NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. VIL ]
Measures in the City of Bombay.
155
result was the entire absence of complaint ; no difficulty was experi-
enced by European soldiers or sepoys employed in searching or on
disinfection duty. "
Detailed account
of No. X Dis-
trict.
The detailed working of the organisation is explained in Chapter
VI of General Gatacre's report, which describes the work done in No.
X District.
Equipment of
the district.
The following statement shows the general equipment of each
sub-division of the district:—
(1) A temporary plague hospital (the size of which was regu-
lated by the number of inhabitants) with quarters for the
medical nursing and menial staffs, and also for segregat-
ing the relatives of patients.
(2) A subdivisional office.
(3) A temporary barrack for a military detachment.
(4) Conductors of search parties, such as Justices of the Peace,
and other gentleman who volunteered for the work of
house-to-house visitation.
(5) A subdivisional staff, comprising a subdivisional medical
officer, a clerk, medical subordinates, nurses, ward-
orderlies, military and police sepoys for search work,
hospital servants, sanitary staff for disinfecting, workmen
for building, demolishing, lime washing, and other purposes,
coolies for conveying ambulances, an office peon, and
police *ramosees for watch work.
(6) Hand ambulances on bicycle-shaped wheels, with india-rubber
tyres, and stretchers attached.
(7) A locksmith, or bunches of keys, for opening up locked
houses.
(8) Pails, mops, engines, reels, hand-pumps, and all other
appliances and tools necessary for disinfecting, building,
demolishing, digging, burning, limewashing, etc.
(9) A stock of disinfectants, jars for holding solutions, and
kettles for holding small quantities.
(10) Complete hospital equipment according to a scale drawn up
with reference to the size of hospital.
(11) Arrangements for supplying hospitals with daily provisions,
stores, ice, etc.
(12) Arrangements for disposal of unclaimed dead bodies.
(13) Arrangements for discharging patients on recovery in as
antiseptic condition as possible.
* Watchmen,
156
Measures in i he City of Bombay.
[CHAP. VIL
(14) The provision of a bullock carriage, when necessary, for
conveying the relatives of patients to the hospital segrega-
tion rooms.
(15) Provision of leather shoes for all servants on plague hospital
work who would otherwise be barefooted.
Description of
the district.
Subdivision.
The district was in charge of Surgeon-Captain Jennings.
It was an extensive but comparatively sparsely populated district, and
comprised the whole northern half of the island. It included the
quarters of Mahirn, Worli, Sion, Parel, and Siwri. The total popula-
tion of these quarters of the city is over 98,000, or about one-eighth of
the total population of Bombay, and the number of houses is approx-
imately 9,600 or about one-quarter of the total number of houses in
Bombay. The district was divided into four subdivisions, namely,
Parel, Sion, Mahim, and Worli. Each subdivision was provided with
a complete organisation and establishment for the purpose of detect-
ing plague cases, removing them to a temporary hospital and there
treating them, providing accommodation for the relatives of the sick,
disinfecting infected quarters, and attending generally to the sanitary
condition of the locality.
Subdivisional
staff.
" The subdivisional medical officer, as a rule, was the visiting medi-
cal officer to the subdivisional hospital. He held himself available
each morning to assist search parties in diagnosing cases, and to
issue detailed directions as to disinfection of infected quarters,
destruction of suspicious articles, etc. He visited houses period-
ically in the subdivision to inspect them as to their fitness for
human habitation and as to the condition of their water connections,
making notes of his observations. He also made notes of all
O
sanitary defects in the subdivision, and submitted a weekly report
of such work to the District Medical Officer, who periodically inspected
the subdivision with him in order to see for himself such matters as
required action.
"The subdivisional clerk was responsible for submitting all returns
regularly; for receiving and despatching reports of conductors of
search parties, for keeping hospital accounts, for preparing indents
for disinfectants, stationery, and other requisites; for keeping time of
employés, and preparing the pay-sheets of all employés in the sub-
division who were paid by the Plague Committee, and nominal rolls
of all who worked in the scheme.
" Of the rest included under the heading of subdivisional staff,
medical subordinates, nurses, ward coolies, ward orderlies (military
sepoys), police ramosees (watchmen), and hospital servants,
all constituted the hospital staff and did the duties usually assigned,
to such appointments.
CHAP. VII. ]
Measures in the City of Bombay,
157
" The military detachments were for the purpose of providing
sepoys to accompany conductors of search parties, and were
located near the hospitals so as to constitute incidentally additional
protection.
"The sanitary staff was the usual municipal sanitary staff of the
district, placed at the disposal of the District Medi cal Officer, and
augmented according to requirements.
" The workmen were taken on temporarily and placed under an
experienced inspector, who divided them into batches under sub-
inspectors for each subdivision; and their duties were lime-washing,
erecting huts, demolishing insanitary structures, tile-turning and
digging up of floors."
DETECTION OF CASES AND REMOVAL OF PATIENTS TO
HOSPITALS.
House-to-house
visitation.
Justices of the
Peace.
Importance of
the aid afforded
by the Justices.
In addition to the death registration and report rules, the main
agency employed for detecting cases of plague was the system
of house-to-house visitation. This most important portion of the
"operations was carried out under the superintendence of the Justices
of the Peace, of whom, it has been stated above, one hundred and fifteen
were employed in the different districts of the city. The number of
Justices was augmented by appointing other citizens of influence to
be special constables for the purpose of assisting in the work.
The Justices were also appointed to be special constables. The
importance of the aid thus afforded by the Justices can scarcely
be over-estimated. The immediate detection of all cases must lie
at the root of any successful organisation against plague ; no
scheme can be successful that leaves undiscovered cases of the dis-
ease to spread the infection. It was essential that the house-to-house
visitation should be carried on under the superintendence of men
in whom every reliance could be placed, and the fact that the
gentlemen employed in the work were citizens of influence, whom
the poorer members of the community were accustomed to trust, had
the greatest influence in removing opposition and inducing the popu-
lation to submit patiently to the necessary invasion of their homes.
General Gatacre considered that the house-to-house visitation could
not have been successfully carried on without the important help given
by the Justices and special constables.
Lord Sandhurst's
speech to the
Justices.
The period of the Justices' assistance was inaugurated by a
speech delivered on the 24th February by His Excellency Lord Sand-
hurst. In the course of this speech His Excellency invited the Justices
158
Measures in the City of Bombay.
[CHAP. VII.
Inauguration of
the work.
of the Peace to assist in the operations that were being conducted,
especially in the matter of house-to-house visitation. A large number of
the Justices came forward and offered their services in response to
this appeal. Before the work commenced, a meeting was held in
each district at which the Plague Committee, the District Medical
Officers, and the Justices conferred and the method of procedure was
explained. Each Justice was at the same time given a sheet of ins-
tructions.
Description of
the method of
house-to-house
visitation.
The following account of the manner in which the house-to-house
visitation and the removal of patients was conducted is derived from
General Gatacre's report :—
" Meeting at 7 A.M. each morning at the nearest sub-divisional
office—each Justice was supplied with the following staff :—
1 Sub-Inspector belonging to the disinfecting staff.
3 Military sepoys,
2 Police sepoys.
1 Locksmith.
1 Ambulance and ambulance sepoys.
"The Justice, after signing the book to notify his presence, pro-
ceeded to the locality selected for the morning's visitation.
" If possible, he was accompanied by the subdivisional medical
officer of the district and, when the quarter was Muhammadan, by a
lady doctor.
"The houses in each street were systematically searched down one
side and up the other ; no exceptions were made, all alike being sub-
jected to the same rigid inspection.
" On arriving at a house, sepoys were stationed at all the entrances
to prevent persons leaving before the inspection was completed ; the
search party then entered the building.
"Each room, landing, passage, loft, every nook and corner was
thoroughly investigated ; owing to the exodus that had taken place
from the city, a large number of rooms, dwelling-houses, shops
and warehouses were found locked up, the owners having fled and left
their property behind them. None of these places were overlooked.
All were opened and examined in the presence of a police sepoy, who
saw that no unnecessary damage was done to property and that the
premises were securely fastened after the search had been completed.
Concealment of
cases.
" A considerable amount of ingenuity was exercised in the conceal-
ment of cases. Patients have been found hidden under bedding and
under bundles of clothing, and friends have even gone so far as to
lock their sick up in large wooden chests when the search-parties
were expected, in the hope that they might thus elude their vigilance.
A favourite device was for the patient to assume an air of great
activity ; he would be found so busily engaged in his work that he
CHAP. VII. ]
Measures in the City of Bombay.
159
had not time even to answer questions put to him. In the case of
women, the sick were frequently come upon grinding corn and sing-
ing energetically, but the tell-tale, anxious, haggard face, and the
suffused eyes would arouse suspicion, and upon examination the
diagnosis was often confirmed by high temperature and enlarged
glands.
" On one occasion a Justice entering the house of a dhobi was
told there were no sick on the premises; this apparently was the
case, the only people present being busily engaged in ironing
clothes, and the remaining available space being taken up with piles
of clothes. Happening to notice what was apparently a movement
among the clothes, the Justice further investigated the matter and
found, to his surprise, that an old man (a dhobi) was concealed under
the pile. On being removed and examined, he was found to be in an
advanced state of plague.
" On another occasion a search-party visited a room occupied by a
whole family and found apparently nothing wrong; on the usual
enquiries being made, all protested there had been no sickness in the
place. The Justice when leaving observed a chair in the corner of
the room covered with a cloth which had been thrown over it. On
pulling the cloth aside, an old woman was disclosed huddled up
between the legs of the chair, also in an advanced state of plague.
" Other cases of concealment, such as persons being shut in
boxes, in lofts, and in privies, were constantly being brought to light
and even corpses have been made to simulate life, to avoid the inevi-
table disinfection of the premises.
Respect paid to
the feelings of
the people.
" Whilst making these visitations every care was taken to respect
the customs and caste prejudices of the different communities ; before
examining the house of a Muhammadan, the rule was to request the
owner of the house to assemble the ladies of his family in a room
apart, where the lady doctor could examine them, while the other
members of the party were carrying out their inspection of the pre-
mises. A like consideration was shown in regard to the religious
prejudices and observances of all other castes and communities.
This fact was soon generally recognised and appreciated by the
people and, as a result, a cheerful and ready willingness to second the
efforts of the searchers took the place of the passive resistance met
with during the earlier days.
Removal of the
sick.
" On finding a sick person—a suspicious case—the medical officer
was called on to certify as to whether it was a case of plague or
not ; if diagnosed as plague, the ambulance was brought to the door
of the house and the stretcher to the room of the sick person if the
width of the door-way or the incline of the staircase permitted
of this being done.
160
Measures in the City of Bombay.
[ CHAP. VII.
" The friends and relatives of the patient were then consulted as to
the patient's wishes in regard to a hospital, and, if the person was a
caste Hindu or Muhammadan, he or she was invariably sent to the
hospital of the caste or sect.
" The patient having been carefully placed on the ambulance
stretcher, it was lifted on to the ambulance and the vehicle sent off to
the hospital in charge of a military sepoy accompanied on some
occasions by two police sowars when the removal took place from a
crowded Muhammadan quarter."
At 10-30 or II A.M. the Justice and his party returned to the
subdivisional office and filled in a certificate of the work done. In
the certificate the number of houses visited and the number of cases
and deaths of plague discovered were entered.
As an example of the result of the work it may be noted that over
four hundred cases were detected in No. X District and sent to the
subdivisional or other hospital.
Ambulances.
Special attention was bestowed on the ambulances used to carry
the sick to hospital with a view to minimize the risk of the transit.
Sixty-three special ambulance vehicles were constructed on one of two
plans. The ambulances were light and small and designed to carry one
person in a recumbent position. The framework was of iron, sup-
ported on springs. The wheels were either bicycle-wheels, or specially
prepared light iron wheels with rubber tyres. A covering for the pro-
tection of the patient was supported on a light framework. The
ambulance was drawn by hand.
TREATMENT OF THE SICK IN HOSPITAL.
General features
and aims of the
hospital system.
Having described how the cases of plague were detected and the
patients removed, the next point to notice is the arrangements made
for their treatment in hospital. The most noteworthy features were the
large number of well-equipped hospitals that were established and
maintained, and the efforts made to overcome the reluctance of the
population to the hospital system by the establishment of numerous
private hospitals.
General Gatacre states that " the aims of the Committee were directed
to procure such situations for the hospitals that the removal of patients
to them from any part of a district should not involve too great a
distance, to add the fatigue of transport to the dangers of the disease ;
that the patients should be placed under every possible advantage of
modern skill and knowledge, and that the position of the hospitals
should ensure air, healthy surroundings, convenience of water-supply,
CHaP. VII. ]
Measures in the City of Bombay,
161
Rapid
establishment of
fresh hospitals by
the Committee.
and other important hospital and sanitary details, while giving every
consideration to the health and sentiments of the people in the neigh-
bourhood." Three large Government plague hospitals, the Arthur
Road Hospital, the Grant Road Hospital, and the Parel Government
House Hospital, had been established before the appointment of the
Committee, and by the middle of January six private hospitals were in
use and two more were in course of preparation. Under the auspices
of the Plague Committee the hospital accommodation was largely and
rapidly increased. By the end of March eighteen hospitals were ready,
and finally fifteen Government hospitals and twenty-nine private hos-
pitals were established, giving a total of forty-four.
The fifteen
Government
hospitals.
The fifteen Government hospitals were designed to contain a total
number of about six hundred and eighty beds. The following is a
list of the Government hospitals :—
Number of
hospital accord-
ing to General
Gatacre's
report.
I
2
3
4
6
6.A
8
9
10
14
15
16
17
18
19
Name of hospital.
Pilot Bandar
Jamsetjee Bandar
Modikhana
Charni Road
...
...
Grant Road
Police
Wari Bandar
Nariahvadi
Reay Road
...
...
Arthur Road
Parel
Sion
...
...
...
Mahim Causeway
Worli
Jullaia Muhammadan
...
TOTAL
Number of.
district
in which
hospital
situated.
I
I
II
V
VI
VIII
IX
IX
IX
VIII
X
X
X
X
VIII
...
Approxi-
mate
number of
beds in
hospital.
10
10
20
40
80
60
40
20
20
60
200
4o
40
20
20
580
Number of
cases
treated.
34
33
18
70
401
28
...
22
321
304
44
50
1,533
NOTE.—NO hospitals were established corresponding to numbers 5, 7, 11, 12 and 13.
21
162
Measures in the City of Bombay.
[ CHAP. VII.
The figures in the above statement are taken mainly from the
detailed reports on hospitals contained in Chapter II of General
Gatacre's report.
In some districts it was found necessary to establish hospitals in
several subdivisions, and some of the more crowded and smaller dis-
tricts in the centre of the city were served by the hospitals of adjoin-
ing districts. This was usually the case when a convenient site could
not be found in the district itself.
The Parel Hospital was much the largest ; it was used for cases
of plague discovered among persons entering Bombay by road -viâ the
Sion Causeway, and by the Great Indian Peninsula Railway, and for No.
X District. The next largest hospitals were the Grant Road Hospi-
tal, the Arthur Road Hospital, and the Police Hospital. The latter
was used exclusively for the police force. The Grant Road Hospital
was in a very central position and was used both for No. VI District,
and for surplus cases from the surrounding districts. The Arthur
Road Hospital is a permanent municipal hospital. It served a
portion of No. VIII District.
The twenty-nine
private hospitals.
Distribution
among districts.
The private hospitals were mostly congregated in the central and
densely populated portion of the city. Their distribution among the
districts was as follows :—
District No. II
„ ,, III
„ IV
» v
„ VIII
...
„
,,
IX
„
„ X ...
3
9
4
».
...
...
2
5
3
...
1
Distribution
among
communities.
The position of the remaining two private hospitals is not stated.
The following is a list of the communities and other bodies for whom
the private hospitals were established:—
European
...
...
...
...
Servants of Europeans
...
...
...
Port Trust employés
...
...
...
Muhammadan (general and particular communities)
Memon (Muhammadan religious sect) ...
Khoja (a sect of Muhammadan converts)
...
Borah (a sect of Muhammadan traders)
...
Mogul
..
...
Gojari (Gujarat traders) ...
...
...
Hindu (general) ... ...
Number of
hospitals.
I
I
I
6
3
2
3
I
I
>
S
CHAP. VIL]
Measures in the City of Bombay.
163
Marwari (Hindu trading caste)
Bhatia (Hindu trading caste)
Bannia (Hindu trading caste)
...
Parsi
...
Jain
Telugu
...
...
...
Number of
hospitals.
1
...
1
3
... 1
2
1
The European hospital was the St. George's Hospital, situated in No.
II (Fort and Esplanade) District ; 95 cases were treated there. The
biggest of the private hospitals were the General Hindu Hospital
(District No. IX) in which 331 cases were treated, and the Jain
Hospital (District No. VIII) (206 admissions). In the 23 private hos-
pitals, with respect to which details are given in Chapter II of
General Gatacre's report, the number of admissions was 1,244.
Usefulness of
private hospitals.
General Gatacre stated that the moral and practical support which
the Committee received from the establishment of private hos-
pitals was invaluable, as it quelled at once the misgivings and fears
entertained by the people with regard to the hospital system.
Hospitals for
individuals and
families not
allowed.
The Committee insisted that the private hospitals should be open
to all the members of the caste or sect for which it was established
and declined to sanction any applications for hospitals for private
individuals or for groups of private individuals.
The multiplica-
tion of hospitals
caused no spread
of the disease.
At the outset some persons entertained misgivings that "the
multiplication of plague hospitals in the city and their location in
thickly populated quarters would cause virulent centres of infection,
which would be a source of greater danger than the alternative of
treating the sick persons in their own houses. This important
question was keenly discussed and considered, but the Committee
adhered to its decision that the private hospital system would meet
the requirements of many who by reason of caste or custom would
not have gone to hospital under any circumstances without forcible
removal. Accordingly, applications for private hospitals were sanc-
tioned on the distinct understanding that all arrangements in con-
nection therewith would be carried out by a hospital board, and
that the medical attendants and staff should be under the super-
vision and control of the medical officer of the district in which the
private hospital was located ; and this officer was made responsible
for compliance with the orders of the Committee. The results of
the system fully realised the convictions of the Committee, and the
opinion, generally expressed in many quarters, that the private
hospitals would be a further source of danger to the city proved
erroneous ; the careful supervision maintained by those in charge of
these institutions secured the result that in no single instance