NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
APP. IX.]
spread of infection by sea.
319
course of the epidemic. These communications should be made at
least once a week.
The reports concerning the outbreak and course of the disease
should be as complete as possible. They should, in particular, state
the measures taken to check the spread of the epidemic and should
give, in detail, the preventive measures adopted, with regard to—
sanitary or medical inspection ;
isolation ;
disinfection ;
and the measures prescribed with regard to the departure of ships, and
the export of susceptible articles,
It is to be understood that neighbouring countries reserve to them-
selves the right to make special arrangements, with the object of
organising an exchange of direct information between the principal
administrative officers on their frontiers.
The Government of each country must publish, immediately, the
measures which it decides to adopt with regard to arrivals from an
infected country or local area.
The information must be at once communicated to.the diplomatic
or consular agent of the country affected, resident in the capital. In
the absence, in the capital, of a diplomatic or consular agency, the
communication should be made direct to the Government interested.
The withdrawal of the measures, or any modifications which may
be made in them, must be communicated in the same manner,
SECTION II.—Conditions under which a local area* is to be Con-
sidered injected or healthy.
Any area in which a case of plague has been officially reported to
exist will be considered to be infected.
Any area in which plague has existed will cease to be considered
as infected when it is officially reported that no death or fresh case
of plague has taken place for ten days after the recovery or death
of the last case, provided that the necessary disinfection has been
carried out,
Preventive measures will be taken in the infected territory as soon
as cases of plague are officially reported.
These measures will be discontinued as soon as it is officially
stated that the area has again become healthy.
* A local area means a portion of the territory of a country placed under a recog-
nised administrative authority; as, for instance, a province, a Local Government, a
district, a department, a canton, an island, a commune, a town, a village, a harbour, an
area reclaimed from the sea, etc., whatever may be the extent and population of the
portion of territory.
32O
Measures to prevent the
[ APP. IX.
It will not be necessary to apply these measures on the occurrence
of a few imported cases if there is no diffusion of the malady.
SECTION III.—Necessity of restricting to the infected local areas
' the measures taken to prévent the spread of the epidemic
The precautionary measures should be confined to the infected
tract and the Governments concerned should only apply them to per-
sons and goods from infected areas.
But the obligation to restrict precautions to the infected area
exists only on the express condition that the Government of the infect-
ed country takes the necessary measures to prevent the exportation of
susceptible articles derived from the infected area.
No restrictive measure should be enforced against persons and
goods from an infected area, if they left it at least five days before the
occurrence of the first case of plague.
SECTION IV.—~-Goods and articles which may be considered ' suscept
ibie " with reference to the rules regarding the prohibition of
import and transit, and the rules regarding disinfection.
/.—Import and transit.
The following is a list of the susceptible articles and goods, the
importation of which may be prohibited :—
1. Used linen, clothing, personal effects and bedding.
When these articles are carried as baggage, or in consequence
of a change of abode (household goods) they are subjected to special
treatment.
Soldiers' and sailors' kits, returned to their country, after their
death, should be treated in the same way as the articles named above.
2. Rags, not excepting rags compressed by hydraulic force, which
are carried as merchandise in bales.
3. Old sacking, carpets and old embroidery.
4. Raw hides, untanned and fresh skins.
5. Animals' refuse, claws, hoofs, horse hair, hair of animals gene-
rally, raw silk and wool.
6. Human hair.
The transit of susceptible goods or articles packed in such a way
that they cannot be handled on the way should not be forbidden.
Similarly, when merchandise or susceptible articles are transported
in such a manner that " they cannot have come into contact with
infected objects during the journey, their transit throngh an infected
local area should not bar their importation into the country to which
they are consigned.
APP. IX. ]
spread of infection by sea,
321
The rules regarding the prohibition of the import of susceptible
goods and articles will not be applied in cases where it is proved to the
satisfaction of the appointed authority of the country to which they
are consigned that they were despatched at least five days before the
occurrence of the first case of plague.
Merchandise must not be kept in quarantine on land frontiers.
Absolute prohibition or disinfection are the only measures which
may be taken.
//.—Disinfection.
Baggage.-—Disinfection will be compulsory in the case of soiled
linen, wearing apparel, clothes and articles carried as personal baggage
or household goods, coming from a local area, declared infected, and
which the local sanitary authority deems contaminated.
Merchandise.—Disinfection will only be enforced in the case of
merchandise and articles which the local sanitary authority considers
contaminated, or whose importation may be prohibited.
It rests with the authorities of the country to which the articles are
consigned to settle the manner by which and place in which disinfec-
tion should be carried out.
The disinfection should be carried out so as to injure the articles
as little as possible.
Each country will settle the question of the compensation to be
paid for damages resulting from disinfection.
Letters and correspondence, printed matter, books, newspapers,
business documents (not including parcels received through the post),
should be subject to no restriction or disinfection.
SECTION V.—Measures to be taken on land frontiers. Railway
traffic.
Travellers.
Passenger carriages and mail and luggage vans should not be
detained on the frontiers.
If a carriage is infected, it should be detached from the train to be
disinfected, either at the frontier, or at the nearest stopping place, if
this can be arranged.
Goods vans should be treated in the same way.
Land quarantine will no longer be enforced. Only persons pre-
senting symptoms of plague should be detained.
This principle does not affect the right of each country to close,
if necessary, any part of its frontiers.
The railway staff should keep a watch on the travellers' health.
Medical intervention will be confined to an inspection oï the travel-
lers, and the care of the sick.
c 41
322
Measures to prevent the
[ APP. IX.
Where there is a medical inspection, it will be combined, as far as
is practicable, with the custom-house inspection, so as to detain the
passengers as short a time as possible. On the arrival of travellers
from an infected area at their destination, it will be found very
desirable to keep them under supervision for 10 days, counting from
the date of departure.
The measures to be taken in regard to the crossing of the frontiers
by the railway, and the Post Office staff should be settled by the
administrations concerned. They should be arranged so as not to
interrupt the regular service.
Governments reserve to themselves the right to take special
measures with regard to certain classes of people, especially—•
A.—Gipsies and vagabonds.
B.— Emigrants and persons travelling or crossing the frontier in
large bodies.
SECTION VI.—Special rule for Frontier Tracts.
The regulation of the frontier traffic, and of the questions involved
in this traffic, as well as the adoption of exceptional measures of
supervision, must be left to special arrangement between neighbouring
countries.
SECTION VII.— Wafer-ways, rivers, canals and lakes.
The task of regulating by special arrangements the sanitary rules
for water-ways must be left to the Governments of the countries bor-
dering such water-ways.
SECTION VIII.—Ocean traffic.
Measures to be taken at ports.
Any ship with plague on board, or on board which one or more
cases have taken place within 12 days, will be considered infected.
Any ship on board which there has been a case of plague at the
time of departure, or during the voyage, but on which no fresh case
has occurred for 12 days, will be considered as suspected.
Any ship, even though coming from an infected port, which has
had no death, or case of plague on board, either before departure, dur-
ing the voyage, or on arrival, will be considered as healthy.
Infected ships are subj ect to the following rules :—
1. The sick will be immediately disembarked and isolated.
2. The other persons on board should also, if possible, be disem-
barked and kept under observation or surveillance * for a period
* Note.—The expression "observation" means isolation of the passengers, either on
board a ship, or in a lazaretto till they have obtained free pratique. The expression
"surveillance" means that the passengers will not be isolated ; they will at once obtain
free pratique, but on arriving at their destination they will be kept under medical
surveillance.
APP. IX. ]
spread of infection by sea.
323
varying according to the sanitary condition of the ship, and the date of
the last case, but which must not exceed ten days.
3. The soiled linen and personal effects of the crew and passengers
which, in the opinion of the sanitary authority of the port, may be con-
sidered as infected, will be disinfected.
4. The bilge-water will be pumped out after disinfection, and good
drinking-water will be substituted for the water stored on board.
o
5. All parts of the ship which have been inhabited by plague
patients should be disinfected. More thorough disinfection may be
ordered by the local sanitary authority.
Suspected ships are subject to the following measures :—
(1) Medical inspection.
(2) Disinfection ; the soiled linen and personal effects of the crew
and passengers, which, in the opinion of the local sanitary
authority, may be regarded as contaminated, should be dis-
infected.
(3) Pumping out the bilge-water after disinfection, and the substi-
tution of good drinking-water for the water stored on board.
(4) Disinfection of all parts of the ship which have been inhabited
by plague patients. More thorough disinfection may be
ordered by the local sanitary authority.
It is recommended that a watch should be kept over the health of
the crew and passengers for ten days from the date of arrival of the
ship.
It is also recommended that the crew should not be allowed to
land, except on duty.
Healthy ships will be given free pratique at once, irrespective of
the nature of the bill-of-health.
The only measures which the authorities of the port of arrival may
enforce with regard to such ships consist in those which are prescribed
in the case of suspected ships (medical inspection, disinfection, pump-
ing out the bilge-water, and the substitution of good drinking-water
for the water stored on board), except that the measures prescribed for
the disinfection of the ship itself may not be enforced in the case of
healthy ships.
It is recommended that the crew and passengers should be kept
under medical supervision for ten days from the date on which the ship
left an infected port.
It is also recommended that the crew should not be allowed to land
except on duty.
It is to be understood that the appointed authority of the port
of arrival may always demand a declaration, on oath, from the doctor
3 2 4
Measures to prevent the
[ APP. IX.
of the ship, or failing him, from the captain, that there has been no
case of plague on the ship since her departure.
In deciding on the extent to which effect is to be given to the
measures prescribed above, the authorities of the port should take into
consideration the fact that there is a doctor, or a disinfecting appara-
tus (stove) on board the ships coming under the three headings men-
tioned above.
Special measures may be prescribed for crowded ships, particularly
for emigrant ships, or any other ship which appears to be in an
insanitary state.
Goods arriving by sea should be treated in the same way as goods
arriving by land, as regards disinfection, prohibition oí import, transit,
and quarantine.
Any ship objecting to submit to the obligations imposed by the
authority of the port will be free to put back to sea.
The disembarkation of goods may be authorised, after the following
necessary precautions have been taken :—
(1) Isolation of the ship, crew and passengers.
(2) Pumping out the bilge-water after disinfection.
(3) Substitution of good drinking-water for the water stored on
board.
The disembarkation of passengers wishing to land may also be
authorised on condition that they submit to the measures prescribed
by the local authorities.
Each country should supply at least on port on each of its seaboards,
with the organisation and equipment necessary to enable it to receive
a ship, whatever its sanitary state.
Coasting vessels will be subject to special rules, to be drawn up
conjointly by the countries concerned.
SECTION IX.—Measures to be taken with regard to ships coming
from an infected port and ascending the Danube.
Until the town of Sulina is provided with good drinking-water, the
sanitary condition of ships ascending the river will be subject to
thorough sanitary supervision.
Overcrowding of passengers will be strictly forbidden.
Ships entering Roumania by the Danube will be detained for
medical inspection, and until disinfection has been completed.
Ships arriving at Sulina must, before being permitted to ascend
the Danube, undergo one or more medical inspections by day. Each
morning, at a given hour the doctor will satisfy h imself as to the state
of health of all persons on the boat, and will not permit it to enter the
APP. IX. ]
spread of infection by sea,
325
river, until he is assured that their condition is satisfactory. He will
deliver, free of charge, to the captain or master, a sanitary passport,
bill-of-health or certificate, the production of which will be demanded
at the subsequent stations.
There will be a daily inspection. The detention at Sulina of
healthy ships will not exceed six days. Contaminated clothes will be
disinfected on arrival.
Drinking-water of good quality will be substituted for water of
questionable quality that may be on board.
The bilge-water will be disinfected.
The measures above indicated will only be applied to arrivals
from ports infected with the plague.
It is to be understood that a ship coming from a healthy port may,
if it does not wish to submit to the restrictive measures indicated
above, refuse to embark travellers from an infected port.
The rules for suspected and infected ships will be the same as at
other European ports.
CHAPTER III.
Instructions regarding the method of disinfection.
1. Personal effects, rags, infected bandages, papers, and other
articles without value should be destroyed by fire.
2. Under-clothing, bedding, wearing apparel, mattresses, carpets,
etc., which are contaminated or suspected should be disinfected in
stoves at normal pressure, or at a pressure of from one-and-a-half
to two degrees, with or "without the presence of steam.
Before a stove is passed as efficient for the purposes of disinfec-
tion, it should be subjected to a test, with the aid of a signal ther-
mometer, showing the moment when the temperature in the middle of a
mattress rises to at least 100° (Centigrade).
To ensure that the disinfection is effective, this temperature must
be maintained for from 10 to 15 minutes.
3. Disinfecting solutions—
(a) Solution of corrosive sublimate, of 1 part in 1,000, with the
addition of 10 parts of chloride of soda.
The solution should be coloured with aniline dye or indigo. It
should not be placed in metal vessels.
(b) A 5 per cent, solution of pure crystallized carbolic acid, or 5
per cent, of crude commercial carbolic acid, in a warm solution of
soft soap.
326
Measures to prevent the
[ APP. IX.
(c) Fresh slaked lime.* .
4. Special instructions to be observed in the employment of dis-
infecting solutions.
The linen, clothing and articles soiled by the excreta of patients
should be soaked in the solution of corrosive sublimate. The solution
of pure carbolic acid, and the solution of soap and carbolic acid are
equally suited to the purpose. The articles should remain in the solu-
tion for at least six hours.
Articles which cannot be subjected to the temperature of the
stove (100° Centigrade) without injury, such as leather goods, wooden
articles stuck together with glue, felt, velvet, silk, etc., should be
washed with the solution of corrosive sublimate; coins can be dis-
infected with the solution of soap and carbolic acid.
Persons engaged in nursing the sick should wash their hands and
faces with the solution of corrosive sublimate, or with one of the
carbolic solutions.
The carbolic solutions will be useful move particularly for dis-
infecting articles, such as metals, instruments, etc., which can neither
be subjected to a temperature of 100° Centigrade, nor placed in con-
tact with corrosive sublimate.
Slaked lime is particularly recommended for disinfecting excreta.
Expectorated matter should be burnt.
5. Disinfection of ships with plague patients on board.
The cabin or cabins, and all parts of the ship occupied by the
sick or suspected, should be cleared out and all articles in them should
be treated as described above.
The partitions should be disinfected with the solution of corrosive
sublimate with an addition of 10 per cent, of alcohol. The washing
should commence from the top, horizontally, and be continued down-
wards, so that the whole surface of the partition becomes covered
with a coating of minute drops.
The boarding should be washed with the same solution.
Two hours after, the walls and flooring should be washed over
with plenty of water.
6. Disinfection of the hold of an infected ship.
* To get very strong slaked lime, take lime of good quality, slake it, by moisten-
ing it gradually, with half its weight of water. "When the operation is completed, put
the powder in a carefully corked receptacle, and place it in a dry spot. As each kilo-
gramme of lime absorbs 500 grammes of water in order to become slack, it acquires a
volume of 2 litres 200, and it is sufficient to dilute it with double its volume of water,
say 4 kilogrammes 400 grammes to obtain a whitewash which will be of about 20
per cent, strength of lime.
APP. IX. ]
spread of infection by sea.
327
To disinfect the hold, sulphate of iron, in quantity sufficient to
neutralise the sulphurated hydrogen, should first be thrown in, the
bilge-water should be pumped out, and the hold washed with sea-
water. Solution of corrosive sublimate should then be thrown in.
The bilge-water should not be pumped out while the ship is in
port.
CHAPTER IV.
Precautionary measures recommended for ships on departure,
during the voyage, and on arrival.
Note.—Plague appears to be transmitted by the excretions of the
sick (from the air passages and bowels), by the morbid products of
the disease (pus), and consequently by means of linen, clothing-, and
soiled hands.
I.—Measures to be taken on departure.
1. The captain should be careful not to embark persons suspected
to be suffering from plague. He should refuse to receive on board
dirty or suspicious linen, personal effects, and bedding, and, generally,
all dirty or suspicious articles.
Bedding, wearing apparel, personal effects, etc., belonging to
persons suffering from plague should not be taken on board.
2. Before embarkation the ship should be put in a state of perfect
cleanliness and she should, if necessary, be disinfected.
3. It is essential that the drinking-water taken on board should be
obtained from a source free from all possible contamination.
Water is not dangerous if it is distilled or boiled.
II.—Measures to be taken during the voyage.
1. Every ship should have a special place reserved for the segre-
gation of persons attacked by contagious disease.
2. If there is no such place on board, the cabin or other place, in
which a person is attacked with plague, should be isolated.
Only those attending the patients should be admitted.
Such attendants should be cut off from all contact with the other
persons on board,
3. The bedding, linen, and clothing which have been in contact
with the patient should immediately, and in the patients' room, be
soaked in a disinfecting solution.
The same measure should be taken in the case of the clothing of
the persons who have access to the patient which may have become
polluted.
328
Measures to prevent the
[ APP. IX.
Articles which are of no value should be burnt, or thrown over-
board, if the ship is not in port or in a canal. Other articles should
be carried to the stove, in impermeable bags, sprinkled with a solution
of corrosive sublimate, so as to avoid all contact with surrounding
objects.
If there is not a stove on board, the articles should be soaked in
the disinfecting solution for six hours.
2. The excreta of the sick should be collected in vessels, into
which a glass of the disinfecting solution above described has been
previously poured.
3. The vessels should be at once emptied into the latrines which
should be disinfected each time.
4. The places occupied by the sick should be carefully disinfected
according to the rules previously laid down.
5. Corpses should be wrapped in a shroud impregnated with cor-
rosive sublimate and thrown into the sea.
6. All the preventive measures taken during the voyage should be
stated in the log, which should be submitted to the sanitary authority
immediately on arrival in port.
7. The measures should be applied to everything that has been in
contact with the sick, irrespective of the gravity and result of the
illness.
III.—Measures to be taken on arrival.
1. If the ship is infected, the persons attacked should be disem-
barked and segregated in a place set apart for the purpose.
Those who have had access to the sick should be considered as
suspected.
2. All contaminated objects and articles, such as clothes, bedding,
mattresses, carpets, and other articles which have been in contact
with the sick, the clothes of those who have been in attendance on
them, the articles in the patients' cabin, and in any cabin and on the
deck, or parts of the deck where the sick have been placed, should be
disinfected.
CHAPTER V.
Administration and Control.
Powers of the Constantinople Board of Health (Red Sea—Persian
Gulf—Perso'Turkish, and Russo-Turkish frontiers).
I. The execution and control of measures against the spread of
plague, prescribed by this Convention, are entrusted, in exercise of
the powers of the Constantinople Board of Health, to the Committee