APPENDIX—MEDICAL HISTORY OF THE DUFFLA EXPEDITION. 249
of operations. The rivers of Eastern Bengal are seldom free from cholera during the latter
months of the year, and it is only by not permitting crowding, by a liberal use of disinfectants,
and by enforcing cleanliness that sickness can be avoided.
The above general view is given for the information of medical officers.
2. On coolies first going on board, it should be ascertained if their bundles contain
indigestible food or old rags: all of which should be destroyed. Their clothes should be clean.
Medical officers of troops will understand how to warn their men on these heads.
The men should be examined daily by the medical officer. They should rise early, and
after dusting their blankets to leeward, should fold and sling them out of the way.
Clothes, mats, blankets, &c., should be aired and put in the sun as often as possible,
especially during damp weather.
3. In the early morning the decks should be freely sprinkled with a mixture of
McDougal's powder of three ounces to a gallon of water, before sweeping. This lays the dust
and prevents it settling on the bundles and roof; after the sweeping the powder itself might be
lightly strewed on the deck. Decks should only be washed down when weather, time, and other
circumstances permitting; the men may be landed, or accommodated in another place, until
their deck is thoroughly dry. They should also be dry holystoned at regular intervals.
4. The greatest care should be taken to keep the latrines clean; that sewage passes clear
of the side of the vessel; that no urinous or bad smells exist. McDougal's powder, in the
proportion of six to eight ounces to one gallon of water, should be used for latrines, two or
three times a day, or as often as required.
5. The coolie sirdars or other officers should be instructed to visit their men at intervals,
and bring all cases of sickness to notice. Slight ailments can be attended to at the dispensary,
but all more serious cases should be treated in hospital. The sick should be attended to as in
a good hospital on shore. Diarrhœa should be watched for and attended to immediately.
6. In the event of cholera, or small-pox, or other communicable disease occurring, the
patient, with all that belongs to him, should be thoroughly isolated from the healthy. All
cl ot hes, bl anket s, mat s, &c. , t hat have been i n any way i n cont act wi t h hi m, or have been
soiled, or are suspected of infection or impurity, should be burnt on shore in the presence of a
responsible officer. Persons who die of cholera should be buried or burnt.
7. On a case of cholera, &c., occurring, McDougal's powder and carbolic acid should be
used freely round the patient; matters purged or vomited should be received on small broken
coal and sand or ashes, and then covered with the powder, &c., and everything in the shape of
clothes or vessels soiled, cleared away and cleaned as quickly as possible. The place on board
should be also vacated, the deck and woodwork thoroughly cleaned, scraped, and scrubbed
with hot sand, if procurable, and the strong mixture of disinfecting powder. A solution of the
common sulphate of iron, 10 lbs., carbolic acid, 1 lb., to five gallons of water, is also good to
wash a soiled deck, and to clean vessels that have been soiled.
8. Fumigation by burning 4 oz. of sulphur, and clearing the atmosphere subsequently by
hanging up pieces of woollen substance or tat saturated with the stronger mixture of
McDougal's powder, can also be employed; this latter plan prevents flies from gathering. Pieces
can also be hung round the hospital; and if hung about the lower deck in the evening will keep
the air free from the smell of men and clothes through the night. Latrines suspected of having
been used by choleraic patients should be purified by fumigation and subsequent scrubbing with
the copperas and carbolic acid solution.
9. The first case of any such illness should be watched for. The object is to prevent
and not to wait for an epidemic, which may be checked by promptly attending to premonitory
symptoms, isolation of the sick, general and personal cleanliness, careful disposal of excreta,
disinfection and destruction of infected articles, free ventilation, and general care of the healthy.
10. Should choler
a_ become epidemic, the healthy should be landed on a suitable spot;
while the whole of the decks are scrubbed, and the other measures used for purifying the vessel.
The sick also are to be landed, isolated, and their deck space thoroughly purified. Even on two
or three cases occurring, land the sick at one place, steam up stream, empty and purify
the ship. The principles on which to act are: the preservation of healthy men by enquiry
as to premonitory symptoms, the separation of the sick and suspected from the healthy,
isolation of the affected, and preventing the spread of the disease. More definite rules
cannot be laid down and the medical officer must act as prompted by his knowledge
and experience. Should fresh cases subsequently occur, the same procedure must be adopted.
If it can possibly be avoided, the men must not remain in the vessel until the outbreak
subsides. The bilges of vessels should be examined if necessary.
11. The medical officers of stations arrived at, must be informed of the occurrence of
any epidemic, and measures taken in concert with them. If there are any severe or continued
fevers, or any of a typhoid form, they should be left at the station for treatment.
12. It is desirable that vessels should anchor in the afternoon so as to admit of the men
landing for cooking purposes. A supply of wood should be available, for, should drift not be
found on the banks, an issue of coal is useless without fuel to light it. They might take their
bundles and blankets on shore and shake and air them; they should not, however, be allowed
to visit villages or bazars in the vicinity. The vessels should not lie near a defiled or unwhole
-some bank. When landing is not practicable, there are cabooses on each vessel for cooking
purposes for those who do not object to cook on board, while for those who do object, non-
cooking rations will be obtainable.
If the place for landing should be near a village, or at any station, inquiry should invari
- a b l y b e m a d e b e f o r e t h e m e n g o o n s h o r e w h e t h e r t h e r e i s c h o l e r a , & c . , i n t h e n e i g h b o u r h o o d .
While the men are absent, the decks, &c., should be thoroughly sprinkled with the mixture of
McDougal's powder and well swept. After cooking, the men should return to the vessel to