NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
infected houses, and to direct the removal and if necessary,
the destruction of all articles of food and drink found in such
places.
Restrictions
on the wash-
ing of clothes,
32. The President may prescribe that no person under-
taking for hire the cleansing of clothing or other laundry
process within an infected area to which he may extend this
regulation shall store or wash or otherwise prepare clothing
except at such places within or without municipal limits and
under such conditions as he may direct.
Dissolution
of plague
hospitals and
camps.
38. No hospital or suspect camp or observation camp
shall be closed without the special orders of the Health officer,
and until the receipt of such orders the municipality shall
maintain such places in efficient repair.
Provided there have been no actual or suspected case of
plague therein, the Health officer may, in his discretion, allow
a health camp to be closed after ten days, and the town or
an infected quarter of the town in which no death or fresh
case of plague has taken place for ten days after the recovery
or death of the last case to be re-inhabited as soon as it has
been thoroughly disinfected.
Menial staff
entitled to,
and bound to
give, one
month's
notice.
34. (1) In the absence of a written contract to the
contrary, every maistri, peon, watchman, cooly, scavenger or
other menial servant employed to do duty in connection with
plague or general sanitation shall be entitled to one month's
notice before discharge, or to one month's wages in lieu
thereof, unless he is discharged for misconduct or was engaged
for a specified term and discharged at the end of it.
(2) No such maistri, peon, watchman, cooly, sca-
venger or other menial servant in the absence of a written
contract authorizing him so to do, and without reasonable
cause, shall resign his employment, or absent himself from
his duties without giving one month's notice or neglect or
refuse to perform his duties or any of them.
Mode of
disinfection,
35. Whenever disinfection is prescribed by any of these
regulations, it shall be carried out in accordance with the
general principles laid down, by Government and such subsi-
diary instructions as may be issued by the Sanitary Com-
missioner or, in respect to management of hospitals, by the
Surgeon-General with the Government of Madras,
Compensa-
tion.
36. When in the exercise of, the powers conferred by or
under these regulations, any damage or loss is caused, no
person shall be entitled as a matter of right to claim any
a As amended by notification No, 335, Fort St. George Gazette, dated 9th April
1001, part I-A, page 166.
compensation, but the President or any person authorized
by him may, in his discretion, award compensation at the cost
of municipal funds and shall do so when the loss would fall
upon people in very poor circumstances, to whom it would be
a great hardship to bear it, or he may, in such cases, arrange
for providing other necessary articles in the place of those
destroyed or damaged.
Contents of
certificates,
passes, &c.
Their im-
proper use
prohibited.
37. Any certificate or passport or pass granted under
these regulations shall contain an accurate description of the
person named in it to prevent, so far as possible, its being
used by another person ; nor shall such a certificate or pass-
port or pass given to any person to enable to go from one
place to another or for any purpose shall be used by any
other person or for any other purpose.
Segregated
or detained
persons
bound to obey
directions
given to
them.
38. Every person segregated or detained under any of
these regulations shall obey the directions issued to him by
the officer in charge of the place of segregation or detention
and shall not leave such place except with the written per-
mission of the said officer, who may take such steps as may
be necessary to enforce this prohibition.
Canal boats,
subject to
same
regulations
as buildings.
39. (1) A canal boat shall be subject to all the regula-
tions applicable to buildings ; and passengers by a canal boat
shall be subject to interrogation, inspection and detention in
the same manner as passengers by railway.
(2) In order to prevent the spread of the infection of
the plague either by or to a canal boat, the President or any
officer generally or specially empowered by him in this behalf
may require such boat to alter its moorings or to stop during
its passage and moor in such position as such officer may
indicate, or direct that it desist from plying until such time
as may be stated in a notice placed on a conspicuous position
of the boat,
Privileges
granted to
inoculated
persons.
40. (1) Persons who hold certificates that they have been
inoculated by M. Haffkine's process shall be entitled to the
following privileges, provided such certificates bear a date
not earlier than six months but not later than ten days
previously :—
(a) Unless suffering from, or suspected to be suffer-
ing from, plague, they shall not be liable to detention at any
railway or road observation camp when travelling, except
for such period as may be required to disinfect their baggage
and clothes, if those are considered suspicious,
(5) They shall not be liable to take out passports and
present themselves daily for observation for ten days after
arrival from a plague-infected place, or from any place noti-
fied by the Governor of Fort St. George in Council for the
purposes of No. 1 of these regulations ; but they may be
observed at their own residence and shall, with this view,
be bound when required by any plague officer to give their
names and addresses for the next ten days.
(c) Inoculated persons who have been living in an
infected house or have otherwise been exposed to plague
infection shall not be liable to be segregated, but may be
required to evacuate the infected house and to have their
clothes and personal effects disinfected. When, however,
all the occupants of a house have been inoculated, neither the
patients nor the other inmates of the house shall be required
to be segregated, provided arrangements are made to the
satisfaction of a plague authority for the disinfection of the
house and its contents, and for the prevention of the spread
of plague to the neighbouring dwellings.
(2) The inoculation certificate shall be in the form
appended [Appendix E]. But when in a certificate issued
under authority, the thumb impression has not been
taken, other satisfactory evidence of identification may be
accepted.
Inoculated
persons bound
to produce
their inocu-
lation, certifi-
cates and
make an
impression
of thumb-
marks.
41, Every inoculated person (who is exempted from segre-
gation, detention and observation under the preceding regu-
lation 40) shall be bound, when called upon to do so by the
officer mentioned in clause (4) of No. 1 of these regulations,
to produce the certificate showing that he has been inoculated
by M. Haffkine's process, and also to make an impression of
his thumb-mark for the purpose of identification.
42. The whole of the city of Madras is hereby declared
to be subject to the provisions of section 309 of the City of
Madras Municipal Act, 1884.
Penalty for
breach of
regulations.
43. Any person disobeying or contravening or refusing to
submit himself to any regulation made under the Epidemic
Diseases Act, 1897, or obstructing any measure which has
been taken by Government, or which any authority, or officer
appointed under competent authority to carry out such
regulation, has been required or empowered to take under
any such regulation, shall be deemed to have committed
an offence punishable under section 188 of the Indian Penal
Code, and shall be liable, on conviction, to imprisonment of
either description for a term which may extend to six months
or fine which may extend to one thousand rupees or both.
CHAPTER II.
* INSTRUCTIONS WITH REGARD TO THE CARRYING OUT OF
PLAGUE MEASURES AND WITH REGARD TO OTHER
MATTERS CONNECTED WITH PLAGUE.
General Remarks.
A combination of the following measures is likely to
produce the maximum of good :—
(a) The prompt discovery and isolation of every case
of plague.
(b) The thorough disinfection of the personal effects,
clothes, and houses of patients.
(c) The segregation and inoculation of contacts.
(d) The removal and destruction by burning of plague-
infected rats, and the disinfection of the houses in which
they are found.
Every endeavour should be made by the officers respons-
ible to apply the first stated measure by sufficiently early
organization of observation staffs . . . and by frequent
insistence as to care and promptitude in effecting plague
regulations by all authorities concerned, so as to secure
that the first imported cases are rapidly and effectually dealt
with ; for it is only at the commencement of the outbreak
that the remaining three measures can be carried out with
success and within reasonable expenditure, and can therefore
be expected to stamp out the disease before much harm is
done. But when once the plague has been allowed to obtain
a footing
. it Avili be found very difficult to apply
the above measures.
2. In the City of Madras the measures that will be
found applicable are disinfection, inoculation, the evacuation
of specially infected quarters, and (so long as infection has
not spread through the town) the isolation of the sick,
. '. .
Evacuation
. . .
should be conjoined
with an opening up of houses sufficient for the admission oí
sunlight and air whenever this is required. . . .
* The regulations contained in Chapter I should be worked subject to the explana-
tions and conditions stated in this chapter.
The portions omitted in this reprint, which are indicated by dots ( . . . )
relate to matters not concerning the city of
Madras.
3. Experience has shown that it is hopeless to carry out
effectively any system of plague administration which is not
supported by the people, and in a wide-spread epidemic, the
resources of Government in the matter of funds and establish-
ment being limited, much must necessarily be left to the
people themselves. Steps should therefore be taken to inform
them beforehand of the measures they will be required to
submit to, and to convince them of the utility of the parti-
cular methods selected, so that they may be induced to carry
them out not by force but by the exercise of their own free-
will and as a consequence of their appreciating and under-
standing the benefits to be anticipated therefrom. The
measures are new to the people, particularly in fresh areas of
infection, and if injudiciously or overzealously pressed, must
defeat themselves by exciting opposition instead of gradually
winning the co-operation of the people. On the other hand,
if the services of the leading inhabitants are secured to assist
the Government officials in carrying ont measures which are
clearly beneficial, it may often be possible, by reason of their
example and attitude, to carry out with good results measures
which would be ineffectual or injurious if enforced by definite
orders upon a population ignorant of their advantages and
suspicious of the object with which they are adopted,
Agency for Working Plague Regulations.
4. Special attention should be directed to the restriction,
so far as possible, of the employment of subordinate Govern-
ment officials of the medical and police departments and
in especial to the advisability of enlisting to the utmost
possible extent volunteer agency to assist in carrying out
plague measures. Whenever practicable private hospitals and
camps may be placed in charge of native practitioners.
Police officers should hold no inquiry into suspicious cases of
plague. Small representative committees of the inhabitants
may be appointed in various parts of Madras to co-operate
with the authorities and to bring to their notice matters
requiring attention or inquiry.
5. As far as circumstances permit, Hindus should be
employed in those parts . . . where Hindus predominate,
and Muhammadans where Muhammadans are in a majority.
Officers of all grades should use the greatest courtesy and
consideration to the people, and should interfere as little as
possible with their habits, feelings and religious prejudices.
- 6, Where subordinate native agency t is used, it is abso-
lutely necessary that Europeans should be appointed as
supervisors over small and convenient units. -
7. The following procedure should be adopted in obtain-
ing the-services of military officers for plague duty :—
I. A Local Government or Administration requiring an
officer or officers for plague duty will apply to the Govern-
ment of India, in the Home department, detailing the number
of officers required, and where and when they should be
-ordered to join. Such applications shall always be accom-
panied. by an intimation whether the officer should bring
horses with him.
II. The Government of India will then address the
Adjutant-General in India, who will issue instructions under
the orders of the Commander-iii-Chief to one or more Com-
mands to supply the officers wanted, the Government of India
being at the same time informed of the instructions issued.
III. On learning from the Adjutant-General's depart-
ment from what Command the officers asked for will be
supplied, the Government of India will inform the Local
Government or Administration concerned, and all further
correspondence in reference to the individual officers detailed
by Commands, or their replacement, should they for any
reason revert to military duty, will be conducted between the
Local Government or Administration and the Lieutenant-
General Commanding,
IV. When the officers selected have joined their appoint-
ments, the Lieutenant-General Commanding will communicate
their names to the Adjutant-General's department, and their
services will then be placed at the disposal of the Govern-
ment of India.
IV-A. It is not considered desirable that a military
officer should remain absent from his regiment on plague
duty for more than a year at a time. The Lieutenant-
General Commanding has therefore instructions to arrange
with the Local Government for the relief by a substitute of
any such officer who has been employed on plague work for
over a year.
V. When an officer's services are no longer required, he
should be directed by the Local Government or Administra-
tion to rejoin his regiment, the Lieutenant-General Com-
manding and the Government of India being at the same time
informed, and the latter will then replace the officer at the
Commander-in- Chief's disposal.
8. No officers of the Indian Medical Service or the Royal
Army Medical Corps lent for plague duty should be permitted
to revert to military duty without the previous sanction of
the Grovernment of India.
9. The use of troops for plague purposes should be
avoided as far as possible and their employment should be
confined to disinfection when local labour is not available.
Before engaging on plague duty, the sepoys should be
inoculated and each of them should be supplied with two
suits of white drill, one pair of boots, and two white turbans;
they should not wear military uniform or carry arms while so
employed. The sanction of Government should be obtained
before requisitioning them, and where the employment of
troops has once been sanctioned, the men may be changed
without reference to Grovernment. Arrangements should be
made for the relieving detachment to be inoculated before
arrival.
10. ...
Discovery of Plague,
11. The most important and the most difficult matter in
all operations against plague is to obtain early information
regarding the cases that occur. The prompt discovery of an
imported case of plague may enable the local authorities to
prevent a local outbreak, and even where a few indigenous
cases have occurred, early information regarding each new
case may make it possible to prevent the outbreak from
spreading beyond a. confined area. Every endeavour should
therefore be made to obtain information of each case of plague
that occurs, as soon as possible after the patient has been
attacked, or where this is not possible, soon after death.
12. For this purpose, the surveillance system as de-
scribed in regulation 1 should be mainly relied upon, and
the co-operation of the people in working it should be
secured by pointing out to them the advantage of protect-
ing themselves by not mixing with persons coming from
infected areas and by giving the authorities prompt notice of
their arrival, and of any cases of plague or suspicious fever
among them. . . . One or more volunteers of each caste
should be invited to assist the circle officers in prosecuting
enquiries and discovering plague cases. The risk of conceal-
ment of cases is lessened where people see that their leaders
have ranged themselves on the side of the
authorities.
13.
Besides carrying out the other measures prescribed
in part I of the ' regulations, attention should be paid
to the improvement of the existing system of registering
deaths. . . . Special daily returns of mortality may be
called for and checked with the aid of trustworthy subordi-
nates posted at burning and burial grounds.
14. The employment of paid spies or informers as well as
the grant of rewards for information regarding plague cases
is prohibited.
Removal of Plague Patients to Hospital.
15. Plague patients who are left without any one to look
after them or who have no home should in all cases be removed
to hospital, and there can be no question that in dealing
with imported cases . . . the first measure to adopt
is the compulsory removal of the sick to hospital. In dealing
with early indigenous cases the same policy may be advisable.
But if this policy prove unsuccessful . . . a point may
soon be reached where the authorities will not succeed in
getting the bulk of the cases. - When this point is reached,
the fact must be faced that the evils of leaving the sick in
their houses are being incurred and that the attempt to
remove them to hospital may be super-adding to these the
evils that result from carrying about sick persons from house
to house. At this stage the less the sick are interfered with
the better. All that can then be done is to endeavour to
palliate the evils that result from leaving people in their
houses by arranging for continual visitation of the sick at
home, the frequent disinfection of the infected room, and
the encouragement of inoculation among persons left in the
houses with the sick.
16. Except in the cases mentioned above, the removal of
patients to hospital should not be made compulsory. Every
effort should, however, bo made to induce patients to go
voluntarily to hospital and to lessen the aversion to hospital
by the following means-—(1) by encouraging the establish-
ment of private and caste hospitals ; (2) by locating hospitals
near to infected quarters ; (3) by limiting the size of hospitals
so that patients may receive more individual attention, and
accommodation may be more readily made available for their
immediate families and friends ; (4) by arranging for the
provision of an adequate number of medical attendants
and, nurses and of ample and comfortable accommodation for
' •
Segregation of Contacts.]
29
patients; (5) by permitting at least two friends to be in
attendance on each patient so that the patient may never be
left alone ; (6) by allowing the patients to have their own food
and medicines and to receive visits from their relations,
friends and religious instructors; (7) by taking care that all
arrangements for observance of caste customs and for the
comfort and convenience of patients and their attendants are
completed before inviting admission to hospitals.
17. Moribund patients should never be removed to hospital
except at the express wish of the friends or relations of the
patients. The risk of leaving in his house a patient whose
case is so serious that the medical officer thinks he has not a
fair chance of recovery is not great since, as the existence of
the case will have become know)), there will be no difficulty
in carrying out measures of disinfection during the progress
of sickness (if necessary), or after death,
18. The pneumonic variety of plague being the most con-
tagious, persons suffering from this type of the disease should
not be removed to the general wards of plague hospitals, but
should be isolated in separate wards of the greatest possible air
space. It is further advisable that such cases should not be
treated in private houses, unless in the opinion of the medical
officer, the room occupied by the patient is suited for his
complete isolation, and proper control over the number of
attendants and enforcement of disinfection could be had.
Segregation of Contacts.
19. Persons who have been in immediate contact with
plague patients are known as contacts. By segregating them,
persons who are likely to develop plague are isolated and cease
to be a danger to other people ; the plague-infected houses are
emptied for the process of disinfection, and the contacts
themselves are protected from further risk of infection from
those houses. To render segregation effective, the following
measures are necessary :—
(1) All contacts should be diligently searched for and
be detained for the maximum period of incubation, and pre-
vented from mixing with healthy people ;
(2) Those in contact with each successive case of plague
that occurs in the segregation camp must be similarly dealt
with ;
(3) All clothing must be effectually disinfected on entry
into the camp and if plague cases have occurred in the camp
since the date of entry, at the time of departure also ; and
30
[Evacuation.
(4) The staff employed must be very strong relatively
to the number of cases that occur and must be trustworthy,
20. These measures are not always practicable and the
Indian Plague Commission are of opinion that the facts
investigated by them do not justify the conclusion that in an
outbreak the contacts from a house in which a case of plague
has occurred must be regarded from the point of view of the
protection of the rest of the community as so dangerous that
they ought to be compulsorily removed to a segregation
camp. The Government of India have accordingly ordered
that the compulsory segregation of contacts should be aban-
doned as ineffective and harassing except when dealing with
imported cases or when the infection is confined to so small
an area that contacts can be accurately known and establish-
ments can be provided sufficient to secure the detention of
every contact. Where these conditions do not exist, it is
better to subject the contacts to mere surveillance at their
houses, as any attempt to segregate them will not only lead
to the general concealment of cases but also tend to scatter
the people and thus spread the infection to distant places.
While under surveillance, the contacts may be allowed to
pursue their daily avocations.
21. An officer who, not being on leave, is unable to perform
his official duties owing to a short period of segregation.on
account of plague may be treated as on duty on full pay. In
the case, however, of officers who are segregated while
returning from leave and thus overstay their leave, the
period of detention may be treated as duty on half-pay, if it
is considered that some concession is required, but officers
who are suffering from plague should be treated in accord
ance with the ordinary rules.
22. Officers in charge of plague camps should give deten-
tion certificates to all persons who were detained by them,
on their discharge from the camps.
Evacuation,
23. By evacuation is meant the emptying of all or some
of the houses in an infected town . . . with the idea that
they should not be occupied is dwelling houses until it is
believed that they can again be occupied without risk of infec-
tion, the people thus removed being lodged in temporary
camps in the open country. To make it thoroughly effective,
the following conditions aro required : (1) the people should