NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
18
the triplicate must be on the alert for the appearance of any
suspicious symptoms in the locality where the traveller
may reside.
2. Regulation 17 on page 7 above imposes on every house-
holder and every medical practitioner the duty of giving the
earliest possible intimation to the nearest revenue or medical
authority of any unusual mortality among rats or any
suspected case of plague. If a person bearing a notification
paper from an infected area stays in a house, the house-
holder must also report any illness in the house within a period
of one month from the arrival of the person. In areas
under observation any one who finds or becomes aware of
the finding of a dead rat must similarly inform the authori-
ties. The authority frist informed should at once pass on the
information to his immediate superior.
PART II.—INSTRUCTIONS TO BE OBSERVED IN AREAS
UNDER OBSERVATION.
Formation of
observation
and pre-
ventive
circles.
3. The observation circles above referred to will be
introduced permanently in the following areas; temporary
observation or preventive circles may also be formed, when
necessary, round any infected area in the Madras Presi-
dency :—
Districts.
Coimbatore
Salem
North Arcot
Chittoor ...
Anantapur
Bellary ...
Taluks.
Gobichettipalaiyam.
kollegal.
Hosur.
Krishnagiri
Kangundi.
(Madanapalle.
... Palmaner
Punganuru.
Kadiri
Penukonda.
Dharmavaram.
Hindupur.
Kalyandrug.
Madakasïra.
Bayadrug.
Hospet.
Bellary.
... Harpanahalli.
Siruguppa.
Kudligi.
Adöni.
Hadagalli.
19
Size of
observation
circles.
4, The size of each observation circle should admit of
an inspector's visiting every portion of it in ten days.
(a) For each non-municipal town with a population in
excess of 5,000 a separate plague inspector should be
appointed.
i
(6) In a municipality observation circles should, as far
as possible, follow the municipal wards. When any ward
ton tains less than 1,200 houses or a population of less than
5,000 persons it may be combined with other wards to form
one circle. Three circles should ordinarily form a division
and each division should be placed under a divisional in-
spector or supervisor.
Note.—The limits of population and extent laid down above may be varied
according to local conditions.
(c) As far as possible plague inspectors should be
certificated sanitary inspectors, sub-assistant surgeons not
below the third grade, or persons who have received a special
training in dealing with plague. Sub-assistant surgeons, when
available, may in all cases be employed in place of sanitary
inspectors on plague work.
Note.—Certificated sanitary inspectors include sanitary inspectors, assistant
auitary inspectors and certificated sanitary inspectors under G-.O. No. 1131 L., dated
4th September 1903—vide Appendix C.
Size of
preventive
circles.
5. (1) The size of each preventive circle should be such
to enable the inspectors to visit every portion of it once in
seven days and the distance between its extreme limits should
ever exceed 20 miles.
(2) When an observation circle becomes plague
afected it should be formed into a preventive circle and a
few observation circle formed along the line of traffic and so
on until the epidemic is under control.
Duty of th»
observation
staff.
6. (1) Subject to the control of the Collector or plague
officer, who (see Regulation 1 (f) on page 4 above), is
usually the District Medical and Sanitary Officer or the
Revenue Divisional Officer, the observation staff should work
officer the District Medical and Sanitary Officer or other officer
pointed by the Collector for the purpose. In municipali-
ties the Collector may place the staff under the control of
the assistant plague officer, who (see Regulation 1 (g) on
age 4 above) is usually the chairman of the council. The
observation staff should constantly and systematically patrol
the circle in order to gain the earliest possible information of
any suspicious death or of the occurrence of any case of plague,
could report immediately any such case or any suspected
2-A
20
case and should remove with the aid of the ordinary conser
vancy establishment all defects in sanitation which would
favour the propagation of plague, such as accumulations of
filth, sewage, or the like.
(2) The staff should also ascertain whether any special
sickness or mortality has occurred among rats and
examine
any rats that may be found, in order to see whether any
enlarged glands are present. Houses in which sick or dead
rats are found should be disinfected.
(3) The duties of the staff in preventive circles
are
similar to those of the observation staff.
(4) Inspectors for their respective charges and
village
headmen for their villages should keep a record of all person
suffering from continuous fever for more than twelve hours
and inspectors should arrange with the village
headman
have such persons inspected twice daily.
PART III.—INSTRUCTIONS TO BE OBSERVED IN
INFECTED
AREAS.
.
7.
In Appendix A below will be found general instru
tions regarding evacuation, inoculation, disinfection and
destruction of rats. On. the occurrence of an actual or
suspected case of plague in any place, the village headma
or other local officer should—
(i) isolate the patient and order the evacuation
the house ;
(ii) send intelligence by express to the municipality
chairman, tahsildar or deputy tahsildar an
if plague inspectors have been appointed, to the
nearest plague inspector,
8, If the patient is suffering from pneumonic
plague
and not otherwise, the village headman or other local officer
should segregate in a separate camp or hut all persons
have been, or are suspected to have been, in contact with the
patient. It is sufficient in cases of bubonic plague to disinfection
their clothing and effects.
Action to be
taken by
assistant
plague
officers and
plague
inspectors.
9. Upon receiving information of the occurrence of a
actual or a suspected case of plague, the municipal
chairman
tahsildar or deputy tahsildar should inform all superior
officers up to the Collector by the quickest possible measures
(for the -form of the report—see rule 53 below) and should
at once to the infected locality with a sufficient staff
constables and peons. He should arrange to he accompani
or followed by the nearest medical officer with a supply
medicines and disinfectants.
21
10, On arrival at the infected place, the plague inspector
(or medical officer if there is no plague inspector), should
supervise the isolation of the patient and the disinfection of
his residence, clothing, sputa and excreta, and the clothing,
and, at his discretion, the persons of all who have been in
contact with the patient. Houses immediately adjoining that
in which the case of plague has occurred should also usually
be disinfected and as far as possible evacuated.
11, (1) The municipal chairman, tahsildar and deputy
tahsildar on his arrival should see that the patient is kept
properly isolated and that the house and everything in it and
all contacts of the patient are or have been properly dis-
infected.
(2) He should also provide for the efficient maintenance
of the segregation of contacts, if they have been segregated.
Action to be
taken by
plague
officers.
12. On receiving information of a case of plague, the
duties of a plague officer (that is, see Regulation 1 (/), the
District Medical and Sanitary Officer or the Revenue Divi-
sional Officer), are as follows :—
(1) To send telegraphic information to the Colleotoi
and a post copy of the telegram to the District Medical and
Sanitary Officer if the outbreak is in a locality hitherto un-
affected or when an existing epidemic suddenly assumei
alarming proportions.
(¿) To go to the scene of outbreak and see .that the
I measures mentioned in the last preceding rules have beer
! duly carried out.
(3) To see that a plague hospital, suspect camp anc
health camp are properly organized if necessary,
(4) He may also, with the previous sanction of thi
Collector, direct the evacuation of the village or town or airj
part of it, and the removal of the inhabitants to a healtl
camp, provided sufficient shelter is available. Evacuatec
houses should be surrounded by a cordon to prevent th(
return of the inhabitants without written permission.
Removal of
plague
patients to
hospitals.
13. 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.
I
14. Except as mentioned in the last preceding rule, the
I removal of patients to hospital should not be compulsory,
i Every effort should, however, be made to induce patients to
| go voluntarily to hospital and to lessen the aversion to
I hospital by the following means:—(1) by encouraging the
I establishment of private and caste hospitals ; (2) by locating
22
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 accommodation 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; (6) 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.
15. Moribund patients should never be removed to hospi-
tal 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.
16. The pneumonic variety of plague being contagions,
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 advisable 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 ensured.
Officers
suffering
from plague
or subjected
to plague
measures.
17. An officer not being on leave who is prevented from
discharging his duties through segregation on account of
plague may be treated as on duty on full 'pay. In the case
of an officer who is segregated while returning from leave
and thus overstays his leave, the period of detention may be
treated as duty on half-pay. Officers who are suffering from
plague should be dealt with in accordance with the ordinary
rules.
PART IY.—APPOINTMENT, PUNISHMENT, CONTROL AND
DISCIPLINE OF PLAGUE STAFF.
Powers of
Collectors
to incur
expenditure
on plague.
18« Collectors may not incur expenditure from Provin-
cial, Local or Municipal funds in connection with plague
establishments or for carrying out works without the
previous sanction of Government, except for the following
purposes and subject to the existence of budget provision.
í)0
¿O
(1) Employment of temporary clerks and menials on
daily wages for short periods for notification work or simi-
lar purposes or for disinfection or rat»catching or attendance
upon plague cases.
(2) Purchase of fuel for disinfecting machines.
(3) Purchase of disinfectants required for plague
purposes and of serum for inoculation and of rat traps and
rat poison.
(4) Payment of rent for buildings or lands temporarily
occupied for plague purposes and of compensation for
destruction of grain, clothes, roofs of houses, etc., under
Regulation 32 on page 11 above.
(5) Contingencies, subject to the usual limits for
Provincial contingent expenditure.
Sanction
foi* the
employment
of plague
establish-
ments.
19. All appointments in connection with plague require
the sanction of Government. Tn the case of appointments
which are added to an existing establishment in consequence
of extra work occasioned by plague, and the cost of which is
under the standing; orders debitable to the ordinarv service
o
t/
heads, the application -for sanction should be forwarded
through the head of the administrative department concerned.
Applications for additional establishments, the cost of which
is debitable to 3-A. Land Revenue, should be submitted to
Government through the Accountant-General and not
through the Board of Revenue. Sanctions for establishments
employed under this rule will remain in force to the end of
the following March or September whichever is earlier, unless
for special reasons a different date is specified in the order in
any particular case. On the Jst of March and on the 1st of
September, each Collector will submit in a single communi-
cation proposals for the retention of such of the establish-
ments as, in his opinion, should be retained in the ensuing
half-year, clearly explaining the necessity for the retention of
each establishment proposed to be retained. Such proposals
should be accompanied by a statement showing all existing
plague establishments in the form in Appendix I below.
Special sanctions should, however, be obtained for all addi-
tional establishments which it may be found necessary to em-
ploy in the course of the half-year, but all such sanctions will
expire at the end of the half-year unless otherwise directed.
Collectors should also effect f uom time to time such reduc-
tions in establishments as may be feasible and should certify
in the establishment lists submitted by them that the
establishments which it is proposed to retain are necessary.
'
U.
20. Applications for sanction to additional plague estab-
lishments or additional plague expenditure, which cannot be
met by reappropriation from the sanctioned budget estimate,
should specify particulars regarding the additional allotment
required.
Allowances
to officers
and
establish-
ments on
plague duty.
21. The conduct of plague operations in an infected
district must be regarded as part of the general duty of the
executive officers of the district» Save in , exceptional cases
no recommendation should be made for the grant of special
salary, allowance or pension for plague duty.
22. The Government of India have authorized the grant
of special allowances to medical officers for plague duty per»
formed in addition to their ordina.ry work in cases where it is
sufficiently arduous to deserve special remuneration. The
Local Government may also sanction local allowances to
officers of other classes provided their plague work lies
entirely outside their ordinary and legitimate duties. The
Secretary of State has also sanctioned the grant of extra-
ordinary pension to the families of police-men who die of
plague contracted in the execution of their duties in plague-
stricken localities, provided such duties entail imminent risk
from plague.
23. The special allowances given to certain, classes of
officers for plague duty and the salaries attached to special
temporary appointments created on account of plague are
shown in Appendices B and C. All questions relating to the
grant of any extra allowances should be referred for the
orders of Government.
Adminis-
trative staff.
24. The general control of all measures connected with
plague is vested in the Collector of the district unless
Government in any case otherwise direct, and all officers
of Government, of local boards and of municipalities,, and
all plague and assistant plague officers must obey and carry
out the Collector's orders.
Plague
measures in
Cantonments.
25. In cantonments, the military authorities are imme-
diately responsible for carrying out the plague measures,
and Collectors should delegate to them the necessary powers
under the plague regulations.
Control of
Collector
over medical
subordinates
on plague
duty.
28. The. Collector may fine or suspend subordinates of
the Government medical department who ar,e employed on
plague duty within his district, but against such punishment
there shall be a right of appeal to Government through the
Surgeon-General. Before passing any order regarding the
punishment of a medical subordinate, the Collector should
06
consult the District Medical and Sanitary Officer. A copy of
every such, order should forthwith, be communicated to the
Surgeon-General who may, in any case in which he considers
that the fault ascribed to the subordinate is one which
touches his professional conduct only, require that the order
shall not be carried into effect pending reference to Govern-
ment. No appeal to the Government will be entertained
unless preferred within three months from the date of the
order appealed against.
87- The Collector may grant casual or privilege leave to
subordinates of the Government medical department whose
services have been lent to local boards or municipalities for
plague duty. Intimation of the application should, however,
be made to the Surgeon-General before privilege leave is
sanctioned. Leave of all other descriptions, such as furlough
or sick leave, is granted by the Surgeon-General.
Control of
plague and
assistant
plague
officers over
the plague
staff.
28. Subject to the Collector's approval and general
control, a plague officer may appoint, fine, suspend, or
remove from plague duty any member of the plague staff
except a medical subordinate. The Collector may delegate
any of the powers of a plague officer in this regard to any
assistant plague officer.
The chairman of a municipal
council may not exercise any of these powers merely by
virtue of his office as chairman or on the ground that the
staff is paid out of municipal funds. He can only exercise
these powers to the extent to which the control of the staff
may have been vested in him by the Collector.
Right of
appeal of
the plague
staff'.
29- The order of any Collector or plague officer dispens-
ing with the services of a temporary plague subordinate shall
have general effect throughout the Presidency. The Collec-
tor's order of suspension or dismissal shall be final with
regard to officers lower in rank than that of certificated
sanitary inspector. Certificated sanitary inspectors shall
have a right of appeal to Government. The appeal should
be forwarded to Government through the Collector and the
Sanitary Commissioner. There aha il be an appeal to the
Collector against any order of suspension or dismissal passed
by a plague officer or assistant plague officer.
Employment
on plague
duty of
Government
officials of
the medical
and police
departments.
30. The employment on plague duty of Government
officials of the medical and police departments should be
restricted, and volunteer agency should be utilized as much
as possible to assist in carrying out plague measures.
Whenever practicable, public and private hospitals and camps
may be placed in charge of native practitioners. Police
'5?
26
officers should not hold enquiries into suspicious cases of
plague. ¡Small representative committees of the inhabitants
may be appointed in various parts of a city to co-operate
with the authorities and to bring to their notice matters
requiring attention or inquiry.
Class of
persons to be
employed on
plague dub?.
31. As far as circumstances permit, Hindus should be
employed in those parts of a city where Hindus predominate
and Muhammadans where Muhammadans are in a majority.
Officers of all grades should show the greatest courtesy and
consideration to the people, and should interfere as little as
possible with their habits, feelings and religious prejudices.
PART V.—-ACCOUNTS.
Distribution
of plague
charges.
32- Each municipality will bear its own plague charges.
As regards district boards, the measures adopted in frontier
districts proper, i.e., those districts which adjoin plague-
stricken areas outside the Madras Presidency, not only benefit
those districts themselves as being nearest the seat of infec-
tion, but also protect other portions of the Presidency as
well. This condition is also fulfilled, in some measure, by
districts in which railway inspection stations have been
established by notification in the Forf ¿it. George Gazette.
Expenditure incurred by district boards in such districts on
plague preventive measures is therefore distributed by Gov-
ernment in the ratio of one-third against the district in which
the expenditure is incurred and the remaining two-thirds
against the other districts of the Presidency rateably on
their annual receipts as shown in their budget estimates for
the year. The budget estimates should, however, provide for
the gross expenditure to be incurred by each district board,
credit for the contribution being taken subsequently on
advice from the Accountant-General.
Govern tnenb
contribution
to private
pingue
hospitals.
33- Contributions towards the cost of the construction
and maintenance of private plague hospitals and segregation
camps in infected areas and areas under observation will be
made by Government from Provincial funds in accordance
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 actiug under his control. In any case of
doubt or dispute the Government will have the right to esti-
mate by means of- the Public Works Department the value of
the work done.
27
(&) 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.
Provided that such hospitals and camps will remain under
the general supervision of Government officials and will
observe any detailed instructions that may be given by the
Sanitary Commissioner or the Surgeon-General ;
provided also that the sale-proceeds of such camps and
hospitals will be proportionately divided between the Govern-
ment and the plague committee concerned.
Grants for
t.lie erection
of sheds in
rural areas-
34> I* 1 rural areas where evacuation of houses may be
ordered under the Plague Regulations district boards may
give poor people grants not exceeding Es. 3 per household as
a grant-in-aid towards building sheds. Such grants should
be kept at as low a figure as possible and should be made ay
a rule only to those who are otherwise unable to furnish
themselves with shelter.
Subsistence
allowance
to inoculated
persons,
35. To encourage inoculation, it is open to Collectors
with the previous approval of Government to sanction to
poor persons a grant not exceeding 8 aunas a day for an adult
and 4 annas for a minor who maybe temporarily incapacitated
for work as a result of inoculation for plague. Such grants
should not be paid to any one individual for more than three
days.
Expenditure
on inspection
sheds on
railway
platforms.
36- Any expenditure incurred in providing inspection
sheds on railway platforms in cases where there are no proper
facilities in the railway station for the examination of passen-
gers in accordance with the Plague Regulations will be borne
by the civil department and not by the railway administrations.
The construction of all such buildings will, in the absence of
the orders of the Government to the contrary, be carried out
ordinarily by the railway administration concerned, the civil
department defraying merely the cost.
Government
grants to
local bodies
for plague
expenditure.
37. If any district board or municipality finds its funds
unequal to the burden of plague charges, it should revise its
budget by omitting all avoidable expenditure and in the labt
resort may apply for an advance from Provincial funds or for
a loan from the Government of India. Care should be taken.