NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
152
Measures to prevent the
[ APP. VIII.
compartment is reserved for railway servants on duty, Fuel Contractors,
State Excise Contractors, Post Office oficiáis and others travelling
locally on duty. These men's passes are examined and they are let
out. The outgoing train stands on line No. 2 (see Map A) and in
this are the disinfected passengers. Two constables are placed
between the two trains to prevent any one slipping out of the
incoming train. On the completion of the Inspecting Medical Officer's
examination the whole train is taken out to No. 5 line (see Map A),
the 1st and 2nd class passengers and contents of Brake and Postal
Van having been previously transferred, though the use of this latter
step is not very apparent, so long as neither Postal officials, bags,
nor contents of Brake Van, are disinfected. The Camp Clerks,
Hospital Assistant and all Police on duty accompanied the train to
No. 5 line. On its arrival there the remaining passengers were entered
in the Register and the male passengers conducted to the detention
lines by the Disinfecting Officer and quartered. The women were
taken by a separate route to the Women's Lines by the Female
Hospital Assistant and the Dhai. The camp water-carriers attended
to carry the women's baggage, etc.
(b) On the withdrawal of the incoming train the outgoing train
was brought on to the platform and was generally despatched before
the incoming passengers were clear of their train. This was a
distinct advantage, as the passengers quickly resigned themselves to
their stay in the lines when they found the other train had already
left.
Women's enclo-
sure.
12. The women's lines were, as originally directed, placed entirely
under the charge of Hydari Begum, Female Hospital Assistant under
the supervision of the Inspecting Medical Officer. Every effort has
been made to avoid any inconvenience or discomfort to the women.
Women of the better class with their husbands have been, so far as
possible, allowed the use of the intermediate quarters (see Pian B),
which is also under Hydari Begum's charge. I would point out in
this connection that it is not practicable to use sweeper women to
carry clothes, as recommended by the Plague Conference. Many
castes would consider the clothes defiled and decline to receive them
again. But the women's lines have been dealt with fully by the
Inspecting Medical Officer. I have only to add that Hydari Begum
has made herself thoroughly respected and liked by all with whom
she has been brought in contact. A woman of less strength of char-
acter would never have been able to manage the women's enclosure
with half her success.
Water-supply.
13. (a) The camp has been dependent for its water-supply on the
Railway tanks. These are two in number, measure each 51' x 13.8'x
153
APP.
VIII.]
spread of infection by land.
5', and contain 45,562 1/2 gallons. They are filled by the pumping
engines from the two wells shown in map A. The water is considered
good by the Inspecting Medical Officer. The supply has through-
out been sufficient though care had to be taken latterly as the wells
ran low. On the loth April Mr. Ritchie laid water on into the
centre of the camp and supplied a standpipe and tap. This has been
most useful. It has not been possible to have a drain from the
standpipe. A pit was dug, where the water collected under it, and.
Lnedwith ashes. This was baled out twice a day and disinfectants
thrown into it.
(5) A reserve moveable tank, Jacobabad pattern, holding 3,490
gallons, was lent by the railway authorities. The water was used
for washing purposes. It was filled from the engine hydrants.
(c) The daily consumption of water exceeded 6,000 gallons, the
bathing tank alone, using 4,000.
Food-supply.
14. (a) The State supplied one bania for the camp. He was
found by the city and received, I am told, Rs. 75 a month from the
other traders. As, however, the station food contractor eagerly set
up a rival shop, it is probable that business was good. A weekly
price list was obtained from the Kárdar and prices regulated by it
(vide Camp Standing Orders).
(b) The food supplied was not of the best quality, nor could good
food always be procured. Summary justice, however, in the shape of
destruction of all supplies condemned by the Inspecting Medical
Officer, kept the supplies as good as they could be. Vegetables were
scarce and of bad quality. Mutton almost unprocurable and very bad.
Goat's flesh equally bad. Under the Inspecting Medical Officer's
advice the sale of meat within the lines was forbidden. The pur-
chase of liquor or drugs was prohibited. Liquor in the possession of
passengers was sometimes stored in the office till their departure.
The railway icemen were encouraged to sell aerated waters and ice
to passengers in the lines.
- Establishment,
15. (a) The strength of the establishment is given as an appen-
dix. Their ordinary duties have already been described in various
paragraphs.
(6) Many of the establishment had only one suit on their arrival.
A second suit at half price was supplied them from the stores. Their
clothes were disinfected once a week. Care should be taken that the
sweepers do not collect rags, etc., thrown away by passengers. Here
the huts were inspected weekly.
c 20
154
Measures to prevent the
[ APP. VIII
(c) Some of the establishment first entertained was found to be
unnecessary. The final numbers as shown in Appendix D are the
minimum strength with which 200 travellers can be disposed of daily.
(d) Considerable difficulty was experienced by the Deputy Com-
missioner, Mooltan, in obtaining men, even at the high rates offered,
the terrible death-rate amongst municipal servants in plague centres
being the deterrent.
(e) I have already drawn attention to the excellent work of Hydari
Begum. The Head Clerk, Abdul Karim, has also worked very well,
and his industry has been marked. Fazl Din, Hospital Assistant, has
carried out the duties entrusted to him satisfactorily.
Accounts and
Registers.
16. The following list gives all the Camp Accounts and Registers-,
The form of those marked with an asterisk is given in Appendix
E:—
(a) Cash Book, containing m addition record of cheques issued
and cashed—
(One copy in English,)
( Ditto
Vernacular.)
(b) Cheque Book on Mooltan Treasury.
(c) Pass Book of Personal Ledger Account.
(d) Abstract of Accounts.
(e) Store Book.
*(f) Cash and Clothes Compensation Register (Awards),
(g) Daily Pay Register (for labour).
(h) Miscellaneous Account.
(i) Establishment Roll.
(j) Vernacular Letter Book.
*(k) Cloth Register.
*(l) Passenger Register.
Statistics.
17. A statement of the passengers and the plague centres from
which they came is given as Appendix G.
The total expenditure is shown in the Abstracts Statement, Appen-
dix F.
The total number of clothes destroyed and given as compensation,
in Appendix C.
General
remarks.
18. Fire arrangements.—No cooking was allowed inside the
cells. With sleeper huts there was comparatively little fear of fire.
Each cell contained one or more ghurras, which were kept filled. A
small fire-engine was also kept in the Engine House and would have
155
APP. VIII. J
spread of infection by land.
been at once available (see Plan B). Five buckets were also kept at
the station and at the wood piles. The latter were kept filled. Five
fire buckets were kept in the Women's Lines.
Lighting.-- Large station lamps were used. These were supplied
by the North-Western Railway Stores.
Charpoys.— It was impossible to supply all passengers with char-
poys. The banias and one contractor were allowed to hire out
charpoys at 3 pie the night or 6 pie the 24 hours. A certain number
of reserve charpoys belonging to the lines were entrusted to the
contractor, who hired them out, receiving 2 annas per rupee as his
share of the profits. This brought in a small amount, but more than
their value. The Women's Lines were supplied first with charpoys.
Gcvernment servants on sick leave were supplied free.
Caste prejudice.—The question of caste prejudice, re disinfection,
has already been discussed.
It was found advisable to reserve one line for Hindus, one for
Muhammadans and one for Native soldiers. Sweepers were allotted
a distinct line.
Certain Hindus, Vishnu's and down-country or Purbyiah Brahmins
objected to drinking the tank water. They were not allowed to fetch
other water, as this would have been from the nearest nallah. It was
understood that the protest relieved their conscience.
Attitude towards plague precautions.—Generally speaking the
average passenger considered the precautions worse than the disease.
They would have preferred no action whatever being taken. The
native railway officials were actively or passively hostile.
Languages.—It is advisable to have Pashtu and Persian speaking
men among the Camp establishment. Both my Munshi and Orderly
spoke Pashtu. I found some acquaintance with Persian and Pashtu
useful.
Conclusion*
19. I have in conclusion to particularly thank the management of
the North-Western Railway for their ever-ready help and for their
support to measures that frequently tended to kill traffic and cause
loss of revenue. To Mr. Ritchie, District Loco. Superintendent,
Sukkur, I am especially indebted for his help and advice.
Among the minor railway officials, Mr. Roach, Station Master,
and Kali Charan, Assistant Station Master, have helped me in every
way. I have also met with much help from Mr. Taylor, Loco. Fore-
man, who has devoted much of his spare time to superintending the
actual disinfecting arrangements. Mr. Donohue, Permanent-Way
Inspector, has aided me frequently in building operations.
156
Measures to prevent the
[ APP. VIII.
I beg finally to draw the attention of Government to Surgeon-
Lieutenant Milne's cordial co-operation in all matters connected with
the camp, even where Í had no right to ask his aid. His advice has
been of the greatest use to me throughout, and the whole sanitary
arrangements of the camp have been entirely in his hands.
Report B. I ( to company Disinfection/30), dated Khánpur, ---July 1897
From—SURGEON-LIEUTENANT C. J. MILNE, M.B., I.M.S., Inspecting
Medical Ofíicer, Khánpur,
To—The Deputy Commissioner, Mooltan.
1 have the honour to forward the following supplementary report
to that herewith submitted by Lieutenant J. G. Crosthwaite, the
Disinfecting Officer, who has been associated with me in the work of
retarding the spread of the plague into the Punjab from Sind since
the 5th April 1897 : —
1. In accordance with instructions received from the Inspector-
General of Civil Hospitals I arrived at Khánpur on the morning of the
19th January and assumed charge of my duties as an Inspecting
Medical Officer at once. The work done between that date and the
date when detention commenced will be embodied in my final report
to be submitted by me to the Inspector-General of Civil Hospitals in
the Punjab when my duties here are terminated.
2. On the 31st March I received a letter No. 1240, dated 3oth
March 1897, from the Inspector-General of Civil Hospitals, enclosing
a copy of a letter (No. 510, dated 20th March 1897) from the Junior
Secretary to Government in the Punjab. In this letter the Inspecting
Medical Officers at the chief places of inspection in the Punjab were
requested to report on the time required by them to inspect trains,
and also to suggest any alteration in the method of inspection. Î
replied to this in my No. 39-A., dated 2nd April 1897, in which I
suggested the detention of all passengers (and the disinfection of
their kits) for 24 hours at least if a ten days' detention could not be
enforced. The suggestion to detain, etc., the passengers thus made
seems to have met with the approval of the Plague Committee, who met
in Lahore on the following day, April 3rd, as on the evening of that
date I received a telegram stating that such had been adopted. Next
morning, April 4th, I received a demi-official with preliminary instruc-
tions with regard to the detention, but pending the arrival of the
Assistant Commissioner and the Baháwalpur representative, I could
do nothing but go over the ground where the camp could be formed.
This I did, and the site chosen was fully approved of by the others on
their arrival on the 5th. The subsequent proceedings are fully
157
APP. VIII. ]
spread of infection by land.
detailed by Mr. Crosthwaite and I have but to supplement his remarks
with the following notes.
The site of the
camp.
In the selection of a site for the camp in question—proximity to
the engine shed—the source of our means of steam disinfection, etc.
had to be chiefly considered. Very luckily the ground along-side of
the shed and a continuation eastwards of the lowlying waste ground
wherein the hospital was placed, presented so many natural aids to
such a camp as ours that its selection was at once justified. That
the site is a healthy one may be judged from the fact that among all
the staff who are permanently resident there, including the police
there has only been one case of illness requiring admission to the
hospital, and only very few cases of any sort (chiefly among the
Police) requiring any attention whatever.
The huts.
4. The points in connection with the housing of the persons in
rows of sleeper huts such as has been carried out, to which I wish to
refer, may be classed under the following heads :—
(a) With reference to the occurrence in them of cases of suspicious
or actual plague and how the hut was to be rendered free of further
infection.
In my demi-official dated April 16th, to the Inspector-General of
SECTION OF HUTS.
A.
Before extraction of the infected one.
B.
After the demolition of the same*
Civil Hospitals, I explain-
ed the method we had
decided to adopt in the
event of such an incident
occurring. It was that
the section of the row
of huts be extracted and
the sleepers forming the
roof and walls of the
section be burnt. The
ground on which the hut
had stood was to be duo-
up and treated similarly
to that on which a case
had died in the hospital.
Represented diagram-
atically supposing A. in the row of huts 1 —12 a case of plague had
occurred in No. 4, then all the sleepers between the points marked
by a red cross were to be taken out and burnt. Fig. B. shows the
appearance the row of huts would present after the 'demolition of the
infected one,
158
Measures to prevent
the
[ APP. VIII.
(b) The monthly disinfection of the huts by syringing with I :
1,000 corrosive sublimate solution. This necessary procedure was
rigorously carried out as directed by Surgeon-Colonel Raye. One
hundred gallons of such a solution were required in order to disinfect
the 118 huts in the camp. This involved roughly the expenditure of
11b. of the antiseptic in question.
(c) The huts as a protection from the elements.
(1) The temperature.—With regard to the heat, the position of
the huts (facing the east) and the solidity of their roofs were a
considerable protection from the hot rays of the midday and afternoon
sun. Still, as the month of May progressed complaints as to the heat
were not infrequent, and one or two cases of slight fever were probably
due to the same. The erection of the Inspection Chhappar under
which a considerable number of the detenus could accommodate
themselves during the day has been found to greatly alleviate these
conditions.
(2) Rain and Storms.—These are of very rare occurrence, but
this year have been more frequent than for many years past. Rain
unaccompanied by wind gave no trouble, but when wind was present
the front row of huts as a rule suffered, the others only leaking
slightly and to an inappreciable extent. The addition of a small
verandah cover of sarkhána grass which has been suggested would be
of immense help not only as a protection from rain, but also aiding
the protection from the sun. Should the camp be likely to continue
for any length of time, this addition will be undertaken. I am
strongly of opinion that sleeper huts made in the form carried out
are infinitely more satisfactory than grass ones for such a purpose as
ours has been.
The water-sup-
ply.
5. In addition to the abundance of the supply we have been very
fortunate in having water of such excellent quality. The standpipe
laid down into the centre of the camp by Mr. Ritchie proved a great
boon to all concerned. The pipes conveying it were carefully
covered, and cool water has been procurable at all times during the
day. The tank supplied by the railway was a most excellent reserve
for cases of emergency, but has rarely been put in requisition. Should
a similar camp ever be formed again on a larger scale, such tanks
would be of extreme importance, but it would be necessary to erect
some sort of a structure over them so as to prevent the water getting
so hot as to be unfit for drinking purposes.
The'general sani«
tary arrange-
ments.
6. (I) The lines themselves were kept scrupulously clean. The
moment the passengers had evacuated them at 5 P.M., the whole of the
sweepers were enjoined to overhaul the lands thoroughly.
159
APP. VIII. ]
spread of infection by land.
(2) As regards the important matter of latrines, the system
originally suggested and adopted was that of an enclosure in which a
number of receptacles were placed. These when soiled were to be
carried away at once to the trenches, which were some 70 yards
distant, by the attendant sweepers. But this method was quite
impracticable. After the arrival of the train the latrines were so
crowded that do what the sweepers could they were unable to do
their work quickly enough to be satisfactory, and the smell, etc., gave
rise to frequent complaint.
We then made the long trenches over w,hich the men could sit,
and this system has proved admirable. The trenches are two in
number, each 50 yards long, and about 80 men can use them at once.
All that the sweepers have to do is to run along the line and throw
in earth and carbolic powder. Since this system has been in vogue
there has not been the slightest odour apparent. The trenches have
been visited daily once or twice by either the Hospital Assistant or
myself. For the reception of urine, a number of flat gumlahs, one
foot in diameter, were placed in the latrines. They were filled with
sawdust (an idea suggested by reading Dr. Poore's paper in the
Journal of State Medicine for January 1897), No smell was caused,
and at the end of the day the sawdust was burnt. I have reason to
think, however, that the men used trenches for urination to a great
extent.
(3) A"pucca" incinerator not being considered advisable we
built a small 'cutcha one in which condemned clothes and the other
refuse of the camp were burnt.
l The disinfection
of clothing.
7. Since the tanks were erected disinfection by steam of the men's
clothing at least has been adopted on all occasions. Prior to this
boiling or steeping in antiseptic solutions were employed, and these
methods have been continued with regard to the women's clothing in
the majority of instances. Women travelling alone could not be
prevailed on to part with their clothing, and so steam disinfection was
only used when they were willing to hand over their clothes to their
husbands, etc.
I regret very much that I was unable to obtain a thermometer by
which the exact heat in the tanks could be ascertained. From various
observations (Parkes' Hygiene, vide pages 440 et seq., etc.) I have
calculated that with our pressure of 61bs. the temperature in the tanks
rose to 220°—230° F., probably nearer the latter figure.
Taking the latest authority on the subject, Dr. W. R. Smith in his
paper on steam disinfectors in the May number of the Journal of
16o
Measures to prevent the.
[ APP. VIII-.
State Medicine, we find him stating "that many of the pathogenic
organisms (i.e., the non-spore bearing ones) have their thermal death-
points for 10 minutes exposure at or below 60° C. (140° F.)." As the
plague bacillus is a non-spore bearing pathogenic organism similar
to the ones he mentions, I have but little doubt in stating that our
steam disinfection at six pounds pressure for an hour was thoroughly
efficacious with regard to the disease in question. Great care was
taken, too, that the clothes be loosely tied up and loosely packed
so as to ensure the penetration of the steam.
The ablutionary
arrangements.
8. One of the hollow spaces between the rails near an engine-
house used for working at the under parts of an engine proved, when
filled with water from the adjoining hydrant, to be a most excellent
swimming bath. Many of the men, however, preferred the shower
bath afforded by the hydrant, and either method was perfectly satis-
factory.
The medical
inspections.
g. All trains coming here from Karachi were inspected on
arrival. Obviously sick persons were removed to the hospital at
once and the remainder of the 3rd and Intermediate passengers were
carefully observed as they passed from the train into the landis.
First and second class passengers were "Invariably examined on
the platform and passed, unless their condition or the state of their
clothing was absolutely prohibitive. The persons booking from
Khan pur were similarly inspected.
Every day at 9 A.M., after all clothes had been handed in for
disinfection and every person had bathed, a thorough inspection of every
person took place. Many cases of slight fever, especially in the earlier
clays, were detected, and these were either detained in special huts
built for the purpose, or, if considered necessary, were taken to the
hospital. When a passenger had thus been disinfected; bathed and
passed, he had Khánpur stamped on the back of his ticket.
At 5 P.M., the passengers from the preceding mail and mixed
trains were let off, each person being observed as he left the landing
and his ticket examined for the stamp noted in order to assure us that
the conditions of his detention had been fulfilled.
From April 8th to July 8th, 13,876 persons had been detained-, etc.,
in the landis. In addition to this I inspected about 5,794 others on the
platform, making a grand total of 19,670 inspected during that time.
Out of that number it was found necessary to admit into hospital
under observation as suspicious 19 persons. Nine of these were
actually sick, the remaining ten being their companions.
;