NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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APPENDIX I,
NOTES ON CERTAIN MATTERS CONNECTED
WITH PLAGUE.
(1) General Remarks,
1. In dealing with an outbreak of plague, a combination of the
following measures is likely to produce the maximum of good :—
(1) Prompt discovery and isolation of every case of plague.
(2) Disinfection, observation and segregation of contacts.
(3) Evacuation of dwelling-houses.
(4) Inoculation.
(5) Disinfection of dwelling-houses.
(6) Removal and destruction by burning of plague-infected rats,
and the disinfection of the houses in which they aro found.
(7) Systematic destruction of rats generally.
Of these measures the first is the most important. When once
plague has obtained a footing in a large place or has spread to a
number of villages it will be found very difficult to apply the measures
of disinfection and segregation. The policy to be adopted at a
particular place will depend on its physical features, the season of the
year, the general sentiment and state of education of the people in
regard to plague measures, the strength of the staff available, and the
influence of the local authorities. The systematic destruction of rats in
a threatened locality as well as in an infected area is of the greatest
value both as a preventive and an arrestive measure.
2. In the larger places, i.e., towns with a population of more than
10,000, the measures that will be found most applicable are disinfection,
inoculation, the evacuation of specially infected quarter and (so long
as infection has not spread through the town) the isolation of the sick.
In villages, the chief measure to be relied on is evacuation, but inocula-
tion and chemical disinfection should also be resorted to so long as there
is sufficient staff to supervise those measures. .Evacuation in both towns
and villages should be conjoined with an opening up of houses sufficient
for the admission of sunlight and air whenever this is required. In
carrying out these measures it should be borne in mind that it will
always be better to apply one method efficiently and thoroughly than to
apply a number of methods with an inadequate and insufficiently trained
staff. Another point of importance is that in places where plague is
constantly recurring and the amount of plague is liable to great seasonal
variations, plague measures should be carried out with special vigour at
the season when the epidemic is at its minimum.
3. Experience has shown that it is hopeless to carry out effectively
any system of plague administration which is not supported by the
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(3) Observation, Disinfection and Segregation of
Contacts.
7. Persons who have been in immediate contact with a plague
patient are known as " contacts" and as they are likely to develop
plague, special surveillance in their case is necessary. The clothing
and personal effects of all contacts should be disinfected and the contacts
placed under surveillance for a period not exceeding ten days under a
pass in the form in Appendix II-E1. While under surveillance, the
contacts should be allowed to pursue their ordinary avocations. When
there is reasonable suspicion that any contact will not duly report
himself for the daily observation, he may be segregated in the plague
camp. Contacts of cases of pneumonic plague should however be
ordinarily segregated.
8.
*
*
*
(4) Evacuation.
9. By evacuation is meant the emptying of all or some of the
houses in an infected town or village, so that they may not be used as
dwelling houses until it is believed that they can again be occupied without
risk of infection, the people thus removed being lodged in temporary
camps in the open country. To make such evacuation thoroughly
effective, the following conditions are required : (1) the people should
all be got out promptly ; (2) their effects should all be disinfected ;
(3) each new case of plague should be immediately isolated ; (4) suitable
accommodation should be available ; (5) the people should be effectually
prevented from visiting or sleeping in the infected houses until either
the houses have been disinfected or until sufficient time has elapsed for
the infection to disappear ; and (6) lastly they should not be permitted
to scatter and spread the infection in the neighbourhood.
10. Evacuation provides the most effective safeguard against the
spread of plague that has yet been discovered. Its advantages are
self-evident and it should be resorted to wherever practicable. In
villages and small towns (population not exceeding 10,000) complete
evacuation (i.e., evacuation of all the houses) will be found to he generally
possible. In large towns, the extent to which it can be carried out
will depend on the willingness of the people, the season of the year, the
situation of the town, the facilities for providing camp accommodation,
and the strength of the available staff. It will be found to be of the
greatest value at the very commencement of the outbreak, for the
removal of the small number of people affected will not present any
great difficulties, and prompt evacuation of the infected quarter may
save the rest of the town.
11. Evacuation is, however, likely to do more harm than good in
the following cases :—
(a) During the rainy season, when it is impossible to keep the
people, after they have once been removed from their houses, from
going back to them. In such circumstances, the people who are
removed are exposed to great inconvenience and misery without any
countervailing advantages being derived from evacuation.
5
66
of the vessels used for measuring out the concentrated solution shall
be accurately adjusted to that of the wooden buckets in which that
solution is diluted for use. Further, the buckets employed should
be of such capacity as to hold just the quantity of water suffi-
cient to dilute the measure of concentrated solution to the desired
effect. The perchloride may also be issued in the solid form in packets,
the contents of which are accurately adjusted to the size of the vessels
in which they are to be dissolved for use.
20. Steam-sterilisers, unless their working is committed to skilled
and trustworthy operators are found in practice to be quite ineffective,
and are therefore not suitable for general application. Their use is
limited to ports for the disinfection of the effects of native crews and
native ship passengers bound for ports out of India. Full instructions
as to the mode of working them should be supplied with each machine,
21. In cases where it is not possible to carry out chemical disinfection,
the disinfecting agency of desiccation should be relied upon. For this
purpose, the house ought to be thoroughly cleaned out ; the removal
from the house of cow-dung and other moist accumulations should be
particularly insisted upon, and the inmates of the house should be
induced to remain away for a period of at least two months until the
process of desiccation is complete. Disinfection by desiccation cannot,
however, be relied upon during the rains.
22. The breaking of holes in the roof or walls and partial untiling
will not accelerate the process of desiccation to such a degree as to
counterbalance the damage done to the house. This measure should
not therefore be adopted in the case of masonry houses with concrete
roofs. As a rule, such houses can be disinfected without great diffi-
culty and are to a certain extent open to light and air. But in rural
areas, where the majority of the buildings are of a comparatively poor
character it will rarely be possible to provide for efficient chemical dis-
infection. In these cases, wherever possible, the whole roof should
be removed especially when it affords harbourage for vermin.
23. Owing to the risk of infection from the blowing about of the
floor-dust, the digging up of floors ought not to be resorted to except
in imported and early indigenous cases and should be accompanied by
disinfection.
24. The actual burning down of houses should, not be resorted to
except in the case of temporary structures which are of little or no value,
or in the case of houses which are unfit for human habitation.
25. With the view of encouraging people to produce their goods
for disinfection and of preventing them from secreting them, nothing
which could have any real value for its owner should be broken up or
destroyed by fire. Liberal compensation may be paid for any articles
so destroyed, when the loss would fall upon people in very poor circum-
stances ; such compensation, if allowed, should be paid promptly.
26. Disinfection of personal effects should not be attempted in the
case of travellers by road or railway but should be carried out in the
case of—
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(a) native crews, third class or deck passengers and native
servants leaving infected or healthy ports for ports out of
India. This should be done on shore ;
(b) plague patients and contacts removed from infected houses,
ships or railway carriages ;
(c) plague patients discharged from hospitals and persons return-
ing to their houses from health or suspect camps.
27. That the disinfection of the person is effective is indubitable as
is proved by the- practice of washing the hands with disinfectants in
bacteriological laboratories and in surgical operations. The measure,
however, is extremely unpopular, and has been ordered to be abandoned
in the case of travellers as very little is to be gained by disinfecting
them. It will be found useful in the case of persons taken out from
plague-infected houses into health camps and in the case of plague
convalescents leaving hospital.
28. Laboratory experiments and practical experience alike tend to
show that there is little danger of the spread of plague by means of
ordinary articles of merchandise, and that it is therefore not necessary
to disinfect such articles. The only restriction found necessary is the
prohibition against the importation from infected localities of rags,
waste paper and soiled linen. Any such articles brought in contraven-
tion of this prohibition should be destroyed. Old newspapers and any
paper used for packing purposes are not included within the prohibition,
but washed linen articles such as washed dhotis, come within the
meaning of the term " soiled," although they have not been worn since
they were last washed. Persons who send parcels by railway or post
from plague-infected areas are required to declare in writing that the
parcels do not contain any soiled linen and bedding, rags or waste paper.
29. When any carriage from an infected area is detached from a
train at any railway station in the Madras Presidency, it shall be
disinfected and ventilated by the railway authorities in the following
manner as soon as possible and before it is again brought into use,
and if such carriage is detached at an inspection station such disinfection
and ventilation shall be effected to the satisfaction of the inspecting
medical officer :—
(i) Third and intermediate class carriages—
The interior wood-work of the carriages, especially the
floors and seats, shall be thoroughly washed with a solution of perchlo-
ride of mercury (1 in 1,000) and of hydrochloric acid (2 in 1,000) ; the
doors and windows shall be opened, and the vehicle exposed to the air ;
the sweepings shall be carefully collected and be burnt.
(ii) First and second class carriages—
The floors and wood-work shall be treated as above, the
cushions being also brushed and thoroughly cleansed and exposed to
the sun for not less than four hours.
30. (1) Any railway carriage from which a passenger who is
suffering from the plague has been removed shall be detached at the
nearest convenient station, and shall be disinfected by the railway
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authorities as follows, and if that station is an inspection station, such
disinfection shall be effected to the satisfaction of the inspecting
medical officer :—
(i) The carriages, after being detached from the train, should
be thoroughly washed with soft soap. 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
..
..
.. 1/2 oz.
Hydrochloric acid
,
..
I „
Water
..
..
..
..
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 carriage should be kept out in the
open for 48 hours. They can then be brought into use again.
(iii) In the ease 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 wood-work in the manner
indicated above, and re-paint the interior.
(2) If a compartment has been used by a person suspected of
being infected with plague, it shall be treated as directed in the preced-
ing section. If of the third or intermediate class, its use may be
permitted as soon as it is thoroughly dry ; but if it be of the first or
second class, it shall, after such disinfection, be kept locked and unused
until the nature of the case be definitely ascertained, when the question
as to whether or not the cushions be destroyed and further disinfection
be effected, shall be decided in accordance with the preceding clause (1)
(iii) of this paragraph.
31. Detailed instructions as to the mode of disinfection to be
adopted in each case will be issued by the Sanitary Commissioner and,
in respect to the management of hospitals, by the. Surgeon-General.
(7) Rat-Plague and Destruction of Rats.
32. It has been observed, and proved by experiment, that rats are
very susceptible to plague and a .large mortality among rats ordinarily
precedes an epidemic of plague among human beings. Eats, when
infected, carry the disease from house to house, and are main agents in
its dissemination. Their destruction, and the observation of any special
sickness or mortality among them, is of the first importance.
33. Measures for the destruction of rats should be universally
adopted. These vermin should, as far as possible, be exterminated in
every locality which is likely to be exposed to infection. Special
precautions in regard to rats should not be confined only to infected
localities or localities immediately threatened and the neighbourhood.
The common-sense rat exterminator has been found to give results
superior to those of other poisons and should be adopted for general use.
Granaries being the favourite haunts of rats, grain bags arriving from
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a place suspected of being infected with, plague should be carefully
examined, and any rats found should be destroyed and their bodies
burnt. Infection once brought into a granary spreads rapidly among
the healthy rats, and thence to human beings living in the neighbour-
hood. Collectors, presidents of district boards, and chairmen of munici-
pal councils, should therefore take special precautions to prevent
infection from this source. Arrangements should be made for the
constant inspection of granaries and grain bazaars and care should be
taken to keep them clean and disinfected and to have the rats extermi-
nated. In inspecting granaries particular inquiries should be made
whether any dead or sick rats have been observed. Rats sick with the
plague seem careless in the presence of men and run about.in a dazed
way with a peculiar limping gait in the hind legs, owing to painful
glands in the groin. The port and sea customs authorities should be
instructed to see that no rats are landed with goods imported by sea,
and that rats found in ships are as far as possible destroyed. Bandi-
coots, mice and other rodents are also liable to become infected with
plague and should therefore be destroyed.
34. The systematic destruction of rats whether in infected or unin-
fected areas must be regarded as a measure of the first importance, but
more especially should the destruction be carried out in—
(a) infected places and the surrounding area within a radius of
ten miles round it ;
(b) landing places and railway goods-sheds, where rats from
infected places are likely to be imported with goods brought by sea or
railway ;
(c) grain godowns.
In the case of (a), rewards may be necessary, but the maximum rate
should not ordinarily exceed three pies. In other cases, the port or
railway authorities are expected to do all that is required without the
reward system.
35. The charges incurred in the destruction of rats should be
debited to local or municipal funds according to the area within which
such charges are incurred.
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APPENDIX II-B.
GENERAL PASS.
[See Rule 83 cm page 32.]
(To be issued for daily or frequent journeys by road or boat to or
from an infected area.)
No.
District.
Station of issue.
Name of person.
Father's name.
Caste.
Age.
Ordinary residence.
Journey covered by this pass.
This pass protects the person named above and the members of
his family mentioned on the reverse, but it does not authorise journey
by rail, for which a separate pass shall be obtained by each individual
requiring it, nor does it cover residence outside the village * of
It will be in force until revoked.
Signature
Designation.
Date.
* The -village specified should be that in which the holder permanently resides with
his family.
(Reverse of Form.)
Name.
How related to pass-holder.
Signature.
Designation.
Date.
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APPENDIX II-C.
GENERAL PASS.
[See Rule 83 on page 32.]
(To be issued for daily or frequent journeys by rail to or from an
infected area.)
No.
District.
Station of issue.
Name of person.
Father's name.
Caste.
Age.
Ordinary residence.
Journey covered by this pass.
Signature.
Designation,
Date.
APPENDIX II-D.
GENERAL PASS.
[Seo Rule 83 on page 32.]
(To be issued to persons who leave an infected or notified place to
attend markets in the adjoining non-infected area.)
1. Inspection station through which the holder will pass.
2. Railway station where the holder will alight.
3. Name of person.
4. Father's name.
5. Caste.
6. Age.
7. Sex.
8. From what infected or notified place.
9. To what market
...
...
...
District,
Taluk.
Village.
District.
Taluk.
Village.
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This
pass allows the holder to remain in the village of
time
without a passport. On the expiry of the period
he must either have left the village or have provided himself with a
passport. He must show this pass to the officer in charge of the
inspection station through which he will have to pass when proceeding
to the village where the market is held and to the passport-issuing
officer at the railway station where he alights as also to the local
authority of the village at or near which the market is held and obtain
their initials on the reverse. Ho will likewise show this pass on his
return to the officers mentioned above and obtain their initials. There
is, however, no necessity to present it at the railway inspection station
if there be no medical inspection on his return journey from the village.
Holder's Signature
Date
Signature of issuing officer.
APPENDIX Il-E.
SPECIAL PASS.
[See Rule 85 on page 32.]
(To be issued to persons leaving an inhabited infected area to reside in
its neighbourhood.)
No.
District.
Station of issue.
Number of office of issue.*
Name oí person.
Father's name.
Caste.
Occupation.
Age.
Ordinary residence.
The above-named person (and his family consisting of
males
and
females as per reverse) is are permitted to reside temporarily at
(name of site or number of field] on his producing this pass, with the
accompanying certificate † duly filled in by the officer responsible for
disinfection.
Date
Signature and designation,
* To be entered when there is moro than one office of issue in a town.
† If the family leaves a healthy area of the town or a house that has not been
infected, this part of the certificate may be dispensed with at the discretion of the
issuing- officer.
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(Reverse of Form.) .
Name.
How related to pass-holder.
Signature.
Designation.
Date.
Disinfection Certificate.
I hereby certify that having satisfied myself that arrangements for
residence at the site named by the above-described person (and his
family) were complete, I immediately before his their departure
carefully
disinfected all clothing and property removed by him them
Date.
Signature of officer in charge of
disinfection.
------------------ APPENDIX II-E1.
[See Rule 85-A on page
33.]
--------------------------------
Pass for Plague Contacts.
Take notice that you
being a plague contact
are required to submit yourself daily for examination at *------------------
between
the hours of -------------------------and -------------------by the
passport examining officer until he is satisfied that by reason of disin-
fection of all infective matter in your residence, property and clothing,
and complete recovery and discharge of any person who has suffered from
plague with whom you may have last been in contact, a period of ten
days' freedom from imminent danger of contact with infective matter
has elapsed.
Date
Range Inspector.
* Here insert either a public office, or in special cases the person's residence.
---------------------------------------------------------------------------------------------
Register No.
I acknowledge receipt of contact pass No------------, and am aware
that disregard of its conditions will subject me to prosecution under
Bule 100 of the Madras Plague Regulations in force outside the Presi-
dency town.
Date
-.
Signature of contact or guardian of contact.
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APPENDIX II-F.
[See Rule 121 on pages 44 and 45.]
[COUNTERFOIL.]
No.
Name.
Father's name.
Street
Village
Town
Taluq
District
Date
Initials of operator.
Plague Inoculation &
No.
CERTIFIED that
, resident of
Town
Taluq
, has been
that his thumb-mark was
before me.
Certificate.
son of
Street
Village
District
inoculated by me, and
at the time impressed
Space for left thumb-mark. Signature and
designation.
Dated
NOTE,—"unless suffering from, or suspected to be suffering from,
plague, the holder of the certificate is exempted from segregation,
from detention when travelling, and from ten days observation
under the passport rules. It does not, however, exempt him from
liability to evacuate an infected house, except in the case where all
the occupants of the house, have been inoculated, or to have his
clothes and person disinfected when travelling. The certificate is
valid for a period of four months.
APPENDIX II-G.
Register of permanent passes issued to persons attending markets.
[See Rule 84 on page 32.]
Name of person.
Pass number.
Date of
Arrival.
Return.
Remarks.