NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
19
rod ink. If only some of the items in a bill are plague
charges, the word 'Plague' should be written against each
such item instead of at the head of the bill.
(ii) Contingent expenditure on account of plague, e.g.,
stationery, postage, telegrams, office furniture and such like,
should be charged against the heads of account to which the
salaries of the officers incurring such expenditure are debited.
(iii) The pay and allowances of officers and establish-
ments forming part of existing departments or services whose
employment on plague duty does not involve the payment of
salaries to other persons for the performance of their legiti-
mate duties, or the payment to them of extra allowances on
account of plague, do not constitute indirect plague charges
(of course they are not direct plague charges) because they
do not involve extra expense. A statement should be for-
warded to the Accountant-Gen eral by the twentieth of each
month showing the pay and allowances drawn in the previous •
month by officers and establishments so employed.
30. All correspondence about plague should be addressed
to the Secretary to Government, Local and Municipal ( Plague)
Department, and should be marked with the word '' Plague '
in red ink on the outside covers and on the left-hand corner
of the papers. Telegrams should be addressed to 'Madras,
Plague.' All references regarding account matters should
be addressed to, or forwarded through, the Accountant-
General.
Plague
correspond-
ence and
destruction
of records.
31. Plague correspondence should be entered in a separate
current register, and the papers shown against a new item
'Plague' in the quarterly business returns. A separate
series of numbers should be given to the disposals, and the
question of destroying or retaining them should be dealt with
in accordance with B.P. No. 101, dated 18th April 1898.
Reports of plague cases and deaths received from authori-
ties outside the Presidency may be destroyed at the end of
the month succeeding that to which they relate ; all other
reports and returns after one year.
2-A
20
APPENDIX A,
[Seo Standing Order 2.]
MEMORANDUM ON PLAGUE PREVENTIVE MEASURES.
Plague, as we know it in India, is a disease of rats in which man
and a few of the lower animals participate. The disease is caused by
the invasion of the body by the plague bacillus. The plague bacillus
is spread from rat to rat, and from rat to man, and to certain other
of the lower animals, by the bite of the rat-flea. The fact that man
is susceptible to the disease is the reason of course that the disease
is of such importance to the public health of India, but it must bo
remembered that from the point of view of the plague bacillus, if
such an expression be permitted, man is relatively of small account.
An epidemic of plague among men is but an index of the epizootic
that is raging among the rat population of the community. Were
there no rats, or were rats less "domesticated," or were the habits
and customs of people in this country such that rats found it difficult
to obtain food and shelter in human habitation, plague, as a human
disease, would disappear from India. The fact that the association
between rats and man is so close in this country is the sole reason
why plague is so serious a factor in our vital statistics.
If the significance of these simple facts be grasped, measures for
the eradication of plague as a human disease suggest themselves.
Every effort should be made to induce the people of this country to
realize that the apathy with which they gladly suffer the rat to share
their food, and find shelter in their homes, is directly responsible for
the fact that they suffer and die from this disease. Once this lesson
has been driven home plague as a human disease will cease to afflict the
converted community.
In the meantime, it is necessary to consider what measures can be
undertaken most profitably to save the people in spite of themselves,
realizing that the degree of success obtainable must depend in some
measure on the amount of co-operation secured.
One of the most remarkable facts about outbreaks of plague in
India is the remarkably constant seasonal prevalence that the disease
exhibits in any given part of the country. For example, plague epi-
demies always reach their height in the Punjab and the west of the
United Provinces in the month of April ; in the east of the United
Provinces and in Bihar in the month of March ; in the South of the
Bombay Deccan about October ; in Bombay City, about March, This
phenomenon is explained by the fact that the rat plague, on which
the human epidemic depends, is most acute at that season of the year
when rat-fleas are most numerous. Tho number of rat-fleas is de-
pendent upon conditions of atmospheric humidity and temperature.
This dependence upon climatic conditions explains, not only why plague
has a constant seasonal prevalence in any given area, but also why the
disease is much inore virulent and widespread in some years than in
21
others. Thus severe epidemics in the north of India have always
been preceded by abnormally damp weather in the cold weather
months.
In places where rats are very numerous plague may develop when
climatic conditions are adverse, i.e., when rat-fleas are scarce, but
plague tends to disappear with the advent of hot dry weather.
It cannot bo too strongly emphasized that anti-rat measures, direct-
ed towards the eradication of plague infection, can be prosecuted
with most chance of success in the hot dry months when plague cases
and foci of infection are fewest. The relatively plague-free season
should synchronize with maximum anti-plague effort and not be regard-
ed as a suitable time for a cessation of anti-plague measures.
Anti-plagus measures can be grouped under four heads :—
(a) Rat elimination or the prevention of rat infestation. This
comprises such modifications in the habits, customs, and dwellings of
a community as will result in a diminished rat infestation in the homes
of the people and make the association between rats and men less
intimate than at present.
(6) Measures designed to protect the rat population of any given
town or village from plague infection. Those entail a clear under-
standing of the manner in which plague infection is carried from
place to place.
(c) Rat destruction designed, as is (a), to diminish the chances
of infection, and to keep the rat population at so low a level that if
plague be introduced the severity of the resulting epidemic will be
appreciably diminished.
(d) If our efforts under these three heads fail to keep plague out
it is left to try and render the human population immune to a f tacks
of the disease by means of inoculation, or to remove the population
at risk from close association with infected rats. The latter involves
the evacuation of infected dwellings and the provision of temporary
accommodation outside the rat-infested, plague-infected area.
Measures included under (a), (6) and (c) can be carried out at any
season of the year ; measures under (d) are generally applicable only
in the plague season.
Segregation of the sick is not essential. For all practical purposes
tho patient suffering from bubonic plague is not capable ot infecting
those in close attendance on him. Such a statement is not true of
pneumonic plague. Small outbreaks of this disease, which is extremely
infectious, are occasionally experienced in India. These are, however,
of infrequent occurrence and of small moment when compared with
the incidence of bubonic plague.
It will bo 'noted that of the four' components' of a plngue
epidemic, viz., the plague bacillus, the rat-flea, the rat, and man,
only
the rat and man have been specifically mentioned in this preliminary
discussion of preventive measures. Tho plague bacillus is so short-
lived outside the body of either the rat-flea, the rat, or man, that
for practical purposes it need not be considered as possessing an
independent existence. Similarly, the welfare of the rat-flea is so
dependent on the plentiful supply of rats which they parasitize, and
23
approximate each other in number. So prolific ara rats that given
sufficient food and shelter a pair of rats may become eighty pairs in
the course of a year.
In most parts of India the majority of Mus rattus burrow :
burrowing does not appear to be essential provided shelter and free-
dom from molestation can be secured, a state of affairs that is
everywhere found in Indian habitations.
Rats do not commonly migrate far from their homes.
These then are the more important of the characteristics of the
Indian house rat which plays so important a part in the spread of
plague. Successful efforts at rat elimination and rat destruction
necessitate a display of intelligence, energy, persistence and a lively
understanding of their habits and customs as outlined above.
Before considering measures in detail it may be worthwhile to
refer to the economic aspects of the case. An adult rat consumes
upwards of f oz. of grain each day. Let us take the case of an
Indian town with a human population of a quarter of a million people,
Such a town at a very low estimate will have a rat population
amounting to half a million. Let us suppose that the rats of this
town have a preference for a grain selling at ten seers for the
rupee. The rat population of this town would consume grain each
day to the value of Rs. 1,170 and at the same time do a vast amount
of damage to human property of other kinds. (This sum is equivalent
to Re. 1-11-0 per head of population per annum, an amount which if
devoted to public health would insure freedom from plague and many
other diseases as well.) Truly the inhabitants of this country in so
gladly suffering the rat suffer in other ways than those of disease and
death.
2. Rat elimination.—Energetic and sustained rat destruction
campaigns, carried out on lines such as those that will be described
hereafter and with due attention to detail, will do much towards
keeping the rat population at a low level with a consequent markedly-
diminished risk of plague-infection and the certainty of a much
milder epidemic, should the disease gain a foothold, than would
otherwise be the case. Such measures have the great, disadvantage
that they necessitate sustained effort which is very difficult to secure
in India when a few years' freedom from plague so commonly en-
genders a false sense of security. If half-heartedly carried out, the
results will be most disappointing and the number of those who claim
that rat destruction campaigns are useless, and consequently waste of
funds, will bo increased.
Moreover, rat destruction campaigns are of only temporary benefit
and it is necessary first to consider whether the houses, habits, and
customs of the people cannot be so modified as to render the associa-
tion between the rat and human population less close than it is at
present. As things are there is no limit to the amount of food and
shelter that the average Indian house affords to the rat. In this
connexion it would be well to draw attention to the fact that the two
terms 'rat-proof' and 'rat-free' as applied to dwellings and store-
houses are by no means synonymous. Very little advantage is gained
24
if the floors, walls and roof cf buildings be so constructed as to make it
impossible for rats to burrow therein, if such erections offer no lack
of food and shelter to rats and if ingress and egress through doors
and other apertures be not prevented by some special device. This
word o£ warning is very necessary : in many parts of India one can
see buildings that have been made 'rat-proof' harbouring, all the
same, a very large number of rats. Small wonder that such laudable
endeavours to abolish plague have met with a degree of success in no
way commensurate with the comparative large outlays that some such
schemes have involved.
These remarks must not be construed as meaning that pucca build-
ings are not preferable in every way to kuicha, but the provision of
pucca walls and floors is not in itself sufficient to ensure freedom from
rats.
Even in kutcha buildings something can be done to wards eliminat-
ing the rat. The rat population of any place is directly determined
by the amount of food and shelter that such place affords. All
measures that lessen the amount of food and shelter for rats automati-
cally effect a reduction in the number of rats, Protection of stores of
food from the depredations,of rats, and efficient scavenging, are thus
anti-plague measures of the first importance.
II.—.PROTECTION OF THE Rats OF A COMMUNITY
FROM PLAGUE.
Before embarking on a detailed description of active rat-destruc-
tion measures it will be well to consider how best to protect the rat-
population of any town from becoming infected with plague or co
make the ever-present possibility of such an occurrence less likely.
To this end it is important to bear in mind the methods by which
plague infection is conveyed from place to place.
1. Grain and plague.—It is a common experience to find plague
in towns and villages beginning in the close vicinity of markets and
grain stores, and it is important to have a clear conception as to why
this should be ao. As things are at present the rat population of any
given town or village is very much larger in the neighbourhood of
markets and grain stores than in other localities, with the result that
when plague is present, the rat epizootic is likely to be more widespread
in such localities than elsewhere. It follows that grain exported from
a plague-infected town to another, goes from a part of the town of
despatch where plague is most severe, to a part of the receiving town
where the rat population is at a maximum. Not only so but grain and
similar merchandise offer facilities for the transport of rats which
baggage consisting of personal effects rarely affords. Plague-infected
rats are likely to be much more harmful as plague-infecting agents
than are fleas alone which, apart from their definitive hosts, are short-
lived especially if infective.
From these and other considerations it follows that the methods
of grain storage and grain transport are of paramount importance in
plague-infected and plague threatened India, where the grain trade is
in a very special sense a 'dangerous trade' and as such demands very
25
close supervision. There is a large mass of epidemiological evidence
to show that the rate of diffusion of plague infection is very slow when
it has to rely on the movements of. the human population per se, but
that the movements of grain afford facilities for the dissemination of
infection equalled by no other agency, Were the grain stores of
India kept relatively rat-free a marked and rapid diminution of plague
would most assuredly result. Is such a consummation as impossible
of attainment, or as difficult, as is usually assumed ?
A great deal can be done with no prohibitive outlay. In discuss-
ing this matter it is important to bear in mind certain facts regarding
the habits of rats cited above. They explain the logical basis of the
following desiderata of grain stores :—
(a) Wherever possible the wholesale storage of grain should be
effected in buildings apart from those in which retail trade is carried
on.
(b) Wholesale grain stores should not be situated in close
proximity to densely-crowded areas of a city.
(c) Wholesale grain stores should never be utilized for purposes
of human habitation.
(d) Bearing in mind that water is essential for the life of the
rat, no water accessible to rats, or fresh vegetables should be allowed
in wholesale grain stores.
(e) As rats are unable to circumvent a smooth horizontal pro-
jection of nine inches, such a ledge surrounding a grain store on the
top of a plinth 3 feet high is effective in prohibiting the ingress of rats.
On the sides of the building in which the doors are situated this ledge
can conveniently be enlarged into a platform 2 feet or 2 feet 6 inches
in width. Reinforced concrete is a suitable material for such ledges
and platforms.
(f) The roof of the godown should overhang this platform and
ledge to prevent the accumulation of rain water thereon.
(g) No steps or similar means of facilitating ingress should be
allowed. In practice the inconvenience caused by the absence of such
steps will be found inconsiderable. For unloading sacks of grain -
designed for such a store the bullock cart can be pushed close to the
. platform, which is also at a convenient height to facilitate the deposit
thereon of sacks from a coolie's back.
(h) Hats will, from time to time, be introduced into such a
store, but they will be compelled to leave in search of water and
should find their return extremely difficult.
(i) In villages and places where the cost of such pucca build-
ings is prohibitive relatively rat-free stores can be made of almost any
material, provided the roof is water-tight, by raising the floor on
uprights summmounted by rat guards similar in design to those
commonly employed on ship' cables. These uprights should be at
least three fest high and would support the beams on which the
floor rests. The floor might be made of wood. The space under-
neath the floor can be left open and kept free from weeds and rank
growth with but little trouble.
The above suggestions should be sufficient to enable 'rat-free'
godowns, suitable for any requirements, to be designed. Provided
26
the principles on which the suggestions are made be borne in. mind,
suggestions which are all based on an appreciation of the habits of
rats, these godowrns will be so constructed and kept as to ensure a
remarkably decreased rat population.
Other means of diminishing the risk of the conveyance of plague-
infection through the medium of grain and similar merchandise will
suggest themselves. The diminution of the facilities, at present
existing, for rats to enter goods wagons and carts; the breaking of
bulk of consignments of grain ; the election of pucca platforms on
which grain received loose can be bagged ; these and similar measures
all require attention in certain cases. Enough has been said to draw
attention to the importance of the grain trade in the spread of plague
and the above suggestions and principles should sufiice to indicate
how the dangers can be minimized, if not entirely averted.
2. Other means of conveying plague infection.—Grain and similar
merchandise has been considered at length to emphasise their import-
ance, but it is not contended that they afford the only means of
conveying plague-infection. Clothing and bedding from, plague-
infected house may contain infectad rat-fleas: the chance, however,
of such finding a susceptible rat as a host, without which they cannot
give rise to an epidemic, is sufficiently remote to explain the fact that
merchandise is a more potent source of plague infection.
When articles from a plague-infected source are of such a nature
as to reader them likely to harbour fleas they can be rendered inno-
cuous by exposure to the direct rays of the sun. The ground used for
the purpose should be so chosen that the sun is able to shine on it for
the whole of each day. It should be flat, devoid of grass, stones, or
anything which might afford shelter to fleas. Preferably it should be
covered with a smooth layer of fine sand three inches deep. The surface
temperature of the sand should be at least 120° F. to ensure the
destruction of all fleas. One hour's exposure in such conditions is
sufficient for the purposes of disinfection. Thick coats aud rezais
should be turned once or twice during the process. No articles should
be placed within three feet of the edge of the sand.
III.—BAT DESTRUCTION. 1
Careful attention to detail and a knowledge of all that has been
said above regarding the habits and customs of rats are essential to
success in any rat destruction campaign. Not infrequently rat destruc-
tion as a plague measure has been stigmatized as useless on the
results of attempts at rat-trapping with traps into which entry is
difficult, and from which escape is absurdly easy, or of attempts at
poisoning with substances which possess taste or smell, or both, which
is positively repulsive to rats.
1 All that is new in the following paragraphs, relating to the vise of poison baits,
is tlie oatcomo of nurerous well-designed and carefully controlled experiments that
have been carried out in Poona by Dr. Chitre in ths course 'of «in inquiry that was
planned and commenced by Major J. C. G. Kunhardt, I.M.S., under the auspices of the
Indian Research Fund Association.
28
If rat poisoning be carried out with careful attention to all these
details, a very notable degree of success will be achieved, with very
appreciable benefit when plague threatens,
2. Tropping.—To effect a considerable diminution in the rat
population and to keep it at a low level by means of trapping is a rela-
tively expensive measure and one that requires careful and intelligent
supervision if results commensurate with the outlay are to be secured.
It is a measure, however, that usually excites less opposition than does
the use of poison baits, and if trapping operations be conducted with
energy and with due regard to detail they are of very considerable
value as a plague-preventive measure.
Many rat-traps on the market are defective in design and construc-
tion. Traps selected haphazard have very varying degrees of
efficiency, and recent observations have shown that the size of the
trap, the size of the inlet, the strength of the trap, the accuracy with
which the flap fits the frame designed for its reception, are all
important points in determining the efficiency of the trap. Other
things being equal the larger the diameter of the inlet the more
satisfactory the trap. Experiments designed to determine the type of
trap best suited to Indian requirements are now in progress, and it is
hoped that specifications of the best all-round trap will soon be avail-
able.
Traps should be oiled only sufficiently often to ensure freedom
from rust. Frequent washing of the traps is not recommended : rats
are not attracted by cleanliness which appears to make them suspi-
cious.
Tho traps are best baited with a small quantity of the staple food-
grain of the community or of flour made therefrom in the form of
dough. In the hot months, fresh green vegetables, notably cucumber,
make an attractive bait.
To obtain the most economical results each house should be
trapped once each week. One trap for every two rooms of an Indian
house will probably suffice. All traps should be set over night and
collected early in the morning. All rats caught can be drowned or
destroyed in some humane manner, their bodies being burnt. In the
presence of plague, when a rapid reduction in the rat population is a
matter of moment, more frequent trapping can be carried out with
advantage. For systematic trapping a number of traps equal to 3
per cent of the human population will bo found sufficient. Frequent
inspection of traps, with the rejection for repair of all found defective,
is essential.
IV.—PROTECTION OF A COMMUNITY IN THE PRESENCE
OF RAT PLAGUE.
Inoculation and evacuation of infected dwellings.—When plague has
obtained.a foothold in a town, or when plague threatens, it will be
necessary to press the claims of inoculation with plague vaccine. It
is nob necessary to urge here the remarkable protection that inocula-
tion aiïords to the individual ; this is now well recognized. In the