NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. XI. ] Measures to prevent the spread of infection by sea. 361
she was boarded, and the passengers examined by a medical officer,
who gave a certificate of health if the result of the examination was
satisfactory. This work was extremely arduous from the number of the
boats and also from the fact that most of these boats carry vegetables,
etc., for the Bombay market. They arrive at about midnight, and if
their men were not allowed to go ashore the first thing in the morn-
ing, great inconvenience would be felt by the whole city for want of
fresh vegetables, etc. The work of inspection had therefore to be
carried on mainly in the night."
Treatment of the
suspicious.
Sheds were erected at Nariel Wadi, Reay Road and Wari Bandar
for the shelter of persons detained under observation, and the shed
on the Malet Bunder for the inspection of Mecca pilgrims was used
for the same purpose. The procedure followed in dealing with sus-
pected cases varied according to the locality whence the person had
come. In the case of passengers from Cutch-Mandvi and the Kolaba
district detention was more vigorously enforced than in the case of
passengers from less infected localities. Persons developing plague
while under observation were sent for treatment to Government or
private plague hospitals.
Results of the
inspection.
The following statement shows the results of the inspection :—
Month.
April
May
June (up to 21st)
Persons
suspected.
106,272
123,812
33,205
Sent to obser-
vation camp.
447 (from April I3th)
3,047
...
... }
1,341
...
...
Plague cases
detected from
March 1st to
June 30th.
57
Rules for minor
ports in Bombay.
To protect minor ports against Bombay the two resolutions of the
17th February, which have already been noticed in the examination
of the railway travellers' inspection rules, provided for the appoint-
ment of officers to examine, and if necessary to detain, persons
whether passengers or members of a boat's crew, arriving in vessels,
from the direction of Bombay. On the 6th March the Government of
Bombay issued a general resolution empowering the Commissioners of
divisions to apply certain rules at the ports within their jurisdiction
against arrivals from infected ports. The rules provided for the medi-
cal inspection of vessels, for the removal of the sick, for the segregation
of passengers on shore, if suitable accommodation were available, for a
quarantine of infected vessels for eight days from the date of arrival or
occurrence of the last subsequent case, for the destruction of
bedding and rags, for the disinfection of articles likely to carry
the seeds of the disease, and for the quarantine of healthy vessels
46
362 Measures to prevent the spread of infection by sea. [ CHAP. XI.
up to eight days from the date of departure from the infected
port.
Precautions
against arrivals
from Cutch.
The outbreak of a violent epidemic of plague in Cutch-Mandvi
was a serious menace to other ports in the Bombay Presidency with
which it is in constant communication, and special arrangements were
made to prevent the spread of infection by arrivals from the Cutch
port.
Quarantine at
Aden,
The quarantine arrangements at Aden were the subject of con-
siderable correspondence, the fact that Aden is the port of call for
ships sailing from India to Europe rendered the matter specially
important and difficult. The history of quarantine at Aden has
already been described, and it has been stated that the rules
framed for Aden against arrivals from Bombay in October 1896
followed the general rules issued for Indian ports against Hong-kong
in 1894, and were somewhat stricter than those enforced against Bom-
bay at ports on the Indian mainland, inasmuch that they required
eight days' quarantine of healthy vessels which did not carry a quali-
fied medical officer.
Modifications of
the Aden Rules.
Subsequently certain modifications were made in the Aden rules,
of which the most important was the imposition of ten days' quarantine
from the date of departure from Bombay or Karachi on persons
landing at Aden. This rule was introduced on the 3rd February,
with the previous sanction of the Governor General in Council,
because the voyage from Bombay and Karachi does not occupy the
full ten days which has been recognised for practical purposes as the
maximum incubation period. It was also decided in correspondence
with the Government of Bombay that the Health Officer should not,
for fear of being compromised, visit the vessel until the ten days'
period expired, and that vessels using Aden merely as a port of call,
and not holding communication with the port, need not be examined
or detained. The Government of Bombay undertook the amendment
of the rules in accordance with these decisions, in communication
with the Resident at Aden, but before this work was completed the
whole question of sea quarantine had been reconsidered in the light
of the provisions of the Venice Sanitary Convention. The Government
of Bombay reported on the 30th April that no practical difficulty was
being experienced in working the Aden rules,
Revised rules
issued by the
Government of
Madras.
Before the general discussion of quarantine in the light of the
Venice Convention commenced, the Government of Madras proposed
(on the 3rd April) important modifications in the rules in force in the
ports of the Madras Presidency, based on the orders of the English
CHAP. XI.]Measures to prevent the spread of infection by sea, 363
Local Government Board of 1890, and in the direction of the altera-
tions subsequently made in conformity with the Convention.
The main object of the alteration was to avoid the detention of
the sick and healthy together on boardship. With the sanction of
the Government of India the rules previously issued by the Govern-
ment of Madras under the Quarantine Act were cancelled by a
notification under that Act, and in their place a set of rules was
issued under the Epidemic Diseases Act (June 22nd). It is unneces-
sary to do more than notice the main features of these rules as they
were afterwards replaced by rules drawn up in accordance with
the Venice Convention. If the vessel were found to be healthy after
examination, free pratique was to be at once granted ; if the vessel
were found to be infected, the following principal measures were
prescribed. The sick were, if possible, to be landed and detained in
an isolation hospital, the healthy were to be landed and detained in
segregation up to ten days from the date of landing or the occurrence
of the last subsequent case. Contaminated clothing and bedding were
to be destroyed, and other articles likely to carry infection were to be
disinfected. The ship was also to be disinfected, and if possible, the
tanks on board were to be emptied, disinfected, and refilled.
Original Measures for the Inspection of outward
bound Vessels.
The measures for the examination of outward-bound vessels were
all enforced under the clause of the Epidemic Diseases Act, which has
been quoted in the preceding section of this chapter.
Rules for
Bombay and
Karachi,
The Government of Bombay telegraphed to the Government of
India on the 27th January that it was considered urgently necessary
to medically inspect persons leaving Bombay by sea, and that a com-
plete scheme had been prepared and rules drafted under the Quaran-
tine Act. The telegram recited the rules and asked the Government
of India to accord sanction to them. A reply was sent, on the 28th
January, to the effect that the Government of India were doubtful
whether the rules came entirely within the authority conferred by the
Quarantine Act, but that the rules might be acted upon, and that the
Epidemic Diseases Bill, which was then under consideration, con-
tained a provision enabling rules to be framed of the nature con-
templated. It was also suggested that similar rules should be
enforced at the port of Karachi. Accordingly the Government of Bom-
bay issued rules under the Epidemic Diseases Act for the inspection
of vessels sailing from the ports of Bombay and Karachi on the 6th
364 Measures to prevent the spread of infection by sea. [ CHAP. XI.
and 15th February respectively. The rules for the two ports were
similar and contained the following main provisions. No vessel
might leave the port without medical examination by the Health
Officer, and until the master had obtained a bill-of-health certifying
that no case of plague existed on board. If a case suspected to be
plague were found during the examination, the bill-of-health might not
be granted until the person suspected had been removed. After the
grant of the bill-of-health no person or cargo might be taken on
board without a fresh medical examination of the vessel. Port clearance
might not be delivered to the vessel until the master was in possession
of the bill-of-health. Practically the measures came to this, that no
vessel was permitted to depart until everyone on board had been
examined, and any case suspected to be plague had been removed.
Results of the
inspection at
Bombay,
These measures were worked in the port of Bombay with great
care and with eminent success.
The number of persons examined in the months of February,
March, April and May 1897 amounted to 79,623, 91,779, 80,608
and 81,398, respectively, giving a total of 333,408 and an aver-
age of over 80,000 a month.
Staff.
To examine this enormous number of persons, the following large
staff was employed :-—
1 Port Health Officer (Surgeon-Major MacCartie).
1 Additional Port Health Officer.
3 Commissioned Medical Officers.
3 Assistant Surgeons.
1 Hospital Assistant.
2 Lady Doctors.
In addition to the above, the services of another lady doctor were
utilised on at least two days of each week, and three qualified medical
officers were employed under the supervision of the Customs Depart-
ment, chiefly in connection with the inspection of small native sailing
craft. On mail days the staff was supplemented by at least two and
sometimes by four of the Professors of the Grant Medical College.
Difficulties,
Dr. MacCartie stated that this large staff was able to get through
its duties satisfactorily only by working at very high pressure. The
magnitude of the work resulted, not only from the large number of
persons to be examined, and because vessels sail at all hours from
different portions of the extensive harbour, but because for the detec-
tion of plague a rigid inspection is required of all persons presenting
themselves for examination.
Any man with fever or buboes was an object of suspicion
and had to be examined with the utmost care. In the months of
CHAP. XI. ] Measures to prevent the spread of infection by sea. 365
February and May, the numbers placed on one side for temperature
observation ranged from 20 to 25 per cent., and as many as a dozen
thermometers were in use at the same time.
Place of
examination.
At the port of Bombay vessels start from one of three places—
(1) the outer wall of the dock ;
(2) the docks ;
(3) the stream.
In the first case the passengers were examined on shore in sheds
specially arranged on the dock wall, and the crews were mustered and
examined on board before the passengers were allowed to enter the
ship. The vessels starting from the outer wall of the dock are chiefly
engaged in the coasting traffic, and their passengers were the most
likely to be infected. In the second and third cases the examination
of both passengers and crew was made on boardship before the
vessel started.
Examination of
crew.
Experience showed that the examination of the crew was the
most important part of the work. In the first place their number
exceeded the number of the passengers. In April and May out of a
total of 162,006 examined, 86,938 persons belonged to the crews
of vessels. In the second place the crews were much more likely to
carry infection than the passengers. Dr. MacCartie has recorded
the following observations on this point:—
" Every Peninsular and Oriental Company's liner during the height
of the plague, on arrival in Bombay, was, under the law and practice
of the port, forced to discharge its native crew : by law the crew can
and do claim their discharge. Three or four days, sometimes one
day, before a vessel's departure another crew has been signed on the
articles. This fresh crew has come from the slums of plague-stricken
Bombay, whilst the passengers who are almost all Europeans have
come from up-country stations and boarded their vessel direct from
the train. Even in the case of local passengers they have come from
parts of Bombay comparatively free from plague. The natural result
has been that during the height of the epidemic no passenger, except
two postal officials, both natives, was removed on suspicion from any
vessel, whilst it was found necessary, in almost every instance, to
remove several of the native crew."
Success of the
measures.
The thoroughness with which the measures were carried out in the
port of Bombay is attested by the fact that only in very few instances
did aperson infected with plague escape detection and depart on
a vessel sailing for the port. A case occurred on board the troop-
ship Dilwara, two on board the pilgrim ship Pekin, and one case
believed to be plague on board a liner. In addition there was the case
366 Measures to prevent the spread of infection by sea. [ CHAP. XI.
of the two Portuguese stewards, mentioned in Chapter II, who were
believed to have caught plague from infected articles carried in bundles
of clothing left unopened until the vessel arrived in the Thames.
Risk of the
spread of
infection by sea
traffic said to be
small,
The facts recited above show clearly how small is the risk of infec-
tion being carried to Europe by persons sailing on vessels from an
infected port, provided that an efficient system of inspection is main-
tained at the port. Dr. MacCartie considers that the danger of plague
spreading on a sea-going vessel is very small, and made the follow-
ing remarks in support of this contention :—
" The Dilwara and Pekin were therefore infected vessels, and the
latter vessel carried over 1,000 of perhaps the most insanitary and dirty
people, who travel by sea—pilgrims—yet the disease did not catch on,
nor did the passengers on board these very crowded vessels suffer in
health from the fact that plague cases were amongst them. During
the inspection on boardship from February up to date, many persons
have been removed from outward-bound vessels as suspicious cases.
Some of these developed plague after removal, but in no instance did
the disease appear amongst those who remained on the vessels. They
sailed away and no more plague occurred, from which it would seem
that the circumstances of a sea voyage are inimical to the plague
microbe: and that people affected by manifest plague, or in whom the
disease is incubating, may be on boardship without danger to the rest
of the passengers, unless, indeed, the number of infected ones is very
great."
In the month of May an alteration was made in the rules for the
port of Bombay to meet the case of vessels using Bombay only as a
port of call, and holding no communication with the port except through
persons embarked there. It was provided that in this case the exam-
ination might be confined to the persons embarking.
Calcutta and
Madras.
The medical inspection of vessels was enforced at the ports of
Calcutta and Madras as well as at ports in the Bombay Presidency.
This measure was considered necessary in order that there might be
no doubt in European countries as to the freedom from plague infection
of vessels sailing for those ports. Although both Calcutta and Madras
are situated a very long distance from the infected area, there was a
possibility—likely to be considered greater in foreign countries than
it was in India—that infected persons might embark there.
Bengal Rules.
The Government of Bengal issued rules for the port of Calcutta on
the 10th February, which were similar to those in force at Bombay and
Karachi, but contained the additional provision that if a plague case
were detected on board, the vessel must be detained seven days
before being permitted to depart.
CHAP. XI.] Measures to prevent the spread of infection by sea. 367
The rules were drawn up in a general form applying to all vessels
sailing from the port of Calcutta, but were in practice only applied
to vessels bound for ports out of India.
The Government of India subsequently addressed the Government
of Bengal on the subject of these rules, and suggested that it was not
necessary to detain all vessels on which a case was discovered : if the
vessel carried a medical officer she might be allowed to depart after the
prescribed precautions had been taken, but a vessel carrying no
medical officer should be detained for ten days in the interests of the
persons on board. On the 25th May the Government of Bengal issued
a fresh notification for the inspection of vessels sailing to ports out
of India from any of the Bengal ports which embodied the above
suggestions. The notification contained an additional rule, borrowed
from Madras, preventing any person from embarking who had within
the previous ten clays resided in or visited an infected port of India.
It may here be said in anticipation that in the rules that finally
issued the detention of a vessel from which a plague case had been
removed was not prescribed, the experience in Bombay having shown
that this was not necessary. The prohibition against the embarka-
tion of persons who had been in an infected locality within ten days
was also cancelled.
Madras Rules,
Tuticorin and
Ceylon.
The Government of Madras issued rules for the inspection of I
vessels sailing from the port of Madras for ports in other countries
on the 23rd February, and similar rules for other ports in the presi-
dency on the 8th April. The rules followed those prescribed by the
Government of Bombay with two additions. The first was the pro-
hibition against the embarkation of persons who had within ten days
resided nor visited an infected locality, which has been alluded to above.
The second prescribed that on the removal of a person suffering from
plague the parts of the vessel that he had frequented should be dis-
infected. At the commencement of the outbreak the Government of
Ceylon imposed fifteen days' quarantine and other stringent rules
against arrivals from the west coast of India. In order to protect Tuti-
corin against such regulations, the Government of Madras prescribed,
in a separate notification of the 22nd February, rules for vessels sail-
ing from that port to ports in the island of Ceylon, the terms of which
followed exactly those of the general rules. Later on the Government
of Ceylon stationed a medical officer at Tuticorin for the examination
of persons embarking for the island, and on the 4th May the Govern-
ment of Madras issued a notification prohibiting any deck passenger
of the labouring classes (coolie emigrant) from embarking until he
had satisfied the medical officer of the Colonial Government that he
had not been in an infected part of India for ten days, and that he
was free from plague infection. Other passengers were not compelled
368 Measures to prevent the spread of infection by sea. [CHAP. XI.
to obtain a certificate from the Colonial doctor, but they were permit-
ted to do so, and they were warned that unless they possessed such
a certificate they were liable to be prevented from landing at Colombo.
The Government of Madras issued a special set of rules for vessels
sailing from east coast ports to Burma. These rules were similar to
the general rules, but omitted the provisions about persons who had
been in an infected locality, and dispensed with examination at a
port of call except in the case of the passengers embarked there.
The Venice Sanitary Convention of 1807.
General scope
and arrange-
ments.
In the preceding chapter the provisions of the Venice Sanitary
Convention dealing with the prevention of the spread of plague by
land have been noticed ; in Chapter XIV the Convention will be consid-
ered in connection with the regulations restricting trade and commu-
nication issued in foreign countries. The present chapter is specially
concerned with the Convention rules for the inspection of the inward
and outward bound sea traffic, but it will also be convenient to
notice briefly the general scope and arrangement of the Convention
and the circumstances attending its adoption.
Circumstances
leading up to the
Venice Sanitary
Conference.
Great alarm having been experienced in European countries in con-
sequence of the outbreaks of plague at Hong-kong and in India, it
was considered necessary to formulate an international code of
regulations, with a view to prevent the infection from being conveyed
from one country to another, and notably from the East into Europe
by either a land route or by sea. An international conference, at
which twenty-three countries were represented, assembled at Venice
for this purpose on the 16th February. At the last sitting of the con-
ference, which was held on the 19th March, the Convention was signed
by the representatives of eighteen Governments, including the repre-
sentatives of Her Majesty's Government.
Indian delegates.
The Government of India nominated Surgeon-Major-General
Cleghorn as one of the delegates of Her Majesty's Government.
Surgeon-Colonel Richardson represented the interests of British India
at the Conference pending Surgeon-Major-General Cleghorn's arrival.
Regulations
are based on
previous
Conventions.
The regulations* prescribed by the Convention are based on the
conclusions of the Sanitary Conferences of Venice, 1892; Dresden,
1893; and Paris, 1894; these conclusions were modified to meet the
* The Regulations are reprinted in Appendix IX.
CHAP, XI. ] Measures to prevent the spread of infection by sea. 369
special peculiarities of plague, and in accordance with modern
scientific views regarding sanitary precautions for the prevention of
the spread of epidemic disease.
Important
points of
difference.
The following are the most important points in which the Con-
vention of 1897 differs from the previous Conventions on which
it is based :—
(i) The fact that the period of incubation in the case of plague
may be considerably longer than in the case of cholera
led to several important modifications. By the Venice
Conference of 1892 the period of incubation for cholera
was fixed at five days. The conference of 1897 adopted
a ten days' incubation period for the purpose of plague
regulations.
(ii) The list of articles of commerce which may be considered
''susceptible" was considerably increased ; but it is left
to the option of the Governments concerned to allow or
prohibit the importation of the commodities, on the
"susceptible" list, no article being subject to absolute
prohibition.
(iii) Modern principles of disinfection were substituted for the
obsolete system of land quarantine, but, with a view to
meet the wishes of Governments who may find it difficult
to thus protect their borders, the option is given of
closing the frontiers to travellers and merchandise.
(iv) The provisions of the Paris Convention on the subject of
the regulation of the pilgrim traffic were embodied in the
Venice Convention, but in several respects those provisions
were altered in the directions for which the Government of
India have from time to time contended.
Measures for the
prevention of
plague to be
adopted outside
Europe.
Notification.
The first chapter of the regulations prescribed by the Conven-
tion deals with the measures for the prevention of plague which are
to be adopted outside Europe. In the first place, it is laid down
that the Governments which adhere to the Convention are to notify
to other Governments the existence of plague within their several
jurisdictions, and must communicate to them a statement of the
measures that are being carried out to prevent its diffusion. This
requirement as to notification is, however, subject to certain import-
ant conditions. Thus the area to be deemed infected is strictly
limited to the actual district, town, village, etc., where the disease
prevails ; and no locality is to be deemed infected merely on account
of the importation into it of a few cases of plague which have led to
no diffusion of the malady. It is also provided that any area in
which plague has existed will cease to be considered as infected
47