NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. VIL ]
Measures in the City of Bombay»
137
object of the notification had been misunderstood, as it was principally
intended to meet the event of a large increase of plague. It was
further stated that no cases would be removed to hospital which could
be properly treated and segregated on the premises, and that in cases
which required removal, no action would be taken except upon the cer-
tificate of a duly qualified medical practitioner.
Extent to which
isolation of the
sick was
enforced,
These orders bad the effect of greatly restricting the segregation
of the sick, but it is stated in Mr. Snow's Report on the Plague in
Bombay that all attempts at isolation were not given up. "The mere
proposal of this measure," says Mr. Snow, "resulted in the majority
of the cases being concealed, but when they were detected arrange-
ments were invariably made in the patients' own houses to give them
the best chance of recovery possible by removing them to the lightest
and best ventilated rooms, and every endeavour was made to dissuade
all but the few necessary attendants from frequenting that part of the
dwelling. At the same time, where circumstances made it absolutely
impossible to make any suitable arrangements, or where the patients
were paupers or friendless, they were removed to the Municipal
Hospital at- Arthur Road."
Private and
Caste Hospitals
The following extract from Mr. Snow's report shows the extent
to which an endeavour was made to overcome the opposition of the
people to the segregation of the sick in hospital by encouraging the
establishment of private caste and sect hospitals :—
"As early as October private hospitals for Hindus on these lines
were opened in Mandvi and Bhuleshwar, but this effort proved
abortive, the unreasoning terror of hospital-life was still in full vigour
and extended even to institutions managed entirely by men of their
own class. Those from whom co-operation rather than obstruction
might have leen expected backed up the unreasoning voice of public
opinion by the specious argument that hospitals, while unnecessary in
themselves, were a source of the utmost danger to their vicinity. In
December, however, more successful efforts were made in this direc-
tion. A Jain Hospital was erected in the compound of the Arthur
Road Institution, a little later Dr. Bahadurji opened a most success-
ful and well managed hospital for Parsis in Parel, and on the 28th
January a Hindu Hospital, which did excellent service, was opened
under the efficient management of the Hon'ble Dr. Bhalchandra
Krishna. Similarly, the Port Trustees opened a model hospital at Wari
Bandar for their employés on the 23rd December, and through the
energy of Professor Muller an institution was started at Modikhana
for the servants of Europeans on 31st January. It may also be
mentioned that a temporary hospital was erected in December by
18
138
Measures in the City of Bombay.
[ CHAP. VII..
the Health Department at Narelwadi for the benefit of the people of
that locality which was at the time being very severely visited."
Increase of
hospital
accommodation.
The opposition to the segregation of the sick continued so strong
that up to January the Arthur Road Hospital was only half full. By
the end of January the patients had increased in number and the
hospital arrangements at Grant Road were extended. The services
of the Sisters of the Convent at Mazagon were procured as nurses,
and quarters were erected for them. The staff of the hospital was
augmented and another ward was added to it.
The Plague
Research
Committee.
The next step in the operations to be noticed is the formation of
the Plague Research Committee. This Committee of experts was
appointed to enquire into the nature and history of the diseases, by
a resolution of the Government of Bombay of the 13th October.
Five scientific experts served on the Committee. Surgeon-Major
R. Manser, the President of the Committee, investigated the
treatment by drugs ; M. Haffkine undertook the study of the
plague microbe itself, its effect on human and animal bodies, and the
questions of immunity, protective inoculation, and the use of
therapeutic serum ; Mr. E. H. Hankin, the Chemical Examiner and
Bacteriologist for the North-Western Provinces and Oudh, another
expert in bacteriology, occupied himself with questions connected
with the plague bacillus in nature, in water, the soil, food-stuffs and
other articles ; Surgeon-Captain L. F. Childe was engaged on the
pathologo-anatomical part of the investigation ; and Dr. Nasarvanji
Fakirji, Surveyor, dealt specially with the question of plague epidemic
in rats.
Sanitary
measures in
November and
December.
Surgeon-Major-
General
Cleghorn
visits Bombay.
Memorandum of
Bombay medical
gentlemen
recommending
the removal of
the inmates of
infected houses.
Throughout November and December the cleansing, disinfec-
tion and sanitary measures were pushed on vigorously, without
however making headway against the disease, which now began
to rapidly increase in violence. At the beginning of January
the Government of India directed Surgeon-Major-General Cleghorn
to visit Bombay with a view to inform himself fully on the ex-
isting state of affairs and to advise on the situation. After making
a careful investigation on the spot and holding consultations with
the local medical officers and private practitioners, Dr. Cleghorn
presented to the Government of India a note dealing with the
position and a memorandum on the plague signed by a number
of the medical officers of the Government and principal medical
practitioners of the city. The gentlemen who signed the memo-
randum were of the opinion that the bubonic plague then pre-
' vailing in the city was, under certain circumstances, only slightly
CHAP. VIL]
Measures in the City of Bombay.
139
contagious and infectious, and that the facts observed in connection
with individual cases and those associated with the general pro-
gress of the disease, warranted the conclusion that its incidence
was greatly due to local conditions. In other chapters of this report
ample illustrations are given to show how completely this opinion
was in accordance with the previous experience of plague epide-
mics in India and in other countries, and how fully it was justi-
fied by the experience subsequently gained in the City of Bombay
and elsewhere in the Presidency. The medical gentlemen also
expressed an emphatic opinion that the only practical method of
dealing with the outbreak and of arresting the progress of the disease
was the removal of the inmates from houses in which cases of
plague occurred, and the subsequent complete cleansing, disinfecting
and sanitary overhauling of the premises. They suggested that
suitable huts should be provided, free of rent, for the accommoda-
tion of different classes, and they believed that it only required the
concurrence and sympathy of the leaders of the different sections
of the native community to render the scheme a success. In pointing
out the necessity for adopting the course recommended, stress was
laid on the fact that the untiring energy displayed in the systematic
cleansing and disinfecting of the affected parts of the city had failed
to arrest the progress of the disease.
Dr. Cleghorn's
concurrence.
Energy with
which sanitary
improvements
were being
prosecuted not
sufficient to stay
the disease.
In the note which he presented to the Government of India, Dr.
Cleghorn expressed the fullest concurrence with the views of the
medical gentlemen who signed the memorandum. He stated that so
far as general sanitary precautions went, the municipal authorities were
displaying the utmost energy. The whole city was under the inspec-
tion of the Health Department. All latrines, drains and narrow lanes
were being flushed, houses were, as far as possible, being cleansed,
disinfected and whitewashed, and in those parts of the city which
were not drained, surface drains of excellent construction were being
made in connection with the house-pipes. The efforts of the Health
Department were, however, to a certain extent frustrated by the diffi-
culty they found in carrying out their operations in inhabited houses,
and this important difficulty the suggestion of the medical gentlemen
would overcome. Dr. Cleghorn gave the description, which has been
quoted in another place, of the insanitary condition of the tene-
ments in which the majority of the poor classes lived, and he
represented that the evacuation and thorough disinfection of these
edifices was the only course likely to stay the epidemic. Dr. Weir,
who was alive to the importance of this matter, was gradually induc-
ing the inhabitants to vacate infected houses, but he required more
assistance.
140
Measures in the City of Bombay.
[ CHAP. VU
The Government
of India
recommend
the proposal to
evacuate infected
houses to the
Government of
Bombay.
In a letter, dated the 19th January, the Government of India
earnestly recommended these suggestions to the Government of
Bombay. They stated that in the crisis that had arisen there should
be no hesitation in taking the strongest measures to prevent the
spread of the epidemic, which was menacing the whole of India, even
though they might be distasteful to the people affected. The parti-
cular measures advocated in the memorandum, namely, the removal of
all persons from infected houses and the thorough disinfection of
those houses, appeared to the Government of India to be well calcu
lated to check the progress of the disease, and the vigorous action
that had been taken to clean and disinfect the infected parts of the
city having failed to arrest the progress of the epidemic, the Govern-
ment of India considered that the measures advocated in the memo-
randum should be adopted, and that temporary accommodation suit-
able to the families to be removed should be at once prepared.
Summary of the
measures adopted
presented to the
House of
Commons.
On the 22nd January the following summary of the measures at
that time being carried out in the city was given by Lord George
Hamilton in the House of Commons :—
" The efforts of the Government and of the Corporation, between
whom hearty co-operation exists, were devoted to relieving sufferers
from the plague, to checking its extension in Bombay and Karachi,
and to preventing its spread elsewhere. Hospital space was increa-
sed, special plague hospitals were provided for six different sec-
tions of the community and are being prepared for two other sections.
House-to-house visitation is being carried out under medical super-
vision. Every suspected case of plague that is not at once removed
to the hospital is isolated as far as practicable. Every house where
a plague case has occurred is disinfected, and is, as far as possible,
vacated, temporary accommodation being provided elsewhere. In-
sanitary houses are pulled down, in others partitions are removed or
ventilation introduced. Special sanitary precautions and improve-
ments have been carried out in the backward parts of Bombay City.
A fuller staff of doctors and Indian medical men is being organised,
and the Bombay Government will indent on England for a temporary
staff of doctors and nurses, if more aid is required. "
The position
having become
worse, the
Government of
India again
recommend
the evacuation
of infected
houses.
On the 9th February, the position having in the meantime
become much worse, the Government of India telegraphed to the
Government of Bombay in continuation of their letter of the 19th
January, again impressing on that Government the importance of
giving effect to the suggestions contained in the memorandum of the
medical gentlemen. The Government of Bombay replied on the
10th February that the evacuation of all infected houses and the
CHAP. VII. ]
Measures in the City of Bombay.
141
The Government
of Bombay point
out difficulties in
carrying out
the measure on
a large scale.
removal of people to temporary dwellings was deemed impracticable
if carried out on a large scale and by force. They stated that all
that was practicable was being done by persuasion. Vigorous action
was being taken for the demolition of insanitary huts, and regulations
were about to issue under the Epidemic Diseases Act providing for
the evacuation of infected houses, the entry into and cleaning, etc.,
of deserted houses, the prohibition of the further use of evacuated
and deserted houses, the summary abatement of overcrowding and
the closing of houses unfit for habitation. House-to-house visitation
was being conducted energetically in order to ascertain the existence
of plague cases, and houses needing cleaning or unfit for habitation
were being marked with a view to the remedy of the defects.
The Government
of India consider
that the
experiment
should be made
and that
temporary
accommodation
should be at
once provided.
The Government of India replied in a telegram dated the 12th that
they had learnt with regret the opinion of the Government of Bombay
with regard to the evacuation of infected houses and the removal of
the inmates to temporary dwellings. In view of the great gravity of
the situation and the manifest importance of rigorous action they
desired the Government of Bombay to reconside their decision.
They considered that the measures described by the Government of
Bombay were very useful, but were not calculated to take the place
of the removal of the inmates of infected houses to a healthy locality.
This course appeared to the Government of India to be the only one
left which offered a hope of subduing the epidemic. They again
urged that sufficient temporary accommodation should be supplied
in a healthy locality.
More detailed
explanation of
the difficulties
made by the
Government of
Bombay.
On the same day that this telegram issued the Government of
Bombay sent a letter explaining in greater detail their objections to
the proposed evacuation of infected houses on a large scale. These
objections were mainly the difficulty in providing temporary accommo-
dation for the very large number of people who would be removed
from their homes, the opposition to be expected from the inhabitants of
the city, and the panic the measure would be likely to occasion amongst
them. The Government of Bombay were advised that it would be
necessary to provide for the accommodation of about 30,000 persons in
camps outside the city, and that this accommodation could scarcely be
prepared before the rainy season made it unfit for habitation. The
inhabitants of the city also had the greatest fear of their sick or them-
selves being removed from their houses. The attempt to enforce removal
on a large scale could probably result in great panic. The people would
refuse to go to the health camps provided for them, and would flee from
the city in thousands, spreading the infection of plague all over the
country.
142
Measures in ¿he City of Bombay.
[ CHAP. VIL
The Government
of India suggest
that the
experiment
should be made
for the worst
quarters.
Measures
adopted by the
Government of
Bombay to give
effect to the
wishes of the
Government of
India.
The Government of India replied to these representations in a tele-
gram dated the 21st. They pointed out that the experiment had
already been tried in Karachi with success, whilst in Bombay matters
were getting worse and worse and the health of the whole continent
of India was menaced. They suggested that although accommodation
for the whole city could not be prepared at once, such accommodation
might be prepared for the inmates of infected houses in the worst
part of the city, at that time the north of the Island. The Govern-
ment of India had no apprehension that the preparation of healthy
accommodation would occasion the panic or other evils described
in the letter of the Government of Bombay, and they thought that
any difficulties in inducing the inhabitants of the worst quarters to
seek comparative safety in a healthy camp could be removed if the
necessity were carefully but quietly explained. The experiment
having been started for the worst quarters it could then be extended.
To this telegram the Government of Bombay replied on the 23rd that
on the occurrence of plague, and even before its breaking out,
groups of workmen had lime washed dwellings, cut off the water-
supply, and taken off roofs, etc. In this way hundreds of houses
had been vacated and were being kept empty. Simultaneously huts
had been and were being erected, and every effort was being made
to induce the people to enter them. The Government of Bombay
stated that it would be seen from these details that the desire of the
Government of India that infected houses should be evacuated and
thoroughly disinfected was being studiously prosecuted.
Mr. Snow's
remarks on the
evacuation of
infected houses
and localities.
The following remarks on the evacuation of infected houses and
localities are contained in Mr. Snow's Report :—
" The importance of evacuating infected houses and localities was
realized at an early date, and, when the disease appeared with con-
centrated virulence in a particular house, the whole of the residents
were removed. Wholesale operations in this direction commended
themselves to many men of light and leading, who could not reconcile
themselves to the idea of compulsory isolation of the sick. On the
nth December an influential committee was formed and approached
me with the object of forwarding these views. A camp of refuge for
the whole of Bombay was an utterly impossible scheme : but the
proposal was; obviously in the right direction, and I gave the com-
mittee all the assistance and co-operation in my power. Camps were
opened for the healthy at Connaught Road and Northbrook Gardens,
capable of accommodating 1,500 people, as an experimental measure,
but the difficulty of success in this direction was shown by the fact
that these camps were hardly used. Nevertheless the principle was
successfully put into operation at various local centres of the epidemic
CHAP. VIL ]
Measures in the City of Bombay.
143
and in all the outlying villages,—such as Naigaùm, Siwri, Koli-
wada, Worli, etc.,—it was the invariable practice to persuade or
coerce the people to leave their houses for temporary sheds erected in
the fields, and this measure was generally attended with the most
satisfactory results. Rao Saheb Ellapa Balaram at this time rendered
great assistance to the cause of hut segregation by himself erecting
and working at Foras Road a temporary camp of sheds of consider-
able extent for several months. The same course was followed by
the Bombay Tramway Company, several clubs, hotels and mills, and
many business firms in Bombay, and there are not a few instances
where groups of families clubbed together and did the same. At the
height of the epidemic and afterwards the whole of Northern Bombay
where suitable sites could be obtained was studded with segregation
huts; to say nothing of the very large number of people encamped
along the Maremma at Santa Cruz, Andheri, Goregaum and north-
wards : most of the refugees remained in camp till the middle of May
when the disease had almost vanished."
Regulations for
the City of
Bombay issued
under the
Epidemic
Diseases Act.
The regulations for the City of Bombay alluded to in the telegram
of the Government of Bombay of the 10th February were published
in a notification of the same date issued under the Epidemic Diseases
Act. The regulations provide for—
(1) prohibition of the further use of insanitary dwellings;
(2) summary abatement of overcrowding ;
(3) vacation of buildings for the purpose of cleansing, disinfec-
tion, etc., or otherwise for the purpose of checking the
spread of disease ;
(4) entry into deserted buildings, their cleansing, disinfection
and ventilation, and the disinfection and destruction of
dangerous articles found in them ;
(5) summary entry into and cleansing and disinfecting of other
buildings, and the disinfection or destruction of property
found in them;
(6) limewashing, digging up floors, removal of roofs, and burning
of substances in dwellings ;
(7) cutting off of water connection ;
(8) demolition of buildings unfit for human habitation,
Payment of
compensation
and incidence of
expenditure.
Provision is also made in the rules for the payment of com-
pensation and the incidence of expenditure. With regard to the
payment of compensation, a general rule was laid down in accord-
ance with the Municipal Act that the Commissioner might in his dis-
cretion allow compensation for damage done in the execution of the
144
Measures in the City of Bombay.
[CHAP. VII.
matters provided for in the regulations, but that no one should be
entitled to claim compensation. Special rules were laid down with
respect to compensation for demolished buildings. These rules
require that the building shall be surveyed and assessed by a
person appointed by the Government, that the valuation shall
be final and conclusive, and that the owner shall be entitled to
recover the amount thereof out of the municipal fund, but shall
not be entitled to receive any further or other sum by way of com-
pensation. The rules further provide that in assessing the value of
the building regard shall only be had to the actual market value of
the structure, and that no allowance shall be made, nor any compen-
sation paid, for compulsory demolition or otherwise.
With regard to the incidence of expenditure, it is laid down
in rule 6 that the expense of cleansing and disinfecting buildings
should be defrayed, in the first instance, by the Municipal Com-
missioner, but should, at his discretion, be recoverable from the owner
or occupier.
Establishment of
Parel
Government
House Hospital,
In the middle of February a new large Government hospital
was provided for plague cases. This hospital was established
in the old Government House at Parel in the north of the Island,
which was lent by His Excellency the Governor of Bombay for the
purpose. The hospital staff was provided by Brigadier-General
Gatacre, the General Officer Commanding the Bombay District.
It was at first fitted up for 150 beds, but was capable of being
extended to hold 250 patients. Two commissioned medical officers
were placed in charge of the hospital, assisted by an Assistant
Surgeon and two hospital assistants. Ward orderlies and atten-
dants were supplied by volunteers from native regiments, and the
nursing staff from the St. Joseph's Convent at Bandora. In reporting
these arrangements for the confirmation of the Government of India,
the Government of Bombay stated that they anticipated great indirect
benefit from a measure which brought the military into touch with
the civil authorities in organising measures for preventing the spread
of plague, for it had become probable that the civil authorities might
before long be driven to seek considerable assistance at the hands of
the military.
Appointment of
the Bombay
Plague Commit-
tee.
This event brings the narrative up to the time when the Govern-
ment of Bombay decided to entrust the operations against plague
in the City of Bombay to a special Committee under the chairmanship
of Brigadier-General Gatacre. The measures devised and executed
by this Committee will be described in the second portion of this
chapter.