  It is evident from what has been said that to prevent plague our efforts should be directed in For the second, we require (a) sanitary precautions by guardians of public health; (b) observance of rules of personal hygiene by which good health can be maintained. (1). Wherever possible a medical inspection should be made to prevent importation of the disease. This is, however, a very difficult matter, and one unforeseen difficulty was experienced at Sukkur, where it was found that people booked to stations short of Sukkur, and rebooked at stations on the other side. Still this measure is highly important, and should be carried out most rigorously as long as there is any chance of importation of plague into an unaffected country. It is needless to feel the pulse of the patient; his gait, temperature, and look would afford a great deal of information. Information should be obtained from where the patient is travelling. An examination should also be made of clothes. Dirty clothes, soiled linen and rags should not be allowed to pass through an inspection post. (2). There should be a disinfecting or sterilizing room fitted with a steam sterilizer in all (3). If quarantine is imposed, it should be for a period not less than ten days. Every arrangement, however, should be made for suitable accommodation and sanitation in quarantine camps. In a quarantine camp new arrivals should not be mixed up with those who are already in quarantine. (4). Ships from infected ports should be carefully watched. If any infection is discovered, then isolation of the sick, disinfection of the ship and quarantine are required, but ships with clean bills of health, and if ten days have passed since its departure from the infected port, may be admitted after medical inspection. It must, however, be borne in mind that rats could easily carry infection from one port to another without any fear of detection. These facts show that medical inspection and quarantine may be useful, but they can never be perfect, and therefore the principal safeguard of a place lies in the improvement of its sanitation, and therefore greater attention and energy should be directed towards it. Sanitary Measures that should be taken by Municipal and Railway authorities.(1). All filth should be removed from the vicinity of towns and villages and burnt, and no filth of any kind should be allowed to remain within an inhabited area for any length of time. (2). All private and public latrines and public urinals should be cleaned and disinfected daily. All receptacles used for night-soil either in the latrine or for transport should be daily disinfected. (3). Latrine accommodation, according to the requirements of the population, should be provided. (4). Drains should be well washed and flushed with a disinfectant solution. In towns where there is an underground sewer, it should be well flushed and ventilated, and a disinfectant solution used for cleaning it. A house-to-house examination should be made to ascertain that all house-connections are properly and efficiently trapped. Deposits in the sewer should be taken out and suitably disposed off after disinfection. (5). Special attention for cleansing should be given to the following:— Cesspools, privies, cow-houses, stables, slaughterhouses, markets, workshops, common lodging houses, serais, bustees, and crowded quarters of a town. (6). All public roads should in the dry season be watered with a weak disinfectant solution. (7). Pure drinking water should be supplied. All articles of food should be inspected. Musty and decomposing grains should not be allowed to be sold. The meat market, dairies and bakeries should be under strict sanitary supervision. (8). Over-crowding in houses should be prevented. Steps should be taken for spreading out the population of much over-crowded and congested parts of towns. (9). Lime in a dry state and in solution should be abundantly used in drains, &c. (10). All railway carriages travelling through infected areas should be daily washed with a reliable disinfectant solution, such as 5 per cent. carbolic acid. (11). Railway platforms, waiting rooms and halls, and latrines should be frequently cleaned and disinfected. (12). There should be a system of house-to-house inspection to ascertain the sanitary condition of dwelling-houses, and also to find out, as far as possible, the condition of health of the inmates. Common lodging houses, serais and houses of a similar nature should be most carefully examined. (13). If plague breaks out, then isolation of cases is a great necessity. When practicable, such isolation may be done in the house of the patient. The patient should be kept in a separate room apart from those where other inmates of the house live. A temporary room could be put up on the roof of a house or in the compound, if there is any, or a tent may be pitched. Where possible, all healthy inmates of the house should at once remove themselves in camp leaving only such near relatives who must attend and nurse the patient. For patients living in lodging houses, or, where there is no means of such isolation as stated above, segregation in special isolation hospitals should at once be done. The isolation hospitals should be separate for each of the following classes—(a) for lower class people; (b) for middle class people; (c) for such people of the middle or upper class who may chose to pay for their expenses. It is needless to say that there should be special hospitals for women, where only Suitable means for ambulance should be provided, and should be had ready within convenient distances. They should be thoroughly disinfected after the conveyance of any case. Ambulance carts or doolies should be comfortable, for physical exertion and exhaustion, attending a long journey in the early stage, greatly compromise chance of recovery. Burial within inhabited areas of a town or village should be stopped. Dead bodies should be removed under strict precautions for disinfection and disposed off quickly. Bodies should be buried deeply—4 to 6 feet. |
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