There is much to recommend the acquisition in suitable areas of land which could be let out in small plots to labourers who would build their own huts and pay ground rent and fees for water supply and sanitation. The immense difficulty of making effective even the comparatively small amount of supervision that would be needed to prevent unlimited overcrowding, and to secure the protection of the water supply and the observance of sanitary regulations, stands in the way of large experiments in this direction. The advantages of the Criminal Tribes Encampment at Sholapur, in which houses and huts of many types appear side by side, can perhaps be secured only amongst those who are segregated. It is a great achievement to have made a camp of that kind at the same time homelike and sanitary, and it is difficult to believe that areas holding out similar variety in arrangement and construction of houses and huts would not prove so attractive in industrial centres that a considerable amount of supervision would be tolerated.

CHAPTER XIII

HEALTH

IN matters of health, as in other aspects of this study, it is impossible to consider conditions in modern industry without having some slight framework in which to place them. There are no illnesses that are prevalent only in mill areas. The advance of medical science of late years opens up prospects of steady and unprecedented progress towards a higher standard of general health in the east. One type of epidemic after another has been patiently traced to its source, and now these sources are being attacked with steady persistence. The slackness and carelessness of human nature, great as these are, and the power of custom and superstition, must eventually give way before hygienic reform when the consequences at stake are so great.

It is confidently affirmed that the end of bubonic plague is within sight. Its epidemic recurrence might already be a thing of the past, were it not that rats carry infection over the gaps that occur; with a steady rise in average cleanliness of dwellings, these pests will gradually be shut out from frequent access to human beings.

Smallpox is being fought by widespread efforts to secure the vaccination and re-vaccination of all. In this disease special difficulties meet the medical reformer, as the goddess of smallpox is held in great reverence. Her image, blurred beyond recognition, watches over wells, and holds an honoured place in the thoughts of the villagers. The coming of the disease with which she is associated is taken as a manifestation of her presence by many of the illiterate, and the proposal to take a sick child to an isolation hospital may be met not, as one might expect,

by unwillingness to part with the boy, but by fear to displease the goddess. "If Mata has deigned to visit my house, who am I to send her away?" Still such protests have little power to withstand the public will as it increases in determination to secure immunity.

Cholera tracked the steps of pilgrims and claimed its victims annually during the festivals that are held at sacred places, at some of which many thousands congregate for a week or more in an area inhabited, during the rest of the year, by a few hundred simple villagers, some groups of professional beggars, and the priests that wait on the shrines. Little is known of the careful plans by which the Government arranges for sanitary and hygienic conditions at these gatherings beyond the circle of those who are immediately responsible, but the decrease in death from cholera within recent years bears witness to their success.

Perhaps the most exciting incident in medicine just now is the discovery of treatment which it is hoped will prove to be a permanent cure for leprosy. If the hopes of experimenters are justified, the leper asylums of India will be changed into hospitals for treatment.

Malaria, with its clearly defined cause, will be hard to eradicate because of the extreme difficulty there is in preventing the occurrence of stagnant water open to the approach of the anopheles mosquito. But though the complete extinction of the latter cannot be hoped for in the near future, great progress is being made in many districts by drainage, and by the introduction of cultivation.

Consumption is prevalent, and the fact that it is often mistaken for malaria adds to the difficulty of dealing with it. Hundreds of workers from Bombay return to the villages of Ratnagiri to die slowly of " fever," which is only occasionally identified as tuberculosis. It is certain that mill conditions are responsible for some of these cases,3 but no statistics are available from which propor

The goddess of smallpox.

See Fairs and Festivals in Bengal, by Charles A. Bentley, M.B., D.P.H., D.T.M. and H., Sanitary Commissioner for Bengal.

3 See Tuberculosis in India, by Arthur Lankester, M.D., pp. 180, 182, 247.

tionate numbers can be judged. The irritation caused by inhaling fluff-laden air in cotton and jute mills causes various illnesses of throat and chest.

In the Bengal industrial area there is much hookworm.1 This illness can be completely cured by treatment, and the treatment is provided in some of the mills, but as the hook-worm breeds in contaminated ground and enters through the skin of the feet of those who come in contact with it, the illness is apt to be contracted over and over again.

A vigorous educational campaign is carried on by the various Health Services in their efforts to raise the general standard of vitality. Illustrated sheets are scattered broadcast, printed in different vernaculars, but all bearing the same gruesome pictures of flies and mosquitoes, of hookworm and tubercle, magnified and dissected, and of the evil results of their activities. Besides scientific investigation and much machinery for prevention, the cities and larger towns of India are provided with hospitals and dispensaries controlled by the municipalities. Many institutions for the cure and alleviation of illness owe their origin to private individuals or to missionary societies. It is in those country districts in which there are no missions that the lack of medical help is most acutely felt. But the opening of hospitals and dispensaries does not adequately meet the need even in the cities. Even where there is accommodation in the former, many sufferers are entirely shut out from the advantages open to them by their own attitude. This is specially true with regard to large numbers of women, who are reluctant to go even to the maternity hospitals of Bombay and Calcutta, or the gosha hospitals of Madras.

When great numbers of immigrants first gathered in the crowded mill areas, it was found that they became specially liable to epidemics. The hospital accommodation

• See Annual Report on the Working of the Indian Factories Act in Bengal, Bihar and Örissa, and Assam, for 1920, by R. P. Adams, O.B.E., A.M.I.Mech. E., p. 6.

The word gosha is used in the south of India in the sense in which purdah is used in the north.

of the cities was inadequate. Apart from that, the need was felt for preventive measures. This led not only to the introduction of special water supplies, of better housing, and of more careful hygienic arrangements, but also to the introduction of dispensaries within mill compounds, and to the appointment of doctors or hospital assistant surgeons by many firms. There are mills where any treatment that is done within the works is undertaken by the manager. Where the relations are friendly, the workers may prefer to come to the man they know. His simple medicines and bandages, aided by their faith in him, work wonders. In times when fever is raging, he may be seen dosing a whole roomful of workers from one or other of two bottles, containing respectively quinine and fever mixture. If his patients have heightened temperatures, they get mixture; if they have not, they get quinine. He has to discriminate, however, and takes the precaution where caste people are employed to send a workman from amongst themselves to fetch and to distribute the doses.

While a large proportion of mills have medical attendance of one kind or another, great differences in the quality of it may be noticed even by the uninstructed visitor. Two tests are specially useful. One is the condition of the dispensary. The other is the manner and bearing of the doctor. In some places the dispensary is like a very untidy scullery, and the attitude of the doctor is slack and indifferent. In one temporary dispensary the manager drew attention to the general disorder, and pulled the doctor up sharply: "You have two servants and a sweeper, and yet you let it be like this!" But when the imposing building that was almost ready for occupation as a permanent dispensary was visited, the bright rooms did not dispel the fear that conditions might soon deteriorate there too, for the operating table and the instrument case, though new, had already lost their freshness by standing in the empty rooms uncovered except by dust. The common custom of employing as mill doctors men with slight qualifications reacts on Especially in Calcutta.