NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
42
[Disinfection,
attending Government and aided schools, who undergo inocu-
lation, will be marked in -the registers for not more than
three consecutive days as " under inoculation," and such an
entry will be regarded as equivalent to attendance. No
subsistence allowance can be granted to inoculated persons
for the period during which they are incapacitated for work
owing to the operation.
31. The Sanitary Commissioner is in charge of all measures
connected with inoculation and he will issue the necessary
rules as to the conduct of the operation, supply of haffldnine
and inoculation syringes, &c. He should submit to Govern-
ment a weekly return showing the progress of inoculation in
the presidency.
Disinfection.
32. Chemical disinfection ought to be resorted to wherever
possible. Of all measures of disinfection, it is the only one
which, when effectively carried out, immediately destroys
the infective material present in a room and renders the room
at once practically safe for re-occupation. It is however,
essential that it should be carried out by a trained agency,
and experience shows that where such an agency cannot be
employed, it is better to rely on gradual desiccation rather
than on a process of disinfection which is likely to be
incomplete and ineffective. Imperfect disinfection involves
waste of energy and material, brings discredit on the system
by exhibiting unsuccessful results, and engenders a false
sense of security with regard to localities which have been
incompletely disinfected and still contain the living germs
of plague.
33. According to present knowledge, perchloride of mer-
cury is the most effective chemical disinfectant. It should be
used in a strength of 1 in 1,000, to which 2 per 1,000 of
hydrochloric acid and a little aniline blue should be added.
If the owners have no objection, interiors of plague-infected
houses should, as a rule, be treated with Wilkinson's coloured
solution which contains the perchloride in the strength stated
above. To ensure that the chemical is free from impurities, it
should be obtained from the Madras Medical Store depot by
submitting indents through the district medical and sanitary
officer and the Surgeon-General. The perchloride should be
issued in the form of a concentrated solution in acid and clear
instructions should be forwarded with each consignment as to
the amount of water to be added. With a view to securing
that the dilutions prescribed should be the solutions in which
the disinfectant shall actually be employed, the capacity of
43
Disinfection.]
the vessels used for measuring out the concentrated solution
shall be accurately adjusted to that of the wooden buckets in
which that solution is diluted for use. Further the buckets
employed should be of such capacity as to hold just the
quantity of water sufficient to dilute the measure of concen-
trated solution to the desired effect. The perchloride may
also be issued in the solid form in packets, the contents of
which are accurately adjusted to the size of the vessels in
which they are to be dissolved for use.
34. Steam-sterilisers, unless their working is committed
to skilled and trustworthy operators, are found in practice to
be quite ineffective, and are therefore not suitable for general
application. Their use is limited to ports for the disinfection
of the effects of native crews and native ship passengers
bound for ports out of India. Pull instructions as to the
mode of working them should be supplied with each machine.
35. In cases, where it is not possible to carry out chemical
disinfection, the disinfecting agency of desiccation should
be relied upon. For this purpose, the house ought to bo
thoroughly cleaned out; the removal from the house of
cowdung and other moist accumulations should be particularly
insisted upon, and the inmates of the house should be induced
to remain away for a period of at least two months until the
process of desiccation is complete. Disinfection by desicca-
tion cannot, however, be relied upon during the rains.
36. The breaking of holes in the roof or walls and the
partial untiling will not accelerate the process of desiccation,
to such a degree as to counterbalance the damage done to.
the house. This measure should not therefore be adopted
in the case of masonry houses with concrete roofs. As a
rule, such houses can be disinfected without great difficulty
and are to a certain extent open to light and air. But
in rural areas, where the majority of the buildings are of a
comparatively poor character it will rarely be possible to
provide for efficient chemical disinfection. The removal of
portions of the roof of such huts can be done with no
structural injury to the huts and at small cost and is
permitted.
37. Owing to the risk of infection from the blowing about
! of the floor dust and owing to the fact that it is practically
1 impossible to secure that the whole material shall be carried
¡ away, the digging up of floors with a view to kiln burning
1 them ought not to be resorted to.
;
o
38. The actual burning down of houses should not be
! resorted to except in the case of temporary structures which
44
[Disinfection. -
are of iitble or no value or in the case of houses \vhich are unfit
for human habitation.
39. With a view to encourage people to produce their
goods for disinfection and to prevent them from secreting
them, nothing which could by any possibility have any
value for its owner should be broken up or destroyed by
fire. Liberal compensation should be promptly paid for any
articles that may be necessary to destroy, when the loss
would fall upon people in very poor circumstances to whom
it would be a great hardship to bear it.
40, Disinfection of personal effects should not be attempted
in the case of travellers by road or railway but should be
carried out in the case of—
(a) native crews, third class or deck passengers and
native servants leaving infected or healthy ports
for ports out of India. This should be done on
shore ;
(b) plague patients and contacts removed from
infected houses, ships or railway carriages;
(c) plague patients discharged from hospitals and
persons returning to their houses from health or
suspect camps.
41. That the disinfection of the person is effective is
indubitable as is proved by the practice of washing the
hands with disinfectants in bacteriological laboratories and
in surgical operations. The measure, however, is extremely
unpopular, and has been ordered to be abandoned in the
case of travellers as very little is to be gained by disinfect-
ing them. It will be found useful in the case of persons
taken out from plague-infected houses into health camps and
in the case of plague convalescents leaving hospital.
42, Laboratory experiments and practical experience
alike tend to show that little danger is to be apprehended
by the spread of plague by ordinary articles of merchandise,
and it is neither advisable nor necessary to take any steps
towards their disinfection. The only restriction found neces-
sary is the prohibition against the importation from infected
localities of rags, waste paper and soiled linen which cannot
be classed with ordinary merchandise inasmuch as they are
very likely to carry infection. Any articles brought in
contravention of this prohibition should bo destroyed. Old
newspapers in bales and paper (whether newspapers or not)
45
House-seafch.es.]
used for packing purposes ave not included within the prohi-
bition, but washed linen articles which, such as washed dhotis,
are considered possibly dangerous, might, when they come to
notice, not' unreasonably beheld to come under the prohibition
expressed in the term " soiled, " although they have not
been worn since they were last washed. Persons who send
parcels by railway or post from plague-infected areas are
required to declare in writing that the parcels do not contain
any soiled linen and bedding, rags or waste paper.
43. Detailed instructions as to the mode of disinfection
to be adopted in each case will be issued by the Sanitary
Commissioner and, in respect to the management of hospitals,
by the Surgeon-General.
House-searches.
44, The system of house-visitation and house-search will
! be permitted only—
I
(a) when plague exists in small and well defined areas,
such for instance as an isolated quarter or ward
!
of a town, or a single village in a neighbourhood
j
which is otherwise completely free from infection;
and
j
(b) it is clear that it will be effectual in saving the
people from disaster.
When this mode of discovering plague is adopted, care
should be taken that a sufficient number of European officers
are employed to render the powers of search effective and at
the same time prevent the subordinate establishments from
abusing their authority. Failing officers of the civil establish-
ments, young officers of the Staff Corps should be deputed
for this duty. Respectable inhabitants who volunteer for the
service should be employed to assist in searching for concealed
cases of plague ; as fur as possible houses should be allowed
to be entered only by persons of caste or of the same religion
as the occupants; and subject to the same limitation, women
should be utilized in examining women and in searching any
I room or place exclusively occupied by them.
Inspection and Burial of Corpses.
45, Regulation 30 deals with the mode of disposal of
plague corpses. It in no way interferes with the religions
customs of the people, but merely authorises the local
46
[Corpse Inspection.
authorities to insist on certain necessary precautions as to
the routes to be taken by funeral processions and as to the
placo and manner of burial. Any rules which the Collectors
may find necessary to frame under clause 1 (b) of this
regulation should provide that when the burial of a person
who has died of plague takes place in proximity to habit-
ations or sources of water-supply, the corpse shall be buried
six feet deep. By clause (3) it is not intended that public
undertakers should alone touch the corpses. The dead may
be dressed for the grave by their own relations or in whatever
manner may be customary among the class to which the
deceased belonged.
46, Under the first clause of regulation 28 the Collector
may require in respect of any particular area that the certifi-
cate of a medical officer shall be obtained showing the cause
of every death within two hours after such death. But it
must be understood that medical examination of a corpse
is entirely optional on the part of the relations, and that no
one will be compelled to allow the inspection of the corpse
of a deceased relative. In the event, however, of a certificate
not being produced or inspection invited, it may be presumed
that any death, the cause of which cannot be determined
not to be plague, has been caused by plague and the rules
regarding the segregation of the contacts and the disinfec-
tion of the house may be enforced. The examination of the
corpses of women by men should never be required. The
orders of the Government should be obtained before this
regulation is acted upon in any area, and in applying for
sanction, the Collector should report fully on the following
points : —
(1) What classes of officers will be authorized to issue
certificates under the regulation.
(2) Whether any fee will be required for the grant of
this certificate.
(3) Whether there is such a number of Government
medical officers, male and female, at the station as will be
sufficient to carry out inspection promptly so as not to cause
any delay in burials.
(4) Whether there has been any increase in the rate of
mortality.
(5) Whether there is any reason to believe that deaths-
are concealed or that causes of death are not correctly
reported.
47
Plague Hospitals and Camps.
47, The Government will, whenever necessary, construct
either itself or through local bodies temporary segregation
and health camps and plague hospitals and will also by grants
of money help private persons or bodies to construct them
on sites shown to them or selected by them and approved by
the authorities. It is also prepared to place both public and
private plague hospitals and camps in charge of native practi-
tioners so far as the public can find suitable men who will
undertake the responsibilities and can be trusted to carry out
the prescribed rules. The hospitals and camps will, however,
be under the general supervision of Government- officials, but
these officials will have nothing to do with the treatment of
the sick except at their request, and their duties will be
confined to preserving order, preventing theft and keeping
guard, and attending to sanitation. Detailed instructions
with regard to the construction, equipment and management
of plague camps will be issued by the Sanitary Commissioner
and of plague hospitals, by the Surgeon-General.
48, The Government has sanctioned the following rates
of contribution towards the cost of the construction and
maintenance of private plague hospitals and segregation camps
in places which are or may be threatened with plague :—
(a) For construction, half the cost will be paid by
Government provided the charges are considered reasonable.
In any case of doubt or dispute the Government will have
the right to estimate by means of the Public Works depart-
ment the value of the work done. The buildings shall be
erected on sites approved by the sanitary authorities.
(b) For maintenance, grants not exceeding half the
actual expenses will be sanctioned by Government on the
following conditions :—
(1) The arrangements for the sanitation and supply
of food must meet with the approval of
the local medical officers and the Collector
(2) The amounts will be paid, month by month, in
arrears to the manager or managers approved
by the Collector . .
These grants will be met from provincial funds.
The sale-proceeds of private hospitals to which Govern-
ment has made a contribution should be equally divided
between Government and the plague committee concerned,
48
[Surveillance,
49. In agricultural villages, district boards may find it
cheaper to give poor people grants not exceeding Rs. 8
a household and let them make their own arrangements than to
build sheds for them. Such advances should be kept at as
low a figure as possible, and should be granted as a rule only
to those who are otherwise unable to furnish themselves with
shelter.
50. It may become necessary at any moment for Collectors
or other plague authorities to occupy buildings belonging to
other departments than the Revenue department, for plague
purposes. In such cases the earliest possible intimation of
such occupation should be given to the authorities in charge
of such buildings. Before occupying them, any moveable
articles in the building at all likely to retain infection
. should be first carefully removed and placed under proper
custody.
Surveillance or Passport Hules.
51. Regulation 1.—Copies of this regulation should be
hung up at railway stations. The regulation does not apply
to passengers from a non-infected area, who pass through
an infected station without breaking journey at that station.
51-Ai Under this regulation, the Government or the
Collector of a district may declare any place to be infected
with plague. As a rule only the places actually infected
with plague should be declared as such. The execution of
precautions against the spread of plague is rendered more
difficult when they are directed against an unnecessarily wide
area.
52. Passport-issuing officers should not suppose that they
have merely to issue passports to those who come and apply
for them. The main object of declaring persons from in-
fected parts to be bound to take out passports is to punish
cases of wilful evasion of the rules, and it was never the in-
tention to relieve the passport-issuing officers of their duty of
tracing out such passengers and not allowing them to go
away without passports. Passengers who fail to take out
passports should be prosecuted at the discretion of the
Collector, but whether prosecuted or not, they must be
required to present themselves for inspection for ten days as
soon as their arrival has been detected.
53. Passport-issuing officers should note that every person
who holds a ticket marked in the manner indicated in
rule.82 should be given a passport. To ensure that none
escapes taking a passport, the passport-issuing officer should
question passengers where they come from, in cases where
49
Surveillance3
they do not hold specially marked tickets. In cases where a
passport has been wrongly issued owing to erroneous plague-
marking of the railway ticket, or otherwise, . . . the
municipal chairman or any revenue officer not below the
grade of deputy tahsildar . . . is authorized to cancel
the passport on satisfactory proof that it was wrongly issued.
54. It is the duty of railway authorities assisted by the
platform police to see that passengers alighting at a railway
station do not leave the premises except by the proper exit,
and to afford every facility for the working of the plague
regulations. Ticket collectors should be required to stop .
all passengers holding tickets issued at infected or notified
stations until their names and addresses are taken down, and
passports issued to them either by the plague official appointed
for the purpose, or at smaller stations, by the station staff.
55. Arrangements should be made to have all arrivals
at large towns like Salem, Trichinopoly, Madura, not only
examined by a medical subordinate at the railway platform, but
also similarly inspected daily for ten days afterwards, The
Collectors concerned must see that this is done, and should not
leave the matter wholly into the hands of municipal chairmen.
At stations where medical subordinates are not available for
the duty of watching arrivals, granting them passports and
inspecting them for ten days, the work should be entrusted
to Stationmasters or competent persons already in the employ
of Government, and if they are found neglecting their duty,
they should be prosecuted. Collectors are requested to check
their action carefully from time to time.
56. When a large body of troops or police or coolies
engaged in plague operations are returning to a healthy district,
previous intimation of their departure should be given to the
local authorities of the place of destination. Before starting,
they should be carefully examined and disinfected, and on
arrival at their destination, they should be given passports
according to the rules. With regard to troops and their
families and followers leaving infected areas, the orders
issued by the military authorities require (a) that they should
I
be inspected and disinfected before departure, (b) that they
should also be disinfected on arrival at their military stations,
and (c) that where possible regimental arrangements should
be made to house them separately for from ten to twelve
days.
57. In the case of persons from a plague-infected or
notified place who regularly attend markets and stay in the
village only for a few hours a permanent pass in the form
G
50
[Surveillance,
appended [Appendix D] to regulation 31 should be issued.
The local authority of the village at or near which the
market is held, the passport-issuing officer at the railway
station at which the pass-holders usually alight and the
officer in charge of the inspection station through which the
pass-holders usually pass should be informed from time to
time of the names and other particulars of the persons to
whom the passes are granted. These officers will enter the
names in a register in the form appended [Appendix G], and
affix their initials and the date of presentation on the reverse
of the passes on being presented by the holders.
58. As long as the disease is confined to narrow limits,
an infected place must be regarded as requiring as much
protection as any other place against fresh importations of
infection, and all persons who may come from a second centre
of contamination, or from a railway station which in conse-
quence, of its proximity to such a second centre has been
notified by the Local Government, should be furnished with
passports and be kept under surveillance. But a person
who comes to an infected place from a railway station which
has been notified in consequence of its proximity to that
place does not require a passport. On the other hand, a
person who proceeds to such a railway station from the place
which is infected must take out a passport though if he
returns to the infected place within ten days the passport
may be given up on his return and further inspection is
unnecessary.
59. With a view to facilitate the working of the passport
rules, railway employés holding periodical railway passes
and Government officials holding standing passes should be
required to provide themselves before departure with certifi-
cates signed by the stationmasters concerned showing the
places from which they start.
60. The extent to which the passport rules may be relaxed
and the classes of persons in respect to whom the relaxation
may be made by Collectors . . . are indicated in the
note of the Plague Commissioner appended to his Proceedings,
No. 16, dated 5th January 1899, and printed as Appendix H.
60-A. The passport rules should be worked in such a
manner as to cause the minimum of inconvenience to gosha
women, and persons belonging to that class should, whenever
it is possible to do so, be exempted from attendance on the
local authority at the hospital or elsewhere and be inspected
at their own houses. The examination of gosha women
51
Surveillance.]
should always be conducted by females, who, when not trained
or duly qualified, should work under the instructions of
the local medical officer.
61; Regulation 1 (3) (c).—The Collector should settle
with the railway authorities of each district at which stations
the railway staff shall be required to perform the duties
connected with the issue of passports, and at which stations
the Collector should make other arrangements. Station-
masters requiring forms or service postage stamps should
apply to the Collectors concerned, and should use the
following designation in frankino- covers containing corre-
O
O
O
O
spondence connected with their passport work—" Station-
master and Honorary Plague Passport issuing oflicer."
62. Regulation 1 (5) (ii) (b).—The intimation should-
contain the following particulars :—
Passport number, date and station of issue.
Passenger's name and his father's name.
How long observed and where.
New place of residence—District, taluq, village, street, and
number or name of the house.
The forms should be printed at the District Presses.
63. Regulation 1 (9) does not require the maintenance
of a register. The information referred to therein should be
recorded in duplicate with the aid of carbon paper, a separate
slip of paper being used for each passenger, except in the
case of the members of a family proceeding to the same
destination, when their names may be entered in one slip.
One set of copies should be forwarded at once to the respective
destinations and the other kept for reference at the inspection
station. No such intimation is necessary in the case of
persons exempted from, the passport rules under rule 60 of
this chapter, as the officers to whom they are immediately
subordinate are responsible for their observation ; but it should
be forwarded in the case of inoculated persons from infected
areas who hold valid certificates us they are liable to be observed
at their own houses. The intimation forms will be supplied
by the Superintendent, Government Press, to Collectors on
indent.
64. If the guards of the trains and other railway subordi-
nates do not carry out the instructions given to them with
regard to the transmission of the names and addresses o£
passengers, there should be no hesitation to prosecute them
under the Epidemic Diseases Act.
65. Regulation 1 (9), (10).—The object of sending inti-
|
mation of arrivals from infected parts to the district medical
•