NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. VIII.] Measures in the Bombay Presidency and Sind. 233
Flight of inhabit-
ants.
occurred which were not brought to notice and which the relatives
had palmed off as deaths from natural causes. A very large number
of the population immediately deserted Sukkur. There was a rush of
the healthy to Shikarpur, but the measures there and in other big
towns were more or less dreaded, and the bulk of those who had sick
in their families—and there appear to have been many—fled to the
neighbouring villages. The country is well cultivated in that part of
Sind, and villages are pretty close together. A day or two after the
removal of the girl, the sister-in-law of a Municipal Commissioner
took the disease and was immediately secreted in a village five miles
off, where she died—poor creature—''possessed of the devil," as her
brother-in-law pleaded. How many perished in these villages before
their condition was known and help could reach them it is difficult
to say, but in the Sukkur Taluka the excess of reported deaths over
the normal was 436. The fugitives also crossed over to the left
bank of the Indus, and infected Rohri and the villages in its neigh-
bourhood. Some 10,000 people are said to have thus suddenly
decamped.
Detection of
concealed cases.
" Surgeon-Major Corkery set himself to find out the truth. He
traced one family to Rohri, where 4 deaths occurred ; spies were
placed over a suspected lane in New Sukkur. A sick man was
caught as he was being placed in a boat with a temperature of 105°a
nd delirious. This was on the 25th. Next day, the 26th February,
the same date on which the first two local cases occurred at Hyderabad,
a search was made in the lane. One dead boy and two sick were
found, and these were removed to the isolation sheds, and the other
inmates to the health camp. There was only slight opposition.
Clothing and bedding were burnt, and the houses fumigated and
locked. It is to be regretted that the Municipal Commissioner
of Sukkur lent no assistance.
Existence of
many cases,
" Sukkur, like Karachi, showed no imported cases. All were local,
and, though Karachi people went to Sukkur, none were traced
to have died of plague. By the 12th February, when the girl was
discovered, there must have been a good many sick in Sukkur to give
rise to the panic that followed her removal. In the neighbouring
town of Shikarpur, plague measures aroused no panic, because the
townspeople had no sick in their households."
Surgeon-Major Baker was sent to Sukkur to assist Surgeon-
Major Corkery. He arrived on the 8th March and reported on the
12th that he had found two plague cases in the isolation camp, and
twenty persons in the health camp, one of whom had just developed
plague. Old Sukkur, where the wealthier portion of the community
30
234 Measures in the Bombay Presidency and Sind, [CHAP. VIII.
Desertion of New
Sukkur.
lived and which is separated from New Sukkur by the European and
railway quarters, was not deserted to any appreciable extent, but
three-fourths of the inhabitants of New Sukkur had left for the sur-
rounding villages.
Increase of
supervising staff
Trained labour
sent from
Karachi,
Military
assistance.
Plague Com-
mittee appointed
On the 28th March Surgeon-Major Baker presented a report
which showed that the local organization was not abreast of the disease.
The supervising staff was immediately increased. The chief difficulty
that had been experienced was want of labour, due to the panic and
flight of the inhabitants. To overcome this obstacle from two to
three hundred trained Karachi labourers and masons, under supervi-
sors, were at once despatched from Karachi, with a supply of corro-
sive sublimate. At the same time 30 British soldiers of the Duke
of Edinburgh's (Wiltshire) Regiment were sent from Hyderabad.
On the 3oth March a Plague Committee was appointed for Sukkur and
Rorhi, with Lieutenant-Colonel Mayhew as President, and Mr. Lucas,
Dr. Corkery, and the Secretary to the Municipality of Sukkurj as
Members.
Improvement
in the situation.
With these improvements in the administration the work was soon
brought into order, and Mr. Wingate states that the visits he paid to
Sukkur during April and May showed that there was little to do, " but
be thankful that so fine a body of officers had been provided, animated
with the one mind to clear plague from the Province and suspicion
from the people."
Accommodation
for the sick.
Nurses.
" At Sukkur, as elsewhere, the sick were accommodated in
some of the best buildings in the town, the Schools having
been placed freely at disposal by the Educational Inspector, and the
best comforts and nourishment that could be procured were provided,
while' the nursing was that of the motherly sisters of the Lady
Aitchison Hospital, Lahore, generously spared and eager for the ser-
vice, assisted by the Zenana Mission Ladies."
Extension of
evacuation and
camp system.
At the same time the evacuation and camp system was largely ex-
tended. The heat of Upper Sind interfered with the comforts of the
occupants, but the buildings were made as substantial as possible.
The authorities of the North-Western Railway gave valuable aid.
" It suggested itself to them to utilise sleepers, and huts made by
sinking sleepers in the ground, and across these uprights supporting a
roof of sleepers covered with mud, were multiplied by the hundred
at little expense. Water was laid on to the camps, and paved and
enclosed bathing places provided ; shops moved themselves bodily
in, and with a few screens for the better classes life was bearable."
Cleansing and
disinfection.
" The inhabitants of these camps were detained for thirty days to
permit Mr. Cadell, who commanded the disinfecting gangs, to finish
CHAP. VIII.] Measures in the Bombay Presidency and Sind. 235
the work of house-cleaning, so that when the population returned, not
a nook or corner had escaped the perchloride of mercury ; and not a
rag or rubbish heap remained ; while walls inside and out shone with
limewash, with which disinfectant had been mixed ; and light and air
penetrated to the darkest recesses through holes in walls and roofs."
Rohri.
Evacuation of
infected streets.
Notwithstanding a careful watch at the bridge plague spread from
Sukkur to Rohri, Here the arrangements were under the immediate
control of Mr. Mountford, the sub-divisional officer, who was assisted
by three Military officers. Mr. Wingate states that the arrangements
were admirable. With the aid of Hospital Assistants the sick were
treated in sheds under trees and made as comfortable as possible. The
disease was held thoroughly in check and the bulk of the population
remained. " Mr. Mountford went on the plan of emptying thoroughly
particular streets. He always got good information of sickness, and
carried the sensible part of the townsfolk with him."
VILLAGES IN THE SHIKARPUR DISTRICT.
General account.
The following brief account given by Mr. Wingate of the work in
villages in the Shikarpur District offers another striking instance of
the salutary effect of evacuation, disinfection and cleansing :—
Outbreak at
Dharki.
Evacuation and
disinfection.
" Mr. Lucas' hands had been strengthened by a strong contingent
of officers. Plague had to be kept out of Shikarpur, and should it
get a footing there, it was desired to have officers, ready to put into
the town, and plague had to be beaten back, if that might be possible,
from the Punjab frontier. The frontier station is Reti. At Dharki,
the next station south and only some 15 miles from the boundary, a
sudden and sharp outbreak occurred—34 cases and 24 deaths in all.
Surgeon-Major Baker and Mr. Mountford, I.C.S., the Assistant Col-
lector in charge of the taluka, were on the spot immediately. Some good
work had had already been done by the local authorities and the people
had segregated themselves under trees. A disinfecting gang was organ-
ised, all the inhabitants removed, the houses systematically cleaned,
the people replaced and the public health restored. Mr. Pringle had
been moved up from Hyderabad, and was again selected for the duty
of clearing plague out of the villages in the Sukkur taluka. Mr. Lucas
had done a great deal of preliminary enforcement of orders by special
plague inspectors. Mr. Pringle, after visiting every village, was able to
confirm the intelligence that plague was in May confined to two villages
in the Sukkur taluka and had never been local in more than three or
four. These two villages gave some trouble, but yielded eventually to
236 Measures in the Bombay Presidency and Sind. [ CHAP. VIII.
the effective method of turning out the population and disinfecting and
cleaning the houses, and after the re-occupation there were no more
cases. This sounds easy, but May in Upper Sind represents the worth
of the workers who stayed not to rest till their task was done. The
result of the Gharibabad exodus was widely known, and the villagers
quietly accepted the same remedy."
HEALTH CAMPS.
Mr. Wingate's
memorandum.
Evacuation of
infected localities
the special
characteristic of
the Sind system.
The invaluable memorandum written by Mr. Wingate on the 30th
July on the subject of the effect on the disease of the evacuation of
infected localities and the removal of the inhabitants to temporary
health camps, forms an appropriate close to the account of the measures
adopted in Sind. It was the measure that specially characterized the
Sind administration and was signally successful in its results. It is
not too much to say that the removal, after disinfection, of the
inhabitants of an infected locality to a carefully supervised health
camp, combined with the thorough cleansing and disinfection of the
locality before the return of the inmates, affords a means of staying
the disease which is practically certain in its effect. No more valu-
able lesson was furnished by the history of the vast organisation
formed in India to meet the crisis.
Variations in the
conditions of
different camps.
The following is Mr. Wingate's account :—
" The figures of cases and deaths due to plague among the inhabi.
tants of camps which have been regularly furnished to Government
are misleading in this way that no distinction has been drawn
between camps regarding the degree to which the inhabitants were
exposed to infection or were liable to contract the disease during
their residence.
No disinfection
or segregation in
the Nasarpuri
Camp.
" Take for an instance the Nasarpuri Camp, the first that was
established. The huts were new and the locality healthy. The
population were permitted to enter the camp carrying with them their
sick, their dirty clothes and all their belongings. They were permit-
ted to go daily to their work, and to have such intercourse as they
pleased with the rest of the town, and no restrictions were placed
upon other persons entering the camp. Add to this that the sick
were not segregated from the healthy, the survivors after death were
merely placed in a new hut with their belongings, the hut in which
death occurred and the clothes and bedding of the deceased only
being burnt, and it is then a matter for surprise what an effect the
mere removal of the inhabitants had. The Nasarpuris belonged to an
influential and well-to-do class, and it was a matter of importance
CHAP. VIII.] Measures in the Bombay Presidency and Sind. 237
Results in the
Nasarpuri Camp.
in the early days of the plague to induce the population to move
voluntarily. The Nasarpuri Camp opened with a population varying
from 2,500 to 3,000 during the first two or three weeks following the
24th January and closed with a population of nearly 1,000 at the end
of May. The total numbers of cases and deaths during these five
months were .97 and 80, respectively, of which 38 cases and deaths
occurred within the first fortnight.
Camps with strict
segregation and
supervision.
Kalankot in
Karachi.
"The following examples, however, of camps instituted when
the organization was complete show the results which followed strict
segregation and supervision. The village of Kalankot in the Trans-
Lyari quarter had a record of 42 cases and 33 deaths between the
7th and 16th March in a population of 900 roughly. The village was
entirely evacuated on the 17th March and the inhabitants placed in
huts 500 yards away. They were not disinfected before entering the
camp. The following words are quoted from the Collector of Karachi's
report:—
" 'The sick were segregated, but there was no disinfection ; 19
cases occurred during the first eight days (i.e., within the ordinary in-
cubation period), after which the disease completely disappeared,
except one case, which was traced to infection from outside and
occurred six weeks after the move.'
Gharibabad in
Karachi.
" On the 1st and 2nd May the inhabitants of a village, called !
Gharibabad, in the Trans-Lyari quarter, were located in the same
camp which the Kalankot population left two days previously to return
to their homes. The Gharibabad population of 849 was thoroughly
disinfected before they were admitted into the huts. On the 3rd
May two cases of plague were found, and none occurred afterwards.
Twelve cases had occurred in Gharibabad village during the week
previous to removal.
Village near
Karachi,
" A small village of 170 Mekranis, who were badly infected, were
placed in huts on the Trans-Lyari side on the 4th May after thorough
disinfection. No further cases appeared among them.
Small nest of
houses in
Karachi.
" A small nest of tumble-down houses, known as Nagarbai's com-
pound, became infected. The inhabitants, about 200, were disinfected
and moved into a camp not more than 100 yards away.
There had been 28 cases and 18 deaths in the 2o days prior to the
move, including 4 cases and 3 deaths on the day previous to and one on
the day of removal. Only one case occurred three days after removal.
Kiamari in
Karachi.
" Plague broke out in Kiamari in February. On the 2oth Feb-
ruary the disease appeared in the old native village, where it re-
mained till April, when the whole population was turned out and the
village burnt, What is known as the new village was treated in the
same way.
238 Measures in the Bombay Presidency and Sind. [ CHAP. VIII.
" ' Scarcely a hut in this area,' writes the President of the Plague
Committee, 'inhabited by 1,300 persons could be declared free from
infection. The Kiamari Health Camp of 255 huts, with all necessary
sanitary arrangements, having been built and the camp placed
under a military guard, the healthy persons were, after careful
medical examination, moved into it from the infected village. Before
being allowed to enter the Health Camp all persons and their belong-
ings were most carefully disinfected by European subordinates under
medical supervision.
*
*
*
* After removal
to the Health Camp only two cases of plague occurred among these
people.
*
*
*
*
*
No local case oc-
curred in the Kiamari Health Camp.' The two cases appear to have
been due to infection from outside, workmen being attacked who
were permitted to leave the camp by day on passes and were dis-
infected before re-admission at night.
" Two more examples may be given, in conclusion, from Sukkur :—
Gharibabad in
Sukkur.
' On the 17th April a quarter of New Sukkur, known as Gharib-
abad, where 106 cases had occurred in the previous three weeks, was
surrounded, and the inhabitants en masse, to the number of about 600,
were conveyed, with their goods, poultry and domestic animals to two
camps of huts made of railway sleepers. Of these 367 were taken
to the Gharibabad Health Camp. One case was found in this camp
on the day of removal, and not a single other case occurred during
their stay of one month. It may be mentioned that 5 cases and 2
corpses were found in the Gharibabad quarter on the day the inhabit-
ants were removed. Exact information cannot be given regarding
the remaining 215, who, being railway employés, and their families
were sent to a Railway Loco, camp, which contained 1,100 persons,
among whom from first to last 6 cases and 4 deaths occurred.'
" The following is quoted from the report of the Sukkur
Plague Committee :—
Small quarter
in New Sukkur
Town.
' A second case worth recording is that of the Limji Charhi*
people. This neighbourhood was also badly infected for at least a
fortnight prior to the 26th April, 4 and 5 cases occurring daily among
a somewhat limited population. * * * * The residents of this
quarter were removed en masse on the 26th April to a camp specially
set apart for them. * * * * Not a single case occurred amongst
them for the month they were in camp, and since their return to
* A small quarter in New Sukkur Town.
CHAP. VIII. ] Measures in the Bombay Presidency and Sind. 239
their quarter they have been absolutely free from infection. The
number of persons removed was 232.
' On the day of their arrival in camp their clothes and bedding
were disinfected by boiling ; rags and dirty bedding were destroyed
*
*
*
and their beds and furniture disinfected with per-
chloride solution.'
New Sukkur
Segregation
Camp.
" Examples might be multiplied. At the New Sukkur Segre-
gation Camp 11 cases and 7 deaths occurred among 529 people, drawn
from the most virulently infected parts of Sukkur Town. In the report
of the Plague Committee it is stated that of these cases—
I occurred
.,.
...
..«
1
„
4
1
„
1
„
1
„
1
„
1
„
I day after admission.
2 days
„
4
,,
,,
5
,,
,,
6 „
7 „
11 ,,
13 „
The last case was a doubtful one.
Efficacy of
segregation after
disinfection.
" The examples which have been given are those which point
most conclusively to the efficacy of segregation after disinfection and
supervision in stopping plague in an infected population. Enquiries are
still in progress regarding caseswhich may have occurred under similar
conditions after ten days' residence in camp. The evidence that plague
does not incubate more than a few days is so strong that it may be
considered that cases like the one that occurred after eleven days in
the New Sukkur Segregation Camp are capable of explanation, and
the simplest seems to be the supposition that in such cases the infec-
tion was taken from a previous case in the camp."
General Remarks on the Disinfection of Houses.
Use of corrosive
sublimate solu-
tion.
A solution of corrosive sublimate (strength 1 in 1,000) was the
agent commonly used for disinfecting houses. It was found to be the
most convenient and to give the best results. The following
240 Measures in the Bombay Presidency and Sind. [CHAP. VIII.
summary of its advantages is taken from a report by Surgeon-
Captain Dyson, Deputy Sanitary Commissioner, Gujarat:—
Its advantages.
(a) It is simple, cheap and efficient, and secures a great saving
of time and labour. Further experience will probably show
that a weaker solution (1 to 2,000) is sufficiently strong.
(b) It ensures almost complete immunity from infection to
labourers.
(c) It entails a minimum of discomfort and inconvenience on the
occupants of a house.
(d) Perchloride of mercury is odourless and non-volatile.
The former quality recommends it to natives, and the second
gives a greater chance of a permanently good effect.
Mr. Hankin's
experiments on
the floors of
houses.
Mr. Hankin conducted a series of important experiments on the
action of different disinfecting agents under the ordinary conditions of
an Indian dwelling. The following is a summary of his method and
conclusions :—
The floor the
portion of the
house most in
need of
disinfection.
Principle of the
experiments.
"Owing to the fact that the excreta of men and rats suffering from
plague are likely to fall on to the floor of houses, and that
such excreta are likely in some, but not in all, cases, to
contain the plague microbe, and owing further to the prob-
ability that the infection of plague gains entrance to the human
body in the majority of cases through the skin of the feet and legs,
it is probably the floor of the house that is most in need of disinfec-
tion. The floors of houses of the lower classes in India are usually
covered with a mixture of mud and cow-dung. My experiments
therefore have been in the first place directed to examining the means
of disinfecting such floors. The most satisfactory way of carrying
out such a test would be to impregnate a cow-dung floor with the
microbe of plague, and then to test for its presence after the applica-
tion of the disinfectant. Unfortunately, however, this is at present
impossible as no reliable test exists for the presence of the plague
microbe when mixed with others. Hence I have had to experiment with
floors that had not been infected. By estimating the numbers of ordinary
microbe present before and after the application of the disinfectant
some idea can be formed of the activity of the latter on a cow-dung
floor. No doubt some of the microbes present are more resistant
than the plague microbe to the action of disinfectants; others, on the
other hand, are likely to be as sensitive, and hence it would probably
not be safe to employ a disinfectant against plague that had no action
CHAP. VIII.] Measures in the Bombay Presidency and Sind. 241
in decreasing the numbers of harmless microbes present on an
ordinary floor.
Method.
" The method I have employed was to remove as much of the
material of the floor as could be taken up on the end of a flattened
needle. This was put into a test tube containing melted agaragar,
mixed up well with the food medium, and the mixture was then allowed
to solidify. On the following day the number of colonies that had
developed was counted. It is needless to say that this method does
not give results of any absolute value. If, for instance, the material of
the floor was dry, it is likely that most of the microbes present in the
specimen removed for examination would adhere to the particles of
sand and dirt, and that each particle would produce only a single
colony. If, on the other hand, the particles were damp, it is likely
that the microbes adhering to them would more readily become
suspended and distributed in the agaragar and thus produce a large
number of colonies. Though the method has no absolute value, it has
some relative value, if repeated sufficiently often. If a specimen
taken before disinfection produced a great number of colonies and a
specimen taken after disinfection produced no colonies after 24 hours,
we may infer that some disinfectant action has been exerted. It
would not be safe to conclude that the specimen taken after disinfec-
tion was absolutely sterile, for microbes might be, and as a matter of
fact were always, present that could not produce colonies after 24
hours, but that did so after a longer interval."
Experiments in
the Hardwar
laboratory.
Results
" Experiments to test the action of different disinfectants were
carried out on the mud floor of the grass hut that served me
for a laboratory in Hardwar in the following manner:—The floor
had been covered with the ordinary mixture of mud and cow-dung
some days before. Areas about a foot square were divided off
from each other by ridges of earth. Two specimens of the mud
mixture of each area were examined bacteriologically as described
above before pouring on the disinfectant. The disinfectant to be tested
was then poured on to the surface, so that the whole of it was wetted,
but no attempt was made to rub it in. After this, at different intervals
other specimens were taken and tested. In every case two specimens
were taken from different parts of the area. The figures in the
following table give the average of the two results. For the sake of
clearness 1 have not given the actual number of colony-producing
microbes found, but I have given the relative numbers that developed
for every hundred colonies found in the control observations. For
instance, for every hundred colonies present before treatment with
sublimate, half an hour afterwards only 60 were present and 24 hours
31