NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. IX. ]
Measures outside the Bombay Presidency.
283
the fair on the 25th October, and effective measures have been taken
to prevent any communication of the visitors with Kankhal.
Decline of the
epidemic.
" The latest reports which have reached the Government from :
Kankhal are encouraging, and there is reason to hope that the
vigorous measures of the authorities, coupled with the exertions of
the people themselves, will, under Providence, get the better of the
disease. The type of disease is said to be growing less virulent, and
no seizure has been reported since the 1st instant."
Khandraoni.
PRELIMINARY REMARKS.
Lessons to be
derived.
Position at the
time the
epidemic was
discovered.
Arrival of Dr.
Crofts.
The lesson to be derived from the operations carried out at
Khandraoni is no less important than that furnished by the events
which occurred at Hardwar. At Hardwar measures of segregation,
evacuation and disinfection were successful in stamping out isolated
cases before they had grown into a serious epidemic. At Khandraoni
similar measures carried out on a small scale in a very thorough
manner were successful in arresting almost immediately an epidemic
which had become virulent in the confined area of a small village. In
a previous chapter an account has been given of the beginning
of the epidemic. When the existence of the outbreak was ascer-
tained there had been 59 seizures and 47 deaths in a village of about
550 inhabitants. Intimation of the outbreak was first received by
the Magistrate of Jhansi (which is only twenty-one miles distant from
Khandraoni) and telegraphed to the Government of India by the
Government of the North-Western Provinces and Oudh on the 15th
March. The Government of India telegraphed the news to the
Agent to the Governor General in Central India and His Highness
the Maharajah Sindhia (in whose territories the village of Khand-
raoni is situated) immediately despatched Surgeon-Lieutenant-Colonel
Crofts, the Medical Officer to His Highness, to the spot with instruc-
tions to see to the care of the sick and to stamp out the epidemic
and prevent its spread. He arrived on the 18th March and the sub-
sequent arrangements were carried out under his orders and per-
sonal supervision. Dr. Crofts had no doubt from the first that the
disease, was plague and without delay instituted and carried out
stringent and radical measures.
EVACUATION OF THE VILLAGE.
An order was sent to the officer commanding the Karera canton-
ment to march at once to Khandraoni with four companies of infantry
and hospital establishment and equipment. The executive officer in
284
Measures outside the Bombay Presidency.
[ CHAP. IX.
Classification of
villagers.
charge of the Karera subdivision (in which Khandraoni is situated
was also ordered to come to the village and arrange for supplies for
the troops and villagers. In the meantime a nominal roll was made
of all the inhabitants of the village, and it was found that the total
number present was 435. These were examined and were divided for
the purpose of segregation into the following four classes:—
Class I,—Those families who were perfectly healthy and
amongst whom no case of plague or fever of any kind had
occurred since the 9th of January (it was thought advisable
to treat any case of fever as coming under the head of
plague as it wasi mpossible, from questioning the villagers
themselves, to distinguish, with any certainty, between so-
called fever and plague).
Class II.—Those families who were in good health, but amongst
whom cases of plague and fever had occurred since 9th of
January.
Class III.—Those families amongst whom there were cases
convalescent from plague or fever.
Class IV.—Those families some of whose members were then
suffering with plague or fever.
Method of
evacuation.
On the 19th March the military arrived and the inhabitants were
ordered to go to their houses and remain there. Sentries were
then posted on all the infected houses (i.e., of classes II, III and IV) as
well as on those of class I in their immediate vicinity, and strict orders
were issued to prevent any persons entering or leaving those houses
or taking any article from them. The remainder of the inhabitants
were then turned out of the village and surrounded by a cordon of
sentries. They were allowed to take with them any property which
they wanted. Classes 11, III and IV as well as those of class I living
in their immediate vicinity were then taken successively out of the
village and segregated one from another by a cordon of sentries, those
of class I hitherto detained being allowed to join the others of the
same class.
Classes II, III and IV and the members of class I who were detained
with them were not allowed to take anything out of their houses
except the clothes they were wearing, as much bedding as was abso-
lutely necessary, and their money, ornaments and cooking utensils.
The village having been evacuated, sentries were posted all round
with strict orders to prevent any one from entering it.
ARRANGEMENTS IN THE HOSPITAL AND SEGREGATION
CAMPS.
Hospital camp.
At the time of Dr. Crofts' arrival there were eleven persons ill
of plague. They were isolated in a camp hospital which was
CHAP. IX. ] Measures outside the Bombay Presidency.
285
placed under the immediate medical charge of the hospital assistant
who had arrived with medicines with the troops. A temporary hut
was provided for each patient, the huts being placed about twenty yards
apart. Similar huts were provided for the members of the patient's
family who were allowed to attend upon their own sick, but were dis-
couraged from coming in any number to the huts of the patients.
Bedding was also supplied, and suitable food was cooked for all
patients either by a member of the family or by a Brahman who was
•appointed cook. A sweeper was entertained for the hospital camp
and was not allowed to go outside until it was finally broken up.
When a patient died his clothing, bed and bedding and hut were
burnt, compensation for the clothes being paid to the relatives.
Food-supply,
The following arrangements were made for feeding the villagers :—
" (a) Two retail dealers were engaged from a neighbouring
village, where it was ascertained that no plague was
present, and the necessary supplies were also brought
from the same source.
" (b) Both retail dealers and supplies were placed under a guard,
orders being given not to allow any of the villagers to
come in contact with them, nor to allow the latter to mix
with the inhabitants of the village.
" (c) The amount of grain, etc., necessary for each individual
family was calculated and supplied once a day under the
following arrangements.
" (d) The daily supplies were taken by a bunniah under escort to
the boundary of the segregation camp, where one member
of each family was deputed to receive them. The supplies
were then weighed and handed over, care being taken
that neither the bunniah nor his scales came in contact
with the segregated inhabitants ; the bunniah was then
marched back to the place allotted for supplies and again
placed under the Commissariat guard."
Little or no grain was bought from the village by class I villagers
as the previous year's store was exhausted.
Arrangements in
camp.
Arrangements were also made for the provision of temporary huts,
and straw and blankets for the old and weakly. The segregation
camps were all situated on the banks of a small river, so that the
water-supply presented no difficulty, but care was taken that the
segregation camp of the healthy portion of the inhabitants was
highest up stream, while the hospital camp was lowest.
Roil call.
Every morning and evening a bugler blew " the assembly " for
roll call and inspection in the several camps, and any one showing
signs of disease or debility was put apart for further examination.
286
Measures outside the Bombay Presidency.
[ CHAP. IX.
Arrangements
for the support
and comfort of
the inhabitants.
Those among the inhabitants who earned their livelihood by daily
labour or begging were unable to pursue their ordinary avocations
and were therefore put on free rations at the expense of the
State. Every effort was made to convince the people that the
measures taken were . for their own benefit, and to stop the mortality
amongst them. Compensation was promised for the unavoidable
damage to their property and crops, and they were made as comfort-
able as was possible under the circumstances. Small luxuries, such
as tobacco, were given to them ; they were urged and encouraged to
scatter themselves as much as possible ; to wash themselves ; and their
clothing and to keep the ground in their vicinity clean. At the same
time they were given clearly to understand that the camp rules would,
if necessary, be carried out by force.
Harvest.
At the time of the segregation the crops were ready for the harvest.
To enable the villagers to harvest them a few more companies of
infantry were sent for, and on their arrival the line of sentries round
the segregation camp was thrown back to the village boundary.
The villagers belonging to class I were then allowed to harvest their
crops at leisure, and, after ten days in segregation camp without the
occurrence of any case of plague among them, the villagers belonging
to class II were given the same permission. The crops of classes III
and IV were harvested under the direction of a subordinate revenue
officer of the State.
ARRANGEMENTS FOR GUARDING THE CAMPS.
Strangers not
allowed to enter
the village.
Nobody except the segregated villagers, the medical staff, and the
officers and sepoys engaged on segregation duty, was allowed to
remain within the limits of the village.
Guard.
The sentries were prohibited from entering the segregation camps
and were warned not to let any of the villagers approach within fifteen
yards of their post. No person, whatever his rank, business or occu-
pation, was permitted to enter or leave the segregation camps or
cross the village boundary without an order from Dr. Crofts, and
without being accompanied by one of the orderly havildars detailed
for this duty, and orders were issued to the sentries that under no
pretext whatsoever was this rule to be broken. To make obedience
to the rule more certain, entrance to or exit from the village boundary
limits or segregation camps was absolutely prohibited except at one
place appointed for this purpose. Dr. Crofts states that considerable
inconvenience no doubt arose from this rule, but it was early recog-
nised that its strict observance was of the most vital importance.
Only one instance came to light in which the rule was evaded.
CHAP. IX.]
Measures outside the Bombay Presidency.
287
Supplies.
Supplies for the sepoys were brought from outside into their camp
(which was pitched about a mile from the village) under escort.
The carts were unloaded and the carts and cartmen were at once
conducted outside the village limits. Similar precautions were
observed in the case of the supplies brought to the retail dealers for
the use of the village.
CLEANSING AND DISINFECTION OF THE VILLAGE.
Burning infected
huts.
At the time of the evacuation of the village, hay and other inflam-
mable materials were placed in the infected houses and those in their
immediate vicinity and they were then set alight and destroyed, care
being taken that nothing that could be burnt escaped.
The cleaning and disinfection of the village was delayed until the
place had been exposed to the disinfecting action of the sun and air
for three weeks, with a view to remove any danger of the persons
engaged in the operation contracting the disease.
Method of
cleansing and
disinfecting.
Dr. Crofts gives the following account of the way in which the
cleansing and disinfection were carried out :—
"A number was affixed to every house in the village and a list of
the owners was made. The houses being divided into classes to
correspond with those into which the inhabitants had been divided in
the first instance, except that class II was amalgamated with class I.
Class I.
"The owners of class I were then required to clean their own
houses and, for this purpose, were divided into working parties of not
more than ten persons in each, each working party being supplied
with phowras,* baskets, etc., to clean away dirt and rubbish, and lime
for the purpose of whitewashing the houses inside and outside, and
were placed in charge of two sepoys who were ordered to see that this
work was thoroughly and quickly carried out, and that all rubbish was
removed to a distance and burnt as far as possible, that the working
parties did not enter houses other than their own, and that every
evening they marched them outside the chain of sentries posted round
the village and saw that the phowras, baskets, etc., were deposited in
the place assigned to them under a guard. Rest from noon to 2 o'clock
was allowed, and the work was daily inspected in order to see thait it
was properly done.
Classes III and
IV.
"As the people of classes III and IV were still segregated from
the rest of the population and remained so until the camp was finally
broken up, working parties were engaged to clean their houses from
which the debris was first removed ; the floors were then dug up to
the depth of one-and-half feet, the walls were scraped, and both were
* A form of spade.
288
Measures outside the Bombay Presidency.
[CHAP. IX.
thoroughly spread with disinfectants by means of a fire-engine,
worked by hand, brought from Gwalior for this purpose.
" In the meantime the working parties were engaged in cleaning
up the village generally, every one employed being paid daily, and
the working parties being all under the supervision of sepoys told off
for this purpose ; no slouching was allowed, and the work was carried
out systematically and continuously until I was satisfied that the
village was cleaned as far as any Indian village could be."
MEASURES TO PREVENT THE SPREAD OF INFECTION TO
SURROUNDING VILLAGES.
Daily reports
from
neighbouring
villages.
The following measures were adopted to prevent the spread of
the epidemic to the surrounding neighbourhood :—
" (1) A list containing the names of every village within a radius
of ten miles from Khandraoni was made out. These
villages were divided into circles of four or five villages,
each according to the distance between them, and each
circle was placed in charge of a policeman, whose duty it
was to collect daily reports from the officers of each vil-
lage. The reports contained the following information :—
(a) whether there were any sick in the village, and if
so, the nature of the sickness ;
(b) whether any one had arrived or left the village since
last report, and if so, where they had come from
or gone to.
Return of
emigrants from
Khandraoni.
"(2) On comparing the census of Khandraoni, taken in July 1896,
with the number of people present when the roll was
made out, it was seen that there was a considerable
decrease in the population, even allowing for the number
who had died of plague and other cause during the pre-
ceding eight months. A return was therefore called for
from all villages within ten miles radius showing if any
one from Khandraoni had arrived in the village since the
beginning of January, and if so, whether they were still
there, a list of their names with dates of arrival being also
asked for: enquiry was also made from the inhabitants of
Khandraoni itself as to the whereabouts of any one who had
left the village since the arrival of the Brahmins who
brought the infection from Bombay.
Arrivals from
Bombay.
" (3) Orders were issued that if there were any persons who had
come from Bombay since July 1896, or from Khandraoni
since the 1st of January 1897, such persons were to be
CHAP. IX. ]
Measures outside the Bombay Presidency.
289
segregated outside the village until inspected by the
medical officer.
Absentees in
Bombay.
" (4) A list was called for giving the names of any of the inhabit-
ants of villages who might then be in Bombay, and orders
were issued that their relations in the village should write
and tell them that they were prohibited from coming back
to the State during the continuance of the plague at
Bombay.
Directiors to
villagers of the
neighbourhood.
" (5) Orders were issued to the inhabitants of all villages within
ten miles round that no person from Khandraoni or Bom-
bay was to be admitted into the village ; moreover, they
themselves were prohibited from coming to Khandraoni,
and they were also told that, except for any very urgent
reasons, they were to remain at their own village for at
least a month.
Inspection of
neighbouring
villages.
" (6) The villages all round were inspected, those in which there
were people who had come from Khandraoni and Bombay
being taken first, and no case of plague was found to be
present amongst them. False alarms were at first of fre-
quent occurrence, as the daily reports contained many
cases, whose symptoms, roughly described by the village
officers, might be those of plague; these were inspected
without delay, and none of them were proved to be plague."
EXTINCTION OF THE EPIDEMIC.
Only four
admissions to
hospital camp
after the start.
The measures thus carefully devised and carried out were
completely successful in achieving their object, and in a very
short time the epidemic was extinct. On the day Dr. Crofts arrived
there were eleven persons ill of plague. After that date there were
only four admissions to hospital, all of which occurred within ten days
of the formation of the segregation camps.
Mortality.
It is worthy of note that of the fifteen cases treated in the hos-
pital only five died, whilst the mortality before Dr. Crofts' arrival
was 80 per cent. of the seizures.
RETURN TO THE VILLAGE.
Breaking up of
camps.
Precautions on
breaking up
hospital camp.
The village having been thoroughly cleansed and disinfected, no
case of plague having occurred since the 1st April, and no death since
the 11th, and the patients under treatment having recovered, the
segregration camps were broken up on the 29th of the month. Be-
fore this was done every man, woman and child in the hospital camp
was obliged to bathe and exchange the clothes he or she was wearing
for new ones, which were supplied free. The hospital huts, patients'
clothes, blankets, beds, and all other articles of a combustible nature
37
290
Measures outside the Bombay Presidency.
[CHAP. IX.
were burnt, and the only things brought out of the hospital camp
were money, jewellery, metal cooking utensils, and the new clothes
given to the occupants.
Compensation.
Arrangements were made for a hospital assistant with medicines
to remain at the village for one month, and he was directed to hold
periodical inspections and to report the result. The harvest having
been gathered, and there being many in the village who gained their
livelihood by daily labour or begging, relief works were started for the
former and free rations were continued to those of the former who
were unable to work. A careful estimate was made of the loss sus-
tained by the villagers by damage to the crops and the destruction of
houses and property and the amount of that loss was paid to them by
the State.
CHAPTER
X.
MEASURES TO PREVENT THE SPREAD OF
INFECTION BY LAND.
Discussion of principles—Land Quarantine and the
stoppage of Railway Traffic.
Discussion of
principles.
The early efforts made to prevent the spread of plague infection
by persons travelling by land are described in succeeding sections
of this chapter. The whole subject of the principles governing these
efforts came under careful discussion in February and March 1897,
in connection with proposals to impose quarantine against the Bom-
bay Presidency or to prohibit third class railway traffic from stations
within the Presidency.
Proposals for
land quarantine
and the stoppage
of third class
railway traffic.
On the 13th February the special Calcutta Medical Board urged
that all persons leaving Bombay, Karachi or other infected places
should be detained for ten days under observation. The Government
of Bombay then suggested the expediency of imposing quarantine
against the Bombay Presidency, posts being established on the
border at suitable places, generally a long distance on the Bombay
side of the frontier. It was also suggested by the Government of
Bombay that third class railway passenger traffic might be tempo-
rarily suspended along certain sections of the line of communication.
On the 4th March the Lieutenant-Govern or of the Punjab proposed
that, plague having broken out in Sukkur, an endeavour should be
made to check the advance of the disease into the Punjab by the
imposition of ten days' quarantine at some place within the southern
portion of the province, cordons being thrown out at right angles
to the railway and river extending some distance west into the Dehra
Ghazi Khan district and east into the Bahawalpur State. On the
16th March the Agent to the Governor General in Rajputana tele-
graphed a proposal that, plague having become endemic in the native
state of Palanpur near the Rajputana border, people from Palanpur
should be prevented from travelling northwards by rail.
Objections to
land quarantine.
The Government of India having carefully considered these propo-
sals, and having taken the opinion of their sanitary adviser, decided that
there were insuperable objections both to the imposition of land
quarantine and to the prohibition of third class railway traffic from
infected districts. In arriving at these conclusions, the Governor Gen-
eral in Council was mainly influenced by the following considerations.