NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Investigating, etc., of infectious disease.
Appx. XIX.
Lectures. —During the months preceding the malarial season lectures
should be given to officers and other ranks and should be accompanied
by demonstration of mosquito eggs, larvae, pupae and adults, diagrams
showing the sporozoites in the pharynx of the mosquito, etc. Per-
functory lectures are of little use, and the aim should be to teach in such
a way that every man has a real knowledge of the subject.
VII. Malaria carriers.—While malignant tertian malaria can be
cured in the great majority of cases, the effective eradication of the
parasite from benign tertian cases is notoriously difficult. In heavily
infected units systematic search should be made by examination of
blood films in order to detect carriers, and special means should be
taken to render them harmless, e.g., removal to hill stations, quinine
treatment, careful use of mosquito-nets, etc.
MEASLES AND RUBELLA.
26. Spread.—By direct personal infection : the virus dies as soon
as it is completely dry. Infectivity is greatest in the early prodromal
stage of the disease and continues until the catarrhal stage is over.
27. Preventive measures.—In the presence of an epidemic, troops
should be kept under daily observation with a view to the prompt
detection and segregation of cases of coryza. When a case of measles
occurs, contacts should be examined daily from the 7th to the 14th
day, in the case of rubella from the 7th to the 23rd day but their segre-
gation is not considered necessary. Disinfection will be carried out
as indicated in para. 554.
MEDITERRANEAN OR UNDULANT FEVER.
28. Spread.—Almost entirely by the ingestion of milk and milk
products from infected goats. Certain cheeses manufactured from
the milk of sheep have also been found infected.
29. Preventive measures .—Disinfection will be carried out as indi-
cated in para. 554. In case of outbreaks not only milk itself but
butter, cheese, and other milk products in which bacteria have not
been killed by heat require investigation. The use of any fresh milk,
or butter and cheese made from it, should be entirely prohibited in
infected areas.
The urine of patients at times contains the causative organism
and should be disinfected as a routine measure.
MUMPS.
30. Spread.—By direct " droplet " infection or by infected utensils.
31. Preventive measures.—The patient should be rigidly isolated.
This should be carried out with special promptitude in susceptible
Indian units, in which mumps assumes epidemic proportions with
extreme rapidity. Disinfection will be carried out as indicated in
para. 554.
Contacts should be medically examined daily for 22 days.
255
Appx. XIX.
Investigating, etc., of infectious disease.
Children of infected families should be kept from attending school
for 22 days.
PLAGUE.
32. Spread.—Bubonic plague is a disease of rodents, and is trans
-mitted to man by means of infected fleas. Epidemics in human beings
are preceded by high mortality in rodents. The spread of the disease
follows trade routes, infected fleas and rats being conveyed in personal
belongings and food-stuffs. Fleas have been shown to be infected for
a period of six weeks.
Pneumonic plague though caused by the same organism, is intensely
and directly infectious from man to man by means of " droplet "
infection, as in coughing, talking, etc.
Septicaemic plague also occurs. Diagnosis is sometimes difficult
owing to its rapidly fatal course.
33. Preventive measures.
—
I. Bubonic plague.—Systematic rat
destruction, rat proofing of grain godowns and food stores. Evacua-
-tion-of rat infested quarters.
Patients should be isolated, and disinfestation as indicated in
para. 554 carried out at the earliest opportunity, contacts should be
disinfected and medically examined daily for 10 days.
Men disinfesting or working in infected houses should wear over-
-alls fitting tightly at the wrists and ankles, gumboots, gauntlet-gloves
and caps. These should be disinfected and disinfested daily.
Effective measures for the treatment of quarters are as follows :—
(a) By burning mealie straw (" patai ") : the straw is spread on
the earth floor to a depth not exceeding 4 inches and is
then ignited ; the resulting sheet of flame, which does not
exceed 2 feet in height, effectively destroys all fleas.
(5) Floors may be coated with one of the following emulsions :—
(i) Hard soap, 1 lb. (or soft soap, 11/2 lbs.) dissolved in hot
water, 1 gallon, and made up to 5 gallons by crude
kerosene added gradually with continued heating
and shaking.
(ii) Cresol, 5 parts and soft soap, 20 parts, added gradually
to 75 parts of continuously-shaken hot water.
(c) Textiles may be freed from fleas by spreading flat in a tropical
sun at midday for an hour.
II. Pneumonic Plague.—Both patients and attendants should
wear masks impregnated with disinfectant. Sputum should be
received in an antiseptic solution and destroyed.
All attendants should be given 20 c. c. of anti-plague serum imme-
diately, and should be simultaneously injected with plague vaccine,
a second dose being given 10 days later. All cuts and wounds
should be carefully protected.
256
Contacts should be strictly isolated and inspected daily for at least
6 d a y s .
III. General preventive measures on an outbreak of plague.—When
plague exists in the immediate neighbourhood of troops the senior
executive medical officer must take prompt steps to obtain informa-
tion of all cases occurring. Communication between infected and
non-infected places should be restricted. Medical examination of
units should be carried out with a view to the discovery of ambulant
cases.
IV. Measures against rats, etc.—The prevalence of plague either
within a military cantonment or in the villages and towns in its vicinity
calls for the careful and thorough extermination of rats. In con-
junction with the M. E. S. and the cantonment authority every
endeavour should be made to destroy rats by trapping, and baiting.
Dead or dying rats should not be handled except with a pair of
tongs or similar appliance, and the bodies should be dropped at once
into a strong solution of cresol. The microscopical examination of
dead rats is most important as a guide to the prevalence of the disease
among them.
V. Evacuation of lines, etc.—The occurrence of plague cases among
troops must not be regarded as necessarily involving migration of the
whole unit into camp. Where the condition of the lines is bad and
such as to offer reasons to believe that the buildings contain infected
rodents, immediate evacuation is indicated, coupled with a thorough
overhaul and disinfection of all clothing and bedding.
VI. Inoculations.—The value of plague inoculation during epide-
mics must be remembered and when a number of cases have occurred
or a unit or group of units is seriously affected, every endeavour should
be made by the O.C. hospital concerned in conjunction with O.C.
units to encourage men and all likely to be exposed to plague infec-
tion to submit to the procedure. It is undesirable to press ant
i
plague inoculation on the occurrence of a single case or even a few
isolated cases in a unit. It should be invariably carried out for
persons actively engaged in anti-plague work, who also need the
same protective measures as attendants.
RABIES.
34. Spread.—The causal agent is so far unknown. It is a filter-
passing virus and remains infective for long periods in glycerin. Spread
is by the bite of rabid animals, usually a dog.
Infection is by means of the saliva, the virus being implanted
on to a nerve ending or nerve tissues by a bite or through an abrasion
of the skin or mucous membrane. The saliva of a rabid animal may be
infective for as long as 10 days before symptoms declare themselves ;
observation of the animal for a period of 10 days will always decide
whether it was rabid at the time of biting or not, as if at the end of
1 0
d a y s t h e d o g i s a l i v e a n d w e l l i t c a n n o t h a v e b e e n r a b i da
t t h e t i m e
of biting.
257
Appx. XIX.
Investigating, etc., of infectious disease.
The Incubation period in man varies in accordance with the severity
and site of the wound. In lacerated wounds of the face the incubation
period may be very short.
The incubation period varies in the dog from about 16 to 90 days.
The majority of cases in the dog show symptoms between the 25th
and 55th day after the bite. The symptoms of rabies in dogs are.
often indefinite, but it is wise to assume rabies (1) if the disease is of
short duration (2) in cases of " bone in the throat "or paralysis of the
jaw or hind legs (3) in cases of unprovoked attack especially where-
several persons are bitten.
35. Preventive m easures.—The individual patient.—Wash, dry
and thoroughly cauterise the wound. Pure carbolic acid is best, failing
this nitric acid, silver nitrate, potassium permanganate crystals, etc.
Persons bitten by rabid or suspected rabid animals in the following
circumstances should undergo anti-rabic treatment :-
(1) Persons bitten by a rabid or suspected rabid or unknown
animal.
(2) Persons licked by a rabid or suspected rabid animal on fresh
cuts or abrasions (less than 48 hours old).
(3) Persons-
(a) bitten on head or neck,
(b) badly bitten elsewhere (i.e., with many deep or extensive
bites) by any animal, whether suspected of rabies or
apparently healthy. Treatment can be suspended
later if it transpires that the animal remained alive.
and well for 10 full days.
(4) Persons bitten—or licked on fresh cuts or abrasions—but
not coming within (1), (2) or (3) above need not be sent
immediately for treatment. If the animal however falls
ill during the ten days of observation, the persons bitten—
or licked on fresh cuts or abrasions—should be treated.
(5). In any case of doubt a detailed telegram will be sent to the
Pasteur Institute asking for advice.
The animal .—All details concerning the animal will be sent with.
the patient to the Pasteur Institute (I. A. F. M-1247).
The animal should not as a rule be killed unless, or until, it shows
symptoms of rabies, but should be kept under observation. If killed,
the brain should be sent to the Pasteur Institute, similarly if at the
end of 10 days' observation the dog is fit and well the institute should
be immediately informed.
A. Inspection by Veterinary Officers.—veterinary officers will readily
give an opinion on dogs suspected of rabies, the property of officers
and soldiers, although such inspection forms no part of their military
duties. The following rules in connection with such inspections will
be carefully observed :-
(a) Suspected dogs are not to be taken to a veterinary hospital
for an opinion unless they are properly secured with a.,
258
Investigating, etc., of infectious disease.
Appx.
strong collar and chain ; full particulars such as name of
person bitten, date of bite, etc., signed by an officer should
always accompany them to enable veterinary officers to
supply necessary information to the Pasteur Institute
concerned, vide I. A. F. M-1247.
(b) No dogs will be taken to a Veterinary officer's private residence
without his permission.
(c) No suspected dogs will be kept in veterinary hospitals to the
danger of the staff and government animals. These
buildings are not adapted, nor intended for isolation
purposes, and the danger to valuable horses, etc., is serious
in the event of a rabid dog breaking loose. Neither can
arrangements be made by veterinary officers for the feed-
ing and exercising of suspected dogs.
In cases where destruction is deemed necessary the veterinary
officer will communicate with the Officer Commanding
the unit to which the owner of the dog belongs, who will
make necessary arrangements for its destruction.
For method of dealing with the brain of-a dog suspected of suffering
from rabies see Appendix XXI.
3. General measures.—These should include the licensing of all
dogs, the labelling of each dog with the name and address of its owner
and the rounding-up and destruction of all stray and ownerless dogs.
I. A. F. M-1248 should be hung up in all barrack-rooms, institutes
and hospitals. A dog or other animal which has been bitten by a
rabid animal should be destroyed. Animals suspected to be rabid
should be kept securely chained up for 10 days and be seen by a veteri-
nary surgeon.
4. Rules for the guidance of patients proceeding for anti-rabic treat-
ment to the Pasteur Institutes in India and Burma.—(i) The following
are the Pasteur Institutes in India and Burma to which patients may
be sent for anti-rabic treatment:
—
The Pasteur Institute, Kasauli.
The Pasteur Institute, Shillong (British officers and their families,
lady nurses and Indian ranks only).
The Pasteur Institute, Coonoor.
The Pasteur Institute, Rangoon.
The Pasteur Institute, School of Tropical Medicine and Hygiene,
Calcutta.
The Pasteur Institute, Lahore.
(ii) The rules governing conveyance of military patients are laid
down in Passage Regs., India. Particular attention is drawn to the rule
authorising contract second and third class passengers to travel for
anti-rabic treatment by mail train.
(iii) The despatching officer will wire commencing with the letters
A. R. T. (anti-rabic treatment) to the O.C. station and Superintendent,
259
Appx. XIX.
Investigating, etc., of infectious disease.
the Pasteur Institute, full particulars as to name, rank, sex of each
patient being despatched for treatment and will state the date and
time of arrival.
On arrival military patients will report themselves to the O. C.
station and at the Institute.
(iv) Accommodation.—British officers, their families and members
of the military nursing services make their own arrangements for
accommodation.
B. O. Rs. and their families are accommodated in barracks.
I.O.Rs. and followers and their families are accommodated usually
at the Institute—but at the Indian lines in the case of Rangoon, Shillong
and Calcutta.
Military anti-rabic treatment centres are established at the follow-
ing stations :
—
Northern Command.
Rawalpindi (and Murree)
.
Western Command.
Quetta.
Eastern Command.
Jhansi.
Southern Command.
Mhow.
Jubbulpore.
N a s i r a b a d .
P o o n a .
Secunderabad.
Colaba(Bombay).
Bangalore.
Belgaum.
Wellington.
There is no objection to the administration of anti-rabic treatment
in any military hospital selected by the Deputy Director of Medical
Services of the Command, provided that carbolised vaccine can be
obtained.
The rules concerning these centres are published in local orders
from time to time.
N O T E . — F u r t h e r i n f o r m a t i o n o n t h e P a s t e u r I n s t i t u t e s w i l l b e f o u n d i n t h e p a m p h l e t "Rabies and anti-rabic treatment in India" published by the Government Printing
Press, Calcutta.
RELAPSING FEVER.
36.Spread.—By lice or ticks. (In the case of ticks, the minute
immature forms are as dangerous as the adults.)
37.Preventive measures.—The measures described in relation to
lice, under typhus fever, are applicable to this disease. Isolation
of patients and disinfestation of clothing and bedding.
260
Investigating, etc., of infectious disease:
Appx. XIX.
SANDFLY (PHLEBTOMUS) FEVER.
38.
Spread.—By one or more species of the genus Phlebotomus.
As these insects pass the winter in their larval stage, sandfly fever is-a
disease of the summer months. The infective agent is unknown, but
is believed to be a spirochæte.
39. Preventive measures.—Destruction of the adults by flame
by swatting or by fumigation. The flies breed in low cracks in walls
and nullahs, etc. These should be dealt with in such a way as to
prevent breeding.
40.
SCARLET FEVER.
41. Spread.—By " droplet " infection and by bedding, clothing
and personal belongings, etc., occasionally by milk. The danger of
slight cases with transitory symptoms must not be overlooked.
42. Preventive measures .—Disinfection will be carried out as indi-
cated in para. 554. Isolation of convalescents should be maintained
for a minimum period of six weeks from onset, and until any nasal or
aural discharge ceases. In the presence of an epidemic, all cases of
sore throat should be isolated for three days. Contacts should be
inspected daily for ten days after exposure to infection. Cups and
other drinking utensils in huts, messes, etc., should be sterilized by
immersion in boiling water after ordinary washing has been completed.
SMALL-POX.
43. Spread.—Small-pox is intensely infectious to non-immagses.
Infection is by personal contact or by clothing, bedding and personal
belongings, etc., also probably by flies, and is said to be carried to a
considerable distance by currents of air. Convalescents are infectious
as long as any scabs or scales remain on their skins.
44. Preventive measures .—Patients must be isolated immediately
in isolation hospital, tents or huts.
Attendants and nurses should be vaccinated. Contacts should
be immediately segregated and re-vaccinated and segregated for
three weeks, unless successful vaccination meanwhile proves that
they are protected from the disease. In the presence of an outbreak
all persons suffering from fever should be isolated for four days, and
special search made for any eruptions on them of a papular or vesicular
character; the occurrence of such eruptions should call for the most
careful investigation at all times. Special attention should be paid
to the health of personnel employed, and to the conditions obtaining in
all places where military clothing is washed, made or repaired. Imme
- d i a t e d i s i n f e c t i o n i n c o n n e c t i o n w i t h s m a l l - p o x i s o f g r e a t i m p o r t a n c e ,
and will be carried out as indicated in para. 554. The clothing, bedding
and personal belongings of contacts and attendants and all tents or
other quarters used for their accommodation as well as any vehicles
which might have become infected should also be disinfected.
Infected areas should be placed out of bounds. With suspects the
complete procedure as for proved cases must be carried out.
261
Investigating, etc., of infectious disease.
TETANUS.
44. Spread.—By the infection of wounds of the tissues by fæcally
contaminated soil.
Tetanus may also occur where there is no apparent lesion of the
skin, as in trench foot; some of the most rapidly fatal cases of tetanus
during the Great War occurred in such cases, the dead epithelium
offering no bar to the entrance of spores or bacilli, and the dead tissues
affording an excellent pabulum for the growth of the organism.
Both men and animals, particularly the horse, may be intestinal
carriers of the spores of this bacillus. Thus tetanus is most prevalent
where the soil is heavily manured. In human carriers, tetanus has
'occurred after abdominal and other operations.
45. Preventive measures.—In all cases of wounds, especially those
which are contaminated with earth, prophylactic doses of anti-tetanic
serum should be given as follows:—
Units.
1. At once . . .
1,500
2. 7 days later . . .
500
3. 7 days later . . .
500
4. 7 days later . . .
500
The wound should be thoroughly cleansed and any dead tissues
removed. Before operation on old gunshot wounds it is advisable
to give a prophylactic dose of anti-tetanic serum.
TRENCH FEVER.
46. Spread.—The disease is carried from man to man by lice;
infection is introduced either by bites or by inoculation of louse excre
- m e n t t h r o u g h s c r a t c h i n g , o r b y t h e i n f e c t i o n o f w o u n d s w i t h d r i e d
louse fæces.
47. Preventive measures .—The measures for the prevention of this
disease are similar to those described under typhus fever. As it has
been shown that louse excreta may remain infective on blankets or
clothing for a period of three months or more, steps should be taken,
under conditions of active service, to disinfect such articles before they
are again taken into use or returned to store. Abrasions on the hands
of personnel employed in stores, where such articles are dealt with,
should be protected.
TUBERCULOSIS.
48. Spread.—Among adults chiefly by the spray ejected when
phthisical subjects cough, and by their desiccated sputum floating
about in the form of dust; is greatly favoured by malnutrition, over
- c r o w d i n g , p o o r v e n t i l a t i o n , d a m p a n d l a c k o f s u n l i g h t , a n d b y s u c h
practices as dry-scrubbing of barrack-rooms.
The forms of tuberculosis affecting children are frequently con
-veyed by infected milk.
Appx. XIX.
262
Investigating, etc., of infectious disease.
Appx. XIX,.
49. Preventive measures.—Disinfection will be carried out as indi-
cated in para. 554. Must be based principally ,on the early diagnosis
and segregation of cases of consumption.
General preventive measures include the cleansing of barrack-
rooms in such a manner as to obviate the raising of dust, and the
prohibition of dry-scrubbing, attention to over-crowding or defective
ventilation, especially in tents. Cases of coughs, debility or loss of
weight, especially among Indian troops should be investigated.
TYPHOID AND PARATYPHOID FEVERS.
50: Spread.—Infection may be carried in a number of ways, either
in food or water infected with the specific micro-organism by acute-
or chronic " carriers " or through the medium of flies. Sudden and,
explosive epidemics may be due to water which has been fouled by
sewage containing the specific bacilli ; smaller outbreaks and thos
e d e v e l o p i n g s l o w l y a r e m o r e c o m m o n l y d u e t o c o n t a m i n a t i o n o f f o o d .
or milk.
About 1 .5 per cent. of cases of these fevers continue to excrete
the germ for years after recovering from the disease and while in
apparently perfect health. Many outbreaks have been traced to such
chronic carriers. Cases of these diseases also occur of so mild a nature
that the persons attacked do not report sick. Such cases are potent
factors for infection as they may distribute the specific germs broad-
cast.
51. Preventive measures.—Disinfection will be carried out as indi-
cated in para. 554. The chief preventive measures consist in protective.
inoculation and in the discovery and isolation of the carrier and the.
undetected case. With this object in view all cooks, water-carriers,
dairy men and bakers will have their stools bacteriologically exam-
-ined before enlistment. Dates of examination of all cooks and
cookmates will be available for inspection in cookhouses, etc.
No one who has suffered from typhoid or paratyphoid fever or who
is proved to be a " carrier " will be employed in the preparation or
h a n d l i n g o f f o o d o r d r i n k .
Food which is stored before issue should be adequately protected
from flies and dust ; milk and butter must be especially safeguarded,
the former being a favourable medium for the growth of germs. The
safe disposal or destruction of excreta is of particular importance.
52.Classification.—(a) The classification of the Enteric group of
fevers is as follows :—
T y p h o i d F e v e r .
„
Carrier.
Paratyphoid fever " A."
, ,
,, " B."
, ,
,, " C."
, ,
„ " A " carrier.
, ,
„ " B " carrier.
, ,
„ " C " carrier.
Enteric group.
263