NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Inoculation.]
31
all bé got out promptly ; (2) their effects should all be dis-
infected ; (3) each new case should be immediately isolated ;
(4) suitable accommodation should be available ; (5) the
people should be effectually prevented from visiting, or sleep-
ing in, the infected houses until either the houses shall have
been disinfected or until sufficient time shall have elapsed
for the infection to disappear ; (6) and lastly they should
not be permitted to scatter and spread the infection in. the
neighbourhood.
24. Evacuation provides the most effective safeguard
against the spread of plague which has yet been discovered
its advantages are self-evident and it should be resorted to
wherever practicable . . . The extent to which it can
be carried out in Madras will depend on the willingness of
the people, the season of the year. . . . the facilities for
providing camp accommodation, and the strength of the
available staff. It will be found to be of the greatest value
at the very commencement of the outbreak, for the removal,of
the small number of people affected will not present any
great difficulties, and prompt evacuation of the infected
quarter may save the rest of the town.
25. Evacuation is, however, likely to do more harm than
good in the following cases :
o
O
(a) During the rainy season, when it is impossible to
keep the people, after they have once been removed from
their houses, from going back to them. In such circum-
stances, the evacuated people are exposed to great incon-
venience and misery without deriving any countervailing
advantages from evacuation.
(b) When the infection is widely distributed among the
inhabitants, . .
it is then advisable to agitate the
people as little as possible, especially when there are among
them a considerable number of artisans and traders who may
lose their occupation by being removed from the town and
are therefore likely to run away and infect other places.
Inoculation.
26. The exhaustive inquiries made by the Indian Plague
Commission have established the fact that inoculation with
haffkinine lessens the liability- to plague and greatly in-
creases the chance of recovery from an attack of the disease,
and disproved the statement that serious ill-consequences have
resulted from such inoculation. The maximum period for
which protection is afforded by inoculation has not yet been
32
[Inoculation.
determined. For practical purposes, it has been fixed, for
the present, at six months, but it should be noted that inocu-
lation does not confer any great degree of protection within
the first few days. Recently inoculated persons therefore
incur risk of infection by remaining in infected places.
27, Inoculation should be encouraged wherever possible
and in particular among disinfecting staffs and the attendants
of plague hospitals. . . . No effort should be spared to
explain to the people in quarters threatened with a visitation of
the disease the advantage of being inoculated before the disease
is among them and to secure the co-operation of the more
enlightened members of the communities. At the same time,
no compulsion of any sort, direct or indirect, should be used.
An awkward attempt at persuasion is liable to create opposition,
resistance, and occasionally, unfounded apprehension, and great
circumspection is necessary in introducing inoculation in places
where there is no demand for it. . . . The people should
be distinctly warned that inoculation is not by any means a
certain prophylactic, but that it considerably reduces the
chances of the inoculated getting plague, that an inoculated
person when attacked has increased chances of recovery, and
that the process, if properly conducted, is harmless.
28. Only trained and reliable persons should be entrusted
with the actual operation of inoculation, and supervision
should be exercised over them to ensure that they use only
sterilized implements. To remove any possible ground for
distrust as to the conveyance of disease from one person to
another, the inoculation syringe should be sterilized in the
presence of the person about to be inoculated. The steriliza-
tion should be effected by immersion in carbolic acid, or
preferably carbolized oil kept hot by the flame of a spirit lamp
underneath. After a bottle has once been opened and only a
portion of its contents used, the remainder should invariably
be thrown away.
29. Inoculated persons should be furnished with certifi-
cates in the prescribed form. The certificate should bear the
left thumb mark of the person inoculated and should be issued
immediately after one full dose has been given, but the
recipient should be recommended to return for a, second
inoculation after ten days. • The full dose should always be
given at one time, unless for medical reasons it is considered
advisable to divide it. If it is necessary to do this, a certifi-
.cate should not be given until the equivalent of two full doses
has been given. If, however, no undue reaction ensues
Disinfection,]
33.
after the first fractional dose has been taken, it is advisable-
to give the full dose at once on the second occasion, after
which a certificate may be given.
30. The privileges attached to inoculation are mentioned
in regulation 40. They are not admissible in cases of
persons who bave recovered from plague. As a further
encouragement the Government has authorized the grant
of three days' extra casual leave on full pay to all public
servants for the purpose of being inoculated. Students
attending Government and aided schools, who undergo in-
oculation, 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 haffkinine
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 wher-
ever 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 in
complete and ineffective. Imperfect disinfection involves
waste of energy and material, brings discredit 011 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 thousand of
hydrochloric acid and a little aniline blue should be added.
If the owners have no objection, interiors of infected houses
should, as a rule, be treated with Wilkinson's coloured
5
34
[Disinfection,
Solution which contains the perchloride in the strength
stated above, To ensure that the perchloride is free from
impurities, it should be obtained from the Madras medical
store depot . . . 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 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 con-
centrated 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. Full 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 be
thoroughly cleaned out; the removal from the house of
cow dung and other moist accumulations should be particu-
larly 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 desiccation 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.
37. Owing to the risk of infection from the blowing about
of the floor dust and owing to the fact that it is practically
Disinfection.]
35
impossible to secure that the whole material shall be carried
away, the digging up of floors with a view to kiln burning
them ought not to be resorted to.
38t The actual burning down of houses should not be
resorted to except in the case of temporary structures which
are of little or no value or in the case of houses which 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
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 proceeding to 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
impopular, and has been ordered to be abandoned in the
case of travellers as very little is to be gained by disinfect-
ing them. Tt 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 or rags, waste paper and soiled linen which cannot
bo classed with ordinary merchandise inasmuch as they are
36
[House-searches.
veŕy likely to carry infection. Any articles brought in
contravention of this prohibition should be destroyed. Old
newspapers in bales and paper (whether newspapers or not)
used for packing purposes are 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 be held 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—
(a) when plague exists in small and well defined areas,
such for instance as an isolated quarter or ward
. and
(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 far 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
room or place exclusively occupied by them.
Inspection and Burial of Corpses.
45. Regulation 28 deals with the mode of disposal of
plague corpses. It in no way interferes with the religious
customs of the people, but merely authorises the; local
Corpse inspection.]
37
authorities to insist on certain necessary precautions as
to the routes to be taken by funeral processions and as
to the place and manner of burial. Any rules which the
President 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
habitations 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 21 the Presi-
dent may require in respect of any particular area that the
certificate of a medical officer shall bo 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 causo 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
disinfection 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 President 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.
38
Plague Hospitals and Camps.
47. The Government will, whenever necessary, construct
either itself or through the municipality 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 private plague
hospitals and camps in charge of native practitioners
so far as the public can find suitable men who will under-
take 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 arc or may be threatened with plague :—
(a) For construction, half the cost Avili 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.
(6) For maintenance, grants nut 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 Pre-
sident Municipal Commission, Madras . . .
(2) The amounts will be paid, month by month, in
arrears to the manager or managers approved
by . . . the President.
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,
Surveillance.]
39
49. ...
50. It may become necessary at any moment for . . .
plague authorities to occupy buildings belonging to other
departments, than the Revenue department, for plague pur-
poses. 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 Rules.
51. Regulation 1.—Copies of this regulation should be
hung up at railway stations. The regulations do not apply
to passengers from a non-infected area, who pass through
an infected station without breaking journey at that station.
51-A. Under this regulation and mufassal regulation 1,
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
President, 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 ques-
tion passengers where they come from in cases where 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 President or
40
• [Surveillance.
the Health Officer of the municipality . . . 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 ...
by the station staff.
55, ...
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
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. ...
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 th, passport may be given
up on his return and further inspection is unnecessary.