NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
161
CHAPTER IX.
IMPORTANT ORDERS RELATING TO PLAGUE MEASURES.
(1)—Agency for Working Plague Regulations.
Special attention should be directed to the restriction, so
far as possible, of the employment of subordinate Government
officials of the Medical and Police departments and in especial
to the advisability of working with the help of native
practitioners appointed by the people themselves. Where
subordinate native agency is used, it is absolutely necessary
that Europeans should be appointed as supervisors over small
and convenient units. Police officers should hold no inquiry
into suspicious cases of plague. Public and private hospitals
and camps may be placed in charge of native practitioners.
Medical subordinates are not required for the supervision of
disinfection work. Staff Corps officers have been found of the
greatest use and should be largely employed when the services
of Assistant Collectors are not available.
(G.O., No. 1023-P., dated 7th September 1898.)
2. As far as circumstances permit Hindus should be em-
ployed in those parts of a city where Hindus predominate,
and Muhammadans where Muhammadans are in a majority.
Small committees of the inhabitants may be appointed in
various parts of a city to bring to the notice of the authorities
matters requiring attention or inquiry.
(G.O., No. 1196-P., dated 28th September 1898.)
(2)—Evacuation of Infected Houses and Segregation.
When plague breaks out, the segregation of the sick and
of the persons who have been in immediate contact with them
is a fundamental precaution which is essential to the success-
ful issue of any operations against it. Experience has shown
that in order that segregation may be efficacious, it must be
carried out in hospitals or other suitable places specially
appointed for the purpose. To enable this measure being
carried out without prejudice to the feelings and habits of the
people, the Government has authorised the establishment of
private hospitals and segregation camps for particular castes
or classes under the conditions stated in Chapter VII.
(G.O., No. 396-P., dated 27th April 1898.)
21
162
2. Where, however, in the opinion of the Plague Commis-
sioner, the Collector, or the President of the Madras Munici-
pal Commission, the circumstances are such that complete
isolation can be ensured without removal to a hospital or
camp, the patient may be treated, and those who have been
in contact with him may be put under observation, at home.
The conditions under which this course may be adopted are
indicated in Confidential G.O*., No. 1210-P., dated 1st October
1898. It must, however, be noted that home segregation on
a large scale is extremely difficult, and that, even if attempted,
it cannot be as efficacious as isolation in well-ventilated and
sanitary hospitals and camps. No batta should be paid to
home segregated persons.
(G.O., No. 303-P., dated 1st April 1898 ; No. 1196-P., dated 28th September 1898 ;
No. 822-P., dated 31st May 1899 ; No. 1225-P., dated 10th August 1899.)
3. The instructions contained in the appended orders of the
Bombay Government should be carried out in this Presidency
as far as practicable, subject to the following remarks of the
Plague Commissioner. A census is costly and may create
alarm and it is undesirable to look upon the taking of a census
of an infected village or town as a necessary part of plague
operations. Free access to evacuated houses should be pro-
hibited, and the prohibition enforced by prosecution where
considered advisable and practicable. As regards mainten-
ance of the prohibition that no one from a village which has
been vacated shall be allowed to take up his residence in
another village without a pass, the measure involves a large
expenditure under establishment as well as great inconveni-
ence to the people. Persons from infected villages are, as a
rule, refused admission by the people of healthy villages and
the cases of such men must be left to be dealt with under the
passport rules by village officers, who must be carefully super-
vised by the plague and the ordinary district establishments.
Resolution of the Bombay Government, No. 6013—6105-P.,
dated 1st November 1898.
His Excellency the Governor in Council desires to impress upon all
officers that Government continue to attach the highest importance to
the following measures :— †
(a) Early and accurate information of the appearance of any
suspicious cases of sickness and death,
* This should be kept in the personal custody of the Collector or the President,
Municipal Commission, Madras.
† Vide also Plague Commissioner's Proceedings, No. 321, dated 3rd February 1899,
and No. 1130, dated 25th April 1899.
163
(6) Prompt and complete evacuation of a village on the occurrence
of the first well ascertained local cases or where mortality among rats
is apparent.
N.B.—The people should receive sufficient notice and all their reasonable requests
be met as far as possible.
(c) A sufficiently accurate census of the population of the infected
village to prevent people leaving the village lands and entering other
villages.
(d) Well-organised arrangements to prevent surreptitious access
to the houses vacated and to permit access when necessary, under due
precautions.
N.B.—If the oases occur among the evacuated population, the reason may in almost
every case be traced to surreptitious communication with the vacated village.
(e) Thorough and careful disinfection under responsible super-
vision of infected houses and clothing and admission of light and air.
N.B.—In small villages where the entire effects of the people can be exposed to the
sun and the houses can be easily opened out to sun and air and two or three months
can elapse before re-occupation is permitted, it may be left to the discretion of the
Collector, advised by medical opinion, whether disinfection is necesary. Unless
disinfection is conducted by a trusted officer, it is no use.
(f) Maintenance of the prohibition that no one from a village
which has been vacated must be allowed to take up his residence in
another village, except with the written permission of the Plague
authority. This prohibition must be enforced by a Circle Inspector or
other authority (according to the extent of infection) systematically
moving in the villages round the infected area. As soon as any popu-
lation is pronounced to be healthy, the prohibition should be cancelled
and the population be free to move about.
N.B.—As a rule no passes should be given to leave an infected village till the
population have been ten days in the open. The Circle Inspector's work must be
carefully supervised.
(g) The separation of the sick and infected families from the
healthy.
N.B.—The healthy families should first be moved into the open. Then the sick
with their families should be moved to a separate spot, for example, the opposite side
of the village site.
2. For the effective supervision of these measures, the plague-infected
area must be sub-divided under responsible officers, Staff Corps officers
being employed where necessary. These officers should enlist to the
utmost possible extent volunteer agency to assist in carrying out the
measures. The measures are new to the people, particularly in fresh
areas of infection and, if injudiciously or overzealously pressed, must
defeat themselves by exciting opposition instead of gradually winning
the co-operation of the people, or by scattering the people instead of
inducing each village as soon as it is infected to settle down quietly on
its own lands. His Excellency in Council trusts that every officer on
plague duty will continue to make it his special aim to train his subor-
dinates to work with sympathy and consideration. Complaints should
be encouraged and, where possible, the objection should be removed.
The importance of these considerations cannot be overrated.
164
Circular of the Bombay Government, No. 6977—7068-P.,
dated 21st December 1898.
With reference to Government Resolution, No. 6013—6105-P., dated
the 1st November 1898, General Department (Plague), Grovernment are
aware that a large number of villages have now been vacated. The
next step is to ensure that proper effect is given to clause (g), the
separation of the sick from the healthy.
2. Officers on plague duty when visiting a village should first endea-
vour to make the people understand the meaning of what they enjoin
and the reason for the separation of the sick and for prohibiting visits
to infected families, houses and sites. Unless the people understand,
their intelligent co-operation cannot be secured and without their good-
will no effective organization is possible.
3. Next, the infected families should be completely separated from
the rest of the population; and the sick person in an infected family
should have a hut apart from that occupied by the as yet healthy
members of his family. That is, the healthy should not be suffered to
live in the same hut with the sick person. On any case occurring in a
healthy family the family should be immediately removed from the
neighbourhood of other healthy families.
4. In the towns and larger villages a proper organization can be
established with means for treating the sick. But in all villages the
danger of infection must be taught and guarded against or plague will
linger on. Wherever cases are occurring in the fields, the officer on
plague duty should give his earnest attention to these points, and endea-
vour to get at and remove the cause of infection continuing.
5. Collectors will be held responsible for the efficient working of these
instructions and that officers on plague duty understand what they have
to do. As cases diminish, the establishment should be massed on the
place remaining infected and the last cases should be sought for and
segregated with ever-increasing vigilance.
(P.O. No. 405, dated 10th February 1899 ; No. 1179, dated 1st May 1899.)
(3)—Search Parties.
Should there at any time be reason to suspect that plague
exists and has not been detected, search parties should be
organized. A sufficient number of European officers should be
employed to render the powers of search effective and at
the same time prevent the subordinate establishment from
abusing their authority. Failing officers of the Civil estab-
lishments, young officers of the Staff Corps should be deputed
for this duty. Respectable inhabitants who volunteer for the
service should be employed to assist in searching for concealed
cases of plague; as far as possible houses should be allowed
to be entered only by persons of caste or of the same religion
as the occupants ; and subject to the same limitation, women
165
should be utilized in examining women and in searching any
room or place exclusively occupied by them.
(G.O., No. 396-P., dated 27th April 1898 ; No. 1196-P., dated 28th September 1898.)
(4)—Inspection and Burial of Corpses.
Original Mufassal Regulation 25 (page 37) and City
Regulation 16 (page 16) deal with the mode of disposal of
plague corpses. They in no way interfere with the religious
customs of the people, but merely authorise the local autho-
rities to insist on certain necessary precautions as to the
routes to be taken by funeral processions and as to the place
and manner of burial. It is not intended that public
undertakers should alone touch the corpses. The dead may
be dressed for the grave by their own relations or in whatever
manner may be customary among the class to which the
deceased belonged.
(G.O., No. 396-P., dated 27th April 1898; No. 1196-P., dated 28th September 1898.)
2. Under the first paragraph of Additional Mufassal
Regulation 16 (page 46), 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 it must be
understood that medical examination of a corpse is entirely
optional on the part of the relations, and that 110 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 the
segregation of the contacts and the disinfection of the house
may be enforced. The examination of the corpses of women
by men should never be required. The orders of the Govern-
ment should be obtained before this regulation is acted upon
in any area, and in applying for sanction, the Collector should
report fully on the following points :—
(1) What classes of officers will be authorized to issue
certificates under the regulation.
(2) Whether any fee will be required for the grant of
this certificate.
(3) Whether there is such a number of Government
Medical officers, male and female, at the station as will be
sufficient to carry out inspection promptly so as not to cause
any delay in burials.
166
(4) Whether there has been any increase in the rate of
mortality.
(5) Whether there is any reason to believe that deaths
are concealed or that causes of death are not correctly
reported.
(G.O., No. 330-P., dated 14th April 1898; No. 396-P., dated 27th April 1898;
No. 1023-P., dated 7th September 1898 ; No. 278-P., dated 22nd February
1899; and P.O. No. 359, dated 8th February 1899.)
(5)—Disinfection.
The utmost importance should be attached to the perfec-
tion of the system of disinfection, for any flaw in it may
render nugatory carefully devised and executed operations
against plague. The advice and instructions contained in
the following memorandum drawn up by the Sanitary Com-
missioner with the Government of India should be carefully
followed :—
MEMORANDUM.
1. "It has been brought to the notice of the Government of India
that the disinfection of plague-infected houses and clothing is often
carried out in an imperfect way. In most cases this depends upon the
lack of proper appliances and of skilled workmen, but occasionally it
seems to be due to incomplete acquaintance with the principles that
underlie the art of disinfection. This is, to some extent, inevitable
where much of the agency is directed by non-professional persons, and
it has been considered advisable to review for the guidance of those
concerned the general principles on which disinfection should be carried
out.
2. The purpose of disinfection is the destruction of the specific germs
of disease. In the case of plague, the germ, in any stage in which it
has been hitherto found, is fortunately easy to destroy, if it is reached by
the means used for its destruction. The germs of plague may be killed
by means of—
(a) moist heat,
(b) chemicals.
Without undervaluing the great efficacy of direct sunlight and
ventilation, it may at once bo stated that these agents should bo used
as aids only.
3. Moist heat is most effectively employed in one of the numerous
apparatus specially devised for the purpose. All these apparatus are
not of equal value ; but the three essential conditions in determining
whether an apparatus is efficient or not are (1) that the steam employed
shall be saturated; (2) that the temperature of the steam shall reach
171
14. C. The person.—" For disinfection of the person reliance must be
placed upon soap and warm water, but there is no objection to the
additional use of any weak disinfectant which will not injure the skin."
(G.O., No. 1154-P., dated 27th July 1809.)
2. In the case of articles that are regarded as " specially
liable "—in the sense emyloyed by the Venice Convention—to
infection, namely, rags, used apparel and bedding, and waste
paper, their import from plague-infected areas is prohibited
and any articles brought in contravention of such prohibition
should be destroyed, it being impossible to estimate the extent
of liability to infection these have undergone or to rely fully
upon available means of disinfection. Ordinarily, it is not
necessary to take special action in regard to articles other
than those to which this term is applicable. But when, for
exceptional reasons, other articles of merchandize not deemed
specially liable to infection are treated it should be arranged
that, on arrival of a consignment, it should be stored, when
weather permits in the open air; but if this is not feasible
in a well-ventilated shed. The flooring should be impervious ;
by preference the walls should also be of impervious material
—for example, of corrugated iron or cement plastered. Earth
that can be removed should be soaked with the milk of lime
and then be mixed with sawdust and kerosine oil, and be
burnt on the spot. Packages or wrappings, earth—or other-
wise—stained should be painted over with milk of lime—one
part of lime to four of water. When feasible having regard
to weather, the whole of the packages before opening should
be exposed to the direct rays of the sun, and be carefully
turned so as to subject all surfaces to this influence during
a period of two days—it being held that even four hours'
exposure, sufficient to produce desiccation, is fatal to the
plague bacillus (Yersin). When the contents of packages
are not food-articles, the complete spraying of them with a
solution of perchloride of mercury would prove a most effect-
ive method of treatment. Godowns or places in which these
articles have been stored should have their flooring washed
down, with a solution of perchloride of mercury (1—1,000),
whilst the walls should be sprayed with the same solution.
Subsequently, as soon as the walls are dry, a freshly-slaked
lime should be employed as whitewash. If impervious floor-
ing is not available, the earth should be disinfected with milk
of lime, and be removed and replaced from time to time.
The time requisite for detention of articles for the purpose
of the above treatment is as follows :—
(a) If the spray of peichloride of mercury be used—
a process not applicable where articles connected with the
172
production or distribution of food, or articles of food, are dealt
with—sufficient time after application should be allowed to
enable the surfaces to become thoroughly dry,
(b) If milk of lime be employed, not less than two hours
after application is requisite.
(c) When disinfection by exposure to sun is trusted to,
although, four hours is held to be sufficient to compass the
death of the bacillus of plague, so many uncertainties attend
the process in practice that two successive days' exposure to
the sun under careful supervision as to all surfaces being
under its influence should be demanded.
(G.O., No. 779-M., dated 2nd April 1897 ; No. 1170-M., dated 11th May 1897.)
3. Persons who obtain supplies from plague-infected parts
are strongly advised to burn all the litter and straw in the
baskets which arrive and either to destroy the baskets or,
at all events, thoroughly disinfect them. Any basket may
reasonably be regarded as dangerous, as it may have been
stored by sufferers from plague. Unless, however, they
have been contaminated with damp earth from infected loca-
lities, the retention of infection for long by baskets is not
likely. Collectors are requested to give the widest publicity
to these remarks and endeavour to pursuade people as far as
possible to cease importing eatables from plague-infected
parts until danger of plague has passed; and, in any case, to
attempt to ensure that the precautions mentioned above are
always observed.
(P.C.'s Progs., No. 109, dated 8th October. 1898.)
4. All articles known or suspected to be infected should be
burnt unless they can be properly disinfected, especially when
a case of plague is first discovered.
(G.O., No. 929-P., dated 27th August 1898.)
5. Persons should not be considered entitled to compen-
sation because it becomes necessary to destroy property in their
possession which is dangerous to the public health, and the
prescribed authorities should always retain the discretion to
award or refuse compensation according to the circumstances
of the case. At the same time, it is of importance that the
disinclination of the poorer classes to disclose cases of plague
should, by all reasonable means, be reduced, and the Govern-
ment of India consider that, in the case of the destruction of
bedding, clothing and similar articles, the authorities may be
reasonably liberal in. admitting payment of compensation,
when the loss would fall upon people in very poor circum-
stances, to whom it whould be a great hardship to bear it.
As regards damage caused to houses during disinfection, the
173
Madras Government has ruled that no compensation should
in any case be given either for replacing floors, or for filling
up holes in the walls, but where roofs have been destroyed,
so much may be given as will enable the occupiers to place
the roofs in fair repair. Any such compensation should be
given only where the disinfecting work has been done by
organized gangs of coolies or sepoys.
(G.O., No. 864-M., dated 12th April 1897 ; No. 1066-P., dated 12th July 1899.)
6. The following table shows the efficient strength of some
of the principal disinfectants as ascertained by laboratory
experiments. In actual practice greater strengths are relied
upon:—
Perohloride of mercury
Permanganate of potash
Chloride of lime
"Lysol"
Hydrochloric acid
Quick lime
Sulphate of copper ...
Izal ...
Nitric acid
Sulphuric acid
Phenyle or Lawes' fluid
1 in 5,000
1 in 5,000
1 in 2,000
1 in 2,000
1 in 1,428
1 in 1,000
1 in 1,000
1 in 1,000
1 in 500
1 in 500
1 in 400
It will be seen that perchloride of mercury, permanganate
of potash, chloride of lime and " lysol" proved to be by far
the most potent substances examined. That most classical of
germicides—carbolic acid—cannot be included, its efficient
strength being but 1 in 50.
Perchloride of mercury is a thoroughly reliable germicide.
As already known, its power is enhanced by the addition of a
certain quantity of hydrochloric acid. The drawback to its
indiscriminate use is its very poisonous nature.
Permanganate of potash though non-poisonous is speedily
rendered impotent in the presence of oxidisable organic
material.
Chloride of lime possesses the merits of cheapness and
great efficiency. It is not dangerous, in any marked degree,
to animal life.
" Lysol " is a potent germicide, but its cost is against its
use on a large scale.
Quick lime is a harmless disinfectant, and is readily obtain-
able in most parts of the country.
Sulphate of copper exerts its germicidal properties in a
somewhat irregular and uncertain manner.
Phenyle is fairly cheap. It is harmless to animals,