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Public health — Insights from the 1896 Bombay Plague
Context:
The interplay between public health crises, surveillance, control, and ethical governance remains critical in addressing contemporary global health challenges.
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- Historical epidemics offer valuable insights into how authorities have managed these complex dynamics.
- The 1896 Bombay Plague exemplifies how colonial authorities used mapping and policing not only for disease management but also as tools of surveillance and control.
The Bombay Plague and Its Impact on Colonial India
- The Bombay Plague of 1896–97 was a devastating epidemic that severely disrupted colonial India.
- Introduced to Bombay through trade routes with the Far East, the plague quickly spread across the Bombay Presidency, neighboring princely states, and the broader subcontinent.
- By September 1899, over 370,000 lives were lost, as recorded by the Indian Plague Commission.
- The epidemic highlighted significant deficiencies in colonial India’s public health infrastructure.
- In response, the colonial government established the Indian Plague Commission in November 1898, led by T.R. Fraser of the University of Edinburgh.
- Over 70 sittings and 260 testimonies were documented in five comprehensive volumes.
- Despite this extensive investigation, the Commission failed to determine the plague’s exact origins and transmission, reflecting a governance approach focused on population control and order maintenance rather than community-based health solutions.
Shifting Focus: From Cases to Control
- The Commission’s work prominently featured maps, but their purpose and design diverged sharply from earlier examples like John Snow’s 1854 cholera map.
- Instead of identifying locations of affected individuals to trace disease patterns, the plague maps emphasised infrastructure for controlling movement, such as railway lines, inspection stations, quarantine zones, and police cordons.
- Railway Plague Inspection Stations Map: Highlighted inspection points on railway networks, focusing on monitoring mobility.
- Chausa Observation Camp Plan: Detailed quarantine camp layouts, with prominent police presence reflecting a militarised approach.
- Khanpur Station Map: Showed disinfection zones and emphasised police involvement in maintaining these areas.
- These maps prioritised control over epidemiological understanding, portraying the epidemic as a security issue rather than a public health crisis.
- Vibrant colors and detailed infrastructure depictions may have been designed to project an image of organised control, downplaying the epidemic’s human toll.
Policing and the Management of the Plague
- Policing was central to the colonial response, enforcing quarantines, monitoring population movements, and collecting data on plague cases.
- Observation camps at railway stations, managed by the police, enforced inspections and quarantines.
- Military personnel were deployed to hospitals and municipalities to reinforce control, legitimising the use of force in public health measures.
- Police stations served as data collection hubs, with local watchmen reporting deaths to the police, who then relayed information up the administrative hierarchy.
- This system persists in some regions of India today, where police involvement in death registration reflects a colonial legacy.
- The reliance on policing highlighted the colonial authorities’ focus on surveillance and enforcement over care and prevention.
- The 22nd Law Commission of India criticised the “unbridled and incongruous powers of the State” under the Epidemic Diseases Act of 1897, noting that such measures prioritised control over effective health interventions.
- Modern approaches have since shifted, with medical professionals assuming primary roles in surveillance, reflecting evolving ethical considerations.
Framing and Representation in Plague Maps
- The design and presentation of plague maps shaped public perceptions of the epidemic and the effectiveness of control measures.
- By emphasising surveillance infrastructure rather than disease impact on individuals and communities, these maps reinforced colonial power dynamics.
- The vibrant visuals projected an illusion of control, potentially masking the crisis’s severity and legitimising harsh measures against the populace.
- This cartographic approach shifted attention from those affected to the perceived threats posed by movement and mobility, aligning with the colonial agenda of maintaining order and authority.
Implications for Modern Public Health Surveillance and Policy
The historical use of mapping and policing during the Bombay Plague offers critical lessons for contemporary public health policy:
- Evolving Surveillance Mechanisms: Modern health surveillance increasingly involves medical professionals rather than law enforcement, reflecting shifts in ethical governance and public expectations.
- Understanding this transition can inform the roles of different stakeholders in health crises.
- Framing Health Issues: The emphasis on control points rather than individuals illustrates how problem-framing shapes policy responses.
- Modern health strategies must prioritise community well-being and equity to foster trust and effectiveness.
- Ethical Governance: Balancing surveillance with respect for individual rights is essential.
- Policymakers must ensure transparency and accountability, continually assessing who benefits and who may be harmed by public health measures.
- Data and Power Dynamics: Recognising how maps and data can reinforce power structures helps address inequities in health surveillance today.
- Data collection and representation must serve public health goals without perpetuating control or marginalisation.
- Continuities and Changes: Historical practices continue to influence modern governance.
- For example, advancements in population registers and surveillance technologies have streamlined data collection but also raise concerns about privacy and equity.
