NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
428
Measures in the Bombay Presidency and Sind. [ APP. VI.
An area of earth, about ten feet square, under the shade of
a tree, was covered with a mixture of mud and cowdung. The
smooth surface thus produced was allowed to dry during four days.
Then a small portion of the surface was again covered with fresh
cowdung and mud. The whole was then covered with a layer of
dry grass about two inches thick. In addition bamboos about
an inch thick were laid side by side at about half an inch distance
from each other, over about half the area. The grass was then
set alight, and after the fire had gone out the surface was tested
with the following results :—
(1) Surface afterwards covered with a
thick layer of grass
...
(2) Surface afterwards covered with a
thick layer of grass
(3) Surface covered with a thin layer
of grass
...
(4) Half an inch below the part of
the surf ace covered with a thick
layer of grass
...
,.,
(5) Half an inch below the part of
the surface covered with a
thick layer of grass ...
(6) Two inches below above surface.
(7) Freshly covered surface afterwards
covered with grass and bamboos.
(8) Fresh covered surface afterwards
covered with grass and bamboos.
(9) Half an inch below this surface,
(10)
Ditto
ditto
(11) Two inches below above surface
Before burning.
1,600
1,030
0
3,200
2,000
0
7,300
2,400
0
0
0
After burning.
1
0
40O
22
100
900
0
0
0
2
48
Thus in the above experiment, complete disinfection appears
to have been produced by the burning of a layer of grass two
inches thick. Where the heat was greater owning to the combus-
tion of the bamboos, the disinfectant action appears to have reached
to some distance below the surface. Although probably the quickest
and most certain method of freeing an earthen floor from infection,
the method of firing must be for obvious reasons limited in its
applicability. It was tried with apparent success in an infected
chawl in Bombay inhabited by the families of policemen. Grass
as in my experiment was burnt all over the floors and no more cases
of plague occurred. Though the method can thus be carried out
with the help of intelligent supervision, it would probably lead to
accidents if employed in a town on a large scale. In most cases,
however, it can be used in public latrines, which are frequently made
of corrugated iron or other incombustible material. Both on the
APP. VI. ] Measures in the Bombay Presidency and Sind.
429
general grounds that human excreta are apt to contain the microbe
of the disease, and on the a posteriori evidence of the Hong-kong
epidemic, it is probable that public latrines may become sources
of infection, and consequently are greatly in need of efficient disin-
fection. Owing to the existence of caste and other prejudices
the disinfectant of public latrines is very often shirked. Further, if
ordinary disinfections are used, it is not easy for an inspecting
officer to know whether the work has been properly carried out.
Hence I suggest that public latrines in infected areas should be
frequently treated with burning grass or other fuel. The sweeper
could put a bundle of grass on to each compartment and light
it. Afterwards the ashes could be washed out with a dilute solution
of sulphuric acid.
The probable efficiency of disinfectants is not the only factor
to be taken into consideration. Their cost must also be noted.
Taking commercial prices, the cost of various possible disinfectants
is as follows :—
(1)
(2)
(3)
(4)
(5)
Sublimate 1 in 1,000
,
Sublimate 1 in 1,000 plus hydrochloric acid
2 in 1,000
...
Sulphuric acid 1 in 250
Sulphuric acid 1 in 250 plus 1 in 500 of per-
manganate of potassium
,,,
,,,
Phenyle 1 in
100
...
,
Number of gallons of the solution
obtainable for one rupee.
15
14
1,920
128
144
The above prices do not include cost of transit which is higher
for sulphuric acid than for permanganate or sublimate.
Another question that must be taken into consideration in choos-
ing a disinfectant is whether its action is likely to be lasting, whether
in other words its employment is likely to make the medium unsuited
for a considerable time for the life of the bubonic microbe. This is
possibly more important in the case of bubonic plague than with other
diseases. Not only in this disease is a disinfected area liable to be
reinfected by human patients, but in addition in many cases this may
occur through the agency of infected rats. Hence a disinfectant that
merely destroys the microbes present at the time, and that has no
lasting action is not sufficient for the purpose. As shown by previous
experiments, acidulated sublimate solution is the only one of the dis-
infectants tried that showed a clearly good action on a cowdung floor.
Unfortunately, however, solutions of mercuric salts, even with the
addition of volatile hydrochloric acid, are by no means stable, espe-
cially when mixed with the material of a cowdung floor. Dilute
sulphuric acid on the other hand is not volatile, and if used in sufficient
43o
Measures in the Bombay Presidency and Sind. [ APP. VI.
quantities is likely for some time at least to make the floor an unsuit-
able nidus for the bubonic microbe. Although, as shown in previous
experiments, there are many microbes in a cowdung floor not readily
affected by it in the strength recommended, the special sensitiveness
of the bubonic microbe to acids in general and to sulphuric acid in
particular makes it likely that the latter substance will be efficient
when used on such a floor. The acid will slowly diffuse to the deeper
layers and combine with calcium salts and various alkaline substances
that may be present. But the upper layers which are in most need
of disinfection are most likely to be affected, and the acid will be
less quickly neutralized if the floor has been treated with acid sub-
limate solution on the preceding day. In a locality in which the soil
is highly calcareous, sulphuric acid is not likely to be a convenient
disinfection for cowdung floors.
A further consideration bearing on the choice of an antiseptic
depends on a view that is generally held by those having experience
of plague, namely, that the virus is sooner or later destroyed by
ventilation. As I have elsewhere shown, the plague microbe is some-
what resistant to the action of drying, and hence it is difficult to
believe that the asserted benefit of ventilation is only due to dessica-
tion tending to destroy the microbe. Its action is more likely to be due
to the oxidation processes that are produced by the evaporation of water
in the presence of air and light. Many authorities have brought forward
reasons for believing that the destruction of microbes through the action
of light is in reality due to an oxidation process. Microbes are found not
to be destroyed by light when exposed to it under condition in which
oxidation processes cannot occur. My experiments have further
shown that bubonic microbe is very susceptible to the action of
such oxidising agents as chloride of lime and permanganate of
potassium. If the evidence in favour of the use of ventilation is consi-
dered to be sufficient to justify the costly and troublesome method of
removing the roofs of houses, and if the good effects of ventilation
are admitted to be due to oxidation, ought not cheap and convenient
oxidising agents such as permanganate of potassium to be used in
combating the plague. Unfortunately in the case of cowdung and
mud floors it is not likely to be practicable to employ sufficient per-
manganate to produce the effect desired. It might be possible in
better built houses with cement floors. Permanganate might be used
in water suspected of being infected, such as water used by dhobies
for washing infected clothes. But owing to the risk of insufficient
quantities being employed, it would be most objectionable to put it into
the hands of unskilled workers for ordinary purposes. I have shown
above that a mixture of sulphuric acid permanganate is more active
APP. VI.] Measures in the Bombay Presidency and Sind.
431
in destroying microbes than either of these substances used separate-
ly, Such a mixture would have the further advantage of removing
smells from dwelling rooms, such smells being unaffected by corro-
sive sublimate. But it must be borne in mind that the sulphuric
acid enters into the reaction, and is decomposed with the perman-
ganate. Hence the addition of permanganate to dilute sulphuric
acid may diminish the durability of the effects of the latter. Strong
solutions of permanganate mixed with dilute sulphuric acid slowly
decompose with liberation of ozone. With concentrated sulphuric
acid the reaction is violent.
It must further be borne in mind that coolies employed in dis-
infecting work may not carry out the process thoroughly. Hence it
would be preferable for the disinfection of a room to be carried out
twice wherever practicable. In the case of one of the rooms dis-
infected in Hardwar and referred to above, I told the coolies that
as soon as they had finished, I should come to see that they had done
their work properly. Nevertheless after they had finished, I found
some undisturbed cobwebs in a corner of the room, although they had
splashed the disinfectant over the rest of the walls and the whole of
the floor and ceiling.
The above considerations lead me to suggest the following rules
for treatment of infected buildings :—
(1) In the case of corrugated iron latrines, isolated pucca build-
ings, and other pucca buildings in which the work can be
done with safety under intelligent supervision, a layer of
dry grass or other inflammable material, at least two
inches thick, should be laid over the whole of the floor and
burnt. Afterwards the whole of the interior of the build-
ing should be washed out with a solution containing one
part in 250 of sulphuric acid.
(2) In the case of dwelling rooms in which there are definite
grounds for believing infection to be present, the whole of
the interior should be first washed with a solution of corro-
sive sublimate of 1 in 1,000 strength to which hydro-
chloric acid in the proportion of 2 in 1,000 has been
added. On the following day the rooms should, if pos-
sible, be washed out with the dilute sulphuric acid.
(3) In case of dwelling rooms in which there is no actual evidence
of infection, but which are being merely cleaned out as a
precautionary measure, the dilute sulphuric acid need
alone be used, The inhabitants should be advised not to
" lepo " the floors after this has been done, with the
432
Measures in the Bombay Presidency and Sind. [ APP VI.
unfortunately necessary exception of the part of the floor
near the cooking place.
(4) Dilute sulphuric acid should be used in large quantities for
washing out passages, courtyards, and surface drains.
(5) In order to diminish the risk of coolies being burnt by having
to handle strong sulphuric acid, it should be diluted with an
equal bulk of water at the dispensary before being sent out.
To make a dilution containing one part in 250, three ounces
of strong sulphuric acid, or six ounces of the acid mixed with
its own bulk of water, should be added to every "nand" of
water: an ordinary " nand " holds nearly four gallons. A
rough indication as to whether or not water has been added to
sulphuric acid maybe obtained by adding pure sugar to some
of the acid. If sulphuric acid contains more than 40 per
cent. of water, the mixture will not turn black during the
next hour. The sugar employed should be slightly moist.
Though my experiments are not sufficiently advanced for me
to be able to give a definite opinion, I may point out the probability
that clothes, the hands, etc., are far more easy to free from the bubonic
infection than mud floors, and in such cases therefore a wider choice
of antiseptics is permissible,
No. 7,
REPORT BY SURGEON-CAPTAIN DYSON, DEPUTY SANI-
TARY COMMISSIONER ON DISINFECTION WITH
CORROSIVE SUBLIMATE AT BULSAR, No. B. P.—157,
DATED THE 21ST JULY 1897.
" In reply to your memorandum No. 1472 of 1897, forwarding
a copy of a letter from the Colonial Secretary, Colombo
(herewith returned), I have the honour to submit the fol-
lowing statement. Briefly I may state that the use of per-
chloride of mercury for disinfecting purposes proved such
a success in Bulsar that any further treatment of plague
infected houses was found unnecessary.
2. The plan adopted was as follows :—
In the case of a badly infected quarter of the town the occu-
pants were turned out of their houses and accommodated
temporarily in sheds.
Every house, infected and non-infected, was then thoroughly
washed down, inside and outside, with solution of per-
chloride of mercury (1 to 1,000) by means of fire-engines
and hand-pumps.
APP. VI. ] Measures in the Bombay Presidency and Sind.
433
All furniture, bedding and clothing found in the houses was
similarly treated.
On completion of the houses the sheds and their occupants
were attacked, special care being taken that no bedding
or clothing escaped disinfection.
After a week's immunity from plague the people were allowed
to re-occupy their houses.
In less deeply infected quarters it was not found necessary to
disturb the occupants, except during the operation of
disinfection, and for the few hours during which the
houses were drying,
3, The following statistics will give some idea as to the
results obtained :—
(a) NanaTaivad—Contains 141 houses, of which 51 were
known to be infected. Two-thirds of the houses were
occupied by about 300 Muhammadans—
Total number of cases of plague
.,,
,,,
Do.
deaths
...
Disinfection was begun March 29th, when the daily
average of cases for the previous week was
,,,
Disinfection was completed April 4th.
Daily average of cases from April 4th to nth
,,,
93
68
4
0'5
After April nth only three cases occurred, one of whom was an
attendant on a sick relative.
(b] Mota Taivad—Contains 151 houses, of which 98 were
known to be infected ; all houses occupied by about 500
Muhammadans—
Total number of cases of plague
,,,
.,,
Do.
deaths
...
.,,
,.,
At the time of disinfection, April 13th, the daily
average of cases was
...
...
.,,
After disinfection the daily average was
...
128
98
5
1
Nine cases in all occurred after disinfection was completed.
(c) Ghanchivad.—In the affected area there are 92 houses, in
19 of which cases of plague had occurred, and in the 92
houses there were about 300 Muhammadans—
Total number of cases of plague
...
...
Do.
deaths ...
..,,
,,.
30
24
There was an average of one case daily up to the time disin-
fection was completed; while only 4 cases occurred after
disinfection.
34
Measures in the Bombay Presidency and Sind. [ APP, VI.
(d) Khatrivad.—In the infected area there are 180 houses, in 43
of which cases of plague had occurred ; only two-thirds of
the houses were occupied by about 300 people—
Total number of cases of plague
....
...
For the week ending April I7th, when disinfection
was completed, the daily average of cases was ..,
From April 18th to 24th the daily average of cases
was
...
...
Subsequently 7 cases occurred.
60
2
I
In calculating the number of cases which occurred in any quarter
after disinfection had been completed, a proportion should
be deducted, as representing those persons already infect-
ed at the time of disinfection.
4. The accompanying* Chart A shows the continuous fall after
disinfection with perchloride of mercury was begun.
5. The two quarters (a) and (b) were deeply infected areas,
and it was deemed advisable to have the houses vacated
during the process of disinfection, so as to reduce the
number of subsequent operations as much as possible.
The other two quarters (c) and (d) were but lightly affected,
and here the occupants were not disturbed, and although
subsequent cases occurred, necessitating a second, and in
some cases a third, disinfection of one or two houses, the
disease never attained epidemic proportions.
I think it is a fair conclusion that the two last quarters, the
Ghanchivad and the Khatrivad, were saved from complete
infection by rapid disinfection, extending wide of the
infected houses.
It may reasonably be objected, however, that perhaps the
disease was on the decline at the time ; but this objection
is, I think, negatived by a reference to Chart A,* which
shows, after March 29th, a much more rapid and contin-
uous fall than one would expect in a declining epidemic.
Moreover up to the very end there was no diminution in
the virulence of the disease.
6. Stated shortly, simple disinfection with perchloride of
mercury presents many advantages over more elaborate
operations.
(a) It is simple, cheap and efficient, and ensures a great saving
of time and labour. Further experience will probably
show that a weaker solution (1 to 2,000) is sufficiently
strong.
* Not printed.
APP. VI.] Measures in the Bombay Presidency and Sind.
435
(b) It ensures almost complete immunity from infection to
labourers.
(c) It entails a minimum of discomfort and inconvenience on the
occupants of a house.
(d) Perchloride of mercury is odourless and nonvolatile.
The former quality recommends it to natives, and the second
gives a greater chance of a permanently good effect.
(e) The solution of the salt neither stains, nor removes colour
from, the finest fabrics.
7. I trust I may be pardoned a slight digression in order to
bring to notice a few points, which seem very necessary
to bear in mind, for the success of any plague-preventive
operations. It will be generally admitted that people may
carry the virus of plague to a house and may also become
infected from a house into which the germs of disease
have been conveyed by rats.
There arc thus two factors to deal with; a human population
above ground, whose movement can be more or less con-
trolled ; and an animal population, under ground, whose
wanderings cannot be checked.
Therefore it is not sufficient to follow in the train of the dis-
ease, disinfecting only where the disease shows itself by
its human victims.
The attack should be directed from all sides and over wide areas,
thereby saving many houses and families from infection.
Again bedding and clothing seem to play an important part in
conveyance of inspection.
This was well illustrated among the Mahomedans, among
whom 46 cases occurred after they had vacated their
houses,
Therefore disinfection of bedding and clothing is equally
important to that of houses.
b 55
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