NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
SECT. X.]
SANITARY REGULATIONS.
213
(b.) If practicable, the names of stations and dates at which passengers
booked at the first affected locality were put down. The facts might
possibly be ascertained from the railway tickets.
(c.) Names of stations and dates at which any passengers suffering
from choleraic disease were left.
(d.) Name of station first attacked with cholera, and date of appear-
ance of cholera there.
(e.) Dates of appearance of cholera in all attacked stations, and groups
of population along the line.
242. Caution necessary in conducting these enquiries.— I t i s
necessary, perhaps, to suggest a caution in carrying out enquiries into the
relation between the movement of population and the movement of epidemic
cholera, in order to avoid the disturbing influence of coincidences.
There are several known factors to be considered in all similar
enquiries :—
(a.) There is the obvious movement of the disease.
(b.) The obvious movement of the population.
(c.) The fact that cholera appears without apparent or known
movement of the population between affected and unaffected districts.
(d.) The fact that cholera has appeared in unaffected districts after
arrivals from affected localities ; sometimes only in persons arriving ; some-
times only in residents ; sometimes among arrivals first, and residents after-
wards ; sometimes in residents first, and among arrivals afterwards.
(e.) The fact that arrivals take place from affected localities in unaffected
localities without any appearance of cholera following on arrival.
243. CHOLERA APPEARING AFTER INTERCOURSE NO PROOF " PERSE " OF IMPOR-
TATION.—It would evidently be impossible to ascertain the truth by simply
assuming that the arrival in unaffected districts of persons from affected
districts was the cause of cholera appearing in these unaffected districts.
244. NEGATIVE FACTS AS WELL AS POSITIVE FACTS TO BE NOTED.—It would be
equally impossible to arrive at truth by noting only those instances in which
diseases followed on the fact of intercourse, without noting those instances
in which intercouse was not followed by spread. of disease.
245. STATISTICAL DATA REQUIRED.—In all statistical comparisons on this
point, two facts are indispensable :
—
(a.) An estimate of the number of localities or groups of population
which had communication with the affected centre, together with an estimate
of their population.
(b.) The number and population of localities in which cholera appeared
after communication, together with the dates of both events,
214
SANITARY REGULATIONS.
[SECT. X.
246. BUT OTHER EVIDENCE ALTOGETHER REQUIRED.—But the fact to be
reasonably shown by other evidence altogether is that that the movement of
population was the cause of the movement of cholera in those cases in which
dates and localities are well-known, and where there can be no doubt that
the date of the appearance of cholera was subsequent to the date of commu-
nication with affected districts.
247. RECAPITULATION OF NATURE OF PROOF.—It may be repeated that the
arrival of persons from affected in unaffected districts, and the subsequent
appearance of cholera there, or the accidental passage of pilgrims near
places or persons subsequently attacked with cholera, are nothing more than
facts, in regard to the relations of which with each other, rigid enquiry is to
be made, and the evidence itself must not be an opinion simply ; for, as
already stated, no opinion would warrant the adoption of legislative measures
and the expenditure of public money. The evidence must be sufficient to
satisfy every reasonable demand. There is no doubt that this part of the
enquiry is beset with great difficulties, as well as by many sources of error.
But at all events a minute detail of such evidence, as it may be possible to
obtain, should be given, in the hope that eventually the truth may be arrived
at by improved methods of enquiry.
248. COINCIDENCES TO BE STATED.—If there is no satisfactory evidence,
except the coincidence ; or if the alleged fact be exceptional, this should be
distinctly stated.
2 4 9 . O B S E R V A T I O N O F C H O L E R A A M O N G T R O O P S O N T H E M A R C H . — M u c h
impor-
tant information regarding the movement of cholera may be obtained by renew-
ed observations on the appearance and course of the disease in troops on the
march.
Besides the usual enquiries into the sanitary condition of camping
grounds, water-supplies, &c., it is desirable to record the following points :
—
(a.) The state of health of the place from which the troops started, and
date of starting.
(b.) The strength.
(c.) The nature of the country, and length of marches, and dates.
(d.) The number of marches.
(e.) The state of health of towns or villages through which troops
passed, and dates of passing, daily state of weather.
(f.) Date of appearance of cholera (if any) in the corps.
(g. ) Names of places through which troops passed after cholera
appeared, indicating those attacked, if any.
(h.) Dates of disappearance of cholera.
(i.) Daily cases and deaths to be entered on the register.
SECT. X.]
SANITARY REGULATIONS.
215
250. MARCHING JOURNAL.—The "Marching journal" which is directed
to be kept by the Surgeon in charge of every regiment or detachment, in
movement. will afford all necessary information under the foregoing para.
The journal will be forwarded to the Deputy Inspector General of the division
for transmission to Head-quarters, at the end of the march.
251. Among no class of population in India more than among troops could
accurate enquiries be made into questions regarding the communication of
cholera from man to man, from passing columns affected with cholera to
unaffected villages, and vice versa.
252. MOVEMENT OF EPIDEMICS ON LINES OF MOVEMENT OF POPULATION.—Epi-
demics of cholera have generally, but not always, travelled in a North-Western
direction in India : it has been assumed that the movement of population is in
this direction, and that the two movements stand to each other in the relation of
cause and effect. A caution on this subject has been already suggested. But
there is another very important element requiring investigation, namely,
whether movements of population towards the North-West are not accom-
panied by corresponding movements in other directions ; and, if so, whether
cholera does or does not follow the course of movement in these other
directions. In other words, it should be determined by observation whether,
if the movement of population has been oscillatory, the movement of cholera
has been in one direction only ; or whether it has oscillated with the
population.
(a.) Again, as there can be no epidemic without population, it is
important to determine whether lines usually taken by epidemics of cholera
are or are not the lines of maximum fixed population.
(a.)
Instances should be carefully examined where communication has
existed between affected districts, and localities which have at other times
been seats of cholera, without being followed by outbreaks of cholera in the
unaffected districts.
253. Unaffected localities. —In localities which have never suffered
from cholera, it should be ascertained whether this immunity has existed,
notwithstanding communication with affected districts,
254. RELATION OF " COMMUNICABILITY" TO EPIDEMIC.—The next ques-
tion of importance is to ascertain what is the relation of communica-
bility, if it exists, to the phenomena of endemic and epidemic cholera ? The
following points require careful examination before an answer to this question
can be given :
( a. ) Can it be shown by the conclusive evidence of facts that endemics
and epidemics are made up solely of cases arising from well-ascertained com-
216
SANITARY REGULATIONS.
[SECT. X.
munica don of the disease, either directly or indirectly, from sick to healthy
persons ?
(b.) Are there facts to show conclusively that endemics and epidemics
are due solely to communication of the disease, and to nothing else ? If so,
the facts should be very carefully detailed.
(c.) Is communicability, if it exists, only one of the elements of the
movement of cholera ? If so, what is its importance in comparison with that
of other elements ?
255, Relation of epidemics to great physical disturbances.— A r e
there facts to show that the phenomena of epidemics are coincident with great
general causes, such as the following :
—
(a.) General telluric disturbances affecting great areas of country, such
as flooding of the country, dryness and cracking of the soil, excess of moisture
in the subsoil, generally increased impurity of water-sources, unusual disen-
gagement of malaria, and the like. Great droughts and famines.
(b.) A generally disturbed or contaminated state of the atmosphere,
Marked by unusual heats, colds, winds, calms, clouds, fogs, storms, rain-fall.
(c.) General vital disturbances affecting animals as well as men, and
probably also affecting vegetable life, such as unusual prevalence of febrile
diseases, diarrhœas, dysenteries, influenzas, and the like. Epizootic diseases,
blights in cereal crops, &c.
(d.) These phenomena existing not only in the epidemic region, but in.
distant parts of the earth (for instance, the epidemic cholera of 1867 in India
co-existed with the great Mauritius epidemic of intermittent and remittent
fever, and with epidemics of cholera and yellow fever among the West India
Islands, and round all the shores of the Gulf of Mexico).
256. Enquiry into causes why epidemics ceases.— E n q u i r y
s h o u l d b e
made to ascertain why endemic or epidemic attacks of cholera come to an end.
(a.) If atmospheric conditions are causes of cholera, do the conditions
undergo alteration when cholera declines and disappears ?
(b.) If defective sanitary conditions are determining causes of outbreaks
of cholera, why do they cease to act after a time ?
(c.) If cholera is spread from person to person by contagion or cholera
poison, how does it happen that the agent or poison communicated ceases to
act after a time ?
These questions require rigid scientific investigation ; but light may be
thrown on them by practical enquiries, such as the following.
—
(d.) When cholera is in a district it might be observed to what extent
the disease can be mitigated by better diet and regimen among troops and
prisoners ; and it might be further ascertained whether improvements in these
SECT. X.]
SANITARY REGULATIONS.
217
particulars have been extending themselves among these classes of population
during outbreaks of cholera for the express purpose of precaution.
( e. ) It might be further ascertained whether, when the arrival of
cholera is anticipated, the past known susceptibility of a well-marked endemic
district can be diminished by sanitary measures, cleansing, improved water-
supply, and the like, to such an extent that it may escape the disease more or
less : and further, whether in other cases the progress of sanitary improve-
ments has been coincident with decline of the disease.
257. Localities. —Questions regarding locality might be further
elucidated, as follows
: —
(a.) By observing and recording the effect produced on an epidemic
or endemic attack among troops or prisoners by camping out on clean ground,
as contrasted with the progress of cholera in barracks or prisons where this
measure has not been adopted, or only partially adopted.
(b.) By removing small groups of population out of bad sanitary condi-
tions from houses where cholera prevails, into healthy localities under good
sanitary conditions, and by noting carefully the results to health.
258. STATE OF PUBLIC HEALTH AFTER CHOLERA.— After an endemic or
epidemic attack of cholera has ceased in a well-marked locality, it would be
important to examine into the general health of the people, and to compare
it with the state of health before cholera appeared.
259. Observations of cholera on Board ships.—A n i m p o r t a n t c l a s s
of facts might be obtained regarding outbreaks of cholera on board troop and
emigrant ships by the following form of record :—
(a.) State of health of port and district from which troops or coolies
have been embarked. Date of last cholera case. Date of departure of
ship.
(b.) Sanitary state of ship and passengers at the time of departure,
including questions of ventilation, crowding, quality of water, food, &c
(c.) Whether cholera broke out on the passage, and, if so, the dates,
cases, deaths, state of weather, the then sanitary state of the ship, and other
occurrences.
260. All Medical Officers to aid in the enquiry. —All Medical Offi-
cers, whether of the British or Indian Medical Departments, who have had
the opportunity of recording facts, in connection with any of the foregoing
heads of enquiry, will submit them in as soon as convenient after the termi
nation of an epidemic, or endemic outbreak of cholera, a special report to the
head of their department, by whom all papers regarding cholera enquiries will
be forwarded to Government, for transmission to the Secretary of State for
India.
C C
218
SANITARY REGULATIONS.
[SECT. X.
V I . — S a n i t a t i o n o f J a i l s .
G. O. No. 1,834 of
18G5, Judi. Dept.
2 6 1 .
O v e r - c r o w d i n g .
—The constant and serious attention of the Officer
in charge of the Jail, and of the Medical Officer, shall be
directed to prevent the over-crowding of Jails. A greater
number of prisoners than that prescribed for each ward and cell in a Jail shall
not be admitted on any account.
262. In the event of a Jail being full, the Officer in charge shall accom-
modate, either in huts or tents outside the Jail, any other prisoners who may
be sent, reporting the circumstances immediately to the Inspector General of
Jails, and he shall give due and sufficient notice to the local Police Officer, who
shall take measures for the safe custody of the prisoners.
263. NOT MORE THAN THIRTY-TWO IN ONE WARD.—It is not desirable that
more than thirty-two prisoners should sleep in one ward. This rule shall be
carried out, as far as practicable, in existing Jails.
264. AREA AND SPACE DEFINED.—An inscription, specifying the superficial
area and cubical contents of each ward, and the number of prisoners it is
capable of containing—allowing not less than 54 square feet (9 x 6) of ground
area, and not less than 648 cubic feet (9 x 6 x 12) of breathing space for
each prisoner—shall be affixed to the door of every ward.
265. No increase in the height of a ward shall justify any diminution of
the ground area, nor shall any emergency justify any reduction in the cubic
space prescribed for each prisoner,
266. Solitary cells.—No separate cell, whose cubical contents is less
than 1,000 cubic feet, with a ground area of 75 square feet, shall be declared
fit for separate or solitary confinement.
267. Ventilation.— The special attention of the Officer in charge of the
Jail, and of the Medical Officer, shall be paid to the ventilation of the sleeping
wards, to ensure a constant supply of fresh air, while an exit for the foul air
shall also be provided. In all cases there should be amply sufficient lateral
ventilation in addition to roof ventilation.
268. NIGHT INSPECTION.—As the condition of the atmosphere breathed by
prisoners can only be judged of by visiting at all seasons the sleeping wards
several hours after the inmates have been locked up, the Officer in charge of
the Jail and the Medical Officer shall, at uncertain intervals, visit the Jail at
night to satisfy themselves as to the adequacy of the ventilating arrangements,
and the results are to be recorded in their respective journals.
269. SLEEPING WARDS.—Every possible arrangement shall be made for
the thorough ventilation of the sleeping wards, and their contents during the
day, as many hours of free ventilation are required to remove the organic mat-
SECT. X.]
SANITARY REGULATIONS.
ter which adheres to the walls and bed clothes, and which is but slowly
oxydized. The bedding shall be hung up during the day-time, so as to be
freely exposed to currents of air and light.
270. Conservancy. —LATRINES AND URINALS.—Drains of any description
for sewage purposes within a Jail or its precincts are absolutely prohibited.
The dry earth conservancy system shall, as far as practicable, be adopted in
all Jails in substitution of any other system for disposing of the liquid sewage
of Jails, The form of latrine adapted to .the earth system, and to the local
circumstances of each Jail, shall be prescribed by the Inspector General of
Jails.
271. NIGHT PRIVIES.—Every sleeping ward shall be provided with three
vessels, viz., a urinal, an earth-closet, and an earth-reservoir with wooden
scoop.
272. URINAL.—The urinal, loosely filled with dry earth, is only to be used
for the reception of urine. If urine appear on the surface in the morning, it
is an indication of insufficiency of earth in the vessel. It is an essential con-
dition for success that the earth should absorb all the urine.
273. CLOSET.—The earth-closet is any suitable vessel; containing a layer
of dry earth into which the inmates of a sleeping ward or hospital can defe-
cate, a scoopful of earth from the earth-reservoir being immediately thrown
over the recently voided excreta. Every prisoner is to be made to throw a
sufficient quantity of dry earth over his excreta to cover the same.
274. NIGHT-LIGHT.—To prevent nuisances around the urinal and earth-
closet, a night-light is to be kept burning in their immediate neighbourhood.
The places occupied by the urinal and earth-closet, and a space of two feet
round these vessels, shall be thickly coated with coal-tar.
275. At 3 o'clock P. M., the night-vesels shall be put in their proper places
in every sleeping ward, and care shall be taken that they are placed on, and
surrounded by, a thick layer of dry sifted earth, to protect the floor from being
accidently soiled by excreta. If any effluvium remain after the removal of
the night-vessels and the earth, it is a sure sign that there has been an
insufficiency of earth.
276. CLEANSING OF CLOSETS AND URINALS.—Immediately after the prisoners
vacate the sleeping wards in the morning, the vessels used as night-urinals and
earth-closets shall be removed to the garden, and their contents disposed of in
the manner prescribed for sewage generally, and the vessels themselves
thoroughly cleaned and scrubbed with dry earth and exposed to the sun until
replaced at 3 o'clock P. M. for night use, when the urinal should be filled with
dry sifted earth, and the earth-closets furnished with a thick layer of it.
2 2 0
S A N I T A R Y R E G U L A T I O N S .
[ S E C T . X .
277. Water-supply.—Great attention should be paid to secure purity
in the water used by prisoners for drinking and culinary purposes. As purity
of water is of extreme importance, it is absolutely necessary that the Officer in
charge of the Jail be assured of the non-contamination of the water used.
Unless the inmates of a Jail receive their rations of pure air and pure water,
it is impossible that their ration of food—however liberal and varied the diet-
ary—can maintain them in health.
2 7 8 . M E D I C A L O F F I C E R T O R E P O R T O N W A T E R - S U P P L Y . — I ts
h a l l b e o n e o f t h e
duties of the Medical Officer to examine and report on the amount and quality
of the water-supply, and also to indicate the sanitary precautions required in
collecting, storing, and distributing it for use.
279. PERSONAL CLEANLINESS TO BE ENCOURAGED.—Disregard of cleanliness
may result from an insufficient water-supply, therefore, in addition to an
abundance of pure drinking water, a copious supply of water is necessary to
enable clothes to be thoroughly and frequently washed, and personal cleanliness
facilitated, thus removing one important preventible source of disease.
280. CONTAMINATION OF WELL WATER.—Of all the sources by which water
becomes so impure as to become a source of disease, the most serious and
dangerous is the soakage from cess-pools diffused widely, the sub-soil contami-
nating the wells—even a hundred yards distant—from which the water-supply
is obtained. As water kept in open vessels in an inhabited barrack absorbs foul
air, and becomes foul and unwholesome in consequence, it is absolutely neces-
sary that there should be thorough ventilation to prevent each prisoner's supply
for the requirements of the night becoming dangerously contaminated, and
hence also the desirability of supplying fresh water to prisoners as late at night,
and as early in the morning as practicable, whilst they are locked up.
281. SURFACE SPRINGS TO BE AVOIDED.—It should be remembered that the
deeper the source from which water is derived the less liability there will be
of its becoming contaminated by the infiltration of surface impurities, and it
is in all cases desirable that Jail wells for the supply of drinking water, should
be sunk to a depth at which the true springs are reached, and that in the
" steening" of the well all surface springs should be carefully excluded.
282. WELLS TO BE CONSTANTLY DRAWN.—Well-water is to be preserved
pure by the daily removal of decomposing matter ; the prevention of stagna-
tion—most easily and thoroughly effected by the daily withdrawal of large
quantities of the water for irrigation—thus allowing a fresh supply to be
obtained from the well-spring ; by obviating the re-entrance of ablution water
through chinks or fissures in the sides of the masonry shaft ; and especially
by preventing the percolation of sewage from cess-pools, which should never
be allowed within the Jail and its precincts.
SECT. X.]
SANITARY REGULATIONS.
221
283. TANK WATER.— The conservation of tanks for the supply of drinking
and cooking water consists in keeping the collecting ground clean ; in arrest-
ing the entrance of solid, organic impurities, as leaves, grass, &c. ; in remov-
ing the vegetable scum, which, when passing into a state of decay, is injuri-
ous ; in preserving a sufficiency of the proper kinds of vegetable and animal
life essential for the purification of the water in which organic matter exists
in solution ; in stopping their excavation at depths beyond which water-plants
cannot rise from the bottom ; in preventing the accumulation of filth and rank
vegetation on their sides ; in having the slimy sediment at the bottom
annually removed ; and, above all, by preventing them being used for bathing
or washing in.
284. BATHING TANKS.—Bathing tanks should invariably be kept as far
apart as possible from those for the supply of drinking water.
Rules for the guidance of Officers in charge of Tails on the occurrence of
epidemic diseases.
285. Epidemic disease in Jails. —In many instances, epidemic disease
has been introduced into Jails by newly arrived gangs of prisoners, and by
persons recently committed to Jail. These persons shall be carefully examined
before they are admitted into the Jail ; and by the Medical Officer daily,
during ten days after admission, and attention shall be paid to their personal
cleanliness and to the cleanliness of their clothes.
286. NEWLY ARRIVED PRISONERS.—When prisoners arrive from other Jails,
they shall, if unhealthy, be kept strictly apart from the other prisoners in the
Jail, during a period of ten days—and if any epidemic disorder be present
among them, they shall not be allowed to enter the Jail, but be camped at
a convenient distance from it, and be detained until reported healthy.
287. OCCURRENCE OF DISEASE TO BE REPORTED.—The Officer in charge of
such prisoners on the march shall, on the appearance of any epidemic, report
the same, through the Police, without loss of time, so that medical assistance
and a camp may be in realiness for them on arrival near their destination.
268. These precautions are specially necessary when cholera prevails on
the line of march.
289. When epidemic disease has attacked gangs of prisoners, they shall
not be admitted into Jails until fourteen days have elapsed since the last case
has appeared, and only then if the prisoners are all healthy.
290. While encamped, for these reasons, all the rules hereinafter set
forth, regarding camps, shall be strictly observed, both as regards selection of
site, and camp conservancy arrrangements.
291. In the event of the epidemic disease being present in the vicinity
of a Jail, care must be taken to prevent any communication taking place