135
line usually being an impossibility. Inability to retain excreta must be viewed with suspi-
cion, as this frequently occurs in plague. These are the main symptoms. Carbuncles,
boils, hmorrhagic. spots, &c., are so seldom met with that little attention should be paid
to them outside hospitals.
(3).-WHEN PLAGUE HAS BROKEN OUT.
(a) All sick should be removed at once to hospital, and relatives and friends occupying the same room or who have been exposed to the infection should be taken to the segregation camp
close to the hospital. Any person who can be proved to have been in contact with the sick
person should be detained also. In first cases of the disease authorities should segregate large
numbers of those living in the same house. (Authority-Rule 7 of Government Resolution No.
1728, dated 29th March 1897.)
(b) If there is any disinclination on the part of the populace to notify cases of plague or
suspected plague or to bring their sick to hospital, more stringent measures will have to be
adopted in the shape of house-to-house visitation by search parties and compulsory removal to
hospital and segregation camp.
At the beginning and the end of an epidemic comparatively large numbers of people should
be segregated, as these are the times for its greatest necessity, not to mention the fact that
accommodation will not be strained then.
(c) Thorough disinfection of the house from which a case has been removed should then
be carried out and the house closed until the inhabitants have completed their segregation
period of nine days. The contents of the house must also be disinfected. Nothing should
be allowed to be removed until disinfection has taken place -particular attention must be
paid to this.
(d) The inside of all houses in the infected district should be limewashed as a sanitary
measure. In this case good chloride of lime is preferable to quicklime.
Good chloride of lime spread freely on floors will undoubtedly lessen the chance of
infection of a house, especially by rats; and even after a case has occurred in a human being
in that house, it will lessen the chance of infection of the healthy. In an infected district
this should be carried out in all houses.
(e) After the segregation period has ended the people may resume occupation of the house, presuming that the disinfection has been carried out properly.
In an epidemic all cases of fever should be treated as suspicious and removed for obser-
vation; they usually turn out to be plague. The patient has a better chance of recovery by
this procedure, and the chance of surrounding friends becoming infected is very greatly
lessened.
(4).-DISINFECTION.
Infected rooms in houses.-In all of these there should be a preliminary disinfection by
chlorine before an attempt is made or allowed to remove anything in the house. This is
done by first sousing the walls, floors and contents of the house with water. Then add one
pint of water to one-third of a pint of sulphuric acid and pour this on to a pound and a half
of chloride of lime in an earthenware vessel. All windows and doors should be closed and
holes closed by paper before the materials are mixed. The above amount suffices for on
thousand cubic feet -say, a room eight feet high and twelve feet by ten. If the house be
of the better class, only the room which is infected should be treated thus; if a bad house,
all the rooms should be treated and the house shut up on the certificate of a Medical
practitioner. Many native houses, however, cannot be treated thus.
Another method of chlorine disinfection may be used, but this requires more laborious
preparation. Take eight ounces of common salt and two ounces of dioxide of manganese
and add them to a mixture of two ounces of strong sulphuric acid and two ounces of water.
This suffices for a room of the size mentioned above. In this case also the house and its
contents should previously be rendered moist.
Instead of this chlorine disinfection, if hand pumps and corrosive sublimate or carbolic
solution be at hand, disnfection can be carried out by these agents. Good mops may be used
almost as effectually as hand-pumps, but the work will proceed more slowly. The room must
be washed down by hand pump with a solution of corrosive sublimate (4 oz. of corrosive
sublimate and 1/2 lb. of common salt to 30 gallons of water) or carbolic acid solution (one quart
to 25 gallons of water with a small handful of soft soap added to enable it to be mixed pro-
perly); all old clothing and bedding is to be taken out and burnt; all good clothing to be
dipped in one of the disinfecting solutions for half an hour or into boiling water and
thoroughly boiled for at least 30 minutes. Any partitions, shutters, &c., ordered to be
removed by a medical officer are to be burnt in the street; all crevices, angles of walls,
junction of floor with wall, are to be thoroughly mopped with a disinfectant solution. If the floor is composed of earth, it should be treated with a disinfectant solution and then
removed to a depth of two inches. After this has been done the walls and roof should be
whitewashed.