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Carbolic acid and corrosive sublimate may be procured from the Executive Engineer,
Presidency. These disinfectants are the best for use in plague.
(f) Large cauldrons should be procured for disinfecting clothes, &c., by boiling, as this
is the best and cheapest method of disinfection for articles which are not seriously spoilt by
the process.
Barrels cut in two form most effective wooden tubs in which corrosive sublimate disinfection
(g) The hospitals should be only partially equipped, if stores exist where the remainder
of the equipment can be procured rapidly.
(h) A suitable burying ground should be selected; a separate one for plague burials alone
is recommended.
(i) Arrangements for the organization of—
(1) house-to-house visitation parties,
(2) removal of sick and probably infected,
(3) removal of dead (sometimes necessary),
should be made. The sanitary staff may require strengthening for whitewashing and disinfecting
processes if plague breaks out. Suitable ambulances will have to be procured for the sick.
The principal difficulties are—
(1) Procuring native medical assistance.
(2) Irregularity of houses preventing successful searching.
(3) Procuring female assistance, hospital accommodation, &c., for purdah women.
(4) In addition to usual native obstruction, the prevention of free handling or dead
bodies.
(5) Labour.
If an epidemic has commenced and labour is scarce, it has been proved to be sound
policy to utilize it all at once on building accommodation in preference to going on with
town work.
Prior to plague breaking out, it is advisable that a proclamation should be issued to
that every precaution will be taken to preserve caste distinctions. Each community might be
invited to erect their own hospitals and segregation huts, but at the same time they should be
clearly given to understand thai these institutions will be under European supervision. The
necessity should also be impressed on them of removing their sick at once to hospital, both
on account of the better chance of recovery and the less chance of compulsory measures being
carried out which might interfere with their caste system.
It cannot be too strongly impressed on all that, provided the above measures are carried
out, the first cases of sickness isolated at once, the people immediately in contact with them
segregated and the house thoroughly disinfected, the probability of the disease assuming epide-
mic dimensions will be greatly lessened, and this will be proportional to the thoroughness with
which the work is done.
Roughly speaking, the main links of the chain by which the disease is spread are—
(1) Human beings,
(2) Infected houses,
(3) Eats,
(4) Clothing of the infected,
always remembering that man is the great factor in spreading it over a distance.
To non-professional plague authorities the general signs and symptoms of plague may
be summarised thus :—To commence with, there is usually high fever with considerable
headache, which may be either throbbing or boring in character. There is frequently a
feeling of chilliness which may amount to a severe shiver, with severe pain in back and
limbs occasionally. The pulse generally rises to over 100 per minute, full and easily felt
in the early stages, but weak, more rapid and difficult to feel in the later stages of
20 — 30 or more per minute. In adults the glands of the groin, armpit or neck are usually
enlarged and tender; in children the neck or armpit glands are more frequently affected
than these of the groin. In the early stages there may be a dry hacking cough without
any sputum. In later stages the sputum may be copious, thick or thin, and sometimes
blood-stained. A feeling of intense oppression or weight about the heart and stomach is
frequently complained of. Delirium comes on early in the disease, and may be of a quiet
and stupid or very violent type. It is shown by incoherence of speech, inability to pro-
trude the tongue properly, and tardiness and tremor in doing so, as also inability to concen-
trate attention on what one says to him, being unable to fix his eyes straight on the ques-
tioner's face. The eyes are generally somewhat inflamed (suffused) and occasionally jaun-
diced. A tottering gait is usually well-marked early in the disease, walking along a straight