NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
CHAP. IX.] Measures outside the Bombay Presidency.
251
areas by the maintenance at police-stations of registers of villages in
communication with the Bombay Presidency and of persons arriving
from the Bombay Presidency.
North-Western
Provinces,
In rural areas in the North-Western Provinces and Oudh addi-
tional arrangements were made, by employing the police and all other
available local agencies, to obtain the earliest information of any cases
of plague that might occur. The officers of the subordinate land
revenue staff, who are constantly travelling around the villages, were
directed to give information to their superior officers of the occurrence
of any deaths with plague symptoms. Hospital assistants stationed at
villages where there are branch dispensaries were required to watch
all arrivals and to report a description of the symptoms, in cases of
illness, to the Civil Surgeon of the district. Officers employed on
duty connected with the famine prevailing in the North-Western
Provinces and Oudh received instructions to ascertain on their rounds
whether any cases of plague had occurred in the vicinity. In munici-
palities householders were required to at once report all cases
of plague in their houses, and the illness or death of any person
who had been residing in an infected locality. Employers of labour
were likewise required to give notice of the engagement of any factory
hands from the Bombay Presidency and Sind, and medical practi-
tioners were required to report any cases which they attended and
which they had reason to believe were cases of plague. The reports
were to be made to the nearest police-station, and the officer in
charge of the station was directed to send immediate information to
the District Superintendent of Police, the District or City Magistrate
and the Health or Sanitary Officer of the municipality or the can-
tonment. The rules also require the owner or occupier to permit the
Health Officer to enter his premises and examine any person believed
to be infected with plague, provided that if the person be a female,
who, according to the custom of the country, does not appear in
public, the examination must be made by female agency.
Bengal.
The Bengal regulations of the 10th February for Calcutta and
other municipalities only provided for the report of plague cases by
householders. The further regulations for Calcutta published on the
12th March required every medical practitioner and every police-officer
or municipal servant who becomes cognisant of a case of plague to
report the fact to the Health Officer. The Bengal rules of November
1897 contain provisions similar to those of the North-Western Prov-
inces rules.
Punjab.
The Punjab regulations of the 8th March deal at length with the
report of plague cases, etc. In municipalities owners and occupiers
of houses are required to report all cases of plague to the police-
station and the same obligation is imposed on the eldest adult in houses
in rural areas, and on the proprietors and managers of hotels,
252
Measures outside the Bombay Presidency [CHAP. IX.
rest-houses and other such places. All medical practitioners are
required to report the cases they attended. Municipal Commissioners
and servants, village-officers, subordinate revenue-officers, police-
officers, holders of revenue free land, and pensioners, are directed
to report to the police-station all cases of plague that came to their
knowledge. Similar arrangements were made for reporting the arrival
of persons from the Bombay Presidency and Sind.
Madras.
The rules for the City of Madras only provide for report by house-
holders. In other localities in the Madras Presidency the obligation
is laid on householders and medical practitioners.
Central
Provinces.
In the Central Provinces the rules are similar to those prescribed
in the North-Western Provinces and Oudh.
Corpse
Inspection.
The detection of plague cases by the inspection of corpses has
been noticed in Chapter II.
MEASURES TO BE ADOPTED ON THE OCCURRENCE OF
PLAGUE CASES AND EPIDEMICS.
Division of the
subject.
This portion of the subject will be discussed under the following
heads :—
(1) Treatment and segregation of patients.
(2) Segregation of other persons likely to be infected.
(3) Conveyance of patients.
(4) Disinfection or destruction of infected dwellings.
(5) Disinfection or destruction of contaminated articles.
(6) Payment of compensation.
(7) Disposal of corpses.
(8) Infected conveyances.
(9) Evacuation of infected localities.
Treatment and segregation of plague patients.
Native opinion
on the subject of
segregation.
In discussing the measures enforced in the Bombay Presidency
the difficulty of this subject has been described. In dealing with
it the different Local Governments and Administrations were com-
pelled, on the one hand, to consider the importance of devising means
sufficient to prevent sufferers from plague from infecting their surround-
ings, and, on the other hand, they had to take into account the state
of feeling in their respective provinces and the extent to which poli-
tical disaffection and disorder were to be apprehended from the
enforcement of a rule rendering every person suspected to be suffer-
ing from plague liable to be sent to hospital.
Original
North-Western
Provinces rule.
The original segregation rule framed by the Government of the
North-Western Provinces and Oudh, was as follows:—
" If on examination of a sick person in a house or other place
within the limits of a municipality or cantonment, the Health Officer
CHAP. IX.]
Measures outside the Bombay Presidency. 253
suspects (1) that such person is infected with bubonic plague, or
(2) considers that he is actually suffering from bubonic plague, the
Health Officer shall, if he considers it necessary, arrange for the
removal of such person (1) to an observation shed, or (2) to a tempo-
rary hospital established for the purpose and for his detention, diet-
ing and medical treatment therein ; also for the removal of the other
occupants of the house to segregation huts, tents, or suitable struc-
tures constructed at a distance from the town, to be detained under
observation for ten days."
Revised
North-Western
Provinces rule.
The rule in this form was most unacceptable to the Muhammadan
and Hindu communities of the North-Western Provinces and Oudh,
and in the second set of regulations the arrangements for the segre-
gation of plague patients were considerably modified and stated
in much greater detail. The Local Government gave the following
description of the modified rule :—
Home
segregation
allowed.
" Isolation may be effected either in the residence of the sick
person or in a segregation hospital or camp. In this matter the
Lieutenant-Governor desires to apply to the native community the
same rules which will apply to the European community. If, in the
opinion of the sanitary authorities, isolation and segregation can
be effectively carried out at the sick person's residence, it will
not be necessary to remove such sick person to a hospital or segre-
gation camp ; but, if isolation and segregation in the sick person's
residence is not, in the opinion of the sanitary authority, practicable,
then it is essential that such authority should have the power to
Private
hospitals.
direct removal to a segregation camp or hospital established in a suit-
able situation. This segregation camp or hospital may be a suitable
house or hut or collection of huts licensed for the use of a particular
family ; or a suitable house or collection of huts licensed for the sole
use of particular castes or classes of the people ; or, lastly, a hospital
or collection of huts established for the general use of the public by
Government. The Government will, whenever necessary, construct
such huts or hospitals, or help private persons to construct them. In
designing these huts or hospitals particular care will be taken that the
customs of the country regarding the maintenance of purdah* shall
be strictly observed, and that those members of the family who wish
to accompany the sick person shall be comfortably accommodated,
Private medical
practitioners.
submitting themselves merely to the sanitary precautions which
are required by the rules. It is also to be understood that private
medical practitioners of all classes must be allowed free access to the
sick who desire their attendance, and that it is incumbent upon no
one to submit himself to European medical treatment. Each patient
may choose freely his own medical attendant."
i.e., the privacy of women who do not appear in public,
254
Measures outside the Bombay Presidency, [CHAP. IX
Home segrega-
tion found im-
possible at
Hardwar and
Kankhal.
In dealing with the epidemics of plague at Hardwar and Kankhal
the Local Government did not find it possible to adhere to the prin-
ciple of home segregation. The evacuation of infected houses and
localities and the removal of the sick to special accommodation were
found to be essential, These measures were successfully carried out
without opposition from the people who were treated with great tact
and consideration.
Removal of
plague patients.
The rules forbade the removal of any person suffering from
plague, except for the purpose of taking him to hospital, until six
hours after the delivery of notice of the intended removal at the
nearest police-station.
Persons accom-
panying the sick.
The principal sanitary precaution to which persons accompanying
the sick were required to conform was residence in segregation in the
immediate vicinity of the private or public hospital. If any person
were attacked by plague while thus segregated the rules directed his
removal to hospital.
Special plague
hospitals.
In April the Lieutenant-Governor ordered the erection of special
hospitals containing 56 beds in the larger cities, and from 30 to 32
beds in other places, special provision being made for the privacy of
females and families.
Revised Bengal
rule.
Home segrega-
tion not allowed.
Private hospitals.
The regulations issued by the Government of Bengal at the time of
the recrudescence contain revised rules for the segregation of the
sick and infected. The Lieutenant-Governor, after considering the
alternatives of home segregation and segregation in hospital, came
to the conclusion that home segregation could not be permitted on
a large scale; it "would multiply the so-called 'hospitals' to such
an extent that no effective control could be exercised over the
intercourse of plague patients and suspects with uninfected mem-
bers of the community." The regulations therefore authorize the
Health Officer to cause all sufferers from plague to be removed to
hospital. But in order to show all possible consideration to the
feelings of the upper classes of the native community, the estab-
lishment was authorized of private hospitals " for particular castes,
classes, joint families, or associations of families," the equipment
and administration of which must be approved by duly appointed
authority. This was an extension of the private hospital system so
successfully adopted in the City of Bombay. General Gatacre refused
to permit the establishment of hospitals for families and groups of
families. He had, however, to deal with an already virulent epidemic,
whilst in Calcutta, and in Bengal generally, there was time to make
beforehand all arrangements for the crisis, should it arrive. The
experience of Bombay had also shown that there is no danger to be
CHAP. IX.] Measures outside the Bombay Presidency.
255
apprehended from the existence of a considerable number of plague
hospitals in a large town provided they are properly managed. The
following is the full text of the Bengal segregation rules :—
Text of the rules.
" (i) If on examination of any person the Health Officer suspects
that such person is suffering from or infected with plague, he may
cause such person to be removed to a hospital, and may arrange for
his detention, dieting and medical treatment therein. He may also
cause the other occupants of the bouse in which such person resides
to be removed to a segregation camp and to be detained under
observation for ten days. In the case of pardanashin ladies a lady
doctor shall conduct the examination.
" (2) When private plague hospitals or segregation camps have
been provided and fully equipped by or for particular castes, classes,
joint families, or associations of families, and the Health Officer, or
in Calcutta two members of the Plague Commission empowered for
this purpose by the President, have in writing approved of the site,
plan, furniture and arrangements for medical administration of such
hospitals and camps, sick or suspected persons may, if they so desire
and if accommodation is available, be removed to the private hospital
or segregation camp constructed for the use of the caste, class or
family to which they belong, instead of to a public hospital or camp.
" (3) In both public and private camps and hospitals separate and
suitable accommodation shall be provided for females, and in the case
of a female who by the custom of the country does not appear in
public, her parda shall be strictly preserved, both in removal to the
camp or hospital and during her stay there.
" (4) The relatives, friends, hakims and priests of sick persons
shall be allowed free access to them during the day time, subject
only to such precautions as the Health Officer may consider neces-
sary.
" (5) Members of the family of a sick person who are in attend-
ance on him may also be admitted to the hospital, whether public or
private, provided that they shall sleep in the compound in suitable
accommodation provided for the purpose, and not in the hospital
itself.
" Explanation 1.—It is not necessary that hospitals provided in
accordance with this rule should be constructed in remote or incon-
venient situations.
" Explanation 2.—Persons desirous of taking advantage of clause
(2) should at once communicate with the Plague Commission and
satisfy that body of their ability to provide adequate hospitals and
camps when plague breaks out.
256
Measures outside the Bombay Presidency.
[ CHAP. IX.
" Explanation 3.—Private hospitals and camps may be closed by
order of the Plague Commission, if the Health Officer reports that
medical attendance and segregation are not maintained to his satis-
faction, or that the conditions on which such camps or hospitals were
sanctioned are not compiled with. "
Arrangements in
Calcutta.
The Bengal rules further provide for the erection and maintenance
of temporary hospitals and segregation accommodation. A plague
hospital was prepared at Maniktola, a suburb of Calcutta, subdivided
for Hindus, Muhammadans and Christians, and provided with observa-
tion and rest camps for each sect. Arrangements were made to
provide this hospital, should plague break out, with a staff of two com-
missioned medical officers, two lady doctors, twelve trained nurses,
twenty-four hospital assistants, and menials. Sites were also selected
for three other similar hospitals. At the time of the recrudescence a
more complete system was organized which divided the town into
districts and required thirty-five medical officers for its execution.
The Bengal Government stated it could provide ten and asked for
twenty-five more to be placed at its disposal should the emergency arise.
Twenty-five private medical practitioners were accordingly procured
from England and were placed on plague duty in the Bombay
Presidency in readiness to go to Calcutta if plague should break out
there.
Central
Provinces rule.
The Central Provinces rule followed the original North-Western
Provinces rule.
Punjab rule.
The rule framed by the Government of the Punjab was merely an
enabling rule and empowered the District Magistrate to require any
person infected or believed to be infected with plague to remain
in the place specified by the District Magistrate.
Madras rule.
The Madras rules require municipal authorities to provide and
maintain suitable accommodation for the isolation and treatment of
persons suffering or suspected to be suffering from plague. On
the occurrence of any case of plague the patient is to be removed to
the appointed accommodation, or to be segregated in his own house
or any other suitable place, if, in the opinion of the Health Officer,
this course can safely be adopted. These measures were successfully
carried out on the detection of some imported plague cases.
Segregation of other persons likely to be infected.
The adoption of this precaution is subject to much the same
difficulty as the segregation of persons suffering or suspected to be
suffering from plague.
CHAP. IX.]
Measures outside the Bombay Presidency.
257
North-Western
Provinces rule.
Bengal rule.
The revised rules framed by the Government of the North-Western
Provinces and Oudh state that if it is found necessary to segregate
the family or any members of the family of the patient, this should,
if possible, be effected in their own house ; if not, then the segregation
must be carried out in a suitable place chosen by the family and
approved by the Health Officer, or in a general segregation camp.
Instructions were given to pay strict attention to the seclusion of
females and the convenience of the family. Upon the death of a sick
person from plague the non-professional persons who had been in
attendance upon him were required to be segregated for ten days, in
the house or its enclosure if this could safely be done, or if not, in a
segregation hut or tent or other suitable accommodation. At Hard-
war and Kankhal home segregation was not carried out. The infect-
ed localities were completely evacuated, and persons who had been
specially exposed to the risk of infection were segregated in camp.
In the Bengal rules of November 1897 the segregation of persons
likely to be infected is provided for on the same principles as the
segregation of the sick. The rule is contained in the extract quoted
above. The Health Officer may cause all the occupants of a house
in which a case of plague occurs to be removed to a segregation camp
and detained for ten days. The establishment of duly supervised
private camps for " particular caste, classes, joint families or associa-
tions of families " is encouraged.
Conveyance of patients.
Bengal and Pun-
jab rules.
This matter is not specially dealt with in the North-Western Prov-
inces rules. The rules framed by the Government of Bengal require
the municipal authorities to provide suitable conveyances, painted in
a conspicuous manner, for the free carriage of persons suffering,
or suspected to be suffering, from plague, and for the free trans-
port of infected clothing, bedding, etc. A similar rule appears
in the Madras regulations. The special Punjab rules on the subject
of conveyances authorize the District Magistrate to require the pro-
prietor of any vehicle ordinarily employed to carry passengers for
hire to convey plague patients or corpses.
Disinfection or destruction of infected dwellings.
North-Western
Provinces and
Bengal rules.
The regulations framed by the Governments of the North-Western
Provinces and Oudh and Bengal require householders, etc., to comply
with any direction that may be issued by the Health Officer with re-
gard to the disinfection or cleansing of houses, and to permit the
Health Officer to enter for the purpose of inspection, opportunity
being afforded for the withdrawal of females who do not appear in
public,
33
258
Measures outside the Bombay Presidency.
[ CHAP. IX,
The Health Officer is also empowered, should he consider it neces-
sary, to himself adopt the prescribed measures of disinfection, etc,
By the authority of the District Magistrate huts or temporary struc-
tures may be burnt or destroyed if they cannot be properly dis-
infected.
Punjab rules.
The Punjab rules empower the District Magistrate to order the
disinfection or destruction of any building, or part of any building in
which any declared or suspected plague case has occurred. A
detailed set of instructions for the treatment of buildings and sheds
which have been occupied by persons infected with plague is append-
ed to the Punjab Government circular letter of the 19th June.
North-Western
Provinces and
Bengal rules.
Disinfection or destruction of infected articles.
The instructions issued by the Governments of the North-Western
Provinces and Oudh and Bengal for the disinfection or destruction of
contaminated articles are contained in the same rules as the instruc-
tions regarding infected houses and are similar in their purport,
Householders, etc., are required to carry out any instructions given
by the Health Officer, who is also empowered to himself cause the
disinfection or destruction of any bedding, clothing, or similar articles
which he may consider to be infected.
Punjab rule.
In the Punjab the District Magistrate is empowered to order the
disinfection or destruction of any article that has been in the possession
of a plague patient or any other person who has been in dangerous
proximity to him. Detailed instructions were issued regarding the
method of disinfection.
The disinfection of the clothing and baggage of travellers is dis-
cussed in Chapter X.
Summary of pre-
vious remarks
on the subject.
Payment of compensation.
The importance of this subject has been noticed in the account of
the measures adopted in the Bombay Presidency and the views held
by the Government of India have been explained. It will be re-
membered that the Government of India stated in a resolution issued
in March that persons should not be considered entitled to com-
pensation because it is necessary to destroy property in their
possession which is dangerous to the public health, but that in
view of the importance of overcoming the reluctance of the lower
classes to disclose cases of plague, the authorities should be rea-.
sonably liberal in paying compensation for destroyed bedding,
clothing, and other effects, when the loss would fall upon poor
people to whom it would be a great hardship to bear it.
The rules finally framed by the various Local Governments and
Administrations followed this principle, and provide generally for
the payment of compensation for the destruction of dwellings, etc., and