NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
113
the standard. Whether or not the patients should be accommo-
dated in double rows will depend upon the nature of the material
obtainable locally. As the amount of superficial or floor space
per patient must not be less than 12 × 12 feet, the breadth of
such a ward would be 24 feet, and for ten patients the length
would be 120 feet. This would necessitate the use of beams,
giving a span of 24 feet.
17. In many temporary rural plague hospitals, therefore, it
may be found necessary to accommodate single rows of patients ;
allowing them sufficient room for convenient nursing, the breadth
of the single rectangular ward should be not less than 16 feet,
and the length—12 feet multiplied by the number of patients
for whom the shed is intended.
18. The eaves should be 9 feet high. The side walls
should extend up to 6½ feet; above this height, the whole length
of the shed should be open. The opening of 2½ feet all round
should, however, be protected by a thatched verandah extend-
ing to 5 feet from the ward walls, supported on poles 7 feet in
height, and with the thatch projecting beyond the 5 feet to the
extent of 2½ feet; at regular intervals between each bed flap
windows in each side wall of the shed 3 × 3 feet should be
formed, so as to be exactly opposite each other.
19. Where it is difficult to obtain hutting material, and
economy must be studied, the verandahs may be dispensed with.
In this case, the opening between the eaves and the wall should
be protected by flaps formed of matting throughout the length.
These flaps should be supported on bamboo, so that, in the
presence of rain, the interior shall be protected. The flap
windows should also be omitted.
20. Circular buildings may also be employed. These are
economical, convenient for effective administration, and offer
less obstruction to perflation of camps than the rectangular
form. The only difficulty in making this form is that the ser-
vices of a blacksmith are required for the making of one part of
the structure, viz., the bracket, on which rests the roofing.
Thus, in making a circular shed of 25 feet diameter which will
give 2,000 cubic feet per head for three persons, a palmyra or
cocoanut palm tree is selected of 24 feet height. Of the tree, 4
feet may be sunk in the ground surrounded with concrete, or
firmly packed with stone. Near the top of the centre pole is
placed a circular iron bracket, which is secured by iron bands.
On this, bamboos intended for the roofing are placed, each one
having a projecting piece fastened to it at right angles. The
bamboo or jungle wood posts used for the side walls supporting
15
114
the external ends of the roofing should be 8 feet from the
ground to the eaves. The walls should be formed of matting ;
2 feet from the eaves, a space should be left in the side walls
open throughout. Thatched roofing should be used in the
ordinary manner. This should project 2 feet beyond the
eaves, so as to protect the open space. The entrance door
should have a special pent porch roof at right angles to the
main roofing. Opposite the main door and at the two sides,
the side matting may be made so as to form doors capable of
being supported on bamboo props in fine weather, and closed
during rain. The opening over the circular bracket should
be guarded by a pent roof structure, having a space pro-
tected by its projection from entrance of rain. This forms an
admirable ventilator. An intelligent village artizan ought also
to be able to make two ventilators in the roof itself, which can
be protected by bamboo matting flaps from entrance of rain.
These can be made moveable by attaching strings, but the
formation of these extra ventilators should not be attempted
unless the requisite skill is available.
21. The internal surface of mat walls may be, and, after
occupation by plague cases, should be, whitewashed. Daubing
with earth or cow-dung should be prohibited.
22. In the case of wards intended for Europeans, there
should be approached by a small thatched covered verandah, a
room having an impervious space of not less than 6' X 10', that
may serve as a bath-room. A cistern should be attached to
catch waste water.
For natives, there should be formed bathing platforms for
each sex. Where time will allow, the flooring and the cisterns
to which waste water from them is led should be rendered
impervious. Where time does not allow of these arrangements,
the water should be led into a small excavation, which should
be carefully disinfected at intervals. These bathing spaces
should be protected so as to provide for decency.
23. A latrine should be provided for each sex. If time
allows, the surfaces and receptacles should be of impervious
material.
24. Huts at the rate of one for each patient for whom
accommodation is provided should be supplied for the relations
of the sick, who may choose to reside in the hospital camp, with
the object of looking after the patients. A floor space of 10' X
10' will usually suffice ; a verandah of 5 feet should be attached.
The front should have a blank space for ventilation of 9 inches
115
breadth at the eaves. The verandah should project downwards
sufficiently to allow of protection of the open space
25. For every ten patients there should be erected huts for
the accommodation of four superior and four inferior menial
servants. . These may be of the same character as for " rela-
tions," but without the verandahs.
26. If nurses are attached, quarters must be provided for
them with a floor area of 12' X 12' for each, with bath-room
and cook-room attached. For each hospital assistant, accom-
modation of the same nature must be provided.
27. A cook-room, 12' X 6', should be formed for the sick
for the preparation of patients' food. This, as well as those for
the hospital assistants and nurses, should be formed of corrugated
iron so as to prevent the danger of their catching fire. A dead-
house, measuring 20' X 10', should be prepared, the side walls
being formed of corrugated iron, if available, or the lower parts
may be of wire-netting. In both cases, if corrugated iron
cannot be procured, stone slabs or any other device may be used
that will diminish in the one case the risk of fire and in the
other, of animals entering.
28. Sheds for females should be separated by reasonable
intervals from those occupied by males.
29. The general disposition of the hospital and of the
buildings attached to it should follow the plan circulated with
G.O., No. 256-P., dated 23rd March 1898.
EQUIPMENT OF HOSPITALS.
30. If "urgent hutting" or other method of isolation is
used pending the arrival of the Ambulance Staff,* the officer in
charge should see that tarred mullays containing disinfectants
for spittoons are used by the patient, and that solid and fluid
excreta are suitably received, that soiled rags are burnt, and that
special arrangements are made for the bringing of water to the
patient, without the employment of any person likely to have
been in contact with plague matter. On the arrival of the
Ambulance Staff, all requisites for hospital equipment as per
list on pages 128-133, except bazaar products, will be brought
by it.
THE SUSPECT CAMP.
31. The object of this camp is to afford shelter to persons
who, it is suspected, may be undergoing incubation of plague,
* Vide Regulations 9 and 21 of the Regulations printed on pages 41 to 56.
116
and whom it is determined to keep under observation so as to
secnre their isolation at the earliest moment in the event of an
attack. This being so, it is evident that the camp should be
arranged so that the shed occupied by a person eventually
attacked may be destroyed or disinfected with the least practi-
cable disturbance of sheds inhabited by the unaffected, and with
the least expenditure. It follows that it is better to make each
shed as small as compatible with the comfort of a single family,
which may be taken as the unit, The average family consists
of five souls. Where this is exceeded and, in consequence,
overcrowding occurs, all male adults over 12 years of age should
be provided with sleeping accommodation in huts separate from
the family.
32. Each hut should afford an area of 12 feet in length
by 10 feet in breadth. The roofing may be formed of any shape
or material that can be conveniently obtained; but a plan having
been adopted, it should be adhered to throughout the camp.
Each hut should be 20 feet distant from its neighbour in the
same line. Each line of huts should be 40 feet distant from its
neighbour. Each line should consist of four huts ; four such
lines would form a block. Each block should be 60 feet distant
from the neighbouring block. Blocks may be arranged in lines
not exceeding two deep to any length desirable. If it be
desired to make a second series of such blocks opposite to one
already formed, an interval of 100 feet should be allowed. The
second series of blocks should have huts en echelon with
reference to those opposite to it. Where economy of space is
desirable, the intervals may be reduced to one-half the measure-
ments here suggested.
33. In places where, in consequence of want of funds or
space, it is found impracticable to construct, in accordance with
Rule 32, separate detached hats, they may be replaced by large
sheds, each containing twenty rooms in rows of ten arranged
back to back. The rooms may be separated by partitions of
matting, 7 feet high, so that the space under the roof slope
will be common to all the rooms. No windows are necessary
and it will be enough to provide each room with a single door,
2 feet 6 inches in width.
34. Blocks should be distinguished by initial letters. These
should be exhibited on boards placed in front of each. Each
hut should have its number and block distinctly painted on a
board, in white letters on black ground. The boards for huts
should be large enough to allow the number of inhabitants to be
shown in chalk letters,
117
35. No camp should contain more than 1,000 inhabitants.
When more have to be accommodated, a distance of at least a
quarter of a mile should be allowed between the camps. In
this event, completely separate executive staff's should be pro-
vided for the respective camps.
36. The whole camp should be effectually fenced. Huts
for the police guard should be placed in such position that the
whole camp is under view.
37. Huts should be provided for the menial servants.
38. Attached to the "suspect" camp should be an observa-
tion ward. This should be built for accommodation of patients
at the rate of 1 per cent. of suspects. The design should be
in all respects as stated in paragraph 13 et seq. In this ward
should be placed persons who having fever or other complaints
simulating plague must await the decision of the medical officer
before transport to the plague hospital.
HEALTHY CAMP.
39. The object of this camp is to provide shelter for the
healthy and those not suspected of being subject to incubation.
The structure as stated for the suspect camp would in all
respects suit, except that no fencing need be employed. It
would, however, rest with the officer responsible to use large
huts for accommodation of several persons at a time, if it be
found impossible to meet the demand for small huts on the
family principle, on account of want of labour. In this case,
sheds should be classed for males and females, respectively.
Association in this manner is not likely to be otherwise than
distasteful except to the poorest classes, and should not be
followed unless excessive expenditure or absence of the neces-
sary labour at command requires it. Sheds on this system,
preferably of the circular form described in paragraph 20,
should be made. These sheds might be arranged in triangular
form, so that the base of the camp is exposed to the prevailing
winds.
40. Persons should be encouraged in the healthy camp to
erect their own huts, but care should be taken that old material
from unknown sources is not used in their erection. When
persons build their own huts, the site must be carefully
measured, and any attempt to exceed defined limits should be
prohibited,
118
WATER-SUPPLY fOR HOSPITALS AND CAMPS,
41. The water-supply should be secured from a source
-reliable as to its purity. When open water-sources are used,
care must be taken to prevent contamination by plague-infective
matter borne on chatties, ropes or hands. The only way to
secure this is to see that no person connected with the handling
of plague patients or the disinfection of material, is allowed to
have anything to do with the drawing of water or its distribu-
tion. In other words, specially-selected persons should be
employed. If a stream or tank, the use of impervious platforms
or special lifting apparatus designed so as to prevent contami-
nation should be arranged for. Wells should be effectually
covered in. Where pumps can be obtained and are suitable in
respect to extent of lift required, these should be employed.
If pumps are not employed, at least the water-source should
have a special guard, and the water should be lifted by use of
a metal bucket and light chain reserved for this purpose. The
water thus lifted by any of these means should be stored in
covered barrels provided with taps, or, still better, in iron cube
tanks provided with taps, On no account should the promis-
cuous plunging of vessels into water-supplies by persons in camps
and hospitals be permitted. At the same time, every facility
for the observance of caste sentiments should be afforded by
the employment of caste natives, wherever handling of vessels,
&c., is unavoidable. In towns having public water-supplies,
the extension to hospitals and camps of the supply by means of
a temporary line of pipes is advisable.
42. Where open wells are unavoidably employed, disinfec-
tion by means of permanganate of potash at intervals of three
days is desirable. In the case of tanks of such size that expense
of using permanganate of potash must be regarded as undoubt-
edly excessive, the alum process should be employed either to
the bulk if comparatively small, or to the breadth of 25 feet
from the edge, if unmanageably large.
LATRINES IN CAMPS AND HOSPITALS.
43. In camps, one latrine should be provided for every
block. If time permits, the surface should be made impervious,
If this is not feasible and earthen flooring is unavoidable, it
should be burnt over daily, and the earth should be renewed at
intervals. In hospitals and suspect camps, all excreta should
be received in impervious vessels, in which disinfectants are
ready" placed.
119
DISPOSAL Of COrPSES.
44. The clothes surrounding the corpse of a person dead of
plague should be saturated with coloured perchloride of mercury
solution—the necessity for so doing having been carefully
explained to the relatives. Cremation is the preferable method
of disposal, but great care should be taken before burning a
corpse to ascertain whether there are caste or race objections to
this being performed. If there be reasonable objection, the
corpse should be buried not less than six feet deep. It is
advisable to select a place for cremation in reasonable proximity
to the plague hospital, so as to prevent corpses being carried
through inhabited parts. If plague corpses are to be buried,
the burial-ground should be specially selected by a Medical
officer after careful examination.
GENERAL SANITARY PRECAUTIONS.
45. When disinfection of a person is to be effected, all
clothing should be removed in a shed protected from public
view. If women are treated, a female attendant only should
be present. Any useless rags should be burnt. The clothing
should be removed, and be plunged into a wooden tub contain-
ing a solution (1—1,000) of perchloride of mercury, and be
allowed to soak for 30 minutes. It should then be removed,
washed in the ordinary manner, and dried in the sun with free
exposure to the air. Suitable clothing for temporary use should
be provided. When the disinfected clothing is ready for use,
the whole body should be carefully cleansed with soapnut; but
preferably, soft soap should be employed. If the latter be
used, it should be explained to the person that soft soap is made
from vegetable oils, but its use should not be insisted on.
Except as to method of disinfection of clothing, as to which
special rules have been issued, the same procedure should be
pursued at stations where disinfection by steam is practised.
It would suffice to use the disinfecting bath in the following
cases only:—
(1) where the dirty condition of the skin of the
traveller is, on inspection, found to be of a
decidedly pronounced type;
(2) before discharge from hospital after treatment for
plague;
(3) where persons are known to have been in intimate
contact with plague cases.
120
46. The treatment of a person before admission to the
healthy camp shall be as laid down in paragraph 45. But, in
the case of the suspect, the persons may be required to throw
over the body, after careful cleansing, a solution of phenyle in
the proportion 1—100. A bath of plain water may be used
subsequently.
47. Bathing of patients admitted to hospital should be
conducted only under orders of the Medical officer responsible.
The method of disposal and disinfection of clothing just de-
scribed will, however, be applicable.
CAMP STAFFS.
48. Subordinate Superintendents of camps should be ap-
pointed as held requisite by the officer responsible. No sub-
ordinate charge should be for a larger population than 1,000.
CONSERVANCY STAFF.
49. One toti of each sex and one sweeper should be
appointed for every 300 inmates of the suspect and health
camps. For every 12 servants of the menial conservancy staff,
one peon should be employed.
CONSERVANCY ARRANGEMENTS.
50. At each camp and hospital, an incinerator should be
made. Any native mason who has seen a country " chunam
kiln," will be able to make an incinerator of mud and brick or
stone, sufficiently well for the purpose. They should be
circular structures 4 feet in internal diameter at the bottom
and 3 feet at the top.* Openings should be left at the bottom
for vents. In these, all rubbish, rags, and other destructible
matter collected from the camp site should be burnt daily. If
the plague hospital is attached to a large town, it is well to
obtain a field "Silchar incinerator." If such an incinerator is
possessed, all excreta from the suspect camp and hospital should
be burnt in it.†
51. All excreta from the hospital and suspect camp having
been received on disinfectants should be buried in pits not less
than 5 feet deep in a locality well removed from habitations
and water-supplies. Excreta from the healthy camp should be
* In rainy weather these can be provided with corrugated iron covers with protected
smoke vents.
† Vide G.O., No. 487-P., dated 17th May 1S98 ; and G.O., No. 636-P., dated 2nd July
1898.
121
treated in trenches of the ordinary breadth and depth, that is,
not exceeding 18 inches, but quick lime should be added freely
to the trench contents.
52. Care should be taken to see that no slops are thrown
on the ground in any camp. In the suspect camp and plague
hospital, all waste water other than that from the kitchen
should be received in open tarred dhobie tubs, in which disin-
fectants are already placed. Their contents should be removed
at regular intervals to trenches at a suitable distance from the
camp. In the case of the healthy camp, the inhabitants should
be required to transport all slops to trenches specially prepared
for the purpose.
BAZAARS.
53. .Arrangements should be made in the proximity of each
camp for the maintenance of bazaars. Only dealers having the
written authority of the officer in charge of the camp should
be permitted to ply their trade. It should be seen that these
persons are not inhabitants of affected villages. If the number
of persons segregated is not so large as to demand the opening
of a special bazaar, the officer in charge should make such
arrangements compatible with sanitary requirements as will
prevent inconvenience to the inmates.
PRECAUTIONS IN HOSPITALS.
54. Bottles of lysol or phenyle, and solution of perchloride
of mercury should always be placed beside conveniently
arranged basins for the washing of the hands of Medical offi-
cers, nurses and attendants, respectively. It is better not to
dry the hands with towels after disinfection.
55. All excretions and secretions and rags soiled with them
should be received into vessels already containing disinfectants.
Promiscuous spitting in the wards should be specially prohibited
—all sputa should be carefully received into small tarred
mullays or earthen receptacles having disinfectants in them.
Soiled mats should be burnt; soiled clothing should be steeped
in perchloride solution directly it is removed from hospital.
Soiled patches of flooring should be disinfected with perchloride
solution, and be replaced by fresh material.
56. Clothes used during duty in wards and disinfection
should be exposed to sun action as soon as the person has
fulfilled duty. Before washing, they should be soaked in
16
122
perchloride of mercury solution. Menial servants in wards and
disinfectors should be provided with shoes during work.
(G-.Os., Nos. 629-P., dated 30th June 1898 ; 964-P., dated 31st August 1898; 1023-P.,
dated 7th September 1898; 1196-P., dated 28th September 1898; 1245-P., dated 5th
October 1898 ; 757-P., dated 20th May 1899 ; 935-P., dated 17th June 1899 ; 991-P., dated
26th June 1899 ; 1443-P , dated 30th September 1899 ; and P.O., NOB. 102, dated
8th October 1898 ; 110, dated 8th October 1898 ; 354, dated 22nd October 1898 ; 534,
dated 5th November 1898 ; 1019, dated 27th December 1898 ; 296, dated 31st January
1899 ; 321, dated 3rd February 1899 ; 981, dated 14th April 1899.)
(2)—PLAGUE COMMISSIONER'S HINTS REGARDING THE PRO-
VISION OF PRIVATE PLAGUE HOSPITAL ACCOMMODA-
TION IN THE CITY OF MADRAS.*
1. Three means of providing private plague hospital
accommodation exist—
(a) Temporary sheds can be erected to suit the purpose
on ground sites to be approved of by the Special Medical
officer appointed by Government to be in charge of Plague
Hospitals in the City of Madras.
(b) Houses may be taken up, such houses having been
approved of for the purpose by the Special Medical officer
appointed by Government to be in charge of Plague Hospitals
in the City of Madras.
(c) A site can be selected and materials for hospital
sheds collected ready for use at a moment's notice.
2. To save initial expense and at the same time to provide
suitable accommodation, the Plague Commissioner would
suggest that, wherever possible, arrangements may be made
by a sub-committee to select suitable houses, either unoccu-
pied, or houses which can be vacated for occupation in a few
hours. The Plague Commissioner should be furnished with
the addresses of such houses. He will then arrange to have
them examined and reported upon by the Special Medical
Officer appointed by Government to be in charge of Plague
Hospitals in the City of Madras. It is, however, pointed out
that buildings will almost always require some alteration to
fit them as hospitals. It would probably save much expense
and much reduplication of staff if committees would unite
to form one large private caste hospital for the north and
one for the south, carefully equipped. A central committee
* Note.—These may also be adopted in the mufassal as far as practicable. For plar,
lists of equipment, specification, estimate forms, &c., see Plague Commissioner's
Proceedings, No. 220-A., dated 18th October 1898.