NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
242
Measures in the Bombay Presidency and Sind. [CHAP. VIII.
later the relative number had risen to 130 as shown by the first line
in the table :—
Disinfectant.
A. Sublimate 1 in 1,000
B. Sublimate 1 in 1,000 plus
hydrochloric acid 2 in 1,000
C. Chloride of lime 1 per cent. .
D. Potassium permanganate 1
per cent.
E. Sulphuric acid 1 per cent.
F. Permanganate and sulphuric
acid each 1 per cent.
G. The same mixture diluted ten
times
H. Sulphuric acid I in 250
I. Sulphuric acid I in 500
J. Sulphuric acid I in 500 plus
permanganate 1 in 1,000 ...
K. Phenyle 1 per cent.
...
L. Lysol 1 per cent.
Before treat.
ment.
100
100
100
100
100
100
100
100
100
100
100
After ½
hour.
60
0
0
98
0
17
31
87
91
68
0
0
After 1
hour.
55
43
112
55
79
12
49
63
140
72
248
72
After 2
hours.
40
0
63
76
57
II
131
45
142
63
166
67
After 24
hours.
130
I
315
86
35
7
112
112
300
161
138
220
Deductions.
''After addition of the disinfectants, the treated areas were
protected from dust by means of covers placed over them. It will
be noted that the only substance tried that produced anything
approaching a complete disinfection was corrosive sublimate in
an acidulated solution. Chloride of lime, phenyle, and lysol appear
to be without much action on the microbes of a cow-duno; floor,
although as is known they are energetic disinfectants of microbes
suspended in test tubes of bouillon. A comparison of experiments
D, E and F shows that a mixture of permanganate and sulphuric
acid acts more strongly than either of these substances alone. The
same deduction can be drawn from experiments I and J. As
already explained, moistening a cow-dung floor is likely to lead to
an increase of the number of colonies that will appear in these ex-
periments. The specimens taken before treatment were obtained
CHAP. VIII. ] Measures in the Bombay Presidency and Sind. 243
from the floor while it was dry. Those taken after treatment were
taken when it had for some time been moistened with the disin-
fectant solution. This is the most probable cause of the increase
in the number of colonies developed after addition of the solution of
phenyle in experimnt K."
Experiments at
Hardwar and
Kankhal.
Similar experiments with disinfecting agents were carried out with
a like result during the disinfecting operations at Hardwar and the
neighbouring village of Kankhal.
Disinfection by
fife.
Disinfection of
latrines by fire.
Experiments with fire were found to give the best results. Complete
disinfection was produced by burning a layer of grass two inches thick
on a surface of earth under the shade of a tree. The experiment was
also tried with apparent success in a tenement in Bombay inhabited
by policemen ; grass was burnt all over the floors and no more cases
of plague occurred. " Though the method can thus be carried out
with the help of intelligent supervision, it would probably lead
to accidents, if employed in a town on a large scale. In most
cases, however, it can be used in public latrines, which are frequently
made of corrugated iron or other incombustible material. Both on
the general grounds that human excreta are apt to contain the
microbe of the disease, and on the a posteriori evidence of the
Hong-kong epidemic, it is probable that public latrines may become
sources of infection and consequently are greatly in need of efficient
disinfection. Owing to the existence of caste and other prejudices
the disinfection of public latrines is very often shirked. Further, if
ordinary disinfectants are used, it is not easy for an inspecting officer
to know whether the work has been properly carried out. Hence I sug-
gest that public latrines in infected areas should be frequently treated
with burning grass or other fuel. The sweeper could put a bundle of
grass on to each compartment and light it. Afterwards the ashes
could be washed out with a dilute solution of sulphuric acid."
Duration of the
action of
different
disinfectants.
A matter to which Mr. Hankin attached considerable importance was
the duration of the action of the disinfectant " whether in other words
its employment is likely to make the medium unsuited for a con-
siderable time for the life of the bubonic microbe."
" This is possibly more important in the case of bubonic plague
than with other diseases. Not only in this disease is a disinfected
area liable to be re-infected by human patients, but in addition in
many cases this may occur through the agency of infected rats.
Hence a disinfectant that merely destroys the microbes present
at the time, and that has no lasting action is not sufficient for the
purpose. As shown by previous experiments, acidulated sublimate
solution is the only one of the disinfectants tried that showed a
244 Measures in the Bombay Presidency and Sind. [CHAP. VIII.
clearly good action on a cow-dung floor. Unfortunately, however,
solutions of mercuric salts, even with the addition of volatile hydro-
chloric acid, are by no means stable, especially when mixed with
the material of a cow-dung floor. Dilute sulphuric acid on the other
hand is not volatile, and if used in sufficient quantities is likely
for some time at least to make the floor an unsuitable nidus for the
bubonic microbe. Although, as shown in previous experiments, there
are many microbes in a cow-dung floor not readily affected by it
In the strength recommended, the special sensitiveness of the
bubonic microbe to acids in general and to sulphuric acid in par-
ticular makes it likely that the latter substance will be efficient
when used on such a floor. The acid will slowly diffuse to the
deeper layers and combine with calcium salts and various alkaline
substances that may be present. But the upper layers which are
in most need of disinfection are most likely to be affected, and the
acid will be less quickly neutralized if the floor has been treated
with acid sublimate solution on the preceding day. In a locality
in which the soil is highly calcareous, sulphuric acid is not likely
to be a convenient disinfectant for cow-duns floors."
Sulphur fumiga-
tion not reliable.
Mr. Hankin came to the conclusion that sulphur fumigation cannot
be relied on to destroy microbes. "Experiments carried out by
the German Health Officer," states Mr. Hankin," have shown
that though gaseous disinfectants may destroy the microbe
in experiments on a small scale, they will not do so in large rooms
as the gases do not show sufficient penetrative power." Lie carried
out two experiments which confirmed this conclusion,
Disinfection by
oxidation.
Mr. Hankin recorded the following remarks on disinfection by
oxidizing action of the atmosphere and by oxidizing agents :—
" A further consideration bearing on the choice of an antiseptic
depends on a view that is generally held by those having experience
of plague, namely, that the virus is sooner or later destroyed by
ventilation. As I have elsewhere shown, the plague microbe is
somewhat resistant to the action of drying, and hence it is difficult to
believe that the asserted benefit of ventilation is only due to dessica-
lion tending to destroy the microbe. Its action is more likely to be
due to the oxidation processes that are produced by the evapora-
tion of water in the presence of air and light. Many authorities
have brought forward reasons for believing that the destruction
of microbes through the action of light is in reality due to an oxida-
tion process. Microbes are found not to be destroyed by light when
exposed to it under condition in which oxidation processes cannot
occur. My experiments have further shown that the bubonic microhe
is very susceptible to the action of such oxidizing agents as chloride
CHAP. VIII. ] Measures in the Bombay Presidency and Sind. 245
of lime and permanganate of potassium. If the evidence in favour
of the use of ventilation is considered to be sufficient to justify the
costly and troublesome method of removing the roofs of houses, and if
the good effects of ventilation are admitted to be due to oxidation,
ought not cheap and convenient oxidizing agents such as perman-
ganate of potassium to be used in combating the plague ? Unfortu-
nately in the case of cow-dung and mud floors it is not likely to be
practicable to employ sufficient permanganate to produce the effect
desired. It might be possible in better built houses with cement
floors. Permanganate might be used in water suspected of being
infected, such as water used by dhobies for washing infected clothes.
But owing to the risk of insufficient quantities being employed, it
would be most objectionable to put it into the hands of unskilled
workers for ordinary purposes. I have shown above that a mixture
of sulphuric acid permanganate is more active in destroying microbes
than either of these substances used separately. Such a mixture
would have the further advantage of removing smells from dwelling
rooms, such smells being unaffected by corrosive sublimate. But it
must be borne in mind that the sulphuric acid enters into the reac-
tion, and is decomposed with the permanganate. Hence the addi-
tion of permanganate to dilute sulphuric acid may diminish the
durability of the effects of the latter. Strong solutions of perman-
ganate mixed with dilute sulphuric acid slowly decompose with
liberation of ozone. With concentrated sulphuric acid the reaction
is violent."
Disinfection
should be done
twice over.
In view of the fact that the coolies employed in disinfecting work
may not carry out the process thoroughly, Mr. Hankin advises that
wherever practical the room should be disinfected twice over,
Practical rules.
The following are the practical rules for the disinfection of build-
ings which Mr. Hankin derived from his experiments :—
"(1) In the case of corrugated iron latrines, isolated pucca build-
ings, and other pucca buildings in which the work can be
done with safety under intelligent supervision, a layer of
dry grass or other inflammable material, at least two inches
thick, should be laid over the whole of the floor and burnt.
Afterwards the whole of the interior of the building should
be washed out with a solution containing one part in 250
of sulphuric acid.
(2) In the case of dwelling rooms in which there are definite
grounds for believing infection to be present, the whole of
the interior should be first washed with a solution of corro-
sive sublimate of 1 in 1,000 strength to which hydrochloric
246 Measures in the Bombay Presidency and Sind. [ CHAP. VIII.
acid in the proportion of 2 in 1,000 has been added. On
the following day the rooms should, if possible, be washed
out with the dilute sulphuric acid.
(3) In the case of dwelling rooms in which there is no actual
evidence of infection, but which are being merely cleaned
out as a precautionary measure, the dilute sulphuric acid
need alone be used. The inhabitants should be advised
not to " lepo "* the floors after this has been done, with the
unfortunately necessary exception of the part of the floor
near the cooking place.
(4) Dilute sulphuric acid should be used in large quantities for
washing out passages, courtyards, and surface drains.
(5) In order to diminish the risk of coolies being burnt by having
to handle strong sulphuric acid, it should be diluted with
an equal bulk of water at the dispensary before being sent
out. To make a dilution containing one part in 250, three
ounces of strong sulphuric acid, or six ounces of the acid
mixed with its own bulk of water, should be added to
every " nand '' of water : an ordinary " nand " holds nearly
four gallons. A rough indication as to whether or not
water has been added to sulphuric acid may be obtained
by adding pure sugar to some of the acid. If sulphuric
acid contains more than 40 per cent. of water, the mixture
will not turn black during the next hour. The sugar
employed should be slightly moist."
* Smear with cow-dung.
CHAPTER IX.
MEASURES OUTSIDE THE BOMBAY PRESI-
DENCY.
Preliminary Remarks.
Arrangement of
subject.
The general orders issued in provinces lying outside the Bombay .
Presidency and Sind will first be described and an account will then
be given of the operations carried out at Hardwar and the neighbour-
ing town of Kankhal in the North-Western Provinces and at
Khundraoni in the Gwalior State.
General Regulations.
PRELIMINARY REMARKS.
Regulations
reprinted in
Appendix IV.
The regulations issued by the Governments of Madras, the North-
Western Provinces and Oudh, Bengal and the Punjab under the
Epidemic Diseases Act are set forth at length in Appendix IV, and
those portions which relate to the prevention of the spread of infec-
tion by land will be separately discussed in Chapter X.
General
Regulations of
the Government
of the North-
Western
Provinces and
Oudh.
Revised
Regulations.
The Government of the North-Western Provinces and Oudh issued
its first set of general regulations on the 12th February, and subse-
quently modified them by a set of regulations issued on the 26th of
March. In issuing the second set of regulations the Lieutenant-Gov-
ernor remarked that representations had been made to him that it
would conduce to the smoother working of the rules if the procedure
to be followed under them were more carefully and clearly defined.
The rules of the 12th February were accordingly reconsidered by the
Local Government with the assistance of a committee formed of the
Commissioner of Lucknow, the Sanitary Commissioner of the Prov-
ince, and a number of leading Hindu and Muhammadan landowners
and residents. The regulations issued on the 26th March after this
reconsideration modified the former rules mainly in the direction of
defining and limiting the action of the police, in associating more
definitely the proprietors of land and the chief residents in the
248
Measures outside the Bombay Presidency. [CHAP. IX.
towns with the Government officers, and in laying down definite (and
in some respect less stringent) rules for the segregation of the sick
and of persons likely to be infected, and the disposal of corpses.
Both sets of rules are given at length in Appendix IV. They deal first
with the measures to be taken in villages and small towns, and then
prescribe general rules for municipalities and cantonments.
Town
Committees.
The rules direct the formation of a committee in each municipality
or cantonment for the purpose of assisting the Health Officer.
The committee should, the rule states, consist of two members, one a
Hindu and one a Muhammadan, for each ward of a municipality or
definite portion of a cantonment. Their most important duties are
to accompany the Health Officer on his rounds of inspection, to
explain the necessity of the sanitary measures, to assist in their
execution and to bring to notice any complaint that may be made
and any abuse that they may discover.
First orders of
the Government
of Bengal.
The Government of Bengal addressed the Corporation of Calcutta
on the subject of the measures to be adopted with reference to the
outbreak of plague in Bombay on the 30th September, and suggested
that certain measures of precaution and preparation should be enforced.
On the 10th of October, when it was believed (erroneously as it sub-
sequently appeared) that a case of plague had been imported from
Bombay to Howrah, the Government of Bengal considered it desir-
able to issue a resolution appointing a Medical Board for the purpose
of determining the action to be taken by all executive authorities,
whether official or municipal, with the object of preventing and check-
ing the plague throughout Bengal.
Resolution
appointing the
Medical Board.
The resolution directed that all cases of illness believed to be
plague should be at once reported to the Board by the Magistrate of
the district, or by the Health Officer of the Calcutta Corporation, as
the case might be. The orders issued by the Board on matters affect-
ing health and conservancy were to be deemed the orders of the
Government and were to be carried out with all possible despatch by
the executive authorities. The Board were directed to order the exe-
cution of any reasonable measures of precaution, segregation, or disin-
fection which might appear to be called for. The areas with which
the Board had to deal in the first place were stated to be—
(1) The town of Calcutta.
(2) The port of Calcutta.
(3) The municipality of Howrah.
(4) The small municipalities adjacent to Calcutta and Howrah.
(5) The lines of railway,
Special instructions were given with respect to the precautionary
and sanitary measures to be carried out in these five circles. As soon
CHAP. IX. 1 Measures outside the Bombay Presidency.
249
Notification
under the
Epidemic
Diseases Act.
as the Epidemic Diseases Act was passed, the Government of Bengal
issued a notification under it charging the Medical Board with the
general conduct of plague operations, and directing all municipal
authorities to carry into effect the measures prescribed by the Board.
In addition to fulfilling these functions, the Medical Board acted as an
adviser on plague matters to the Local Government.
General
Regulations for
Calcutta and
other
Municipalities.
On the 10th of February a set of general regulations were issued
under the Epidemic Diseases Act for the town of Calcutta, and a second
set, which practically reproduced the first, for other municipal towns.
On the 12th of March further regulations were prescribed for Calcutta
and other municipalities. The regulations of the 10th of February
were only to come into force if plague became prevalent. Experience
in Bombay having shown that it is necessary to adopt the preventive
and precautionary measures immediately a case occurs, and that it
is too late to wait until the disease has become prevalent, the later
regulations of March prescribe the measures to be adopted on the
occurrence of even a single case. The regulations (apart from the
portions dealing with general sanitary matters and with preparation)
were never put into execution, as not a single case of plague was dis-
covered in Bengal,
Draft rules of
June 1897.
Revised
Regulations of
November
1897.
Bengal Plague
Commission.
These first regulations were admittedly in many respects incomplete
and the Government of Bengal considered the question of the issue of
more comprehensive rules. A set of revised regulations was sub-
mitted to the Government of India with a letter of the 3rd June,
and at the same time the question whether segregation in hospital
should be prescribed was discussed. Plague having by this time
greatly abated, it was not considered necessary to issue any new rules.
But when the recrudescence of plague in the Bombay Presidency
again imperilled the safety of Calcutta, the Government of Bengal
considered it necessary to issue a comprehensive set of rules for
dealing with any outbreak that might occur. They forwarded a
revised set of draft rules on the 1st November 1897, and the Govern-
ment of India sanctioned their publication on the 9th of the same
month. The rules were mainly based on the North-Western Provinces
rules of the 26th March, and also contained many of the provisions of
the rules already issued by the Government of Bengal, The Medical
Board of the earlier rules was re-named a Plague Commission, and
the number of members was increased to eighteen, with the Secretary
to the Government of Bengal, in the Medical Department (the
Honourable Mr. H. H. Risley) as President. The main function
of the Commission was defined to be advising the Government,
the district and railway officials, heads of departments, munici-
palities and district boards, as to the measures to be taken in order
32
250
Measures outside the Bombay Presidency. [CHAP. IX.
Plague
Authorities.
to prevent the outbreak and spread of plague. As in the case of
Bombay, plague authorities were to be appointed to carry out the
measures under the control of the District Magistrate, The manner
in which the rules deal with the subject of segregation will be
described in a later portion of this chapter.
Punjab rules.
The Government of the Punjab issued two sets of general regula-
tions on the 8th of March. The first empowered the District Magistrate
to adopt the various remedial and precautionary measures which
experience had shown to be necessary. The second provided mainly for
the immediate report of the existence of cases of plague. With these
regulations the Government of the Punjab issued a set of executive
instructions prescribing the precautionary measures in detail. On the
19th of June a further set of practical instructions were issued in the
form of a circular letter.
Madras rules.
The Government of Madras issued on the 5th of February a set
of regulations for observance in the City of Madras, and a second set
for district municipalities, towns and villages. These rules, though
sufficient to meet the existing circumstances and to authorise the
adoption of the precautions at the time necessary in the Madras
Presidency, were not in some respects sufficiently comprehensive to
combat an actual epidemic of plague. The rules for the City of
Madras came into force from the date of their issue, the rules for
other municipalities were, with the exception of one or two sections
not actually brought into force.
Rules in other
provinces.
General regulations for dealing with plague were also prescribed by
the Government of Burma, the Chief Commissioners of the Central
Provinces and Ajmere-Merwara, the Agents to the Governor General
in Rajputana, Central India, Baroda, and Baluchistan, the Residents
at Mysore and Hyderabad, and the Mysore, Hyderabad and Baroda
Governments.
Main divisions
of the subject.
In examining the general regulations it will be convenient to
discuss them under the three main heads of—
(1) measures to ascertain the existence of plague cases ;
(2) measures to be adopted on the occurrence of isolated plague
cases and in plague centres ; and
(3) general sanitary measures.
MEASURES TO ASCERTAIN THE EXISTENCE OF PLAGUE
CASES.
Village registers
maintained at
police-stations.
In the chapter dealing with the prevention of the spread of
infection by land a description will be given of the measures adopted
in the North-Western Provinces and Oudh, Bengal, the Punjab and
the Central Provinces for the detection of cases of plague in rural