NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
216 Measures in the Bombay Presidency and Sind. [CHAP. VIII.
in a satisfactory manner by the end of June. The benefits to the
district of this thorough cleansing are incalculable. All the towns
that were in a filthy condition have now been brought to a condition
of average cleanliness.
Difficulties in
dealing with the
people.
" Throughout the epidemic the difficulties in the way of combating
the evil, owing to the prejudices of the masses and the scarcity
of labour, were enormous. Great trouble was experienced in getting
people to disclose the occurrence of cases of plague, and then
inducing them to remove the plague-stricken patients and their fami-
lies to the hospitals and segregation camps. These difficulties were
more especially experienced in dealing with the Brahmins, who all
through gave us very little assistance in quelling the disease, though
in almost every case patients who recovered in hospital expressed
their regret that more of their fellow-sufferers did not avail them-
selves of the hospitals, and invariably spoke very highly of the
manner in which they were treated.
Good effects of
segregating
healthy inmates
of infected
houses.
"As regards the segregation of the healthy from infected houses,
I may mention one instance of its highly beneficial effect. On the
1st June a policeman was attacked with plague in the police lines
at Alibag. He was removed to hospital and died three days after of
a very virulent type of the disease. The room in which he was at-
tacked was immediately disinfected with perchloride of mercury and
the roof removed, while the whole of the inhabitants of the lines were
promptly removed into a segregation camp, the result being that not
a single case of plague occurred amongst the police at Alibag. All
the rooms in the lines are covered with a common roof, and the par-
tition walls between each quarter do not extend quite up to the roof,
so that there is a free circulation of air between the individual rooms.
There is not the least doubt that had the quarters not been immedi-
ately vacated, there would have been a general outbreak of plague all
through the lines."
Cutch-Mandvi.
PRELIMINARY REMARKS.
Report by Dr.
Wilkins.
In Chapter V it has been stated that the seaport town of Mandvi
in the Native State of Cutch was the scene of one of the most virulent
outbreaks of the epidemic. The following account of the measures
taken for its suppression is mainly derived from the report by
Surgeon-Lieutenant-Colonel J. S. Wilkins, the officer entrusted
with the control of the operations. Unfortunately the existence of
CHAP. VIII. ] Measures in the Bombay Presidency and Sind. 217
Beginning of the
"epidemic.
Desperate
situation.
Help sent from
Bombay.
the epidemic was not ascertained until it had reached a virulent
stage. The local authorities appear to have reported the existence
of plague on the 8th April, but it must have been in existence for
some time before that date. The Political Agent, Major Hyde-Cates,
having received information that the disease was more serious than
had been reported, went to Mandvi on the 20th April with a view to
organise preventive measures. By this time the reported death-rate
was 70 to 80 a day, and the actual death-rate was probably consider-
ably greater. Major Hyde-Cates was assisted in the first effort to
organise effective operations by Dr. Lowson. The work was rendered
In the highest degree difficult by the terror of the people, their dislike
to the necessary measures, and the difficulty in procuring labour. The
situation was said to be desperate and the people were panic-stricken
and not attending on their sick. In this extremity help was asked
for from Bombay and was afforded, on the direction of the Governor
in Council, by General Gatacre's Committee. With the approval of
His Highness the Rao of Cutch Surgeon-Lieutenant-Colonel Wilkins,
who had been in charge of No. V District of the City of Bombay,
left for Mandvi on the morning of the 27th April. He was accom-
panied by a native medical practitioner, four nurses, a hospital
assistant, six sepoys and a non-commissioned native officer, three
ambulances, and four native servants. Further relays of staff, medical
and disinfecting, was sent from time to time as fast as they could be
collected, with two experienced inspectors and a large staff of
Bombay labourers for disinfecting work. Surgeon-Captain Mason
followed on the 11th May.
DETECTION OF CASES.
As In other places, search parties and an improved system of
death registration were the measures adopted to ensure the detection
of cases and the removal of the sick to hospital.
Search parties.
Difficulties in
dealing with the
people.
" For the removal of the sick we formed search parties in the
city, and we had very difficult work getting at these, as the people
were very reluctant to have their sick taken away to the hospital,
and every endeavour was made to evade the search parties. In
our visitation to the houses many cases were found either dead or
dying, and all feeling of humanity amongst the people seemed to be
blunted, as on several occasions we unlocked doors closed from the
outside and found cases left to die, chiefly women. This house-to-
house visitation was instituted at once and is still going on, as the
necessity for removing every infectious agent still remains, and the
people are so apathetic or ignorant that they prefer the risk of
infection in their own houses to the removal to the hospitals. The
Plague Committee had sent three ambulance carriages with me, and
28
218
Measures in the Bombay Presidency and Sind, [CHAP. VIII.
Ambulances,
Death
registration.
we had to obtain five others from Bombay to enable the sick to be
removed in comfort. The country carts used with the ambulances
were rather a rough method of transport, but, strange to say, some of
the people preferred these bullock-carts to the ambulances."
For the purpose of securing a more accurate death registration,
reliable persons were posted at the various burial and burning
grounds, and in especial at the city gates, to take the names and
addresses of the deceased,
TREATMENT OF THE SICK IN HOSPITAL.
Five plague
hospitals.
Five plague hospitals were established for the treatment of the sick.
The following is a statement of these hospitals and the cases treated
in each from the 24th April to the 21st June:—
Name of Hospital.
Hindu ...
...
...
...
Hajira (Borah community)
...
...
General Muhammadan
...
...
Khatri
„
...
...
Khojah
„
...
...
TOTAL
...
Admitted.
937
91
103
60
29
1,220
Discharged.
239
38
31
37
17
362
Died.
646
53
65
23
3
790
Remaining.
52
0
7
0
9
68
Staff.
The following was the total medical and nursing staff:—
Commissioned medical officers
,,.
Medical Practitioners
...
...
Lady Doctor
...
...
Senior Nurse
...
...
...
Nurses
...
...
...
Hospital Assistants
...
...
Assistants
...
...
...
Students
...
...
...
Surgeon-Lieutenant-Colonel
Wilkins.
Surgeon-Captain Mason.
2
Mrs. Van Ingen.
Mrs. Remy.
15
4
3
2
Hindu Hospital.
The Hindu Hospital was a large masonry building, " very suit-
able for a hospital and capable of accommodating about 150 patients.
The open verandah-like rooms were about 200 feet in length on two
CHAP. VIII, ] Measures in the Bombay Presidency and Sind. 219
sides of a square, the other sides being occupied by a cooking-room,
orderlies' quarters, etc.; the middle was a quadrangle containing a
well of water.
Wards.
" The hospital was divided into two portions—one wing for
females and the other for males ; but as the patients flocked in and
the female ward in particular got much overcrowded, I had three sheds
built in the quadrangle. The two long pucca-built wards were then
given over to the females—who had by far the greater number of sick
—and one of the chappars or sheds given for the males with a small
ward in the building (where about 30 cases could be accommodated).
This relieved the tension in the wards, and we used the second shed
as a convalescent ward for females and the third as a convalescent for
males.
Disinfection and
ventilation.
" A batch of coolies were always on the premises with plenty of
lime ready, and the wards were kept as clean as possible, and the
use of disinfectants was free. To allow of greater ventilation the
tiles were removed here and there and roof ventilation was then
obtained.
General account
of work in the
hospital.
" It is impossible to describe in words the hospital and its sights.
The two long wards full of sick lying side by side in every stage of
this dreadful disease ; the nurses going about here and there in their
merciful work; the ward orderlies and other attendants; outside
the constant admission of patients in carts and ambulance carriages ;
and in one angle of the square the dead lying in numbers prior to
removal to the burning ghat near. It was a mournful sight that
met our eyes every morning and evening when we had to pass near
the burning ghat and saw the numerous fires which told the heavy
mortality. The whole of May and the first week of June, or for
about five weeks, the admissions and deaths were heavy, and it was
not till about the second week in June that anything like a sensible
diminution in the admissions and deaths occurred. The discharged
cured, also, were few till about the middle of May, and I am afraid
many were sent out with their buboes not quite healed, so as to make
room for others who had to be admitted. When it is considered that
in this hospital alone 937 cases have been admitted up to the third
week in June, it will be seen that the work was of no light character."
The hospital was in charge of Surgeon-Captain Mason, assisted
by two medical practitioners and three hospital assistants. Four to
eight nurses were attached to the hospital.
Borah Hospital.
The Hajira Hospital for the Borah community was attached
to their segregation camp in the suburb of Hajira. It consisted of
a line of sheds. All requisites for the hospital were supplied by the
community and, when possible, Dr. Wilkins detailed the lady
220 Measures in the Bombay Presidency and Sind. [CHAP. VIII.
doctor (Mrs. Van Ingen), a nurse and an assistant to tend the
sick.
Muhammadan
Hospital.
The Muhammadan Hospital was originally a dispensary and was-
situated on the riverbank outside the city walls. It was capable of
accommodating 30 to 40 sick persons. It was at first intended to
provide (with enlargements) for the whole Muhammadan community,
but the Khojas and Khatris insisted on separate accommodation. The
hospital was under the superintendence of Dr. Mason, who was assis-
ted by a native medical practitioner. Nursing assistance was also-
given.
Khatri Hospital.
The Khatri Hospital originally consisted of a badly made and
managed hospital constructed of huts on the north of the city walls.
After much persuasion and with the help of the headmen the people
were persuadede to use a properly constructed hospital on a suitable site
the patients did well. Medical and nursing assistance was given.
Khojah Hospital.
The Khojah Hospital at first consisted of sheds outside the city
in which such medical and nursing help as could be afforded was
supplied. Later, " owing to the kindness and humanity of Mr.
Jairaj Pirbhoy, of Bombay, " a staff of nurses and assistants were-
sent for the use of the community and the sick were then transferred
to a building opposite the Muhammadan Hospital where they were
properly looked after.
EVACUATION OF INFECTED HOUSES AND QUARTERS.
Voluntary and
compulsory
evacuation.
A considerable portion of the city was evacuated by the inhabi-
tants either voluntarily or, in the case of infected houses, com-
pulsorily. The inhabitants of the evacuated houses were not how-
ever segregated, and Dr. Wilkins fears, no doubt with reason, that
they spread the diseases outside the town. He states that were he
required to take similar measures again, he would make different
arrangements to induce the people to overcome their reluctance to
segregation. His remarks on the subject are of great importance
and are reproduced at length below :—
Failure to
segregate the
inmates of
evacuated
houses.
" On the breaking out of the plague at Mandvi, and when the
disease was pronounced and fatal, a large proportion of the inhabi-
tants, estimated at about 10,000 people, took refuge all around the
town in the various gardens there are about, and also outside the
villages within easy reach of the city. On our arrival here it was
proposed to erect sheds about a mile to the west of the city in a
convenient place, so that the inhabitants of the houses, where there
were sick, could be kept under observation, and with this view
a long row of comfortable sheds were erected, but the people
refused to make use of them and preferred to live in the gardens.
CHAP. VIII.] Measures in the Bombay Presidency and Sind. 221
Spread of plague
into the interior.
Plan
recommended by
Dr. Wilkins.
Every endeavour short of actual force was employed, but failed,
and it was concluded that it was better that they should be
allowed to live in huts in these gardens, where they had at all events
pure air and light, than that they should leave their houses and
carry infection to other houses in the town. So a careful watch was
placed on the villages and gardens, and the people of the villages
warned not to enter Mandvi or allow Mandvi people to enter their
villages. In most instances these warnings were not heeded, and
cases of plague occurred in villages, whether prior to thein timation,
when the inhabitants fled in all directions, or subsequent, it is diffi-
cult to determine, at all events, the attempt to segregate the in-
habitants in these huts made for them failed. The reason given was
that certain classes would not live near others. In case I were
called on to take similar measures again, I think I should feel
inclined to act differently—by calling the headman of each caste and
getting him to select a spot for a camp which would answer the
purpose and making him responsible for his caste people going
there. There are a great number of gardens around the city of
Mandvi and adjacent villages, and these afforded shelter to the
refugees, who in most instances made themselves temporary booths and
huts and lived in them with their families. A great many cases,
I have no doubt, occurred amongst them, but I think it would have
been better if they could have been persuaded to live in the segre-
gation huts, where a better watch could have been kept on them and
cases removed as they occurred.
Procedure at
Bhuj on discovery
of plague cases.
" In the city itself all the gates but two were closed, and a watch
kept on these by military sepoys from Bhuj, who were also posted
around the city at one time. On any case being found, the residents
of the house were sent out of the city and the house closed for lime-
washing, and after cleansing thoroughly and removing tiles to some
extent, the house was sealed, so that it could not be used again
for some time. In this way a good deal of the city was evacuated."
Good
arrangements
made by the
Borah
community.
The Borah community were an exception to the general rule and,
owing to the sense and foresight of their leaders, complete measures
were taken at an early stage of the epidemic. The whole community
removed from the city and was segregated in huts constructed for
them in the suburb of Hajira. Nearly 400 men and 190 children
belonging to this community were also inoculated with prophylactic
serum. The hospital arrangements of the Borahs have already been
described. The sensible measures adopted by the leaders of the
community appear to have met with marked success; at any rate, the
disease amongst them abated earlier than in the case of other sections
of the population.
222
Measures in the Bombay Presidency and Sind. [CHAP. VIII.
CLEANSING AND DISINFECTION OF INFECTED AND OTHER
HOUSES.
Large
disinfecting staff
from Bombay,
Two hundred coolies under the charge of two capable European
inspectors, and furnished with large quantities of lime and other
materials, having arrived from Bombay, the arduous work of dis-
infecting and cleansing the filthy city commenced on the 21st of
May.
"The usual measures were taken, viz., opening out the rooms
as much as possible to light and air, and removal of part of the tiles,
taking out all rubbish and clothes and burning them, the use liberally
of disinfectants, and, finally, hot limewashing the whole premises."
Extensive
cleansing and
disinfecting
operations.
The experienced Bombay inspectors and labourers proceeded
rapidly with the work, and as the inhabitants took heart on seeing
the plague decrease, the Bombay agency was gradually replaced by
less expensive local labour. In addition to the regular disinfecting
parties small gangs of labourers were placed at the city gates, so
that when cases or dead bodies were removed through them, labourers
were at once despatched to disinfect the house in which the sick
person had resided. Finally, whole streets were operated on at a time,
and the houses abandoned by their owners were opened and cleansed.
In this way the whole town was purified, and Dr. Wilkins states-
that he has no doubt that it was rendered cleaner than it had been
for the past few centuries. Mr. Attes, the Bombay Disinfecting
Inspector, gave the following account of the operation :—
Description of
the work.
"3,338 houses were disinfected by me, containing 16,540 rooms.
Tiles were taken off partially from the roofs of 2,540 houses to admit
light and air ; 8,843 coolies were employed on the above works from
the 5th May to 21st June. I found it necessary to use about 12 oz,
of carbolic acid to every cask of mixed lime, as the lime was more or
less slaked. Care was taken to freely use this solution to the walls,
more especially to the flooring until it fairly permeated it. In every
instance the men were not allowed to enter the infected houses
until some chloride of lime was used, and in some extreme cases
where the smell of dead rats and cats was unbearable, I fumigated
the rooms with about 2 lbs. of chloride of lime with 2 lbs. of dis-
infecting powder. This fumigation answered the purpose very
satisfactorily, although expensive. In some extreme cases I used
the pump and washed the walls and flooring with a solution of carbolic
acid, and then limewashed the place with carbolic acid in lime. I
found nearly 50 per cent. of the houses disinfected by me had dead
cats and rats, and I believe if the disinfection had been started
immediately the plague broke out (a month prior to our coming here),
one-half of the mortality would not have taken place. The whole
length and breadth of the town was fairly infected when we came."
CHAP. VIII.] Measures in the Bombay Presidency and Sind. 223
OTHER GENERAL SANITARY PRECAUTIONS.
Recommenda-
tions for much
needed sanitary
improvement of
Mandvi.
Dr. Wilkins did something towards the general sanitary improve-
ment of the town by causing new privies to be constructed within and
without the city, but he found the condition of affairs so bad that
nothing but a set of radical alterations and reforms could place the
city in a reasonably wholesome condition. In a letter to the Political
Agent, dated the 24th May, he made a number of practical sugges-
tions of great utility for the improvement of the city, and in his report
these suggestions are set forth at greater length. The suggestions
made by Dr. Wilkins have been placed before His Highness the Rao
and arrangements have been made to destroy many insanitary houses
with a view to give more air space in the city. The Government of
India also informed the Government of Bombay with reference to Dr.
Wilkins' suggestions that they trusted that the terrible experience of
the epidemic had impressed on the local authorities the necessity for
keeping the town in a more sanitary condition.
CONCLUDING REMARKS.
Success of the
operations in
Mandvi.
Spread of plague
and precautions
taken in the
interior.
The vigorous and ably conducted operations appear to have been
eminently successful in combating the virulent epidemic which had
taken hold of Mandvi, and the disease declined rapidly as soon as
they had been brought into complete effect. Unfortunately the
infection was spread from Mandvi to a number of villages in the
interior where it still exists. This danger was realised from the
outset, the Government of India expressed their anxiety on the
subject to the Government of Bombay and asked what was being
done to minimise the evil. In reply the Government of Bombay
forwarded a letter from the Political Agent in which it was stated
that the Mandvi staff was taking precautions in the villages in the
neighbourhood of Mandvi to which the disease had extended ; that
Surgeon-Captain Ricketts, assisted by the State officers, was looking
after the towns of Bhuj (the capital), Anjur and Mundra ; and that
the local officials were keeping a watch on the villages hitherto
uninfected. Notwithstanding these precautions the disease spread
widely in the interior, principally in villages situated in the sub-
division surrounding the town of Mandvi.
Sind.
PRELIMINARY REMARKS.
General remarks
and arrangement.
It is not necessary and it would be wearisome to detail under
their different heads the operations carried out in Sind at the same
length as the descriptions that have been given of the measures
224 Measures in the Bombay Presidency and Sind. [CHAP. VIII.
adopted in various places in the Presidency proper. In the following
account, which is mainly derived from the report by Mr. Wingate,
Acting Commissioner in Sind, the history of the operations at Kara-
chi and other principal plague centres will be given briefly and in
chronological order. Particular notice will be taken of the special
features of the work in Sind, the most important of which was the
evacuation of infected localities, and the lodging of the inhabitants in
health camps.
KARACHI.
Beginning of the
epidemic.
Opposition of
the people to the
precautionary
measures.
Plague was declared to be epidemic at Karachi on the 19th De-
cember, and the first case occurred shortly before that date. Early
in October the Health Officer of the Municipality, Dr. Kaka, called,
attention to the necessity for special sanitary vigilance, and on the
16th December he informed the President of the Municipality that he
had already experienced opposition, and that the residents of houses
where cases had occurred flatly refused to permit disinfection of the
rooms occupied by the sick. This opposition lasted for a long time
and required most careful treatment. The recognised precautionary
measures were introduced gradually and with great caution, and by
this means it is said that the authorities were enabled to carry the
people with them. But it was long before any systematic isolation
or even treatment of the sick was intreduced.
Limited
segregation in
hospital,
Cleansing and
disinfecting.
Caste hospitals.
On the 17th December a meeting was held where several of the
headmen of the Hindu sects consulted with the Municipal authorities.
On the 21st and the 23rd, the Municipality issued resolutions in
which segregation in hospital was prescribed only when there was no
suitable accommodation in the house of the sick person. In the mean-
time the cleansing and disinfection were being efficiently and ener-
getically carried out by the municipal executive "as far as local con-
ditions allowed." Suitable houses in the town had also been set apart
as caste hospitals. In describing these arrangements, Surgeon-Cap-
tain Arnim, the Deputy Sanitary Commissioner, remarked that " there
is a marked opposition among the Municipal Commissioners and the
inhabitants of the town to the complete isolation which the removal
of the sick to the Lyari isolation sheds would necessitate ; indeed,
there is reason to believe that, at present at least, the feeling among
the townspeople would not admit of this segregation of all cases
at the Lyari sheds." The position stood thus when the Commissioner
in Sind arrived on the 3rd of January. He found that the municipal
executive was displaying the greatest energy, and that the disinfec-
tion of houses with corrosive sublimate solution was being
systematically prosecuted. But the caste hospitals were empty, and