NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Paras. 500-04.
Hygiene and Pathology.
500. Records of vaccination.—Records of all vaccinations per-
formed and their result will be entered in—
(a) A. B. 28 (Vaccination Register),
(b) the medical history sheets of soldiers and followers.
(c)
When troops are mobilized, the results of vaccinations per-
formed will be entered
—
(i) officers in A. B. 439,
(ii) British troops on page 19 (XXII) of Part I of A. B. 64
(Soldiers' pay book),
(iii) Indian troops on page 16 of A. B. 64-M (Indian Soldiers'
pay book),
(iv) Followers on the inside of the right-hand cover of I. A. F.
K-1157 (Followers' service book).
501. Vaccination returns. —A return will be rendered half-yearly
on 30th June and 31st December on I. A. F. M-1225 in accordance
with the instructions printed thereon.
502. Source of lymph.—Vaccine lymph is procurable by book
transfer from the most conveniently situated local government vaccine
lymph depôt.
Prophylactic inoculations.
503. Persons to be inoculated. —All troops and followers and their
families should be adequately protected against the Enteric Group
of Fevers.
In the case of Cholera or Plague, protection should when necessary
be given to the same classes.
In all cases consent to inoculation is necessary. Officers com-
manding and officers in medical charge of troops will make every
endeavour to persuade individuals to be inoculated as and when
recommended.
504. Inoculation and re-inoculation. —Inoculation and re-inocula-
tion will be governed by the following principles :—
(a) T. A. B.—Persons who have never been inoculated with
T. A. B. should be inoculated with two doses, viz.,1 / 2
c . c .
and 1 c.c. with an interval of ten days between. Re-
inoculation should be carried out at 18 months intervals
by two doses of 1/2 and 1 c. c. with ten days between.
(b) Cholera. —Inoculations, when carried out, should be in 2
dos e s , vi z . , 1/ 2 c . c . a nd 1 c . c . wi t h a n i nt e r va l of t e n da ys
between.
(c) Plague. —Inoculations, when carried out, should be in 2
doses, viz., 11/2 and 2 c. c. with an interval of ten days
between.
(d) The dosage in the case of children will be as follows :
—
For children from 4 to 12 years 1/4 dose.
For children from 12 to 15 years 1/2 dose.
For children from 15 to 18 years 3/4 dose.
124
Hygiene and Pathology.
Paras. 505-09.
When for exceptional reasons of military expediency it is not
possible to give two doses of vaccine, the preliminary dose will provide
sufficient protection for a short period. If opportunity arises re-inocu-
lation will be carried out as in (a), ( b) and ( c) above if the necessity still
exists.
505. Duration of protection.—The duration of protection given by
inoculation is considered to be as follows:
—
(a) From two doses of T. A. B. vaccine 18 months.
(b) From two doses of cholera or plague vaccine-6 months.
506. Overlapping of inoculations. —In cases of emergency, e.g.,
troops proceeding on active service, cholera inoculations may be given
so as to overlap with T. A. B. inoculations, provided the doses are
properly interspaced and that the individuals to be inoculated are
in good health. In such cases, the first dose of the cholera vaccine
should be given first, and when the reaction has subsided the first
dose of the T. A. B. vaccine may be given. The second doses will
follow at intervals of 10 days respectively.
507. Rest after inoculation.—Medical officers should endeavour
to ensure that all men who have been inoculated will, except in cases
of emergency, be struck off all duties for 48 hours immediately after
inoculation.
508. Inoculations, when carried out. —Prophylactic inoculations
will be carried out at the following times:—
(a) T. A. B. inoculation.— Every quarter in March, June, Sep-
tember and December, or in the presence of an epidemic,
officers in medical charge of troops will review the in-
oculation state of all persons in their charge and will take
steps to ensure that they are protected by inoculation.
In the case of recruits inoculation should be carried out
as soon as possible after joining.
(b) Cholera.—Where cholera is endemic or recurs annually,
just prior to the cholera season ; in other areas, when
cholera is anticipated or an epidemic exists.
(c) Plague.— W h e n a n e p i d e m i c e x i s t s .
509. Records of inoculation. —A record of each inoculation per-
formed will be entered by the officer in medical charge of the troops
in—
( a) an inoculation register in which officers, other ranks, follow-
ers and families will be shown separately,
(b) the medical history sheet of soldiers and enrolled followers.
When troops are mobilized the record of inoculation will be re-
corded in the same manner as vaccinations (para. 500).
125
Paras. 510-14.
Hygiene and Pathology.
The method of recording inoculations in the documents of all ranks
and followers will be in accordance with the following examples :—
When two doses given T. A. B
. / 2 1 - 1 1 - 1 7
/ 1 1 - 1 1 - 1 7
.(signature of officer).
When one dose given
Cholera/1 1-11-17 (Signature of officer)
.
510.Returns of inoculation.—Returns of inoculation with T. A. B.
will be rendered half-yearly on I. A. F. M-1225 in accordance with
the instructions printed thereon.
511.Vaccines and Sera.—Vaccines and sera for prophylactic and
curative use, the form in which issued and their time limit of use are
detailed in Appendix XVI.
instructions for obtaining, recording and using vaccines and sera.
512.Indents.—All indents for vaccines and sera will be submitted
on the general indent form (I. A. F. Z-2091) and will be forwarded
to the A. D. M. S. district or independent brigade for approval and
transmission to the Central Research Institute, Kasauli, or—in the
case of plague vaccine only—to the Bombay Bacteriological Labo-
ratory, Parel, Bombay. Column 6 will give full reasons for the de-
mand, and column 16 will bear the designation of the C. M. A. con-
cerned.
In stations where both British and Indian military hospitals exist,
the indenting officer will be the 0. C., B. M. H. The O. C., I. M. H.,
will apply to him for all requirements of vaccines and sera. Where
an I. M. H. only exists, the O. C. will indent direct.
In cases of urgency, vaccines and sera may be demanded by tele-
gram addressed direct to the C. R. I., Kasauli, or in the case of plague
vaccine—to the Bombay Bacteriological Laboratory, Parel, Bombay
(telegraphic addresses, " Problem Kasauli" and " Research Bombay);
in such cases a post copy of the telegram, together with
a covering indent for record, will be submitted to the A. D. M. S.
district or independent brigade for countersignature and transmis-
sion to the supplying institute concerned.
513.Returns.—Os. C. hospitals will render a monthly return of
vaccines and sera on I. A. F. (Medical) 20 to the A. D. M. S. district or
independent brigade area who will forward in duplicate a
consolidated return for the district or independent brigade to the
D. D. M. S. command who will forward one copy to the
D. M. S.
514.Stocks.—Curative vaccines will not be stocked in military
hospitals, but will be obtained as required.
Small stocks of sera, and—when considered necessary by the
A. D. M. S. of the District—small emergency stocks of prophylactic
126
Infectious Diseases.
Paras. 515-18
vaccines may be maintained. Endeavour should be made at all times
by carefully spacing indents to ensure that sera and vaccines are
expended as far as possible before the original date of expiry.
A reserve stock of 120 c. c. of anti-meningococcic serum will be
maintained for emergency use in all stations in India where troops
are located. This reserve stock will be kept at one hospital only
in each station and in those stations where both British and Indian
military hospitals exist, the responsibility for its maintenance will
rest with the Officer Commanding British military hospital.
The stocks will be stored in ice chests and fresh supplies will be
telegraphed for from the Director, Central Research Institute, Kasauli,
whenever the stock is drawn upon.
Arrangements will be made by A. Ds. M. S. districts that when
B. M. Hs. in hill stations are closed at the end of the hot weather
any vaccines and sera remaining are sent to selected hospitals in the
plains where they may be utilised as occasion arises.
Special duties in connection with infectious disease.
NOTIFIC1ATION.
515. Notifiable diseases.—Acute poliomyelitis, anthrax, cerebro-
spinal fever, chicken-pox, cholera, diphtheria, dysentery, encephalitis
lethargica, enteric group of fevers, epidemic influenza, measles (unless
A. D. M. S. directs otherwise), plague, epidemic pneumonia, relapsing
fever, scarlet fever, small-pox, typhus.
516. Procedure.—When one of the above infectious diseases is
diagnosed amongst troops, followers or families, the medical officer who
makes the diagnosis will prepare A. F. A-35 in accordance with the
instructions in the book of Army Forms A-35.
517. Diseases to be notified by telegram.—On the occurrence of a case
of cholera among any of the classes mentioned in para. 516, the A.D.M.S.
district or independent brigade area will be notified by telegram which
will be repeated to the D. D. M. S. Command, to the D. M. S. in India
and to the Director of Public Health of the Province.
The following information will be given :-
(a)Disease.
(b)Date of occurrence.
(c)Status and unit of patient.
(d)Number of deaths since last report.
(e) Whether the disease is prevalent in bazar, city or district.
The code laid down in Appendix XVIII will be used.
518. Alteration in diagnosis.---In the event of an alteration of
diagnosis becoming necessary, all those originally notified will be inform-
ed accordingly. A new A. F. A-35 will be rendered if the new diagnosis
is that of a notifiable disease.1,
127
Paras. 519-24.
Infectious Diseases.
519. Outbreaks of infectious disease among troops moving or about
to move.—(i) When any infectious or epidemic disease occurs within
a few days of the date of movement in a unit under orders to sail or
to supply drafts to sail, a telegraphic report will be sent by the O. C.
station or troops to the A. G. in India, the Q. M. G. in India, the D.
M. S. in India, and the Embarkation Commandant concerned, vide
item 115 of I. A. F. Z-2000. All relevant information will be given
and it will also be stated whether the intended draft is affected
and has been segregated or whether through special circumstances
it will be able to proceed.
When the segregation period is completed and the unit or draft
is clear of infection, the A. G., Q. M. G. and D. M. S. should be imme-
diately informed by telegram.
(ii) The action to be taken on the outbreak of infectious disease
among troops travelling by rail, or on the march, is laid down in para-
graphs 633 and 570, Regulations for the Army in India.
520. Authorities responsible for reports.—The O. C. station or troops
is the authority responsible for sending the telegraphic report laid
down in paragraph 517, but in cases where delay is likely to ensue he
may delegate this duty to the O. C. hospital concerned. Duplication
of reports is to be avoided.
521. Reports on small-pox to D. M. S. in India.—In the column
of general remarks of A. F. A-35 in cases of small-pox particular
care must be taken to report the vaccinations history and to distin-
guish between information obtained from documents and from the
man's statement. The results of all vaccinations should be given,
the number and size of scars, and the marks of a previous attack of
small-pox noted if present.
522. Special report on fevers of the enteric group.—In addition to
A. F. A-35 submitted for these diseases a special report on each case
of fever of the enteric group will be submitted on A. F. I-3056 in
accordance with the instructions thereon.
523. Manuscript reports.—Infectious diseases other than those
enumerated in paragraph 515 will—if occurring in epidemic form—
be reported in manuscript to the A. D. M. S. by the O. C. hospital
concerned weekly or as may be directed by the A. D. M. S. The
A . D . M . S . w i l l k e e p t h e D . D . M . S . c o m m a n d a n d t h r o u g h h i m t h e
D. M. S. informed of the progress of such epidemies.
Should the infectious diseases detailed in paragraph 515 or other
infectious diseases occur in epidemic form among the civil population
in localities adjacent to those occupied by troops and be considered
likely to spread to the troops, manuscript reports will be made to the
A. D. M. S. as in the first part of this paragraph by the senior executive
medical officer of the station.
5 2 4 . L o c a l c o m m a n d e r s t o b e k e p t i n f o r m e d . — T h e O . C . h o s p i t a l
concerned will keep the O. C. station or troops informed of the occur-
rence and course of any outbreak of infectious disease within the
128
Infectious Diseases.
Paras. 525-32.
latter officer's command. Similarly administrative medical officers
will supply G. Os. C. with all necessary information.
525. Other stations to be informed.—Where considered advisable,
stations on the same traffic route as, or which receive supplies from,
an infected station will be kept informed of the occurrence and pro-
gress of epidemic disease by the O. C. station or troops.
General management of infectious diseases.
526. Responsibility of medical officers.—As soon as a case of in-
fectious disease is diagnosed (provisionally or finally) the medical
officer making the diagnosis will inform the O. C. hospital concerned.
With the latter officer will rest the responsibility for representing to
the proper quarter the precautions which it is necessary to take as re-
gards isolation and disinfection. He will also take immediate steps
to trace the source of the infection.
527.Responsibility of local commander.—The O. C. the station or
troops will direct the measures to be taken in connection with the
troops and will arrange, if necessary, for the exercise of the power
given under the Cantonment Act for dealing with outbreaks of in-
fectious disease.
528.Prevention and control of infectious diseases.—Appendix XIX
is intended to serve as a guide in the prevention and control of infec-
tious diseases, and in the preparation of special reports thereon.
529.Isolation.—Isolation and segregation of contacts, when
necessary, will be carried out all in cases of infectious disease. Where-
ever proper accommodation exists, isolation will be effected in hospital,
but where this is impracticable, as frequently happens in the case of
officers and their families and amongst the families of soldiers, isola-
tion will be carried out in quarters or tents, as far as possible. When
considered necessary, the isolation of other occupants of the quarters
will also be effected, until in the opinion of the medical officer all risk
of their spreading the disease has ceased.
Sick may also be isolated in buildings, grass huts, or the oldest
suitable tents procurable without prohibitive delay or expense, as may
be recommended by the 0. C. hospital concerned.
530.Isolation in civil hospitals.—Where adequate isolation ac-
commodation is not available in a military hospital and such accom-
modation is available in an adjacent civil hospital, cases of infectious
disease requiring admission to hospital may be admitted to a civil
hospital in accordance with the rules laid down in Section III—
Medical Attendance.
531.Transport of infectious cases.—A conveyance used for trans-
' porting an infectious case will be disinfected immediately after use
(vide paragraph 550).
532.Infectious diseases and attendance at school.—In cases of
infectious or contagious disease special care will be taken to prevent
children of the affected family attending school until the medical
129
Paras. 533-37.
Infectious Diseases.
officer certifies that they can do so without risk of spreading infec-
tion. Schools will not, as a rule, be closed in consequence of the
occurrence of cases of infectious disease, but, should the outbreak
assume an epidemic form or should the medical officer, for any special
reason, deem it necessary that the schools should be closed, the dis-
trict or brigade commander concerned will order their closure.
•
DISINFECTION.
533.General Instructions.—In all cases of communicable disease
the question of disinfection must be considered in regard to (1) the
quarters occupied by the patient before removal to hospital and their
contents, (2) the patient's discharges, and the bedding, clothing,
feeding utensils, etc., used by the patient while under treatment, and
(3) on the recovery of the patient, the ward or room in which the
patient was treated and its contents. The appropriate measures of
disinfection are indicated in the succeeding paragraphs.
In regard to (1) and (3) above the disinfection will be " local "
or " complete ". as indicated for diseases or groups of diseases in para-
graph 554.
In the case of carriers or contacts, disinfection will be carried
out at the discretion of the officer in medical charge of the individual.
534.By whom carried out.—All measures of disinfection (except
as mentioned in paragraph 549 (c)) will be carried out by the medical
authorities assisted by such working parties from the troops as may
be considered necessary.
535.Supervision.—It cannot be too strongly emphasised that the
efficiency of any method of disinfection depends entirely on the in-
telligence with which it is performed. All such processes will there-
fore be carried out under the directions of a medical officer or a member
of the I. M. D,
536.Materials.—The scale of authorised disinfectants is given
in E. R., India, and the efficient strength in Appendix XX of these
Regulations.
537.Disinfection of barrack rooms or quarters.—Disinfection will
be either " local " or " complete " as indicated in paragraph 554.
Local disinfection will consist in the disinfection of the bedding
and bedstead recently occupied by the patient ; the walls, floor and
other surfaces for a distance of 6 feet all around the bed; also of all
articles within this area, including the equipment shelf or locker and
its contents. In certain diseases disinfection of the adjoining beds
and bedding which come within the area indicated above will no t be
necessary ; such diseases are noted in paragraph 554.
Complete disinfection will consist in the disinfection of the whole
room and its contents.
A room of less than 200 square feet will always require complete
disinfection.
130
Infectious Diseases.
Paras. 538-41.
538. Disinfection of a room.—In the disinfection of . a room the
surfaces of the room and the contents of the room must be considered
separately, and the procedure will depend on whether the disinfection
is to be local or complete.
(a) As regards the room, in local disinfection, the area of floor
space defined in paragraph 537 and the skirting bordering
on it will be scrubbed with 21/2 per cent. cresol solution, and
the bedstead, equipment shelf or locker and any other
metal, or wooden articles or articles of crockery located
within that area will be similarly treated.
-
(b) In complete disinfection all surfaces of the room and all
articles in the room other than those which are to be re-
moved for steam disinfection, or which may be injured
by formaldehyde solution and will consequently require
removal for special disinfection will be disinfected in
situ by formaldehyde solution.
539. Procedure in complete disinfection of rooms.—The operator,
before commencing the disinfection, should put on a suit of overalls,
which will be removed after use and placed inside the last room to
be disinfected.
With the exception of those articles removed for special disinfection
as indicated in paragraph 538 (b), all articles, including the contents
of boxes, drawers and cupboards, will be arranged in such a manner as
to expose all surfaces to -the action of the disinfectant. The room
should be sealed up by gummed paper strips, or ordinary glazier's
putty rendered plastic by the addition of a little linseed oil. The putty
should be applied to all crevices and placed around the jambs of the
door in readiness for closing. The fire-place should be sealed with a
piece of paper cut to the necessary size and fixed by putty pressed
around the edges.
540. Application of the formaldehyde solution to a room.—Formal-
•dehyde solution used in the form of a spray acts by direct contact
of the dissolved formaldehyde and by volatilization of the gas from
wetted surfaces. The solution must be applied as a fine spray (the
finer the I. etter) to every object in the room and to the whole of the
floor, walls and ceiling. The walls must be sprayed from below up-
wards, the process being carried out twice in the most complete manner,
inch by inch, over the entire surfaces it is intended to disinfect. When
the spraying is completed the door should be sealed as described above
and the room kept closed for six hours.
541. Subsequent procedure.—On opening the room at the end of
six hours after the above process of disinfection, the room will be
spring cleaned by damp dusting. The floor, window-sills and all other
horizontal surfaces, other than the ceiling, also tables, chairs, bed-
steads and other articles of furniture which will not be injured
thereby will be cleaned with soap and hot water containing soda,
The windows will be opened wide top and bottom to flood the room
with fresh air and sunlight and fires will be lighted to dry the room
before it is re-occupied.
131