NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
161
APP. VIII. ]
spread of infection by land.
The nine cases are certified in the Admission and Discharge Book
of the hospital as follows : —
Remittent Fever
Malarial cachexia
Bronchitis
..,
,,.
Tubercle of lung
Heat apoplexy
...
...
...
...
...
,..
TOTAL
... 4
... 1
... 1
... 2
I
... 9
All of these recovered with the exception of one of the cases of
tubercle of the lung admitted into hospital in a moribund condition on
the 4th July and who succumbed on the 6th.
No case of actual plague was detected during the period. The
ïast case which affords grounds for the suspicion that it was a case of
so-called pneumonic form of bubonic plague (so ably described by
Childe and others, the reading of whose experiences bias me in this
opinion) was a man who died on the 9th April and who was admitted
with symptoms of fever and bronchitis on the 7th.
Every case admitted into hospital was treated with the same pre-
cautions which would have been observed in undoubted cases of
bubonic plague.
A sepoy of the 25th Bengal Infantry proceeding on sick leave
met with an accident at Hamai station. He arrived here suffering
from acute synovitis (right knee) complicated by a suppurating wound
which fortunately did not communicate with the joint. Dr. Rave
permitted his admission into the Railway Hospital on the 25th April,
and under treatment there he recovered so as to be able to proceed
on his journey on the 15th of May.
In addition to these no less than 155 cases of fever were detected.
These were trivial and mostly due to the heat of the journey, etc.
Retention in the huts for the purpose built midway between the
hospital and the landis for two or three days sufficed to prove the
nature of the case, and these patients were discharged as soon as
they had recovered. None of them ever required transference to hos-
pital.
Surprise has been expressed at the small number admitted into
hospital, but people are oblivious to the fact that natives, or in fact
any one, will rarely travel when sick, and certainly not at such a
time as the present, when detention, etc., were being- enforced.
The women's
enclosure.
1o. Female Hospital Assistant Hydari Begum who had been
associated with me in the work of examining the trains since the
23rd February was, when this camp opened, placed in full charge
c 21
162
Measures to prevent the
[ APP. VIII.
of the female enclosure. Mr. Crosthwaite requested me, as he had so
much to do with the men, to generally supervise all matters connected
with the women and children.
Female Hospital Assistant Hydari Begum met the trains along
with ourselves and took charge of the women's carriage at once. After
detention commenced no inspection of women took place at the
station, except in the case of 1st and 2nd class passengers, who were
examined in the carriages. When the train had reached the siding,
the women were taken off by the Assistant and her staff to the zanana.
There she made her inspection, reporting at once if any of the women
were ill, etc.
At the same time that the clothes inspection took place in the
male landis, the Assistant and her staff made a complete examination
of the women's kits. Clothes to be destroyed were separated from
those for disinfection and this being done, the Assistant sent for me
to come and decide compensation, etc.
On the occasions of my entering the zanana, the purdah women
were placed in a screened hut, and queries, if necessary, transmitted
through the Assistant.
Disinfection was carried out by boiling or by soaking in corrosive
sublimate solution. Women very rarely trusted their clothes out of
their sight even to their husbands, etc., but as often as possible this was
done and the steam tank employed. Male passengers who had women-
kind in the " zanana " were only allowed to converse with them at
some distance from the entrance to the enclosure. They were freely
permitted to do this as often as they chose.
With the exception of myself when summoned and accompanied
by the Assistant, I have reason to believe that the rule excluding all
male passengers from the precincts of the zanana has never been
transgressed.
No cases of serious illness have been found among the women.
A weakly infant born before its time and only 2 or 3 weeks old died
shortly after its arrival at Khánpur on a very hot day. The matter
was reported, and the usual precautions taken. On no less than two
occasions have women been admitted into the zanana with babes born
in the trains, and to these, as to all the passengers who came under
her, was every possible attention paid by Hydari Begum irrespective of
caste, creed or status.
I really cannot speak too highly of Hydari Begum's services, In
a trying position she has shown both ability and tact.
Note.—There was a small latrine for females (see maps) near the
zanana, This was worked on the original trench latrine system and
proved satisfactory.
APP. VIII. ]
spread of infection by land.
163
The two sets of family quarters were seldom occupied, and when
so, were generally by persons of some education and position who
conformed to the regulations, etc., as a matter of duty.
Food.
II. The matter of food has been a most serious one for every-
body here. It is seemingly impossible to get good fresh meat during
the hot weather. The shop-keepers were allowed at first to provide
meat, but as daily complaints were made by the passengers, I in-
quired into the matter and was compelled to prohibit its sale in the
lines. Vegetables are scarce and of inferior quality, and what was
more serious, the atta, etc., sold by the banias had more than once to
be condemned. All the best of the food-stuffs at Khánpur are ex-
ported, and the matter of the provision of a sufficient and good supply
of food-stuffs ought to be primarily considered when such a camp is
formed again, essential as it is to the health of all concerned.
12. I have in conclusion to thank Lieutenant J. G. Crosthwaite,
Assistant Commissioner, I.S.C., for his many kindly services to me
during our stay here together. He has worked indefatigably and has
exhibited the most marked interest in the details of the work, much
of which lay entirely beyond his province.
Additional Note.—Two days after Mr. Crosthwaite had handed
over to me I was relieved by Surgeon-Captain H. Smith, to whom I
showed all the details of the work, and who is now carrying it on.
Correspondence regarding the Disinfection of
Railway Carriages.
No. 97.
No. 172, dated Allahabad, the 17th March 1897.
From—The Chief Secretary to the Government of the North-Western
Provinces and Oudh,
To—The Secretary to the Government of India, Home Department.
I am directed to submit, for the information of His Excellency the
Governor General in Council, the accompaying copy of a letter No.
136-XVI—404-B.-164, dated the 8th March 1897, and enclosure, to the
address of the Agent, Bombay, Baroda and Central India Railway, on
the subject of the disinfection of carriage used by a person suffer-
ing from a contagious disease.
No. 136/XVI-404-B.-164, dated Allahabad, the 8th March 1897.
From--The Secretary to the Government of the North-Western Provinces
and Oudh.
To—The Agent, Bombay, Baroda and Central India Railway, Bombay.
I am directed to acknowledge the receipt of your letter No,
2I07-T., dated 24th February 1897, forwarding a copy of the rules in
164
Measures to prévent the
[ APP. VIIÏ.
force on the Bombay, Baroda and Central India Railway for the disin-
fection of a carriage used by a person suffering from a contagious
disease. You say that these rules apply in the case of persons
suffering from bubonic plague, and that they are considered adequate.
2. Rule IO (f) of the rules in question provides that "when
evacuations, etc., of the infected person have contaminated the floor or
seats of a carriage, but not otherwise, it should be washed with
carbolic acid solution, consisting of a wineglassful of carbolic acid
mixed in a gallon of boiling water" This rule falls far short of the
rules in force on other railways (for instance, the North-Western
Railway, the Oudh and Rohilkhand Railway, and the Indian Midland
Railway), which provide that when a carriage is being disinfected
every portion of the woodwork must be washed over with boiling
water, containing in each gallon a wineglassful of carbolic acid. It
is obviously insufficient to wash the floors and seats only when they
have been contaminated by evacuations, etc. Moreover, it appears
from the rules in force on the Bombay, Boroda and Central India
Railway that a carriage occupied by a person suffering from bubonic
plague may be again brought into use immediately the disinfection
has been completed.
3. As the ordinary rules on the subject of disinfection of carriages
in force on the Bombay, Baroda and Central India Railway do not
adequately provide, in the opinion of the Sanitary Commissioner of
these provinces, for an emergency such as the present, and as you ex-
press no intention of adopting the precautions considered necessary by
this Government, the Lieutenant-Governor and Chief Commissioner,
acting on the opinion of his professional advisers, and being satisfied,
that the procedure adopted by your railway is dangerously insufficient,
is constrained to issue orders which have the force of law on the sub-
ject under Act No. III. of 1897 for observance by railway officials of
the Bombay, Baroda and Central India Railway, serving in these
provinces. I am to forward for your information a copy of the orders
issued, and to say that spare copies will be supplied for distribution
and for affixing to notice boards at the various railway stations. The
Railway Company, which comes under the definition of the word
"person" used in sections 2 and 3 of Act No. III of 1897, will be
held responsible for the due observance of the orders, and I am now
to call upon you to take effective measures to secure compliance with
the orders on the part of subordinate officials.
4- I am to remark in conclusion that rule 10 (g) of the rules
forwarded with your letter under reply, which lays down that when
disinfectants are required, application should be made to the District
APP..VIII. ]
spread of infection by land.
165
Traffic Superintendent for them, is not sufficient, unless care is taken
that a'proper supply of disinfectants is kept at each station for use,
whenever occasion may arise.
Orders
issued under Act No. III of 1897 (vide G. O. No,136/XVI-404-D,104)
dated 8th March 1897).
In exercise of the power conferred on this Government by Noti-
fication No. 302, dated 4th February 1897, of the Governor General in
Council, the Lieutenant-Governor of the North-Western Provinces
and Chief Commissioner of Oudh is pleased to make the following
orders under Act No. III of 1897 (an Act to provide for the better
prevention of the spread of Dangerous Epidemic Diseases) for
observance by the Bombay, Baroda and Central India Railway Com-
pany within the limits of the North-Western Provinces and Oudh :—
1. When a case of bubonic plague has been detected in a rail-
way carriage, the carriage shall be disinfected in the manner provided
in the rules dealing with ordinary contagious diseases.
2. In addition, carbolic acid powder shall be sprinkled on the
floors and seats, or the interior woodwork of the carriages shall be
thoroughly washed with a solution of perchloride of mercury (1 in
1,000) or with, a carbolic acid solution (a wineglassful to a gallon).
3. The doors and windows shall then be thrown open, and the
carriage kept in a siding unused for ten days.
4. A sufficient supply of disinfectants shall be kept at all stations.
No. 98.
No. 349-R.T., dated Simla, the 21st April 1897.
From—G. A. ANDERSON, Esq., Undersecretary to the Government of
India, Public Works Department,
To—The Joint Secretary to the Government of Madras, Public Works
Department, Railway Branch.
„ The Secretary to the Government of Bombay, Public Works De-
partment, Railway Branch.
„ The Secretary to the Government of Bengal, Public Works Depart-
ment.
„ The Chief Commissioner of Assam.
„ The Resident at Hyderabad.
,, The Agent to the Governor General in Rajputana.
„ Director-General of Railways.
„ The Consulting Engineers to the Government of India for Rail-
ways, Calcutta, Lucknow, and Assam.
The Government of India have had under consideration the
advisability of cleansing all vehicles conveying passengers and their
166
Measures to prevent the
[ APP. VIII.
luggage from districts affected with the bubonic plague to other parts
of India, and are of opinion that the disinfection of all such vehicles
is absolutely necessary as a precautionary measure against the spread
of infection.
2. For this purpose it is considered imperative that vehicles in
which suspected or declared cases of plague have occurred should be
stopped at, and not allowed to run further than, either the station at
which such cases are removed from the carriage or the nearest medi-
cal inspection station,—preferably the former if the process of disin-
fection can be promptly and satisfactorily carried out there,—while
non-suspect vehicles should be disinfected at the medical inspection
station nearest to the boundary of infected areas. This need involve
no detention to the latter beyond that necessary for their actual dis-
infection, the inspection of the occupants and the disinfection of
their baggage.
3. The Government of India accordingly desire that, subject to
the foregoing remarks, the Administration (s) of the railway(s)
under the control of the Government of be requested to disinfect all vehicles
your control
conveying passengers and their baggage from areas infected with
the bubonic plague in the following manner :—
(a) Vehicles in which cases of plague have not been detected—
Third and intermediate class carriages, goods, vehicles carry-
ing passengers and luggage vans.—The interior woodwork, espe-
cially the floors and seats, to be thoroughly washed with a solution of
perchloride of mercury (1 in 1,000), or with a carbolic acid solution
(a wineglassful to a gallon) applied with a mop ; the doors and
windows to be opened and the vehicles exposed to the air,
First and second class carriages.—The floors and woodwork to
be treated as above, the cushions being also brushed and thoroughly
cleaned.
(b) Carriages in which cases of plague have been detected—
(i) These, after being detached from the train, should be
thoroughly washed with soft soap and lime-water.
After an interval of two or three hours this should be
washed off with plain water, and then the following
disinfecting solution should be thoroughly sprayed all
over the interior as well as the exterior of carriages
by means of a syringe :—
Corrosive sublimate
Hydrochloric acid
Water
•••
•••
•••I
•••I
•••
•••
•••
•••
•••
½ oz.
1 OZ.
3 gallons.
App. VIII. ]
spread of infection by land.
167
This solution should be allowed to dry on the carriages. Special
care must be taken to direct the solution into all the cracks and
crevices and jilmils.
(ii] After disinfection, the carriages should be kept out in the
open for 48 hours. They can then be brought into use
again.
(iii) In the case of first and 2nd class carriages, which afford
greater facilities than third class compartments for the
harbouring of plague germs, it will be necessary, if the
carriages are contaminated, to burn the cushions and
to disinfect the woodwork in the manner indicated
above, and re-paint the interior.
(iv) Any compartment in which a suspicious case has travelled
should be sprayed with the above disinfecting solution
before being allowed to proceed.
No. 99.
Telegram, dated Luck now, the 30th April 1897.
From—The Secretary to the Government of the North-Western Prov-
inces and Oudh, Judicial Department,
To—The Secretary to the Government of India, Home Department.
Please see my letter No. 172 of I7th March, forwarding copy of
orders issued under Act III of 1897 for disinfecting in these provinces
infected carriages of the Bombay, Baroda and Central India Railway.
Similar orders were issued in cases of East Indian and Bengal and
North-Western Railways. Other railways voluntarily issued similar
rules, At instance of this Government His Honour was advised by
sanitary experts that it was necessary for infected carriages to be kept
unused for ten days. Lieutenant-Governor now finds that Govern-
ment of India in Public Works Department letter No. 349-R. T.,
dated 21st April 1897, have issued instructions for disinfection which
will supersede orders issued by this Government under the Act in
particular. Disuse for 48 hours only is prescribed. His Honour
would be glad of instructions in the matter. Should he modify the
orders or not.
No. l00.
Telegram No. 1421, dated Simla, the 3rd May 1897.
From—The Secretary to the Government of India, Home Department,
To—The Secretary to the Government of the North-Western Provinces
and Oudh, Judicial Department.
Your telegram dated 3oth April. Copy of Public Works Depart-
ment letter No. 349-R. T., dated 21st April, being forwarded
168
Measures to prevent
the
[ APP, VIII.
to North-Western Provinces Government. Advisers of Government
of India consider 48 hours disuse of railway carnage after disinfec-
tion sufficient, and will be glad if North-Western Provinces Govern-
ment will modify their orders in accordance with orders in the Pub-
lic Works Department letter.
No. 101,
No. 1497, dated 22nd May 1897.
From—The Secretary to the Government of Bombay, Public Works
Department, Railway Branch,
To—The Secretary to the Government of India, Public Works Depart-
ment.
With reference to your letter No. 349-R. T., dated 21st April
1897, I am directed to forward, for the consideration and orders of
the Government of India, an extract of a report by the General Traffic
Manager, Great Indian Peninsula Railway Company, No. 2136,
dated 12th May 1897, bringing to notice certain difficulties on that
railway in carrying out the orders contained in your letter quoted
above.
2. The infected area for the Great Indian Peninsula Railway
ends at Manmad Junction on the North-East and Dhond Junction on
the South-East line and the medical inspection stations nearest to
these on the boundaries of this Presidency are Bhusawal and Hotgi
Junctions.
3. It must be understood that on the Great Indian Peninsula
Railway if any carriage is found to have a case of plague in it or a
suspicious case, it is at once cut off the train, and disinfected, in
accordance with the rules, so that the train, at any time, consists of
carriages of which there is no reasonable suspicion that they contain
or have contained persons suffering from plague.
4. I am accordingly to ask if, in the opinion of the Government
of India, all practicable and reasonable security will not be given—
(a) if every carriage, in which a suspicious case is found, is at
once cut off and disinfected ; and
(b) every carriage, in which no such case has been found, is
disinfected at the end of its journey.
This it appears would give practical security whilst it would
obviate the difficulties and delays that the present orders must cause,
5. As regards the other point raised, i. e., the burning of cush-
ions and repainting the interior of first and second class carriages,
paragraph 3 (b) (iii) of your letter. This is understood to apply
only to carriages in which persons whoare undoubtedly suffering from
ÁPP. VIII. ]
spread of infection by land.
169
plague had been travelling. Such cases would be exceedingly rare, and
unless on medical inspection the passengers were found to be actually
suffering from plague and were in consequence removed from the
train, their detection would be practically impossible.
I am to say that this Government of course understands that in
issuing this order the Government of India were probably acting on
expert advice ; but I am to ask that this matter may be reconsidered.
Railway cushions in India besides being often, if not generally fix-
tures, are almost always covered with leather, universally so on
the lines under the control of this Government, and they are also
in general very dry. They are accordingly most unlikely to harbour
plague germs and their destruction whilst a very costly measure and
one which would render useless for a considerable time the carri-
age to which they pertained, would apparently be productive of little
real benefit,
Extract paragraphs 1 to 6 and 8 from a letter No. 2163, dated 12th May1897,
from the General Traffic Manager, to Agent, Great Indian Peninsula Rail-
way.
With reference to the Resolution of the Bombay Government,
No. 1207 of the 27th ultimo, as to the disinfection of all vehicles
conveying passengers and their luggage from districts affected with
the plague into other parts of India, copy of which you sent me
under your memorandum No. B.-18—6560 of the 5th instant, I beg
to point out that if the Resolution is carried out as it at present
stands, it will disorganise the whole of the passenger train service.
We cannot, for want of sufficient spare stock, keep spare trains at
the places where the disinfection of all vehicles and of the luggage,
whether they have contained a case of plague or not, has to be done.
It is to be understood, I presume, that parcels are included in the
term luggage. If the latter requires to be disinfected, the former
certainly does also.
2. If we have to keep trains standing at the station until they
and the passengers and their baggage and the parcels have been
disinfected, very considerable delay will result.
As you are aware, when a heavy mail steamer comes in, we
have on occasion to run as many as three and sometimes four mail
trains to the North-East line and two to the South-East line, and these
require almost the whole of one available upper class stock, so that it
would be impossible for us to have spare trains into which to trans-
fer passengers, and therefore the trains will have to be delayed while
they are being disinfected, which, in the case of many of them, will
be late at night, during which passengers will have to remain on the
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