NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
22
Of the foregoing staff the ward attendants, dhoby and
cooks belonging to the medical section need not be entertained
unless and until cases of plague occur, and it will usually be
sufficient to appoint a single hospital assistant until plague
occurs.
Plague
camps.
59. The Collector may call upon any municipal council or
local board within an area under observation to provide and
maintain any or all of the following :—
(a) a hospital camp for the isolation and treatment of
persons suffering or suspected to be suffering
from plague ;
(b) a suspect camp for the detention of contacts ;
(c) a health camp for the occupation of persons who
may be required to vacate any building or ground
under these regulations and who may be unable
to procure necessary accommodation for them-
selves.
60. The municipal council or district board shall be bound
to provide these camps in accordance with the requisition of
the Collector, and at such places (whether within or without
the local jurisdiction of the municipality or local board) as the
Collector, or subject to the Collector's control, the district
medical and sanitary officer or such other medical officer as
the Collector may depute, may determine. For the camps so
provided the municipal council or the district board, as the
case may be, shall furnish such hospital establishment, equip-
ment and supplies as the Collector may direct, and shall also
make arrangements for feeding persons detained under any
of these regulations on payment by them of the cost. In the
case of indigent persons, the municipal council or the district
board, as the case may be, shall supply them with food free of
charge : provided that any person so detained shall have full
liberty to supply his own food subject to such rules and
• conditions as the medical officer in charge may prescribe.
Acquisition
of lands or
buildings
required for
plague
purposes.
61. The Collector or the chairman of the municipal
council or the president of the local board may without notice
enter upon, occupy and use, or may depute any person to
enter upon, occupy and use, without having recourse to the
provisions of the Land Acquisition Act, 1894, any building or
place which is required for and is, in the opinion of the
district medical and sanitary officer or other medical officer
deputed in this behalf, suitable for the purposes mentioned in
the last preceding rule or for any other purposes connected
with plague measures, provided that if the building or place
is occupied, twenty-four hours' notice in writing shall be given
23
to the occupier or shall be conspicuously affixed on such
building or place, The owner or the lessee of such building
or place shall be entitled to a reasonable rent to be fixed by
the Collector with the sanction of Government for the period
during which the ground or building may remain in the occu-
pation of the municipal council or the Collector and president
of the district board, as the case may be : and the Collector,
chairman of the municipal council or president of the local
board, as the case may be, shall, when the building or place
ceases to be occupied for the purposes of the last rule,
thoroughly cleanse and disinfect it, and if the owner so desires,
shall whitewash internally and externally any building so
occupied. Nothing in this rule shall authorize the chairman
of a municipal council to enter upon, occupy or use any build- ..
ing or place which is the property of Government without the
previous permission of the Collector.
Private
plague
camps.
62. Contributions towards the cost of the construction
and maintenance of private plague hospitals and segregation
camps in places which are or may be threatened with plague
will be made by Government from provincial funds in accord-
ance with the following scale :—
(a) For construction, half the cost will be paid by
Government provided the charges are considered reasonable
and the buildings erected on sites approved by the Collector
or plague officer acting under his control. In any case of
doubt or dispute the Government will have the right to
estimate by means of the Public Works department the value
of the work done.
(6) For maintenance, grants not exceeding half the actual
expenses will be sanctioned by Government on the following
conditions : —
(1) The arrangements for the sanitation and supply of
food must meet with the approval of the Collector.
(2) The amounts will be paid, month by month, in
arrears to the manager or managers approved
by the Collector.
63. Hospitals and camps to which a grant is made under
the last preceding rule will be under the general supervision
of Government officials, but these officials will have nothing to
do with the treatment of the sick except at their request, and
their duties will be confined to preserving order, preventing
theft, keeping guard, and attending to sanitation. Detailed
instructions with regard to the construction, equipment and
24
management of plague camps will be issued by the Sanitary
Commissioner and of plague hospitals by the Surgeon-General.
The sale-proceeds of private hospitals to which Govern-
ment have made a contribution will be equally divided
between Government and the plague committee concerned.
Grants for
erection of
sheds in
rural areas.
64, In rural areas district boards may find it cheaper to
give poor people grants not exceeding Es. 3 per household and
let them make their own arrangements rather than to build
sheds for them. Such grants should be kept at as low a figure
as possible, and should be made as a rule only to those who are
otherwise unable to furnish themselves with shelter.
Occupation of
buildings
belonging to
Government
departments.
65. It may become necessary at any moment for Collectors
or other plague authorities to occupy buildings belonging to
other departments than the Revenue department for plague
purposes. In such cases the earliest possible intimation of
such occupation should be given to the authorities in charge
of such buildings. Before occupying them, any moveable
articles in the building at all likely to retain infection
should be removed and placed under proper custody.
Conveyances
for the
carriage of
the sick and
of infected
articles.
66. The Collector, or the chairman of the municipal
council or president of the local board, as the case may be,
shall provide suitable conveyances for conveying to the plague
camps established under Rule 59 persons suffering, or suspected
to be suffering, from plague, and for the transport of any
clothing, bedding or other articles which have been exposed
to infection.
List of areas
under obser-
vation.
66-A. (I) Collectors of districts containing areas notified
under Rule 52 should submit not later than the 1st of April
and the 1st of October in every year, a statement showing
separately the taluqs and municipalities which should continue
to be regarded as being under observation during the ensuing
half-year and the areas which should be freed from observation.
Government will then publish a single consolidated notification
specifying all the areas in the Presidency which will remain
under observation during the half-year, municipalities and
taluqs of districts being shown separately.
(2) If any area not included in the half-yearly notification
is imminently threatened with plague in the course of the
half-year, proposals for placing it under observation should be
submitted to Government immediately, the municipal and non-
municipal areas comprised in it being specified separately ;
but no proposal for rescinding a notification declaring an area
to be under observation should be submitted except on the
dates specified in the previous paragraph.
Note.—For the purpose of this rule municipalities and taluqs of districts shall be
regarded as units. Proposals should not be submitted in rcspect of any smaller areas.
25
Part III.—Measures to be adopted 021 the occurrence
of a case of plague,
Report by
local officers
of occurrence
of plague ;
isolation of
patients and
contacts.
87. (1) On the occurrence of an actual or a suspected case
of plague in a town, village or railway station other than an
inspection station whether in a district declared to be under
observation or not, the village headman or other local officer
shall—
(i) isolate the patient in the camp provided under
Rule 59 supra, or, if no camp has been provided,
in a hut or shed to be immediately constructed
for the purpose on a site remote from inhabited
houses, and shall invariably cause the houses
in which the patient was found to be completely
evacuated ;
(ii) send intelligence by express to the tahsildar or
municipal chairman, and, if plague inspectors
have been appointed, to the nearest plague
inspector.
(2) The village headman or other local officer may
segregate in a separate camp or hut all persons who have been,
or are suspected to have been, in contact with the patient, but
he shall not ordinarily do so unless it is likely in his opinion
that they will not submit to or will evade observation for ten
days. When he decides not to segregate the contacts, he shall
cause them to be observed daily for ten days. In the case of
contacts of cases of pneumonic plague, however, he shall
ordinarily insist on segregation. If plague in an indigenous
form is already present in the town or village, the village
headman or other local officer shall ordinarily not segregate
the plague contacts, but shall cause them to be observed daily
for ten days.
Report by
plague
inspector and
tahsildar or
municipal
chairman.
68. Upon receiving information of the occurrence of a
case of plague, the tahsildar, the municipal chairman or plague
inspector shall inform all superior officers up to the Collector
by the quickest possible means, and shall go at once to the
infected locality. The tahsildar or the municipal chairman
shall arrange to be accompanied or followed by the nearest
medical officer with a supply of medicines and disinfectants
and by a sufficient staff of constables and peons.
Action to be
taken by
plague
inspector and
tahsildar or
municipal
chairman.
69. On arrival at the infected place, the plaguo inspector
(or medical officer if there is no plague inspector) shall
supervise the isolation of the patient and the disinfection of
his residence, clothing, sputa and excreta, and the clothing,
and at his discretion, the person of all who have been in
26
contact with the patient and shall continue such supervision
until relieved under the orders of a plague officer and sent
back to other duty. Houses immediately adjoining that in
which the case of plague has occurred shall also usually be
disinfected.
70. (1) The tahsildar or municipal chairman shall, if the
plague patient has already been completely isolated, arrange
for the efficient maintenance o£ such isolation, for the provi-
sion of medical attendance on the patient, for the complete
evacuation of the house and for the thorough carrying out of
the measures of disinfection specified in the last preceding
rule. If the patient has not been isolated, the tahsildar or
municipal chairman shall at once provide for his isolation, and
shall, if necessary, provide the accommodation referred to in
Rule 59 supra.
(2) The tahsildar or municipal chairman shall, in like
manner, provide for the efficient maintenance of the segregation
of contacts, if they have been segregated, or for the efficient
carrying out of the ten days' observation, if they have been
placed under observation.
Note. - When a town or village has become clearly and unquestionably infected with
indigenous plague, the compulsory segregation of contacts should ordinarily cease.
It will, however, always be open to the plague officer to insist on segregation in any
individual case if he has reason to fear that the contact will evade observation, or for
any other sufficient cause.
Action to be
taken by
plague officer.
71. On receiving information of a case of plague, the
duties of a plague officer (see Rule 103) shall be as follows :—
(1) He shall send telegraphic information to the
Collector" and the district medical and sanitary officer.
(2) He shall then go to the scene oí outbreak, and shall
enforce the measures mentioned above.
(3) He shall see that the hospital, the suspect camp and
the health camp are properly organized and guarded.
(4) He shall see that the patrols and guards round the
infected area completely isolate it, or such part of it as he
deems fit, so as to prevent the return of the inhabitants without
his written permission.
(5) He may also, when authorized by the Collector,
direct the evacuation of the village or town or any part of it,
and the removal of the inhabitants to a health camp, provided
sufficient shelter is available, and their detention there for a
period not exceeding ten days from the date of the occurrence
of the last case of plague among them.
(6) On the evacuation of houses, he shall cause them to
be surrounded by a cordon with the object of preventing the
27
return of the inhabitants without his written permission, and
to be thoroughly disinfected.
(7) He may also cause the village to be disinfected.
Note.—For further information as to the steps to bo taken in plague outbreaks, the
importance of early discovery of plague cases, and the segregation of contacts, see note»
(1), (2) and (3) in Appendix 1.
Report by
Collector and
the action to
be taken by
him.
72. (1) The Collector, on receiving information, shall
telegraph to Government, the Surgeon-General and the Sani-
tary Commissioner, and shall despatch the ambulance staff
with its equipment to the village under the district medical
and sanitary officer, or his assistant.
(2) He may notify by tom-tom (the notification to be as
soon as possible published in the District Gazette) that any
town or village, or part of a town or village, or group of
villages, is infected, and thereupon the regulations contained
in Part II shall come into force in the district if they have not
been brought into force by Government already.
(3) He may order the evacuation and disinfection of
infected houses and houses in their neighbourhood, or of
infected villages and towns, and may prohibit their reoccu-
pation without permission, provided that such arrangements
as the Collector thinks fit shall be made before evacuation,
for the accommodation, in a health camp or elsewhere, of
those who may be unable to provide shelter for themselves.
Note.—For further remarks regarding evacuation, see note (4) of Appendix. I.
(4) He may require the evicted people to reside in any
place which he may appoint, under such restrictions as ho may
deem necessary.
(5) He may requisition the services of any public ser-
vant or, for work connected with a railway, of any railway
employee.
(6) He shall, if possible, go to _the village and direct
operations.
Part IV.—Rules applicable to areas declared
to be infected.
Preventive
ranges.
73. If observation ranges have already been established
under Rule 56 supra in the neighbourhood of an infected area,
they shall be reduced in extent so as to enable the inspectors
to visit every village within their respective ranges in seven
days. The distance from the extreme limits of any such range
to any point on the periphery of the infected area shall not
exceed twenty miles. If an observation staff has not bee»
28
already appointed, he shall at once organize one so as to meet
this requirement. Ranges so formed round infected areas
shall be termed preventive ranges to distinguish them from
the observation ranges mentioned in Rule 5.0 supra. These
ranges shall bo placed in the charge of plague inspectors,
whose duty shall be to visit frequently every inhabited part of
their ranges, to check the working of the passport system, and
to maintain a watch over the health of the inhabitants with the
object of quickly discovering cases of plague and preventing
the spread of the disease.
Inoculation.
74. The Collector shall arrange with the Sanitary Commis-
sioner for a sufficient supply of Haffkine's vaccine in order to
bring inoculation within the reach of the inhabitants of plague-
infected and plague-threatened localities and shall afford them
every facility for being inoculated.
Note.— For further information regarding inoculation, see note (5) in Appendix I.
Certificates
of causes of
death.
75. (-1) When he has a sufficient medical staff at his
disposal to secure immediate inspection, so that there may be
no chance of funerals being delayed, the Collector may, with
the previous sanction of Government, order in respect of any
particular area that a certificate of a medical officer showing
the cause of every death shall be obtained within two hours
after such death. It must be understood that medical ex-
amination of a corpse is entirely optional on the part of the
relations, and that no one will be compelled to allow the inspec-
tion of the corpse of a deceased relative. The examination of
the corpses of women by men shall never be required. The
orders of the Government shall be obtained before this rule
is acted upon in any area, and in applying for sanction, the
Collector shall report fully on the following points :—
i. What classes of officers will be authorized to issue
certificates under the rule.
ii. Whether any fee will be required for the grant of
this certificate.
iii. Whether there is such a number of Government
medical officers, male and female, at the station as will be
sufficient to carry out inspection promptly so as not to cause
any delay in burials.
iv. Whether there has been any increase in the rate
of mortality.
v. Whether there is any reason to believe that deaths
are concealed or that causes of death are not correctly reported.
(2) If, after the issue of an order under clause (1) of this
rule, a burial or cremation takes place without such a certifi-
29
cate having been obtained, the death may be presumed to have
been due to plague, and the rules regarding the segregation of
the contacts and the disinfection of the house may be applied.
Ilouse-
search.
76, With the previous sanction of Government, the
Collector may organize search parties to visit houses for the
purpose of detecting cases of plague, when there is reason
to believe that the residents are attempting to conceal them.
Special enquiries shall also be made as to any sickness or mor-
tality among rats, and houses in which sick or dead rats have
been found shall be disinfected.
77. The system of house-visitation and house-search will
ordinarily be permitted only when plague exists in small and
well-defined areas, such for instance as an isolated quarter or
ward of a town, or a single village in a neighbourhood which
is otherwise completely free from infection. When this mode
of discovering plague is adopted, care should be taken that a
sufficient number of European officers are employed to render
the powers of search effective and at the same time prevent
the subordinate establishments from abusing their authority.
Failing officers of the civil establishments, young officers of
the Staff Corps should be deputed for this duty. Eespectable
inhabitants who volunteer for the service should be employed
to assist in searching for concealed cases of plague. As far as
possible, houses should be allowed to be entered only by persons
of caste or of the same religion as the occupants, and women
should be utilized in examining women and in searching any
room or place exclusively occupied by them.
Removal of
plague
patients to
hospital.
78. Plague patients who are left without any one to look
after them or who have no home should in all cases be removed
to hospital, and in dealing with imported cases or with an out-
break in a small place upon which it is possible to concentrate
a sufficiently strong establishment, the first measure to adopt is
the compulsory removal of the sick to hospital. In dealing
with early indigenous cases the same policy may be advisable.
But if plague continues a point may soon be reached when it
will cease to be possible to obtain information as to all cases.
When this point is reached, the continuance of attempts to
remove the sick to hospital may result in the sick being carried
from house to house for purposes of concealment, and at this
stage the less the sick are interfered with the better. All that
can then be done is to endeavour to palliate the evils that result
from leaving people in their houses by arranging for continual
visitation of the sick at home, the frequent disinfection of the
infected room, and the encouragement of inoculation among
persons left in the houses with the sick,
30.
79. Except as mentioned in the last preceding rule the
removal of patients to hospital shall not be compulsory. Every
effort shall, however, be made to induce patients to go
voluntarily to hospital and to lessen the aversion to hospital
by the following means—(1) by encouraging the establish-
ment of private and caste hospitals; (2) by locating hospitals
near to infected quarters; (3) by limiting the size of hospitals
so that patients may receive more individual attention ; (4) by
arranging for the provision of an adequate number of medical
attendants and nurses and of ample and comfortable accom-
modation for patients and their immediate relatives or
friends ; (5) by permitting at least two relatives or friends to
be in attendance on each patient so that the patient may never
be left alone; (G) by allowing the patients to have their own
food and medicines and to receive visits from their relations,
friends and religious instructors; (7) by taking care that all
arrangements for observance of caste customs and for the
comfort and convenience of patients and their attendants
are completed before inviting removal to hospitals.
79-A. For each plague hospital or camp in a town or other
large centre of population, the Collector shall appoint a com-
mittee of non-official visitors. The committee shall consist of
as many members as may be fixed by the Collector, shall be as
representative in character as possible, and shall work subject
to such rules as may bo laid down by the Collector. The
functions of the committee shall be confined to the making of
useful suggestions in connection with the administration of
the hospital or camp and shall not include any power to
interfere with or issue orders to any of the officials on duty at
the premises.
80. Moribund patients should never be removed to
hospital except at the express wish of the friends or relations
of the patients. The risk of leaving in his house a patient
whose case is so serious that the medical officer thinks he has
not a fair chance of recovery is not great after the existence
of the case has become known. The pneumonic variety of
plague being the most contagious, persons suffering from this
type of the disease should not be removed to the general
wards of plague hospitals, but should be isolated in separate
wards of the greatest possible air space. It is further advis-
able that such cases should not be treated in private houses,
unless, in the opinion of the medical officer, the room occupied
by the patient is suited for his complete isolation, and proper
control over the number of attendants and enforcement of
disinfection can be had.