NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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iii. Erect upon these sites temporary sheds or huts for the accommodation
of those who may require them.
iv.—Leave space to the leeward of each section for the carts and cattle of
the people occupying each section.
v.—As far as possible assign sections to different castes, indicating each by
a legible sign board.
II.—Conservancy,
1. "Erect suitable latrines for males and females, in number sufficient to
meet the requirements of the crowd.
2. " Establish separate pits for the burial of (a) rubbish and (b) filth.
3. " Organize a conservancy establishment according to requirements for
the following purposes :
(a). The removal daily of all rubbish and refuse, including the dung of
cattle, from the streets both of the town and camp, and from the camp-
ing ground generally.
(b). The removal of all human excreta from the public latrines and from
residences within the town.
(c). The disposal of the same in the filth pits.
III.— Water Supply.
1. " Select suitable but distinct tanks, wells, reservoirs or other sources of
water supply
(a). For drinking and domestic purposes only.
(b). For bathing ; and,
(c). For watering cattle,
2. " Place a Police guard over the source of supply selected for drinking, to
guard it from contamination.
3. " Establish water pandalls for the distribution of drinking water.
IV.—Medical Supervision.
1. " Appoint as Sanitary Officer a Medical or Subordinate Medical Officer,
whose duty it shall be to superintend the sanitary arrangements generally ; to visit
the hospitals and places for distribution of medicines ; to make himself acquainted with
the medical history of the assemblage, as far as possible by from day to day keeping a
return of all deaths reported through the Police.
2. " Establish temporary hospitals with suitable establishments at conve-
nient sites and in numbers proportionate to the assembly.
3. " Depute medical subordinates to examine, at the barriers, all travellers,
coming or departing, who may appear to be laboring under sickness.
4. " Distribute, through suitable agency and at selected localities, « cholera
pills," for immediate use by persons attacked by Cholera.
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V.—Precautions against accidents.
1. " Assign gates for ingress and egress into each town, temple or shrine, in
cases in which numbers are considerable, and where instances of loss of life have occur-
red from want of due arrangements of this nature.
2. " Erect barriers, when necessary, to prevent an undue influx of people
into limited areas, fully occupied by devotees ; admitting fresh worshippers only as
numbers decrease by egress from the opposite barrier gate.
VI.—Police (Sanitary).
1. " The Officers of Police to be instructed to bring to the notice of the
Sanitary Officer, all deaths occurring within the limits of the camp or town.
2. " Publicity to be given, through the Police, to the fact that hospitals are
established and depots opened for the distribution of Cholera medicines.
3. " Notices to this effect to be posted, in the vernacular, all over the town
and camp, and pilgrims or those frequenting fairs to be instructed to apply for such
medicines on the first occurrence of illness.
4. " Notices of the arrangements made for the general convenience of the
people to be also freely distributed amongst them, and posted upon all conspicuous
places.
VII.—Construction of Latrines.
1. " Latrines to consist of walled enclosures, in which parallel trenches should
be dug, 2 feet wide by 3 feet deep. The soil removed from these trenches to be
stored at their edges and a portion daily shovelled in to cover the night soil.
2. "At the termination of the feast these trenches should be fully covered in.
VIII.— General.
1. " Prior to feasts and festivals, chuttrums, choultries, and grounds generally
resorted to by pilgrims as camping or halting grounds to be put, by district authorities,
into good sanitary conditions, and provision made for a pure water supply. The same
to be maintained in a good sanitary state till after the dispersion of the pilgrims.
2, "At the termination of the feast or festival, should cholera have prevailed
amongst the people, halting grounds to be ploughed up, and chuttrums and choultries
fumigated and white-washed."
VI.
EPIDEMIC CHOLERA IN JAILS.
Epidemic Cholera in Jails.
69. Government had so recently passed orders on the rules to be adopted on
the appearance of epidemic diseases in jails, that we are unwil-
ling to enter upon any detailed consideration of the subject ;
but, in accordance with the principle adopted throughout this report, we simply record
the " Rules for the guidance of officers in charge of jails on the occurrence of epide-
mic diseases," with such modifications as appear to us to be required.
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Officer daily, during ten days after admission, and attention shall be paid to their per-
sonal cleanliness and to the cleanliness of their clothes.
ii.
"When prisoners arrive from other Jails, they shall, if Cholera be present
among them, not be allowed to enter the Jail before a period of ten days ; but be
camped at a convenient distance from it, and be detained until reported healthy.
iii. " The Officer in charge of such prisoners on the march shall, on the ap-
pearance of Cholera, report the same through the Police without loss of time ; so that
medical assistance and a camp may be in readiness for them on arrival near their desti-
nation.
iv. " When Cholera has attacked gangs of prisoners, they shall not be admit-
ted into Jails until 14 days have elapsed since the last case has appeared, and only then
if the prisoners are all healthy.
v.
"While encamped for this reason, all the rules hereinafter set forth re-
garding camps shall be strictly observed both as regards selection of site and camp con-
servancy arrangements.
vi. " In the event of Cholera being present in the vicinity of a Jail, care
must be taken to prevent any communication taking place between the inmates of the
Jail and the infected locality, either directly or indirectly.
vii. " More than ordinary attention should be paid to all the usual conser-
vancy arrangements of the Jail.
viii. " Such alterations in the Jail diet as may be calculated to guard pri-
soners from liability to the attacks of Cholera shall be adopted on the recommendation
of the Medical Officer.
ix. " Fires of grass and green wood shall be lighted in the wards and yards
daily, so as to purify thoroughly the Jail.
x. " The Hospital shall be white-washed, and especial care be taken that all
hospital arrangements to meet an outbreak of epidemic disease are complete.
xi. " It is the duty of every Officer in charge of the Jail, in communication
with the Civil authorities, to have marked out, suitable camping sites for the removal
of prisoners on the occurrence of Cholera in the Jail.
xii. " It is of essential importance that these sites should be selected for
every Jail, and that the selection of sites should not be delayed until the occurrence of
epidemic disease.
xiii. " Every Officer in charge of a Jail will make a quarterly return to the
Inspector-General of Jails, stating whether any change in the selection of sites for such
camps has been rendered necessary from any cause soever.
xiv. " The requirements of the site of such a camping ground are as follows :—
(a.) It should be easy of access and neither to windward or leeward of any
Military cantonment, Civil station or Native town, nor within a distance
of two miles of such place.
(b.) It should not be on the great lines of communication, or thoroughfares; or
villages.
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(c.) The ground should be high with natural facilities for drainage.
(d.) There should be a good supply, if possible, of drinking water.
(e.) Rank vegetation is objectionable, and experience has shown that thick
topes of trees should be avoided.
(f.) The distance of the camping ground from the Jail must depend on local
circumstances, but as a rule two or three miles will probably suffice.
(g.) The site should be selected with special reference to its state during the
rains.
(h.) The camping ground should be measured and the number of prisoners
with their guards, which it is capable of accommodating, recorded.
" To remove doubts which have arisen, as to when Cholera shall be con-
sidered to have assumed an epidemic tendency, the following rule is prescribed for the
observance of the Medical Officer in charge of the Jail, with whom rests the responsibi-
lity of declaring that it has assumed such a degree of epidemic intensity as to render the
removal of prisoners necessary.
xv. " ' If within one week after the first case of Cholera has shown itself in a
Jail, three or more cases occur, it shall be considered that the disease has assumed an
epidemic form.'
xvi. " In the case of epidemic Cholera a portion or the whole body, of
prisoners will, at the discretion of the Medical Officer, move into the camp provided
for the outbreak of epidemic disease in the Jail, and be located in tents or in tempo-
rary huts erected for that purpose.
xvii. " The Officer in charge of a Jail at a station at which there is a Camp
Equipage Depôt shall indent on such depôt for a supply of the tents necessary for the
accommodation of prisoners, to be moved into camp.
xviii. " In like manner Officers in charge of Jails, accessible by Railway, will
indent by telegraph on the nearest Camp Equipage Depot for a supply of the tents
required.
xix. " Provision will be made for supplying tents to Jails, not within easy
reach of a Camp Equipage Depot, unless from local circumstances huts can be easily and
quickly constructed so as to supply this accommodation for prisoners, instead of tents.
xx. Where epidemic disease has broken out in a Jail and it may not be con-
sidered desirable to remove all the prisoners into camp, the following precautions will
be observed in the Jail during the prevalence of the disease.
" The prisoners shall be organized in small gangs for exercise beyond the Jail
walls.
" Work in factories shall be relaxed, but not entirely discontinued.
" The most scrupulous attention shall be paid to the state of the privies.
xxi. "Disinfecting and deodorizing agents shall be freely used, such as Mac-
Dougall's powder, charcoal, wood-ashes, coal tar and earth, and every precaution con-
nected with ' dry earth conservancy' shall be most carefully and continuously enforced.
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xxii. " If soiled, the cell floors shall re-rnade, the walls shall he scoured with
a stiff broom, removing from their surface and down from the roof, every particle of dust
or animal matter.
xxiii. " A wood fire shall be burned in each cell, the doors and windows being
temporarily closed.
xxiv. " Special attention shall be paid to the boiling and subsequent filtra-
tion of all drinking water.
xxv. " A portion of the Jail establishment shall be organized as a guard
for night work ; this guard should go round frequently to the cells, wards, &c, to ascer-
tain if any prisoner has been taken ill, and to remove him to the hospital at once.
xxvi. "All overcrowding must be strictly avoided, not only in the hospital,
but in every cell and ward.
xxvii. " During the prevalence of Cholera and Jail Diarrhoea, slight cases of
colic or ordinary diarrhoea must be treated separately. They shall not be admitted in-
to hospital until the characteristic symptoms of Cholera and Jail diarrhoea have appeared.
xxviii. " The hospital floors shall be thickly sprinkled with powdered charcoal,
wood-ashes and earth ; the dejecta shall be immediately removed, and the wood-ashes
and earth swept up and removed when any portion becomes soiled by the discharges.
xxix. " The charcoal nets in the hospital shall be increased in number, and
the charcoal more frequently re-placed than under ordinary circumstances.
xxx. " The same Bules apply to the sleeping cells or wards.
xxxi. "The al vine discharges on being removed from the hospital shall be
collected outside in an iron pan, with a suitable cover, into which a quantity of Mac-
Dougall's disinfecting powder has been thrown, they shall, as frequently as possible, be
carried off to the garden trench, which shall, on each occasion, be covered over with
six inches of earth.
xxxii. " The hospital latrines demand the most scrupulous attention to clean-
liness.
xxxiii. " The utmost attention to personal cleanliness shall be enforced in
the case of every prisoner : small bathing and washing gangs, to be frequently relieved,
shall be organized for this purpose,
xxxiv. " The hospital clothing, or clothes and bedding used by patients,
shall invariably be burnt.
XXXV. " It frequently happens that the hospital passage gets saturated
with choleraic discharges. A layer of fine sand and ashes a couple of inches thick,
should be spread along the passage. This ought to be swept up and removed as often
as any portion gets soaked, and fresh sand or ashes strewed in its place. The trench
for the reception of the hospital filth need not be far removed : all that is required is,
that the excreta should be constantly covered with sifted earth,
xxxvi. " The water in which the prisoners have bathed or washed their
clothes shall not be allowed to be thrown within the Jail walls.
xxxvii. " Wood fires shall, under due precautionary measures, be kept burning
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to the windward and within the Jail enclosure night and day, on the occurrence of any
epidemic, in cases where it may not be practicable to remove the prisoners either into
another building or into tents.
xxxviii. " Attention shall be paid to the diet which should be modified in.
such a manner as the Medical Officer in charge may consider desirable.
xxxix. " When prisoners are moved into camp, dry straw should be procured
for the prisoners to sleep on, and cots for the sick.
xl. " In camp there should be two detached hospitals, one for the treatment
of miscellaneous cases and the other for the treatment of epidemic cases. These should
be to the leeward of, and some distance from, the camp.
xli. " Careful attention should be paid to the conservancy of the camp, and
the trenches should be dug every day to the leeward of the position. To these trenches
the prisoners and all connected with the camp should be made to go for the purposes
of nature. These trenches should be covered over with earth every evening.
xlii. " If the disease continues in frequency and virulence for three or four
days after the removal of the prisoners, it will be advisable to shift the camping ground."
VII.
IN HOSPITALS.
75. The precautionary measures to be taken against the extension of Cholera
in and its dissemination from Hospitals, as probable foci of infection, are practically the
same whether applied to Military or Civil life, and comprise " inter alia :"—
(a.) The separation of the sick by Cholera from the general sick, and their
isolation, as far as may be possible, by treating them, either in separate
wards, or in distinct buildings.
(5.) The most rigid enforcement of all acknowledged rules of conservancy,
(c.) The disinfection of the excreta and their immediate removal and burial.
(d.) The destruction of all bedding and clothing used by the sick,
(c.) The disinfection of clothing worn by attendants upon the sick.
(f.) The assignment of special attendants to the sick.
76. The rules given in connection with Section VI, for the guidance of Officers
in charge of Jails on the occurrence of Cholera, sufficiently indicate the measures that
should be applied to Hospitals. We could however draw attention to the fact that we
have struck out the concluding para, of Eule 29, as we dissent from the recommenda-
tion therein made of removal from Hospital of " all cases other than Cholera,"—-of the
conversion in fact of the Hospital into a cholera hospital, which the reading of the
rule would imply.
77. The principle of removing the general sick from a Hospital under
these circumstances, and of congregating therein all the Cholera cases, we think
erroneous, as likely to lead to the impregnation of the building with the cholera
germ, to the risk, under favoring conditions, of reproduction of the disease, which is
notoriously liable to recurrence in buildings in which it has once established itself.
The principle should be, to remove from the Hospital to a detached ward or building
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III. Teaching of experience on the subject of the isolation of the sources
and centres of Cholera.
IV. Cases in which the interruption of communications with infected places
is applicable ; and,
V. The advantages of restraining emigration from infected places, and the
means by which this can be attained.
83. We do not purpose entering into detail upon these subjects ; suffice it
to say that the conclusions arrived at by the Conference were as follows :—That
it is incontestible that quarantine established on rational bases, and in conformity
with the progress of science, may serve as an efficacious barrier against the invasion
of Cholera and that the measures of prevention should consist in, first, combating
the germs of the disease in its primary sources before they disseminate and propagate
themselves beyond ; and, second, by establishing quarantine in accordance with the
principles now admitted, regarding the transmissibility of Cholera, and its mode of
propagation.
84. The measures recommended by the Conference for the enforcement of
quarantine, are of the most rigorous nature, including " quarantine of observation," and
" rigorous quarantine," the latter involving detention of contaminated, or suspected to
be contaminated, ships for a period of ten days, dating from arrival, with the enforce-
ment of isolation, disinfection and discharge of all cargo liable to purification—excep-
tional precautions being suggested in overcrowded ships, or in vessels on board of which
a severe epidemic of the disease has occurred.
85. The conclusions of the Conference upon this important question—im-
portant both in their bearing upon public health and social and commercial intercourse
—have not been accepted by a large and influential section of the general and medical
intelligence of the country : and quite recently, on the 19th of March of the present
year, a Memorial was laid before the Duke of Marlborough, the President of the
Privy Council, by a deputation consisting of the President of the College of Physicians,
the Director General of the Medical Department of the Navy ; Sir W. Jenner, and
Drs, Tweedie, Dickenson and Milroy, praying for the appointment of a Royal Com-
mission to report upon this subject. The Memorial was signed by numerous gentlemen
of high distinction in the ranks of science, amongst whom may be named Dr. Logan,
C.B., Director General Army Medical Department, Sir J. Martin, Sir J. Clark, Dr.
Sutherland, member of the International Conference on Quarantine, and others. These
names are a sufficient guarantee of the dissatisfaction felt with the conclusions of the
Constantinople Conference, and the Memorial itself is of sufficient import to justify our
quoting it in extenso in our report.
MEMORIAL ON QUARANTINE.
Addressed to the Lord President of the Privy Council.
i. " During the last twenty years the subject of quarantine has, on several
occasions, engaged the attention of Government and of the public in this country and
on the Continent.
ii. " In 1848, on the approach from the East of the second visitation of epidemic
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ed, to Egypt and thence to Europe, so strongly impressed the public mind in many
Continental countries, that the Emperor of the French deemed it necessary to propose
that an international conference should he assembled, with the special view of deter-
mining what measures ought to be adopted to prevent, if possible, the recurrrence of
a like calamity. The conference—which consisted of twenty-four delegates, medical
and diplomatic, representing the chief European states—was held at Constantinople at
the beginning of 1866, and continued its sittings throughout that year.
x. " The results of the labours of the conference are embodied in a voluminous
report which has recently been made public. A rigorous and lengthened quarantine
is strongly insisted upon as an indispensable measure for the exclusion of the disease
in future ; and, for this purpose, it is recommended that a comprehensive scheme of
lazarets and of health-police be instituted at every large commercial port in all the
maritime countries throughout Europe.
"It is manifestly of national importance that the soundness, or otherwise, of these
doctrines be duly investigated, as professional opinion both in this country and abroad
is known to be far from unanimous on the subject,
xi, " At no former time have quarantine restrictions against epidemic cholera
been carried into effect, in the south of Europe, with such extreme rigour or to so
great an extent, as during the last two years and a half, and there appears to be at
the present time a marked disposition generally to the re-institution of more stringent
external precautions than have, for many years past, been deemed necessary for the
protection of public health.
xii. "In the course of the winter of 1866-67, and again during the last few
months, restrictive measures have been ordered by the Government in respect of
several of the royal mail steamers, arriving at Southampton from the West Indies,
so much more rigorous than were adopted, under apparently similar circumstances
in 1852-53, that it is most desirable that the public should be made acquainted with
the nature of the proceedings which are in future to be taken, and with the reasons
for their adoption.
xiii. " During last session of Parliament, it was officially declared in the House
of Commons that quarantine in this country was resorted to not on medical or public
health grounds, but solely on commercial grounds, and to meet the requirements of
foreign Governments ; by—
Lord Robert Montague, April 4, 1867,
May 4, „
Mr. Cave
May 21, „
xiv. " Much of the uncertainty and obscurity which have always surrounded,
and which still surround, the quarantine question is owing to the want of authentic
evidence as to the working and the results of the system in those places where it has
been most rigorously carried into effect.
xv. " No committee of either house of the legislature has examined the subject
since 1824 ; and there has been no publication of official correspondence relating to it
since 1843-46, with the exception of a short document in 1860 having reference to
the practice of quarantine in Turkey.
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89. Ennore is well adapted for a quarantine station. It is sufficiently
remote from Madras and from any villages ; and capable, with little difficulty, of very
complete isolation, while the site is open to the sea breeze.
90. The regulations in force are obviously so judicious, and in a recent
instance (the arrival of the ship " Challenge" from Calcutta, with Cholera on board)
their enforcement was attended with such satisfactory results, and moreover entailed so
little inconvenience upon ship, troops or crew ; that in the present aspect of the subject
of quarantine in its relation to the prevalence of importation by ships, we would depre-
cate any relaxation of them.
91. In the case of ordinary ships, that is vessels carrying neither troops nor
emigrants, the port rules require that the commander, in the event of there being disease
on board, shall signalize the same, whereon the Port and Marine Surgeon receives in-
structions to visit such ship, and the Master Attendant interdicts any communication
between the infected vessel and the shore, or with other ships, till a clean bill of health
is granted by the Port Surgeon.
We have the honor to be,
Sir,
Your most obedient servants,
W. MACKENZIE, M. D.,
Inspr, Genl. Ind. Medl. Dept.
A. C. SILVER, Colonel.
J. L. RANKING,
Sanitary Commissioner for Madras.
President.
• Members.
Cholera Committee.