NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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Measures in the City of Bombay.
[ CHAP. VII,
was the disease spread by the proximity of a plague hospital to other
dwelling houses, and notably there was an example in the Khoja
Hospital in Tantanpura Street, which had a number of patients and
was next door to an orphan school in which none of the children
suffered from plague."
Construction
and equipment
of Government
hospitals.
The following account of the plan of construction and general
arrangements of the hospitals is of great interest :—
"A scheme [of hospital organisation was proposed and a standard
plan of hospitals was designed, a special equipment of staff, stores,
furniture, and appliances, being drawn up on a ready basis, suitable
to any pressing demands.
Standard plan.
" In designing the hospital, a section was taken as the unit ; this held
20 beds in an area of 120 feet x 24 feet, giving each bed a superficial
area of 144 square feet—a somewhat liberal provision ; but bearing
in mind the necessity for attendance of one or two relatives with
the patient and looking to the fact that a large cubic space of fresh
air favourably influences the progress of recovery and lessens the
possibility of contagion, it was determined by the Committee to
adhere to the above measurements. Subsequently it was found
convenient to build half-section hospitals (10 beds) and quarter-sec-
tion hospitals (5 beds) in districts where few cases were anticipated.
" The standard adhered to, however, was that of a one-section
hospital, and to it was apportioned its standard equipment, so that on
an order being issued by the Committee for the institution of a hospital
of any proportion, the District Medical Officer had merely to follow
the orders laid down on the subject for a hospital of the size indicated.
This saved much delay in ordering staff, stores, etc., for any hospital,
more especially at outlying stations. Copies of the plan and equip-
ment of a one-section hospital were accordingly issued to the vari-
ous executive departments of the Committee and to all contractors,
with directions to regulate the construction of buildings and the
supply of stores, medicines and furniture accordingly.
" As will be noticed by referring to plan No. 4* attached to
the appendices of this report, the hospital was enclosed in a ring
fence constructed of bamboo matting fixed on bamboo uprights.
" The plan No. 4* shows a one-section hospital and is designed
to fit into the smallest area possible, viz., 140 feet x 160 feet, but wher-
ever more room was available, advantage was taken to spread the
buildings over more ground.
" The two wards for males and females were placed at the end
of the site further from the enclosure gate, and the accommodation
for families of patients was built near the door as far from the
* Reproduced on a reduced scale, Volume IV, page. 13.
CHAP. VII.]
Measures in the City of Bombay.
165
actual hospital as possible ; the arrangement shown was adhered
to, as far as feasible, in all Government hospitals.
"All hospital buildings were constructed of the lightest and cheapest
materials compatible with safety. The posts and framing were
of bamboo or benteak set well into the ground on a 12-inch plinth ;
the sides were of single bamboo matting ; the roof of two thick-
nesses of jowli or cadjan (plaited palm leaf in general use in tropical
countries) ; the latter in some instances lined. inside with cloth.
The whole hospital, inside and out, except the roof, was limewashed
at intervals.
" The cook-houses were constructed of corrugated iron, both roof
and sides, on wooden framing.
" Drinking-water was drawn from two or more taps to meet the
wants of the various castes.
Sanitary
arrangements.
" As regards sanitary arrangements, the privies were on the dry ;
system, the night-soil being removed by hand after being disin-
fected with perchloride of mercury or carbolic acid ; a washing
place, with one or more taps, with a paved space around it, was
always provided in a convenient position, and from that and the
bathrooms in connection with the nurses and hospital assistants'
quarters and the various cook-houses was led a small open drain
constructed of 4-inch stoneware pipes cut in half and laid on concrete,
connected either with cesspools or the nearest available drain.
"It has generally been found convenient to supplement the build-
ings shown on the plan by a general cook-house for the wards,
and an extra bathroom for nurses' quarters ; in some hospitals
which were continually full, a dispensary and office were also
given, otherwise a corner of one of the wards was made use of
for this purpose. It was also found desirable to place a width of
rabbit wire-netting round the lower walling of the mortuary, or to
supply a wire bier cover to prevent dogs interfering with corpses
lying therein; the mortuary was, wherever practicable, placed well
away from the hospitals and quarters.
"The cost of the buildings above described averaged annas 6 per
square foot of area covered ; the arrangements and style were found
to be eminently successful and the generality of Government hospitals
were much cooler than those of private hospitals located in permanent
buildings.
Staff.
"The staff of a one-section hospital was fixed as follows :—
2 Nurses,
1 Ayah.
1 Hospital Assistant.
4 Ward Orderlies.
1 Bheesty.*
2 Sweepers.
2 Nurses' servants.
1 Hospital cook.
* Water carrier.
106
Measures in the City of Bombay,
[ CHAP, VII
" If there were many severe cases, it was found necessary to
supplement the staff with an extra nurse, to increase the number
of ward orderlies, and when the caste and other conditions of the
patients required it, the number of cooks also. "
The fourteen Government hospitals that were in active work con«
tained 32 sections. According to scale this would give 64 nurses
and 32 hospital asistants.
Construction and
equipment of
private hospitals.
In private hospitals the arrangements were not on so regular
a plan as in the Government hospitals, but, as has already been
stated, they were controlled by a board and were subject to the
approval and supervision of the Committee and the District Medical
Officer. As an example, the Cutchi Memon Hospital, which was
opened on the 29th March, was established in an existing building.
On the ground floor there was accommodation for the relatives who
wished to remain with the sick. On the first floor there were separate
wards for males, females and children, a dispensary, a cook-room,
etc. There was also a convalescent ward. Again the Bohra Hospital
was established in a schoolhouse. The building contained three
blocks, one of which was used as a hospital and two for segregation
purposes. The hospital was furnished with twenty beds and con-
tained room for more. Room was also provided for the relatives of
the patients. The persons in the hospital were lodged, fed and nursed
free of charge, and arrangements were made to provide the services
of a practitioner in native medicine should they be required.
Precautions
against infection
in hospitals.
Ward attendants.
The following regulations were issued with regard to precautions
to be observed against infection in hospitals :—
" Ward attendants on the sick.—Each attendant will be furnished
with two suits of ward clothes.
A suit will be put on before going on duty.
On coming off duty, the suit will be soaked in a disinfectant
(carbolic, 5 per cent., or perchloride of mercury solution) and dried in
the sun.
All the clothing of men about to rejoin their regiment should be
disinfected before they leave the hospital compound.
Patients.
" Patients.—A patient on admission will be undressed and well
washed with hot water and carbolic soap. Hospital clothing will be
supplied.
All articles not worth preserving will be at once burned under the
supervision of some responsible person.
There being no steam disinfector available, clothing of any value
should, if of cotton, be boiled for three hours in a 3 per cent, solution
CHAP. VII. ]
Measures in the City of Bombay.
167
of soft soap in water, or steeped in perchloride of mercury solution
before being washed.
Wards.
Woollen clothes worn by the patient should be burned.
" Wards.—The boarded floors should be swabbed twice daily with
perchloride of mercury solution.
The whole of the stone floors will be whitewashed with freshly
made limewash at least once a week.
Should any discharge from a patient fall on the floor, it must be at
once covered with carbolic powder and swept up. Perchloride of
mercury solution should then be applied to the spot, and fresh
whitewash applied to the stone floor. Crockery and glassware should
be washed in a 5 per cent, solution of carbolic acid before it is
allowed to leave the ward.
Beds will be limewashed after a patient's recovery or death; the
straw burned, and the bedding disinfected.
Excreta.
"Excreta.—A small quantity of some disinfectant, such as carbo-
lie-powder, lime-water, perchloride of mercury solution, or chloride of
zinc solution should be placed in each bed-pan before use. After use,
the motion should be covered with a similar disinfectant before
being taken out of the ward.
The solid excreta will be destroyed in the incinerator.
After use, the bed-pans should be scalded with hot water. "
Sanitary
precautions in
the Grant Road
Hospital.
As an instance, the following is the description given of the
sanitary precautions adopted in the Grant Road Hospital :—
"Disinfection consisted in adding perchloride solution 1—1,000 to
every excretion, whether evacuations, urine, vomited matter, or suppur-
ated discharges, and as far as possible to pulmonary expectoration.
1—1,000 solution of perchloride of mercury or a 5 per cent. solution of
carbolic acid was ever ready in the wards to wash the hands, sponges,
or instruments used in connection with cases.
"Rags or linen squares used as dressings or to wipe up excretions
and sputa being of no value were burnt.
" Bedding, as sheets, blankets, pillow slips, etc., and clothing were,
ou being changed, saturated with a one per cent. solution of per-
chloride of mercury then exposed in the sun till dry and subsequently
washed in the ordinary way by a resident dhobie.
" The general latrines for native employés and convalescents
were treated twice a day with carbolic-powder. The evacuations
received in an iron vessel with deep sides to prevent splash were
disinfected with a 1—1,000 corrosive solution and every night
conveyed to a special night-soil cart for disposal, "
168
Measures in the City of of Bombay.
[ CHAP. VII.
Medical and
nursing staff.
The following details of the medical and nursing staff in the
Government hospitals are mainly taken from the hospital* reports
given in Chapter 2 of General Gatacre's Report, and from Appendix 7*
of the same report :—
Number
of OX
hospital.
I
2
3
4
6
8
9
10
14
15
16
17
18
19
Name.
Pilot Bandar
Jamsetji Bandar
Modikhana
Charm Road
Grant Road
Wari Bandar
Narialwadi
Reay Road
Arthur Road
Parel
Sion
Mahim Conservancy ...
Worli
Jullaia Muhammadan
Number
of
district.
I
I
II
V
VI
IX
IX
IX
VIII
X
X
X
X
VIII
Medical
officers.
(c)
(a)
2
I
(a)
I
(a)
(a)
I
2
2
I
I
I
(b)
I
Subor-
dinate
medical
officers.
I
2
3
2
2
2
I
...
3
3
1
2
I
Compoun-
ders.
I
...
...
...
I
...
...
I
I
...
...
I
...
I
Nurses.
...
4
3
3
16
3
2
2
7
00
2
7
2
(a) Not stated.
(6) The doctor was a Muhammadan who treated according to the native system of medicine.
(c) The medical officers were either Commissioned Medical Officers or private practitioners.
* The figures in the hospital reports and in the appendix do not in some cases agree ; the figures from
the reports have been taken.
CHAP. VII.]
Measures in the City of Bombay.
169
The following details are taken from the reports of the private
hospitals :—
Number of hospital.
I
2
3
4
5
6
7
9
10
II
14
15
17
20
21
22
23
24
25
26
27
Medical officers.
I
I
2
2 (a)
2 (b)
I
I
2
I
I
I
2
3 (0
1
1
1
4 (d)
X
1
2
I
Subordinate medical
officers.
I
2
I
...
...
...
I
2
I
...
...
I
I
I
I
...
I
...
...
Compounders.
I
I
2
...
I
...
I
...
...
...
I
I
...
...
...
...
...
...
I
...
Nurses.
3
2
...
2
...
...
I
...
...
..,
...
...
2
1
...
...
I
I
2
...
(a) Also a lady doctor. (b) One of these was a hakim or practitioner in native medicine.
(c) Two of these were hakims. (d) One consulting officer, two in charge and one for night duty.
22
170
Measures in the City of Bombay.
[ CHAP. VII.
There were not many nurses in these private hospitals, but female
attendants (ayahs) were employed in almost all cases.
Difficulty of
procuring
nurses.
The nursing staff was a matter that presented some difficulty as
there was no considerable permanent staff of nurses on which to draw.
Aid given by the
Roman Catholic
convents.
Nurses procured
in India and
from England.
The difficulty was in the first place met by the help afforded by
the Sisters of the Roman Catholic Institutions in Bombay—the convents
at Clare Road, Grant Road, and Mazagon. Nurses trained in India
were also procured from different parts of the country, and twelve
nurses were brought out from England.
General
supervision of
nurses.
The Reverend Mother Superior, All Saints' Sisters, Mazagon, under-
took the duties of the general supervision of the nurses, whilst for all
purposes of hospital nursing and discipline they were under the charge
of the officer in charge of the hospital or the District Medical Officer.
Classes and
remuneration of
nurses.
The nurses were divided into the classes of Matrons, Senior
Nurses, Junior Nurses, and Subordinate Nurses. They were paid
according to the following scale :—
Matrons
Senior nurses
Junior nurses
...
Subordinate nurses
Rs.
150
100
80
20 to 30
In all cases quarters, food, light, etc. (or an allowance in their
stead) were provided in addition to salary. The nurses engaged in
England were paid at the rate of Rs. 175 a month.
Duties of
nurses.
The duties of matrons and senior nurses were as follows :—
The management of servants ; the charge of nurses' messes ; the
supervision of all ward arrangements; the supervision of the cleansing
of wards, latrines, etc., and of the disinfection of clothes ; the control
of nurses, ayahs, ward boys, etc., the disbursement of all petty cash.
The duties of junior and subordinate nurses were as follows : —
To assist the matron generally ; to be responsible during her tem-
porary absence ; to go round with the doctors ; to receive orders and
to see to their execution.
Useful and
devoted work
of the Roman
Catholic
Sisters.
The Sisters from the convents displayed great devotion in the
performance of their task. Their care went far to reconcile the
people to the hospital system, and several instances are cited in Gene-
ral Gatacre's report to show the usefulness of their ministration and
the gratitude which it evoked. One of the Sisters, Sister Elizabeth
of the Bandora Convent, died a victim to the plague in the prose-
cution of her duty. General Gatacre concludes his account of the
work of the Sisters in the following passage :—
"The special features of the plague from the point of view of the
Sisters who had to deal with it, were the state of filth in which the
CHAP. VII. ]
Measures in the City of Bombay.
171
majority of the patients arrived, the sickening odour of the buboes, and
the violence of the patients, many of whom had at first to be tied
down to their beds to prevent their leaping out in an attempt to escape.
The fortitude with which the Sisters faced these horrors in the perform-
ance of their self-imposed tasks was well rewarded by the triumphs over
the prejudices of their patients and by the evidence of the gratitude felt
by them. In other measures, necessary and well-managed though
they were by the officers in charge of them, taken for the suppression
of the plague, the people at large at best gave a silent acquiescence.
But the record of services rendered by the Sisters, and the gratitude
evoked by them, forms one of the most pleasing pictures in the history
of the plague. "
Aptitude of
the English
nurses.
In the report on the Grant Road Hospital it is stated that the
nurses from England exhibited great aptitude and intelligence, both
medical and surgical, in the discharge of their duties, and were a credit
to the hospitals where they had received their professional educa-
tion.
The Bombay Plague Committee gave similar testimony to the
good work done by the lady nurses from England.
Sanitary
condition of
burial-grounds.
Closure of the
Grant Road
Muhammadan
burial-ground.
DISPOSAL OF CORPSES.
In the disposal of corpses the matter principally looked to was the
condition of the burial-grounds. It has already been stated that
the supervision of the sanitary condition of cemeteries was one
of the duties entrusted to the District Medical Officers. A measure
of particular importance enforced in this connection by the Govern-
ment of Bombay was the closure of the Grant Road Muhammadan
burial-ground. This cemetery is situated in a densely populated
portion of the city, and its overcrowded condition made the continu-
ance of its use, and especially its use for the burial of plague patients,
a menace to the health of the population. The cemetery was closed
under an order of the Government which was issued under the
Epidemic Diseases Act on the 21st April, and new burial-ground in a
more suitable situation was presented to the Muhammadan commu-
nity by the Municipal Corporation.
Last rites
performed by the
relatives.
The actual disposal of the bodies of persons who died of
plague was left, as far as possible, to the relatives and friends of the
deceased, who performed the last rites according to the custom of
172
Measures in the City of Bombay.
[ CHAP. VII.
General rule for
observance in
hospitals.
their sect, subject only to such sanitary supervision as was essential.
One of the standing rules for observance in hospitals was that the
body should be wrapped in a sheet soaked in perchloride of mercury
before being handed over to the friends of the deceased.
Arrangements in
the Grant Road
Hospital.
The following description is given of the manner in which corpses
were treated in the Grant Road Hospital :—
" All persons who died were removed to the mortuary and, pending
removal to the cemetery, were sprinkled over with carbolic-powder.
On removal their bodies were washed with a solution of phenyle and
afterwards rolled in a sheet saturated in solution of perchloride of
mercury. When friends provided their own burial arrangements for
the dead and dressed the body in new clothing, the disinfecting sheet
was not omitted. When friends desired a private burial for their
dead and had no means to carry out their intentions, money was
given them from the Pollen Fund, or they were assisted with money
and new clothing from the hospital stock. "
Biers,
Biers were supplied in each hospital of the district for conveying
bodies to the cemetery or burning-ground.
Relatives of the
sick compelled to
evacuate infected
rooms and
houses and
accommodated
in segregation
near the
hospitals.
SEGREGATION OF PERSONS LIKELY TO BE INFECTED.
Very little is said in General Gatacre's report about the segre-
gation of the persons who occupied the same portion of a tenement or
the same house as the sick person, but it is to be gathered that all
such persons were compelled to vacate the room or house to allow of
its disinfection, and that they were in general segregated in the
neighbourhood of the hospital in which the sufferer was being treated.
It will be remembered that on the 23rd March an addition was made
to the notification appointing the Plague Committee specially
authorising the segregation, for a period not exceeding ten days,
of the inmates of an infected building. In the public notice issued
by the Committee shortly after its formation, the following passage
occurs: "When a sick man has been taken away from a room, his
family shall also vacate such room and shall take care of and tend
the sick man."
In the standard plan for Government plague
hospitals provision was made, it has already been seen, for accommo-
dating the families of sick persons, and the details of both Govern-
ment and private hospitals show that a large number of persons were
segregated in this manner.
Disinfection of
houses and their
contents,
TREATMENT OF INFECTED AND INSANITARY BUILDINGS.
The disinfection of the house and of its contents formed the sequel
to the Justice's visit. The following is the account given by
CHAP. VII. ]
Measures in the City of Bombay,
173
General Gatacre of the prescribed procedure :-—
" I. Immediately a patient is removed from a room, the disinfect-
ing staff should be ready and brought into operation.
" 2. All rags, bedding, clothing of the patient and kutchra* generally
should be carefully lifted up and removed and burned outside the
building. In placing the articles outside, they should be carefully
laid down so as not to raise dust.
" 3. No brushing of walls or floor should take place ; this is a most
dangerous proceeding and is calculated to spread infection.
"4. The first work in all instances is to flood the floor with a
solution of perchloride of mercury not weaker than 1 in 1,000, the
junctions of floor and walls and all corners should then be mopped
with the solution as well as the wall, as far as the mop will reach,
and above this a small hand-pump should be used ; the floor, if made
of earth, should then be dug up to a depth of four inches.
"5." All furniture that can be dealt with should be likewise disin-
fected with perchloride of mercury solution, either with a pump or
with a cloth dipped in perchloride solution.
" 6. After the above work has been thoroughly done and the
solution has dried, quicklime in a hot state, and in as strong a solution
as possible, should be laid on all the walls, floor and ceiling.
" 7. In the crent of the whole house requiring disinfection, the
privies should be attended to at first, not forgetting the shafts, then
the staircases and corridors should be operated upon ; lastly, the
rooms in order, first by washing every part with perchloride of
mercury solution and laying on the quicklime as described in para-
graphs 4 and 6.
"8. All nahanis† and nahani pipes should be carefully disinfected by
flooding them with perchloride of mercury solution, and where neces-
sary, they should be altogether removed and replaced with new ones
at the cost of the owner of the premises.
" In the case of the poor, a small money grant was made them as
compensation for articles destroyed. Property, the destruction of
which would inflict great loss on the owners, was moved out into the
road and left there, exposed to the sun and air for three days, a guard
being placed over it. The contents of shops and godowns in which
cases of plague occurred were treated in a similar manner.
" Besides the actual disinfection and limewashing of the inside of
the houses affected with plague, a steam flushing engine was obtained
and the outside of the premises was thoroughly washed down,
and the gullies and drains and nahani traps well flushed with disin-
fectants.
* Refuse.
† Drains,