NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
74
sites; death may be ushered in by convulsions, delirium,
insensibility, &c.
(b) The prime cause of the disease is believed to be a
microbe found in the blood and especially in the neighbour-
hood of the enlarged glands. Its mode of dissemination has
not been fully ascertained, but there is good reason to believe
its propagation is favoured by foul soil, and that not only
the bloody discharges, but the excretions, more especially
the fæcal, demand special care as to disinfection. The rela-
tion of infection to water is open to doubt, but certain facts
have been observed that point to this being a possible
medium. The clinging of the infective agent to clothing and
rooms is more certain. Foul soil, crowded and narrow
streets, and badly-ventilated dwellings are specially favouring
causes. Eats, snakes and cats being liable to infection may
act as conveyers of the disease.
(c) It is the object of these rules, therefore, to ensure
(1) that the earliest possible information of every attack of
plague should be conveyed to the authorities, so that the
plague microbes may be at once prevented from being con-
veyed into situations in which they might spread the infec-
tion ; (2) that the microbes should be at once completely
destroyed; and (3) that medical assistance may be provided
for those who, in spite of precautions, are attacked by the
disease. They accordingly follow these three divisions.
RULES.*
1. These rules shall be applicable to all municipalities in
the Madras Presidency except Madras town.
2. Municipal councils shall be responsible for the general
carrying out of the scheme, and District Medical and Sanitary
officers for the necessary medical arrangements both in their
head-quarters and elsewhere, except in municipalities where
there are Civil Surgeons. In these, the Civil Surgeons shall
be responsible. The preventive staff referred to in Rule 12
shall be under the Medical officer designated by the District
Medical and Sanitary officer or the Civil Surgeon, as the case
may be, to carry out the necessary arrangements, or, in the
absence of such designation, under the Senior Medical officer
on the spot, while the observation staff mentioned in Rule 6
shall be directly under the Chairman.
* " These rules are ancillary to the Regulations issued under the Epidemics Diseases
dAt III of 1897, and must be read subject to the Regulations." (G.O., No. 522-M.,
acted 13th March 1897, para. 2.)
75
3. For the purpose of these rules, every municipality to
which they apply shall be divided into " circles," which
should, as far as possible, follow ward divisions so that they
may be readily comprehended. In municipalities where there
are wards containing less than 1,200 houses and a population
of less than 5,000 persons each, two or more wards may be
comprised in one circle. Three circles shall ordinarily form
a division, and in no case shall a division contain more than
four circles. Chairmen will at once map out their towns into
" circles " and " divisions," and after approval by the Col-
lector record the maps in their offices and send a copy to
the Senior Medical officer of the municipality.
4. For each division, the Chairman shall at once procure
and retain in the municipal stores not less than the following
apparatus and disinfectants, and will be responsible that these
stores are always maintained and in good condition :—
12 portable tin canisters for disinfectants.
9 lb. perhloride of mercury.
9 lb. commercial hydrochloric acid.
60 lb. carbolic acid.
600 lb. of sawdust and 600 lb. of unslaked lime.
[Note.—The prices of these articles are approximately as follow :—
One tin canister
One ounce perchloride of mercury
One ounce commercial hydrochloric acid
One lb. carbolic acid ...
One lb. sawdust
One lb. unslaked lime ...
RS.
1
0
0
0
}0
A.
8
3
2
4
1
p.
0
0
0
0
9.]
I.—Observation.
5. Should it appear to the Collector of the district that
plague imminently threatens to attack any municipality to
which these rules apply, he shall warn the Chairman of the
Council and the District Medical and Sanitary officer and the
Senior Medical officer of the town accordingly.
6. Upon receipt of such warning or otherwise receiving
information, the Chairman shall immediately appoint in each
circle of the town an observation staff consisting of an In-
spector, a peon and a toti, and in each division a Divisional
Inspector and an orderly, or such smaller establishment as
the Collector may, under the circumstances of the particular
occasion, consider sufficient. The orderly should be allowed
76
a jutka or pony to enable him to carry without delay such
orders to Circle Inspectors as may be given. The Chairman
shall, without delay, report to the Collector the date on
which these appointments were made.
[Note.—The salaries and allowances of this staff should not ordi-
narily exceed the following rates:—
Circle Inspector
Circle peon
Circle toti
Divisional Inspector ...
Jutka or horse allowance
Orderly
Jutka or pony allowance to orderly ...
RS.
15
8
7
35
15
8
7.]
7. This staff may consist of temporary hands if available
and competent. Otherwise, it should be drawn from the
existing sanitary establishment of the municipality, whose
local knowledge will be valuable. In the latter case, the
vacancies so caused should be filled by temporary hands, who
should be paid at the rates sanctioned for that establishment.
8. It will be the duty of the members of the observation
staff to constantly and systematically patrol the whole of
their circle in order to gain intelligence of the first case of
plague in it, so that immediate action may be taken. The
members of the observation staff should also be employed
in removing, with the aid of the ordinary conservancy estab-
lishment, all defects in sanitation which would favour the
propagation of plague (such as accumulations of rubbish or
stagnant sewage, absence of perflation of groups of dwellings
and ventilation of individual buildings) and should report
their action to the Chairman.
9. They should further warn the inhabitants of the circle
to adopt the precautions against plague prescribed in the
extract from Surgeon-Lieutenant-Colonel King's "Simple
Sanitary Rules" which is printed as an appendix to these
rules, and should distribute gratis and as widely as possible
copies of this, which the Chairman will keep ready printed in
the vernacular.
10. The Chairman and councillors and municipal servants
of all ranks should assist the observation staff in every way
possible, and the police in every way that is compatible with
their other duties, both in getting information of the first
attack and in removing sanitary defects in the circle.
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II.—Prevention of Infection.
11. On receipt of information under the above system of
the first attack of plague, the Chairman shall at once employ
in the circle in which it has occurred (but not in other
circles) three peons and three toties or such smaller estab-
lishment as the Collector may, under the circumstances of
the particular case, consider sufficient, and shall report to the
Collector and the District Medical and Sanitary officer the
date on which he did so.
[Note.—The salaries of the peons and toties appointed under this
rule should not, respectively, exceed Rs. 8 and Rs. 7 each per
mensem.]
12. This staff, like the observation staff, may consist of
temporary hands if available and competent. Otherwise, it
should be selected from the ordinary existing municipal
establishment, the vacancies caused in the latter case being
filled by temporary men on the sanctioned rates, and it
should be combined with the observation staff of the circle,
so that the whole may thenceforth form "a preventive staff"
to carry out the duties set forth below.
13. The preventive staff shall visit every house in which
plague has occurred and shall use the greatest care in seeing
that all sputa, vomit, fluid and solid excreta are at once
collected in separate vessels, mixed with carbolic sawdust,*
paddy husk, or other combustible matter, and, where neces-
sary, with kerosine-oil, and thoroughly, completely, and
immediately burnt on or near the premises. The burning
shall, when possible, be carried out in the presence of the
Divisional or Sanitary Inspector, but, in the absence of both,
it may be carried out in the presence of the peon—the Divi-
sional Inspector, Sanitary Inspector or peon, as the case may
be, being responsible that it is thoroughly done. The Chair-
man shall delegate to the Senior Medical officer of the town,
and to such others as may have to act under this rule, his
powers under section 231 (1) of Act IV of 1884 of entering
and inspecting houses.
14. Rags, clothes and bedding stained with vomit or
excreta, or blood passed from any part of the body, or
discharges from the nose, mouth, open sores, boils or wounds
should similarly be burnt upon the spot under the same
precautions, the danger of keeping such articles being fully
explained to the owners and full compensation in money or
* One part of carbolic acid to ten parts of sawdust.
78
kind being offered in the case of the really poor, but, where
the owners or other persons concerned so desire, articles of
clothing proved to the satisfaction of the Medical officer
appointed under Rule 2 to be of great value may be dis-
infected in such manner as he may direct. In each such
instance, that officer, by a certificate signed by him, shall
define the method of disinfection employed and certify to
its having been conducted with care.
1/2 oz. perchloride of mer-
cury.
1 oz. hydrochloric acid.
3 gallons (one small
chatty full) of water with
a * pinch of aniline blue to
colour it to prevent acci-
dents.†
15. Floors and furniture stained with vomit or excreta,
or blood or any discharge, should be dis-
infected by being thoroughly sprinkled
with a solution of perchloride of mer-
cury made up as shown in the margin.
The burning of tar and sulphur in
houses and streets should be discon-
tinued as it is inefficient as a disin-
fectant, but street drains outside the houses attacked and the
drains of these houses where possible should be flushed with
the above solution.
[Note 1.—Wooden buckets or earthen pots should alone be used for
carrying about this solution, as it destroys metal vessels, and the
packets of the solid perchloride should be labelled " Poison " in English
and the vernacular and entrusted only to the Inspectors themselves.]
[Note 2.—As the solution is highly poisonous, the greatest care
must be taken to see that drains flushed with it are not connected with
any tank or well which is likely to be used for drinking purposes.]
16. The greatest courtesy and consideration should be
used by the preventive staff to all classes in carrying out
these instructions, as the exercise of extreme tact is essential
to the success of the scheme.
17. Special measures should be taken to ensure free ven-
tilation of the room in which the patient is under treatment.
18. Removal to isolation hospitals provided for under
section 233 of Act IV of 1884 should be freely exercised.
If the patient be treated in his own house, however, the
utmost care should be taken to strictly limit the number of
persons entering the room or house to those absolutely neces-
sary for the patient's welfare. Disinfectants for washing the
hands of persons touching the patient should be available.
* As amended by G.O., No. 2373-M., dated 29th October 1897 ; Fort St. George
Gazette, dated 16th November 1897, Part I-A., page 286.
† " In cases in which it becomes necessary to entrust non-professional persons with
perchloride of mercury for use as a disinfectant, the solution should be, as. a further
precaution, mixed with crude carbolic acid in the proportion of 1 to 100." (G.O., No.
1500-M., dated 1st July 1897, para, 2.)
79
* Where the attendants are bare-footed, the feet should be care-
fully disinfected at suitable intervals daily.* Native food
vessels used by the patient would be best disinfected by
heating, till they cannot be touched directly over fire.
19. After a patient has recovered, the house, and espe-
cially the room which he occupied during the attack, should
be thoroughly disinfected. The floors should be dug up
wherever stained with plague matter and the earth burnt, or,
if this cannot be easily done, the floors should be burnt over.
The floor, the walls, the house-drains and the furniture
should also be liberally sprayed and washed with the perchlo-
ride of mercury solution above described. The walls should
subsequently be brushed with a dry broom, and be white-
washed with fresh slaked lime in the proportion of one part
of lime to five of water.
[Note.—It is most desirable that the excreta of a patient for at
least ten days after he has recovered from an attack should be carefully
collected, disinfected and carried away. These probably still contain
plague microbes. For this purpose, a Dindigul bullock lorrie costing
Rs. 50 and air-tight iron excreta drums costing Rs. 2-8-0 each may
be provided. The purchase of these will, however, be left to the option
of the councils.]
20. Rats, cats and snakes suffer from the disease. If
found alive in infected localities, these animals should be
got rid of as quickly as possible by killing them as a matter
of prevention. Where found dead, their bodies should
invariably be burnt.
21. The Chairman shall provide the Medical officer re-
sponsible for working the rules with a permanent advance of
RS. 50 per division, which shall be recouped from time to
time by bills supported by vouchers where possible.
22. The preventive staff shall continue to be maintained
in an affected circle for ten days after the last attack of
plague in it, and the observation staff in all circles or groups
of circles as the Collector may approve for twenty-one days
after the last attack in the town. During this time, they
should be employed in remedying sanitary defects.
III. — Medical Aid.
23. There shall be a head-quarters in each division at
which a medical subordinate shall reside, who shall be supplied
with medicines and medical comforts from the municipal
*--* Added by G.O., No. 1719-M., dated 4th August 1897; Notification No. 560,
Fort St. George Gazette, dated 10th August 1897, Part I-A, page 176.
80
hospital for the treatment of those attacked, and who shall
be available for attendance gratis on the sick in their own
houses. This shall also be the head-quarters of the Divisional
Inspector and of the preventive staff on night duty.
24. In one place at least in each town, there shall be
isolation huts with separate accommodation for males and
females for the treatment of those who desire it or who are
brought there. These shall be in charge of a medical subor-
dinate with the necessary staff, and supplied with equipment,
medicines and medical comforts. This subordinate shall be
deputed to no other duty. He shall reside with his staff on
the spot and shall be adequately housed.
25. Charges for medical treatment under these rules
shall be met from the allotment in the budget under Grant
3, Hospitals and Dispensaries.
26. The head-quarters of the divisions and the sites for
the isolation hospitals shall be at once selected, and shall be
marked on the maps referred to in Rule No. 3 above.
27. In order to make provision for meeting the charges
under the portions of this scheme relating to observation and
prevention, the council of every municipality to which the
scheme applies shall be required to allot in every budget
under " Epidemic charges " a sum which shall be in the
proportion of Rs. 1,000 to every 25,000 inhabitants in the
municipality—provided such provision has not already been
made under G.O., No. 1536-M., dated 9th September 1896,
when such funds shall also be applicable to the purpose of
these rules. This shall be called the " Epidemic reserve,"
and shall not be spent upon any object but the carrying of
this scheme into execution.
28. The provision of this reserve should not be allowed
to disturb the existing percentages to the total municipal
income of the expenditure upon communications, education,
sanitation, &c., or to swell the total of the allotment made
for sanitary purposes under Grants 1, 3 and 4 taken together,
but should be set aside from funds which are at present
annually expended upon sanitary works of a permanent
nature.
29. Municipal councils are hereby authorized to employ
establishments on the scales above laid down as the necessity
for them arises, and to defray the charges from the " Epi-
demic reserve " in anticipation of the sanction of Govern-
ment, but this sanction should be obtained without delay.
81
30. The Medical officer responsible for working these
rales shall, within seven days of the final withdrawal of the
special staff, forward a report on the epidemic and the opera-
tion of the rules through the Chairman of the municipality
to the Collector for the orders of Government. In cases
where the Medical officer in question is subordinate to the
District Medical and Sanitary officer or the Civil Surgeon,
such report shall be forwarded through those officers. In
every case, such communications shall be submitted to Gov-
ernment through the Sanitary Commissioner,
APPENDIX.
[EXTRACT from Surgeon-Lieutenant-Colonel King's " Simple
Sanitary Rules."]
Precautions to be observed on the approach of Plague.
A.—HABITATIONS.
1. Bach house must be thoroughly cleansed, that is, all
manure, dirty water, washings of cattle stalls and collection
of dirt of any description, must be completely removed.
2. Where the earth remains damp and foul after such
removal, it should be dug up till dry and clean earth is
reached.
3. The old earth should be taken far from the town and
may be used as manure for the fields ; new earth from a
clean place should be laid down.
4. The interior and exterior of houses should be white-
washed. If persons cannot afford to do the outside, the
inside at least should be whitewashed.
5. Bundles of clothing and other materials hanging from
the beams, or occupying in any other way the rooms in which
persons sleep, should be removed.
6. Doors and windows should at all possible hours be left
open, so that free ventilation be obtained.
7. If private latrines are used, they must be kept free
from fæcal matter by removal at least twice daily.
8. The drains leading from houses should be cleansed
twice daily.
11
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9. Cesspools and pits for receipt of urine of cattle should
be emptied daily.
B.—THE PEE SON.
1. The body and clothing should be kept scrupulously
clean. If delicate, persons should use warm, not cold, baths.
2. The food should be plain, nourishing and of good
quality.
3. All vegetables, or leaves, or fruits, likely to cause
diarrhoea, should be abandoned.
4. All forms of drinking to excess, debauchery, late hours
and exposure to wet and cold should be avoided.
5. Cold cooked food should never be used. Care should
be taken not to allow flies to settle upon food. Vegetables
and leaves should never be eaten otherwise than after cooking.
Before being cooked, they should be well washed in water
that has been purified by boiling. Salt should be freely used
with the diet; but, on the other hand, it must not be used in
such unusual amounts as to excite uneasiness or looseness of
the bowels.
6. An inferior quality of water should not be kept in the
house ; only the cleanest available should be employed.
7. Water for drinking purposes and for washing the
mouth or eating and drinking vessels, and milk, should be
boiled before use.
8. * Persons with cuts or abrasions on their hands, feet or
other exposed parts of the body should avoid attendance on
plague patients. But if attendance is essential, the wounded
parts should be covered, and on occasions of temporary with-
drawals from attendance, the parts should be washed with
disinfectants which can be obtained from the sanitary staff
on application.*
*—* Inserted by G.O., No. 1500-M., dated 1st July 1897.
83
PART II.
CHAPTER VI.
(1)—RESOLUTION OF THE GOVERNMENT OF INDIA, HOME
DEPARTMENT, SANITARY, No. 227—240, DATED THE 3RD
FEBRUARY 1898.
THE Epidemic Diseases Act (III of 1897) * empowers the
Governor-General in Council when satisfied that India or any
part thereof is visited by, or threatened with, an outbreak
of any dangerous epidemic disease, to take special measures
over and above those permissible under the ordinary law,
with the object of preventing the outbreak of such disease
and the spread of it, and further authorizes the Governor-
General in Council by general or special order to direct that
the powers conferred by the Act may also be exercised by
any Local Government with respect to the territories adminis-
tered by it. By the Home Department Notification No. 302, †
dated 4th February 1897, the Governor-General in Council
directed that the appropriate powers conferred by the Act
might be exercised within their respective territories by the
different Local Governments and Administrations in British
India, and by notifications issued in the Foreign Depart-
ment, the Agents to the Governor-General were also em-
powered to issue Regulations under the Act both in respect of
parts of British India under their charge and in respect of
territories in India under the Administration of the Governor-
General in Council which are not parts of British India. The
Government of India have themselves from time to time
issued Regulations under the Act in respect of matters in
which Imperial interests were involved or action had to be
taken by Departments under their direct control, but their
object in delegating the powers conferred by the Act to Local
Governments was to avoid hampering them in action taken
by them to prevent the outbreak or spread of the plague,
and to admit of the Regulations under the Act being adapted,
so far as this is possible without preventing them from
being effective, to local conditions and so as to respect local
prejudices. Copies of all the Regulations issued by Local
* Printed on pages 5 and 6.
† Printed on page 6.