leaving a net loss at the end of Juno of nearly 16,000 people. The full table
is given in the Appendix B. As already stated, the figures for 1891 are much
below the true population.
In his final suggestion, Surgeon-General Cleghom called attention to the
necessity of more effectual control over this exodus. As early as the first week
in January, a few days after his return to Karáchi, Mr. Giles addressed the
Principal Medical Officer, pointing out that the arrangements at the Karachi
departure platforms were not stringent enough. On the 8th, the Acting
Commissioner wrote that the Government of India seemed very anxious that
it should be made impossible for any one ill with bubonic fever to get away
from Karachi. With this object, 4 European Travelling Inspectors, engaged
by the Collector to travel as far as Dádu Station with each train, had been sanc-
tioned, and suggestions for strengthening the medical inspection were invited
from the Principal Medical Officer. On the same date, the 8th, a letter was
received from the Deputy Sanitary Commissioner, Sind Registration District,
forwarding copy of a letter addressed to District officers, based on instructions
received from the Sanitary Commissioner, Bombay, as to the necessity of watch-
ing the arrival of trains at stations and intercepting any sick persons. On the
4th, Government had inquired by wire what arrangements were proposed, and
on the 6th the Manager, North-Western Railway, telegraphed that the Punjab
Government had taken precautions at Khanpur, Shershah and Raewind. From
a letter received from the same source on the 9th, it appeared that the Mana-
ger, by request of the Director General of Railways, had on the 31st December
1896 wired to the Principal Medical Officer to order inspection of passengers
at principal stations in conjunction with the Civil authorities. Accordingly,
on the 10th, the Acting Commissioner issued detailed directions to all District
officers in continuation of previous correspondence, informing them that the
Principal Medical Officer had, in consultation with the North-Western Railway,
issued instructions to the Civil Surgeons and Hospital Assistants for medical
inspection of travellers at Karáchi and all principal Railway stations in Sind.
These arrangements required to be supplemented by watchfulness on the part of
Revenue and Police officers. Each District officer should make himself acquaint-
ed with the arrangements made for his district, and, if in any way defective, he
should at once take necessary action. Any remissness or inability on the
part of the Hospital Assistants to inspect or attend the arrival of trains should
be promptly brought to notice of the officer to whom they were subordinate.
The object now was, if possible, to prevent the disease spreading. All Munici-
palities should be called on to take steps for their protection, and any suspicious
case entering a town should be promptly reported to the Medical officer.
Attention was invited to the Railway Rules dealing with infectious cases, and
it was pointed out that the sick man's relations or friends travelling with him
should also be kept under observation. Great care would have to be exercised
that sick did nob alight at wayside stations with the intention of avoiding
medical inspection and getting to their destination by road. The Railway
Police and officials were asked to assist in preventing this. At main stations,
two sheds should be provided, one for sick and one for relatives. Communica-
tion with the town should be prevented, and everything clone for making the
detenus as comfortable for the days of their enforced residence as circumstances
would permit. For this end, each Hospital Assistant should be allowed a small
permanent advance from Municipal or Local Funds. Magisterial and Police
officers should be responsible for enforcement of segregation. The Principal
Medical Officer had been asked to arrange for examination by an experienced
Medical officer of persons detained on suspicion. The utmost consideration
should be shown to all sufferers, and persons should not be forcibly examined
for glandular swellings, but if suspicious detained. Females should in 110 case
be subjected to-any bodily examination, and the strictest attention should be
paid to their customs and prejudices.
In forwarding a copy of the Circular to Government, the Acting Commis-
sioner observed that these measures appeared the least stringent that could be
of any use to check spread of infection, and, if the law did not justify them, he
hoped steps might be taken to legalise the action taken. Government approved
the measures, and this was communicated to all officers on the 6th February.