XXXIV
(g) At the conclusion of each clay's operations the operator should himself rinse out with
carbolic lotion (1 in 20) all syringes that have been in use and should sterilise all
his needles and instruments in oil heated to 160° C, thus also protecting them from
rust.
Records to be written up on completion of each
day's operations.
(II) As soon as all persons who offer themselves and are fit have been inoculated and have been
provided with completed certificates,
all the clerks must complete the work
of copying into the Inoculation! Regis-
ter the enteries concerning all persons
who have been inoculated, and they should also prepare the daily registers and returns
prescribed below for Inoculating Officers.
Persons who should not be inoculated.
(12) No person in a bad state of health should be inoculated. The only exception to this rule
should be that during epidemics of
plague when there is considerable
danger of a person contracting the disease, he may on his express request be inoculated, if
the operator considers that his life is not endangered thereby.
Great care should be taken to refrain from inoculating any person who has contracted plague before
presenting himself for inoculation. A few persons have been inoculated during the very early stage of plague
without the course of the disease being prejudicially affected thereby, but the Indian Plague Commission
(Report, paragraph 462) recorded its opinion that " it seems to us unlikely that the anti-plague inoculation
can exert any favourable influence on persons who are already incubating plague." If plague, contracted
before inoculation, developes in the usual course and death supervenes, the result is likely to be attributed to
the inoculation and the people are likely to become suspicious of the operation.
Infants under six months and very old people are but slightly liable to attacks of plague, and may
therefore be preferably left uninoculated.
In the absence of immediate danger of infection it is preferable not to inoculate women far advanced
in pregnancy lest any ill-effect occurring after the operation should be attributed to it and thus raise a pre-
judice against the inoculation. During an epidemic it is advisable to inoculate pregnant women up to with-
in a few weeks of their delivery, for attacks of plague in such cases are almost uniformly fatal both to the
woman and child.
Inoculation in exceptional circumstances.
33. While it is obviously convenient to adopt and adhere to one method of operating, the wishes of
persons who desire to be inoculated in any particular
situation should be complied with as much as possible. It
is not uncommon, for instance, for a person to ask to be inoculated over some painful spot or rheumatic
joint with the hope of obtaining relief from the pain of sciatica or rheumatism. Moreover, special arrange-
ments are required for the inoculation of "pardah" women, who, as noted above, are to be inoculated free of
charge under "pardah" conditions. The best way of dealing with such women is to have as many as
possible collected in one locality and to fix upon a place where the women can pass under" pardah " to and
from a room or yard which has a doorway or convenient window communicating with the outside. This
doorway or window should be screened by a curtain having a hole in it, and the inoculator should station
himself outside it so that he can operate on each woman as she comes up to the curtain from the inside and
presents her arm at the hole. The certificates of women should be written up and their thumb impressions
taken with the help of those who assist in collecting them together for inoculation. Where there are lady
doctors who are willing to perform inoculations for "pardah" women or others, either in the places where
they reside or elsewhere, there is no objection to their doing so, provided they make their own arrangements
for fees and other expenses, such as travelling allowance : such fees and expenses should be arranged for and
paid by those who desire the services of the lady doctors and will not be paid out of Provincial or Local
Funds. Prophylactic and apparatus will be supplied to the lady doctors on the condition that the prescribed
certificates are given to inoculated persons and that the prescribed registers and returns are maintained and
submitted.
CHAPTER V.
THE "PREACHING" OF INOCULATION.
Points of practical importance for every one to
consider in connexion with inoculation in plague-
infected or threatened places.
34. It is very important that not only individuals but whole communities should be inoculated and
that as much in advance of an outbreak of plague in
their midst as is possible. Uninoculated persons in a
community are a greater source of infection and a
greater danger than inoculated persons, and the same
is the case with uninoculated communities as compared with those which are inoculated. If the inhabitants
of a village or town in an infected or threatened area refuse to be inoculated, they are liable to create a centre
of infection for their neighbourhood- The points of practical importance therefore which every individual in
every community should carefully consider are—
(1) that inoculation affords a very considerable protection against an attack of plague, such attacks
as do occur being far less fatal than those occurring among uninoculated persons ;
(2) that the protection afforded lasts as long as epidemics of plague usually do in the Punjab, and
that therefore persons inoculated immediately before or during a plague season may
reasonably hope to escape illness or death during that plague season ; and
(3) that this protection is conferred by a medicine which causes but slight inconvenience and is
quite harmless and which contains nothing that can affect the religious susceptibilities or
social customs of any person.
Plague is a very serious disease because of its long persistence in infected localities, its tendency to recrudesce,
the high case mortality among persons attacked, the absence of any really effective medical treatment appli-
cable after attack, and the difficulty of inducing the people to adopt adequate precautionary and preventive
measures such as avoidance of contact with infection, evacuation, and disinfection. Inoculation offers to any
individual, who may be sensible enough to desire to take precautions for his personal safety, a protection
against plague which he can secure for himself independently oí the co-operation of his neighbours, and he