Abstracts from Reports

ANNUAL REPORT OF THE ALL-INDIA INST*' TUTE OF HYGIENE AND PUBLIC HEAL?1*' CALCUTTA, FOR THE YEAR 1937 The institute has till now produced four batches

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Diplomates in Public Health. An enquiry was 1?. j tuted with a view to ascertaining how far India made use of the graduates of the institute and **

^ they were being employed. A request was made the ex-students to supply information regarding employment and the nature of their duties. ~

g) response shows that about two-thirds of the gradua which the institute has produced since 1934, j official positions, but that less than half are in public health or research work. Most of j employees are government servants. Local bodies other authorities who are mainly responsible f?r

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?^?ARch 1939] ABSTRACTS FROM REPORTS 187

administration of public health, employ only a small "Umber. Epidemic dropsy.?The mode of causation of epi

dropsy has so far remained unknown ana eatment is also unsatisfactory. For the las

t ^ars; ^searches have been conducted at the institute its aetiology. Many of the current theories investigated critically, and the work done

\vh' uVe incriminated mustard oil as the m a lc^ the toxic substances responsible for th

^ , taken into the human body. Attempts fes made to isolate these toxins in the ?n a?ties. M their chemical and pharmacological P .P g lethods for detecting the presence of these sub

it ^UsPected samples of oil are also under nive g >

5 18 hoped that the problem of its causation win

?rtly be solved. f

en ,9recasting cholera epidemics.?A method ? ?/ve ? lnS cholera epidemics which proved useful tut *he disease has been applied by

^ Jte, with respect to certain areas in Bengal, not

^appropriately considered to be the home of cholera, a A study has also been made of the causes

Penodie rise in malarial incidence in certain end

ex as m Bengal. It has been found that the

exacerbations in malarial incidence, which usually, ta Place every five or six years, are m all P^MvJ elated with unusual rainfall in the dry ,.

February and March. If the ramfalli arm i

y high in the dry months even when the tota ? ,ramfaU remains unchanged, the inciden

in +{. fever may be expected to be high ??her years. The work is of special interest as

ort t? a-e likely to be of great- assistance 1

Ionization of anti-malaria campaigns. haare?tment for black-water fever.?Black-watei ever

j> hitherto defied treatment to a large e. ?

Researches conducted at the institute during the past hln 7ears have not only indicated the manner in thP i ^er fever is caused, but have also he pe so f ab?ration of a new line of treatment whlch

ar given encouraging results. , . , u* kala-azar, investigations are now being ma e: in o

aza Pr?blem of susceptibility to the disease, v

but n?t yet been experimentally produced in >

is JTi supers from it in nature. This, it is tho g .

^obably due to the fact that infection results only n resistance is lowered. . . ,.

hav?a mortality investigations?Investigations deltv, al.so been made into the causes of maternal it Wi!tt Calcutta. Over 90 per cent of these deaths, as been found, were preventable, and the conclu sup}/6 ed that maternity need not be a^tendedwi civ. grave risks if the expectant mother could be

at tK a4e(iuate medical supervision during Prefnan.cy, Safin "me ?f "teUray and for a few weeks following of ,uement. The enquiry has also revealed that one < the important causes of maternal deaths is

findmnancy anaemiaInvestigations are in progressi lor QiptK out the responsible causal factors and the A m j0^ treatment.

,, i j to a ?^el maternity and child welfare centre attached e

.institute gives practical demonstrations o

and child welfare work can be carried out the I, Indian conditions. The staff of the clinic, und Chiwf^rvisi?n of the Professor of Maternity and

lvornPn le are> tries to get in touch with Preg, heaifk y house to house visits and to teach madl y waya of living. Periodical examinations^are ov;., to asnoM-:- ?l--^1 -?

Jvomen ,elfare, tries to get in touch with pregnant ealthy \ house to house visits and to teach them

nia.de to^^8 ?^. living. Periodical examinations are

exist, ? ascertain whether any abnormal conditions

^?rQi'al ce ahies are delivered in the homes in all

fllr+yfes' the mothers and infants are looked after ^here examinations and treatment are given ^ necessary

is attached to the clinic, admission

t year.? ?ed to children between the ages of 2 and

aches ty, specially trained member of the staff

. le earn01 healthy habits, discipline and sociability, blinds an iel ar? ari-anged for the development of their ar>d ^

u bodies. Through the activities of the clinic means of special lectures and instructions in

mothercraft, the centre helps to create health conscious- ness amongst women. Decline in infantile mortality.?Analysis of figures

for infantile mortality shows a decline in the rate

within recent years, although, as compared with those of Great Britain, the figures are still high. The

problem of infantile mortality is closely related to

that of infant nutrition. A beginning has been made on research into this subject. The Nutrition Department has been conducting dist

surveys amongst certain classes of people in Bengal and Assam. The diet of the Assamese coolie has been found poor both in quality and quantity, and

particularly deficient in proteins, fats, minerals and vitamins. The heights and weights of Assamese children fall much below the normal and also below that of well-to-do groups. The diet of well-to-do residents in Calcutta has been found to compare favourably with that of European standard except that it contains an excess of fat. The trend of population growth in India has lately

come under investigation in the Statistical Department of the institute. The studies made show that ' measures directed towards the reduction of mortality

will also help to lower the birth rate'. Tuberculosis and industry.?In the tuberculosis

enquiry carried on- in the institute, a study is being made of the relationship of certain industries to the disease. India is becoming more industrialized and urbanized and this new factor has been held responsible for a marked increase in the incidence of the disease. The jute industry is particularly being studied to find out how far it contributes towards the spread of tuberculosis. The work so far conducted reveals that the majority

of the cases of tuberculosis in jute mills are found among the poorer labourers living in ill-ventilated and insanitary tenements. The fact that susceptible persons are migrating to take up work in these industrial concerns is also held to be to some extent

responsible for the severe type of tuberculosis

prevalent amongst the mill workers.

ADMINISTRATION REPORT OF THE DIREC-

TOR OF MEDICAL AND SANITARY SERVICES, CEYLON, FOR 1937

The most prevalent general diseases of hospital in-patients were rheumatism, intestinal disorders (diarrhoea and enteritis), bronchitis, and pneumonia. Year by year the number of patients who seek hospital treatment for cancer is increasing. The incidence of plague compared with the average

for the previous five years (57) has decreased to 29

during 1937. Of these, 20 cases were of the bubonic variety and nine septicemic. There were no cases of cholera during 1937 in the

island. There were two cases of smallpox in February 1937,

and both these cases were among new arrivals from India. One hundred and thirty-five cases of diphtheria

compared with 103 cases in 1936 were reported during the year with 21 deaths, giving a fatality rate of 15.55 per cent.

Seven thousand, two hundred and forty-eight cases of measles compared with 2,775 in 1936 were reported during the year with 26 deaths giving a fatality rate of 0.35 per cent. The actual prevalence of enteric fever cannot be

judged from hospital admissions since many cases resort to ayurvedic treatment and the majority of cases probably are not notified. The number of regis- tered deaths does not indicate the actual mortality from this disease, as some deaths from enteric are

undoubtedly included amongst those reported as due to pyrexia. There were 13,918 deaths due to pyrexia in 1937 as against 14,520 in 1936. Two thousand, six hundred and twenty-nine cases were notified in 1937 as compared with 2,503 in 1936, with 502 deaths, giving a fatality rate of 19.09 per cent.

188 THE INDIAN MEDICAL GAZETTE [March, 1939

Three thousand and ninety-three cases or 51.0 per cent of the total number of dysentery cases were stated to be amcebic, 1,564 cases or 25.9 per cent bacillary, and the balance 1,380 or 23.1 per cent undefined. These figures, however, are not of great value since the distinction was often made on clinical grounds.

Tuberculosis oj the lungs.?The following table shows a comparison between the figures for 1937 and the figures for the previous four years:?

1933 1934 1935 1936 1937

Hospital cases .. 4,229 4,278 4,851 4,449 4,554 Hospital deaths .. 1,108 1,126 1,382 1,054 1,169 Total number of

deaths registered for the island .. 3,118 3,094 3,387 3,167 3,145

Leprosy.?During the year 1,292 cases with 84 deaths, as against 1,253 cases with 74 deaths in 1936, were

treated at Government hospitals including the two

asylums which are maintained in the island for the segregation of lepers. During the year 30,411 children in 208 schools were

examined and 16 cases detected of whom eight had definite lesions and eight indefinite lesions. The total area covered by the survey was about

2,000 square miles with a population of over" 600,000. With the organization of the Malaria Control and

Health Scheme the control of yaws has been placed on a more satisfactory basis. Each of the field medical officers and medical officers of health is responsible for the control of the disease in his area. Every case in the area is put on a card, inspected and reinspected every six months, and necessary treatment given. Villages, in which cases are found, are carefully inspected half-yearly for detection of new cases.

Hygiene and sanitation

Public health work continues to make steady progress. The Malaria Control and Health Scheme which was launched during the latter part of 1936 was extended during 1937 to include the whole of the North-Western Province, the Matale and Kandy Districts of the Central Province, Province of Sabara- gamuwa with the exception of Kolonna and Kukul korales, Mannar and Mullaittivu Districts and the Tenmaradchi and Pachchilaipallai-Karaclichi divisions of the Northern Province, Matara and Hambantota Districts and Gangaboda -pattu in the Galle District of the Southern Province, certain areas in the Batticaloa District of the Eastern Province, one chief headman's division of the Province of Uva, Hurulu, Kalagam palatas, and Tammankaduwa division of the North- Central Province, and three chief headmen's divisions in the Western Province.

General sanitation has received the same attention as in previous years. The two important items under this head are: control of soil pollution and the provi- sion of protected water supplies. In the control of soil pollution during the year 4,672

bucket latrines were constructed in urban areas as

compared with 3,687 in 1936; 16,619 deep pit latrines in rural areas as compared with 13,639 in 1936; 179 bored-hole latrines as compared with 312 in 1936; 322 mound latrines as compared with 263 in 1936 making a total of 21,792 as compared with 17,901 in 1936. In order to hasten the construction of latrines a

five-year programme has been formulated for areas

under sanitary assistants (inspectors) and every effort is being made completely to sanitate villages. There still continues to be a good deal of indifference on the part of villagers to construct latrines. In regard to the provision of protected water

supplies during the year 281 new public wells and 4,215 new private wells were constructed, and 2,794 wells were improved. The annual grant for the construction of wells in

rural areas is inadequate to meet the problem in a

satisfactory manner. When village committees con-

struct wells out of their own funds they prefer to build wells for bathing purposes rather than for drinking

purposes. Till such time as an adequate number _? protected wells are provided, the people are beiDp educated to boil their drinking water. " U Housing in urban areas is under control and sina housing schemes have been carried out. In rural afea? all that has been done has been in relation to peasaj? colonization schemes in connection with which dweJ

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ings are being constructed in accordance with two tyP. plans supplied by the department; one for the ma,TTltp and the other for the unmarried settler. In construction of these dwellings each settler is given government subsidy.

t On estates regular inspection has been carried on labourers' lines and government requirements met with in the case of 59,067 rooms as compared w1 49,351 in 1936. Maternity and child welfare work continues . 9 receive popular support. The work has been carrie

out at 207 centres as compared with 77 in 1936; * which 8,395 clinics have been held as compared 4,543 clinics in 1936; with a total attendance of expectant mothers as compared with 17,393 in l"** j 88,479 infants as compared with 29,563 in 1936, 39,637 pre-school children as compared with 18,611 ! 1936. These increased numbers are due to the >AXra number of field medical officers and associated sta who have been appointed. The infant mortality a reduction from 166 in 1936 to 158 in 1937 and tn? maternal mortality rates from 21.6 in 1936 to 19.9.1? 1937. In limited areas where intensive work is be^ done with an adequate staff of public health nUlSfv and midwives the reduction in mortality rates is ver^ encouraging. On school health work depends the future public health work of the country. A good deal , attention has been paid to the health of the ec'l?

child and the work is being appreciated by all c? cerned with the result that work is receiving i110 co-operation. The hookworm campaign was carried out with 1??^ intensity and 2,163,373 treatments were given compared with 1,855,572 in 1936 and 1,401,962 in 19*j The leprosy survey, which had completed t ^ organized its work in the Eastern, Western, Sab;ir'

gamuwa, and Southern Provinces, extended its work the North-Western Province, and continued follow-1 work in the former provinces. , :s An lylailfl Siinrmr nf filon'ooic txroc lin^PvinVpTl .

An island survey of filariasis was undertaken ai in progress. Control work in a demonstration area .

Dewamedi Hatpattu in the North-Western Pr0VinC^|ie being undertaken, and action is being taken for removal of the pistia plant throughout the island. Health work under Urban District Councils is "elt0 carried out satisfactorily. One council continues^ have its own Medical Officer of Health who 1S, g private practitioner and another council nominally 1 the departmental Medical Officer of Health m executive capacity without getting him to funct-i as such.

g Health Unit work which was inaugurated in 11 is now the type of work that is being carried in the major part of the island and continues to satisfactory in every respect.

REPORT OF THE SUDAN MEDICAL SERVI^ FOR THE YEAR 1937

Yellow fever

The examination of liver sections from fatal c(l^ of obscure pyrexia.?During the year eight visceroto specimens of livers were examined histologically .

e in no instances were the morbid changes suggestl of yellow fever. Mouse-protection tests.?In March 1937, Dr. G- V Findlay of the Wellcome Bureau of Scientific Resea*'

London, visited the Sudan, and collected a flly series of human and animal sera from the Mountains and Sennar districts. u, (a) Human sera.?The results, which will be Pl3 lished in full by him, confirm completely the fin(" ?

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March, 1939] '

CORRESPONDENCE 189

and ~ year. The high infectious rate (70 per cent

also +v! Kau district is still noticeable as is

a aPParent rural distribution of the virus, and

from "JP difference in the percentage of positive sera

_ adjacent and apparently similar districts,

on ^use-protection test has also been carried out

iaUnd'e S6ra a nurnber of cases of obscure febrile

neear ?.f 34 sera nine have been positive and 25

tiVe r e\ Little significance can be attached to a posi-

eariv esV^ in these cases unless a previous test (at an

thrpp Se_ of the illness) has been negative. In

serum?+se? Malakal it has been possible to test the

sueow ce *n this fashion, and the results are

Was rip1V+: ?l?0d taken on the 10th day of illness

12 dav i lve three cases. A second sample taken

two it i

r was negative in one case, but in the other

a Do.Protected three out of six mice used in the test?? of tv,? -m result, which has developed during the course

illness.

fainv6 cfera ?^. ^ve persons who visited Kau during the aQd aliekSOn *n were also tested by Dr. Findlay

are rini-f i one ,were positive. Two of these positives

Whose Ki?U j^y interesting?a British medical inspector ?uslv

?d was known to be negative a year previ- nortWaUc; an assistant medical officer from the

had an Hudan' p?sted to Kau in 1936. They both

^as nnt ack ?f fever at the same time in Kau. It

and tht ^ the fever was not influenced by atebnn,

badly V/L a ^ew evenings previously both had been

local v> t , V ̂ mosquitoes while sitting out talking to notables.

there6!? results suggest that during the last two years

the rnVave been at least three human infections with

{b) ? yell0w fever"

I^ntiorwi^u^ _sera.?In the 1936 report it was

in two immune bodies had been demonstrated

Dn ? COw? from Kordofan, and in one monkey.

from^vjL*"8 *our this year Dr. Findlay obtained sera Utter ;

and domestic animals in Kau. Among the '

Cows +mune bodies were found in four out of

Do<?it 0 ou^ ^ve dogs, and three out of 11 pigs,

^?oials 7e sera were obtained from any of the wild 'ncludintr

?m ?^?au' although numbers were tested, atld mongoo?Un^ S(lu'rrels' rats, monkeys, lizards, bats

SeQt frn6m^u Was made in London to infect six gerbils, anirnals

01 Sudan, with yellow fever, but these

and vi;,Pr?yed .completely resistant to both neurotropic # c?r?tropic virus intracerebrally.

?|ist's'rp^? f^vey.?This is considered in the entomol- 'liscoverv^0?' mention may be made here of the

?ntirelv ?

, ^des feeding in 1 tebeldi' trees in

Ulnan habit ?"rroundings? two miles from the nearest