9
more rigorously and efficiently carried out than in any other epidemic of which
there are records.
The measures were carried out with military exactness and under medical
supervision.
On the absolute necessity of the isolation of the sick in this disease, as in a 1
other infectious diseases, it is unnecessary to dilate, but the segregation of the
probably infected, as carried out in Poona, is to a large extent a novelty ; it may
be interesting to describe more fully the measures adopted and the effects of this
procedure on the epidemic.
The persons segregated were those occupying the house from which the
infected patient was removed ; they were in fact treated as "suspects."
A very essential feature of the segregation was the thorough disinfection of
all clothing of those segregated, and to this process is undoubtedly due the
smallness of the number who were subsequently removed to hospital, suffering
from the disease.
The daily inspection of those segregated is also most valuable as insuring
the prompt removal of the infected to hospital and so preventing them from
becoming fresh plague centres.
The word segregation means to separate, and as applied to Epidemiology is
taken to be the separation of those who have become liable to infection by being
in contact either with :—
(A) Those who have the disease developed.
(B) Those who have the disease incubating.
(C) Infected houses and environments of the disease.
As applied to a disease, with such rapid tendency to propagate, as plague,
the importance of segregation cannot be over-estimated. Not only has infection
from the proximity of those suffering from the disease to be guarded against, but
more especially infection from the infected houses.
The advantages obtained by segregating those thus exposed to the risk of
plague are :—
1stly—That those, in whom the disease may be incubating, are, on the
appearance of the disease, immediately transferred to hospital, saving further
risk of infection.
2ndly—The removal of the inhabitants of an infected house gives time
for thorough disinfection, and the germs in such infected houses have time
to die under desiccation.
3rdly—Even though the people segregated may not be liable to plague
themselves, yet they may be the means of disseminating the disease through
their clothes. These latter are disinfected on arrival in camp.
Active operations for the suppression of the epidemic in Poona may be said
to have commenced on the 12th of March 1897. The disease first appeared in
the city about the middle of December 1896 and previous to the military opera-
tions the task of coping with it was entrusted to the Local Native Municipality.
Towards the beginning of February, Surgeon-Captain Lloyd Jones, I. M.S., was
sent to Poona, and he instituted a limited system of disinfection and a personal
search for plague-stricken people ; segregation of course he found impossible to
enforce and none was attempted. His individual efforts, though marked with the
greatest personal energy, were useless in face of the strong native prejudice
against official interference, and the passive indifference of the Native Munici-
pality, and the epidemic continued to spread with increasing rapidity.
On February 5th, a Plague Hospital was opened at Sangum and a few
patients were persuaded to voluntarily trust themselves to treatment, whilst a
certain number more were forcibly removed there.
The majority of people, however, attacked at this stage of the epidemic
were secreted by their relations and died in their own houses. In the first week
B 1215—3