NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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(a) The early recognition of the disease.
(1) Rules 5—10 of the Rules * printed in G.O., No.
522-M., dated 13th March 1897.
(2) Mufassal Regulation 17 of the Regulations † issued
in G.O., No. 2830-M., dated 17th December 1897, as revised
by G.O., No. 466-P., dated 13th May 1898.
(3) Mufassal Regulations 6 and 7 of the Regulations ‡
issued in G.O., No. 93-P., dated 26th February 1898.
(4) Quarantine Regulation 15 of the Regulations §
issued in G.O., No. 745, Marine, dated 23rd August 1897.
(b) The treatment of the sick in places of segregation.
(1) Rules 18 and 24 of the Rules * printed in G.O.,
No. 522-M., dated 13th March 1897.
(2) Mufassal Regulations 3, 14 and 14-A of the Regala-
tions † issued in G.O., No. 2830-M., dated 17th December
1897.
(3) City Regulations 11 and 12 of the Regulations ¶
issued in G.O., No. 2830-M., dated 17th December 1897.
(4) Regulations 5, 17 and 19 of the Regulations ‡ issued
in G.O., No. 93-P., dated 26th February 1898.
(5) Regulations 15, 21 and 22 of the Regulations §
issued in G.O., No. 745, Marine, dated 23rd August 1897.
(6) Regulation 6 of the Regulations || issued in G.O.,
No. 879, Marine, dated 16th October 1897.
(c) The removal of the other inhabitants from the infected
house, locality or area.
(1) Mufassal Regulations 3, 6, 14, 14-A and 23 of the
Regulations † issued in G.O., No. 2830-M., dated 17th Decem-
ber 1897.
(2) City Regulations 4, 11, 12 and 14 of the Regulations ¶
issued in G.O., No. 2830-M., dated 17th December 1897.
(3) Regulations 5, 17, 19, 20, 22, 23 and 24 of the
Regulations ‡ issued in G.O., No. 93-P., dated 26th February
1898.
(4) Regulation 22 of the Regulations § issued in G.O.,
No. 745, Marine, dated 23rd August 1897.
(5) Regulation 6 of the Regulations || issued in G.O.,
No. 879, Marine, dated 16th October 1897.
* Printed on pages 73 to 82.
† Printed on pages 24 to 40.
‡ Printed on pages 41 to 57.
§ Printed on pages 58 to 66.
|| Printed on pages 66 to 72.
¶ Printed on pages 10 to 23.
104
(d) Their segregation for a specific period.
(1) Mufassal Regulations 3, 6, 14 and 23 of the Regula-
tions * issued in G.O., No. 2830-M., dated 17th December
1897.
(2) City Regulations 4, 11, 12 and 14 of the Regulations †
issued in G.O., No. 2830-M., dated 17th December 1897.
(3) Regulation 5 of the Regulations ‡ issued in G.O.,
No. 93-P., dated 26th February 1898.
(4) Regulations 15 and 19 of the Regulations § issued in
G.O., No. 745, Marine, dated 23rd August 1897.
(5) Regulation 8 of the Regulations || issued in G.O.
No. 879, Marine, dated 16th October 1897.
(e) The disinfection of their persons, clothing and personal
effects.
(1) Mufassal Regulations 21, 21-A and 29 of the Regula-
tions * issued in G.O., No. 2830-M., dated 17th December 1897.
(2) City Regulation 7-A of the Regulations † issued in
G.O., No. 2830 M., dated 17th December 1897.
(3) Regulations 5, 19, 20, 22, 24 and 35 of the Regula-
tions ‡ issued in G.O., No. 93-P., dated 26th February 1898.
(4) Regulation 25 of the Regulations § issued in G.O.,
No. 745, Marine, dated 23rd August 1897.
(5) Regulation 6 of the Regulations || issued in G.O.,
No. 879, Marine, dated 16th October 1897.
(/) The disinfection of the houses in the infected locality and
their contents.
(1) Rule 19 of the Rules ¶ printed in G.O., No. 522-M.,
dated 13th March 1897.
(2) Mufassal Regulations 6 and 11 of the Regulations *
issued in G.O., No. 2830-M., dated 17th December 1897.
(3) City Regulations 4 and 5 of the Regulations † issued
in G.O., No. 2830-M., dated 17th December 1897.
(4) Regulations 19 and 22 of the Regulations ‡ issued in
G.O., No. 93-P., dated 26th February 1808.
(5) Regulation 23 of the Regulations § issued in G.O.,
No. 745, Marine, dated 23rd August 1897.
* Printed on pages 24 to 40.
† Printed on pages 10 to 23.
‡ Printed on pages 41 to 57.
§ Printed on pages 58 to 66.
|| Printed on pages 66 to 72.
¶ Printed on pages 73 to 82.
105
(g) The improvement of the ventilation of homes, the abate-
ment of over-crowding and the prosecution of general measures of
sanitary reform.
(1) Rules 8, 9, 10 and 11 of the Kales * printed in G.O.,
No. 522-M., dated 13th March 1897.
(2) Mufassal Regulations 5, 6, 7, 8, 9, 10, 11, 12, 13,
20, 24, 25, 26 and 27 of the Regulations issued † in G.O.,
No. 2830-M., dated 17th December 1897.
(3) City Regulations 2, 3, 4, 5, 6, 7, 10, 14, 15, 16, 17
and 18 of the Regulations ‡ issued in G.O., No. 2830-M.,
dated 17th December 1897.
(4) Regulations 4 and 26 of the Regulations § issued in
G.O., No. 745, Marine, dated 23rd August 1897.
3. Paragraph 3 of the Resolution.—The mortuary returns
received from rural tracts are believed to be at present so
imperfect that little reliance can be placed upon them for
purposes of comparison, so that no object would be gained by
making them weekly, supposing this could be done with the
existing establishment. For detecting the existence of plague
in villages special reports prepared by the local authorities
from local knowledge seem preferable and should be submitted
accordingly under clauses 5 and 11 of the revised Mufassal
Regulation † 17 issued in G.O., No. 466-P., dated 13th May
1898. As regards municipal towns the case is different, and
weekly returns will be useful and should be submitted hereafter.
The co-operation of the residents in discovering cases of sick-
ness (Bombay Rule 8) should be secured as far as possible, and
the returns should be checked in the manner suggested in
Bombay Rule 4 or in such other ways as Collectors may con-
sider preferable with reference to local circumstances. Bombay
Rules 6 and 20 correspond to the revised Madras Mufassal
Regulation † 17 (G.O., No. 466-P., dated 13th May 1898) which
provides for a complete system of observation of persons arriv-
ing from plague-infected tracts ; but in the event of an actual
outbreak of plague the more elaborate procedure prescribed by
these rules should be adopted. As regards the legal obligation
referred to in Rule 9, the provisions of Mufassal Regulation †
1 and 17 (G.O., No. 2830-M., dated 17th December 1897),
City Regulation ‡ 1 (G.O., No. 2830-M., dated 17th December
1897), and Additional Regulation || 17 (G.O., No. 93-P., dated
26th February 1898), seem sufficient.
* Printed on pages 73 to 82.
† Printed on pages 24 to 40.
‡ Printed on pages 10 to 23.
§ Printed on pages 58 to 66.
|| Printed on pages 41 to 57.
14
106
4. Paragraph 4 of the Resolution.—Original Mufassal Regu-
lation 25 * and City Regulation 16 † deal with the mode of
disposal of plague corpses. They in no way interfere with
the religious customs of any class of Her Majesty's subjects, but
merely authorise the local authorities to insist on certain neces-
sary precautions as to the routes to be taken by funeral proces-
sions and as to the place and manner of burial. Under the first
part of Regulation 16 ‡ of the Regulations issued in G.O., No.
93 P., dated 26th February 1898, the Collector may require in
respect of any particular area that the certificate of a Medical
officer shall be obtained showing the cause of every death within
two hours after such death, but no one will be compelled to
allow the inspection of the corpse of a deceased relative. In the
event, however, of a certificate not being produced or inspection
invited, it may be presumed that the death has been caused by
plague and the rules regarding segregation may be enforced.
It must be clearly understood that the examination of the
corpses of women must be made by women, and that Additional
Regulation 16 (G.O., No. 93 P., dated 26th February 1898)
should not be put in force unless and until it is found that the
people are concealing deaths from plague.
5. Paragraph 5 of the Resolution.—All Collectors will now
report whether the instructions contained in rule 3 § of the rules
printed in G.O., No. 522 M., dated 13th March 1897, for the
division of municipal towns into circles have been carried out,
and how many European officers and of what classes will be
required for each town should plague break out. They should
see how far the recommendations regarding the employment
of certificated Sanitary Inspectors (G.O., No. 4 M., dated 3rd
January 1897) have been complied with in each municipality,
and that a stock of disinfectants is maintained as required by
rule 4 § of the rules printed in G.O., No. 522 M., dated 13th
March 1897. The Sanitary Commissioner will report if the
quantities of disinfectants prescribed in this rule should be
increased in any municipal town.
6. Paragraph 6 of the Resolution.—Collectors should take
every opportunity of explaining to the people that the segrega-
tion of plague-stricken patients and of those who have been in
immediate contact with them is found by experience to be a
measure absolutely necessary to stamp out the disease, especially
in its early stages, and that Government seeks to enforce it only
because other measures without it are not of much avail. In
* Page 37.
† Page 16.
‡ Page 46.
§ Page 75.
107
doing so, Government desires to meet every reasonable wish of
the people and to interfere as little as possible with their habits,
feelings and prejudices. They will be permitted, and should be
encouraged and aided, to erect their own hospitals and their own
segregation huts in sites shown to them or selected by them and
approved by the authorities. Friends and relatives will be
allowed to visit the patients, and, if desired, to reside near
them. They can have their own food and they can bring their
own doctors. Every arrangement will be made to respect the
privacy of women. No particular mode of treatment will be
forced upon any one, and women will, under no circumstances,
be required to be examined by men. All that will be required
of the people when plague breaks out is that they should vacate
the infected houses or locality and reside temporarily at a place
shown to them subject to certain sanitary restrictions until the
disease has passed away. During their absence their houses and
such of their property as may be left behind will be taken care
of by Government. Adequate compensation will be paid on the
spot in the case of poor people for articles condemned by the
sanitary authorities. In exceptional cases, where a house is
situated in the midst of a spacious compound and where no
sanitary objections exist, the sick and the other inmates of the
house will be permitted to be segregated under shelter within
the compound, provided they vacate the house to be disin-
fected. In the North-West Provinces' districts of Kumaun and
Garwhal, where plague has existed for a long time in an
endemic form, the villagers have learnt by experience that
evacuation of the plague-infected locality is their best chance of
escape, and it is now their common practice to vacate the village
as soon as plague appears and to camp on the hill sides (page
93, Vol. I., Nathan's Plague in India). It is desirable that each
class or caste of persons in towns should arrange with the district
authorities for sites for hospitals and segregation camps and
organize measures at once to keep everything ready for erecting
them without delay when necessity arises. Collectors will
make it their duty to give them every assistance.
G.O., No. 333 M., dated 1st
March 1897.
G.O., No. 367 M., dated 4th
March 1897.
G.O., No. 2621 M., dated
26th Nov. 1397.*
7. Paragraph 7 of the Resolution.—The results of inocula-
tion with M. Haffkine's prophylactic have
been published from time to time and so
far have been very encouraging. Not
only is the percentage of attacks reduced,
but the case mortality is materially les-
sened. These facts are for the people themselves to consider,
* Vide also G.O., No. 485-P., dated 16th May 1898 ; Notification No. 436, Fort St,
George Gazette, dated 27th May 1898, Part I-A, pp. 134-136.
108
It will be left entirely to them to decide whether they will or
will not adopt the system. If they should determine to do so,
the officers of Government should afford every facility in their
power to those who wish to be inoculated.
8. Paragraph 8 of the Resolution.—The matters referred to
in this paragraph are sufficiently provided for in the Madras
Regulations, and the Bombay rules dealing with them should be
taken as subsidiary suggestions for adoption subject to modifi-
cations according to local circumstances.
9. Paragraphs 9—12 of the Resolution.—The principles
enunciated by the Government of India on the subject of
quarantine are those which have actuated the framing of the
Madras Plague Regulations. This Government has always
endeavoured to substitute observation for quarantine. Under
this system all travellers except those found or suspected to be
suffering from plague or considered " suspicious " are allowed to
move freely, provided they report to the authorities their move-
ments for a period of ten days after arrival from an infected
area and present themselves daily for examination during that
period.
10. The measures explained above apply to all alike with-
out distinction of class or rank. Their sole object is to prevent
the importation of plague into this Presidency and promptly to
check its spread and stamp it out should it nevertheless appear.
That object can only be fully attained if the people themselves,
for whose benefit the regulations have been framed, loyally
accept them and support the action of the authorities. Hie
Excellency the Governor in Council has no doubt that in this
respect he can rely on the hearty co-operation of all classes of
the community.
109
CHAPTER VII.
(1)—INSTRUCTIONS REGARDING CONSTRUCTION, EQUIPMENT
AND MANAGEMENT OF PLAGUE HOSPITALS AND
PLAGUE CAMPS.
GENERAL DIRECTIONS.
THE principle which should guide the choice of sites, the
structure, and accessory arrangements of plague camps and
hospitals are those dictated by the necessity for preventing
the propagation of the plague bacillus. Plenty of sunlight,
plenty of air-change due to free ventilation and perflation,
dryness of the soil and its freedom from contamination by any
organic matter—more especially that derived from human
excretions and secretions—conjoined with a pure water-supply,
must therefore be important considerations when selecting a
site for, and in subsequent management of, plague camps.
Consequently, having regard to reasonable distances from the
village affected, a site should be preferred well elevated, open
to free access of wind and sun. The soil should be dry, and
have a slope that will readily carry off surface water. In the
interest of the patients as well as of attendants, a minimum
cubic space in closed wards of 2,000 feet is desirable; free
ventilation is also necessary.
2. The Government will, whenever necessary, construct
either itself or through local bodies temporary segregation
and health camps and plague hospitals and will also by grants
of money help private persons or bodies to construct them
on sites shown to them or selected by them and approved by
the authorities. It is also prepared to restrict, as far as
possible, the employment of subordinate officials of the
Medical and Police departments and to place both public and
private plague hospitals and camps in charge of native practi-
tioners so far as the public can find suitable men who will
undertake the responsibilities and can be trusted to carry out
the prescribed rules. The hospitals and camps will, however,
be under the general supervision of Government officials, but
these officials will have nothing to do with the treatment of
the sick except at their request, and their duties will be
confined to preserving order, preventing theft and keeping
guard, and attending to sanitation.
110
3. The Government has sanctioned the following rates of
contribution towards the cost of the construction and main-
tenance of private plague hospitals and segregation camps in
places which are or may be threatened with plague :—
(a) For construction, half the cost will be paid by
Government provided the charges are considered reasonable.
In any case of doubt or dispute the Government will have
the right to estimate by means of the Public Works Depart-
ment the value of the work done. The buildings shall be
erected on sites approved by the Sanitary authorities.
(b) For maintenance, grants not exceeding half the
actual expenses may be sanctioned by the Plague Commis-
sioner on the following conditions :—
(1) The arrangements for the sanitation and supply
of food must meet with the approval of the
local Medical officers and the Collector or the
President, Municipal Commission, Madras, as
the case may be.
(2) The amounts will be paid, month by month, in
arrears to the manager or managers approved
by the Collector or the President.
These grants will be met from Provincial funds.
The sale-proceeds of private hospitals to which Govern-
ment has made a contribution should be equally divided
between Government and the Plague Committee concerned.
4. In agricultural villages, District Boards may find it
cheaper to give poor people grants not exceeding Us. 3 a
household and let them make their own arrangements than to
build sheds for them. Such advances should be kept at as
low a figure as possible, and should be granted as a rule only
to those who are otherwise unable to furnish themselves with
shelter.
5. It may become necessary at any moment for Collectors
or other Plague authorities to occupy buildings belonging to
other departments than the Revenue Department, for plague
purposes. In such cases the earliest possible intimation of
such occupation should be given to the authorities in charge
of such buildings. Before occupying them, any moveable
articles in the building at all likely to retain infection should
be first carefully removed and placed under proper guardian-
ship.
6. Patients removed to hospital may use, should they so
elect, their own food and medicines. They may also be
111
attended by such number of relations and servants as the
Medical officer in charge may think reasonable. Friends and
religious instructors should be allowed to visit them. All
persons accompanying patients for purposes of rendering
attendance shall reside within the precincts of the hospital
and shall be subject to such rales as the Medical officer may,
from time to time, dictate.
7. Officers in charge of health and suspect camps may,
at their discretion, allow the inmates to leave the camps during
daytime to pursue their daily employments, taking security,
if necessary, from them or their friends for their clue return
at sunset. Persons who are allowed this freedom should be
medically examined, and their persons and clothing disinfected,
both before they leave the camp and after they return.
8. The scales of diet for European and Native patients and
their attendants who have not their own food are given in
chapter VIII. As regards persons detained in the suspect or
health camps, Europeans and Eurasians should be allowed,
according to circumstances, the " Half," " Mixed " or " Full"
diet prescribed for plague patients of their class, caste natives
the scale prescribed for caste plague patients, and other
natives the diet prescribed for attendants on plague patients.
9. An officer who, not being on leave, is unable to perform
his official duties owing to a short period of segregation on
account of plague may be treated as on duty on full pay. In
the case, however, of officers who are segregated while
returning from leave and thus overstay their leave, the
period of detention may be treated as duty on half-pay, if it
is considered that some concession is required, but officers
who are suffering from plague should be treated in accord-
ance with the ordinary rules. Officers in charge of plague
camps should give certificates of detention to officers who
may ask for them.
URGENT HOSPITAL HUTTING.
10. In dealing with the temporary isolation of one or two
patients in fair weather, pending the erection of a more sub-
stantial building, any mode that may, in the judgment of the
officer in charge, be considered to afford sufficient protection
may be employed for making huts, provided not less than a
superficial area of 12 feet square is secured per patient.
SEMI-PERMANENT HOSPITALS.
11. In the case of municipalities, and of special castes or
classes of persons erecting private hospitals, it is advisable,
112
where funds and time are available, that the floors should be
impervious. This can be arranged for by the use above lime
concrete of Cuddapah stone-slabs cement pointed, or Portland
cement plastering. In the event of impervious floorings being
made, a small refuse water cistern should be constructed, in
which the washings of the wards can be received in disinfect-
ants.
12. The support of the structure may usefully be made of old
rails, wooden beams, or rough-hewn jungle wood, according
to resources available. The sides may be formed of bamboo
matting, or, so long as the weight of the roof is not allowed to
be upon it, the sides may be made of screen walls formed of
single lines of brick in mud or mortar between the supports,
the surface of the wall being maintained well white-washed.
The roofing may be formed of corrugated iron covered with
thatch to secure coolness, or may be made of thatch, hill grass,
paddy or cholam straw, reeds and the like convenient material.
The rectangular forms of hospitals described in paragraphs 16
—19 should be followed.
TEMPORARY HOSPITALS.
13. A typical plague hospital should have all its surfaces
smooth and non-absorbent, with the object of preventing ready
adherence of organic matter of any description and of material
containing plague microbes in particular, and of facilitating
their ready removal by ordinary cleansing and disinfectants.
This perfection cannot be obtained in making temporary hos-
pitals, but these principles should be held in mind when
choosing material and directing construction.
14. The basement should be not less than 9 inches in height.
The flooring should be formed of gravel, or, failing this, red
earth well rammed. Care should be taken to have a store of
gravel at hand, so as to replace with facility portions of the
flooring fouled by the sick. Quick-lime should not be used for
the flooring.
15. In the case of rural areas or where hospitals are
required quickly, the sides must usually be of bamboo matting.
Where this is not available, cholam stalks or reeds run together
in parallel lines, or, even small boughs of trees will, if inter-
laced, suffice. The roofing should be formed of the material in
common use for huts of a superior class in the district concerned,
and should be at a pitch of 45 degrees so as to throw off rain.
16. A single building should not be made for accommodat-
ing more than 20 patients; preferably, 10 patients should be