NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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the death occurred, and by posting trustworthy subordinates,
either members of the Police force or of the Revenue Depart-
ment, at all burying and burning grounds, noting similar
information. These subordinates, not being connected with
the municipality, will afford valuable aid in checking the
returns, and they will assist the Municipal authorities in
arriving at correct results.
5. In villages, the Pátils must submit weekly returns of
deaths in each village, within their respective jurisdiction, to
the Mámlatdár,* who will forward them to the Collector of the
district, after noting on each any peculiarity in the incidence
of the deaths, the mortality for the corresponding week during
the past three years, and explaining, if he can, any excess.
When the Mámlatdár is not satisfied as to the cause of any
excessive or unusual mortality, he should cause special en-
quiries to be made, and, if necessary, call in the assistance of
the nearest medical subordinate.
6. The Pátils should also be required to give notice at the
police station of the arrival in their villages of any persons
from an infected locality. The names of such persons should
be entered in a register at the police station, and they should
be kept outside the village under observation for ten days and
on no account allowed to sleep within the village site. The
cause of the death of any person who has recently been in an
infected locality should be investigated, In villages remote
from a police station the police Pátil should discharge these
duties, but the Revenue Pátil and the Kulkarni † should be
held equally responsible.
7. The returns referred to in paragraphs 4 and 5 will
show, both in towns and villages, any unusual mortality over
the average of previous years, and also the occurrence of two
or more deaths in one house or localised area when immediate
special enquiry is necessary.
8. For the discovery of cases of sickness it will be
necessary to obtain the assistance of the more respectable
residents in each quarter, street or group of houses, In any
doubtful case of sickness they could obtain the services of
the medical subordinate attached to the dispensary, or a
hospital assistant may be specially deputed to aid the
residents in the work of detection.
9. It should be made obligatory under the Epidemic
Diseases Act for the occupier of each room or house in an
infected town to notify all cases of sickness and death,
* i.e., the Tahsildar,
† i.e., the Karnam,
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occurring in the room or house occupied by him, and for
every medical practitioner practising in such a town to report
all cases of sickness and death coming to his knowledge in
the practice of his profession.
10. When there is reason to believe that cases of plague
are occurring in a town or are likely to occur, owing to its
proximity to an infected area, the town should be divided
into quarters or divisions of a size convenient for effective
supervision, and each quarter should be placed, as far as
possible, under the charge of an European official, who may
be a civil officer, taken from any department, a military or a
Medical officer according to circumstances.
11. The quarter under each officer should be sub-divided
into defined areas, which might consist of a street, a portion
of one, or a group of houses, and each of these sub-divisions
should be placed under the charge of a district or local sub-
ordinate, who may, for convenience, be called a supervisor.
With each Supervisor will be associated one or more residents
of the sub-division, who will assist the supervisor in obtaining
information regarding sickness and mortality in the areas
respectively allotted to him. Under each Supervisor will be a
gang of coolies, varying in number to suit the requirements
of each locality. The gangs working in the more populous
towns should be divided into three sections, each with defined
duties as follows:—
(a) for the detection of cases and their removal to
hospital;
(b) for the evacuation of houses and for the removal
of the inmates to camp; and
(c) for the disinfection of houses.
12. So long as plague exists in the Presidency, it is
advisable that the above organisation should be prepared for
each town and district area, Native Superintendents being
substituted for Europeans in the latter, and the members
should be ready -to act when the necessity arises. At each
town exposed to danger an observation camp should be pro-
vided where all suspicious arrivals from infected areas may
be detained for ten days.
13. It is believed that under such a scheme information
regarding all cases of sickness will be easily and readily
obtained, but should the people be unwilling to assist the
authorities, or withhold the necessary information, then it will
be advisable to organise search parties under the charge of
the Divisional Superintendent. Each search party should be
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accompanied by a Medical officer or subordinate, and by a
female, either European or native.
14. It is absolutely essential to success that all the mea-
sures mentioned above for the suppression of the disease
should be carried out promptly and effectively. To ensure
this being done all the members of the staff engaged in the
work should have a clear idea of their duties : the opera-
tions will then be conducted in a methodical and systematic
manner.
15. The Superintendent should be provided with a suit-
able office situated in his own division, where he should remain
the whole day, except at intervals for meals. The office will
be his head-quarters to which all communications should be
sent, and at which the Supervisors will make their daily
reports. He will exercise a general supervision over all the
operations and will issue orders for the necessary action to be
taken by each section of the gang of coolies.
16. No house vacated on account of plague may be re-
occupied without his sanction, and he may cause a notice to
that effect, to be affixed to each vacated house. He should
place a seal on boxes containing valuable property left in
houses which have been evacuated on account of plague.
Such property may be removed by the owner, but if he
declines to do so, it will remain at his risk.
17. Property of any value belonging to the poorer classes
which it may be considered necessary or advisable to destroy
as being infected should be appraised by two or more respect-
able natives and the value paid to the owner by the Superin-
tendent of the division. Compensation should also be given
without delay to the very poor for the destruction of cloths,
&c., which although they may be of no market value yet
serve a useful purpose to the owners.
18. After a house has been disinfected, the door will be
secured by a padlock, of which the Superintendent will retain
the key or entrance may be barred by any other effectual
method.
19. The stock of disinfectants, padlocks and all surplus
appliances for divisional use will be kept in or near the office.
20. Each Supervisor will keep a list of all residents in each
house in his sub-division. . He will inspect all new arrivals,
and will obtain information from them as to their previous
place of residence. He will, in company with the local resi-
dent appointed to assist him, visit all the houses in his sub-
division, and obtain information regarding the health of the
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different inmates, and will, on the conclusion of his rounds,
report verbally to his Superintendent the occurrence of all
cases of sickness and death and any information regarding
arrivals from infected localities. Any case of plague, and all
doubtful ones of sickness should be at once reported to the
Superintendent at his office by day, and at his house by night.
21. The Supervisor will be provided with a sufficient supply
of disinfectants ready for use, with tubs, buckets, watering
pots, one or two hand-pumps, either jet or spray, and imple-
ments required for unroofing houses and making holes in the
walls. There should also be a dooly, charpoy or bamboo
frame for the removal of the sick. It should be thoroughly
washed or sprayed with perchloride of mercury solution, either
at the hospital or sub-divisional depot after use. This is
necessary, as the same dooly may be used for carrying sus-
pected cases to the observation ward. All the above articles
should be kept in a room or yard near the centre of his
sub-division or at the Superintendent's office.
22. On a report being received by a Superintendent, of
the occurrence of a case of plague, he should at once proceed
to the house, and when he has satisfied himself that the case
is one of plague or of a suspicious nature, he will at once give
orders for the removal of the patient, either to the Plague
hospital or to the observation ward, according to the opinion
he has formed of the case. The other inmates of the house,
with their moveable property, should be taken to the segre-
gation camp, in charge of one or more policemen or other
responsible persons.
23. They will be supplied with passes by the Superintend-
ent admitting them into hospital and camp. These passes
after countersignature by the Medical officer or the officer at
the camp will be returned through the policemen to the
Superintendent.
24. After evacuation of the house, the walls and floors of
all rooms, with their contents, except articles of food which
it is not intended to destroy, and of all enclosures, should be
thoroughly drenched with a solution of perchloride of mercury,
and in the course of two or three days coated with freshly pre-
pared limewash. All rags and refuse found in the house or
enclosure should be burned in the presence of the Supervisor.
25- The roof, if not a pucka one, should be removed, and
holes should be made in the walls to admit freely air and light
to the smaller rooms and enclosures. On the completion of
these operations, the door should be secured with a padlock.
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26. The coolies engaged in the work of disinfection, &c.,
should be provided with boots or shoes to protect their feet
from the danger of infection through abraded surfaces.
27. It may be necessary, owing to the occurrence of several
cases in the one area, to vacate a group of houses or a whole
sub-division. Should any necessity exist for the adoption of
such a measure, it should be carried out as soon as possible by
placing a cordon of police or troops around the area and remov-
ing the whole population to the segregation camp. Disinfec-
tion and unroofing of the houses to be carried out in due course.
28. Experience has abundantly proved that the evacuation
of an infected house or houses is seldom in itself sufficient to
stamp out the disease. When plague manifests itself in one
house, in an indigenous form, those in the neighbourhood
have, as a rule, already become infected, and it usually follows
that cases subsequently appear in them. It is, therefore,
always a wise and prudent course on the occurrence of an
indigenous case, not only to evacuate the one house but also
all those in the immediate neighbourhood.
29. On the evacuation of the houses in the infected areas
all the other inhabitants should be encouraged to leave the
town and any obstacles which may tend to delay their depar-
ture should, if possible, be removed. The time for prescribing
the issue of passes should be carefully considered by the
Collector, as, if the rules prohibiting departure without passes
are applied prematurely, the exodus of the inhabitants gene-
rally will be retarded, more particularly of the poorer classes,
who feel diffident about applying for passes or are too apa-
thetic to do so.
30. In a large town where the disease has become of general
prevalence, every quarter being affected, and the arrangements
for dealing with the epidemic are incomplete and defective,
measures must be taken to regulate the departure of the
population and prevent them carrying infection to healthy
areas. Every effort should in the meantime be made to provide
sufficient accommodation in huts for a large proportion of the
population.
31. In the case of villages badly infected the whole of
the inhabitants should be turned out. Villagers are accus-
tomed to erecting shelters for themselves, but, if necessary,
materials for hutting should be supplied. The sick and
suspected villagers should be carefully separated from the
healthy, and an officer should be appointed to examine the
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daily health of the population and prevent migration to
other villages.
32. Daily inspection of villages situated in the neigh-
bourhood of an infected locality should be instituted and
maintained during the outbreak, and continued for ten days
after the occurrence of the last case, with special reference
to the exclusion of refugees who should be required to camp
out.
33. A site for the hospital should be selected as near as
possible to the infected population, but a permanent building,
suitable in all respects for a hospital, may sometimes be
obtained either inside or on the outskirts of the town. It can
be easily disinfected when it is no longer required for an
hospital, and such a building would be more popular and con-
venient than huts erected at a distance from the town.
34. If a suitable building is not available it will be neces-
sary to erect huts for plague patients, for convalescents and
for the observation of doubtful cases, on the nearest site.
The hospital huts intended for females should be some dis-
tance apart from those intended for males. The size of each
hut will depend on the number of patients expected, but it is
advisable not to place a large number of patients in one hut.
A series of huts, each capable of accommodating six to twelve
patients, will be the best arrangement, and it is one which
will admit of the higher and lower castes securing separate
accommodation. Moveable mat screens should be provided
between the beds to secure as much privacy as is possible to
each patient. Every patient should be supplied with a cheap
substitute for a spittoon, and both it and the vessels used as
bed pans, should contain a sufficient quantity of an effective
disinfecting solution. The floor of the hospital huts should
be freely watered daily with the perchloride of mercury
solution, and vessels containing the same solution should
always be available for the disinfection of the hands and feet
of the native attendants.
35. One relative or friend may be permitted to attend a
patient, and a stated time should be set apart for the visits of
relatives and friends of the patients.
36. On the arrival of the patient at the hospital, all his
clothing should be removed and burnt in the presence of the
medical subordinate. Hospital clothing should then be sup-
plied. On recovery the patient may be transferred to the
convalescent ward or dismissed. In either case he-should be
given a warm bath and supplied with new clothes. The
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hospital clothing, on the discharge or death of the patient,
should be disinfected, washed and exposed to the sun for a
few hours, after which it may be again taken into use.
37. The hospital and observation wards should be sur-
rounded with a bamboo or other fence.
38. Huts for the segregation of individuals removed from
infected houses, and of all suspected persons, should, if pos-
sible, be erected at a convenient distance from the hospital
compound, and should be surrounded by a bamboo or other
fence. Individuals brought for admission into this camp
should, for purposes of cleanliness, be bathed in a solution of
carbolic acid, one to a hundred parts of water, and their
clothing soaked in a solution of one to twenty ; if there are no
children, perchloride of mercury solution may be used for the
latter purpose.
39. All the inmates should be inspected daily, either by
the Medical officer or a medical subordinate, and any case of
plague detected should be removed at once to hospital, and
doubtful cases of fever to the observation ward. If no case
occurs amongst them, after an interval of 15 to 30 days, they
may be allowed to return to their houses, if such houses have
been cleaned and disinfected and if the local authority
considers that they are fit for re-occupation, or be admitted
into the camp for healthy individuals, after a second disinfec-
tion of their clothing.
40. Both the hospital compound and the segregation
camp should be guarded by troops or police, to prevent the
egress of inmates.
41. The establishment of separate hospitals and segre-
gation camps for the reception of members of special castes
and religions should be encouraged and every assistance
should be given by the local authority for their erection and
supervision. The treatment of the patients admitted into
these hospitals may, if desired, be placed in the hands of Vaids
and Hakims and the internal management of both hospitals
and camps may be conducted by members of the caste or
religion concerned, subject, however, to the general supervision
of a European doctor where possible and control of the local
authorities and to the usual arrangements as regards guards.
42. A camp for the healthy, i.e., for the people removed
from houses not infected, should also be arranged for. All
individuals admitted into it should also be bathed and their
clothes disinfected as with admissions into the segregation
100
camp. They should be allowed to pursue their daily employ-
ments, on condition that they sleep in camp. The huts should
be numbered, inmates registered and a daily inspection made
of all the residents. If no case of plague has occurred in a
hut for 15 to 30 days, the inmates may, after a second disinfec-
tion of clothing, be allowed to return to their houses if
such houses have been cleaned and disinfected and if the local
authority considers that they are fit for re-occupation.
43. Should a case of plague occur in a hut, the patient
should be removed to hospital, and the other inmates to the
segregation camp. The hut should be removed, the site
disinfected with the perchloride of mercury solution, and the
materials of the hut should be similarly disinfected and
exposed to the sun for a couple of days, when they can be
utilized in the erection of another hut on a new site.
44. The best arrangements should be made for a plenti-
ful supply of water to the different camps. If the water-
supply to the town is conveyed through pipes, connections
should be carried into the camps. Bathing platforms at
some distance apart for the two sexes should be constructed,
and provided with surface drains for the removal of surplus
water.
45. Separate latrines for the sexes should be erected in
connection with the two camps and hospital, and they should
be well lighted with ordinary post lamps.
46. Bunniahs' shops with all supplies should be provided
for each of the camps.
47. Cases of plague imported into towns and villages, if
they are not at once discovered and isolated, will, under
existing conditions, develop new centres of the disease and
thus infect fresh localities. It is a difficult matter to detect
such cases in transit from an infected area.
48. Medical inspection of travellers by rail and road is
useful in discovering those actually suffering from the disease
or affected with the preliminary symptoms of fever, but as the
period of incubation may extend to eight or nine days, it is
evident that inspection is of no avail in detecting infected
travellers, who are in the stage of incubation. Such travellers
cannot be discriminated from the non-infected, and it is
necessary for their detection that they should be kept under
observation for a period not exceeding ten days.
49. Passengers or travellers who can produce satisfactory
evidence that they have not been exposed to infection, may be
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exempted from detention, as it frequently happens that only
one or a few places may be infected in the particular district.
The local authorities should give certificates to all persons
wishing to travel from the non-infected areas in the district,
stating that the holders (giving names, &c.) have not been
exposed to infection.
50. The period of observation may, in the case of travellers
of ascertained respectability, be converted into one of sur-
veillance at places of destination, if they give satisfactory
assurance (or furnish security) that they will report them-
selves daily to an authorised Medical officer. Lists of such
passengers should be forwarded either by wire or post to
the local authority at place of destination, and any one failing
to report may be prosecuted. The Medical officer is not at
liberty to exempt the individual from attendance without the
concurrence of the local authority.
51. The inspecting officer may, however, exercise his
discretion as to the necessity of detaining any particular
individual.
52. In addition to medical inspection at selected stations
a Medical officer or subordinate should, if available, be
appointed to travel by each train from or passing through an
infected district for the purpose of examining passengers
booking and alighting at all stations along the line.
53. The object in exercising control over the movements
of travellers from an infected area is for the general welfare
of the public and not to harass the individuals. It is hoped
that by detaining passengers from an infected area, the
healthy or non-infected will be eliminated after a few days,
and allowed to proceed on their journey. If the preparatory
measures as previously detailed for the suppression of the
disease are carried out in an efficient manner, there is every
reason to believe that restrictions on travelling will be
unnecessary.
54. Any arrangement calculated to prevent the exodus of
the healthy from an infected locality or area must tend to
produce a more virulent form of the disease and its more
rapid diffusion among the community.
55. Camps will be established, under the orders of
Government, at selected stations suitable for detention of
passengers and for the disinfection of clothing and baggage.
56. The above rules will also apply to travellers by road.
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57. For preparation of the perchloride of mercury solu-
tion for disinfection, see Appendix.
APPENDIX.
The most convenient and satisfactory way of preparing
the solution of perchloride of mercury, on a large scale, is
that which has been recommended by Dr. Maynard, now on
plague duty in Nasik.
The ingredients should be mixed in a 50-gallon cask in
the following quantities : to 77 lb. of perchloride of mercury
and 38½ lb. of pure salt add 15 gallons of boiling water, stir
well with a wooden stick, and then fill up the cask with cold
water. The solution contains one part of perohloride to 6½ of
water and one ordinary quart bottle of it, added to 25 gallons
of water—the capacity of the ordinary wooden tubs in use—
will give a strength of 1 in 1,000.
The standard solution can be carried about in quart bottles
placed in partitioned boxes, and is always ready for use with-
out further weighing or measuring.
If the solution is prepared with cold water, the perchloride
of mercury must be powdered and two parts of pure salt to one
part of perchloride added. The whole should be well stirred
until the solids are completely dissolved.
It is of advantage, for several reasons, to add one half
per cent. of crude hydrochloric acid to the solution.
Iron hoops of all casks, tubs and buckets should be dam-
mered. If iron receptacles are used they should be dammered
inside and outside.
If metal pumps are employed for distributing the solution,
they should, previous to use, be worked in vegetable oil, and
after use thoroughly cleaned in water. This will tend to
lessen the corrosive action of the mercury.
(2) — GOVERNMENT ORDER No. 396-P., DATED 27TH APRIL 1898.
Communicated to all Collectors, the President, Municipal
Commission, Madras, Surgeon-General, Sanitary Commissioner,
and Chairmen of Municipalities for information and guidance.
2. Paragraph 2 of the Resolution.—The measures referred
to in this paragraph have been already prescribed in the Madras
Regulations as summarized below :—