NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
174
Measures in the City of Bombay.
[CHAP. VII,
" Where four or more cases had occurred in one house, the place was
vacated and was not reoccupied until the District Medical Officer
was satisfied that it was free from infection. Where the house was
in such an unsatisfactory sanitary condition as to be unfit for human
habitation it was vacated, condemned by a sanitary board and
marked with the letters U. H. H.* Huts for accommodation of
people who were thus turned out of their houses had already been
erected in different quarters of the city by the municipality.
" Thus, not only were plague cases discovered by means of house-
to-house visitation, and the infection of the diseases controlled and
prevented from spreading, but the dark, evil smelling, ill-ventilated,
ill-drained, overcrowded lanes and alleys of Bombay were explored
and thoroughly cleansed. "
Vigorous
measures
instituted by the
municipal
authorities
continued after
the formation of
the Committee.
Statistical
statements for
work done.
GENERAL SANITARY MEASURES.
The vigorous general sanitary measures prosecuted by the
municipal authorities during the early period of the epidemic
were not relaxed after the control of plague operations had been
entrusted to the Committee. In addition to the thorough treatment of
single houses described above, large measures of cleansing and
sanitary reform were continuously executed. At one time as many
as five thousand special workmen were employed on these operations.
The following is a statistical statement of the work done on dwellings
from the beginning of February up to the end of the first week in
April: —
Dwellings condemned
„
recommended for alteration
„
from which tiles removed (to let in light and
air)
„
in which floors dug up
„
limewashed
...
...
...
„
vacated
„
destroyed (by fire or otherwise) ...
1,762
929
10,931
4,37°1
3,891
2,643
416
Treatment of
dwellings
reported to be
insanitary by the
District Medical
Officer of health.
The reports submitted by the District Medical Officers were of
great help in drawing attention to the places requiring cleansing and
disinfection. The following passages describing the working of the
system are from the editions of the Times of India of the 13th March
and the 6th April :—
" The permanent work of improvement has been entrusted to Dr.
Kirtikart and to Khan Bahadur M. C. Murzban, C.I.E. The special
* Unfit for human habitation.
t Special Health Officer,
CHAP. VII. ]
Measures in the City of Bombay.
175
medical officers and Deputy Health Officers appointed in each ward
send in the reports of their observations to Dr. Kirtikar regarding the
defective construction and insanitary condition of houses ; overcrowd-
ing of tenants ; excessive heights of buildings ; insufficiency of
arrangements as to ventilation, and of letting in sunlight; bad floors ;
roofs incapable of affording shelter and shade ; ill-planned drain con-
nections ; uncontrolled water-taps ; ricketty walls, and so forth. The
Superintendents and Inspectors in the Municipal Executive Engi-
neer's Department, under Mr. Murzban's charge, send reports to Mr.
Murzban of a similar character regarding buildings requiring con-
demnation or alteration. Then references from Dr. Kirtikar to
Dr. Murzban and vice versâ ensue. The officers themselves go either
to verify or modify the suggestions made in the reports; to approve
of the recommendations contained therein; orto enhance the number
of alterations already suggested. Then they agree on the points
and recommend the Municipal Commissioner to issue certain direc-
tions to the owners and occupiers of the tenements. In matters
under discussion but awaiting a decision, a reference is made to that
officer, who uses his discretion and passes final orders."
The " U. H. H."
system.
"With regard to the marking of insanitary huts, sheds, premises,
and buildings with the letters ' U. H. H.' in red, the situation is as
follows :—It will be remembered that in the notification promulgated
by Government about the plague measures, the Plague Committee
and the Municipal Commissioner are authorised to remove all
insanitary huts, sheds and buildings.
Under the Commissioner's
instructions, the inspection of buildings was systematically commenced
both by Dr. Kirtikar and by Dr. Jennings, the arrangement made
with whom was that their reports should be forwarded to Khan Baha-
dur M. C. Murzban, C.I.E., Executive Engineer to the Municipality,
whose department would further inspect the structures reported
upon by both the above officers, and if he concurred that the structures
in question were fit ones for condemnation, and were unfit for human
habitation, a declaration would be made by marking them out in red
letters with 'U.H.H.' The people inhabiting such marked dwell-
ings are made to vacate as soon as possible ; but not until some
short time is given to them as sufficient warning to effect the removal.
About the houses which the Executive Engineer's Department deem
capable of improvement, orders are given to the owners to have the
desired measures carried out. But those that are put down as
incapable of improvement are ordered to be pulled down ; whereas
insanitary huts and sheds are demolished and destroyed.
This
system continued to work well for some time, when the Executive
176
Measures in the City of Bombay.
[ CHAP. VII.
Engineer's attention was drawn to the fact that this procedure, if
vigorously and rigorously continued very long, was likely to render
a large number of people in Bombay houseless and homeless. He
thereupon reported the matter to the Municipal Commissioner, who
considered the question whether the inspection, improvement, and
demolition of the buildings should be continued longer in similar
conditions, or should be stopped. The Municipal Commissioner,
after consulting, we are informed, the Plague Committee, decided
that as the rains were coming on soon, the demolition of buildings
should be carried out with greater care. The inspection of the
buildings is, however, still going on ; but the closing of houses and
the marking of them with 'U. H. H.' has so far ceased, unless when
the exigencies of the case demand the adoption of this stringent
measure forthwith. After the rains, the systematic examination and
rejection of unsuitable buildings is expected to proceed, and then all
those houses and pucca* tenements which will be adjudged to be
' U. H. H.' will be subjected either to good sanitary alterations or
improvements, or when they are found to be past redemption will be
demolished without compunction or concern. It will be seen from
this that the popular misconception about the houses being con-
demned promiscuously and carelessly is undeniably erroneous and
without foundation, and that the work is being scrupulously carried
out in accordance with the avowed principles of sanitary science.
In consideration of the amount of work required to be carried out,
the Municipal Commissioner has sanctioned an additional establish-
ment to the Executive Engineer's Department, of one Assistant
Engineer, three Divisional Superintendents, and seven ward inspectors
for the purpose of conducting the examination of houses on the prin-
ciples of sanitary engineering science. The whole of this establish-
ment is not, however, to be entertained immediately ; but the Executive
Engineer is authorised to employ such of the sanctioned men from
time to time as occasion requires. It is probable that the full comple-
ment of this newly-created staff will be required after the rains, when
the strict and systematic examination of buildings and the condemna-
tion of the insanitary ones will be resumed as hitherto."
Mr. Snow stated that up to the beginning of October 1897, the
sanitary condition of 2,000 buildings was carefully overhauled in this
fashion.
Cleansing and
disinfecting of
entire localities.
Seven instances.
Another very important set of operations was the cleansing and
disinfection of entire localities which were insanitary or infected to
• a special degree. General Gatacre gave an interesting account of
the operations conducted in certain localities illustrated by a set of
* Masonry.
CHAP. VII.]
Measures in the City of Bombay.
177
maps and diagrams which are reproduced in Volume IV, pages 8 to 12
In these accounts an endeavour was made to trace the effect of the
operations on the course of the disease.
Kamathipura.
Case No. 1. Kamathipura (District No. VI).—Illustrated by
diagram on page 8 of Volume IV.
"Kamathipura is by virtue of its low-lying position naturally un-
healthy and its houses are mostly dark, damp and without ventilation
and most of them have been built on reclaimed ground." The locality
was the scene of a very severe outbreak. A special gang of 400 coolies
worked on limewashing and other cleansing work throughout part
of December 1896, and the whole of the following month. The opera_
tions were completed about the 10th February. Every house was
limewashed to the number of 1,344, and something over 100 tons of
fresh hot lime was expended on the work. Dropping plague cases
occurred from the end of September, but it was not until the latter
end of November that they became indigenous. From the chart it
will be seen that up to the beginning of November the cases were
probably imported from other parts of the city. The small groups
of cases between the 9th and 12th November and the 15th and 26th
November, respectively, are considered to have been indigenous. The
third and main group occurred between the end of November and the
12th February, and during this period the disease was epidemic.
During December and January the population of the district fell to
one-half of the normal. The end of the epidemic almost coincided
with the end of the cleansing operations.
A quarter in
Tarwadi.
Case No. 2. Daji Purbhoo's Wadi at Gharupdeo in Tarwadi
(District No. IX).—Not illustrated.
This locality contains about go houses and 2,000 inhabitants,
The houses are mostly a wretched class of tenement constructed of
mud. They were found to be dark, damp, badly ventilated and sur-
rounded by insanitary conditions : most of the sewage escaping into
the ground.
" The first recorded case occurred on January 1st, the second on
the 6th, and from that date onwards until the 14th February 21 cases
occurred ; by that date all the inhabitants had left the Wadi. The
usual cleansing operations were carried out, all the houses being
mostly thoroughly limewashed, and those in which cases had occurred
treated with perchloride of mercury. The water was cut off in all
the dwellings and stand-pipes with taps erected from which open
drains were constructed, and all kutchra collected and burned.
" The cleansing operations commenced on January 28th and occu-
pied two days and were most thoroughly done.
23
178
Measures in the City of Bombay.
[CHAP. VII.
" After the 29th of January the following cases occurred :—30th,
one case ; 31st, two ; February 2nd, two ; 3rd, three; 4th, one; 5th,
one ; 7th, one ; 9th, one ; 10th, one ; 12th, two ; 13th, three ; 14th, one.
"This would appear to point out the fact that when the surroundings
are hopelessly insanitary and where buildings are overcrowded, as they
were in this Wadi, and have little or no plinth, and the rooms contain
no means of ventilation, except the door, sanitary operations have little
or no effect in stopping the disease, and that the only certain treat-
ment is segregation of the people and demolition of the buildings."
A quarter in
Mazagon.
Case No. 3. Amba Wadi in Mazagon (District No. IX).—Not
illustrated.
"In Amba Wadi which is in the Mazagon District, there are about
200 houses containing probably a population of 1,800. The houses
are many of them pucca built, rooms fairly dry and light, with ventila-
tion. The first case of disease here occurred as in Daji Purbhoo's
Wadi on January 1st ; another case was not reported until January 13th
and then four are reported : 13th, one ; 14th, one; 15th, two. There
was then an interval of ten days, the next case occurring on the 28th
and two on the 29th.
" On January 21st disinfecting operations commenced and were
completed on February 4th. From that date practically no cases
occurred although many houses remained occupied."
Worli.
Case No. 4. Village of Worli Koliwada* (District No. X].—
Illustrated by plan and diagram, Volume IV, page 9.
"The events which accompanied the course of the disease in this
village are exceedingly interesting. Worli Koliwada is an isolated
village on a peninsula in the north of the island ; it is inhabited
almost entirely by Kolis (fishermen). The number of houses in the
village is 936, and the normal population is 5,493. The character
of the disease was marked by extraordinary virulence, over 90 per
cent. of the persons attacked dying, often after a few hours' illness only.
" The houses are mostly kutchabuiltt with cadjan‡ roofs, which are
in many cases brought down so low as to render the inside very dark.
The streets are exceedingly narrow. There is no artificial drainage,
but good natural drainage exists from west to east ; the whole village is
open to the sea breeze on two sides. During the months of October
and November 1896 there is no record of any case of plague having
been present in the village, the first case being reported on December
1st.
* Fishing village.
† Made of mud.
‡ Plaited palm leaf.
CHAP. VII. ]
Measures in the City of Bombay.
179
"The villagers were fully alive to the dangers of the disease and
of its getting into the village, agreed among themselves as far back
as October to prevent strangers entering the village, by placing
watchmen at the entrances, and to allow no persons to proceed from
the village to any infected part of Bombay ; they even went so far
as to object to the usual municipal coolies visiting the village for
cleansing purposes. But all this was of no avail, as a Koli (named
Roza Maria Creado), resident of the village, died on December 1st.
No further deaths occurred till December 11th."
In both the plan and the diagram the deaths are grouped into three
groups, numbered 1, 2 and 3. No, I group is shown in red, No. 2
group in yellow and No. 3 group in green. The diagram shows
the dates of the deaths and the number of deaths on each date,
and also the period of the disinfecting and cleansing operations.
The plan shows the location of every case of each group. An exami-
nation of the plan and the diagram throws some light on the way
in which the disease spread.
" There is no doubt that the village of Worli was at the time of the
outbreak of plague in a fit state to receive and propagate the germs
of the disease on account of the drainage of generations having
soaked into the ground on which the village stands, combined with
the continual wastage of an ample water-supply.
" No. 1 case, as shown on the plan, died in house No. 6 on 1st
December. There does not appear to be any connection between
No. 1 case and the death in No. 2 group which occurred on the nth
December, but it is probable that No. 1 case in some way spread
the infection to some one in group No. 3, who lived in his vicinity
by some means other than personal. In glancing at No. 2 group, it
will be seen in house No. 535 that two members of the group died
and that two of group No. 3 were affected and died in the same house,
which points to the strong probability of personal infection. In house
No. 534, too, three deaths occurred of neighbours who lived in close
proximity to three members of No. 2 group. In glancing further at
the diagram it will be seen that in almost all the cases the disease
forms itself into groups. But the chief characteristic of the disease,
in this village was its virulence and the extraordinary short period in
which it became epidemic. Usually several warnings take place, first
sporadic imported cases exist perhaps for a month, then a few in-
digenous cases occur and there is a small outbreak, and then comes a
lull in the disease, but in this instance it was not so. Group No. 1
was an indigenous case and the first in the village so far as is known.
Group No. 2 consisted also of indigenous cases, and then group No. 3
commenced with three cases on December 18th, after which the whole
village quickly became affected.
180
Measures in the City of Bombay.
[CHAP. VII.
" As regards the disinfecting operations : on 2oth of January a
gang of 270 coolies were sent to the village ; they disinfected all
affected tenements ; limewashed all houses, and stand-pipes with
drainage to the foreshore substituted ; the whole work being completed,
as shown on plan No. 11a* on the 29th of January. By this date,
with the exception of 176 of the inhabitants, all had left the village.
Many went to live in surrounding fishing villages only it is feared to
infect them. Some 250 went by road to the Karli Caves at Lanowli,
where several cases of a mild type took place after they had arrived
and all recovered. Some 400 encamped near Worli village. Among
these no fresh cases occurred after the ten days' incubation period,
although these persons daily went to the village to get grain which
was stored in the village granaries. During the epidemic 139 cases
occurred in the village, nearly all of which proved fatal. On re-
occupation of the village in March, no further indigenous cases
occurred. It will be seen here that the course of the disease was
most distinctly south to north, From enquiries made in the village, it
has not been possible to ascertain that the advent of the disease was
marked by any great mortality among rats, such as is almost invariably
the case. "
Sewree or Siwri.
Case No. 5. Village of Sewree Koliwada (District No. X).—Illus-
trated by plan and diagram on page 10 of Volume IV. The plan and
diagram are prepared in the same manner as the plan and diagram
for Worli.
" Sewree Koliwada is a village in the north-east of the island, con-
taining a population of some 600 Kolis, inhabiting about 150 houses.
"The first case reported in the village occurred on the 12th of De-
cember, but it was not until January that the disease became epide-
mic. The disease here, as in Worli, was marked with great virulence :
nearly every case being fatal.
" Disinfecting operations were carried on all through December and
January in individual affected houses, but had little or no effect on the
spread of the disease. On the 27th of January these operations
were extended, and some 200 coolies were placed on the work ; they
disinfected and limewashed all and every house ; rags and kutchra
were burned ; all roofs were opened for ventilation ; and the place
generally had a thorough cleansing. This work lasted five days, and
the spread of the disease was checked, But at the back of the
village there was in December and January a long and narrow pool of
water. This pool was daily largely used by the male population of the
village for ablutionary purposes in connection with defæcation. Pro-
fessor Hankin in his researches at this village about the 24th January
* The plan on page 9 of Volume IV.
CHAP. VII. 1
Measures in the City of Bombay.
181
discovered the plague bacilli in large numbers in this water. Upon
this being known, the pool was thoroughly disinfected with carbolic
acid on or about the 27th January, and the whole field, which was
littered with human excrement, was cleaned up. It is possible that in
this incident lies the crux of the situation. Disinfecting operations
apparently up to January 27th had very little effect on the spread
of the disease, and it may be conjectured that its spread was
fostered and maintained by (he daily use of the water in the pool,
especially when we know that most of those affected were males.
The incident, however, is of interest, as from the 27th January little
or no disease occurred in this village, which, although considerably
reduced in numbers, was not altogether depopulated, there being
never less than 350 people in the place." It will also be seen from the
plan that the disease did not form itself into groups, as is usually the
case, but was almost evenly distributed over the village, there being
rarely more than one case in a house. This points to an unusual
element in the spread of the disease, and this element General
Gatacre believes to have been the use of the water of the polluted
tank.
Parel.
Case No. 6. Village of Parel (No. X District).—Illustrated Parel.
by plan and diagram on page 11 of Volume IV.
The plan and diagram are constructed as before. There are 589
houses in the village, many of them well built and well ventilated, and
many others overcrowded hovels of the most insanitary type, situated
on sewage-sodden soil and abutting on narrow lanes ; it was in houses
of this latter description that the disease chiefly raged. The village
had been drained, but no connections had been made between the
sewers and the houses, and the sewage either flowed down on the
surface of the narrow lanes or soaked into the soil. General Gatacre
states that the village was in an almost hopelessly insanitary con-
dition, and had been a hot bed of fever for many years.
"On the 6th of February a large gang of some 350 coolies were
set to work to thoroughly disinfect and cleanse the village. The
whole of the village was dealt with by the evening of the nth, but,
as will be seen from the diagram, this had little or no effect, the
disease being marked with greater virulence after February nth
than before, and continuing more or less throughout March to be
severe."
A fishing
village in
Mahira.
Case No. 7. A fishing milage in Mahim (No. X District).—Illus-
trated by plan and diagram on page t2 of Volume IV.
"In this village the advent of the disease was exceedingly sudden.
Previous to the 20th of January only three cases are recorded, but on