Climate and Health in Hot Countries and the Outlines of Tropical Climatology / A Popular Treatise on Personal Hygiene in the Hotter Parts of the World, and on the Climates That Will Be Met Within Them.

by George Michael James Giles

The opportunities that should be placed at the disposal of the population may be epitomised as follows:—

(1) Evacuation.—The truth of the old proverb as to the policy of “running away,” is illustrated in the case of plague, if possible, even more forcibly than in that of the late Boer war, and as the population, like the warlike Boer, should always have a new position ready to fall back on, a certain number of huts should be set up in the open for the accommodation of those who are wise enough to take Nature’s hint in good time, and to leave the germs of infection behind them to “stew in their own juice” till they die for want of material.

The ruder these structures are made the better, it being essential that they should cost so little that they can be burned without regret should they become infected; and hence nothing beyond the provision of shelter against the sun and rain should be aimed at. In the case of village communities, complete evacuation of an infected site is generally possible, but in towns of any size such a plan may be out of the question. A small camp should, however, be provided for the accommodation of such as are wise enough to avail themselves of it. Where, as is the case with tea-garden and mine managers, the European superintendent for all practical purposes constitutes the government on the spot for the time being, the policy of instant evacuation of “the lines” wherever a case of plague has appeared cannot be too strongly insisted upon. Even when left to themselves, the germs have a strong tendency to die out in the course of a few weeks; and aided as it can be by systematic disinfection of the inhabited site, there can be no doubt that this policy of flight is the sheet anchor of our armament for meeting the disease.

(2) A hospital constructed of the same temporary materials should be provided for the reception of travellers and vagrants, as well as for such cases in which, on account of panic, the friends and relatives decline to attend to the sick; a contingency which, however, is but rarely met with in India.

The patients should be left to choose their own medical attendants as far as possible, but the paid attendants should, if possible, be subjected to protective inoculation, and the people should be further encouraged to bring their sick to this hospital for treatment and nursing by themselves, but no attempt should be made to isolate the persons employed in nursing, or, indeed, to enforce isolation in any form, as experience has shown that, however desirable it might be to do so, such measures cannot practically be carried out.

(3) Protective Inoculation.—Although there is some doubt as to the extent and duration of the protection conferred by injection with Haffkine’s protective emulsion, there can be no doubt that it confers a considerable power of resistance. The operation is one that can only safely be undertaken by professional men, but it should certainly be placed at the disposal of the community wherever practicable. As a matter of example, it is as well for Europeans to submit to the process, though in view of the rareness with which they are attacked, it can hardly be considered necessary, except in the case of those whose duty brings them into close and constant association with the native community.

(4) The destruction of rats is a measure of no small importance, and one which should be undertaken in all towns where there is even a probability of the introduction of the disease. Most communities possess professional rat-catchers, and the services of these men should be enlisted, though where a reward is offered for dead rats, only full-grown animals should be paid for, as otherwise it may lead to breeding rats for the sake of the reward.

Quarantine, protective cordons, train inspections, and the like, have been tried, and found rather worse than useless; as like all other systems that interfere with personal liberty, they lead to concealment of cases, and concealment necessarily involves the treatment of the sick under circumstances that render the spread of the disease to relatives and attendants almost certain. At the same time, measures of this class are those that are regarded with most favour by natives, and provided they are assured that, in case of the discovery of cases, there will be no forcible interference with their habits and customs, they will generally adopt and themselves carry out the more useful and practicable of the measures of this class, such as the watching of new comers by road and rail, and even the inspection of the dead. It is a mistake to think they are not as anxious to keep the pestilence out of their towns as their European rulers can be, and, as a rule, they will make no objection to the proper disinfection of houses that have become infected, but they will prefer to run any risk rather than submit to any interference with their domestic customs.

(5) The means of thorough disinfection should be provided. The best of all disinfectants is fire, and, as far as possible, all infected bedding, clothing and rubbish should be burned, and paid for. In order to secure, to some extent, the destruction of rats and other vermin, as a preliminary measure, the house should be fumigated by means of sulphur fumes, and after this has been completed and the house opened, the floor, walls and furniture should be thoroughly washed down with strong solution of corrosive sublimate (¹⁄₁₀₀₀) thoroughly acidified with hydrochloric acid. Phenyl has also proved serviceable. The men employed in this work should have been, if possible, inoculated. They should thoroughly grease all exposed parts of the skin before commencing work, and should be thoroughly clothed, being made to wear nether garments reaching to the ankles and tucked into boots of European pattern, which should be kept well greased, so that they may not get hard from contact with the disinfecting solutions. I cannot recommend the digging up of earthen floors, as the task is undoubtedly a very dangerous one to the men employed in the work, and there can be no possible real need for it, as, of all parts of a dwelling, the floor is that which can most easily be saturated with powerful disinfectants.

Lastly, after washing down with perchloride do not lime-wash or attempt in any way to employ these agents in any combination, as to do so shows a pitiable ignorance, not only of the Board School rudiments of chemistry, but of the behaviour of the specific germ of plague to external surroundings. I am perfectly aware that the combination is ordered in several sets of Indian regulations, but in justice to the service to which I have had the honour to belong, I hope my readers will accept my assurance that these ludicrous recommendations are one of the natural results of the meddling of ignorant amateurs, military and civilian, who unfortunately have often been allowed to assume the command of sanitary matters within our great bureaucratic dependency.