawn
CHAP. X. ]
spread of infection by land.
299
Further
relaxation of the
rules.
up by Mr. Lely, the Commissioner of the Northern Division, explain-
ing the modified precautions that had been adopted. The Govern-
ment of India agreed that the regulations described by Mr. Lely were
not open to objection. The sketch of the Daman frontier given in
Volume IV (page 20) accompanied Mr. Lely's report. The dotted line
in the sketch shows the cordon as it is ordinarily maintained for
salt and customs preventive purposes ; in order to protect all British
villages the cordon was, for plague purposes, transferred to the line
marked in chain dot along the territorial frontier. To provide for the
greater length of frontier the strength of the guard was increased
from 260 to 320 men. The following is the account of the modified
precautionary measures given by the Commissioner :—
Persons allowed
to enter Daman.
(1) All Portuguese subjects were allowed to pass into Daman ]
without question, and also all British subjects who had
reasonable cause for going there.
Every one was
warned at the time of entry that they ran the risk of
being detained under observation on their return. It is
stated that this operated as an effectual check. The only
people who were prevented from entering Daman were
British subjects who desired to cross the frontier to
obtain cheap drink.
Observation
post and camp
on the frontier.
(2) The cordon round the frontier was used to divert all
traffic into the road leading out of Daman territory viâ
the village of Chola, where the observation post and
camp were situated. All persons not suspected, such as
persons from Big Daman, where the Governor's Fort
stands, were allowed to pass out of Daman after medical
examination ; but all who came from Little Daman and
the neighbouring villages were treated as primâ facie
suspicious. The Commissioner states that considering
the extent to which Little Daman was impregnated with
plague no other presumption was possible. Up to the
end of July 400 persons were allowed to pass out of
Daman without detention. For all suspicious persons
comfortable residential sheds were provided on the
road near Chola. The post was furnished with a pro-
vision shop, good well water, and an isolation hospital for
treatment of the sick. The clothes and personal effects
of the persons detained in the camp were divided into two
heaps—one to be burnt or sent back at the option of the
owner, the other to be disinfected by boiling. After select-
ing a suit of clothes that had been boiled and dried, the
owner went to a healthy shed, and after taking a