NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
334
Measures to prevent the
[CHAP. X.
regulations of the province. The rules issued by the Government
of the Punjab and the Chief Commissioner of the Central Provinces
followed those enforced in the North-Western Provinces and Oudh,
The regulations issued by the Government of Bengal in Novem-
ber 1897 prescribed similar arrangements modified to some extent to
meet the different circumstances of Bengal Administration. In Bengal
the nominal list is prepared from information supplied by the village
policemen and from the information collected at the railway stations.
Disinfection of Clothing and Baggage.
Importance of
this subject.
Special
arrangements at
principal
inspection
stations.
As infection may be spread by the contaminated clothes and
personal effects of passengers, it was recognised that the disinfection
of suspicious articles was a necessary adjunct to the medical inspec-
tion which was made at different stations along the lines of communi-
cation from the infected districts. At a number of the principal inspec-
tion stations, both within and without the Bombay Presidency, special
arrangements were made for the disinfection of all suspicious baggage,
and the rules framed by the Local Governments and Administrations
provided specially for the disinfection or destruction of such articles.
Rules framed
by Local
Governments.
The following rule promulgated by the Government of the
North-Western Provinces and Oudh is similar to that. enforced in
other provinces :—
" If necessary, the medical officer shall himself arrange for the
disinfection or destruction of clothes, etc. In cases where it is
considered necessary that the clothes, or bedding, etc , of a traveller
shall be burnt, the medical officer may, if the person is poor or for
other sufficient reason, arrange for providing other articles in their
place at the expense of Government."
Instructions
issued by the
Government of
India for
disinfection of
baggage near the
Bombay frontier.
On the 28th February and again on the 15th March the Govern-
ment of India addressed the Government of Bombay on the subject
of the disinfection of the suspicious baggage of travellers before
they were permitted to cross the borders of the province. It was
stated that the Government of India considered that the disinfec-
tion should be performed at a railway station near the frontier of
the Bombay Presidency and Sind on each of the railway lines lead-
ing from those provinces to other parts of India, and that the
medical officers at places where the disinfection took place should be
instructed to exercise the widest discretion so as to render it impossible
that articles which might be contaminated should be passed without
being disinfected. Disinfection was not prescribed in the case of
CHAP. X. ]
spread of infection by land.
335
Method of
disinfection.
the personal effects of persons who were not themselves suspected
to be infected, unless the effects were in such a condition, through
their dirt or otherwise, as to raise a suspicion that they might be
contaminated. Disinfection by steam was recognised to be the
most satisfactory method, but until arrangements could be made to
carry out this process, the following instructions were prescribed on
the advice of the Sanitary Commissioner with the Government of
India :—
" (1) All articles which the medical officers consider to be
infected or suspicious, subject to the exceptions noted in clauses (2),
(3) and (4), should be boiled for ten minutes in a solution of carbolic
acid (1—40). The temperature of the solution will of course be
temporarily lowered by each article that is plunged into it, so that
precaution is necessary, not only to see that each article is so unfolded
as to be exposed in every part, but that every part is subjected to the
boiling temperature for the full ten minutes. On removal from the
boiler, articles should be dried in the sun for at least an hour.
" (2) Articles made of leather or wood and glue, etc., which
would be injured by boiling, should be soaked in, or thoroughly
mopped with a solution of perchloride of mercury and dried in the
sun. When it is considered necessary, such articles may, in addition,
be washed with a warm 5 per cent. solution of carbolic acid and soft
soap.
" (3) Metallic articles, which may be unsuited to treatment by
boiling, should be washed and scrubbed with a warm 5 per cent.
solution of carbolic acid and soft soap and dried in the sun.
" (4) Articles capable of conveying infection, which cannot be
treated in any of these ways, should be burnt."
Subsequently the Government of Bombay indented for three
small Geneste-Herscher steam disinfecting apparati from England.
Orders of the
Bombay
Government
for disinfection
at Hotgi,
Bhusawal,
and Ruk.
On receiving the instructions detailed above, the Government of
Bombay issued orders for the disinfection of travellers' clothing, etc.,
at the Hotgi, Bhusawal, and Ruk stations. Amongst numerous
other inspection stations at which special arrangements were made
for the disinfection of clothing the following may be mentioned :—
Ahmedabad, Khanpur, Sharigh, Sutna, and Khana junction.
Arrangements
for disinfection
and segregation
at Khanpur.
General account
of the
arrangements,
Lieutenant J. G. Crosthwaite, Assistant Commissioner, and
Surgeon-Lieutenant Milne, submitted interesting reports on the
arrangements carried out under their superintendence at the disinfec-
tion and inspection station at Khanpur. All passengers from Sind
were examined and the suspicious were detained under observation,
and the disinfection of baggage was carried out on a large scale. Two
336
Measures to prevent the
[ CHAP. X.
daily trains arrived at Khanpur from the direction of Sind—one at
7-11 A.M. and the other at 6-20 P.M. Whilst the disinfecting
operations were in progress the passengers were detained in lines
erected for the purpose. The persons arriving by the evening train of
one day and by the morning train of the following day were all des-
patched, the disinfection being then completed, by the evening train of
that day. Those persons only who were considered suspicious were
detained for a longer time.*
Examination of
passengers and
removal to the
lines.
Lieutenant Crosthwaite gave the following account of the arrange-
ments for detaining the passengers and removing them to the lines:—
" On the arrival of the evening train the inspecting medical
officer and disinfecting officer see each carriage. The former examines
all first and second class passengers. Any to be detained are
locked into their carriages. The camp clerks then enter up the
numbers of tickets and passengers' names and parentage : those of
the women are entered up in a separate slip by the female hos-
pital assistant, which is afterwards copied into the camp registers.
One third class compartment is reserved for railway servants on duty,
fuel contractors, state excise contractors, post office officials, and
others travelling locally on duty. These men's passes are examined
and they are let out. The outgoing train stands on line No. 2
and in this are the disinfected passengers. Two constables are
placed between the two trains to prevent any one slipping out
of the incoming train. On the completion of the inspecting medical
officer's examination the whole train is taken out to • No. 5 line
the first and second class passengers and contents of brake and
postal van having been previously transferred, though the use of
this latter step is not very apparent, so long as neither postal
officials' bags, nor contents of brake van, are disinfected. The
camp clerks, hospital assistant and all police on duty accompanied
the train to No. 5 line. On its arrival there the remaining passen-
gers were entered in the register, and the male passengers conduct-
ed to the detention lines by the disinfecting officer and quartered.
The women were taken by a separate route to the women's lines
by the female hospital assistant and the dhái. The camp water-
carriers attended to carry the women's baggage, etc.
" On the withdrawal of the incoming train the outgoing train
was brought on to the platform and was generally despatched before
the incoming passengers were clear of their train. This was a distinct
advantage, as the passengers quickly resigned themselves to their stay
in the lines, when they found the other train had already left. "
* The arrangements are illustrated by the map in Volume IV, page 18.
CHAP. X ]
spread of infection by land.
337
The camp.
The camp was capable of accommodating 375 men and 40
women and children. The men and women were lodged in separate
lines divided by an embankment ; there was also a third set of inter-
mediate or family quarters, The lines consisted of rows of cubicles in-
geniously constructed of unserviceable sleepers. Each cubicle was 10' 9''
by 8' 6" in area, with a roof 8' 6" in height at the back, sloping down to
7' 6" in front. The sleeper huts were found to be more serviceable and
less expensive than huts made of grass. They were disinfected once
a month with a solution of corrosive sublimate.
The sanitation of the lines and the food supply and comfort of
the occupants were carefully arranged. A staff of policemen and of
soldiers of the Bahawalpur State executed the necessary guard and
patrol duties. The establishment under the Assistant Commissioner
and Medical Officer consisted of one hospital assistant, one female
hospital assistant, and camp servants for the men's and women's
lines.
Disinfecting
arrangements.
Tanks were used for the disinfection of clothing by steam heated
to about 225° to 230° Fahrenheit under a pressure of 6 lbs. A
simply constructed furnace was used for the destruction of condemned
baggage.
The following account of the disinfecting arrangements is from
Lieutenant Crosthwaite's report :—
" (a) At sunrise the camp hospital assistant saw that all kits
belonging to men, passengers of the mail train on the previous even-
ing, were opened up and laid in the sun.
" (b) At 8 A.M. the passengers by the 23 up mixed having been
escorted to the lines and their clothes laid out, I inspected all their
kits, selecting clothing, etc., to be steamed, sun disinfected, or destroy-
ed. As each passenger's property was inspected, he was ordered to
take the clothes to be steamed at the tanks ; clothes to be sunned
were placed on the cell roofs or on charpais ; clothing to be destroyed
was handed over to the sweeper.
" (c) On arrival at the tanks the clothes were laid lengthways
and tied in the middle, not rolled up in a cloth. A brass number was
attached to the clothes and the duplicate retained by the passenger.
Companions frequently made one bundle of all their clothes. Before
leaving their clothes each passenger was supplied, if he desired it,
with a ' langochá '* or waist-cloth. The passenger next bathed either
in the tank or under the engine hydrant as taste or caste advised.
He then returned to the lines to await inspection.
* Note by Lieutenant Crosthwaite.—If these arrangements were continued in the cold
weather, blankets, coats and trousers would become a necessity. 'Langochás' can only
be considered a hot weather arrangement.
43
338
Measures to prevent the
[ CHAP. X,
" (d) Though under the instructions of the Plague Conference
clothes were supposed to be provided, yet in practice no other clothes
beyond 'langochás ' were ordinarily supplied or asked for. Most
passengers had spare clothes, but many preferred to remain in the
'langochá' only until after inspection. Men of the better class
sometimes asked for clothes, and these were at once supplied from the
store. The 'langochás' were washed daily and frequently disinfected."
Compensation,
Compensation either in the form of new garments, etc., or in
cash was given to all persons any part of whose baggage was destroy-
ed. In all 2,357 articles of clothing, bedding, etc., were destroyed,
1,298 were replaced by new articles, and Rs. 189-13-0 was paid in
compensation for the remainder.
Inspection of
passengers and
observation of
the suspicious.
Surgeon-Lieutenant Milne gave the following account of the
arrangements for the inspection of passengers and the observation of
suspicious persons:—
" All trains coming here from Karachi were inspected on arrival.
Obviously sick persons were removed to the hospital at once, and the
remainder of the third and intermediate passengers were carefully
observed as they passed from the train.
"First and second class passengers were invariably examined on
the platform and passed, unless their condition or the state of their
clothing were absolutely prohibitive. The persons booking from
Khanpurwere similarly inspected.
" Every day at 9 A.M., after all clothes had been handed in for
disinfection and every person had bathed, a thorough inspection of
every person took place. Many cases of slight fever, especially in
the earlier days, were detected, and these were either detained in
special huts built for the purpose, or, if considered necessary, were
taken to the hospital. When a passenger had thus been disinfected,
bathed and passed he had Khanpur stamped on the back of his
ticket.
" At 5 P.M. the passengers from the preceding mail and mixed
trains were let off, each person being observed as he left, and his
ticket examined for the stamp note in order to assure us that the
conditions of his detention had been fulfilled.
Statistics.
" From April 8th to July 8th, 13,876 persons had been detained,
etc. In addition to this I inspected about 5,794 others on the plat-
form, making a grand total of 19,670 inspected during that time.
" Out of that number it was found necessary to admit into hos-
pital under observation as suspicious 19 persons. Nine of these were
actually sick, the remaining ten being their companions.
CHAP. X.]
spread of infection by land.
339
"The nine cases are certified in the admission and discharge Cases of sickness.
book of the hospital as follows :—
Remittent fever
Malarial cachexia
Bronchitis
...
...
...
,,,
Tubercle of lung ...
...
...
,.,
Heat apoplexy
...
...
...
TOTAL
... 4
... 1
... 1
... 2
.,. I
... 9
"All of these recovered with the exception of one of the cases of
tubercle of the lung admitted into hospital in a moribund condition on
the 4th July and who succumbed on the 6th.
No case of plague
detected.
" No case of actual plague was detected during the period. The
last case which affords grounds for the suspicion that it was a case
of so-called pneumonic form of bubonic plague (so ably described by
Childe and others, the reading of whose experiences bias me in this
opinion) was a man who died on the 9th April and who was admitted
with symptoms of fever and bronchitis on the 7th.
" Every case admitted into hospital was treated with the same
precautions which would have been observed in undoubted cases of
bubonic plague."
Female
passengers.
Special arrangements were made to secure the privacy of women,
and every consideration was shown to their feelings. The women's
line was in charge of female hospital assistant, Hydari Begum, who
carried out her duties with great care and tact. Women were in
general examined in the camp and not on the platform. Separate
arrangements were made for the disinfection of their clothes, their
messing , etc. Their camp was looked after by female servants, and
practically the commissioned medical officer was the only man that
used to enter it.
Disinfection of Railway Carriages.
Permanent rules
in force on
railway lines.
General
instructions
issued by the
Government
of India,
There are permanent rules in force on the lines of the different
railway companies with regard to the disinfection of carriages in
which cases of infectious disease have occurred, but these regulations
were found to be insufficient to meet the emergency. On the 21st of
April the Government of India issued a set of instructions for the dis-
infection of railway carriages which were to take effect over the lines of
all railway administrations. The instructions provided for two classes
of cases : (a) the disinfection of carriages in which a case of plague
340
Measures to prevent the
[CHAP. X,
had been detected, and (b) the disinfection of carriages coming from
the infected area in which no case of plague had been detected.
Disinfection of
carriages in
which plague
cases are
detected.
In the case of carriages in which cases of plague had been de-
tected, it was ordered that the vehicle should be stopped either at the
station where the plague case was removed or at the nearest medical
inspection station, preferably the former if there were means for the
prompt and thorough execution of the disinfecting process. The fol-
lowing was the process prescribed :—
" (i) The vehicles, after being detached from the train, should
be thoroughly washed with soft soap and lime-water.
After an interval of two to three hours this should be
washed off with plain water, and then the following
disinfecting solution should be thoroughly sprayed all
over the interior as well as the exterior of the carriages
by means of a syringe :—
Corrosive sublimate
Hydrochloric acid
.,,
Water
... ½ oz.
... I
„
... 3 gallons.
" This solution should be allowed to dry on the carriages. Special
care must be taken to direct the solution into all the cracks and
crevices and jilmills.*
" (ii) After disinfection the carriages should be kept out in
the open for 48 hours. They can then be brought into
use again.
" (iii) In the case of first and second class carriages, which
afford greater facilities than third class compartments
for the harbouring of plague germs, it will be necessary,
if the carriages are contaminated, to burn the cushions
and to disinfect the woodwork in the manner indicated
above, and repaint the interior.
" (iv) Any compartment in which a suspicious case has travelled
should be sprayed with the above disinfecting solution
before being allowed to proceed."
Disinfection of
non-suspect
vehicles from the
infected area.
In the case of non-suspect vehicles the instructions stated that
the carriages should be disinfected at the medical inspection station
nearest to the boundary of the infected area in accordance with the
following method :—
" Third and intermediate class carriages, goods vehicles carrying
passengers and luggage vans.—The interior woodwork, especially
* Window blinds.
CHAP. X. ]
spread of infection by land.
341
the floors and seats, to be thoroughly washed with a solution of
perchloride of mercury (1 in 1,000), or with a carbolic acid solution
(a wine glass full to a gallon) applied with a mop; the doors and
windows to be opened and the vehicles exposed to the air.
" First and second class carriages.—The floors and woodwork
to be treated as above, the cushions being also brushed and thoroughly
cleaned."
Instructions not
fully carried out
on the Great
Indian Peninsula
Railway.
Relaxation of
the rules for non-
suspect carriages.
The Government of Bombay reported on the 22nd of May that
the instructions regarding non suspect vehicles had not been carried
out in full on the lines of Great Indian Peninsula Railway, and that
to do this would occasion considerable inconvenience and delay.
They suggested that it would be sufficient if non-suspect carriages
were disinfected at the end of the journey instead of at an inspec-
tion station on the boundary of the infected area. By this time the
virulence of the epidemic had greatly diminished, and the Govern-
ment of India consented to the proposed relaxation of the orders.
At the same time they stated that should there be a recrudescence of
the plague the rules of the 21st May must be enforced in their entirety.
At the time of the recrudescence the matter was reconsidered and it
was determined that it was not necessary to modify the existing
arrangements.
Measures to prevent the spread of infection by road
and river.
Precautions
adopted in the
Bombay
Presidency and
on the Sind
border.
The precautions taken to prevent the spread of plague by pas-
sengers travelling by railway from the infected parts of the Bombay
Presidency to other parts of India having been described, there remains
for description the precautions adopted to prevent the spread of
plague by other means of communication from one part of the
Presidency to another, and across the Sind border into the
Punjab.
MEASURES ADOPTED IN THE BOMBAY PRESIDENCY.
Subject already
noticed in
discussing land
quarantine.
Some notice has already been taken of the measures enforced
in the Bombay Presidency in discussing the subject of land quar-
antine.
342
Measures to prevent the
[ CHAP. X.
General rule
issued by the
Government of
Bombay for the
control of
intercourse
between infected
and healthy
localities.
It will be remembered that Rule 29 of the general Bombay plague
regulation gives the Commissioner of the division discretionary power
to authorise plague authorities, appointed for the purpose, to prevent
the passage of suspicious persons away from infected localities or
into other localities, until they had been detained under observation,
and their clothing, etc., had been disinfected, These plague authori-
ties were allowed a wide discretion to decide what persons should
be regarded as "suspicious."
Other general
rules issued by
the Government
of Bombay.
The following is the substance of other rules on the same subject
contained in the general plague regulations issued by the Govern-
ment of Bombay:—
Inspection of
persons coming
from infected
areas.
Rule 4.—Plague authorities are authorised to inspect persons
coming from infected areas, and to detain suspicious subjects at
places appointed for the purpose.
Establishment
of observation
posts on roads.
Rule 5.—Authority is given to District Magistrates to establish
observation posts on roads leading from infected localities to other
places. The officers appointed to the posts are empowered to detain
for examination any person whom they suspect to be suffering
from plague, and are directed, if not themselves medical officers,
to give information to the nearest medical officer authorised to take
action under the rule.
Rule to secure
the co-operation
of villagers.
Rule 25.—This rule was designed to secure the co-operation
of the villagers in preventing the spread of plague to their villages.
The village headman is directed to prevent the entrance into
his village site of any person believed by him to be suffering from
plague, and if any such person is found within the precincts of
the village to send him in a cart or litter to the nearest isolation
hospital, or if this be too far, to at once build or allot a hut for him
outside the village site and detain him there until the orders of the
executive officer can be procured. The rule further directs that
the companions of any person suspected to be suffering from plague
should not be allowed to enter the village site, but should be required
to accommodate themselves outside the village during the period of
their detention, reasonable assistance being given to them for this
purpose.
Instance
illustrating
the working of
the rules.
The following account of the precautions taken for the protection
of the hill station of Mahableshwar will illustrate the manner in which
these rules were worked.
Arrangements to
protect
Mahableshwar.
Mahableshwar is a hill station and sanitarium in the Satara
District, and is during the hot weather months the seat of the Local