NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. VIII.] Measures in the Bombay Presidency and Sind. 225
Attitude of the
people prevented
compulsory
segregation of
the sick.
every one recognised that the segregation of the sick could in the
then existing state of popular feeling only be carried out by force.
After carefully reviewing the position, the Commissioner came
to the conclusion that compulsory segregation must not be enforced,
and that means must be taken to allay alarm and conciliate the people.
The Mtihammadan communities formed the major portion of the popula-
tion, and they declined even to set apart accommodation for the sick,
It was determined to obtain the assistance of Muhammadan doctors, and
a lady doctor and Muhammadan doctors were accordingly provided. At
this time also the Municipality was divided into districts to each of
which the Municipality appointed an inspector. Later on, the various
districts were placed in charge of medical officers, members of the
Indian Civil Service, and other gentlemen.
Spread of the
disease.
First attempt at
evacuating
infected
quarters.
From the beginning of January the disease increased rapidly
and the question of the evacuation of the infected quarters, which
was recommended by the Government of India on the advice of their
Sanitary Commissioner, was then taken up with serious attention.
The name of Mr. Strachan, the Secretary and Engineer of the
Municipality, is specially associated with the successful endeavours
made to remove the inhabitants from the source of infection. He
first caused an encampment of huts to be erected across the Lyari,
but well away from the Muhammadan settlements. At the same
timie Mr. Tahilram, the President of the Municipality, and the
Collector of Karachi, were persistent in their efforts to persuade the
Nasarpuris, a sect of well-to-do Hindus, occupying good houses in
the Old Town (the infected locality) to move into the camp.
Removal of the
Nasarpuris to
camp.
"For these people to live in mat huts," Mr. Wingate stated, " was
a degradation from which they shrank. Eventually, they agreed to
move, but only in their own conditions. These were wisely agreed
to. To get the Old Town quarter completely evacuated and set an
example that would silence prejudice were the objects in view.
At this stage compulsion would have scattered the population like
sheep, and distrust of the authorities would have been spread through
the land."
The Nasarpuri
camp.
When Mr. Wingate paid a visit on the 23rd January, he found that
the health camp had just been occupied by 2,000 Nasarpuris. He
states that the camp did Mr. Strachan very great credit. " It was
well laid out, with water pipes and bathing platforms ; in fact, the
Municipality had spared no expense to make the camp attractive and
convince the people that the desire was to save, not to kill. As an
instance of the feeling at the time, a few days later a party would
not enter ready-made huts, saying the huts might be poisoned, but
they accepted new materials and made their own huts. It was not
then known that plague affects the heart and the sudden deaths of
29
226 Measures in the Bombay Presidency and Sind. [CHAP. VIII.
people, not apparently very severely ill, gave ignorant imagination
its opportunity."
Visit of Dr.
Cleghorn.
About this time Surgeon-Major-General Cleghorn visited Karachi
and found the disease centred in the quarters, named Old Town, Machi
Miani, Market and Bandar. These localities all lie in the main part
of the town on the east of the Lyari River. He found nearly four
hundred huts erected in the health camp and occupied by 2,500 to
3,000 Hindus. The huts were built separately and arranged along
wide streets. All sanitary requirements were carefully attended to.
The Muhammadans had also agreed to turn out of their houses, and
huts were in course of construction for their occupation,
The inmates of the first camp were persuaded to migrate to them
only on their own terms, and it was not at first possible to institute the
careful medical supervision and precautionary measures which were
afterwards adopted with such success in the health camps both of
Karachi and of other plague centres.
Extension or the
evacuation
system.
General remarks
on the health
camps.
The experiment of evacuation and residence in health camps
having once been successfully started, it was soon extended, and as
the disease spread to new quarters, the measure was found to be
eminently successful in checking its virulence and its progress. In the
end as many as forty-four camps were constructed. Of these, thirty-
one were health camps,* nine were segregation camps for persons
who had been exposed to infection, and four were observation camps,
On the 11th of May the total population of the camps was 6,147
and on the 26th May it was 5,978. From the 8th March there were
242 seizures and 144 deaths in the different camps. Before the 7th
March there were 56 deaths. A detailed statement of the health
camps is given in Appendix VI.
Operations in
progress at the
end of January.
This brief account of the health camps has anticipated the course
of events. In the first week in February the epidemic reached its
climax. At the end of January the operations in progress were briefly
as follows :—
Cleansing and disinfecting streets and lanes.
Vigilant house-to-house inspection.
Supervision of burial and burning grounds.
Thorough disinfection of plague-infected houses.
Destruction of infected clothing.
Burning of infected huts.
Preparation of large health camps and persuasion of the
inhabitants to move into them.
Ventilation of houses by making holes in the roof and walls.
* Nine of those were closed before the nth May,
CHAP. VIII. ] Measures in the Bombay Presidency and Sind. 227
No segregation
of the sick.
Revision of
disinfecting
organisation and
increase of staff.
There was practically no segregation of the sick and no medical
treatment. The disinfecting work had also fallen into arrears.
To remedy this last important defect twenty subordinate revenue
officers were brought into Karachi to supervise the work, and the in-
fected portion of the town was portioned out between two members of
the Indian Civil Service and a Police Inspector, each with a separate
sanitary staff. Even with this organization it was found difficult to keep
up with the work and the town was further sub-divided between a number
of officers who volunteered for the work. Under the superintendence
of these officers, the lost ground was soon regained. Every house was
emptied as soon as it became infected, the sick person being left with
one or two attendants and the rest of the occupants moving to camp.
The house was then disinfected. " Soon the streets all over Karachi
were almost impassable for heaps of burning rubbish and carts remov-
ing what would not burn, while the limewashing by owners or Muni-
cipal Agency became almost universal." By the nth of February the
arrear work in disinfecting houses had been overtaken and the opera-
tions had been carried in advance of the plague by the cleansing of
localities (such as the Sadar Bazar) which had not yet been attacked.
The systematic cleansing of houses in which cases had not occurred
was then commenced.
Supervision of
burial and
burning grounds.
" With the increased mortality, it was feared there might be care-
less burying, and with increased stringency that bodies might be
surreptitiously removed. From the beginning of January one or two
police had been posted, but from the 3rd. February the District Super-
intendent of Police was requested to take the burial and burning
grounds under his personal supervision and thereafter the police
returns became a very useful addition to the daily municipal record,
allaying any suspicion lest deaths might be escaping record."
Trans-Lyari
quarter.
By the beginning of February the Trans-Lyari quarter, inhabited
by a number of poor Muhammadan communities, had become infected.
Work in the quarter was immediately taken up under the superin-
tendence of an able Muhammadan Deputy Collector assisted by a
selected subordinate Muhammadan officer and Muhammadan super-
visors.
Successful
attempts to
segregate and
treat the sick.
The beginning of February was also marked by the first efforts to
bring medical aid to the sick and to segregate them. " The Assistant
Collectors and other officers working in the town were becoming
pretty well known, and it was hoped that access to the sick might now
be obtained if a medical officer moved about in their company.
In writing to Government ....
it was stated that the compulsory
removal of the sick would probably be the most effectual of all
remedies, and was the one advocated by the Medical officers ; but it
228 Measures in the Bombay Presidency and Sind. [CHAP. VIII.
Officers
appointed to look
after the sick.
A plague
hospital
equipped.
Nurses.
was hopeless to work counter to the popular feeling and the Muham-
madans were so far particularly obstinate." Surgeon-Lieutenants
Niblock and Cornwall were deputed for the duty and reported them-
selves on the 12th of February. These two officers entered on their
duties with zeal and devotion and quickly gained the confidence of
the people. In a few days they "had won entrance everywhere" and
convinced the poor that there was nothing to dread. With doctors in
the city and at the railway stations plague patients began to be taken
to the civil hospital. A plague hospital was therefore necessary and
the Government High School was made available for ordinary patients,
the civil hospital being reserved for plague cases. A fully equipped
plague hospital with Dr. Niblock in charge was soon ready. A
Charitable Relief Fund was started about this time and the money
was used amongst other things for supplying necessaries and comforts
for the hospital. Nurses were supplied by the Karachi Convent.
" The Sisters occupied the upstairs or European wards of the hospital
and lived there for several months, nursing the 60 to 100 sick below
by day and by night, and entered on the dangerous duty with happy
self-sacrifice. They were soon beloved. Later on they were joined
by several nurses paid from the Charitable Fund and were assisted by
the two Misses Carey of the Zenana Mission."
General
improvement,
By the middle of February the improvement in Karachi was per-
ceptible. Disinfection of houses was up to date and general cleansing
in full swing, and the unaffected quarters were being taken in hand
in advance of the attack,
Kiamari and
Manora.
In Kiamari and Manora to which the disease had spread, the oper-
ations were controlled by Major Morris of the Karachi Artillery
Volunteers. He segregated every case with extreme care, but the
disease did not cease at Kiamari till, later on, the old village of huts
was burnt and the people disinfected and moved to a new site.
Special trains to
camps.
Arrangements were made to run special trains to two suburban
stations where the Collector of Karachi (Mr. Giles) and several
European merchants had erected camps in which subordinate offi-
cials, office clerks, and labourers were safely housed out of reach of
infection, and were able to come to work daily. " This was a very
successful scheme, and a great boon to the mercantile firms who
were being deserted by their establishments."
End of February
measures
completely
carried out.
"By the end of February, the Collector reported that few cases
now remained undiscovered, and hence the removal of the healthy
was at once universally carried out. To this must be attributed the
progress that was being made as shown in the decreasing mortality,
and also to the sick being rapidly brought under medical treatment."
In the Trans-Lyari quarter, where Sardar Muhammad Yakub Khan had
CHAP. VIII. 1 Measures in the Bombay Presidency and Sind. 229
to contend with much fanaticism, isolation of the sick was only becom-
ing possible, but by the middle of March segregation of infected
families was the rule. Segregation camps were now being formed
by Mr. Stracban in all directions. Early in March the new and un-
occupied Lady Dufferin Hospital was utilized as a convalescent ward
for the plague hospital.
Evacuation of
the Trans-Lyari
quarter.
"The 19th of March, the crowning day to the Sardar's work
across the Lyari, saw the voluntary removal by the Muhammadan
communities of all their sick, and 80 patients were during the day safely
deposited in the isolation sheds, and all came under medical treat-
ment. Mr. Giles, who has devoted himself to this quarter, was justly
proud of the great achievement. Some 40 malcontent families with-
drew to some distance, and from that date there was no reluctance
but eagerness to isolate every case throughout the villages of the
large Trans-Lyari tract."
Private hospitals.
" It should be mentioned that at this time the private hospitals
were beginning to fill, and that Seth Vishindas, a wealthy and philan-
thropic citizen, quite fearless of plague, was constructing what devel-
oped into the best private hospital in Karachi, where he generously
received Hindus and Muhammadans alike, having separate wards for
each, and supplying medical and other attendance, food and medicine
at his own expense. The removal of the sick difficulty, which had
been such a mountain in the way of effective remedies, bad thus
quietly disappeared ; and as the Collector remarks, a few days later
the sick were being removed to hospital as a matter of course. "
Rules under the
Epidemic
Diseases Act.
Special rules for Karachi under the Epidemic Diseases Act were
issued on the 17th March. They will be found in Appendix IV. :
These rules and the general rules issued for the Bombay Presidency
specifically empowered the adoption of the various measures which
were being enforced, and their issue was not accompanied by any
change in policy.
Appointment of
a Plague
Committee.
On the 20th March His Excellency Lord Sandhurst visited
Karachi, and, after inspecting all that had been done, appointed a
Plague Committee for the control of the operations, consisting of
Brigadier-General T. A. Cooke, Commanding Sind District, as Pre-
sident, with the Collector, the Deputy Sanitary Commissioner, and
Mr. Strachan as members. The Committee carried on the work
on the lines already elaborated, but even so the " measure was
like the relief of a beleaguered garrison." It had been necessary
to send some of the officers who had studied the measures in Karachi
to the up-country stations where plague had broken out, and more
officers were urgently required. " The General immediately threw
himself heart and soul into the work, brought to bear the whole
230 Measures in the Bombay Presidency and Sind. [ CHAP, VIII.
strength of the military, with unlimited officers and men and habits
of rigid discipline, on the existing material, and soon had the popu-
lation under thorough control." The first sittings of the Committee
were attended by Surgeon-Major Reade, one of the doctors who had
been through the Hong-kong plague.
Disinfection of
clothing and
bedding before
removal to camp.
" He suggested the bathing and disinfecting sheds for arrivals
at each camp, the disinfection of all bundles and baggage brought
to the camp, and similar arrangements on leaving. These suggestions
were most carefully elaborated by the Plague Committee. Disinfection
of the person and personal clothing had previous to this been in the
back ground, the getting of sick and healthy out of the infected
houses and the disinfecting and cleaning of those houses absorbing
all the time of the workers. Now immediate transference to hospi-
tal and camp was working smoothly, and it was possible to perfect
that control of the camps to which Surgeon-General Cleghorn has
invited attention. This thorough and painstaking disinfection of the
clothing and bathing of the persons in tubs with a mixture of Jeye's
fluid in the water soon extended up-country with marked effect,"
Military search
parties.
" On the 25th March, the first military search party went out.
It was very carefully organised and admirably managed, the civil
officers accompanied by medical men taking charge of each party.
The General had carefully instructed the men, and from that day for-
ward there was no need for the slightest apprehension, either that
the soldiers would not deal tenderly or that the people would not
welcome them : not a complaint was ever preferred."
Close of the
operations.
From this time onwards the epidemic steadily decreased, and the
operations, the gradual and cautious introduction of which have been
described, were carried to their successful conclusion.
HYDERABAD.
Course of the
epidemic.
In Hyderabad very thorough measures were adopted almost from
the outset. After the occurrence of a number of dropping imported
cases local cases began at the end of February, there was a con-
siderable increase in the number of cases in the middle of March,
and a still great increase at the beginning of April. The disease
reached its height in the middle of that month, and the last case
occurred on the 2nd of June.
Organisation,
At the end of January, house-to-house inspection was com.
menced by Municipal officers, and in the middle of February, the
town was divided into eight divisions, each in charge of a European
officer, the Military officers cordially volunteering to assist. Each
CHAP. VIII. ] Measures in the Bombay Presidency and Sind. 231
Divisional officer had working under him One or two Sub-divisional
officers, who were mostly Municipal Commissioners. The efforts of
these officers were directed to cleaning and limewashing the 12,000
houses that composed the town.
Segregation of
the sick.
At the very first the imported, cases were as a rule treated in their
own houses, the necessary precautions with regard to the house, bed-
ding, etc., being taken after the termination of the case. The Collec-
tor, however, insisted on more thorough measures : the isolation of
the sick and the segregation of the family and attendants. If the sick
person was not too ill to be moved, he was taken to the sheds out
side the town, and the rest of the family were also segregated in
the sheds.
On the 23rd of February the Collector caused the
migration of about one hundred families from a group of houses
where cases had been increasing in number.
Segregation of
the inmates of
infected houses.
When local cases began to increase, the supervising staff of
Civil and Military officers was considerably augmented and every effort
was made to stay the epidemic. The sick were removed to hospital,
and the inmates of infected houses were carefully segregated in a camp
outside the town. The occupants of houses surrounding the infected
house for a considerable area were also removed. Mr. Wingate states
that the use of this last measure was proved by the great quantity of
dead rats afterwards discovered in the shops and houses opened for
cleaning. " Had the inmates been sleeping in the rat-infected rooms,
the mortality would in all probability have been severe, whereas as
inmates of the camps they altogether escaped."
Private hospital.
Public hospital.
Mr. Diayaram Gidumul established a private hospital on the native
library premises, and entrusted it to the superintendence of the Revd.
A. Canney, of the Church Missionary Society, and Miss Pigott, of
the Zenana Mission. By his request, Surgeon-Lieutenant-Colonel
Henderson undertook the general medical supervision. A Committee
of native gentlemen supplied every thing that was necessary. This
private hospital was opened on the 19th March, and on the 24th of the
same month the Government High School buildings were opened as
a general plague hospital under Surgeon-Lieutenant-Colonel Hender-
son, assisted by nurses obtained from Calcutta. Both hospitals were
closed on the 15th June.
Appointment of
a Plague Com-
mittee,
In the beginning of April plague broke through the barriers ;
cases trebled and the mortality doubled. On the 9th of the month a
Plague Committee was appointed by the Government, consisting of
the Collector (Chairman) ; Dr. Henderson ; Major Price, Commanding
the station ; Surgeon-Captain Cater Jones ; and the President of
the Municipality. Mr. Wingate states that the Committee did admir-
able work and promoted united and well considered measures.
232 Measures in the Bombay Presidency and Sind. [CHAP. viii.
Health camps.
" The camps were brought under control of European soldiers-,
and non-commissioned officers. These camps had been carefully
laid out and very systematically worked by Surgeon-Captain Cater
Jones, who devoted himself to the efficiency of their management and
the comfort of the inmates. Tickets showed the occupants of each
hut, with full particulars, so as to avoid constant reference by
the inspecting officer to the registers which were kept in the camp
office ; the observation sheds for any sickness, disinfectants, provision
arrangements were all well ordered."
Close of the
operations.
Soon after the Committee was appointed, the disease began to
abate, and the Committee carried the operations through the period
of rapid decline which ended in the extinction of the epidemic
in the beginning of June.
SUKKUR AND ROHRI.
Situation and
importance of
Sukkur and
Rohri.
Sukkur and Rohri form practically one town and are connected by
the Lansdowne Bridge over the Indus. Railway lines run from them
to Hyderabad, to Karachi, to the Punjab, and to Shikarpur and Balu-
chistan. " A more dangerous spot for an outbreak of plague," says Mr.
Wingate, " could hardly be named, and with the large important town of
Shikarpur, teeming with Karachi, Hyderabad, and Sukkur fugitives,
and having business connections all over India and as far as Bokhara
in Central Asia, situated within twenty-five miles of Sukkur, the pro-
gress of the epidemic was watched with the keenest anxiety, and the
resources of the province were strained to check its apparently
resistless march northwards."
Opposition ex-
cited by compul-
sory segregation.
The first events connected with the enforcement of plague pre-
cautions in Sukkur are of great interest as showing the disastrous
results arising from the population combining, owing to their dread of
segregation, to frustrate the efforts of the authorities. The following
is the account given by Mr. Wingate :—
Concealment of
cases.
" On the 17th February, a report was received from the Civil
Surgeon, Sukkur, Surgeon-Major Corkery, stating that a case of
plague was reported on the 12th idem, and in the face of great
opposition he had removed the patient, a girl of 10 years old, accom-
panied by her mother and brother, to the shed prepared for such
cases. Dr. Corkery disinfected the house. This was the first case
of plague reported from Sukkur, and the first case of forcible removal
of a patient anywhere. The result is significant. Ominous silence
followed, and soon it appeared that the people of all ranks had
banded themselves together with one accord to defeat the authorities.
On the 26th February, Dr. Corkery reported that, besides the one
case which he saw and removed, a few suspicious fatal cases had