NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
352
Measures to prevent the spread of infection
by land.
[ CHAP. X.
Russian Turkis-
tan and China.
Quarantine measures were adopted in Russian Turkistan; and
on the Kashmir-Kasgar route into China medical officers of the
Chinese Government were posted for the examination of travellers,
who, if healthy, were permitted to pass on without quarantine deten-
tion,
CHAPTER XL
MEASURES TO PREVENT THE SPREAD OF
INFECTION BY SEA.
Division of the
subject.
This chapter deals with the quarantine of arrivals from infected
ports, and the medical inspection of outward-bound vessels. The
measures adopted at the beginning of the outbreak will first be
described; next the regulations on the subject contained in the Venice
Sanitary Convention of 1897 ; and lastly, the modifications made in
the measures first adopted to bring them into conformity with the
Convention.
Original Quarantine Measures.
Previous history
of sea quarantine
in India.
For a complete understanding of the measures adopted and the
regulations issued for the quarantine of arrivals from Bombay and
other infected ports at the commencement of the outbreak, it will be
necessary to examine briefly the previous history of quarantine regu-
lations in India.
A and B
Quarantine Rules
of 1879.
The whole subject of the quarantine of vessels came under the
careful consideration of the Government of India in the years 1878
and 1879, and after some correspondence with the Maritime Local
Governments the Government of India issued a general resolu-
tion explaining the principles that should govern the imposition of
quarantine. In enunciating these principles the Government of India
had especially in mind the necessity of so far considering the views of
other States as to avoid the risk of the enforcement in other countries
of restrictions detrimental to the convenience and trade of India. It
was considered that a system of medical inspection was sufficient to
meet the case of all vessels arriving with persons suffering from any dis-
ease which is endemic in India, and that quarantine should be reserv-
ed for occasions when there was danger of diseases being imported,
which, are either unknown or not commonly rife in India—such, for
45
354 Measures to prevent the spread of infection by sea. [CHAP. XI.
example, as plague and yellow fever. With the resolutions were issued
two sets of model rules : one set (the A rules) for medical inspec-
tion, which might remain continuously in force ; and the other set (the
B rules) for quarantine, only to be issued as a temporary measure
when the occasion should arise, and with the previous sanction of the
Governor General in Council. Both sets of rules were to be enforced
under the Indian Quarantine Act (I of 1870). This brief Act, contain-
ing only two sections, renders it lawful for the Governor General in
Council and with his previous consent for Local Governments to
make rules—
for putting any vessel in a state of quarantine ;
for regulating the intercourse of vessels In a state of quaran-
tine with the shore, or with other vessels ; and
for regulating the intercourse between ports where an infec-
tious disease prevails and other ports.
B Rules.
The model B quarantine rules provide in the first place for
enquiry by the Health Officer of the Port into the state of the vessel's
health. If he is satisfied that there is and has been no case on
board of the infectious disease against which the rules are directed,
free intercourse with the vessel is allowed. If the Health Officer
believes that there is or has been a case of the disease on board,
then quarantine is imposed for fifteen days from arrival or from
the last subsequent case. The rules permit the disembarkation and
detention in segregation of healthy passengers and of healthy
members of the crew whose services are not required on the vessel.
History of
quarantine
from 1881 to
1893.
The first occasion after the issue of the model rules on which it
became necessary to impose quarantine against plague in Indian
ports was in the year 1881. In March of that year news was
received that plague had broken out in Mesopotamia and arrivals from
the Persian Gulf were at once quarantined in Egypt. The Govern-
ment of Bombay asked the Government of India to sanction the imposi-
tion of the B quarantine rules at Aden, and later, at Bombay and
Karachi. The Government of India sanctioned the proposals, and
rules were accordingly issued for Bombay and Karachi which followed
exactly the B quarantine rules of 1879. But for Aden it was found
necessary to impose more stringent regulations. The Resident at
Aden reported that the Egyptian rules not only ordered the detention
of infected vessels for fifteen days, but also required healthy vessels
to be detained for seven days. He ascertained that if these rules were
not followed at Aden that port would be considered to be compromised,
and that arrivals from Aden would be detained in quarantine to the
great detriment of trade. He accordingly from the first imposed
CHAP. XI. ] Measures to prevent the spread of infection by sea. 355
quarantine at Aden against arrivals from the Persian Gulf similar to
that imposed at Egyptian ports. His action was approved and a set
of rules were issued for Aden on the 2oth May, based on the B quaran-
tine rules, but containing this important modification that seven days'
quarantine from the date of arrival was imposed on healthy vessels.
These rules are printed in Appendix IX.
Quarantine against plague was not again imposed in any Indian
port until March 1891, when, owing to the existence of plague in
Yemen, Egypt enforced quarantine against arrivals from Lith to
Lohaya on the Arabian Coast and the example was followed at Aden.
The rules enforced on this occasion followed exactly those issued
for Aden in May 1881. In June 1892 quarantine against plague was
imposed at Aden against arrivals from Bussorah, and again in July
1893 against arrivals from the coast between Lith and Lohaya. In both
cases the quarantine was enforced on the example of Egypt, and the
rules were the same as those imposed in 1881 and 1891.
Quarantine
against Hong-
kong and Canton,
1894.
Quarantine against plague was next imposed in Indian ports in the
year 1894 against arrivals from Hong-kong and Canton. On the
4th of June of that year intimation was received from the Governor of
Hong-kong that plague was epidemic in that place. On the 16th of the
same month the Government of Bombay stated that Egyptian ports had
imposed quarantine on arrivals from Hong-kong and requested sanction
to the imposition of quarantine at Aden. Sanction was accorded and
rules exactly similar to the rules of 1893 and previous years were
issued against Hong-kong for the port of Aden. On the 22nd June the
Government of India issued instructions to the Maritime Local Govern-
ments, including the Government of Bombay, to impose quarantine
against arrivals from Hong-kong, under rules similar to the
Bombay 1893 rules, but with the following modifications. Isolation
was to be dispensed with in the case of vessels carrying a medical
officer and on which no case had occurred during the voyage, and
eight days' quarantine was to be imposed in the case of vessels not
carrying a qualified medical officer, even if there were no reason to
suspect that cases had occurred during the voyage. These instruc-
tions were less strict than the rules that had been enforced at Aden,
but more strict than the model B rules of 1879.
Rules in accordance with the instructions were issued for the ports
in the Bombay Presidency and Sind, in the Madras Presidency and in
Burma, and for Calcutta and Chittagong in Bengal. The rules issued
for the Bombay Presidency were considered to supersede the earlier
rules issued for the port of Aden, and the rules for quarantine
at that port therefore became assimilated to the general rules in force
in ports on the Indian mainland. Subsequently it was ascertained that
356 Measures to prevent the spread of infection by sea. [CHAP. XI.
Canton was also infected with plague, and quarantine was imposed
against that port. The Bengal Government slightly modified the
general rules by imposing eight days' quarantine if through the vessel
not carrying a qualified medical officer or for other reasons the
Health Officer was not satisfied that there was or had been no case of
plague on board; by directing the detention of healthy vessels until
such measures as were considered necessary had been taken for the
disinfection of the mails and cargo; and by recognising pratique
granted at Singapore. The Burma rules also gave pratique to vessels
that had been quarantined for eight days at Singapore or any other
British port, and the Government of Bombay were directed to grant
free pratique at Aden to vessels that had undergone quarantine at
Bombay or Colombo according to the rules in force at those ports,
Hong-kong having been declared free from plague on the 4th September
the quarantine restrictions were withdrawn with effect from that
date.
The rules against arrivals from Hong-kong at ports in the Bombay
Presidency and Sind and at Calcutta are reproduced in Appendix
IX.
Quarantine
against Bombay,
1896.
The next time that quarantine was enforced in India it was
against the port of Bombay. Official intimation of the existence
of plague in Bombay was received by the Government of India on the
29th September 1896. On the 6th of October the Government of
Bombay telegraphed that the Sanitary Board at Alexandria had decided
to apply the Egyptian plague regulations to arrivals from Bombay,
and they asked for sanction to the imposition of quarantine at Aden.
On the 7th, after receiving the sanction of the Government of
India, the Government of Bombay issued rules for the Aden
ports* against Bombay. Rules were then issued against arrivals
from Bombay at Karachi with effect from the 13th, at Rangoon with
effect from the 2oth, at Calcutta with effect from the 21st, and at
Madras with effect from the 28th, October. The rules were all
issued under the authority of the Quarantine Act (I of 1870). It
was decided that the danger of the disease spreading by means of
the coasting trade was not at that time sufficient to necessitate the
imposition of quarantine at minor ports.
Ru'es for Aden
and Karachi.
The rules for both Aden and Karachi followed exactly the
general rules for ports in India which were issued against arrivals
from Hong-kong in July 1894. They thus imposed fifteen days'
quarantine in the case of vessels on which cases of plague had
occurred, and eight days' quarantine in the case of vessels on which
it was believed that no case had occurred, but which did not carry
* i.e., the ports of Aden, Perim, and the Somali coast.
CHAP. XL ] Measures to prevent the spread of infection by sea. 357
a qualified medical officer, and they allowed immediate free com-
munication in the case of vessels on which no case had occurred and
which carried duly qualified medical officers. On the 23rd February
the Government of Bombay issued a resolution requiring the Health
Officer to make a medical inspection of vessels at Aden and Karachi
before granting free pratique, instead of the mere enquiry required
by the original rules.
Rules for Cal-
cutta, Madras,
and Rangoon.
In sanctioning the imposition of quarantine against arrivals from
Bombay at Madras and Rangoon, the Government of India directed
that a modification should be made in the rules imposed at those
ports against Hong-kong and Canton in 1894, similar to the modi-
fication made at the time by the Government of Bengal, namely,
that if the Health Officer of the port were satisfied that no case
of plague had occurred on board the vessel, free pratique should be
granted irrespective of whether or not the vessel carried a quali-
fied medical officer. The rules as thus modified were somewhat
less strict than it was considered necessary to enforce at Aden and
Karachi, and follow very nearly the model B rules of 1879. Their sub-
stance was as follows : Vessels on which a case had occurred were sub-
jected to fifteen days' quarantine ; vessels on which it was not ascer-
tained that cases had occurred were granted free pratique or detained
for an eight days' quarantine at the discretion of the Health Officer of
the port, with the exception that vessels that had already undergone
quarantine at Colombo or some other intermediate port were to be im-
mediately granted free pratique. No communication might be held
with other boats or vessels or with the shore whilst the vessel remained
in quarantine, but the Health Officer might direct the removal of so
many of the passengers and crew as were not suffering from illness, and
whose services were not required on board, to places of segregation
on shore where they were required to complete the period of quaran-
tine, If a case of plague occurred whilst the quarantine was in
progress, quarantine recommenced for a further period of fifteen
days.
Quarantine
against Karachi,
On the 29th December, after obtaining particulars of the outbreak
of plague at Karachi, and on hearing that the Sanitary Board in Egypt
had established plague regulations against arrivals from that port,
the Government of India sanctioned the imposition of quarantine
against Karachi at the Aden ports, and on the 3oth they directed
the Local Governments concerned to issue quarantine rules against
Karachi, similar to the rules in force against Bombay, for Calcutta,
Madras and Rangoon. Regulations were duly issued in accordance
with these instructions.
358 Measures to prevent the spread of infection by sea. [ CHAP, XI.
Modification of
the rules at
Karachi.
Messrs. Mackinnon, Mackenzie & Co., Managing Agents of
the British. India Steam Navigation Company, then represented
that, as Karachi was an infected port equally with Bombay, it was
unnecessary to retain the strict quarantine rules enforcing fifteen
days' detention of infected ships. After consulting the Govern-
ment of Bombay, the Government of India directed that the rules
then in force at Karachi should be cancelled and that fresh
rules should be issued under the Quarantine Act prescribing such
medical inspections and other sanitary precautions against arrivals
from Bombay as the Government of Bombay considered neces-
sary and sufficient.
A new set of rules was accordingly issued
on the 3rd February, which provided that if the vessel carried
a medical officer, and no case had occurred on board, free
pratique should at once be granted. If no case was reported to
have occurred on board, but the vessel did not carry a medical
officer, then eight days' quarantine was imposed from the date of
arrival. If a case had occurred on board, then the sick, their family
and immediate attendants together with their baggage were disem-
barked and removed to segregation shelter, there to remain
until permitted to leave by the Health Officer. After these
measures had been carried out, the other persons on board were
allowed to land under such precautions as the Health Officer con-
sidered necessary and the vessel was disinfected.
Epidemic
Diseases
Act,
section 2 (2), (a).
The Epidemic Diseases Act, contained a special provision for the
treatment of vessels arriving from infected ports, and for the inspec-
tion of outward-bound vessels. The first part of section 2, sub-
section (2) of the Act runs as follows :—
" In particular and without prejudice to the generality of the
foregoing provisions, the Governor General in Council may take
measures and prescribe regulations for—
(a) the inspection of any ship or vessel leaving, or arriving at,
any port in British India and such detention thereof, or
of any person intending to sail therein or arriving there-
by, as may be necessary."
It has been stated in Chapter VI that the Maritime Local Govern-
ments of Bombay, Madras, Bengal; and Burma were all authorised
under section 2, sub-section (3) to exercise the above powers within
their respective territories. The rules already issued by Local
Government under the Quarantine Act remained in force after the
passing of the Epidemic Diseases Act, and were in some cases
extended and modified. But first the Government of Bombay and then
the Government of Madras issued fresh quarantine rules under the
CHAP. XI. ] Measures to prevent the spread of infection by sea. 359
Epidemic Diseases Act, and the final rules framed in accordance
with the Venice Sanitary Convention were all issued under that Act.
Extension of
quarantine to
minor ports.
As the extent and virulence of the epidemic in the Bom-
bay Presidency increased, it became necessary to extend the
quarantine rules to some of the minor ports on the south-west and
east coasts of India. Quarantine against Bombay and Karachi was
imposed on the 13th January 1897 at Tuticorin, the Madras port for
the island of Ceylon. On the 15th January the Chief Commissioner of
Burma telegraphed that the rice export season brought vessels from
the Bombay Presidency to the minor Burma ports, and requested that
sanction might be given to the issue of quarantine rules against
Bombay and Karachi at the ports of Akyab, Moulmein, and Bassein.
This sanction was given on the 18th. Early in February quarantine
against Bombay, Karachi and Goa was imposed at Mangalore and the
southern ports of Malabar (Madras Presidency) and quarantine
against Goa was also imposed at Tuticorin. On the 27th of the
same month the Government of India sanctioned the imposition of
quarantine rules for all ports in the Madras Presidency against all
ports in the Bombay Presidency and Sind, and against Goa. In
the first part of March quarantine rules against Goa were issued for
the ports of Calcutta, Rangoon, Akyab, Moulmein, and Bassein.
Inspection of the
inward sea
traffic at Bombay.
When plague became widely diffused in the Bombay Presidency, I
the Local Government took measures to prevent the spread of infection
from infected ports to less infected or healthy localities. In especial
when the outbreak declined in the City of Bombay, and a large
influx by land and sea began from other parts of the Presidency,
careful arrangements were made under the control of Surgeon-Major
MacCartie, Health Officer of the Port, for the inspection of the inward
sea traffic. " In addition to the people who had fled from Bombay,"
General Gatacre remarked, "an influx of people, not inhabitants of the
city, flying from the plague in their own villages, was to be anticipated-
Many places were now suffering more than Bombay, and partly on
this account, and partly to escape the vigorous measures of the local
authorities to stamp it out, people had begun to flock into the city
from the districts most affected, Over this influx it was necessary to
keep a careful watch." As early as the 2nd March the Government
of Bombay issued a resolution directing the Municipal Commissioner
to make arrangements for the medical inspection, and if necessary
the detention under observation of all persons entering Bombay by rail,
sea, or road. On the 12th April they issued rules under the Epidemic
Diseases Act authorising the Bombay Plague Committee to appoint
Regulations of
the I2th April.
360 Measures to prevent the spread of infection by sea. [CHAP. XI.
Establishment.
plague authorities who were empowered by the rules to medically
inspect persons coming to Bombay Island by sea, by vessels, includ-
ing native craft, which had touched at any port in India between
Bhatkal (in the north of the Kanara District of the Bombay Presidency)
and a line ten miles north of Karachi, and to detain at the hospitals
appointed for the purpose any persons whom they found or suspected
to be suffering from plague. The rules further provided that the
master of any vessel coming from the infected sea coast should
report any cases of plague or deaths on board, that he should not
allow the landing of passengers or crew until permitted to do so, and
that passengers and crew should only be landed during the day time
and at appointed landing stages. The inspection of the inland sea
traffic like that of the outward see traffic was performed by the
establishment of the Port Health Office, which was largely
augmented for the purpose. The inward sea traffic inspection
staff consisted of three commissioned medical officers, two medical
practitioners, a lady inspector, two lady doctors, a lady medical stu-
dent, five assistant surgeons, thirteen medical students, and an office
establishment. Further assistance was furnished by the outward
inspection staff, The staff was provided with steam-launches, Port
Trust bargres, etc.
Steamer traffic.
Native craft.
General Gatacre stated that the examination of the steamer traffic
presented comparatively little difficulty, especially as Mr. Shepherd,
who owns the line which carries almost all the local passenger traffic,
came forward with the most valuable help and advice. The steamers
arrived at more or less fixed hours, and the passengers were landed
at certain landing stages. The only difficulty therefore was the pro-
vision of the staff. " The examination of the native craft presented
many obstacles. Arriving at all times of the night and day, landing
their passengers anywhere, and owned and sailed by men who were
in full sympathy with those of their passengers who wish to evade
inspection, special measures had to be adopted to prevent cases of
plague being smuggled into Bombay by them. For customs' purposes
there is at all times a regular patrol of the whole harbour from
Middle Colaba as far as Sadri, and the officials of the Customs are
always on the watch to prevent persons from landing in any but the
regular places. The first step, therefore, was to ask the Collector of
Customs to refuse to allow anyone to land who had not obtained a pass
certifying that he was free from plague. All native craft were
ordered to bring up at one of the following anchorages :—Tucker's
Beacon, Free Anchorage, Dutiable Anchorage. At each of these places
there was a barge stationed with a medical staff, detailed from the
medical students placed on the duty. As soon as a craft came to anchor