NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
( 9 )
Telegraphie communication to be made daily tο the Quarter Master General
during e continuance of cholera.
27. On the appearance of cholera at any station, and
during its continuance, the Officer in Command of that
station is to report daily, by telegraph, when possible, to
the Quarter Master General for the Conimander-in-Ohief's
information, giving the number of admissions into hospital,
the class of persons attacked, and the number of deaths in
each corps at the station. Directions to be observed in
despatching telegraphic messages are given in Appendix A.
Eνery effort to be made to provide means of healthy amusement and
occupation for the soldiers.
28. Special attention should be paid to everything
which can tend to the improvement of the general health
of the men. Every effort should be made to relieve them
from duties which cause needless exposure and fatigue, and
especially to avoid night duty, so far as this may be possible
with due regard to military considerations ; to ensure that
their food is wholesome and their clothing appropriate ; and to
promote every means of healthy amusement and occupation.
Use of spirituous liquors to lie guarded against.
29. It often occurs that soldiers, on a visitation of
cholera, indulge in the use of spirituous liquors, under the
impression that they are a preventive against the disease.
Medical authorities unanimously condemn this baneful prac-
tice as a certain promoter of the disease, and Commanding
Officers should therefore exert their influence in every way
to prevent it.
Abandonment of buildings in which one or more cases of cholera have
appeared, and arrangements for accommodation of the inmates.
30. On a case of cholera occurring in any building
occupied by European troops, the room, or portion of the
building in which it occurred should be IMMEDIATELY vacated,
and, except for the purpose of purifying it, no one should be
allowed to enter it ; if the whole building can be left, i t will
be still better. This is laid down as an absolute rule ; for, al-
though individual cases of cholera sometimes occur when there
is no reason for anticipating an outbreak, instant removal
from an infected spot is the best safeguard ; and besides it is
necessary that the room or building in which the disease has
B
( 10 )
shown itself should be vacated for the purpose of being purified.
When men, under the above circumstances, are removed
from a building supposed to be infected, they must be kept
separate, so far as may be possible, from the men among
whom the disease has not shown itself, and, in arranging for
their accommodation, care must be taken that there shall be
no overcrowding either of them or of others. Should no
separate buildings be available, it is desirable that they be
placed under canvas.
31. In carrying out this rule, it is not, however, neces-
sary that the tents should be pitched in one of the encamp-
ing grounds. They may be placed in some convenient spot
in the cantonment ; and where only an individual case has
occurred among the body of men so removed, this arrange-
ment will, as a rule, be the best which can be adopted.
Purification of vacated buildings.
32. When any case of cholera occurs, even though it
may be but a solitary case, the room in which the disease
has shown itself must be thoroughly purified without the
least delay. The walls, floors, and punkahs should be scrap-
ed and white-washed; the wood-work should be subjected to
the action of hot caustic lime-wash, furniture and ropes
washed, punkah-fringes boiled, and generally everything
possible done for the purification of the Wilding ; the latrine,
urinary, and wash-house used by the man who was attacked
should be instantly closed, and their use must not be per-
mitted until they have been completely purified. Chloride
of lime, Condy's fluid, or some other chemical disinfectant
should be freely used. All filth and rubbish from the
latrine must be buried at a distance, and all vessels used
for their removal must be carefully cleaned and disinfected
at the place where the refuse is deposited. Until the purifi-
cation of the buildings is complete, the troops must under
no circumstances be allowed to re-occupy them.
Buildings vacated on account of cholera when ίο be re-occupied.
33. Ten days after removal, and when the room or
building which was vacated has been purified in the manner
above described, it may be re-occupied, provided no other
circumstances have occurred meantime which may render
such re-occupation undesirable. On this point the opinion
of the principal Medical Officer on the spot must be taken.
( 11 )
Procedure tο be adopted on the occurrence of further cases.
34. If a second case of cholera appears among the
particular body so removed, they should be again moved,
and the infected building or tent which they occupied should
be at once vacated and purified. If a thir'd case occur
among this particular body within one week from the
occurrence of the first case, then the men composing it
should be immediately removed from the station to the
preparatory camp.
85. The procedure here laid down, if carried out with
promptitude in successive instances, will often be found
sufiicient to arrest the further spread of the disease; but
when cases occur in several buildings, either simultaneously
or at short intervals, and especially if there be at the same
time any unusual prevalence of diarrhœa, an outbreak of
cholera is seriously to be apprehended, and it will, under
such circumstances, be advisable at once to remove the
inmates of infected buildings to the encampment outside
cantonments.
36. It is to be remembered that, when an outbreak
threatens, removal from the infected locality is the only
remedy in which any confidence can be placed, and that the
earlier the movements are carried out, the greater will be
the chance of success.
AS a rule, only such buildings tο be vacated as have actually
presented cases.
37. Cholera evidently attaches itself to particular
localities. The principle to be borne in mind, therefore,
is that the particular locality in which cholera shows
itself must be looked upon as dangerous, that it must
be immediately abandoned and all communication with
it stopped, and that the body of men who have been
exposed to danger by their occupation of the place in
which the cause of the disease is presumed to be present,
must be separated from the rest of the troops. If, for
example, this body consists only of the inmates of some
one building, the measure need only be applied to them ;
if some particular battery, troop, or company be attacked,
it will be similarly dealt with. A whole regiment or the
whole of the troops at the station need only be sent into
camp when it is found that the measures already adopted
( 12 )
have not stopped the progress of the disease, or there is
reason to fear they will be in sufficient. As a rale, it is
necessary only to vacate such buildings as have actually
presented cases.
Detachments to be kept separate.
38. When separate detachments are moved into camp
in the manner indicated, it is advisable that they should be
kept distinct as far as possible. Officers Commanding Stations
are authorized to call freely for medical aid from other
stations, districts, or divisions free from cholera; and,
where a separate hospital establishment cannot be assigned
to each party, it may be convenient to place an hospital in
some central position not far removed from two or more
camps, the sick from which may be treated together. Such
arrangements must be left to the decision of the local authori-
ties. A central cholera hospital should on no account be
established in cantonments for the reception of cases from
camp and other quarters.
Special preparations necessary on appearance of cholera at stations
on the Line of Railway.
89. On the first appearance of cholera at any of the
stations on the line of Railway, intimation should be given
to the Railway officials of the probabilities of a movement
being required, in order that the necessary trains may be in
readiness, so that if any move be decided upon, it may be
carried out without delay. Tents should also be forwarded
by rail and pitched at the selected camp.
No move by rail to be made without sanction from Army Head Quarters.
40. As, however, all stations on the line of Railway are
in telegraphic communication with Army Head Quarters,
110 move by rail should be made without the sanction of
His Excellency the Commander-in-Chief, obtained through
the Quarter Master General, every preparation being mean-
while made in anticipation, and the troops, if necessary,
being moved temporarily into a convenient camp.
All movements by rail ίο be made during the day.
41. In travelling by rail it will be better to select
the day than the night. On no account are cases of cholera
( 13 )
or diarrhoea to be placed in a Railway carriage, and
any persons who have come in contact with such cases
should have their clothes fumigated with sulphur, and their
hands and other uncovered portions of the body washed
with a solution of McDougal's disinfecting powder before
starting.
Camps at station of departure and arrival,
42. In some cases to avoid fatigue it may be advisable
to encamp the men close to the station of departure, so
that they may start by rail in the early morning, and they
may encamp again for a night close to the station of arrival
before going on to the selected ground next morning.
Trenches should be dug at convenient intervals on the line.
43. Previous to detachments proceeding by rail, the
Military authorities must arrange for trenches being dug in
the vicinity of one or two of the stations at convenient in-
tervals on the journey, so that all discharges may be received
in them. The troops on no account should be allowed to
use the Railway Station latrines.
Purification of carriages occupied by troops.
44. After occupation by the troops, and in the presence
of the Railway authorities, all the carriages, which must be
only those of the 2nd and 3rd class, are to be washed under
regimental arrangements with boiling water, containing in
o
each gallon a wine-glassful of carbolic acid, after which
sulphur should be burnt in each, and the doors and
windows kept closed on the sulphur fumes for two hours.
These disinfectants must always accompany the troops, and
their supply be ensured by the Medical authorities.
Conservancy of camps.
45. As the movement will be made in the hope that
the troops may be in this manner carried out of the infected
aren, the camp will probably be occupied for some time,
and the strictest possible attention should be paid to the
conservancy, trenches should be dug to leeward, tents
pitched over them, and all fithl instantly covered with
earth. A similar system should be adopted for the camp-
followers and other natives. The strictest regulations must
( 14 )
be laid clown and enforced by the Commanding Officer to
ensure attention to this all-important point.
Arrangement of ihe camp.
46. In arranging the camp the tents should be spread
over a large area, and any military considerations or regula-
tions in regard to distances between tents should give
place to the desirability of allowing free ventilation so far
as this can be done with convenience, Tents should not
be pitched immediately under trees, as they prevent the
free access of air at night, and during the rains prevent
their drying,
Number of men in a lent.
47. As a rule, not more than eight men should be
placed in each tent.*
Immediate benefit from change not always to be expected.
48. Immediate benefit is not always to be expected
from the movement into camp, and the occurrence of a few
cases of cholera ought not to be looked upon as proof that
the change has proved a failure. It is clear that men often
take with them the seeds of cholera, and although the im-
mediate cessation of the disease is by no means uncommon,
it is unreasonable to suppose that this will be always the
case. Even if the first apparent result be an aggravation of
the disease, this need cause no discouragement.
Removal of camps—marches to be short.
49. If the disease continue to be virulent for more
than three or four days, a fresh encamping ground may be
tried, either on the line of rail, or by a short movement,
at right angles, if possible, to the prevailing wind, or track
of the disease. The marches should always be short, if
* This Eule is to be read in connection with No. 66. It is by no means intended
that every regiment should be provided with a double supply of tents. The necessity
for vacating all the buildings in a station which are occupied by the troops will rarely
occur. Experience has shown that many stations have not suffered from cholera with
any severity for years, and to provide extra tents for them would therefore be unnecessary.
Again, there are other stations which arc on the line of rail, and which can thus be
supplied with extra camp equipage if required on very short notice. In such stations,
whenever cholera appears, notice should be given to the nearest magazine that tents may
perhaps be needed ; and when it seems that those on the spot are likely to prove inadequate
they can be telegraphed for. In a third class of stations there is an arsenal on the spot.
( 15 )
possible not more than two or three miles ; movements
should generally be made in the morning, in time to admit
of the new ground being reached soon after sunrise, but
if the march is very short, it may be made in the evening,
whenever the delay of a night is regarded as an unadvisable
risk. The men will be supplied with hot tea or coffee before
starting ; they will invariably wear flannel belts, and every
precaution must be taken to prevent their remaining in
damp or wet clothes, especially when the movements are
made by rail. It is of the utmost importance that fatigue
and exposure should be avoided, and everything possible
should be done to keep the men cheerful and in good spirits.
Isolation of camp hospilals.
50. If any case of cholera or diarrhoea occurs in camp,
isolation and disinfection should be had recourse to, and
all communication between the camp and any neighbouring
station or village should be interdicted. The hospitals in
particular should be isolated to as great an extent as may be
practicable.
Separate hospitals in camp.
51. When all the troops in a station are sent into
camp on account of an outbreak of cholera, all ordinary sick
capable of being removed without evident danger should go
into camp also ; the few patients who cannot possibly be
moved should be transferred to one small general hospital,
which will usually be found sufficient for all those who
must remain in cantonments. Separate hospitals should
always be organized in the camps, and under no circum-
stances should patients be brought for treatment from the
camps to an hospital in cantonments.
Cots to be taken into camp.
52. When considered desirable by the principal Medi-
cal Officer on the spot, cots are to be taken into camp for
all the men, so that there may be no necessity for their
sleeping on damp ground. In the event of carriage being
insufficient for the regular cots, the Commissariat Depart-
ment will usually be able to arrange for the supply of light
native charpoys, which answer admirably. Should the
season of the year not necessitate cots being taken, straw
( 16 )
will be supplied, on requisition, by the Commissariat Depart-
ment. If the troops travel by rail, the straw can either be
taken in the train, or be furnished by the Commissariat at
the selected camp.
Water-supply.
53. The utmost attention must be paid to the drink-
ing water. At encamping grounds which have been fre-
quently used, and which are situated upon great thorough-
fares, caution will be especially necessary, and, if consider-
ed desirable, temporary wells must be sunk, so that there
may be no danger of water contaminated by organic matter
being supplied to the troops. As a precautionary measure,
the water used for drinking should be boiled : and as the
taste of water subjected to this process is insipid, the reason
for this proceeding should be carefully explained to the
men. It is left to the local Military and Medical author-
ities to decide whether the filters belonging to British
regiments are to be taken with them when the troops are
moved into camp on account of cholera or not.
Wood-fires tο be maintained when necessary.
54 Wood-fires may be maintained to the windward of
camp when considered necessary by the Medical authorities.
Return of troops to cantonments.
55. It not unfrequently happens that troops are allow-
ed to return far too soon to cantonments or to buildings
which have been infected with cholera, and the consequence
is the re-appearance or aggravation of the disease. The
return to cantonments must only be allowed with the greatest
caution. No part of the cantonment from which the
disease has not altogether disappeared should be re-occu-
pied. Under no circumstances can the re-occupation of
any building which has been attacked by cholera be allow-
ed, unless at least ten days have elapsed since the last
case of cholera in the building, nor until every measure
for the purification of the building, as laid down in para-
graph 32, has been carried out. The prevalence of fever
or other diseases in camp is no reason for returning to can-
tonments while danger from cholera remains. It must be
accepted as the lesser evil of the two.
( 17 )
All movements to be communicated by post to the Quarter Master
General on the day of occurrence.
56. Officers in Command of Stations are required to
communicate by post to the Quarter Master General on
the same day the occurrence takes place all movements of
troops, including changes of camping grounds consequent
on cholera or other sickness, stating the number and class
of persons attacked, the number of deaths, and any other
matter appertaining to the Quarter Master General's
Department.
Weekly communications to be made to the Quarter Muster General
during the continuance of cholera.
57. During the continuance of cholera at any station,
the Officer in Command is to report by post weekly to the
Quarter Master General, for the information of His Excel-
lency the Commander-in-Chief (with respect to the steps to be
taken for the mitigation of the evil), on the general sani-
tary condition of the station, including bazaars, and on the
health of the population around on a considerable radius.
The report should state in detail the number of cases, the
class of persons attacked, the number who may have died,
and the general character of the disease, whether virulent or
not.
Returns required from Batteries of Royal Artillery and Regiments
of British Cavalry and Infantry.
58. When cholera appears at a station, the following
returns are to be kept by Regiments of British Cavalry and
Infantry and Batteries of Royal Artillery :—No. 1 is to
be furnished daily by Medical Officers to the Officer Com-
manding the Regiment or Battery, as the case may be, for
the information of the Officer Commanding the Station, and
a duplicate to the Deputy Inspector General of Hospitals,
Her Majesty's British Torces. At the termination of the
epidemic the Nominal Register (Form No. 2) is to be sub-
mitted to the Deputy Inspector General of Hospitals, and
by him forwarded for the information of the Inspector
General.
( 18 )
No. 1.
Morning State of Cholera in the
STATION
, Date
DISIRIBUTION OF CORPs.
In Cantonment
Barracks
In Camp in
Cantonments.
In Cantonments
Hospital.
In Camp at
In Camp at
Officers
Men
Women
Children
Officers
Men
Women
Children
Men
Women
Children
Officers
Mon
Women
Children
Officers
Men
Women
Children
...
...
...
...
Total
...
...
...
...
TOTAL
...
...
...
Total
...
...
...
...
TOTAL
...
...
...
...
TOTAL
Grand Total
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
Strength.
Case of Cholera
Remained Admitted dur
ing the last
*24 hours.
Total.
Discharged
Died.
Remaining
Remarks.
* This should include the 24 hours from 8 A. M. to 8 A.M., SO as to give the latest information. It
should be made up after the Surgeon's morning visit to hospital.
Summary.
Officers
Mon
Women
Children
...
...
...
...
TOTAL
...
...
...
...
...
Stemgth
No. of cases
previously
reported.
No. since
admitted.
Total
No. of deaths
previously
reported.
No. since last
report.
Total deaths
Number remain-
ing
Surgeon in Medical Charge.
No. 2.
Daily
Nominal
Register
of eases of Citolera in the
Regt.
of
during
the year
STATION
, Date
DATE
Bank
Name
Age
company
previous health
Habits
Period of service in India
Whether married or single
Hours of admission
Date and hour of attack
When of Admitted
Barrack No.
Married quarters No.
Hospital, and cause of original admission
Camp at
Camp at Camp at
Camp at
RESULT
Died
In stage of Collupes
In stage re-action
How long after admission
Recovered,and date
REMARKS
This Register should include all officers, men, women, and children attacked.
Surgeon
in Medical
Charge.
( 20 )
"Return required from Regiments of Native Cavalry and Infantry.
59. From regiments of Native Cavalry and Infantry
Return No. 1 only will be required.
Special report required on disappearance of disease.
60. On the disappearance of the disease, Officers Com-
manding Divisions and Districts in which cholera has
recently occurred among the troops are required to submit
a special report (in duplicate) to the Quarter Master
General for the information of His Excellency the Com-
mander-in-Chief, showing in detail the number of cases,
the class of persons attacked, and the number of each who
have died, the general character of the disease, and whether
any and what extra expense was caused to Government by
movement into camp, &c.
Return required showing the further progress of the disease among the
inmates of any particular building that has been vacated.
61. In all cases where buildings have been evacuated
on account of the appearance of cholera, a very careful
record of the further progress of the epidemic among the
individual body of men, women, and children who occupied
each building so vacated should accompany the above report,
prepared according to the following form :—
Progress Report of Cholera at
in Her Majesty's
Regiment, submitted in accordance with No. 61 of the Revised Rules
regarding measures to be adopted on outbreak of cholera.
STATION.
Corps,
Number or name of the building
number and detail of
occupants Date of first case
Date of evacution of building.
Number of cases before
Number of cases among those accu
Date of re-accupa
Surgeon in charge.
Commanding Regiment.