NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
316
Measures to prevent the
[ CHAP. X.
north of Bandra were stopped for the medical inspection of their pas-
sengers at Bandra, except in the case of the up mail trains, the pas-
sengers by which were inspected at Palghar. No person was allowed
to book at Banclra station by up-trains until they had been medi-
cally inspected. Season ticket-holders and free pass-holders were
ordinarily excused from inspection, but the plague authorities were
permitted to inspect them in any cases in which they considered it
desirable to do so.
Arrangements
for protection
against Cutch-
Mandvi.
Another instance of protective arrangements within the Bombay
Presidency is furnished by the measures adopted on the occurrence of
the virulent outbreak in Cutch-Mandvi. In addition to arrangements
for the quarantine of vessels arriving from Cutch at Bombay, Karachi,
and other ports, and for the closing of some and the institution of
observation posts on the remainder of the routes from Cutch into
Kathiawar, special arrangements were made for the examination of
railway travellers from Cutch at Wadhwan in Kathiawar and at
Ahmedabacl. At Wadhwan travellers were detained for twenty-four
hours for inspection and disifection of clothing.
Method of
inspection.
The plan on which the series of inspection stations along the lines
of communications was arranged having been explained, it remains to
be described how the inspection was carried out under rules framed by
Local Governments under the Epidemic Diseases Act.
The Bombay
Presidency.
Rules issued by
the Government
of Bombay.
Co-operation of
the servants of
railway
companies.
In the Bombay Presidency the arrangements were under the
immediate control of Surgeon-Major Street,
who advised
the Government of Bombay and inspected the stations.
The
rules issued for the principal inspection stations in the Presidency
proper provided for the detention of the train until the com-
pletion of the inspection and until the guard in charge obtained
a certificate from the Chief Medical Officer in charge of the inspect-
ing staff to the effect that all persons proceeding further by
the train, whether railway servants or passengers, were free
from plague. The train was emptied for inspection in such manner
as the Chief Medical Officer on duty directed, and the servants of the
railway company were directed to afford all facilities for the inspec-
tion of persons arriving (whether or not they intended to continue
the journey) and of persons intending to start by the train. In parti-
cular the doors of all railway carriages were to be locked at the sta-
tion at which the train last stopped before arriving at the inspec-
tion station.
Detention of
suspicious case3.
The inspecting medical officers were empowered to examine all
passengers arriving by or intending to leave by the train, and to
detain persons suffering, or suspected to be suffering, from plague in
CHAP. X, ]
spread of infection by land.
Hospital and
segregation
accommodation.
Minor inspection
stations.
places appointed for the purpose. Hospital accommodation was
provided for plague patients, and separate accommodation was fur-
nished for suspected persons and for the medical staff. At minor
inspection stations the officers appointed for the purpose were
empowered to examine all persons alighting or intending to depart, and
to detain at the appointed place all persons suffering, or suspected to
be suffering, from plague. Europeans or natives of a class who could
not be properly accommodated at the Palghar and Kalyan stations
were to be sent back to Bombay and removed to one of the hospitals
in the city.
Sind.
The arrangements for the major and minor inspection stations
in Sind were similar to those enforced in the Presidency proper.
The rules for the major inspection stations were drawn up in
somewhat greater detail than the rules for the Presidency, and
instructions for principal stations were issued to meet the special
features and arrangements of each.
It was specially provided
in the Sind rules that the persons detained might be accompanied
by relatives or friends, and attention was drawn to the arrangements
that should be made for the comfort of the segregated, and for the
proper treatment of females,
Tour of inspec-
tion made by the
Officiating
Sanitary
Commissioner
with the
Government of
India.
Arrangements at
Kalyan.
Bhusawal.
Surgeon-Major-General Warburton (Officiating Sanitary Commis-
sioner with the Government of India), who made a tour of inspection
on the railways at the end of March, recorded the following notes on
the inspection stations at Kalyan and Bhusawal. At Kalyan twenty
scheduled trains were examined daily. The morning report showed
that there were 15 persons in the observation sheds, and 19 cases in
the plague sheds. From the 13th February to the 29th March 301
persons had been detained. Of these 250 were suspects. Approxi-
mately 98 of the cases detained proved to be true cases of plague. Of
these 63 had died, 16 had been discharged cured, and 19 remained
under treatment. Dr. Warburton was present at the examination of
three trains, and found that the inspection was carefully and properly
conducted. At Bhusawal four trains, with about 700 passengers, were
examined daily—at 8-20 and 9-16 A.M., and at 6-40 and 9-5 P.M. There
were no trains to be examined during the night. The inspection of two
evening trains at which Dr. Warburton was present was carefully
performed. In the segregation camp there was accommodation for
twenty plague cases and five suspects. There were two cases under
observation, and three cases recovering from plague under treatment.
Eleven other cases of plague, making 14 in all, had been detected and
segregated, of these 7 had died and 4 had been discharged on recovery.
Staff.
To carry out these numerous inspections of large bodies of travel-
lers a considerable staff was required. A resolution issued by the
318
Measures to prevent the
[ CHAP. X.
Government of Bombay on the 26th February showed that the follow-
ing staff was maintained at the principal inspection stations in the
Presidency proper :—
Kalyan station.
2 Commissioned Medical Officers.
2 Military Assistant Surgeons.
2 Native Medical Practitioners.
14 Hospital Assistants.
Palghar station.
1 Commissioned Medical Officer.
1 Military Assistant Surgeon.
6 Hospital Assistants.
Ahmedabad station.
I Commissioned Medical Officer.
1 Military Assistant Surgeon.
6 Civil Assistant Surgeons.
5 Stipendiary Pupils.
2 Civil Medical Pupils.
Bhusawal station.
1 Military Assistant Surgeon.
3 Hospital Assistants.
(When Dr. Warburton visited this place on the 27th March the staff
consisted of—
1 Commissioned Medical Officer.
2 Military Assistant Surgeons.
5 Hospital Assistants.)
Hotgi station.
2 Military Assistant Surgeons.
3 Hospital Assistants.
Londa station.
2 Military Assistant Surgeons.
3 Hospital Assistants.
In May the total staff employed in the Presidency proper on
railway inspection work consisted of—
9 Commissioned Medical Officers,
4 Private practitioners, and
74 Officers of the Subordinate Medical Service.
CHAP. X. ]
spread of infection by land.
319
Female
inspectors.
With a view to the examination of female passengers, female doctors
or nurses were appointed at the stations named in the following
list:—
Bhusawal ...
...
...
...
Dadu
Karachi
...
Shikarpur ...
Sukkur
...
...
2 nurses.
I nurse.
1 lady doctor.
I lady doctor.
I nurse.
At Kalyan it was found impossible to make arrangements for
accommodating nurses or female doctors; and if the inspection of any
female passenger raised a strong suspicion of plague, she was sent
back to the Parel Hospital, Bombay, for examination.
Success of the
Bombay arrange-
ments.
The success of the elaborate system of inspection carried out in
the Bombay Presidency is best shown by the very few cases of plague
which were discovered beyond the limits of the province, amongst
the enormous number of persons who travelled to other parts of India
during the period of the epidemic.
The North-
Western
Provinces and
Oudh general
rules.
The rules issued by the Government of the North-Western Prov-
inces and Oudh divide the railway inspection stations into three
classes :—
(a) principal inspection stations ;
(b) minor inspection stations with a hospital assistant in charge;
and
(c) minor inspection stations with an officer of the vaccination
department in charge.
Principal
inspection
stations.
Examination of
passengers.
Segregation of
suspects and
treatment of
plague cases in
hospital.
Companions and
attendants.
The rules for principal inspection stations provide, in the first
place, for the detention of the train as long as may be necessary for
the medical examination of the passengers. On arrival of the train
at a principal inspection station passengers are required to remain
in the train until permitted to alight by the railway police or a
medical officer. They are then required to proceed for the pur-
pose of examination to the place appointed for the purpose, there to
remain until permitted to depart. The examination of female passen-
gers was effected under the orders of the medical officer by a female
medical practitioner or subordinate. Persons suspected to be suffer-
ing from plague are removed to the temporary observation shed and
there detained under medical treatment. If the case proves to be a
true case of plague, the patient is removed to the temporary hospi-
tal. The companions and attendants of patients are permitted to
accompany them, and are required to reside in a segregation hut
or tent in the immediate vicinity of the hospital. If any one amongst
320
Measures to prevent the
[ CHAP. X.
Minor stations in
charge of hospi-
tal assistants.
Inspection of
passengers
alighting and
changing trains.
Minor stations in
charge of officers
of the Vaccina-
tion Department.
Other wayside
stations.
Inspection
circles.
Staff.
them catches the plague, he is removed to the hospital. Upon the
death of a patient the persons who have been in attendance on him
are detained under observation for a further period of ten days. The
corpse is disposed of under the orders of the medical officer. At
minor stations in charge of hospital assistants the railway authorities
are directed to allow sufficient time for the hospital assistant to
examine the passengers who alight, and those who change car-
riages for the purpose of proceeding by another train. The arrange-
ments for detaining suspected and declared cases, and other matters,
are the same as in the case of the major inspection stations.
At the other minor inspection stations officers of the Vaccination
Department are posted to assist the station master in watching
passengers. If at any of these stations a person travelling from
the direction of the infected area is found to be suffering from
plague, the station master is directed to arrange for his removal to
the observation shed and for his detention there until he can be
inspected by a medical officer. Any person desiring to accompany
the sufferer is permitted to do so. The station master was directed
to report the circumstances to the medical and district authorities,
and the subsequent procedure is the same as at other inspection
stations. At wayside stations, where no inspection officer is
posted, persons suspected to be suffering from plague are permitted
to proceed to the nearest station where a temporary hospital has
been provided, the station master telegraphing to that station the
details of the case, the name of the sick person, and the number of
the carriage. If the person alights at the wayside station, he
is removed to some isolated place, and the circumstances are
immediately reported to the nearest police station and to the dis-
trict and medical authorities. Temporary hospitals, segregation
shelter, and accommodation for the companions of the sick have been
provided at each of the inspection stations at which officers of the
Medical or Vaccination Department were posted. For the proper
supervision of the general arrangements the railway system within
the limits of the province is divided into three circles, to each of
which an inspecting medical officer is appointed. It is the duty
of each medical inspector to travel frequently over the lines of railway
included in his circle and to make surprise visits at least once a
week to the principal stations. He is specially directed to examine
the method adopted for the inspection of passengers, and the arrange-
ments made to provide observation sheds, temporary hospitals, and
segregation huts or tents. The Government of the North-Western
Provinces and Oudh reported on the 5th of April that 11 commis-
sioned medical officers, 9 assistant surgeons, and 15 hospital
CHAP. X, ]
spread of infection by land.
321
Female
inspectors,
assistants had been detailed for plague duty ; they were mainly
engaged in the work of railway inspection. Female doctors or sub-
ordinates were posted for the examination of female passengers at
the following places :—
Bareilly
...
...
Ghaziabad
Ghazipur
...
...
Haldwani
...
...
Jhansi
... ...
Manikpur
Saharanpur
...
...
1 Compoundor.
1 Nurse, 1 hospital assistant.
I Nurse.
1 Compounder.
1 . Ayah.
1 Nurse.
1 Midwife.
Arrangements at
Manikpur.
Dr. Warburton visited the Manikpur station (which was subse-
quently transferred to Sutna) on the 25th March and recorded the
following remarks on the inspection :—
" Only two trains from the Bombay direction—one at 7-24 A.M.
and the other at 7-5 P.M.—are examined each day. There are no
night trains. I was present at the inspection of two trains, the total
number of passengers examined being 360, of whom about 15 per
cent. were from the Bombay Presidency.
"The examining staff consists of one commissioned medical officer,
Surgeon-Lieutenant Dawes, and a native female nurse ; the former
examines all the men and feels the pulses of the females, whose
examination is completed by the nurse. The examinations were
carefully made. There were no purdah women and no complaints.
" One hospital assistant is in charge of the segregation camp and
is present at inspections to take over any suspects or plague cases
that may have to be detained. The camp consists of tents and huts
for Europeans and natives with hospitals properly isolated ; but, as only
two suspects had so far been detained, the hospital assistant has
had little to do. The small number of " suspects " at this station is
probably due to effective inspections at Jubbulpur and Itarsi.
" The drinking-water is here the great difficulty. Europeans get
theirs from Allahabad, and natives use water from the railway well
and a neighbouring tank, both of which are drying up. The station
is badly lighted.
" The medical officer keeps no diary. I have directed him to do
so, entering the number of passengers examined each day, especially
noting the number from Bombay, and to send a copy of the diary each
week to his superior officer.
" The staff is sufficient and no new passenger is allowed to enter
the train till the inspection is completed."
41
322
Measures to prevent the
[ CHAP, X.
The Punjab
general rules.
Inspection of
passengers.
Segregation of
suspect cases.
Friends and
attendants.
Stations without
inspecting
officers.
The rules framed by the Government of the Punjab provide in the
first place that the inspecting medical officer may direct the passen-
gers to alight and proceed for inspection to an appointed place on the
platform or on the line. The inspecting officer is next permitted to
make such medical inspection of the passengers as he may consider
necessary, provided that the inspection must not be made in any man-
ner or to any extent to which the person examined objects. The
passenger is also bound to answer any questions put to him by the in-
specting officer. If the inspecting officer suspects that the passenger
may be infected with plague, or if the passenger refuses to be examined,
the rules direct his detention in segregation in a place appointed
for the purpose, until the danger of his spreading infection is over.
Friends or attendants of persons segregated are permitted to accom-
pany him, on the condition that they submit to retention in an
appointed place. At stations where there is no inspecting officer the
station master is directed to send any suspected case to the next
inspection station.
Hospitals
and
staff.
For the purpose of carrying out these rules plague hospitals were
established at 59 inspection stations ; and, during the height of the epi-
demic, the following medical staff were employed on inspection duty
at the railway stations and at four road and ferry posts :—
27 Commissioned Medical Officers.
1 Uncovenanted Medical Officer.
2 Native doctors.
4 Military Assistant Surgeons.
12 Civil Assistant Surgeons.
40 Hospital Assistants.
Female inspec-
tors.
Female hospital assistants were appointed at the following
stations :—
Khan pur,
Kalka,
Umballa,
Raewind,
Wazirabad.
Hospital and
segregation
sheds.
The Government of the Punjab prescribed a model plan for
hospital and segregation sheds which will serve as an example
of the nature of the temporary arrangements made at railway stations
all over the country. The dimensions prescribed for a hospital shed
for four patients were 18 feet by 16 feet, with side-walls, 8 feet high,
and a sloping roof rising 6 feet above the walls. This gave a space of
600 cubic feet for each patient. The shed was provided with a mat
door on each side-wall, 6 by 4 feet in dimensions, and with an opening
CHAP. X.]
spread of infection by land.
323
two square feet in size, with a mat shutter, at each end and placed
about 5 feet from the ground. The following rough sketch shows the
arrangement of the beds :—
The dimensions prescribed for the observation shed were 18 feet
by 8 feet, and it was to be adapted for two beds. A moveable screen
of thatch, 6 feet by 5 feet, was to be kept in readiness, so that if a
female patient were admitted privacy could be effected. For the
hospital assistant a hut of similar description and 12 square feet in
size was prescribed. A small thatch work enclosure, without a
roof, and about the size of an ordinary ' necessary ' tent, was to be
placed a few yards from the hospital tent. Directions were given
that at first only two beds in the hospital shed and one in the obser-
vation ward should be equipped. For each bed two pairs of sheets,
three country blankets, one mattress, and one pillow were to be pro-
vided. A tent with the necessary equipment was prescribed for
European patients.
Bengal general
rules.
Segregation of
suspect cases.
Females.
Hospitals and
temporary ac-
commodation.
The regulations issued by the Government of Bengal require
passengers to submit themselves for examination. Persons suspected
by the inspecting officer of being infected with plague are required to
undergo segregation in hospital or in temporary accommodation for a
period of not less than seven clays, which may be reduced at the dis-
cretion of the inspecting officer. The rules direct that in conducting
the medical inspection of females, and in arranging for their segrega-
tion, the inspecting officer should, as far as possible, have regard to the
customs of the country, Arrangements were also prescribed for the
erection of hospitals and temporary accommodation, for the supply
of food and water to persons undergoing segregation, and for the pro-
per sanitation of the place,
324
Measures to prevent the
[ CHAP. X.
The Khana
inspection
station.
The most important of the Bengal inspection stations during
the first period of the epidemic, was that established at Khana
junction on the main line between Bombay and Calcutta. Sur-
geon-Captain Dyson, Sanitary Commissioner of Bengal, under whose
immediate direction the operations were carried out, has given
a detailed account (dated the 12th March) of the arrangements at
Khana, which is reprinted in Appendix VIII and is illustrated by the
map in Volume IV (page 17).
Arrangements in
the observation
camp.
The observation encampment was divided into three portions:
(1) the plague hospital, (2) the contact camp, and (3) the suspect
camp. The contact camp was for the accommodation of persons found
travelling in the same carriage with a plague patient, and the suspect
camp for the accommodation of other suspicious persons. The plague
camp consisted of—
(a) two structures, 45' x 16', which formed the native plague
hospitals ;
(b) six rooms, 10' x 10', for the families of the patient'; and
(c) eight rooms, 8' x 10', for the hospital attendants.
There was also a small masonry building for European patients
and accommodation for sweepers.
The plague hospitals contained accommodation for forty patients.
The beds were of iron and iron platters and water-vessels were
provided, all of which could easily be disinfected by heat. A
Horbury's iron latrine was supplied and a Larrymore's incinerator.
Very careful arrangements were made for the distribution of pure
water from iron tanks.
In both the contact and suspect camps there were 75 huts, each
10' x 8', and accommodating two persons. Both camps were provided
with a Horbury's latrine and a pure water-supply, and both were
surrounded by a barbed wire fence.
Inspection of
trains.
The inspecting staff consisted of two commissioned medical officers
and two lady doctors ; one medical officer and one lady doctor remain-
ing on duty together.
Nine trains were examined daily, and on the date for which Dr.
Dyson gives the information the number of passengers examined
was 3,295. The account given by Dr. Dyson of the method of examin-
ation and the management of the camp is sufficiently important to
deserve quotation at length.
Examination of
passengers.
" Pending completion of the new platform, the examination of
passengers takes place at the station. All passengers are required
to alight and be examined—males by the medical officers and females
by the lady doctors. A European station master, a European police