NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. IX. ]
Measures outside the Bombay Presidency.
275
Female medical
officers.
" The employment of female medical officers was considered
necessary to allay any prejudice against male practitioners, and to
ensure a more thorough examination of houses, the female apartments
of which are not open to male medical officers.
Native practi-
tioners.
Main objects.
" Efforts were also successfully made to enlist the services of
hakims, baids or independent medical practitioners, and they were
given free access to the hospitals, no attempt being made to press
upon the patients European in preference to the native or Yunani
mode of medical treatment. The main objects steadily held in view
were (1) the segregation of the sick and their attendants, (2) the
destruction or disinfection of articles likely to convey infection, (3) the
disinfection of the houses in which the sick were found, (4) the com-
plete sanitation of the town.
Restrictions
against
travelling to
Hardwar by
railway removed.
" On the 12th June 1897 the prohibition of the sale of tickets to travel
by railway to Hardwar and neighbouring stations ceased to have effect,
and from that date pilgrims again began to visit Hardwar. Nearly 300
slept in the special camp on the 13th June, and 248 arrived by train
on the I4th June. The police force on duty in the town was augmented
by one native inspector, six head constables and twelve constables
in order to deal more effectually with this influx, but these police
were only employed to keep order. The accommodation at the pil-
grims' ramp was increased, and the huts made weatherproof in view
of the approach of the rainy season.
Plague among
rats at Kankhal.
" About the middle of June an excessive mortality among rats was
detected in Kankhal : and on bacteriological examination the plague
bacillus was discovered in these rats by Mr. Hankin. The sanita-
tion of Kankhal and the disinfection of the houses had by this time
been systematically undertaken, and the mortality among rats ceased
without the plague again making its appearance among the inhabi-
tants of the place. The Sanitary Commissioner, who again visited
Hardwar to inspect the sanitary arrangements and enquire into the
new phase presented by the mortality among the rats, favoured the
theory that the rats became infected through infected food—sugar,
grain or sweetmeats—which had been removed from Hardwar to
Kankhal when plague was prevalent in the former place.
Precautions with
regard to plague
among rats.
" The disease among the rats died away, but in order to prevent
the transmission of the disease from infected rats to men, the follow-
ing precautions—which proved successful—were adopted. In the
case of any house or godown in which rats were found to be dying
in unusual numbers, the house with its contents and the neighbouring
drains and premises were thoroughly disinfected in the same manner as
if a case of plague had occurred; any grain, sugar and raw food mate-
rial found in large quantities in such house was exposed to the sun and
276
Measures outside the Bombay Presidency.
[ CHAP. IX.
air for eight hours, being carefully turned over at intervals and then
locked up in a specially disinfected room for ten days before being
used for food ; small quantities of such materials were destroyed ; and
sacks, baskets, or other receptacles either disinfected or destroyed,
The inhabitants of such houses were induced to vacate them for ten
days. A reward of two annas per head was at the same time author-
ised for every rat, living or dead, brought in from Kankhal.
Last case.
Removal of staff
and gradual
relaxation of
precautions.
" By the end of June the whole union of Hardwar had been
thoroughly cleansed and disinfected. After the 8th June 1897 (case
No. 18) no case of plague was reported from Hardwar, and it
became evident that the measures taken had been so successful in
stamping out the disease that a relaxation of the precautions was
permissible. Accordingly between the 5th and 12th July all the
commissioned medical officers (with the exception of the Deputy
Sanitary Commissioner, who was directed to remain for a further
fortnight) and Mr. Hankin were recalled from Hardwar, an Assistant
Surgeon being posted temporarily to the charge of each of the three
towns included in the Hardwar Union Municipality; at the same
time the conservancy staff was reduced by one-half. The rules in
force at Hardwar for the prevention of the spread of the disease
were cancelled with effect from the 12th July 1897, with the excep-
tion of rule 11, which provided for the location in camp, and medical
inspection, of pilgrims coming from infected areas. The inhabitants
of all evacuated houses were then permitted to return to them after
the houses had been again thoroughly disinfected : the arrangements
for the medical inspection of passengers by rail remained in force,
but those for the patrol of roads were abolished.
"Before the Deputy Sanitary Commissioner is withdrawn from
Hardwar a careful examination of the whole union will again be
made. No date has yet been fixed for the withdrawal of the Assist-
ant Surgeon or the abolition of the reduced special sanitary estab-
lishment."
KANKHAL.
Danger of spread
to Kankhal
recognised
throughout.
Disappearance
of plague
amongst rats
at Kankhal.
"The danger of the disease spreading from Hardwar to Kankhal,
a town of some 6,000 inhabitants, situated on the right bank of the
Ganges and only one mile distant from Hardwar, had never been
absent from the minds of the authorities ; but during the outbreak of
April to June only one case of true plague had occurred in Kankhal,
although there were reasons to suspect that rats had largely died in
that town. The house in which the case occurred was disinfected
at the time and other precautionary measures adopted. These seemed
to have been successful; for the disease completely disappeared
CHAP. IX. ]
Measures outside the Bombay Presidency,
277
Cause of the
new outbreak of
plague at
Kankhal.
from Kankhal as from Hardwar, and for several months no case
of death from plague was brought to notice either among the
inhabitants or rats in Kankhal, although careful watch was kept in
the town. The medical authorities, however, think that the disease
may have lain dormant during the rains, and that the present out-
break is merely a recrudescence. On the other hand, there appears
to have been communication between Bombay and Kankhal during :
the rains, and it is not impossible that by this means the town may
have become reinfected. If the former alternative explanation be
the true one, it would seem to the Lieutenant-Governor to inculcate
the lesson that in whatever town or village the disease shows itself,
there is no assurance of future safety unless the entire town or village
is disinfected, house by house.
First unfounded
alarm.
Careful watch.
First case.
" In the first week of September 1897 certain rumours reached
the Collector and Civil Surgeon of Saharanpur that acute fever,
quickly followed by death, had made its appearance in Kankhal.
Upon receipt of the information the Collector (Mr. Winter) and the
Civil Surgeon (Dr. Elphick) visited Kankhal and made an inquiry
into the correctness of the rumours which had reached them, direct-
ing their attention more particularly towards the ascertainment of
particular facts of the suspicious deaths in question. Their investiga-
tion satisfied them that merely deaths from the usual malarial fever
prevalent in the locality at that time of the year had occurred. But
the attention thus excited was sustained, and on the 16th September
the Assistant Surgeon in charge of the Hardwar Union Municipality
reported that a suspicious case, supposed to be plague, had been
detected in Kankhal, and that the patient had been removed to the
plague hospital, which had been kept up from the time of the
outbreak in April for the treatment of such cases. The Civil Sur-
geon went to Kankhal the next day, and having satisfied himself
that the case was a genuine case of plague reported it as such to the
Government. The Sanitary Commissioner having heard of the
case on the day of its occurrence, also proceeded with the District
Magistrate to Kankhal, and they were joined there on the 22nd
September by the Commissioner of the Meerut Division. All these
officers, with a brief necessary absence on the Commissioner's part,
remained at Kankhal, conducting and supervising the preventive
operations until the Lieutenant-Governor's visit to the town on 16th
October, when the Sanitary Commissioner left to attend to urgent duty
elsewhere.
Tolal cases.
" From the 16th September (on which date the first ascertained
case of plague occurred) up till to-day (4th November) there have
been 51 cases, which, though distributed practically over the greater
278
Measures outside the Bombay Presidency.
[ CHAP. IX.
Foci of disease.
Measures taken.
Isolation.
portion of the town of Kankhal, have still been concentrated in
groups at certain points. They have been so grouped together as
to form certain definite centres or foci of the disease, and these
groups have been made the basis of the proceedings subsequently
taken for the evacuation of infected localities. In dealing with
these centres of disease the procedure followed by the sanitary
and executive officers has been as follows :—The first steps
taken were to remove the sick to hospital, to segregate their friends
and attendants, to disinfect their clothing, and to completely cleanse
and disinfect the houses in which plague cases had occurred. These
measures proving ineffectual to stop the disease, it was decided to
isolate the whole town and to procure the evacuation of those portions
of the town in which the disease had shown itself or effected a lodg-
ment. Accordingly the town of Kankhal was placed in isolation and
surrounded by a cordon of guards, with orders to permit no one to
enter or leave the town without the permission of the Magistrate.
In case of persons wishing to leave, they were required to pass ten
days in the observation camp provided for the purpose. These
measures were begun on the 23rd September, camps being prepared
and the isolation completed within a week. In consequence of the
isolation of the town preventing labourers, resident within it, from
pursuing their usual occupation outside, it was found necessary to
provide a relief work within the cordon, which has taken the form of
sanitary improvements, clearing jungle, etc. It has also been neces-
sary to establish a charitable fund for relief of beggars, and to provide
a temporary dispensary for the use of the sick poor.
Evacuation of
infected portions
of the town.
" Meanwhile, having selected the portions of the town which,
with reference to the cases that had occurred, required to be vacated,
the local officers directed their efforts to the expansion or, where they
did not already exist from the time of the previous outbreak, to the
creation of four classes of camps, viz.:—
Camps.
(1) the hospitals (public and private) for the plague-stricken,
including huts for the attendants on the sick ;
(2) the segregation huts for the use of those persons who,
being close neighbours of the plague-stricken, were
presumably exposed to the same degree of infection ;
(3) a camp for other persons living in the portion of the town
or block the evacuation of which had been decided
upon ;
(4) a camp for persons who wished to leave the town, and who
were required before doing so to pass ten clays under
observation in isolation.
CHAP. IX. ]
Measures outside the Bombay Presidency.
279
Attitude of the
people.
" Some reluctance to comply with the measures detailed above
was at first evinced, but this was soon overcome, and the local officers
subsequently received much assistance from the people, who recog-
nised that the action was taken for their special benefit and began to
thoroughly co-operate with them.
Visit of the
Lieutenant-
Governor,
"The Lieutenant-Governor, with the Inspector-General of Civil
Hospitals, the Sanitary Commissioner, the Commissioner of the Divi-
sion, the Deputy Sanitary Commissioner, and the local officers,
visited Kankhal on the 16th October and inspected the camps, which
he found to be admirably suited for the objects contemplated. His
Honour found the people to be in excellent temper : he questioned
them both in the camps and in the town of Kankhal, and heard no
complaints whatever. After visiting the various camps, His Honour
held a conference of all the officers on the spot, at which the whole
situation was reviewed, additional precautions discussed, and orders
issued on necessary points. His Honour also discussed the situation
with the chief local residents and was able on certain points to
comply with their wishes. The Lieutenant-Governor was informed
by the medical officers that the general health of the people had
improved since they went into the camps, where suitable arrangements
are made for their convenience, for the privacy of the female mem-
bers of their families, and where special attention is paid to their
sanitary condition. At the time of His Honour's visit there were
nine camps, established in the vicinity of the town, falling under the
classification above noted and containing a population of about 1,200.
Since then the number has largely increased, and information has
just been received by the Government that the whole town has been
evacuated and the entire population accommodated in the camps.
No doubt that
the disease was
plague.
" Of the character of the disease there can be no doubt whatever,
as in numerous cases referred to the Bacteriologist to Government
(Mr. E. H. Hankin) the specimens sent were reported to be "typical
plague." Apart from this, the Sanitary Commissioner, Deputy Sani-
tary Commissioner and Civil Surgeon had no hesitation whatever in
diagnosing the disease as true plague. Out of 51 cases 38 have
proved fatal, the symptoms being those of true plague ; thirteen cases
with similar symptoms remain under treatment in hospital.
Disinfection.
Increase in the
" In regard to the general organisation for dealing with the out-
break, no improvement had to be suggested by the Lieutenant-Gov-
ernor at his visit in the general system or scope of the arrangements,
which followed those which had proved successful last summer. But
it was considered prudent to extend the disinfecting operations to the
towns of Hardwar and Jwalapur (in which the disease has not
appeared). Moreover, the subordinate establishment and the officers
280
Measures outside the Bombay Presidency. [CHAP. IX.
subordinate
establishment.
on the spot were found to be overworked, and it was deemed neces-
sary to strengthen the staff. One Tahsildar and three Naib Tahsildars
have been especially deputed for work in the town, and selected
patwaris are called in to assist in carrying out the operations. It was
directed that' Mr. Kendall, the Assistant Magistrate in charge of the
Roorkee Subdivision, should be temporarily relieved of the work of
the Subdivisional Officer, and should be placed on special duty at
Kankhal, another officer being sent in his place to Roorkee. In the
absence of the Sanitary Commissioner, the Deputy Sanitary Commis-
sioner was placed in control of the medical or sanitary operations,
and another Commissioned Medical Officer was deputed temporarily
to Kankhal. This gives three Commissioned Medical Officers for
the Hardwar Union Municipality. At the time of the Lieutenant-
Governor's visit the following subordinate medical staff was
employed :—
Kankhal
Jwalapur
Hardawar
TOTAL
Assistant
Surgeons.
2
I
I
4
Hospital
Assistants.
10
2
I
13
Compound-
ers.
2
...
I
3
Female
Assistants
(dais).
3
1
...
4
Vacci-
nators.
2
3
5
10
" This staff was considered to be sufficient at that time, but in view
of the possible extension or appearance of new foci of the disease,
and the great necessity of having on the spot sufficient expert staff to
deal with such possible increase of sickness, the Lieutenant-Governor
decided to make immediate arrangements for doubling the disinfec-
tion gangs, and to this end ten more hospital assistants and one
additional Assistant Surgeon were deputed to Kankhal.
Disinfecting
gangs.
" Coming to the executive subordinate staff, ten gangs were at the
date of the Lieutenant-Governor's visit employed on disinfection work
in Kankhal, each gang being composed of 16 men (kahars, beldars,
bhishtis and sweepers) in charge of a medical subordinate (hospital
assistant or compounder). These gangs were employed on the eva-
cuated blocks of buildings in the infected areas. They commenced
work at the house in which the case of plague occurred, taking the
neighbours' houses next in hand and gradually enlarging the circle.
They first remove all property from the house in the presence of the
owner ; they then proceed to burn all worn-out mats, chappars, rags
and destructible articles of little value after such things have been
CHAP. IX. ]
Measures outside the Bombay Presidency.
281
valued by a committee of native gentlemen. Compensation is given
in case of hardship. The house is then thoroughly cleaned and disin-
fected : the walls, floors and roofs being washed with a solution of
perchloride of mercury (1 in 1,000). Furniture and articles of value
are taken out in the sun and treated in the same way. This proce-
dure is followed systematically from house to house in the infected
block, and in due course the disinfection operations will be extended
to every house in the town. The increased establishment will permit
of this disinfecting process being speedily extended to blocks in which
the disease has not yet appeared, and thus have, it is hoped, a salu-
tary preventive effect. Power is left to the local officers to increase
these gangs still more should circumstances call for this,
Grain stores.
" In the town of Kankhal large quantities of grain are kept : and
it was a matter of great importance to prevent these stores from
becoming infected through plague-stricken rats. It was settled
that such stores of grain should be thoroughly aired in the sun and
the godown or store-rooms well disinfected before the grain was again
replaced in them. It was considered unnecessary to issue any
orders for the destruction of grain.
Guard.
" The work of guarding the town of Kankhal and of preventing
ingress and egress was being clone by a force of police and chauki-
dars, including 92 chaukidars who had been withdrawn from villages
in the neighbourhood, substitutes being temporarily employed in their
place. In the same way many of the police officers had been with-
drawn from police stations in other parts of the district : as the services
of these men could no longer be utilized, the Lieutenant-Governor
decicled to make up the force employed at Kankhal to 15 mounted
constables and 100 constables with the necessary complement of head
constables.
" It was also arranged that the repairs to the head works of the
Ganges Canal should be hastened to completion and water sent down
the canal, whereby the isolation of the town, both as regards men
and monkeys, would be greatly helped.
" No special disinfecting or conservancy staff was employed at the
neighbouring towns of Hardwar and Jawalapur. The Collector was
accordingly requested, as a precautionary measure, to cause the
conservancy staff of those towns to be strengthened so far as. in
conference with the Deputy Sanitary Commissioner and medical
officers on the spot, he might consider expedient, reporting his action
for the information of Government.
Plague amongst
monkeys.
"About the time of the Lieutenant-Governor's visit to Kankhal
the possibility of the monkeys (which swarm in the town and
frequent the houses) being attacked by the disease like the rats was
36
282
Measures outside the Bombay Presidency.
[CHAP. IX.
attracting the attention of the authorities. Up to that time the
mortality among monkeys was not specially noticeable, and in two
specimens taken from dead monkeys and sent to Mr. Hankin for
ba teriological examination the plague bacillus was not discovered.
Since then, however, monkeys have died in Kankhal in larger,
though still in moderate, numbers, and in several specimens taken
from their dead bodies, Mr. Hankin has discovered the typical
plague microbe. The matter had therefore assumed a very serious
aspect, for if plague-stricken rats convey and propagate the infec-
tion, so probably do plague stricken monkeys. At all events it would
not be safe to act on any other supposition, while this supposition
invests with risk any expedient, such as deporting the monkeys to
distant jungles or other method of dealing with them, short of
destroying them or trapping and keeping them in confinement. The
destruction of the monkeys is net to be thought of, for this among
other reasons, that they are regarded with a feeling akin to religious
reverence by the people ; while the alternative of trapping and
confining many thousands of these creatures is an undertaking of
great magnitude. However, the difficulty had to be faced: it was
only by facing it and making a beginning that a way out of it was to
be found. Accordingly gangs of Kanjars, who are expert at trapping
monkeys, are now at work in Kankhal catching monkeys, especially
those presenting any appearance of illness, and keeping them under
observation in cages in isolated places The latest reports go to
show that the mortality among the monkeys is not increasing,
and that no plague-stricken monkey had been detected for over a
week. A search recently made through the evacuated quarters
did not result in the discovery of any dead bodies. No doubt
the thorough disinfection of the whole town will have its natural
salutary effect in reducing the danger of infection, whether among
human beings, or monkeys, or rats. The Deputy Sanitary Commis-
sioner reported on the 1st instant that over half of the town had been
disinfected ; and he hoped to have all the houses, etc., disinfected by
the 21st instant.
Pilgrimage.
Temporary
stoppage of
railway booking.
"On the 25th October the Somváti Amávas fair was held at Har-
dwar, and the 9th November is the elate fixed for the Kartik Puran-
mashi. As it was to the general interests to discourage the influx
of people to Hard war at a time when plague was prevalent at Kan-
khal, the necessity of temporarily suspending booking to Hardwar
and neighbouring stations was represented to the Government of India,
who have accordingly directed that, with certain exceptions, no
tickets to travel by railway to Roorkee, Landhaura, Lhaksar, Pathri,
Jawalapur, and Hardwar shall be sold between the 23rd day of October
and the 16th day of November. About 300 pilgrims only attended