NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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Information required as to size and relative position of huls occupied by
Native troops attacked by cholera.
62. When cholera has appeared among Native troops,
full particulars are required as to the size and relative
position of the huts of each Native regiment which suffered
from the disease ; the exact accommodation allotted to the
several ranks should be shown, and the nature and descrip-
tion of the several buildings should be specified.
Report of any expense incurred for hiriny bungalows, & c., to be made
at once.
63. When it has been found necessary to incur any
expense, such as the hiring of bungalows, &c., for the benefit
of the troops during the prevalence of cholera, a special
report, giving every particular, should be at once made to
the Quarter Master General for the information of His
Excellency the Commander-in-Chief and of the Government.
Tents are to be retained for regimental purposes only,
64. Tents belonging to a regiment are to be retained
in all cases for regimental purposes, and are not to be lent
to the Civil authorities for the use of prisoners in the event
of epidemics breaking out in jails, or on other occasions.
Oldest and least serviceable tents to be used for cholera cases.
65. When tents are required for cholera cases among
the troops, the oldest and least serviceable must be selected,
provided they are fit for the purpose.
Supply of camp equipage.
66. In most cases the established proportion of camp
equipage will be sufficient to accommodate that portion of
the garrison which it may be necessary to move into camp.
Extra camp equipage should, therefore, not be indented for
unless the epidemic should prove severe, and render it pro-
bable that a larger proportion than half the garrison may
have to be removed from cantonments. When the necessity
for this has been admitted, Commanding Officers are to
indent on the nearest magazine for such additional camp
equipage as they may require ; the indents to be countersigned
by the Deputy Inspector General of the Circle, or the
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senior Medical Officer on the spot, and by the Officer Com-
manding the Station.
Hospital management.
67. The question of hospital management during the
prevalence of cholera is one of urgent importance. No
sanitary precaution must for a moment be neglected ; no
approach to anything like crowding must be permitted ; all
unimportant cases, the treatment of which in hospital is not
essential, should be discharged ; every case in hospital must
be carefully watched ; and it must be borne in mind that
in very numerous instances it is in the hospital, among
patients under treatment for other diseases, that cholera first
appears. Precautionary measures in the hospitals must be
commenced, whenever it may be possible, before the actual
appearance of the disease ; and, as laid down in paragraph 5,
all slight symptoms of disease must be treated in the bar-
racks, or in observation wards entirely separate from the
hospital.
Separate temporary hospital ίο le prepared for cholera cases.
68. If no separate building can be set apart as a tem-
porary hospital, tents should be pitched for the purpose in
some convenient place at a little distance. Every arrange-
ment must be made, so that if a case of cholera should occur,
it may be immediately removed there, and not be treated in
the regular hospital. For the treatment of patients suffering
from cholera, tents are unobjectionable at all seasons of the
year. The air in a tent is less likely to become contaminated,
and the ground can be changed as often as may be desirable.
Medicines, and everything considered requisite for the treat-
ment of the disease, should be prepared in the temporary
hospital, and a portion of the establishment should be kept
in readiness to be transferred there, so that if a case of
cholera occurs, the means will exist for separate treatment,
and subsequent communication, with the regular hospital
will be unnecessary.
Prévention of fresh cases more important than medical treatment.
69. If, in spite of every effort, the sub-division of hos-
pital establishment should lead to difficulty in the medical
treatment of the disease, this must be accepted as the lesser
of two evils ; for it must be always remembered that the
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main object daring an epidemic oí cholera is the prevention
of fresh cases, much more than the treatment of those who
have already been attacked ; that prevention is often possible,
but that treatment is almost useless after virulent symptoms
have appeared.
Separation of cholera patients and abandonment of hospital buildings
if cholera occur in them.
70. No patient attacked by cholera should ever, under
any circumstances, be placed in the same ward with patients
suffering from other diseases. If a patient in hospital suffer-
ing from another disease be attacked with cholera, or if a
case occur among the hospital attendants or others, the same
system must be adopted as has been ordered in the event of
cholera appearing in other buildings occupied by troops.
The ward in which the case has shown itself must be IMME-
DIATELY abandoned, and every precaution laid down with
respect to other buildings must be taken.
Funeral parties.
71. During the prevalence of cholera funeral parties
should be discontinued, and the band should not play at the
burial either of officers or men.
Removal of cholera excreta.
72. Every effort should be made, during the actual
treatment of the disease, to get rid, as completely as possible,
of all the discharges from the sick or to render them innocu-
ous. The vessels in which they are received should contain
some powerful disinfectant ; they should never be emptied
into the usual receptacle, or carried to the common latrine,
but taken away separately, and the contents thrown into a
trench dug for the purpose and reserved for this use. A
man should be constantly employed in the duty of throwing
fresh earth over all filth the moment it is deposited, and all
vessels should be thoroughly cleaned at the trench into which
the filth is thrown.
Supply of extra articles of diet during prevalence of epidemics.
73. During the prevalence of cholera at a station, such
changes in the diet and such other medical comforts are to
bo allowed to the troops as the Deputy Inspector General of
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the Circle or other principal Medical Officer may deem ex-
pedient. In directing these comforts to he freely supplied,
particularly to the women and children, the senior Medical
Officer on the spot will he required to exercise a wise dis-
cretion to avoid unnecessary expenditure, and to see that
the indulgence is not abused.
Employment of Native servants in attendance on cholera patients.
74. On the occasion of an outbreak of cholera at a
station, the entertainment of Natives to attend European
soldiers in hospital suffering from that disease is authorized
to such an extent as the local medical authorities may con-
sider necessary—the men being provided on requisition by
the Commissariat Department.
European Soldiers lo be employed on Hospital duly as seldom as possible.
75. When the employment of European soldiers as order-
lies in hospitals during the prevalence of cholera is considered
unavoidable, men will be selected, as far as possible, by
volunteering in such number as the medical authorities may
deem necessary. The complete tour of duty shall in 110 case
exceed 24 hours, and no man who is not in good health shall
be thus employed. No orderly is to be kept in actual attend-
ance in the hospital for a longer period than four hours at
one time, nor is he to have a less interval of rest than
six hours between successive tours of duty, whatever be
the period of attendance in the ward. A room entirely
separate from the hospital buildings must be provided for
the accommodation of men relieved from attendance on the
sick, in which they can remain until their tour of duty again
comes round. Men not upon actual duty are not to be
allowed to remain in the hospital. The strictest precautions
must be taken to prevent men employed in the hospital from
making use of the latrines, urinaries, or wash-houses used
by the sick in hospital. The utmost care must be taken that
the hands of all attendants on cholera patients be scrupu-
lously cleaned by means of sand and water containing some
disinfectant, or other thoroughly efficacious means ; and that
if the clothes of any of the men should become soiled by
cholera discharges, they be at once taken off and thoroughly
purified. Every man employed as an hospital orderly in
attendance upon cholera patients is to be provided with tea
or coffee before and after each tour of duty.
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Female nurses for attendance on women and children.
76. For attendance on women and children suffering
from cholera, Native female nurses should, if possible, be
procured.
Removal of the sick and of the dead.
77. Careful arrangements must be made for the
removal of the sick from the barracks to the hospital, and
on no account should the doolie employed for this purpose
be made use of for the removal of the dead.
Purification of bedding and clothing.
78. All bedding and clothing used by cholera patients
which can be subjected to this process must be immediately
purified by being boiled for quarter of an hour in water.
There is no difficulty in boiling such articles as bed-tape
(newar), blankets, and linen. The bug-boilers offer facilities
for boiling the cots. Rezáis and other such articles which
can never be thoroughly cleansed should be burnt.
Purification of cots and punkali-fringes.
79. Cots and punkah-fringes which have been used
by cholera patients, or in wards set apart for them, should
be subjected, in a similar way, to the action of boiling-
water when they are no longer required for such cases.
Purification of tents.
80. Tents used by cholera patients before being struck,
should be disinfected by one or other of the following gaseous
disinfectants,—chlorine, nitrous acid, or sulphurous acid,
and then left exposed to the weather for ten days.
Tents which have been used for cholera purposes in camps
within cantonments should first be removed to an out-of-
the-way, but airy spot outside, and then subjected to the
process of fumigation.
Burning only ίο le resorted to when thorough purification cannot
be at once carried out.
81. It will only be necessary to burn such articles as
bedding, body linen, cots, and punkah-fringes when their
thorough purification cannot be at once carried out in the
manner above laid down, but with proper arrangements this
destruction will rarely be required.
D
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Rules applicable to women and children.
82. It is to be distinctly understood that the above
Rules are equally applicable to the women and children if
cholera should appear in their quarters, and that they are to
be as strictly carried out ; but endeavours should always be
made to assign available buildings to them, so that the
necessity of moving them into camp may, if possible, be
avoided.
Measures to be adopted on the appearance of cholera in the sudder
or regimental bazaar.
83. On the appearance of cholera or any other epi-
demic in the sudder or regimental bazaar of a station,
arrangements should be made for the isolation and treatment
of the cases. One or more grass huts should be placed on
the outskirts of cantonments in a convenient and selected
position, a fresh site being selected weekly, as the ground
becomes contaminated and proves a source of clanger.
Stringent orders should be issued to ensure all cases of
the disease being sent to this isolated hospital for treatment.
Station Staff Surgeon to have charge of the Hospitals for Natives.
1 Native Doctor.
1 Compounder.
1 Cook.
1 Bheesty.
2 Sweepers.
1 Doolie with 4 bearers.
84. The hospital will be under the medical charge of
the Station Staff Surgeon, or other
Medical Officer selected by the Deputy
Inspector General of Hospitals, and the
establishment, as per margin, to be
increased if necessary, will be attached
to it—the servants to be discharged on the subsidence of
the epidemic.
Expenses to be defrayed from Cantonment Funds.
85. When cantonment funds can be made available,
without withdrawing them from such measures of conser-
vancy as may be considered of even more importance, all
expenses incurred by the establishment of these temporary
hospitals, including the dieting of the patients, if that
be also involved, should be defrayed by them, the primary
object of such funds being to secure the proper sanitary
condition of a station in every possible way.
Record of buildings and camps in which cholera occurs.
86. As experience in such matters is of great value,
a careful record should be preserved in the Brigade or
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Station Staff Office showing the number of cases occurring
in each building, and the number of attacks in the different
camps.
SECTION III.
OTHER POINTS REQUIRING· THE SPECIAL ATTENTION OP MEDICAL
OFFICERS.
Investigation into the circumstances of the first case.
87. In any epidemic, it is of the greatest importance
to ascertain all the circumstances connected with the appear-
ance of the first case, and a very careful investigation
should be made at once in order to discover, if possible,
whether it was due to importation. Such enquiries if delay-
ed are usually unsatisfactory.
Condition of camp-followers,
88. The condition of the camp-followers, of the pun-
kah coolies, and others who come about the barracks should
receive attention, and orders should be issued that any sus-
picious cases occurring among them be reported, so that
they may be at once investigated. With the assistance of
the Non-Commissioned Officers, such cases of sickness should
not escape detection. Arrangements should be made for
the early treatment of those attacked either in camp or can-
tonments, and where the general cholera hospital for natives
is distant, measures should be adopted for attending to their
wants on the spot. A careful note of all such seizures
and of the circumstances under which they occur should
be preserved.
Abolition of the term " choleraic diarrhœa."
89. In the forms now adopted the term " choleraic
diarrhoea" has been abolished. All such cases distinguished
by rice-water evacuations should be returned as cholera.
Disuse of the words " sporadic" and " epidemic."
90. It is very desirable that the terms " sporadic" and
" epidemic" should not be used in connection with reports
of cases of cholera. There are no means of distinguishing
between the two, and the exact significance of individua]
attacks can be known only when all the facts regarding the
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prevalence of the disease throughout the year have been
ascertained and considered as a whole.
Cholera cases not to be returned as "discharged" until all symptoms of the
disease have disappeared.
91. In some instances, cases of cholera in which re-
action has taken place have been discharged, and the fatal
event which afterwards occurred recorded under the head
of fever. This system produces great error in the statistics,
and it ought on no account to be followed. No cases of
cholera should be " discharged" until every symptom either
directly or indirectly due to the disease has disappeared.
A lull in the number of cases not to lead to any relaxation of
precautionary measures.
92. When no cases of cholera have occurred for several
days, an opinion is apt to prevail that the disease has dis-
appeared, but it must be remembered that at certain seasons
a lull is to be expected. This generally occurs in the early
part of the monsoon. With regard to it no decided rule
can yet be laid down, but it is important that the fact of
there having been no cases for some time should not lead
to any relaxation of the necessary precautions and prepara-
tions in anticipation of a further and generally more severe
outbreak.
Effect of upper stories on proportion of attacks.
93. As it is important to ascertain the effect of upper
stories in warding off attacks, a daily register in the annexed
form should be kept :—
DATE.
Number occu-
pying upper
stories on
that day.
Number of at-
tacks in upper
stories ou
that day.
Number occu-
pying lower
stories on
that day.
Number of at-
tacks in lower
stories on
that day.
REMARKS.*
* In the remarks, the case of any man lately on guard, or particulars regarding other influences which
may have caused the attack, should be rioted.
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SECTION IV.
RESPONSIBILITY OF COMMANDING OFFICERS.
The Rules to be carried oui by the Officer Commanding the Station.
94. On the Officer Commanding the Station will de-
Yolve the responsibility of having all the directions contained
in these Hules, as regards the evacuation and purification
of buildings, the movements into camp, and all other details,
carefully carried out.
Discretionary powers of Officers in Command.
95. These Rules, founded on the general experience of
the past, must be considered as the guide on all ordinary
occasions. As in outbreaks of cholera, however, so much
depends on the judgment and action of general and other
Officers, they must exercise their own discretion whenever
extraordinary emergencies or unforeseen circumstances occur,
and, in consultation with the senior Medical Officer, must
take upon themselves the responsibility of action incumbent
on their position.
Whenever it may be considered advisable to deviate
from the procedure prescribed in these Suies, a special report,
explaining fully the reasons for so doing must be forwarded
to the Quarter Master General for the information of the
Comniander-in- Chief.
SECTION V.
Rules regarding the measures to le adopted on the appearance of Small-pox
among British or Native troops.
I.—Whenever a case of small-pox appears among either
British or Native troops, it should be immediately isolated,
and all communication between the sick person and others,
whether direct or indirect, should, as far as possible, be
prevented.
II.—In some cantonments a building, no longer re-
quired for other purposes, and occupying an unfrequented
site, has been set apart for the reception of small-pox cases,
and whenever such a building is available, the case should
be at once removed to it.
III.—In those cantonments where no such building
exists, the case must be removed either to a tent or to a
grass hut.
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IV.—As cases are most apt to occur in the hot months,
a grass hut is in every way better suited for the purpose
than a tent. If lined on the sides with a coating of mud,
it affords very good protection,
V.—If, owing to the small number of sick in hospital,
or to other circumstances, a ward or other room, well separ-
ated from the other patients or other persons, can be made
available for the temporary reception of the case, there is
110 objection to its being treated there during the first day
or two of the disease when eruption is still advancing, and
its power of spreading to a distance is comparatively limited.
Time will thus be allowed for the preparation of a grass hut.
VI.—If this course should have been followed, the room
temporarily occupied by the case should be immediately
purified in the manner described in Rule 32 regarding
cholera.
VII.—Whether a tent or grass hut is employed, it
should be pitched in some secluded spot, and the shelter of
trees, if possible, secured.
VIII.—If a tent is used, the oldest and least serviceable
should be selected.
IX.—Good tents should never be employed for the
purpose, except in very exceptional cases, which should in
each instance be explained.
X.—Unless there is an immediate prospect of their
being further required, tents or huts used by small-pox
patients should be destroyed by fire, in presence of a respon-
sible person, as soon as vacated.
XL-—If there is an immediate prospect of the tent or
hut being again required, it should be purified in the manner
described as suitable for buildings in Rule 32 for cholera.
It should then be left standing with the sides and doors
kept closely shut down.
XII.—Bedding and clothing, cots and punkah-fringes,
should be thoroughly disinfected as described in Nos. 78, 79,
and 81 for cholera.
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APPENDIX A.
Directions to be observed in despatching Telegraphic Messages regarding
Cholera.
I.—The message should usually be despatched soon
after 8 A. M. so as to agree with the morning state—Form
No. 1, required by Hule No. 58.
II.—The number of cases and deaths among men,
women and children in each regiment of Europeans at the
station during the preceding 24 hours should be stated
separately.
III.—The number of cases and deaths in each Native
regiment should also be stated.
IV.—Particulars regarding camp-followers or the city
and bazaars should be given only when they are important,
as indicating the advance or decline of the disease.
V.—All particulars regarding movement of troops
should be included in the message, and the condition of each
detachment in camp.
* As in such stations Telegraph Stamps arc not generally
procurable, Officers are required to adopt the procedure set
forth in Notification dated, Calcutta, 22nd December 1868,
paragraph 3, General Order dated 18th January 1869,
namely :—
"Para. 3. Telegrams can be sent from out-stations by
Post, but they must be enclosed in registered covers ; at
stations where Telegraph Stamps are not procurable they
may be paid for by Postage Stamps at the rate of 17 annas
to the Rupee. In such cases the Post Office registration
receipt will take the place of the ordinary Telegraph receipt.
If any telegram be received insufficiently stamped, it will
be returned bearing to the sender."
VI.—When there
is no Telegraph
Station in or near
the
cantonment
attacked, the mes-
sage should be
sent by Post to
the nearest Tele-
graph Station.*
VII.—The following specimens of telegrams are ap-
pended for guidance .·—
From—Allahabad
To—Army Head Quarters
From—Officer Commanding. To—Quarter Master General.
22nd March, one case, 58th Reginient, a soldier. Build-
ing vacated and disinfected.
25th March, twelve admissions from British and five
from Native troops since yesterday's report. All soldiers.
Artillery, three in cantonment.
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Artillery, one in fort.
No deaths.
58th Regiment, eight in new barracks, six deaths. Two com-
panies moved to Camp Jhosee. Affected building va-
cated. Reports from city and district more favorable.
By order of the Right, Honorable the Commander-in-Chief.
FRED. THESIGER, Colonel,
Adjutant General.
IP/ 32 /
H G - 5
ON THE
L O C K H O S P I T A L S
IN THE
P U N J A B
FOR THE YEAR 1887.
Published by Authority.
Price—Rs. 2-8-0.
L o h o r e :
PUNJAB GOVERNMENT PRESS.
1888.
REPORT
ON THE
LOCK HOSPITALS
IN THE
PUNJAB
FOR THE YEAR 1887.
Price—Rs. 2-8-0
.
Lohore :
PUNJAB GOVERNMENT PRESS.
1888.
( 2 )
priety, and the Lieutenant-Governor wishes to repeat the observation made in
paragraph 3 of this Government's Proceedings in the Home Department for
November 1857, No. A., to the effect that he declines to countenance any
such action, and altogether disapproves of officers under his control taking part
in such proceedings.
6. The suggestion of the Inspector-General of Civil Hospitals that
matters relating to venereal disease among the troops and the Lock Hospital
Reports should in future be dealt with entirely by the Military authorities
cannot be carried out so long as it is the wish of the Government of India that the
Civil authorities should co-operate with the Military authorities in the matter.
ORDER.—Ordered that a copy of the foregoing and of the letter from the
Inspector-General of Civil Hospitals, together with the reports, be forwarded
to the Government of India in the Home and Military Departments ; also to the
Surgeon-General with the Government of India, and to the Quartermaster-
General in India.
By order of the Hon'ble the Lieutenant-Governor,
C. L. TUPPER,
Offg. Secretary to Government, Punjab.
Punjab Government Press, hahore-28-11-88-40.