NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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(5) Regulation 8 of the Regulations (a) 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 (b) issued in G.O., No. 2830-M., dated 17th December 1897.
(2) City Regulation 7-A of the Regulations (c) issued in
G.O., No. 2830 M., dated 17th December 1897.
(3) Regulations 5, 19, 20, 22, 24 and 34 of the Regula-
tions (f) issued in G.O., No. 93-P., dated 26th February 1898.
(4) Regulation 25 of the Regulations (e) issued in G.O.,
No. 745, Marine, dated 23rd August 1897.
(5) Regulation 6 of the Regulations (a) issued in G.O.,
No. 879, Marine, dated 16th October 1897.
(f) The disinfection of the houses in the infected locality and
their contents.
(1) Rule 19 of the Rules (d) printed in G.O., No. 522-M.,
dated 13th March 1897.
(2) Mufassal Regulations 6 and 11 of the Regulations (b)
issued in G.O., No. 2830-M., dated 17th December 1897.
(3) City Regulations 4 and 5 of the Regulations (c) issued
in G.O., No. 2830-M., dated 17th December 1897.
(4) Regulations 19 and 22 of the Regulations (f) issued in
G.O,, No. 93-P., dated 26th February 1898.
(5) Regulation 23 of the Regulations (e) issued in G.O.,
No. 745, Marine, dated 23rd August 1897.
(g) The improvement of the ventilation of houses, the abate-
ment of over-crowding and the prosecution of general measures of
sanitary reform.
(1) Rules 8, 9, 10 and 17 of the Rules (d) 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 (b) issued in G.O.,
No. 2830-M., dated 17th December 1897.
(a) Printed on pages 56 to 60.
(c) Printed on pages 22 to 29.
(e) Printed on pages 46 to 54.
(b) Printed on pages 8 to 21.
(d) Printed on pages 61 to 70.
(f) Printed on pages 30 to 45.
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(3) City Regulations 2, 3, 4, 5, 6, 7, 10, 14, 15, 16, 17
and 18 of the Regulations (a) issued in G.O., No. 2830-M.,
dated 17th December 1897.
(4) Regulations 4 and 26 of the Regulations (b) 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 (c) 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 (e) 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 Regulations (c)
1 and 17 (G.O., No. 2830-M., dated 17th December 1897),
City Regulation (a) 1 (G.O., No. 2830-M., dated 17th December
1897), and Additional Regulation (d) 17 (G.O., No. 93-P., dated
26th February 1898), seem sufficient.
4. Paragraph 4 of the Resolution.—Original Mufassal Regu-
lation 25 (c) and City Regulation 16 (a) 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
(a) Printed on pages 22 to 29.
(c) Printed on pages 8 to 21.
(b) Printed on pages 46 to 54.
(d) Printed on pages 30 to 45.
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part of Regulation 16 of the Regulations (a) 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, arid 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 (b)
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 bow 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 (b) 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 in-
creased 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
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
(a) Printed on pages 30 to 45.
(b) Printed on pages 61 to 70.
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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. 1897.*
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.
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
* Vide|also G.O. No. 485-P., dated 16th May 1898 ; and Notification No. 436, Fort St.
George Gazette, dated 27th May 1898, Part I-A, pp. 134-136.
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taken as subsidiary suggestions for adoption subject to modifi-
cations according to local circumstances.
9. Paragraph 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. His
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. (G.O., No. 396-P., 27th April 1898.)
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INSTRUCTIONS REGARDING CONSTRUCTION AND
EQUIPMENT 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. Conse-
quently, 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.
2. People 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.
3. Patients removed to hospital may use, should they so
elect, their own food and medicines. They may also be at-
tended by such number of relations and servants as the medical
officer in charge may think reasonable. All persons accompany-
ing patients for purposes of rendering attendance shall reside
within the precincts of the hospital and shall be subject to such
rules as the medical officer may, from time to time, dictate.
4. In the interests 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.
URGENT HOSPITAL HUTTING.
5. 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.
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SEMI-PERMANENT HOSPITALS.
6. In the case of municipalities, and of special castes or
classes of persons erecting private hospitals, it is advisable,
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.
7. 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 11
—14 should be followed.
TEMPORARY HOSPITALS.
8. 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 choos-
ing material and directing construction.
9. 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.
10. In the case of rural areas or where hospitals are re-
quired 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.
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11. A single building should not be made for accommodat-
ing more than 20 patients; preferably, 10 patients should be
the standard. Whether or not the patients should be accommo-
dated in double rows will depend upon the nature of the material
obtainable locally. As the amount of superficial or floor space
per patient must not be less than 12 Xl2 feet, the breadth of
such a ward would be 24 feet, and for ten patients the length
would be 120 feet. This would necessitate the use of beams,
giving a span of 24 feet.
12. In many temporary rural plague hospitals, therefore, it
may be found necessary to accommodate single rows of patients;
allowing then sufficient room for convenient nursing, the breadth
of the single rectangular ward should be not less than 16 feet,
and the length—12 feet multiplied by the number of patients
for whom the shed is intended.
13. The eaves should be 9 feet high. The side walls
should extend up to 6½ feet; above this height, the whole length
of the shed should be open. The opening of 2½ feet all round
should, however, be protected by a thatched verandah extend-
ing to 5 feet from the ward walls, supported on poles 7 feet in
height, and with the thatch projecting beyond the 5 feet to the
extent of 2½ feet; at regular intervals between each bed flap
windows in each side wall of the shed 3 X 3 feet should be
formed, so as to be exactly opposite each other.
14. Where it is difficult to obtain hutting material, and
economy must be studied, the verandahs may be dispensed with.
In this case, the opening between the eaves and the wall should
be protected by flaps formed of matting throughout the length.
These flaps should be supported on bamboo, so that, in the
presence of rain, the interior shall be protected. The flap win-
dows should also be omitted.
15. Circular buildings may also be employed. These are
economical, convenient for effective administration, and offer
less obstruction to perflation of camps than the rectangular
form. The only difficulty in making this form is that the ser-
vices of a blacksmith are required for the making of one part of
the structure, viz., the bracket, on which rests the roofing.
Thus, in making a circular shed of 25 feet diameter which will
give 2,000 cubic feet per head for three persons, a palmyra or
cocoanut palm tree is selected of 24 feet height. Of the tree, 4
feet may be sunk in the ground surrounded with concrete, or
firmly packed with stone. Near the top of the centre pole is
placed a circular iron bracket, which is secured by iron bands.
On this, bamboos intended for the roofing are placed, each one
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having a projecting piece fastened to it at right angles. The
bamboo or jungle wood posts used for the side walls supporting
the external ends of the roofing should be 8 feet from .the
ground to the eaves. The walls should be formed of matting ;
2 feet from the eaves, a space should be left in the side walls
open throughout. Thatched roofing should be used in the
ordinary manner. This should project 2 feet beyond the
eaves, so as to protect the open space. The entrance door
should have a special pent porch roof at right angles to the
main roofing. Opposite the main door and at the two sides,
the side matting may be made so as to form doors capable of
being supported on bamboo props in fine weather, and closed
during rain. The opening over the circular bracket should
be guarded by a pent roof structure, having a space pro-
tected by its projection from entrance of rain. This forms an
admirable ventilator. An intelligent village artizan ought also
to be able to make two ventilators in the roof itself, which can
be protected by bamboo matting flaps from entrance of rain.
These can be made moveable by attaching strings, but the
formation of these extra ventilators should not be attempted
unless the requisite skill is available.
16. The internal surface of mat walls may be, and, after
occupation by plague cases, should be, whitewashed. Daubing
with earth or cow dung should be prohibited.
17. In the case of wards intended for Europeans, there
should be approached by a small thatched covered verandah, a
room having an impervious space of not less than 6' X 10', that
may serve as a bath-room. A cistern should be attached to
catch waste water.
For natives, there should be formed bathing platforms for
each sex. Where time will allow, the flooring and the cisterns
to which waste water from them is led should be rendered
impervious. Where time does not allow of these arrangements,
the water should be led into a small excavation, which should
be carefully disinfected at intervals. These bathing spaces
should be protected so as to provide for decency.
18. A latrine should be provided for each sex. If time
allows, the surfaces and receptacles should be of impervious
material.
19. Huts at the rate of one for each patient for whom
accommodation is provided should be supplied for the relations
of the sick, who may choose to reside in the hospital camp, with
the object of looking after the patients. A floor space of 10' X
10' will usually suffice ; a verandah of 5 feet should be attached.
The front should have a blank space for ventilation of 9 inches
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breadth at the eaves. The verandah should project downwards
sufficiently to allow of protection of the open space.
20. For every ten patients there should be erected huts for
the accommodation of four superior and four inferior menial
servants. These may be of the same character as for " rela-
tions," but without the verandahs.
21. If nurses are attached, quarters must be provided for
them with a floor area of 12' X 12' for each, with bath-room
and cook-room attached. For each hospital assistant, accom-
modation of the same nature must be provided.
22. A cook-room, 12' X 6', should be formed for the sick
for the preparation of patients' food. This, as well as those for
the hospital assistants and nurses, should be formed of corrugated
iron so as to prevent the danger of their catching fire. A dead-
house, measuring 20' X 10', should be prepared, the side walls
being formed of corrugated iron, if available, or the lower parts
may be of wire-netting. In both cases, if corrugated iron
cannot be procured, stone slabs or any other device may be used
that will diminish in the one case the risk of fire and in the
other, of animals entering.
23. Sheds for females should be separated by reasonable
intervals from those occupied by males.
24. The general disposition of the hospital and of the
buildings attached to it should follow the plan circulated with
G.O., No. 256-P,, dated 23rd March 1898.
EQUIPMENT OF HOSPITALS.
25. If "urgent hutting" or other method of isolation is
used pending the arrival of the Ambulance Staff,* the officer in
charge should see that tarred mullays containing disinfectants
for spittoons are used by the patient, and that solid and fluid
excreta are suitably received, that soiled rags are burnt, and that
special arrangements are made for the bringing of water to the
patient, without the employment of any person likely to have
been in contact with plague matter. On the arrival of the
Ambulance Staff, all requisites for hospital equipment as per
appendix, except bazaar products, will be brought by it.
THE SUSPECT CAMP.
26. The object of this camp is to afford shelter to persons
who, it is suspected, may be undergoing incubation of plague
and whom it is determined to keep under observation so as to
secure their isolation at the earliest moment in the event of an
* Vide Regulations 9 and 21 of the Regulations printed on pages 30—45.