NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
100
The extra allowances on account
of plague of commissioned medical
officers in military employ per-
forming plague duty in cantonments
in addition to their own should be
borne by the Military Department.
LOCAL— INDIRECT.
18-J. GTENEBAL ADMINISTKATION — G-cneml Establishment of Local
Funds.
Establishments.
Allowances.
Contingencies.
(17) Extra establishment employed
in local fund offices.
24-A. MEDICAL — 'Medical Establishment.
District Medical and Sanitary
Officers' establishment —
Establishments.
Allowances.
Contingencies.
(18) Additions to the office estab-
lishment of district medical and
sanitary officer.
24-B. MEDICAL — Hospitals and Dispensaries,
. Salaries.
Establishments.
Allowances.
Supplies and Services.
Contingencies.
(19) Extra expenditure in existing
hospitals and dispensaries due to
plague.
MEDICAL — Sanitation and Vaccination.
Sanitation and Conservancy —
Establishment.
Allowances.
Supplies and Services.
Contingencies.
(20) Additions to the existing
sanitary staff for plague work.
LOCAL— DIRECT.
Salaries —
Salaries
of subordinate
medical officers.
House-rent allowance.
Plague allowance.
Establishment —
Matrons and nurses.
Compounders.
Ward
attendants
and
servants.
Storekeepers.
(21) Pay and allowances of
medical subordinates, clerks and
passport-issuing officers employed in
plague hospitals and at railway
stations not notified as railway
inspection stations in the Fort St.
George Gazette and at road frontier
inspection stations.
(22) Cost of observation staff
consisting of plague supervisors,
plague inspectors and their peons.
(23) Ambulance staff.
101
Establishments employed at
plague camps and road
frontier inspection stations
and at railway stations not
notified as railway inspection
stations in the Fort St.
George Gazette.
Allowances —
Travelling allowances.
Supplies and Services —
Petty construction and repairs
of buildings.
Funeral expenses.
Dietary charges.
Clothing and bedding.
Cost of medicines and instru-
ments and disinfectants.
Other hospital necessaries.
Contingencies —
Purchase of furniture.
Repairs of
do.
Tour charges.
Postage charges.
Telegraph charges.
Office expenses.
Miscellaneous.
(24) Cost of camp establishments,
superintendents and gumastahs and
menial servants.
(25) Cost of construction of
plague hospitals and " observa-
tion," "suspect," "health" and
" staff " camp. The cost of shed--,
constructed in cantonments should
be borne by cantonment funds.
(26) Cost of stretchers, medical
stores, disinfectants, comforts and
furniture and clothing for plague
hospitals.
Nos. (21) to (26) must be
understood as referring to expendi-
ture for purposes other than those
specified in No. (10).
(27) Extra expenditure due to
the deputation of troops on plague
duties other than those specified in
No. (10)— see also No. (16).
(28) Rewards for the destruction
of rats.
(29) Cost of carbon paper sup-
plied to passport-issuing officers
at railway stations not notified as
railway inspection stations in the
Fort St. George Gazette.
APPENDIX Il-U.
Madras Command Order No. 810, dated 27ih October 1903.
[See Hule 38 on page 15.]
* Military
Depart-
ment letter No. 2494-C,
dated 8th October 1903.
ÖANITABY—Plague.'—The following rules, proposed by the Sanitary
Commissioner, Madras, in connection with the precautions to be taken
OD account of plague when troops inhabiting
infected areas move to localities infected or
not, and which the Government of India have no
objection * to being adopted in the Madras Presi-
dency, are published for the information and guidance of all concerned :
BULKS KEGULATING THE MOVEMENTS OP TROOPS INHABITING INFECTED
AREAS PROCEEDING TO LOCALITIES—INFECTED OR NOT—IN
THE MADRAS PRESIDENCY.
I.— Troops above fifty in number unaccompanied by their wives and
families or those of followers.
(a) If possible, ten days previous to departure, all infected areas
shall be out of bounds for all concerned.
103
(i) As far as possible, ten days previous to departure, all infected
areas shall he out of bounds.
(ii) The troops, their families, their followers and their families
shall vacate their lines on a date as close to that of departure as feasible
and encamp upon a clean area and not be "allowed to return to the lines
or to any part of the infected locality.
(iii) They shall be detained in camp only for such period as will
enable the medical officer in charge to superintend disinfection of all
clothing and susceptible property and to grant a certificate that this
has been duly carried out in respect to the property of all troops, their
families, their followers and their families, and servants of officers.
(iv) As soon as the process of disinfection is completed, they
shall be subject to Eule I (i), (ii), (iii).
(6) If, within a period of twelve months, the troops or their
families, their followers or their families have suffered from indigenous
plague :
(i) The troops, their families, their followers and their families
shall be encamped and segregated on a clean area for a period of ten
days subsequent to such time as may be necessary for the complete
disinfection of the clothing and susceptible property of the troops,
their families, their followers and their families, and of servants of
officers, under the superintendence of the medical officer in charge.
During this period, their health state must be daily observed by the
officer in medical charge. If the health state of the persons thus
observed gives rise to suspicion of plague, a special report should be
made by the medical officer to the General Officer Commanding through
the usual channel.
(ii) The requirements of sub-section (1) having been observed,
the troops, their families, their followers and their families shall be
.subject to the requirements of Eule I (e) (i), (ii), (iii).
(c) If, within a period of three months, the troops or their
families, their followers or their families have suffered from indigenous
plague :
(i) The intention to move them to any locality in the Madras
Presidency should be brought to the notice of the Government of
Madras by the Lieutenant-General Commanding the Forces.
A
TROOPS.
Plague Passport.
[See Rule 2 of Madras Plague Regulations in force outside the Presidency Town. ]
1. Number of Passport.
2. District.
3. Station v of issue.
4. Date of arrival.
104
5.* Number of men (Total).
6.* Number of women (Total).
7."*Number of children (Total).
8. "Whence coming (give district, taluk and village).!
9. Destination and residence during the next seven days (give district,
taluk and t village).
10. To whom the triplicate copy of the passport sent.
I declare the information set forth above to be correct, and i do
hereby bind myself (a) to inspect or cause to be inspected the above-
mentioned persons daily, for the next seven days, before the passport-
examining officer of the place where I may be for the time being, (b] or to
grant the necessary certificate fchat this has been done, (c] to report
to-the said officer before departure any change in the residence of the
abovementioned persons within the said period of seven days, and (d)
to deliver to the said officer this passport on the expiry of the said
period.
Date
,
Signature of t/ie Officer
in charge of Troops.
Declared and signed before me.
,
Date
Signature and designation of
Officer issuing the Passport,
List Form B.
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Period of observa-
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* To the triplicate should be attached a complete nominal roll,
t l'or villages in Malabar, give the name of amsatn and desam.
105
2. The above rules do not extend beyond the Madras Presidency
proper, and in those Military districts which lie partly in the Madras
Presidency and partly in the Bombay Presidency, the rules are to
be applied only to the portion which is situated within the former
Presidency.
3. The Madras Presidency should be taken as comprising the
following Civil districts ' .—
Madras.
Ganjárn.
Vizagapatam .
Gódávari.
Kistna.
Nellore.
Chingleput.
Tan j ore.
Trichinopoly.
Madura.
Tinnevelly.
1
Coimbatore.
1
Cuddapah.
Kurnool,
Anantapur.
¡
Bellary.
Malabar.
South Ganara.
North Arcot.
South Arcot.
The Nilgiris.
Salem.
APPENDIX: ii-v.
>^_
G.O., No. 656, b'incMcial, dated 29 ¿A September 1905.
[Seö Rule 162 on page 67-3
Recorded.
2. The quarterly statements of audited plague charges Direct and
Indirect under the heads PROVINCIAL, LOCAL arid MUNICIPAL, which
are submitted to Government by the Accountant-General under para-
graph 10 of G.O., No. 421, Financial, dated the 2nd July 1904-, should,
for the future, contain the following statements only :—
(i) Under PROVINCIAL an abstract statement of Direct and Indirect
charges under each major head showing expenditure by districts in
form A appended to these proceedings ;
(ii) Under LOCAL a statement in form J3 appended to thess
proceedings giving totals of Direct and Indirect expenditure for each
district without details ;
(iii) Under MUNICIPAL a statement in form C appended to these
proceedings showing expenditure for each municipality ;
(iv) A summary in the form at present in use showing the
charges incurred on account of salaries of officers and establishments
employed on plague duty forming part of existing departments but not
replaced by substitutes; and
(v) A statement in the form, at present in use showing the
rateable distribution by districts of plague expenditure among district
boards.
8
H-»
O
OÍ
A.—PROVINCIAL.
Abstract v* Direct and Indirect Plague Charges showing by districts the estimates for 190 -190 and the estimates for, and the
progressive totals of expenditure under, each head for the quarter ending the
190 .
Districts
l
Tota] ..
3. LAND RETENUE.
Estimates
for the
year 190
-190 .
2
B8.
Estimates
for the
quarter.
o
Et.
Expendi-
ture up
to the
commence-
ment of
the
quarter.
4
RK.
Expendi-
ture
during the
quarter.
5
BS.
Total
expendi-
ture to
the end
of the
quarter.
.
IS. GENERAL ADMINISTHATION.
Estimates
for the
year 190
-190 .
6
|
7
BS.
!
us.
Estimates
for the
quarter.
•
BS.
1
'
Expendi-
ture up
to the
commence-
ment of
the
quarter.
«
»e.
Expendi-
ture
during the
quarter.
10
BS.
Total
expendi-
ture to
the end
of the
quarter.
11
BS.
I—«
o
-T
A.—PROVINCIAL—cont.
Abstract of Direct and Indirect Plague Charges showing by districts the estimates for 190 -190 and the estimates Jor, and the
progressive totals of expenditure under., each head for the quarter ending the
190 .
District*.
Tota] , .
20. POLICE.
Estimates
for the
year 190
-196 .
12
Ufa.
,
Estimates
for the
quarter.
13
K».
Expendi-
ture up
to the
commence-
ment of
the
quarter.
Expendi-
ture
during the
quarter.
¡
i
1
14
'
H
K.S.
i
£6.
i
!
i
Total
! expendi-
ture to
the end
of the
quarter.
24- A.. & C. MEDICAL, including Sanitation and Vaccination.
Estimates
for the
year 190
-190 .
16
'
17
v
R8.
BS.
Estimates
for the
quarter.
18
US.
Expendi-
ture up
to the
commence-
ment of
ihe
quarter.
19
RS
!
'
Expendi-
ture
during the
quarter.
20
BS.
Total
expendi-
ture to
the end
of the
quarter.
21
He.
K- 1
O
GO
A.—PEOVINCIAL—cont.
Abstract of Direct and Indirect Plague Charges showing by districts the estimates for 190 -190 and the estimate* for, and the
progressive totals of expenditure under., eaoh Jiearffor the quarter ending the
—190
Distriote.
Total . .
24-D. MEDICAL.
1
1 Estimates
• for the
: year 190
-190 .
22
KS.
Estimates
for the
quarter.
23
E.S.
Expendi-
ture up
to the
commence-
ment of
the
quarter.
24
RS.
I
1
j
1
Expendi-
ture
during the
quarter.
25
ES.
!
Total
expendi-
ture to
the end
of the
quarter.
26
R6.
TOTAL.
Estimates
for the
year 190
-190 .
27
BS.
]
1
Estimates
for the
quarter.
28
ES.
Expendi-
ture up
to the
commence-
ment of
the
quarter.
29
„~.
Expendi-
ture
during the
, quarter.
30
l
us.
i
!
Total
! expendi-
! ture to
the end
of the
quarter.
31
R6.
The estimates in columns 2, 7,12, 17, 22 and 27 should be the sanctioned estimates as contained in the Civil Budget Estimate.
Columns 4> 6 r 9, 11,14. 16, 19, 21. 24, 26, 29 and 31 need not be filled up for the first quarter.
f-»
o
<o
Jb.—IjOCAL.
Abstract Statement of Direct and Indirect Plague Charges showing by districts the estimates for 190 -190 and the estimates
for, and the progressive totals of expenditure under, each head during and up to the quarter ending the
190
Districts.
1
Total . .
Indirect.
Estimâtes
for thé
year 190
-190 .
2
RS.
Estimâtes
for thé
quarter.
ES.
Expenditure
up to the
commence-
ment of the
quarter.
4
ES.
•
Expenditure
during the
quarter.
5
RS.
Total
expenditure
to the end
of ibe
quarter.
6
us.
Direct.
Estimates
for the
year 190
-190 .
7
R8.
Estimates
for the
quarter.
8
RS.
Expenditure
up to the
commence-
ment of the
quarter.
9
KB.
Expenditure
during the
quarter.
10
RS.
Total
expenditure
to the end
of the
quarter.
11
BS.
The estimates in columns 2 and 7 should be tke estimates -which enter into the totals of the Civil Budget Estimate. Columns 4, 6, 9 and 11 need not
te filled up during the first quarter.
<D
0.—MUNICIPAL.
Statement of Plague Expenditure showing the estimates for 190 -190 , the estimates for, and the progressive totals of
expenditure up to the quarter ending the
—
190 .
Districts.
1
Total . .
Serial
number.
2
Municipalities.
3
Estimates
for the year
190 -190 .
4
RS.
Estimates
for the
quarter.
ó
Expenditure
up to the
Oummence-
ment of the
quarter.
6
Expenditure
during the
quarter.
7
Total
expenditure
to the end of
quarter.
8
Columns 6 and 8 need not he filled up during the first quarter.
110
Ill
APPENDIX II-W.
Instructions for the forwarding of Material to the King Institute
of Preventive Medicine, Guindy.
PLAGUE.
A.—HUMAN PLAGUE.
Sources from which material suitable for examination may be obtained.
1. Spleen or liver—
(a) In fatal cases.
(b) Where it is possible to perform puncture of these organs
during life.
2. Buboes.—In Bubonic plague.
3. Sputum.—In Pneumonic plague.
4. Peripheral blood.—When nothing else is available.
The preparation of specimens.
Material for cultural tests. This will be necessary only in special
cases. It is essential in sending such material that it be surrounded
by sufficient ice to ensure its reaching Gruindy without decomposition.
Such material will in general be sent only asa result of correspondence
on the subject when special directions will be given.
2. In all ordinary cases " films " should be forwarded.
Preparation of filmfrom the spleen.
(a) Dip one or two slides in water and clean them thoroughly with
a clean soft cloth. Lay the prepared slides on one side out of the way
of dust, etc.
(b) Remove the spleen or if a complete post-mortem examination
is not made extract the spleen by passing'lhe hand through an incision
over the left costal margin. Kemember that the spleen may be dragged
backwards and upwards by the stomach if this organ is collapsed.
When for any reason even a modified post-mortem examination is
not possible one may resort to puncture with a large needle. In this
procedure it is very difficult to be sure that the spleen has really been
tapped. It is also extremely difficult as a rule to get blood from a
epleen after death. It is best therefore, if driven to use a needle,
to puncture the larger and" more engorged liver.
(c) With a knife or more conveniently still with a pair of scissors
cut into and remove with the aid of a forceps a piece of the spleen about
the size of a small pea. Holding this piece of tissue in the forceps wipe
it thrice along one of the clean slides forming three separate streaks.
Avoid excess of blood by " dabbing " the piece of tissue when this is
necessary on the slide before proceeding to make the streaks.
In the case of the spleen this is usually not necessary.
(d) Wave the slide in the air until everything is quite dry.
9*
112
(e) Wrap the slide in white paper. Write particulars on the
outside of the packet and despatch in one of the boxes provided by the
institute for the purpose.*
Preparation of film from the liver.
Adopt the same procedure as for the spleen taking care to get rid
of an excess of fluid before smearing.
To puncture the spleen during life —
(a) Use an ordinary hypodermic needle.
(b) Do not use any antiseptic but boil the syringe if necessary.
(c) Eject a small drop of the blood obtained on to a slide and
make a film as for peripheral blood.
To obtain material for examination from buboes.
(a) Clean several slides.
(6) Clean the skin over the bubo with a little soap and water and
a clean towel. This is important as the skin of the groin and axilla
contains many organisms which are liable to increase the difficulty
of diagnosis where a minute quantity of fluid only is obtained.
(c) Steadying the bubo with the left hand plunge the needle well
into the mass taking care to avoid such dangerous structures as the
femoral artery. Before doing anything further allow the needle to
remain a few moments in the tissues. Withdraw the point of the
needle very slightly and pull out the piston of the syringe.
It is often difficult to get any fluid whatever from a gland. In such
cases the only procedure is to allow the needle to remain in for some
minutes.
(1) Do not draw the needle too far out. Nor mistake a little
blood drawn in from the skin itself on the withdrawal of the needle for
gland juice.
(2) If there is any doubt as to the origin of the fluid obtained this
should be stated on the specimen as it may be possible microscopically
to confirm or dissipate such doubts.
An alternative method much to be preferred where it can be carried
out is to cut down upon the gland, divide it, and take a scraping from
the cut surface. In cases where diagnosis is of infinite importance this
is by far the best procedure as it will yield almost certain evidence,
both positive and negative, regarding plague.
. -
* Note.—Slides and boxes for forwarding spécimens can be obtained by indenting on
the King Institute. Envelopes should be marked "plague indent" and addressed
" Superintendent, King Institute of Preventive Medicine, Guindy."
The following form of indent is suggested :—
Pleaee supply to
Slides
A box will be sent with every two slides.
Not more than 12 slides with 6 boxes will ordinarily be issued at a time, and when
slides and boxes in excess of this number are required, they should be obtained from the
Madras Medical Stores Depot.
Telegraphio address " Institute,"
Í13
Do not be satisfied with pus from a discharging- bubo or from a
suppurating bubo if less advanced buboes are present. Pus from an old
bubo may very well contain no recognisable plague bacilli whilst pus
from a bubo which has been discharging for some time is scarcely likely
to contain bacilli.
In fatal cases in addition to smears from the spleen any enlarged
glands should invariably be incised and smears made from the cut
surface.
To prepare films of peripheral blood.
(a) Clear one or two slides and rub up the shaft of a needle (surgical
or sewing).
(6) Clean a finger of the patient by rubbing it gently with a wet
cloth and carefully drying it.
(c) Hold the finger between the thumb and first finger of your left
hand and comprees gently to drive the blood to the tip where you are
going to prick.
(d) Prick, and when a drop about the size of a match head has
exuded lower a clean slide upon it taking care not to " dab " the slide
on the skin.
(e) As quickly as possible, taking the slide in the left hand and the
point of the needle in the right lower the shaft of the needle on to the
drop and spread this over the slide in a thin film by passing the needle
slowly and in one sweep from left to right. If the result is not satis-
factory use another slide.
(f) On another slide or if necessary on the same slide at one end collect
another drop of blood and spread this with the head of the needle over
an area equal to that of a two-anna piece. When quite dry wrap in
paper and label.
General cautions regarding films.
(1) On no account cover any specimen with a slide or cover glass.
(2) Never use a slide without having first thoroughly cleaned and
carefully polished it.
(3) Never omit to wrap film in paper before placing in the box for
despatch.
(4) Do not nail, paste over with paper or otherwise deface the box.
All that is necessary is to tie it round with a piece of twine and wrap
neatly in a wrapper.
Interpretation of results.
(1) Do not send a film of peripheral blood with the idea that you
have done all that is required to enable the case to be diagnosed. The
plague bacillus cannot as a rule be found in the peripheral blood of
plague patients. The absence of the plague bacillus from such a speci-
men therefore really means very little and certainly does not exclude
plague.
As a rule the sending of peripheral blood only is an omission on the
part of the Hospital Assistant or other concerned who if more energetic
could as a rule forward more likely materials such as smears from the
spleen of fatal cases, smears from buboes, etc.
114
(2) Sputum as a rule contains countless organisms some of them,
closely resembling in appearance the plague bacillus. Fortunately when
plague bacilli are present at all they are in large numbers and gire
a characteristic appearance to the specimen which enables the pneumonic
type of plague to be detected readily by microscopical examination.
There is in sputum however always the possibility —
(i) That it is not derived from the lungs at all but only from the
throat or even the mouth.
(ii) That plague organisms are scanty and cannot with certainty
be detected ou account of the multitude of other organisms.
(iii) That bacilli bearing a close resemblance to plague may be
present and so render a guarded opinion necessary.
(3) Microscopical examination of a bubo prior to suppuration gives
almost certain evidence as to plague. The only error likely to occur
is that fluid supposed to be from the gland is really from the tissues
around it or even blood from the skin sucked in when the needle is
withdrawn.
It is on account of the uncertainty attaching to puncture that
cutting down upon the gland is so much to be preferred when a great
deal turns upon the diagnosis.
Old buboes which have become purulent may or may not show the
plague bacillus since this organism is apt to be killed off.
(4) The examination of specimens of the spleen or in default of
this the liver of a fatal case is most likely to give definite results.
Almost all fatal cases tend eventually to become septicémie and the
•absence of bacilli from the spleen and liver is extremely strong evidence
against the case being one of plague. On the other hand in no exami-
nation except that of a fresh bubo can such definite positive evidence of
plague be obtained as in films from an undecomposed spleen. Where
decomposition is advanced a guarded opinion is often, necessary since
the plague bacillus rapidly disappears under such circumstances and
even if present is considerably altered in appearance.
B.—RAT PLAGUE.
(a) Whole rats should not be forwarded unless there are special
reasons for such a procedure. If rats are sent whole they should be
packed in sufficient ice to allow them to reach Gruindy undeoomposed.
Hats may also be sent in spirit. In thia case the abdomen should be
opened and at least one pint of spirit be used for each rat. This method
of sending material should only be adopted when no other procedure is
possible.
(6) Material sent for diagnosis should always, if possible, be in the
form of films.
To make a film from a suspected rat.
(a) Lay the rat on its right side and with a pledget of wool
dipped in -weak spirit wipe over the side of the belly which lies upper-
most. This will keep the hair from interfering with the subsequent
dissection.
(6) Pinching up a large fold of skin with a forceps and with a
pair of scissors cut this off. If the whole thickness of skin and muscle