NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
100
LOCAL—DIRECT.
Salaries —
Salaries of subordinate medical
officers.
House-rent allowance.
Plague allowance.
Establishment —
Matrons and nurses,
Compounders.
Ward attendants and servants.
Storekeepers.
Establishments employed at
plague camps and road
frontier inspection stations
and at railway stations not
notified as railway inspection
stations in the Fort St.
George Gazette.
Allowances —
(21) Pay and allowances of
medical subordinates, clerks
and
passport-issuing officers employed
in plague hospitals and at railway
stations not notified as railway
inspection stations in the Fort Sí.
George Gazette and at road frontier
inspection stations.
(22) Cost of observation
staff
consisting of plague supervisors,
plague inspectors and their peons.
(23) Ambulance
staff.
(24) Cost of camp establishments,
superintendents and gumastahs and
menial servants.
(25) Cost of construction of
plague hospitals and " observa-
tion," "suspect," "health" and
" staff " camps. The cost of sheds
constructed in cantonments should
Travelling allowances.
be borne by cantonment funds.
Supplies and Services —
Petty construction and repairs
of buildings.
Funeral expenses.
Dietary charges.
Clothing and bedding.
Cost of medicines and instru-
ments and disinfectants.
Other hospital necessaries.
Contingencies —
Purchase of furniture.
Repairs of
do.
Tour charges.
Postage charges.
Telegraph charges.
Office expenses.
Miscellaneous.
(26) Cost of stretchers, medical
stores, disinfectants, comforts and
furniture and clothing for plague
hospitals.
Nos. (21) to (26) must be
understood as referring to expen-
diture for purposes other than
those specified in No. (10).
(27) Extra expenditure due to
the deputation of troops on plague
duties other than those specified in
No. (10)— see also No. (16).
(28) Rewards for the destruc-
tion of rats.
(29) Cost of carbon paper
supplied to passport-issuing officers
at railway stations not notified as
railway inspection stations in the-
Fort St. George Gazette.
APPENDIX II-U.
Madras Command Order No. 810, dated 27th October 1903.
[See Eule 38 on page 16.]
* Military Depart-
ment letter No. 2494-C,
dated 8th October 1903.
SANITARY—Plague.—The following rules, proposed by the Sanitary
Commissioner, Madras, in connection with the precautions to be taken
on account of plague when troops inhabiting
infected areas move to localities infected or
not, and which the Government of India have no
objection* to being adopted in the Madras Presi-
dency, are published for the information and guidance of all concerned :
101 RULES REGULATING THE MOVEMENTS OF TROOPS INHABITING INFECTED
AREAS PROCEEDING TO LOCALITIES—INFECTED OR NOT—IN THE
MADRAS PRESIDENCY.
I.—Troops above fifty in number unaccompanied by their wives and
families or those of followers.
(a) If possible, ten days previous to departure, all infected areas
shall be out of bounds for all concerned.
(B) On a date as close to that of departure as feasible, all clothing
and property to be carried with the troops and followers, of a susceptible
nature, shall be disinfected in the presence of the medical officer in
medical charge of the troops. A certificate signed by him to this effect
shall be forwarded to the plague local authority at the place of final
arrival.
(c) The requirements of paragraph (6) having been satisfied, the
troops may proceed to their intended destination, subject to the follow-
ing precautions being observed subsequent to their departure :—
(i) At the first passport-issuing station in the Madras Presidency
passed through, the officer in command shall give a complete list of all
troops and of all persons accompanying them and shall bind himself to
exercise his full authority to cause their health state to be daily ascer-
tained and to report promptly to the nearest plague local authority the
occurrence of plague or of any symptoms suspicious of plague. To
meet this requirement, the officer shall sign in triplicate certificates in
the form attached (A) ; to the triplicate should be attached, signed by
him, the nominal roll of the troops under his command and of all
persons accompanying them. This shall be forwarded by the passport-
issuing officer to the declared place of final destination.
(ii) The medical officer in medical charge of the troops or, if no
medical officer be with the troops, the senior officer in charge, shall
each day, during ten days, arrange to inspect the troops under his
orders and all persons accompanying them without exception and shall
certify as to their state of health by using the list form B. When the
passport examining officer of the locality halted at is not a medical
officer, the medical officer in charge of the troops or, if there be not one,
the senior officer in command of the troops shall hand the list duly
signed by him to the passport examining officer for countersignature
in confirmation of the fact that it had been on the day of halt signed
by him.
(iii ) When halting at a village or town where the passport
examining officer is a medical officer, the medical officer of the troops
shall arrange to conduct an inspection as to the state of health of the
troops and those accompanying them in the presence of the passport
examining officer ; but, if no medical officer be in charge of the
troops, the senior officer in command shall arrange in consultation
with the passport examining officer for the conduct by that officer,
in his presence at a reasonable time of day, of such inspection of the
troops and of those accompanying them.
102
//.—Troops below fifty in number unaccompanied by their wives and
families or those of followers.
(a} After conforming with Rule I (a) and (b), the troops and all
accompanying them shall individually be subject to Eule 2 of the
Madras Plague Regulations in force outside the Presidency Town, and
the officer in command, in consultation with the medical officer if there
be one, shall afford all necessary facilities for their observance.
III.— Troops accompanied by their families, followers and
their families.
(a) If, within the period of twelve months, the troops or the
followers or their families have not suffered from indigenous plague :
(i) As far as possible, ten days previous to departure, all infected
areas shall be out of bounds.
(ii) The troops, their families, their followers and their families
shall vacate their lines on a date as close to that of departure as feasible
and encamp upon a clean area and not be allowed to return to the lines
or to any part of the infected locality.
(iii) They shall bo detained in camp only for such period as will
enable the medical officer in charge to superintend disinfection of all
clothing and susceptible property and to grant a certificate that this
has been duly carried out in respect to the property of all troops, their
families, their followers and their families, and servants of officers.
(iv) As soon as the process of disinfection is completed, they shall
be subject to Bule I (i), (ii), (iii).
(6) If, within a period of twelve months, the troops or their
families, their followers or their families have suffered from indigenous
plague :
(i) The troops, their families, their followers and their families
shall bo encamped and segregated on a clean area for a period of ten
days subsequent to such time as may be necessary for the complete
disinfection of the clothing and susceptible property of the troops,
their families, their followers and their families, and of servants of
officers, under the superintendence of the medical officer in charge,
During this period, their health state must be daily observed by the
officer in medical charge. If the health state of the persons thus
observed gives rise to suspicion of plague, a special report should be
made by the medical officer to the General Officer Commanding through
the usual channel.
(ii) The requirements of sub-section (1) having been observed,
the troops, their families, their followers and their families shall be
subject to the requirements of Eule I (c) (i), (ii), (iii).
(c) If, within a period of three months, the troops or their
families, their followers or their families have suffered from indigenous
plague :
(i) The intention to move them to any locality in the Madras
Presidency should be brought to the notice of the Government of
Madras by the Lieutenant-General Commanding the Forces.
103
A
TROOPS.
Plague Passport.
(Seo Rule 2 of Madras Plague Regulations in force outside the Presidency Town.)
1. Number of Passport.
2. District.
3. Station of issue.
4. Date of arrival.
5.* Number of men (Total).
6.* Number of women (Total).
7.* Number of children (Total).
8. Whence coming (give district, taluk and village). †
9. Destination and residence during the next ten days (give district,
taluk and † village).
10. To whom the triplicate copy of the passport sent.
I declare the information set forth above to be correct, and I do
hereby bind myself (a) to inspect or cause to be inspected the above-
mentioned persons daily, for the next ten clays, before the passport
examining officer of the place where I may be for the time being, (5) or to
grant the necessary certificate that this has been done, (c) to report to the
said officer before departure any change in the residence of the above-
mentioned persons within the said period of ten days, and (d) to deliver to
the said officer this passport on the expiry of the said period.
Date
.
,
Signature of the Officer
in charge of Troops.
Declared and signed before me.
.
,
Date
Signature and designation of
Officer issuing the Passport.
List Form B.
* To the triplicate should bo attached a complete nominal roll.
† For villages in Malabar, give the name of amsam and desam.
Period of observation.
1 2 3 4 5 6 7 8 9 10
State of health
104.
2. The above rules do not extend beyond the Madras Presidency
proper, and in those Military districts which lie partly in the Madras
Presidency and partly in the Bombay Presidency, the rules are to
be applied only to the "portion which is situated within the former
Presidency,
3. The Madras Presidency should be taken as comprising the
following Civil districts :—
Madras.
Ganjám.
Vizagapatam,
Gódávari.
Kistna.
Nellore.
Chingleput.
Tanjore.
Trichinopoly.
Madura.
Tinnevelly.
Coimbatore.
Cuddapah,
Kurnool.
Anantapur.
Bellary.
Malabar.
South Canara.
North Arcot.
South Arcot.
The Nilgiris.
Salem.
APPENDIX II-V.
G.O., No, 656, Financial, dated 29th September 1905.
[See Rule 152 on page 58.]
Recorded.
2. The quarterly statements of audited plague charges Direct and
Indirect under the heads PROVINCIAL, LOCAL and MUNICIPAL, which
are submitted to Government by the Accountant-General under para-
graph 10 of G.O., No. 421, Financial, dated the 2nd July 1904, should,
- for the future, contain the following statements only :—
(i) Under PROVINCIAL an abstract statement of Direct and Indirect
charges under each major head showing expenditure by districts, in
form A appended to these proceedings ;
(ii) Under LOCAL a statement in form B appended to these
proceedings giving totals of Direct and Indirect expenditure for each
district without details ;
(iii) Under MUNICIPAL a statement in form 0 appended to these
proceedings showing expenditure for each municipality ;
(iv) A summary in the form at present in use showing the
charges incurred on account of salaries of officers and establishments
employed on plague duty forming part of existing departments but not
replaced by substitutes ; and
(v) A statement in the form at present in use showing the
rateable distribution by districts of plague expenditure among district
boards.
105
A.—PROVINCIAL.
Abstract of Direct and Indirect plague charges showing by districts the estimates for 190 -190
and the estimates for, and the
progressive totals of expenditure under, each head for the quarter ending the
190
Districts.
1
Total ...
Estimates
for the
year 190
-190
2
ES.
3.]
Estimates
for the
quarter.
3
ES.
LAND REVER
Expend-
iture up
to the
commence-
ment of
the
quarter.
4
ES.
NUE.
Expend-
iture
during the
quarter.
5
RS.
Total
expend-
iture to
the end
of the
quarter.
6
RS.
_ .
___
Estimates
for the
year 190
-190
7
ES.
18. GENI
Estimates
for the
quarter.
8
RS.
RAL ADMIN
Expend-
iture up
to the
commence-
ment
of the
quarter.
9
ES.
DISTRIBUTION.
Expend-
iture
during the
quarter.
10
R8.
Total
expend-
iture to
the end
of the
quarter.
11
RS.
106
A.—PROVINCIAL—cont.
Abstract of Direct and Indirect plague charges showing by districts the estimates for 190 -190 and the estimates for, and the
progressive totals of expenditure under, each head for the quarter ending the
190 —cont.
Districts.
Total ...
20. POUCE.
Estimates
for the
year 190
-190 .
12
Rs.
Estimates
for the
quarter.
13
RS.
Expend-
iture up
to the
commence-
ment
of the
quarter.
Expend-
iture
during the
quarter.
14
| 15
RS.
R3.
Total
expend-
iture to
the end
of the
quarter.
16
RS.
.
24-A.& C. MEDICAL, including Sanitation and Vaccination.
Estimates
for the
year 190
-130 .
17
RS.
Estimates
for the
quarter.
18
RS.
Expend-
iture up
to the
commence-
ment of
the
quarter.
19
RS.
..
Expend-
iture
during the
quarter.
20
RS.
Total
expend-
iture to
the end
of the
quarter.
21
RS.
107
A.-PROVINCIAL—cont.
Abstract of Direct and Indirect plague charges showing by districts the estimates for 190 -190 and the estimates for, and the
progressive totals of expenditure under, each head for the quarter ending the
190 —cont.
Districts.
Total ...
24-D. MEDICAL.
Estimates
for the
year 190
-190 .
79
RS.
Estimates
for the
quarter.
23
RS.
Expend-
iture up
to the
commence-
ment of
the
quarter.
21
RS.
Expend-
iture
during the
quarter.
25
RS.
Total
expend-
iture to
the end
of the
quarter.
26
RS.
TOTAL.
Estimates
for the
year 190
-190
27
RS.
Estimates
for the
quarter.
28
RS.
Expend-
iture up
to the
commence-
ment of
the
quarter.
29
RS.
Expend-
iture
during the
quarter.
30
RS.
Total
expend-
iture to
the end
of the
quarter.
31
RS.
The estimates in columns 2, 7, 12, 17, 22 and 27 should be the sanctioned estimates as contained in the Civil Budget Estimate.
Columns 4, 6, 9, 11, 14, 16, 19, 21, 24, 26, 29 and 31 need not be filled up for the first quarter.
108
B.—LOCAL.
Abstract statement of Direct and Indirect plague charges showing by districts the estimates for 190 -190
and the estimates
for, and the progressive totals of expenditure under, each head during and up to the quarter ending the
190 .
Districts.
1
Total ...
Estimates
for the
year 190
-190
2
RS.
Estimates
for the
quarter.
3
RS.
Indirect.
Expenditure
up to the
commence-
ment of the
quarter.
4
Rs.
Expenditure
during the
quarter.
5
RS.
Total
expenditure
to the end
of the
quarter.
6
RS,
Estimates
for the
year 190
-190 .
7
RS.
Estimates
for the
quarter.
8
RS.
Direct.
Expenditure
up to the
commence-
ment of the
quarter.
9
RS.
Expenditure
during the
quarter.
10
RS.
Total
expenditure
to the end
of the
quarter.
11
RS.
The estimates in columns 2 and 7 should be the estimates which enter into the totals of the Civil Budget Estimate. Columns 4, 6, 9 and 11
need not be filled up daring the first quarter.
109
C.—MUNICIPAL.
Statement of plague expenditure showing the estimates for 190 -190
, the estimates for, and the progressive totals of expendi-
ture up to, the quarter ending the.
190 .
Districts.
1
Total ...
Serial
number.
2
Municipalities.
3
!
1
Estimates
for the year
190 -190
4
RS
Estimates
for the
quarter.
5
RS.
Expenditure
up to the
commence-
ment of the
quarter.
6
RS.
Expenditure
during che
quarter.
7
RS.
Total
expenditure
to the end of
quarter.
8
RS.
Columns 6 and 8 need not be filled up daring the first quarter.
110
APPENDIX II-W.
Instructions for the forwarding of material to the King Institute
of Preventive Medicine, Guindy.
. PLAGUE.
A.—HUMAN PLAGUE.
Sources from which material suitable for examination may be obtained.
1. Spleen or liver—
(a) In fatal cases.
(6) Where it is possible to perform puncture of these organs
during life.
2. Buboes.—In Bubonic plague.
3. Sputum.—In Pneamonic plague.
4. Peripheral blood.—When nothing else is available.
The preparation of specimens.
Material for cultural tests. This will be necessary only in special
cases. It is essential in sending such material that it be surrounded
by sufficient ice to ensure its reaching Guindy without decomposition.
Such material will in general be sent only as a result of correspondence
on the subject when special directions will be given.
2. In all ordinary cases " films " should be forwarded.
Preparation of a film from the spleen.
(a) Dip one or two slides in water and clean them thoroughly with a
clean soft cloth. Lay the prepared slides on one side out of the way of
dust, etc.
(b) Remove the spleen or if a complete post-mortem examination
is not made extract the spleen by passing the hand through an incision
over the left costal margin. Remember that the spleen may be dragged
backwards and upwards by the stomach if this organ is collapsed.
When for any reason even a modified post-mortem examination is
not possible one may resort to puncture with a large needle. In this
procedure it is very difficult to be sure that the spleen has really been
tapped. It is also extremely difficult as a rule to get blood from a
spleen after death. It is best therefore, if driven to use a needle,
to puncture the larger and more engorged liver.
(c) With a knife or more conveniently still with a pair of scissors cut
into and remove with the aid of a forceps a piece of the spleen about the
size of a small pea. Holding this piece of tissue in the forceps wipe
it thrice along one of the clean slides forming three separate streaks.
Avoid excess of blood by " dabbing" the piece of tissue when this
is necessary on the slide before proceeding to make the streaks.
In the case of the spleen this is usually not necessary.
(d) Wave the slide in the air until everything is quite dry.
111
(e) Wrap the slide in white paper. Write particulars on the outside
of the packet and despatch in one of the boxes provided by the institute
for the purpose.*
Preparation of film from the liver.
Adopt the same procedure as for the spleen taking care to get rid
of an excess of fluid before smearing.
To puncture the spleen during life—
(a) Use an ordinary hypodermic needle.
(b) Do not use any antiseptic but boil the syringe if necessary.
(c) Eject a small drop of the blood obtained on to a slide and
make a film as for peripheral blood.
To obtain material for examination from buboes.
(a) Clean several slides.
(b) Clean the skin over the bubo with a little soap and water and
a clean towel. This is important as the skin of the groin and axilla
contains many organisms which are liable to increase the difficulty
of diagnosis where a minute quantity of fluid only is obtained.
(c) Steadying the bubo with the left hand plunge the needle well
into the mass taking care to avoid such dangerous structures as the
femoral artery. Before doing anything further allow the needle to
remain a few moments in the tissues. Withdraw the point of the
needle very slightly and pull out the piston of the syringe.
It is often difficult to got any fluid whatever from a gland. In such
cases the only procedure is to allow the needle to remain in for some
minutes.
(] ) Do not draw the needle too far out. Nor mistake a little
blood drawn in from the skin itself on the withdrawal of the needle for
gland juice.
(2) If there is any doubt as to the origin of the fluid obtained this
should be stated on the specimen as it may be possible microscopically
to confirm or dissipate such doubts.
An alternative method much to be preferred where it can be carried
out is to cut down upon the gland, divide if, and take a scraping from
the cut surface. In cases where diagnosis is of infinite importance this
is by far the best procedure as it will yield almost certain evidence,
both positive and negative, regarding plague.
Do not be satisfied with pus from a discharging bubo, or from a
suppurating bubo if less advanced buboes are present. Pus from an old
* Note.—Slides and boxes for forwarding specimens can be obtained by indenting on
the King Institute. Envelopes should be marked "plague indent" and addressed
" Superintendent, King Institute of Preventive Medicine, Guindy."
The following form of indent is suggested :—
Please supply to
Slides
A box will be sent with every two slides. Not more than 12 slides will be [issued
at a time unless there are special reasons for doing so.
Telegraphic address " Institute."
8
112
bubo may very well contain no recognisable plague bacilli whilst pus
from a bubo which has been discharging for some time is scarcely likely
to contain bacilli.
In fatal cases in addition to smears from the spleen any enlarged
glands should invariably be incised and smears made from the out
surface.
To prepare films of peripheral blood.
(a) Clean one or two slides and rub up the shaft of a needle
(surgical or sewing).
(b) Clean a finger of the patient by rubbing it gently with a wet
cloth and carefully drying it.
(c) Hold the finger between the thumb and first finger of your left
hand and compress gently to drive the blood to the tip where you are
going to prick.
(d) Prick, and when a drop about the size of a match head has
exuded lower a clean slide upon it taking care not to " dab " the slide
on the skin.
(e) As quickly as possible, taking the slide in the left hand and
the point of the needle in the right lower the shaft of the needle on to
the drop and spread this over the slide in a thin film by passing the
needle slowly and in one sweep from left to right. If the result is not
satisfactory use another slide.
(/) On another slide or if necessary on the same slide at one end
collect another drop of blood and spread this with the head of the
needle over an area equal to that of a two-anna piece. When quite dry
wrap in paper and label.
General cautions regarding films.
(1) On no account cover any specimen with a slide or cover glass.
• (2) Never use a slide without having first thoroughly cleaned and
carefully polished it.
(3) Never omit to wrap film in paper before placing in the box
for despatch.
(4) Do not nail, paste over with paper or otherwise deface the box.
All that is necessary is to tie it round with a piece of twine and wrap
neatly in a wrapper.
Interpretation of Results.
(1) Do not send a film of peripheral blood with the idea that you
have done all that is required to enable the case to be diagnosed. The
plague bacillus cannot as a rule be found in the peripheral blood of
plague patients. The absence of the plague bacillus from such a
specimen therefore really means very little and certainly does not
exclude plague.
As a rule the sending of peripheral blood only is an omission on the
part of the Hospital Assistant or other concerned who if more energetic
could as a rule forward more likely materials such as smears from the
spleen of fatal cases, smears from buboes, etc.
(2) Sputum as a rule containa countless organisms some of them
closely resembling in appearance the plague bacillus. Fortunately when
plague bacilli are present at all they are in large numbers and give