NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. IX. ]
Measures outside the Bombay Presidency.
267
Cleansing of
towns in the
North-Western
Provinces and
Oudh.
In the North-Western Provinces and Oudh strenuous efforts
were made to protect the country by improving its sanitary condition.
Whitewashing and disinfecting operations were extensively carried
out, insanitary privies were put into a wholesome condition, and the
Lieutenant-Governor stated that the result of these and other similar
measures was to place every city and town in a condition of cleanliness
unknown in their previous history.
FINANCIAL.
Summary of
previous
remarks about
incidence of
expenditure.
Rules made
by Local
Governments
regarding
ncidence of
expenditure.
In the chapter describing the measures adopted in the Bombay
Presidency the incidence of the cost of plague operations was
explained. It will be remembered that the cost of all local remedial,
preventive, and sanitary measures fell, in accordance with the financial
system of the country, on the funds of local bodies, municipalities, dis-
trict boards and the like ; and that the Government consented to defray
from general revenues the cost of the extra establishment and the
special accommodation, etc., required for the system of railway inspec-
tion. The following orders with regard to the incidence of plague
expenditure were issued by the Governments of Madras, Bengal, and
the Punjab.
Madras.—The rules for the establishment and maintenance of
hospitals and the payment of compensation provide that the cost shall
be met by municipalities or district boards as the case may be.
Bengal.—The Bengal regulations prescribe that all expenditure
not directly paid by private persons shall in the first instance be
paid from municipal or district funds, or from loans made under the
Local Authorities (Emergency) Loans Act, 1897. Recovery may be
made from private persons in cases where they would under similar cir-
cumstances be liable to pay under the Municipal or Cantonment Acts.
The Punjab.—The rule runs as follows :—
" The Local Government may determine in what cases or classes of
cases any charges for the provision of accommodation, diet and treat-
ment for persons detained under these regulations and any sums
payable as compensation under them shall be defrayed or paid by
any local body : and such local body shall thereupon become liable
to defray such charges or pay such compensation accordingly.
" In every case in which any charges are to be defrayed or any
compensation is payable under these regulations for which no local
body is liable under an order issued under the last preceding clause or
under any other law or rule having the force of law, such charges shall
be defrayed or compensation shall be paid by the Local Government.
"Provided that nothing in this clause shall be deemed to prevent
the Local Government from recovering any moneys thus paid from
268
Measures outside the Bombay Presidency.
[CHAP. IX,
any Native State or Railway Administration or Railway Company
when such moneys are by agreement or otherwise so recoverable."
Hardwar and Kankhal.
The Hardwar
Municipal
Union,
The three small towns of Hardwar, Kankhal and Jawalapur form
the Hardwar Municipal Union in the Saharanpur District of the North-
Western Provinces.* A short branch of the Bengal and North-
Western Railway runs from Laksar Junction (near Roorki) to
Hardwar. Hardwar is one of the great pilgrim centres of India;
Hindus from all parts of the country flock to the place at certain
periods of the year to bathe in the Ganges. The existence of plague
at a centre of this nature was a formidable menace to the health of the
whole country.
Hardwar
outbreak of
April to June
1897.
Kankhal
outbreak of
September to
November 1897.
The first outbreak occurred at Hardwar in April and was probably
due to infection carried by pilgrims from Sind. The vigorous and well
devised measures that were adopted stamped out the disease, after the
occurrence of eighteen ascertained cases, by the end of the first week
in June. The outbreak at Kankhal began in the middle of September
and by the 4th November fifty-one cases had occurred. The disease
then quickly abated and the last case occurred on the 10th of Novena--
ber.f
North-Western
Provinces
Government.
Resolutions
describing
operations at
Hardwar and
Kankhal,
In a resolution, dated the 22nd July, the Government of the North-
Western Provinces and Oudh published a full account of the measures
successfully adopted to combat the outbreak at Hardwar, and in a
resolution of the 4th November an account was given of the events con-
nected with the Kankhal outbreak up to that date. These two resolu-
tions give a very clear account of the measures enforced and their
effect on the course of the disease ; they are reproduced in full below.
HARDWAR.
Religious fairs of
April.
" Up to April 1897 no report of the appearance of bubonic plague
at Hardwar had reached the Government; but in the month of April
1897 two large and important bathing fairs were held at Hardwar—
the first (Amawas) on the 2nd April, and the second (Adha Kumbhi]
on the 11th, at which it was expected that pilgrims from plague-
infected areas would attend. It is estimated that at the first fair
about 40,000 people were present, and at the second about 200,000.
Many of those who came to the first fair remained at Hardwar for the
second.
Arrangements
for dealing with
the pilgrims.
" Special arrangements were made for dealing with the large
number of pilgrims expected to attend the fairs and for preventing
* See Map, Volume IV, page 14.
† Some other cases have since occurred in the neighbourhood,
CHAP. IX. ]
Measures outside the Bombay Presidency.
269
if possible, the importation of the bubonic plague by pilgrims coming
from plague-infected areas. In addition to the ordinary examination
of railway passengers by medical officers appointed for the purpose
at Saharanpur and Ghaziabad junctions in accordance with rules
made under the Epidemic Diseases Act, every passenger was exam-
ined at Pathri railway station close to Hardwar by a staff of hospital
assistants helped by vaccinators. Those pilgrims who were found
to have come from infected centres were sent on to Hardwar in
locked carriages, and were conveyed on arrival to a camp of obser-
vation on Rori Island, where suitable arrangements had been made
for their accommodation. They were required to sleep and cook
their food on the island, but were allowed to go to Hardwar to bathe
and buy food, etc. They were examined morning and evening by the
hospital assistant in charge, and no disease occurred amongst them.
Sanitary
arrangements.
* Sanitary police ...
Vaccinators
Sweepers and mates
‡ Cliaukidars
34
36
500
130
" Pilgrims coming by road were also inspected, and every
endeavour made to keep infection out of the town, not only by separa-
tion of suspected persons, but also by effec-
tive conservancy arrangements. The site of
the fair was kept clean by a large staff,*
and particular attention was paid to the
sanitary condition of the three towns—Hardwar, Jawalapur and Kan-
khal—comprising the municipality of the Hardwar Union.† Besides
the district staff of Magistrates and police, the following medical
officers were present :—
Medical Staff
present.
Surgeon-Major S. J. Thomson, D.PH. (Camb.), Sanitary
Commissioner, in charge of the sanitary arrangements.
Surgeon-Captain J. Chaytor-White, Deputy Sanitary Com-
missioner.
Surgeon-Major J. F. Touhy, Civil Surgeon of Saharanpur, in
direct charge of the medical arrangements.
Surgeon-Captain T. F. Kelly, on special duty.
Surgeon-Colonel.T. H. Hendley, C.I.E., Officiating Inspector
General of Civil Hospitals, also visited the town during
the course of the fairs, and Surgeon-Major D. S. Reade,
A.M.S., Plague Commissioner, early in May.
Hospital and
segregation
accommodation.
" In accordance with the general orders issued by Government in
connection with prevention of the plague, cottage hospitals or huts
had been provided—some for posssible plague patients, some for the
segregation of relatives and other persons attending plague patients,
and others for the observation of doubtful cases. A general hospital
had also been constructed on the outskirts of the town for the reception
of persons suffering from plague, for whom separate accommodation
† See Map, Volume IV, page 14.
‡ Village policemen.
270
Measures outside the Bombay Presidency.
[ CHAP. IX,
was not needed. This hospital had separate accommodation for males
and females.
Agency for
detecting cases.
" A reporting agency consisting of sanitary police, vaccinators
and chaukidars, under the control of an Assistant Superintendent
of Vaccination, was established for the patrol of the areas concerned
and for the reporting of cases of illness and death. It is believed
that these duties were efficiently performed, and reports promptly
made. The Sanitary Commissioner reported that there was no cholera
and that 'during the whole progress of the two fairs, with this great
concourse of people, only about half a dozen fatal cases of disease
occurred.'
Some of these cases unfortunately consisted of. cases
of bubonic plague.
First plague
cases.
" Up to the 11th April, the date of the second fair, two cases of
plague had been detected, which were followed by six more in the
same month : details of the eight cases are given in the statement
attached.* The first case, which was reported by the police on 8th
April, led to the inspection of a pilgrim lodging-house, in which a
women was found to be recovering from a disease which was prob-
ably plague. It is supposed that pilgrims from Sind or other infected
quarters must have brought infection to her house, which was
specially frequented by Sindi pilgrims prior to the fair. On a thorough
examination of the houses in the neighbourhood three more cases were
discovered, and three more were subsequently reported—one on the
15th, one on the 18th, and one on the 22nd April.
Precautions
adopted.
Examination
of pilgrims.
" All these cases, except one, occurred in a muhalla or quarter fairly
detached from the main body of the Hard war town. They were dealt
with by the sanitary authorities in accordance with the rules issued
by this Government on the 25th March 1897 under the Epidemic
Diseases Act : and the precautions prescribed in those rules, such
as the disinfection of the houses and of personal effects and the
segregation of relatives, were duly adopted. As a further precaution,
pilgrims leaving Hardwar were examined at the Hardwar railway
station and on the roads leading from the town : no cases of plague
are known to have occurred in any part of the country traceable to
these returning pilgrims.
Visit of the
Lieutenant-
Governor (Sir A.
P. MacDonnell).
" On the occurrence of the last case [No. (8)] it became clear
that further measures of a more stringent nature were required. On
the 27th April the Lieutenant-Governor discussed these measures
with the local authorities and the Sanitary Commissioner at Saha-
ranpur, and before coming to a final conclusion on the subject, visited
Hardwar on the 28th, where he met the members of the Municipal
* Not printed.
CHAP. IX. ]
Measures outside the Bombay Presidency,
271
Board, the mahants or priests controlling the temples, and the leading
Brahmans of the town. The existence of bubonic plague in the
place was not denied, and after full consideration of all representa-
tions made the Lieutenant-Governor decided—
Evacuation of
infected areas.
(a) that the infected area* (i.e., the area in which all the cases
but one had occurred) should be placed in quarantine and
evacuated, the inhabitants either leaving Hard war alto-
gether, after examination by, and with the permission
of, the Health Officer, or removing to a camp of observa-
tion established at some distance from the town in charge
of a medical officer : the names and addresses of those
leaving to be forwarded to the authorities of the district of
destination ;
Treatment of
houses.
(b) that after evacuation the houses should be thoroughly cleaned
and disinfected, and should not be re-occupied until
declared safe :
Examination of
corpses.
(c) that all dead bodies should be examined by a medical officer
before burial or cremation (as a further safeguard against
concealment of plague) ; and
(d) that all pilgrims to Hardwar from infected places should
reside in a special camp under medical observation.
Pilgrims made
to reside in
special camps.
" The Lieutenant-Governor acknowledged the good spirit in which
his proposals were received after their necessity had been explained
to the local gentlemen assembled at the meeting.
" Orders giving effect to this decision † were issued on the 1st
May 1897. The evacuation of the infected area was forthwith car-
ried out without difficulty, and steps were at once taken for the
systematic cleansing of the muhalla in the prescribed manner. All
huts and temporary structures were either demolished or burnt (com-
pensation being paid), and the permanent structures and houses
disinfected. This may be said to be the close of the first part in the
history of the outbreak.
Discouraging
pilgrimages to
Hardwar.
" During May the question presented itself,—whether, in view of
the great danger of disseminating plague through India from such a
centre of pilgrimage as Hardwar, it was desirable to prohibit the fairs
or bathing festivals which were fixed for the 31st May and 10th June.
The Lieutenant-Governor was advised by eminent Hindu authority that
these fairs might without objection be stopped in view of the danger of
the spread of infection by persons visiting Hardwar. But Sir Antony
MacDonnell was most unwilling to add to the hardship which the
adverse times had imposed on the people, by stopping pilgrimage to
their great shrines at Hardwar: he thought it best to make widely
* See Map, Vol. IV, page 15,
† Appendix VII.
272
Measures outside the Bombay Presidency.
[CHAP. IX.
Pilgrim camp.
known the dangers which pilgrims would incur ; to discourage pilgrims
from undertaking the journey on this occasion ; and to place pilgrims
visiting Hardwar, while there, under strict regulations. A notice was
accordingly issued in a Government Gazette Extraordinary on 17th
May, warning intending pilgrims that it was dangerous to visit
Hardwar, and intimating that if they did so, they might be required
to live in a camp outside Hardwar under medical observation. At
the same time the Government of India, at the instance of this Gov-
ernment, reduced the facilities for travelling by railway to Hardwar.*
As it was certain that many pilgrims would visit Hardwar by road,
having travelled in many cases for part of the way by rail, an order
was issued by this Government under the Epidemic Diseases Act,
requiring all pilgrims arriving at Hardwar, whether from plague-
infected centres or not, between the above-mentioned dates, to live
in a camp provided for their occupation outside the town. The prac-
tical effect of this was to deter from the pilgrimage those who were
not bent on making it this year, to close all pilgrim lodging-houses in
the town of Hardwar, and to place all arrivals under medical obser-
vation, without interfering in any way with religious observances.
Arrangements were made for escorting pilgrims from the camp to
the shrines and sacred pool at Hardwar for the purpose of bathing,
etc., and for bringing them back when the ceremonies were concluded.
They were advised to return home as soon as possible. A member
of the municipal board or one of the leading mahants supervised
the details of the arrangements, and rendered valuable assistance ;
a special hospital assistant was deputed to the Roorkee railway
station to examine returning pilgrims and others who might have
evaded inspetion by travelling as far as Roorkee by road. It may
be noted that not a single case of plague occurred amongst the
pilgrims.
Sanitary
arrangements.
Fresh cases of
plague.
"All this time the utmost care was bestowed on the cleanliness
and sanitation of the town, and the limewashing and disinfection of
the houses was carried out without intermission. Between the 22nd
April and the 16th May no case of plague is reported to have occurred
at Hardwar. The caretakers residing in the infected area were free
from disease, also the persons who had removed from the infected
area to the camp of observation. But on the 16th May a pujari or
attendant at a temple who had visited, and probably slept in, the
infected area died of plague (case No. 9 in list attached), and subse-
quently, at intervals between the 17th May and 8th June, nine cases
occurred in a part of the town outside the infected and evacuated area.
Details of the cases are given in the list attached.†
* See Home Department Notification No. 1578, dated the 16th May 1897, Appendix
VII, page
† See Map, Vol. IV, page 15.
CHAP. IX.]
Measures outside the Bombay Presidency.
273
Detection of
cases.
Sanitary
arrangements.
" The occurrence of these cases stimulated the already strenuous :
efforts which were being made by the local authorities and the sanitary
officers to free the town from infection. Special attention was paid
to the registration of mortuary statistics, the examination of every
dead body with a view to the prevention of concealment of cases of
bubonic plague being specially insisted on. A systematic examination,
not only of all houses and buildings, but an inspection of every room,
were ordered, the town being divided for the purpose among the officers
available for duty. All rubbish was destroyed, old clothes, etc., disin-
fected, and huts unfit for human habitation demolished. Special atten-
tion was paid to the prevention of overcrowding ; and the coolies
employed near Hard war on the Hardwar-Dehra Railway works were
required to live under supervision in a camp established outside the
town for their occupation.
Staff.
" The operations were carried out under the orders of the follow-
ing officers :—
Mr. E. F. L. Winter, I.C.S., Collector of Saharanpur.
Mr. E. A. Kendall, I.C.S., Sub-divisional Officer of Roorkee.
Surgeon-Captain J. Chaytor-White, Deputy Sanitary Commis-
sioner.
Surgeon-Captain A. W. Dawson, on special duty.
Surgeon-Captain Kelly (temporarily).
Surgeon-Captain Berter (on special duty).
Bacteriological
examination of
suspicious cases.
" Orders were issued deputing Mr. E. H. Hankin, Government
Bacteriologist, who was recalled from Bombay for the purpose, and
Surgeon-Captain Milne (who had had clinical experience of the disease
in the Bombay Presidency) to Hardwar for the purpose of assisting the
medical officers on duty there in diagnosing doubtful cases of plague.
" It was reported by the Collector on the 2nd June that Hardwar
was, in his opinion, cleaner than any other town in India.
Watching the
neighbourhood.
" While special attention was thus paid to Hardwar itself, the
neighbouring places were not overlooked. At Rikhikesh, 13 miles
from Hardwar, a place much frequented by pilgrims, a hospital assist-
ant was posted on duty, and though one man (case No. 14) who died
of plague at Hardwar came from Rikhikesh, no trace of the disease
could be discovered in that village. The Lieutenant-Governor directed
that all villages in the Roorkee subdivision to which Hardwar people
might have gone should be specially looked after, and a hospital assist-
ant travelled regularly from village to village near Hardwar for the
purpose.
Precautionary
arrangements in
neighbourhood.
" As great danger existed of the spread of plague to the adjoin-
ing towns of Kankhal and Jawalapur, orders were issued that their
sanitary condition should be carefully examined and houses, etc., clean-
ed and disinfected where necessary. In order to keep a watch upon
35
274
Measures outside the Bombay Presidency.
[CHAP. IX.
persons residing in these towns who had previously lived in Hardwar
or who frequented Hardwar in the course of their daily occupations, a
list was prepared of their names and residences. Such persons were
inspected from time to time by medical officers, and their clothes
and houses disinfected.
Disinfection of
clothes.
" As no provision existed in the general rules for disinfection of
the clothes, etc., of wandering beggars and travellers, many of whom
pass through Hardwar, an addition was made for the purpose to rule
32 of the rules of 26th March 1897, and the clothing, etc., of such
beggars and travellers were disinfected before they entered the
inhabited area.
" The regulation requiring all pilgrims visiting Hardwar to live
in a camp remained in force till 12th July 1897, the period having
been extended for one month.
Probable
introduction of
the disease from
Sind.
" The Plague Commissioner, Surgeon-Major D. S. Reade,
A.M.S., considered it 'conclusively proved that the disease was
brought to the district by pilgrims from Sind and probably from
Karachi :' he thought 'that the outbreak was probably caused by
clothes brought from an infected area, the evidence pointing to the
person or persons who brought the clothes remaining unaffected.'
The evidence that has been collected undoubtedly supports the view
that the disease was imported from Sind.
Location of the
plague cases.
" The first seven cases occurred within 130 yards of one another
in a definite portion of the town, the evacuation of which for purposes
of disinfection was possible : the remainder* were scattered over an
area lying between the Ganges and the upper road from Hardwar to
Mayapur, and disinfection was therefore carried out without evacuation.
Subordinate
staff.
"To assist the officers named in paragraph 10, the following tempo-
rary establishments in excess of permanent staff were employed in
the Hardwar Union :—
Assistant Surgeons
Hospital Assistants
Female Hospital Assistants
Vaccinators
Conservancy Inspector
Sweepers
† Bhistis
‡ Kahars and beldars
Head Constables
Constables ...
§ Chaukidars
TOTAL
2
3
2
13
1
117
6
56
8
25
77
310
* The places at which the cases occurred are shown in the map in Volume IV, page 15.
† Water-carriers.
‡ Workpeople,
§ Village police.