NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. V. ]
in the Bombay Presidency.
119
Surat.
Kolaba.
Baroda territory,
Daman.
was much later ; both districts became infected in the early part
of February. In Surat the disease spread rapidly throughout the latter
part of February and the whole of March, and the first part of April saw
the climax. Until April was three parts over the number of cases con-
tinued to be very high, but after that the decline was rapid. It lasted
through May and the first-half of June. By the middle of that month
the first period of the epidemic was over in the district. In Kolaba
the epidemic was less severe than in Surat. There was little progress
until the last week in March, when the number of cases rose and
remained at a comparatively high level until the first week in May.
The fall was then steady until the beginning of July. Even during
that month a few cases continued to occur every week, and with
the recrudescence the number again increased. In Janjira State
May was the worst month. In the Navsari division of Baroda State
the main period of the epidemic was from the middle of March
to the end of the first week in May. In Daman plague began early
in March. The disease spread with great rapidity and virulence
until 60 or 70 deaths occurred daily. By the end of May the violence
of the epidemic was spent.
The Poona City.
Nasik and
Ahmednagar.
In the second division Poona City has first to be noticed.
infection appears to have taken hold of the city early in January,
it spread steadily throughout January and February, and culmi-
nated in the middle of March. The week ending the 26th March
showed 345 indigenous cases. The number of cases remained high
until the middle of April, and the epidemic then declined rapidly. In
Poona district, during the first period of the epidemic, there were never
more than occasional indigenous cases. In the Nasik and Ahmednagar
districts a number of imported cases occurred during the earlier
months of the epidemic, but indigenous cases resulted in only a few
instances. Indigenous cases occurred in Kolhapur State from the
middle of February onwards without ever increasing greatly in
number.
Palanpur.
Kathiawar.
In the third division the Palanpur outbreak is the chief point to
notice. The epidemic was short lived, but for a few weeks the number
of cases reported was considerable. The period was roughly from the
middle of March to the middle of April, after which only a few cases
occurred until the recrudescence. In the Kadi and Baroda divisions
of the Baroda territory there were only occasional indigenous cases.
In Kathiawar indigenous cases began in February and continued
steadily until June.
Mandvi.
The outbreak at the port of Mandvi in Cutch (fourth division) was
not discovered until the middle of April, when the disease had already
made great progress. The first week in May showed the enormous
120
Extent and course of the plague
[ CHAP, V.
number of 1,288 cases,
From this point the epidemic declined
gradually. In the week ending the 4th June the number of cases had
fallen to 327, and in the week ending the 2nd July to 44. In August
only occasional cases occurred. From Mandvi the infection spread
into the interior of Cutch. From February onwards indigenous cases
were reported, though at first not in large numbers. The cases were
more numerous in May, June and July, and there was a further
increase in August and September. In the latter month 522 cases were
reported, After September the number of cases again diminished.
Infected
localities.
Sind,
Sind was the scene of several violent outbreaks of the disease, but
the period of the epidemic was much shorter than in the Presidency
Proper and the infection was much less widely diffused. The epidemic
was practically confined to the following places :—
Karachi City.
Karachi district
...
Hyderabad district
,,,
...
...
Shikarpur district
(Kotri.
} Tatta.
(Jangshai.
{ Hyderabad.
{Tando Alahyar.
{ Sukkur.
{ Rohri.
Villages in the Rohri
(and Ubauro Talukas
The Upper Sind Frontier district, the Thar and Parkar district,
and the Khairpur State escaped with hardly a case.
Karachi,
Description of
the town.
Karachi stands on a bay of the Indian Ocean, at the extreme north-
ern end of the Indus delta. The census of 1891 showed a population
of about 105,200; of these nearly 53,000 were Muhammadans and some
44,000 were Hindus. The entrance to the harbour is between Manora
Head and Kiamari Island ; the harbour extends five miles northwards
from Manora Head to the narrows of the Lyari River. The Lyari River
has a low sandy bed and is usually not covered by water. On the east
bank of this river lies the main body of the city. Immediately on the
bank and adjacent to the harbour is the Old Town, the most densely
populated portion of the city. From the Old Town the city extends back
into the Market, Napier and other quarters. North and east of the city,
and some little distance away from it, is the cantonment, and south-
east of the cantonment lie the Civil Lines, On the opposite or west
bank of the Lyari there is another quarter of the town known as the
Trans-Lyari quarter. It contains twenty settlements of poor Muham-
madans of different tribes—fisher people, Sidis, Mekranis, Baluchis,
etc,, each in their separate village. Twelve of the settlements are
CHAP. V. ]
in the Bombay Presidency.
Í2I
mostly only reed and plaster huts ; the remaining eight are inferior
houses of a permanent type. At the census of 1891 the population
of these settlements was numbered at over 22,000, but the population
is now estimated to be over 30, 000, or one quarter of the present
estimated population of Karachi (124,000). There are also villages
on Kiamari Island and at Manora, on either side of the harbour.
Surgeon-Major-General Cleghorn, who visited the city during the
early period of the epidemic, gave the following account of the condi-
tion of the main portion of the city :—
Insanitary
condition of the
main body of the
town.
"The worst parts of the town are the quarters named Old Town,
Machi Miani, Market, and Bandar, where the greatest mortality has
occurred. The two former face the bed of a dry stream, extending
backwards until they become contiguous with the other quarters.
Many of the houses I visited in the quarters above named were quite
unfit for human habitation ; there were no openings for the admission
of air and light, the rooms were overcrowded, and the inmates lived
in complete darkness. The Old Town is the worst in all respects-,
but the overcrowding in houses and of ground area is common to all."
In the report on the plague in Sind Mr. Wingate, who was Acting
Commissioner during the period of the epidemic, gives the following
description oí the beginning of the outbreak :—
Beginning of the
outbreak.
" On the 16th December, while on tour, the Acting Commissioner
in Sind received intimation from the Health Officer, through the Collector
of Karachi, of what was reported to be a 'doubtful ' case of plague. A
Brahman cook, aged 16 years, resident for nine months in Karachi, stated
to have taken ill about the 4th December, was reported on the 8th to
the Health Officer to be suffering from bubonic fever. There was
high temperature and a bubo. The same evening the patient was re-
moved from Rampart Road, Bandar Quarter, to a house in Maoji
Street, Rachor Quarter, where next morning he died. Thus early
began that removal from place to place which to the last was difficult
to deal with.
" The Acting Commissioner directed definite medical inquiry, but
on the 18th he received the Health Officer's report dated the 12th
which left no doubt that the disease had broken out in Karachi, and
the facts narrated below were reported to Government.
"An old servant oí the firm of Radhakishn Tejbhandas & Co. died
on the 11th December after, it was said, a 12 days' illness Another
servant of the firm, aged 28, also living in the Old Town Quarter,
was seen by the Health Officer on the 11th and found to have a tem-
perature of 103° and swellings in both groins. In a house close by,
in which four persons had died in the course of a few days, including
16
122
Extent and course of the plague
[ CHAP. V.
a child seen by the Health Officer on the 11th, another child, aged five
years, was found sick. On the morning of the 12th, the Health
Officer took the Deputy Sanitary Commissioner, Sind Registration
District, to view the cases.
Plague declared
epidemic.
" On the 19th December, at their usual weekly meeting, the Medi-
cal Board declared plague epidemic in Karachi. Their report reached
the Acting Commissioner on the 22nd, and was the same day communi-
cated to Government by telegram, and the Principal Medical Officer
was asked for daily reports of attack and deaths.
The epidemic
dates from the
beginning of
December.
" These facts leave little doubt that, from the beginning of Decem-
ber 1896, the disease had got a footing in Karachi. There was nothing
in the mortality statistics to indicate the presence of the disease— "
Week ending
6th October 1896
13 th
"
"
20th
„
„
27th
„
„
...
...
3rd November 1896 ...
...
10th
„
„ ...
17th
„
„ ...
24th
„
„ ...
1st December 1896 ...
...
8th
„
„
...
15th
„
„ ...
22nd
„
„
DEATHS FROM All CAUSES.
Total.
83
51
61
59
54
59
72
74
80
«5
86
104
Daily aver-
age.
12
7
9
8
8
8
10
II
II
12
12
15
AVERAGE DEATHS OF s YEARS
ENDINO 1895.
Total.
65
56
58
58
62
65
69
67
70
81
82
102
Daily aver-
age.
9
S
8
8
9
9
10
10
10
12
12
15
Spread of infec-
tion.
The infection first spread in the insanitary and overcrowded
quarter of the Old Town, and for some time it was confined to that
quarter. But by the end of January it had spread into the Napier and
Market quarters and thence it attacked other quarters of the city. In
the Trans-Lyari Quarter the cases began to multiply in the beginning
of February. The outbreaks at Kiamari and Manora were of later
date.
CHAP. V. ]
in the Bombay Presidency.
123
January.
Climax during
the first week in
February.
Monthly plague
mortality.
Taking the city as a whole, the beginning of January saw a con-
siderable increase in the number of cases, which continued during the
month. From the 28th January the cases again rose considerably and
the maximum was reached on the 1st, 2nd and 3rd of February, when
the number rose to 59, 49 and 56—a record never subsequently reached.
"In fact," says Mr. Wingate, ''the epidemic in the first week in
February attained its climax, and thereafter, though the outbreaks in
new quarters partially obscured the fact, the disease gradually abated."
Taken by months the reported mortality from plague was as
follows :—
December 1896
...
...
...
...
January 1897
...
...
...
.
February „
...
...
...
.
March
„
...
...
April
„
May
June
„
July
59
743
995
864
53S
167
23
9
Declina.
Throughout February and March the epidemic continued to be
severe ; April saw a considerable fall and May an equally large one.
In June the cases were only occasional and in July the epidemic died
out.
Karachi district.
Tatta.
Jangshahi.
Kotri.
In Karachi district there were small epidemic outbreaks in Kotri,
Tatta and Jangshahi, giving an aggregate of 48 indigenous cases. From
the middle of December to the week ending the 19th February, 31
imported cases occurred at Tatta. The influx then appears to have
ceased, and no more deaths were reported until plague broke out locally
in the week ending the 26th March. Thereafter the epidemic was local
and practically ceased early in May. Jangshahi is the railway station
for Tatta. It contains a population of only about 200 persons and a
sharp local outbreak was easily suppressed by evacuation and disinfec-
tion. Kotri is on the Indus and is the railway station for Hyderabad,
from which it is separated by the river and two miles of road. Up to
the third week in February dropping cases came in from Karachi. Then
there was a lull, and not till the week ending the 26th March did the
first local case show itself, at the same time with cases imported from
Hyderabad, where the disease had just broken out virulently. By
enforcing segregation in huts the disease was stamped out after the
occurrence of 17 cases.*
Hyderabad
district.
In the Hyderabad district the town of Hyderabad was the scene
of an outbreak which was for a short time virulent and occasioned
* A fresh outbreak occurred at Kotri in November 1897.
124
Extent and course of the plague
[ CHAP. V.
Hyderabad City.
Tando Alahyar.
a total number of 544 cases. In 1891 the city contained a population
of nearly 55,000, and at the time the outbreak occurred it was crowded
with Karachi refugees and contained, Mr. Wingate estimates, not less
than 65,000 people. The town is healthily situated on a hill and in a
dry climate. Imported cases from Karachi occurred for some time
before the disease broke out locally. The indigenous cases commenced
during the week ending the 5th March and for some time the disease
made slow progress. Until the beginning of April the number of cases
did not exceed 40 a week, but during the week ending the 9th of that
month the number suddenly rose to 117. Next week the number was
119 and then the disease declined almost as rapidly as it had risen.
During the week ending the 7th May there were only 37 cases, and by
the beginning of June the epidemic had died out. Tando Alahyar
was the only other place in the district where the disease became
endemic. The epidemic was slight and included only 13 cases.
Shikarpur
district.
Sukkur.
In the Shikarpur district the towns of Sukkur and Rohri, situated
on either bank of the Indus, were the scene of a virulent outbreak of
short duration. In Sukkur the first indigenous case occurred in the week
ending the 12th February. The figures during the early part of the
epidemic were obscured by the concealment of case s, but the epidemic
did not gain ground rapidly until the latter part of March. Dur-
ing the week ending the 19th March there were 28 cases reported, and
during the following weeks the figures were—
Week ending 26th March
„
„
2nd April
,,
,,
9 th ,,
„
„
16th „
„. 97
... 105
,.,
...
... 111
... 87
Rohri.
Villages in the
Shikarpur
district.
After the 16th April the disease steadily declined, and died out
by the end of May. Rohri on the left bank of the river did not become
infected until the second half of April. The cases exceeded twenty in
only one week and the epidemic declined from the middle of May and
disappeared before the end of June. From Sukkur and Rohri the disease
was spread to several villages in the Shikarpur district and was carried
nearly as far as the Punjab border. But the infection did not obtain
a strong hold in any place and the vigorous measures adopted quickly
stamped out the disease.
Mr. Wingate gives the following account of the end of the epi-
demic:—
End of the
pidemic.
" As already stated, the last plague cases in Hyderabad and
Sukkur occurred on the 2nd of June. The town of Rohri and the
whole district of Shikarpur were free of plague by the week
CHAP. V. ]
in the Bombay Presidency.
125
ending the 25th June. Plague lingered fitfully in Karachi till the
27th July, when it finally ceased, and the last case was discharged
from hospital on the 6th August. In accordance with the terms of
the Venice Sanitary Convention of 1897, ten days must elapse from
death or discharge of the last case. By Notification No. 4039, dated the
17th August 1897, the City, Cantonments, Harbour of Karachi and the
whole Province of Sind were declared free from infection of plague,
and on the 5th September there were thanksgiving services in the
churches of all denominations at Karachi. "
The Recrudescence in the Bombay Presidency.
Commencement.
The recrudescence began in the month of July 1897, and from
August onwards made wide and rapid progress.
Statistics.
The following is a statement of the number of cases reported
from the localities chiefly affected :—
Period.
July .
.
August
September .
October
November .
December .
TOTAL .
GUJARAT.
Surat District.
58
30
198
429
855
646
2,216
Cutch State.
107
237
523
464
336
151
1,817
Palanpur State.
...
2S
276
240
152
273
969
KONKAN.
Bombay City.
62
124
221
2gO
371
805
1,873
Thana District.
S
36
106
79
33
72
334
Kolaba District.
24
31
79
47
62
36
279
Nasilk District.
...
88
347
203
262
371
1,271
DECCAN.
Poona.
City.
60
77
296
1,446
2,534
1,648
6,061
District.
90
748
904
558
763
474
3,537
Sholapur District.
...
12
161
1,149
1,475
2,771
Satara District.
151
930
2,317
3,841
4,549
KARNA-
TAK.
Belgaum District.
...
...
...
5
194
2,125
342
|
13,913
541
Bombay City.
In the City of Bombay the rise was gradual until the end of Nov-
ember, but in December the epidemic rapidly increased in virulence.
Konkan Coast.
Surat and
Palanpur.
Deccan districts.
The districts of the Konkan Coast, which during the first period
of the epidemic were a principal seat of infection, have, during the
recrudescence, escaped with comparatively few cases. In Gujarat,
Surat district and Palanpur State have again been the scene of
epidemics of some magnitude. But the principal seat of infection
shifted further east and south and the Deccan districts of Poona,
126
Extent and course of the plague in the
Bombay Presidency.
[CHAP. V.
Karnatak.
Satara.
Improvement
in December.
Satara and Sholapur have suffered most severely. The epidemic has
also extended southwards into the Karnatak and a considerable
number of cases have occurred in Belgaum district. The outbreak
in Satara district has been of exceptional virulence and has extended
over a large number of towns and villages. In November over 4,500
cases were reported, a figure which was not approached by any
district during the first period of the epidemic. Outside the City of
Bombay the month of December showed a general improvement in
the places most affected.
CHAPTER VI.
GENERAL ACCOUNT OF PREVENTIVE
MEASURES.
THE EPIDEMIC DISEASES ACT.
General Account of Preventive Measures.
In the succeeding chapters of this report an account is given
of the measures adopted to combat the plague and to prevent its
spread. The following is a brief summary of the measures and
the principles on which they were based.
The nature and
characteristics of
plague determine
the nature of the
preventive
measures.
The account of the nature and characteristics of the plague given
in Chapter II indicates the lines on which the disease can best be
combatted and overcome. It has been explained in what manner and
to what extent plague is infectious ; it has been shown that the excre-
tions of the sick are among the most dangerous sources of infection ;
that plague can be spread by persons suffering from the disease and
by contaminated clothes and other articles ; that infection attaches to
the houses in which cases have occurred ; that dirty and insanitary
conditions favour the growth of the disease to an extent which
can hardly be over-estimated ; that the tendency is for some time
to elapse between the occurrence of the first isolated cases and the
breaking out of violent epidemic; and that once the malady obtains
a firm hold of a locality where local conditions favour its growth, it
spreads with a virulence which is almost irresistible.
Classification of
the
preventive
measures.
The preventive measures maybe roughly divided into the follow-
ing classes :—
(1) Measures to suppress the disease in plague centres, and
to prevent isolated cases establishing a fresh focus of
infection.
(2) Measures to prevent the spread of infection by persons
travelling by land.
(3) Measures to prevent the spread of infection by persons
travelling by sea.
(4) Measures to prevent the spread of infection by merchandise
and food-stuffs.
Measures
adopted in
plague centres.
The following is a summary of the principal measures adopted in
plague centres :—
Arrangements to ascertain the existence of plague cases by
compulsory report, registration at burning and burial grounds,
128
General account of preventive measures.
[ CHAP. VI,
house-to-house visitation, and other means.
(This is a funda-
mental measure, for none of the operations can be successful if
undetected cases continue to spread infection.) The treatment of
plague patients in special hospitals constructed with a view to the
segregation of the sick. The disposai of corpses in a manner calcu-
lated to prevent their breeding infection. The segregation of persons
who have been living with persons suffering from plague. The
evacuation of infected buildings and localities, the inmates being
accommodated in carefully-supervised health camps. The disinfection
and cleansing of houses in which cases of plague have occurred, and
the disinfection of contaminated articles, or their destruction if
they are of little value. The exposure of insanitary and infected
dwellings to light and air. The demolition of insanitary and infected
huts. The general disinfection and cleansing of the locality. The
general improvement of drainage and other sanitary precautions, such
as the abatement of overcrowding.
Measures to pre-
vent isolated
cases spreading
an epidemic.
The measures to prevent isolated cases establishing a fresh focus
of infection were similar to those described above. They consisted
mainly in the segregation of the sick and of those who had been in
contact with them; the disposal of the corpses in a safe manner ; the
disinfection or destruction of contaminated clothing, bedding and
other articles ; the disinfection of contaminated conveyances ; the
evacuation of the dwellings in which the cases occurred, and their
disinfection or destruction ; the evacuation, if necessary, of the
locality, and the adoption of general sanitary precautions.
Measures to pre-
vent the spread
of infection by
persons travelling
by land.
Land quarantine was not imposed to prevent the spread of in-
fection by persons travelling by land. All persons travelling from
: infected localities, by rail, road, or river, were examined by a
medical officer, who was given a wide discretion to retain under
observation, in suitable and isolated shelter, all persons considered
to be likely to spread infection by reason of their symptoms, appear-
ance or the state of their clothes or personal effects, and persobs
without a fixed abode and who were not likely to be traceable or to
give information of the occurrence of plague cases amongst them. This
inspection was in general carried out on departure from the infected
locality or area, and on the route or at the place of destination.
Inspection of the
railway traffic.
The whole of India was protected against the Bombay Presidency
and Sind by a series of inspection stations on the main lines of
railway traffic. Arrangements were also made to keep a watch at
their own homes over persons arriving from infected districts. An
additional and very necessary precaution was the disinfection of the
clothing and baggage of travellers from infected areas, which from
its condition or other reasons was deemed to be dangerous. Rules
were also promulgated for the disinfection of railway carriages.
Precautions similar to those adopted on the railways were put in force