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APPENDIX A.
(Vide para. 3, Section 1, Chapter 2).
SIR,—The undersigned members of the Bubonic Plague Research Committee strongly urge
the adoption of the following measures for dealing with the existing epidemic.
2. Seeing that it is known that each plague patient contains in himself the source of
infection and seeing that there is a possibility of this passing either directly or indirectly from
the sick to the healthy, it is absolutely necessary that the most rigid segregation of the sick
should be practised. For the attainment of this end it is not necessary in all cases that the sick
person or persons should be removed from the house in which the attack commenced. Suitable
rooms might be available in the house in which the case might be efficiently isolated. In select-
ing such room, the points to be especially kept in mind should be the free supply of sunlight
and air, and the minimising the chances of" communication with other persons in the house.
Often in place of a room the flat roof of a house or other such open space in connection with a
house could be utilized for isolation, a temporary erection sufficing to keep off the direct rays
of the sun. Whichever method be adopted, the passage of communication with the house should
be guarded by a cloth hung over it and kept saturated with carbolic solution (I pint to 2
gallons).
3. All secretions, articles of clothing, &c., used by the patient should be disinfected before
removal from the room, or destroyed by fire. Not more than one attendant or at the most two at
a time should be allowed in the room.
4. If no suitable accommodation is available in the house, then the patient must be remov-
ed to a suitable place, which should, if possible, be a special hospital.
5. After the removal, recovery, or death of the patient, the infected room should first be
hermetically closed and thoroughly fumigated with sulphur fumes. The walls and floor shoud
then be scraped and washed together with all the articles in the room capable of being washed, a
solution of carbolic acid (£ pint to 2 gallons) being used for the purpose. Finally the walls
should be washed with fresh quicklime and water, or preferably with a solution of chlorinated
lime. Clothing, bedding, &e., should be treated in a steam steriliser. For the purpose of trans-
porting them to the steriliser it is advisable that they should be wrapped in a sheet soaked in
carbolic acid solution. The room should be then vacated for a period of at least six weeks. About
a week before it is re-occupied the floor and walls should again be treated with chlorinated lime.
On the occurrence of a second case in the same house within 15 days of the occurrence of the
first case, the whole house should be vacated, the sick being removed to a suitable hospita. If
the removal of the sick cannot be effected without giving rise to an objectionable amount of
prejudice, they should be treated in the house if approved of. The whole house when fully vacated
should be subjected to the same process as detailed for the infected room, with the proviso that
any godown or place of businesss not used as a residence, and if provided with a separate entrane e
need not necessarily be vacated, but should be treated on its merits as to how far it shall come
under the operation of the measures applicable to the rest of the house.
6. To meet prejudices against promiscuous segregation, communities in the various districts
objecting to the ordinary isolation hospitals should be permitted to open as many selected and
approved hospitals as may be necessary for the purpose. Vacant houses, huts, tents, or ships in
the harbour may be used for the purpose.
7. To meet the difficulty of housing the evicted healthy persons, temporary accommodation
might be required, and could be erected on any available open land ; but much might be done by
providing accommodation in houses already more or less deserted. Houses that have been vacated
for six weeks owing to the occurrence of plague cases might become available for occupancy.
8. To meet the serious difficulty of the concealment of cases, all house-holders should be
made responsible for the immediate reporting of all serious cases of illness to the Health Depart-
ment of the Municipality. On receipt of such a report, the municipal medical officer should
visit the case, and if it should turn out to be one of plague, the person reporting should be
suitably rewarded. In the case of chawls, it might be necessary not only to make the landlord
responsible, but also to compel him to keep a representative constantly on the premises to report
cases of sickness in the same manner as a householder. The concealment of cases of severe
sickness should be made a penal offence. To ensure the efficient reporting of cases of plague,
house-to-house visitations by municipal medical officers should be carried out daily in all infected
localities.
9. Meanwhile the present measures for opening up and cleansing of drains, gullies, &c.,dis-
infecting of roads, burning of dead rats, &c., should be continued, but we consider that the
practice of burning sulphur in open spaces and open houses had better be discontined.
10. We consider that an extensive mortality among rats in any locality may be taken as an
indication that there is a risk of the appearance of plague among human beings there residing
and that on the occurrence of this phenomenon all rat-holes should be dug up and thoroughly