NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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APPENDIX A.
Notes on certain matters connected with plague.
(J.) GENERAL REMAKES.
1. In dealing with an outbreak of plague, a combination of the
following measures is like]}' to produce the maximum of good :—
(1) Prompt discovery and isolation of every case of plague.
(2) "Disinfection, and, in cases of pneumonic plague, 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 are 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 difficultto apply the measivres
of disinfection and segregation. The policy to be adopted at a
particular place will dopend on its physical features, the season of the
year, che general sentiment and state of education of the people in
regard to plague measures, 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 disinfec-
tion, inoculation, the evacuation of specially infected quarters, 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
inoculation and disinfection should also be resorted, to so long as
there is sufficient staff to supervise those measures. Evacuation in both
toWD3 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 nob supported by the
people, and in a widespread epidemic the resources of Government in
the matter of funds and establishment being limited, much must neces-
sarily be left to the people themselves. Steps should, therefore, be taken
âé
(3) EVACUATION.
7. By evacuation is meant tlie 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 inft-ction, 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 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.
8. 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 be
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 vear, 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.
9. Evacuation is, however, likely to do more harm than good in
the following cases :—
(«) 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.
(6) "When the infection is widely distributed among the
inhabitants of a large place, ifc is then advisable to agitate the people
as little as possible, especially when there are among them a consider-
able number of artisans and traders who may lose their occupation
by being removed from the town and are therefore likely to run away
and infect other places.
(4) INOCULATION.
10. The exhaustive inquiries made by the Indian Plague Commis-
sion have established the fact that inoculation with Kaffkine's vaccine
lessens the liability to plague and greatly increases the chance of
recovery from an attack of the disease, and disproved the statement
that serious ill-consequences have resulted from such inoculation.
The maximum period for which protection is afforded by inoculation
has not yet been determined. For practical purposes, it has been
fixed, for the present, at nine months, but it should be noted that
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15. The Sanitary Commissioner is in charge of all measures con-
nected with inoculation and will issue the necessary rules as to the
conduct of the operation, supply of Hafïkine's vaccine, inoculation
syringes, etc.
(5) DISINFECTION.
16. Recent research seems now to demonstrate, with one important
exception, viz., pneumonic plague (a) that the number of bacilli that
actually leak out of the bodies of plague patients and rats is very
small, and (b) that having left the body of their host they do not
survive the drying action of the atmosphere for longer than 24 hours.
Hence the attempt to kill these bacilli is scarcely worth the trouble
and cost involved. But there remains an agent capable of carrying
about for a considerable number of days large numbers of virulent
plague bacilli, namely., the rat-flea. This insect under normal condi-
tions, lives in the fur of the rat's skin and feeds on the blood of the
animal. But when the rat dies the flea leaves the dead body and
goes in search of other living rats and in the event of a failure to find
another passes to the body of man, bites him and thereby infects the
individual with plague. Consequently the great object of disinfection
should be to kill the rat-flea that has left the dead rat; and in order
to do this a preparation that will kill fleas and not bacilli is required.
But having obtained such a solution which will kill fleas, there are
difficulties in its application. Where the houses are of the ordinary
poor class where plague is most likely to occur, the fleas may easily
escape in holes and crevices'in the walls and escape the syringing of
the solution; and in most such cases the application of the solution is
useless. In the better class of houses of masonry and plaster walls,
disinfection with the solution is more likely to be successful and
should be applied.
Rat-fleas however die of starvation in a week if deprived of blood
from either rat or man ; hence a vacated house slowly disinfects itself.
An empty house moreover has no great attraction for rats especially
if it is infected.
17. Disinfection of houses should be always carried out in the
following cases :•—
(i) in houses where the occupants cannot or will not vacate,
(ii) in well-built pucca houses and bungalows.
In these cases disinfection should be done thoroughly and at the
earliest possible moment after discovery of infection.
18. Plague authorities should manufacture locally kerosine oil
emulsion and should supply it gratis to people who wish to disinfect
their own houses but they need not keep up an expensive staff to do
this work.
19. Breaking holes in roofs and walls and digging up mud floors
should be discontinued.
20. 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.
21. (a) The best disinfecting fluid for general use is an emulsion
of kerosine oil. The emulsion is made as follows :—
To each four cakes of sliced c •" sunlight soap " add half a gallon
of water and boil until all the soap is dissolved.
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Pour half agallón óf the solution still hot into an open tub tilted
to allow the fluid to be beaten up with a cocoanub spoon such as is in
general use by Indians. Whilst stirring or beating up, add oil little
by little at intervals of about a minute, taking care that all trace of
free oil is absorbed into the frothy mass before fresh oil is added.
After the addition of about three gallons proceed very carefully. If
properly done, one half gallon of soap solution should emulsify a whole
tin of kerosine containing- four gallons. The only error likely to be
made iu the first attempt is that from inefficient stirring or too quick
addilion of the oil premature over-saturation should occur, a fact
which is at once apparent to the maker. To make one brew of four
gallons takes about half an hour. It is desirable to have a couple of
coolies to each tub to take turn about stirring and pouring the oil.
Bach couple of coolies should in a day turn out at the very least
four brews; in actual practice they will probably be able to turn
out much more.
Another way in which the emulsion can be made wibh great
ease and rapidity is to do the mixing in a country churn such as
is used for making butter.
(&) The emulsion, should be used in the strength of 1 part to
10 parts of water.
(c) Perchloride of mercury should no longer be used for dis-
infection of houses as it has little or no action on fleas.
22. Disinfection of personal effects should be carried out in the
following cases :•—
(a) Indian crews, third class or deck passengers and Indian
servants leaving infected or healthy ports for porta out of India.
This should be done on shore.
(6) Plague patients and contacts removed from infected houses,
ships or railway carriages.
(c) People vacating their houses on account of dead rats
being found in their houses.
As the disinfection of personal belongings is very unpopular,
especially those of women., and as nothing should be done that is
likely to endanger the speedy vacating of the house when dead
rats are found, the disinfection should take the form of arranging
for the owner to place all soiled clothes in water or a solution of
cyllin and water, and of exposing the bedding and better clothes
to the action of the sun for two days.
23. Disinfection of the person should be carried out in the case
of inmates vacating a plague-infected house, but, for the reason
given in paragraph 22, the inmates should be requested to take
a bath and change tlieir clothes.
24. There seems little danger of the spread of plague by means
of ordinary articles of merchandise, and it is therefore not neces-
sary to disinfect such articles.
Gunny bags that have been in use to carry grain should be
disinfected in a steam-steriliser before being received by railway
companies if they come from a plague-infected area. This does not
apply to new gunny bags packed in bales.
25. Any railway carriage from which a passenger who is suffering
from plague has been removed shall be detached at the nearest
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convenient station, and shall be disinfected by the railway authorities
as follows and, if that station is an inspection station, such disinfec-
tion shall be effected to the satisfaction of the inspecting medical
officer.
(i) In the case of a third class or intermediate class carriage,
the carriage should be thoroughly well swilled with a solution of
kerosine oil emulsion aud allowed to dry.
(ii) In the case of a first or second class carriage, the carriage
should be kept on a siding locked and shut up for seven days. It
should then be carefully swept out and cleaned and may be taken
into use again.
(6) RAT-PLAGUE AND DESTRUCTION OF BATS.
26. It has been observed and proved by experiment that rats are
tbe essential agents in the dissemination of plague amongst human
beings and it is apparent that if rat destruction could be carried out
effectively and the number of rats sufficiently reduced, the risk to man
would be materially lessened.
27. The experience of the Punjab Plague Committee who have
undertaken rat destruction on a large scale, however, shows this
method for the prevention of plague to be ineffective unless carried
out in a systematic manner with a sufficient establishment and under
compétent supervision. If these essentials cannot be guaranteed rat
destruction should not be attempted. Desultory trapping with a
small number of traps and small establishment over a wide area will
not in any way diminish rat population. Rat-trapping *shonld, there-
fore, be confined to places where the whole rat population can be
effectively dealt with, i.e., in landing places, railway goods-sheds, grain
godowns, holds of ships and cotton mills. It may, in special cases,
when the previous sanction of Government has been obtained, be
carried out in selected areas where sufficient establishment, funds and
supervision can be provided.
28. Bat-trapping may be carried out in two ways-—
(a) Continuous systematic trapping, i.e., carrying 011 the work
for some months in such a manner that each house gets trapped
regularly-about once a week.
(b) Rapid trapping with a large number of traps for a short
period.
29. Continuous trapping.—The continuous method is suited to
towns and large villages with a population of 4,000 and over. Work
should be started at least three months before the usual time for the
commencement of plague. It is essential that the trapping should be
systematic and for this purpose the houses should be numbered or
the census numbers used in order to prepare a register of houses to
control the regular distribution of the traps. The town or village
should be divided into four or tive blocks of equal size and the work
conducted simultaneously in each block.
SO. A central office or depot should be arranged as the basis of
operations. The traps will be stored in and baiteH at this depot and
distributed to the different blocks.
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31. The number of traps* required should be equal to at least 2
per cent, of the population. They should be numbered consecutively
and their distribution registered.
32. Baiting.—The best baits are—•
(a) Broad soaked in gingelly or other vegetable oil.
(&) Green vegetable garbage.
(c) Onions.
(d) Cocoanut.
(0) Dried fish (not so good).
33. The trap should be cleaned once a week by dipping in water
and scrubbing with a hard brush, and smeared with cocoanut oil
when dry.
34. Establishment required.—One cooly should be employed for
each 30 traps used and one peon wlio can write in English or the
vernacular should be employed for every four coolies. The castes of
these coolies should be such that some of them can enter every class
- of house.
35. The traps can be carried along on bamboo poles, each cooly
carrying 10 or 12 traps iiTthis way. .Where a large number of traps
are required hand-carts may be used.
36. The trap should be set in the afternoon and collected in the
morning and returned to the depot to be rebaited. The rats caught
should be killed by a knock on the head and then burnt, covvdung
cakes being purchased for this purpose. If preferred, the rats may be
killed by immersing the traps in a tank of water.
37. Records.—The peon should keep the following registers :—
(1) Daily register of traps showing'—•
(a) traps set each day,
(&) houses trapped, and
(c) number of rats caught.
From ihis a weekly statement can be prepared showing the
number of rats caught per 100 traps set.
(2) Register showing how often each house has been trapped
and the number oí rats caught in each house.
38. Rapid trapping.—This method should be used in—
(a) villages in which plague persists in the off-season ;
(&) villages in the neighbourhood of an infected area;
(c) villages in which rat mortality has commenced.
39. Villages in which plague persists in the off-plague season are
a source of danger as being likely to hand over plague to other places
in the following plague season,
40. As an epizootic in the off-plague season is seldom severe,
vigorous trapping affords a reasonable chance of stopping the spread
of plague amongst rats.
41. In villages threatened with infection a successful rat cam-
paign immediately at the commencement of the favourable season \vil
* The trap recommended is the Eawalpindi trap made with a weighted flap—not
a spring flap,
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materially reduce the chances of infection and tide over the critical
period.
42. The idea of these rapid trapping operations is to remove the
largest possible number of rats in the shortest period.
43. The trapping should be carried out by special travelling parties
who should be equipped with traps in sufficient number to permit of
one trap being set daily in each house of the village visited.
44. The visit to each village should last two or three weeks and the
village authorities should be warned to assist the party in their work.
45. One supervisor and three or four peons who have had previous
experience of the continuous trapping should accompany each party.
46. Local coolies should be engaged in the proportion of one to
every 30 traps or whatever number they can conveniently manage.
They will bait and distribute the traps under the supervision of the
peons who will keep the registers of distribution.
47. The general conduct of the operations will be similar to that
followed in the continuous trapping of towns, with the exception that
one trap will be set daily in each house.
48. Special care should be taken in trapping grain godowns and if
many rats are found in these, the traps should be further concentrated
in the godowns.
49. The number of rats caught per 1(0 traps set at the beginning 1
of tie operations contrasted with the number caught at the termina-
tion will show roughly to what extent the rats have been reduced in
number.
50. Trapping may be supplemented by poisoning, the baits being
distributed right through the village once only at the commencement
of the campaign.
51. Poisoning.— (a) Nearly all the most efficient rat-poisons are
mixtures of phosphorus with flour flavoured and sweetened to attract
the rodents. Hence they are poisonous to man and animals and
a certain amount of care is necessary to see thafc children, fowls, dogs,
etc., do not eat the baits. The best preparations are the poison
made by the Punjab Government (The Punjab Eat Exterminator,
price annas 12 per tin) and Mushicide (price Rs. 3 per tin). The
former can be obtained by sending indents to the Sanitaiy Commis-
sioner for Madras who will arrange for the supply, but as a large
stock is not maintained notice of approximate requirements should
be sent early. The latter can be obtained from Messrs. Jaggat
Singh Son & Brother, Rawalpindi.
(6) Procedure adopted in carrying oui poisoning operations.—The
following is the procedure adopted : the contents, 12 ounces, of a tin
of the poison are thoroughly mixed with 2 Ib. of jaggery or treacle
sufficient flour being added to make a stiff paste ; this is rolled into
large pills and is sufficient to make 1,600 baits. Although general
ignition of the poison cannot take place at high temperature, some
slight sparking of particles may occur; to avoid this the -mixing
should not be done in the sun's rays, handling should be avoided as
much as possible, hands should be kept wet with water. The pill
method is superior to spreading the paste on bread because baits can,
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be prepared more rapidly, the poison does not volatilise and the baits
retain their poisonous qualities for some time ; they are also less
luminous in the dark, and, therefore, more readily taken by rats.
These baits are placed about 20—40 to each house, in places that are
practically only accessible to the rat, which, excludes all danger to
children and domestic animals ; such places are in the rat holes them-
selves, behind boxes, underneath corn bins, on the tops of the wall
supporting the roof, etc. In any town or village as large an area as
practicable should be treated in this way, at a single operation, in
order to give as great a shock as possible to the rat population before
they recognise the dangerous character of the bait. Baitings on
successive days have been found to have no advantage over the single
baiting method. Baits are prepared in the morning and ¡aid in the
afternoon and evening. For the preparation and placing of the baits
a compounder and three coolies are usually employed. Such agency
can ordinarily prepare and lay, in a day, from 9,000 to 12,000 baits,
that is to say, they can thoroughly treat a village of 400 houses,
approximate population 2,000—2,400. A sub-assistant surgeon or
assistant surgeon should ordinarily be in charge of one or more gangs,
such gangs operating in large villages or adjacent small villages.
Where the active co-operation of the inhabitants is obtained, more
work than this can be done.
If the baits are properly placed, they may be allowed to remain,
instructions being issued that all village sweepings for the next week
should be burnt ; otherwise baits will find their way to the village
rubbish heap, where fowls, pigs, etc., may find and eat them. The
dead rats found are collected and buried or burnt.
A search for dead rats should be made every morning for six days
after the poisoned baits are put down.
(c) The frequency with which this procedure should be repeated
depends on the rate at which the rat population recover from the
shock caused by the poison, but on the whole a month should elapse
before any fresh trial to poison rats of any particular neighbourhood
is attempted.
(d) This method of poisoning should be made use of whenever
an epidemic is likely to occur, but in all places where a recrudescence
is expected in the cold weather two attempts should be made, one in
the month of October and the other in November.
This should be done once only and not repeated for three months
at least.
52. 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.