NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Medical Officers of the Army of India.
At the very least, hermetically sealed cars with a non-absorbent lining must be
provided, and these must be run on well-laid tram-lines to the installation, to
prevent spilling. No consideration, however, should be allowed to weigh against
the scheme for adequate drainage, whether in the form sketched, or in some
modification thereof, which alone attacks the problem at its root.
Danger of infective urine.—Considering the great danger arising from the
long-continued infectiveness of urine in enteric fever convalescents, the present
arrangements for urinaries demand attention. These are lightly built and cheap
structures, the abandonment of which would not involve much monetary loss;
on the other hand, the immediate and complete removal of this, perhaps the most
dangerous of the excreta, would be a great gain. The precise details are a
matter for consideration, and present no great difficulties, provided it be conceded
that a W. C. and drainage system are essential to adequate sanitation. Some
forms of flush W. Cs. can be used as urinaries; in other cases, it is merely a
question of providing non-absorbent receptacles or channels at the top end of the
latrine and arranging for an occasional flush from the latrine tank; or the urinary
might be placed next to the lavatory, the waste of which, on its passage to the
automatic flush tank at the head of the drain, could be directed to flush the
urinary. The problem presents no difficulties if seriously taken in hand.
As regards urinaries for night use in barracks, the arrangements should
include a receptacle for the ground floor, instead of as at present, for the upper
stories only. Men in the former will utilize the nearest open ground, at night,
instead of resorting to the urinary. These barrack urinaries should properly be
connected with the nearest latrine drain, although it may be admitted that there
are difficulties in providing the necessary flushing, but if water be laid on to
the barracks, as it should be, these should not prove insuperable. Leaving flush
tanks out of the question, a pail of water discharged into each receptacle every
morning would serve the purpose.
2. Disposal.—The sewage runs down by the collecting sewer and immedi
- a t e l y e n t e r s t h e i n l e t p i p e o f t h e i n s t a l l a t i o n ( f i r s t u p w a r d b e d ) ; i t i s c a r r i e d t o
the bottom of this bed, and forces up an equal quantity through the grating upon
which the filtering material is packed. As the sewage continues to flow in and up,
it forces an equal quantity of prepared (hydrolysed) sewage, through small pipes
piercing the wall at the top, into a masonry channel let into the top of the walls,
and running round three sides of the bed, and is thence discharged on to, and
distributed over, the surface of the first filter. When this latter is full, the effluent
from the upward bed is diverted by an automatic arrangement (a balanced tipper,
which is set in motion by the rise of the fluid in the first filter), and the second filter
is then filled. As soon as the first filter is full, and the tank effluent is entering
Scientific Memoirs by
It would require a volume to discuss in detail the many points that might arise
in different places in connexion with the subjects of "removal "and "disposal."
The barest indications are here afforded, and every scheme must receive separate
attention at the hands of Medical Officers and Engineers qualified for the
work. While it is far from the writer's intention to suggest that all problems
have been solved, the principles and the practical indications they afford are plain.
The course is clear; the construction of an installation and its working is simplicity
itself; the knowledge of chemistry and bacteriology which is essential for the
control of the work should be available in every cantonment. It would, however,
be well to entrust the work of the first trial installations, at any rate, to selected
officers, of whom there are several serving in India fully competent to undertake
it.
Although the foregoing remarks have a special reference to cantonments for
European troops, the case for improving the conditions of the removal and disposal
of the excreta of native troops, is little less urgent, where Europeans and natives
are cantoned together. Difficulties there are in the way of a perfect scheme
which one need scarcely anticipate in the case of European troops, and especially
in the supply of the necessary water for dilution and carriage. But at the same
time the whole problem is simplified, if we abandon the system of removal by
drainage, which alone necessitates a fairly large supply of water as the motive
power. If natives can be compelled to walk (as they now do to the trench
-
ing grounds) to the site of an installation, two or more being provided at suit
-
able points to divide up the distance to be traversed, it would appear from
Mr. Silk's Calcutta experiments that a dilution of the excreta with one gallon
in excess of the ablution water in customary use, or even half a gallon per
head with ablution-water, would be perfectly adequately transformed in an
apparatus, the first upward bed or septic tank of which was sufficiently large to
secure the retention of each day's sewage for some 6 to 8 days, and this is only
providing structurally for a daily quantity of excreta with a dilution per head of 6
to 8 gallons. Here we should escape the drainage difficulties with its flushing
requirements, and the men would deposit their excreta in the preliminary mixing
tank before mentioned, or in a flush latrine attached thereto, and water to the
extent of one gallon per head could be added in the latrine or in the mixing tank
before discharge into the upward bed or septic tank. This would entirely meet
the water difficulty, and involve no more expense in construction, as although the
first upward bed or septic tank would have to be slightly larger, to ensure a
due sojourn therein for thorough hydrolysis, it would be more than compensated
by the decrease in the size of the subsequent downward filtration area, which
would only need to accommodate, a body of sewage made up of from 1¼ to 1½
gallons per head.
150
Scientific Memoirs by
the surroundings and the natural flow of the ground water, and after adequate
protection in their course through the soil, they should be provided with pump-
tubes and hermetically sealed by masonry covers; the tube should be
conducted through the lining below the parapet to some distance from the well
mouth, where it will join the pump, so that no pumping is done over the well
mouth. The ground around the well should be laid out in grass and the
whole area fenced-off to obviate all access by man or beast. A force-pump
should be used to raise the water to a proper covered receptacle at
a height sufficient to give a fall to the barrack or hospital, where it should be
accessible by means of brass taps on the verandah. The chief points to be
observed are the choice of the well in unpolluted ground; the protection of the
well both as regards its lining and its cover, which latter must be dust and water
proof; the reservation of the area around, and the provision of the pump outside
the reservation; the distribution by pipes to the barracks, hospital, etc. We
have not dealt fairly with our wells in India; we cannot expect pure water
from a high and fluctuating ground water, which washes a polluted soil
and which is often tapped in ground below the level of a neighbouring native
village or bazaar. Beyond this, we find a good well often fails to yield a
sufficient quantity in the dry months, and is condemned as useless, when deeper
boring would tap the permanent supply, and not the fluctuating "drainage"
level. Systematic bacterioscopic examinations should be carried out at all Station
Hospitals on the lines of Dr. Houston's researches already alluded to (Part I),
i.e., along with an examination of the normal or predominant flora of the soil
of the drainage area of the well Such observations carried on in a large
number of places, differing in their geological and climatological charac--
teristics, throughout the seasons and for a sufficient time, would, if supplemented
by exact meteorological observations be of immense value. The epidemiology
of many diseases would doubtless be elucidated; as it is our knowledge of the
seasonal variations of the bacterial flora of soil and water is very defective.* If,
however, the precautions we have indicated are maintained, we need have no fear
of direct or indirect contamination of the well. Here then, briefly, we may secure
the necessary quantity and quality by adequate means of protection of a simple
character, and then we have to obviate all unnecessary interference and manipu-
lation, by abolishing the various links in the chain of supply, any one of which
may fail, where human agency is employed, and so lead to disaster. A sketch
plan of the arrangements, here proposed, which have proved their efficacy after
a long trial in certain rural lowland districts in Scotland, is appended (see
Plate II). I am indebted for the idea and for details as to the results based on
* See Report of Sansary Commissioner India) for 1899. Sect. VI, Cholera.
154
Medical Officers of the Army of India.
155
bacterioscopic examinations, to Dr. MacMartin Cameron, M. O. H. to the County
Councils of Kirkcudbright and Wigtown.*
The imperative necessity of a reform in the arrangements for water-supply
in camps, especially those used in route-marching and in manœuvres, is too ap
-parent to need emphasis; and the same applies to bazaars affiliated to canton
-ments.
Having already exceeded the space at disposal, it is impossible to dwell at
greater length on this subject, but the writer is convinced by a study of the
reports of the Special Sanitary Officers, and of reports on the water-supply of
268 jails, that (1) there is an abundant supply of good water at our disposal
if we select and treat our wells with proper care, and (2) that contamination from
soil pollution (through soakage or by dust) is exceedingly common. The im
-portant question of artesian borings also requires the immediate attention of
experts, so that, where possible, this source should replace that of the ground
water.
4. This leaves little space for sundry general remarks, which this most im
-portant and comprehensive subject demands.
Sanitary Administration of Cantonment Bazaars .—We have seen how
strong is the consensus of opinion that, in the present state of the sanitation (or
insanitation) of the affiliated Bazaars, they should be put out of bounds" for
the troops. The Cantonment Code which came into force only in October 1899,
is a belated attempt to deal with this difficult problem, and it is perhaps a little
early to judge of its results On this subject, one excellently qualified to form an
opinion, viz., Major Firth, R.A.M.C, late Special Sanitary Officer of the
Rawal Pindi District and now Professor of Hygiene at Netley, offers some strong
but judicious criticism in his report for 1899-1900, which the authorities would
do well to consider. The Cantonment Magistrates are the Executive Sanitary
Officers, and these are supposed to get their technical advice from the "Sanitary
Officer" who is a member of the Cantonment Committee. In the majority of
cantonments no specially qualified Health Officer has yet been appointed, and
the sanitary adviser is practically the senior executive medical officer in the sta
- t i o n . W o r k o f t h i s k i n d i n v o l v i n g s p e c i a l k n o w l e d g e a n d t r a i n i n g i n a s c i e n c e
that is making great strides yearly, if not almost monthly, can only be expected
of an expert. Again, of the Cantonment Committees, Major Firth says, "I fear
but few Cantonment Committees will rise to a sufficient appreciation of their
powers and responsibilities." He points to the apathy engendered during the
hot and rainy months (the period of danger), when everyone is inclined to let
abuses stand over for attention, to the next cold season. There is also a most
* B. M. J., August 13. 1898; also private letters to present writer.
156 Scientific Memoirs by
undesirable lack of continuity in the administration, and "it comes to this that
in nine cases out of ten, the activity, zeal and initiative of the Magistrate are
the true measure of the efficiency of the local sanitary authority." The provi
-sions under the Code as to by-laws are too lax and permissive, and this particu
-larly with regard to the control of trades, etc., from which most of the danger to
the troops is considered to arise ; and "the multiplication of sanitary officers, will
and can do nothing if the law allows any loophole for escaping conformity with
sanitary requirements." In the important matter of conserving a pure-water
supply we find it enacted that "no person shall without permission place any
latrine, cesspool, urinal or drain, or use for the deposit of offensive matter or
rubbish, any place within fifty feet of any source of public water-supply." Any
"person" may, it would seem, put his latrine at a distance of fifty feet or nearer
"with permission." Again the provisions laid down (sections 73 and 76) as regards
latrines, are not calculated to arouse the enthusiasm of the most lukewarm sanitary
reformer. Major Firth concludes by saying that " we can only hope for very gradual,
improvements, as a result of a judicious combination of cajoling and menace on
the part of officials" * "but success in this direction is purely that of the
individual and not of the administration." It must be affirmed that neither the
specific provisions of the Code, nor the authority to which their execution is en
-trusted (with the large amount of judicial and office work this individual has to
perform) provide a basis for sanguine anticipation ; menace and cajolery are tardy
agents to depend on. By the time the ground has been covered at infinite, trou
-ble, those who were first cajoled into some reform have relapsed, and so the work
goes on da capo. For ignorant people it must be made as easy to do well as to,
do ill, and nothing will avail but radical reforms in all the practical measures by
which a community can live cleanly and righteously in a sanitary sense.
A large proportion of enteric fever infections are contracted during
journeys by rail and on route-marching. I affirm from a wealth of experi
-ence as a Civil Surgeon, a Provincial Sanitary Officer and a traveller, that
the lack of sanitary arrangements at our railway stations and dâk bungalows is a
crying scandal. If we cannot touch those sloughs of despond known as hotels,
it is certainly, incumbent on the authorities to put the former under strict sanitary
discipline. A little interest in the matter bestowed by the local sanitary author
-ity would go far to improve matters and save many valuable lives. It can be
done and has been done ( i.e. , the supervision has been exercised) in a few cases
known to the writer, but unless some general action be taken, the task is hope
-less over the length and breadth of the land. A code of rules should be drawn
up setting forth the elemental sanitary conditions that should be observed, and
legalizing supervision and penalties for non-observance of the rules.
Scientific Memoirs by Medical Officers of the Army of India.
first accessible after their parasitic sojourn in the body. Are the excreta of
patients suffering from enteric fever and bowel diseases generally, in all cases,
properly dealt with as containing all the elements for fresh infections, if they get
access to susceptible individuals ? One great difficulty is the frequent absence
of a perfectly simple and efficient incinerator for all contaminated excreta, There
are legion on the market, and most of them are grievous failures. I venture to
draw attention to one that, after daily tests extending over several years; has uni-
formly left nothing to be desired. A glance at Fig, I, Plate II, and the accompany-
ing description will make its modus operandi clear and will show that the princi
-ples on which it is constructed are sound and scientific. As regards its practi-
cal efficiency and simplicity, experience based on its systematic use in civil hospi-
tals in different parts of India, has demonstrated that it completely solves the
incinerator question for infective stools in hospitals. With regard to other pre-
cautionary measures, notably as regards infective urine, see Horton Smith's
Goulstonian Lectures, "Lancet," March and April, 1900.
The adequate sterilization of clothing and bedding is equally necessary.*
The conservancy of the site and surroundings and the adequate supervision
of cook-houses are understood to be receiving attention.
It is surely unnecessary to detail here all the essential points that require attention,
to maintain perfect cleanliness and prevent contamination of the food and drink. No
piece-meal safeguards against the risks run at the various stages of storage and prepara
- t i o n w i l l a v a i l , u n l e s s t h e p r o p e r s t r u c t u r a l a r r a n g e m e n t s a r e p r o v i d e d i n t h e f i r s t p l a c e , f o r
light, air and cleanliness within, and for protection from pollution from without. It
would appear to be absurd to insist upon this, but that the kitchens of those who fare
sumptuously every day, are rarely if ever free from the gravest reproach. Absence of light
and air, smoke-begrimed walls, loose absorbent brick floors and walls, dangerous water-
receptacles, absence of proper drainage, retention of garbage, are too often the conditions
met with.
And then as regards the milk-supply, let any one who imagines that each cantonment
has its own well-appointed dairy, consult the reports of the special Sanitary Officers of
Commands and see how matters stand in this respect.
In conclusion I have to express my thanks to two eminent members of the
Engineering profession for advice on technical points, but whose names I do not
give, as I have no warrant that they would endorse my conclusions, as embodied
in the section on "Removal." I am indebted to Mr. Donaldson, President of the
Simla Municipality, for the great personal interest he took, and for technical
advice he afforded to me, in the construction of the various apparatus used in the
Simla experiments, and for his aid in getting the attached plans drawn.
* See British Medical Journal, November loth,1900, page 1370.
15 8
Plate I.
Fig. I.
Top plan.
Fig. IV.
Top plan.
Type-plan of the Simla (modified Scott-Moncrieff) Installation, for one Regiment.
Scale. 12 Feet = 1 Inch
Plate I.
Fig. II.
Section on A. B. C.
Fig.
V.
Section on D. E. F.
Fig. III.
Section on D. E.
(Scale 6' = 1")
Capacity (15' X 12' X 5⅓') 6,000 Gallons.
Explanation of Plate II.
A safe form of well devised and used by R. W. D. MacMartin Cameron, M.D., D.SC.,
Medical Officer of Health for the County Councils of Kirkcudbright and Wig
-
town. The arrangement and the advantages are equally obvious. The reserved
area should be at least 20 yards in diameter, with the well in the centre; but this
area may certainly be increased largely, if deemed necessary, to ¼ or even
½
acre. The lead pipe running from well to pump should be filted to the latter
by brass screw joining.
Fig. I, Plate II.
Donaldson's Patent Destructor for Hospitals, for the incineration of infectious
dejecta. A is an upright cylinder of sheet iron having a lid B, with inlets I. I.
for the air required for the furnace. C.C. is the firebrick lining of the furnace,
and upon which is suspended the metal pan D. E is the firegrate; F the
ash-pit, which has a door G, for removal. H is one cf a series of corrugations in
the periphery of the firebrick lining which form air-ducts through which air and
the gases are drawn to pass through the closed ash-pit F. These air-ducts
are shown in the plan H.H.H. J is the exit for the products of combustion,
which may be prolonged to any height by means of a stove-pipe. K is the
stirrer for turning over contents of the pan D. It is pivoted in the pan, so that
it can be moved about by the rod L when the lid is closed.
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PUBLIC ROAD
SCIENTIFIC MEMOIRS
BY
MEDICAL OFFICERS OF THE ARMY OF INDIA.
EDITED BY
SURGEON-GENERAL ROBERT HARVEY, M.D. C.B., LL.D.,
DIRECTOR GENERAL, INDIAN MEDICAL SERVICE.
PART XII.
1901.
1.—On the Characters and Relationships of Afzelia (Sm ith).—Major D. Prain,
I.M.S., Superintendent, Royal Botanic Garden, Sibpur, etc.
(Page I.)
2.—Inoculation of Malaria by Anopheles.—Captain C. F. Fearnside, I.M.S.,
Superintendent, Central Prison, Rajamundri, (Page 19.)
3.—Zoological Gleanings from the Royal Indian Marine Survey ship Investi-
gator.—Major A. W. Alcock, I.M.S., Superintendent of the
Indian Museum and Professor of Zoology in the Medical College
of Calcutta, formerly Surgeon Naturalist to the Indian Marine
Survey, (Page 35.)
4.—Some Observations on Spirillum Fever, as seen in the Monkey—Macacus
Radiatus.—Captain George Lamb, I.M.S. (Research Laboratory,
Bombay), (Page 77.)
5.—On the Anatomy of the roots of Phœnix paludosa Roxb.—Lieutenant
A. T. Gage, I.M.S., Curator of the Herbarium attached to the
Royal Botanic Garden, Sibpur, near Calcutta, (Page 103)
6.—On some Practical methods of Sanitation in India with special reference to
Cantonments.—Major Ernest Roberts, I.M.S., (Page 113.)
SIMLA.
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