Abstracts from Reports ANNUAL REPORT ON THE WORKING OF THE CIVIL HOSPITALS AND DISPENSARIES IN THE PROVINCE OF ASSAM FOR THE YEAR 1936

With

brief

explanatory

notes

There were 268 hospitals and dispensaries of all classes at the commencement of the year and 274 in working order at the close of the year. Six new dispensaries were opened during the year, of which two

dispensaries (one state-public at Bajengdoba state-special at Pengin), three local fund and one railway institutions. The total number of in- and out-patients treated at the state-pxiblic, local fund and private-aided hospitals and dispensaries rose from 2,124,973 in 1934 to 2,270,621 in 1935, but fell to 2,185,317 in 1936, i.e., a decrease of 85,304 on the previous year's figure. The district of Sylhet, Nowgong, Kamrup, Manipur and Goalpara show a decrease: of 58,906, 31,014, 23,320, 8,766 and 5,357, respectively. The decline in attendance is attributed to

were

and

state

one

ABSTRACTS FROM REPORTS

Dec., 1937]

the healthiness of the localities and to the less prevalence of malaria during the year. The highest increases were recorded in the districts of Sibsagar (14,538), Naga Hills (10,453), Lakhimpur (6,213), Lushai Hills (5.308), and Khasi and Jaintia Hills (4,901). The increase in the number of patients in the Sibsagar district was mainly due to the high

incidence of malaria in the rural areas and in four districts the increases occurred under ulcerative inflammation and other diseases of nails, excluding tumours. There was also incidence of malaria in the Khasi and Jaintia

the other

diarrhoea, the skin, a higher

Hills and

Lakhimpur.

Cholera.?One thousand two hundred and ninety-nine patients were treated in 1936, against two thousand and three hundred and eighty-five in 1935. Of these Sylhet furnished 940, Cachar 112, Sibsagar 108 and Kamrup 54. No cases were reported by the Naga Hills, Lushai Hills, Lakhimpur, Garo Hills, Sadiya Frontier Tract and Balipara Frontier Tract. Malaria.?In all 663,638 cases were treated with 133 deaths, against 766.896 and 116, respectively, in the year preceding. The disease was prevalent as usual throughout the province. The increase occurred during the year under report in the districts of Sibsagar (45,212), Lakhimpur (26,222), Khasi and Jaintia Hills (20,480), Garo Hills (17,030), Sadiya Frontier Tract (9,143) and Manipur (5,386). Dysentery.?The total number of patients treated was 45,184, with 147 deaths, against 48,929 and 96, respectively, in 1935. The highest figures are shown by Sylhet (14,018), Goalpara (7,909), Kamrup (4,514) and Sibsagar (3,419). Kala-azar.?There were 5,327 cases and 50 deaths, against 5,476 and 52 deaths in 1935. The following figures for the last 8 years show the number of case? treated in hospitals and dispensaries other than those directly under the public-health

department:? 1929 1930 1931 1932 1933 1934 1935 1936

..

..

..

6,166

..

..

4,308

.

..

..

.

.

..

..

..

..

.

..

..

..

..

..

..

..

..

..

..

..

..

..

..

3,755 3,696 4,443 5,558 5,476 5,327

Altogether there was a slight decrease in the figure for 1936 when compared with those for 1934 and 1935, the warning against the increase in the_ number of kala-azar cases in the province as given in the report for 1933 still holds good and the campaign against kala-azar should not be relaxed in any way. Leprosy.?Eight hundred and forty-six cases were treated by hospitals and dispensaries, against 778 in 1935. This however does not give a correct picture of the cases treated in the province. Particulars of the working ot leper asylums and other clinics show that 4,718 cases came under treatment during the year, against 4,926 in 1935. Tuberculosis of lungs.?There were 1,843 cases with 92 deaths, against 1,641 cases with 104 deaths in the previous year. This disease is very prevalent throughout the province. The highest figures are shown by Jvamrup (416), Sylhet (346), and Goalpara (257). and Other forms of tuberculosis.?Three hundred twelve patients were treated in 1936, against 337 in 1935. Smallpox.?The figures rose from 40 with 1 death to 67 with 3 deaths in 1936. /nfluenza.?The fieures fell from 34,365 with 3 deaths to 33,239 with 7 deaths in 1936. Cases of beri-beri T? epidemic dropsy] fell from 139 in 1935 to 90 in the year under report. The highest incidence (54) occurred in the district of Sylhet, against 100 in the previous year. There were 2,600 cases of pneumonia with 152 deaths against 2,350 with 150 deaths in 1935. No cases of plague were reported during the year. _

765

The figures under enteric fever rose from 881 in 1935 1,053 in 1936. Anti-rabic treatment.? The total number of patients treated in the hospitals and dispensaries of the province was 1,535, against 1,315 in the previous year. No new centres were opened during the year. Faute.?The campaign against yaws was 'continued during the year. One thousand eight hundred and forty cases were treated in civil hospitals and dispensaries, against 1,738 in 1935, while 1,656 cases were treated by the public-health staff in charge of dispensaries under the department. Indian Red Cross Society.?Though Assam is a backward and poor province Red Cross work appears to be progressing very satisfactorily, as will be evident from the fact that it has occupied the second position in India so far as the enrolment of members during 1936 is concerned. Summary of activities:? Maternity and child-welfare centre.?The number of welfare centres remainedat five, as in the previous year. The work of the dhai training classes at Silchar, Karimganj and Sylhet was satisfactory. Suitable candidates for training as health visitors are still very few among the better class Bengali and Assamese to

_

families. A large number of grants for maternity and childwelfare work throughout the province have been made

from the Silver Jubilee fund. A Junior Red Cross training camp was held at Shillong on the 20th, 21st and 22nd November, 1936. at the Ladv Kerr Child-Welfare Centre. Miss Norah Hill. A. R. R- C., the Organizing Secretary. Indian Red Cross Society, attended the camp and delivered lectures with demonstrations. The Assam Medical Research Society.?Government continued to give a grant of Rs. 25.000 to the Assam Medical Pesearch Society. The activities of the society were chiefly confined to malaria, cholera and dysentery. ?

OF THE EUROPEAN MENTAL HOSPITAL AT RANCIII FOR THE YEAR 1936 During the period under review, the hospital conserve tinued to Assam. Bihar, Bengal, British Baluchistan, the Central Provinces, the North-West Frontier Province, Orissa, the Punjab and the United Provinces. European mental patients from the French Settlement of Chandernagore are now eligible for admission into this hospital, but no such patients from that area during the were actually admitted period under report. The number of patients resident in the hospital at the beginning of the year was 215 (101 males and 114 females) against 196 (91 males and 105 females) in the preceding year. The maximum number resident in the hospital on any one night was 226 (105 males and 121 females) against 220 (104 males and 116 females) in the previous year. The total admissions during the year under review were 51 (22 males and 29 females) against 58 (26 males and 32 females) in the previous REPORT

vear.

Of these. 12 (4 males and 8 females) were re15 (6 males and 9 females) in the

admissions against

previous

year.

Health of patients.?There has been a decrease in the dailv average number of sick treated in the hosnital during the year under report when it was 4.00 (2.30 males and 1.70 females) as_ compared with 5.02 (3.08 males and 1.94 females) in the previous year. The important admissions were for malaria (24), colitis (3), influenza (6); epilepsy (3) and abscess (9). As heretofore, malaria has been responsible for a large number of cases of sickness. All these cases were treated with quinine hydrochloride iniection followed by cinchona mixture for a month, their blood being examined from time to time. Valuable as systematic psychiatry has proved in the past in establishing a superficial order in the psychoses (a pathological foundation is not yet available) and. in promoting research, it is to a psychiatry of the

THE INDIAN MEDICAL GAZETTE

7(56

individual that we now turn in the hope of effective treatment. Classification which constituted so great a part of institutional psychiatry has been superseded by setiologj', environment and psychobiology. The appositeness of this view is realized when we consider the influence of one adverse environmental factor?malnutrition, the effects of which are at the present moment being amply demonstrated. In common with other countries, India is experiencing the effects of the economic crisis. The psychiatrical repercussions of malnutrition have been demonstrated by Lush, Holt, Levine, Blanton, Laird, and others in the correlation and under-nourishment between intellectual deterioration, lack of energy, impaired concentration and poor memory associated with either irritability and over-excitability or listlessness and apathy. The constitutionally enfeebled are unable to call upon a sufficient reserve; enhanced competition, malnutrition and psychopathic breakdown form a vicious circle. The immediate results of treatment are very grati-

fying; a tonic, a sedative, good food, encouragement, simple trade in the occupational therapy department, are all that is required. Prognosis is unfavourable; the removal of protection and the violence of open competition will result in failure and recertification. Recent research would suggest, also, that these symptomatic manifestations of malnutrition descend through the first generation to appear with the more profound a

effect in the second and that the genotype may be altered and injured for several successive generations. Finally we repeat our annual plea for the early treatment of mental diseases. Often the fear of the social stigma must be considered as a factor in preventing many from seeking earlier advice, but the delay be due to sincere doubt. The commencing may insidious changes of character can become further complicated by appearing in adolescence when moods and waywardness and emotional crises are normally to be expected. It is (he step into the abnormal?the commencing apathy, loss of ambition, fine deterioration in moral character, disinterestedness, or excessive emotional tone which must be recognized, though how far these reticences, enthusiasms and depressions are pathological and "how far physiological may occasion a decision of grave and profound difficulty to the physician. Yet it is necessary to reach the sick mind at this early stage 1o prevent the daydreams from crystallizing into delusions and the moodiness and reticence hardening into apathy and withdrawal. Treatment of mental conditions.?Particular care was given during the year to (lie following methods of treatment.:?

(1) Occupational therapy.?Each patient in the occupational therapy department is treated as an individual; his interests are investigated, his abilities tested, and his potentialities considered. The widely varied crafts enable his talents to be harmoniously utilized. It is not helpful to force carpentry or painting on a patient whose emotional energy would be more smoothly sublimated through music. This important form of treatment has continued to maintain its steady influence as a therapeutic and curative agent, producing contentment, diminishing excitement and inducing a seneral improvement, both physically and mentally, in patients. All the patients discharged from this hospital as recovered and improved during the year have undergone occupational therapy treatment. The interest evinced by them in their respective occupations is very encouraging. The percentage of attendance in the occupational therapy classes (including music and physical culture classes) hag increased during the year under report as compared with the previous year. A number of patients occupy themselves voluntarily even out of the occupational therapy hours; and the dejection and deterioration during holidays are definite. A great advantage which has been achieved is a more thorough training in some of the occupations; patients when discharged from the hospital are thus able to _

utilize this

simple knowledge

to their benefit as in many

[Dec.,

1937

the nature of their disease precludes any return occupation involving mental stress. Physical culturc.?During the year, the patients took All patients who a keen interest in physical exercises. were physically fit attended regularly the classes held at 7 a.m. every day in the well-equipped gymnasium of the hospital. Patients of both sexes attend the morning drill classes for half an hour after which they are taken in batches to the gymnasium. The male patients are taught parallel bar exercises, Indian club swinging, Roman rings, climbing ladders and ropes, boxing, fencing, weight lifting, and other forms of suitable exercises. The female patients are taken in skipping, rowing and other forms of freehand exercises. A few gymnastic exhibitions were staged with excellent effect. These exhibitions were attended by the public who displayed much appreciation of the performances. In hot weather, selected patients were, as usual, taken out once a week for swimming and rowing in the lake of the government agricultural farm. Amusements.?The organization of congenial amusements is another valuable feature in the treatment of mental patients. With this view, attempts have been made throughout the year to provide for patients as many and as varied amusements as possible. The principal items were the following:? Band.?The band continued to provide the patients with a source of very great pleasure so that the expenditure for it is thoroughly justified. Seventyfive per cent of the patients resident in the hospital attended the concerts and dance socials every week. During the hot weather there were moonlight promenade concerts on Thursday evenings -on a spacious lawn. Music..?Dancing and singing.?The music mistress continued to supervise the community singing, piano practice, and dancing classes for patients who showed either a talent or an inclination for such. Some of the patients were given individual attention in singing and dancing in the afternoons. Two variety concerts were staged by the patients and staff of this hospital with great success. On the 1st May there was a Maypole dance 011 the lawn outside the hospital. The patients who took part in it were dressed in country costumes and the spectacle was greatly appreciated by the public. On the 24t,h December carol singing was organized with a batch of selected patients. The patients greatly appreciated this. The usual fancy dress dance for the patients was held on the 30th December and several patients won prizes for their proficiency in dancing and originality in dress. Sports and games.?The outdoor and indoor games were kept up to a high standard throughout the year. As in the previous years, sports were held during Christmas and- proved a great success. About, 40 per cent of the total number of patients resident in the hospital participated in them. Patients who stood first, second and third in each event were presented with prizes. On New Year's day also there were sports in which a large number of patients took part voluntarily. During the appropriate seasons, all able-bodied patients were encouraged by the staff to attend, for an hour every evening, outdoor games, such as tennis, football, hockey, cricket, badminton, basket-ball, and indoor cases

to an

games, viz, carroin, table-tennis, cards, chess, draughts, bagatelle. During the year, nine cricket matches were played against the local teams and eight of them were football season, won by the home team. During the several tournament matches were played by the hospital teams against various teams of the Ranchi district. Selected patients of both sexes were daily taken out for rides on cycles. In short, strenuous endeavours were made by the staff throughout the year to obtain the full therapeutic value out of sports and games' of every description. Picnics.?During the fine weather patients were taken out occasionally for picnics which they enjoyed very

much.

Special methods of treatment.?It has been possible

to try out several of the latest pharmacological preparations in the treatment of the major and minor psychoses

ABSTRACTS FROM REPORTS

Dec., 19371

(in certain cases acknowledgment is due to the gratuitous co-operation of Calcutta druggists). A synopsis of special treatment is given below; this does not include routine tonics, temporary sedatives,

etc.?

Hydrotherapy.?During

the year, IS

treated

cases were

by hydrotherapy. Of these, one recovered and was discharged, ten' improved, one slightly improved and no improvement was noticed in the remaining six cases. Sulfosin treatment.?Thirty-five patients were treated with sidfosin injections. Of these, 5 recovered and were discharged, 10 improved and the remaining 19 cases showed no improvement. Pyrifer vaccine therapy.?Four cases were subjected to this treatment.

in

Of these three

cases

improved

and

improvement was noticed. Sodium amytal (capsule) orally.?Two patients were treated by sodium amytal orally. Slight improvement one

case no

noticed in both of them. with evipansodium.?This treatment given to five patients (2 males and 3 females). Of them, 2 female patients recovered and were discharged from the hospital and the remaining 3 (2 males and 1 female) showed improvement. Glandular treatment.?Five cases (2 males and 3 females) were treated by thyroid and orchitic substances, but no improvement was noticed in any of them. Somnifene.?This was used for the induction of prolonged sleep in three female patients. Three of them were slightly improved and one showed no improvement. Tryparsamide.?Two cases of general paralysis of the insane were treated with tryparsamide, but no improvement was noticed in them. was

Narco-analysis

was

_

Salvarsanized

serum

injections.?Two patients

were

with salvarsanized serum injections (intraspinally) but without appreciable improvement. treated

ANNUAL REPORT OF THE MALARIA ADVISORY BOARD, FEDERATED MALAY STATES. FOR THE YEAR 1936. BY A. NEAVE KINGSBURY, CHAIRMAN This report does not permit of abstraction but it should be read by all medical officers of health who have to deal with malaria control, because it contains the summarized reports on the work of experts in all branches of the subject. ANNUAL PUBLIC HEALTH REPORT OF THE PROVINCE OF BIHAR AND ORISSA FOR THE YEAR 1935. BY LIEUT.-COL. S. L. MITRA, D.P.H., I.M.S., -OFFICIATING DIRECTOR OF PUBLIC HEALTH Population.?The estimated population for the year under review was 39,146,788 as against 38,779,485 of the

previous

year.

?The total number of births in this province during 1,305,580 as compared with 1,268,330 in 1934. This means an increase of 37,250 births or 1.0 per thousand population during the year, over those recorded in the preceding year. Deaths.?The total number of deaths in the province was 947,051 as compared to 981,599 in the previous year. Out of these the rural areas recorded 925,303 deaths and the urban areas 21,748. This means a decrease of 34,548 deaths or 0.9 per mille of population over those recorded in the preceding .year. Provincial death rate for 1935 was 25.1 as compared with 26.0 in 1934 and 22.1 in 1933. The average death rate for the last ten years was 23.6. The rate of increase in the population, i.e., the excess of birth rate over the death rate in the province, was 9.5 as compared with 7.7 in the previous year. The decrease in the number of deaths was chiefly due to a comparatively less number of deaths from smallpox, plague and fevers under which death rates of 0.6, 0.08 and 17.6 were reported as against 0.8, 0.1 and 17.8. The urban death rates for cholera, smallpox and fevers were lower than those of the rural areas. This 1935 was

767

is ascribed to better standard of sanitation in the munitowns but the mortality rate from the diseases still remains higher in the urban respiratory areas The incidence of pulmonary tuberculosis is reported to bo m of the increasing many bigger towns. This disease together with influenza and pneumonia appears to be for the mainly responsible increased mortality rate from respiratory diseases. Control of tuberculosis particularly in bigger towns is necessary. Cholera.?The death rate from cholera rose from 1.5 per nulle m 1934 to 1.7 per mille in 1935 The total number of deaths from this disease in 1935 was 64,876 as compared with 57,289 in 1934. Cholera preventive measures.?Twelve district board* continued to maintain health officers with a suitable subordinate health staff. Forty-six Government epidemic doctors were detailed on epidemic duty during the year in the cholera affected areas of the districts Stocks of disinfectants and also kaolin for use in the treatment of cholera cases are kept in reserve by the district boards. Anti-cholera inoculation has now become a popular preventive measure and Government maintain a large stock of cholera vaccine at the Vaccine Depot, Namkum. The Superintendent, Vaccine Depot is generally asked by telegram to despatch the vaccine immediately wherever it is required in the province Choleraphage was also used for the prevention and treatment of the disease. Smallpox.?The total number of deaths from smallpox during 1935 was 22,967 as compared with 30 310 in 1934. The mortality rate for the year 1935 was'0.6 as against 0.8 in the previous year. As usual the rural areas suffered more than the urban areas. The vaccine lymph manufactured at the Vaccine Depot, Namkum, is supplied throughout the province free of cost. Although it is a known fact that vaccination definitely checks the incidence of smallpox, the rate of mortality from the disease tends to show sharp rises at times. This is due to the fact that a large number of children escape even primary vaccination and thus remain unprotected. Besides, the immunity conferred by primary vaccination passes off within six to seven years. It is, therefore, quite clear that so long as vaccination and also re-vaccination are not made compulsory throughout the province, the incidence of smallpox will continue.

cipal

Plague.?There

2,861 deaths from plague in the year under report as compared the in with 5,411 previous year, and the death rate was 0.08 as compared with 0.1 in the previous year. Government epidemic doctors were detailed on province

duty.

were

during the

Anti-plague

inoculations

were

plague performed

Besides the usual measures of rat destruction, evacuation and disinfection of floors and lower portion of the walls of the infected houses with kerosene oil emulsion were also carried out. Dysentery and diarrhoea .?There were 19,956 deaths from this group of diseases as against 23,481 deaths in the preceding year and the mortality rate was 0.5 as against 0.6 in the previous year. The highest death rate in the districts of Orissa from these diseases is probably due to the climatic conditions and to a large extent is associated with the bad state of water-supply and defective sanitation in these districts. The major portion of the town of Puri received piped water-supply in October 1935 and it is expected that improvement in the water-supply will result in a decrease of the incidence of these diseases in that town. Fairs and festivals.?The towns of Puri, Gaya and Deoghar being sacred places of Hindu pilgrimage attract large numbers of pilgrims even' year from all over India. The Snan and Rathjatra festivals were held in Puri on the 16th June and 2nd July, 1935. Sixty thousand pilgrims, besides the normal population of Puri numberto assembled ing 37,558, participate in the celebration of the car festival. Nine sub-assistant surgeons were detailed by Government. Five of these were deputed on sanitary duties and four were put on special dutv at

768

THE INDIAN MEDICAL GAZETTE

the cholera hospital. Besides these, two more subassistant surgeons were employed by the Puri municipality for the occasion. The town was, as usual, divided into six sanitary wards and each ward was put under the charge of a medical officer. The pilgrims stayed in 14. dharamsalas and 116 lodging houses which are licensed under the Places of Pilgrimage Act. All the wells were regularly treated with choleraphage during this mela period. The Puri waterworks was practically completed just before the mela started. On the 14th June, 1935, a few standposts were ready and the people got the supply from piped water for the first time in the town of Puri. In view of the very encouraging results obtained by the use of choleraphage in recent years in the province, choleraphage was mainly used both as a curative and prophylactic measure and the oneration of anti-cholera inoculation was restricted mostly to the permanent inhabitants of the town and to those pilgrims who particularly desired to be inoculated. The Sonepur fair, the biggest fair in India, started and lasted for a on the 6th November this year fortnight. About three lakhs of people visited the place during the mela period. Special sanitary arrangements as in the previous years were made by the Public Health Department in conjunction with the district board health staff. The whole mela area was as usual divided into three health circles and each circle was placed in charge of a medical officer of health deputed by the Public Health Department. All the 65 wells in the mela area were cleaned and chlorinated before the commencement of the fair and they were regularly chlorinated during the mela period. The drinking-water supply was through the deep tube-wells fitted with pumps and overhead tanks from which it was distributed by means of pipes and standposts throughout the mela area as Nine cases of cholera was done in the previous year. were reported from the mela area. They were all admitted into the isolation hospital for treatment; out of these three died. Prompt measures were taken to disinfect the stools and vomited matter of the cholera The contacts of these cases were all traced and cases. choleraphage was administered as a prophylacticmeasure.

The Pitripaksh mela at Gaya commenced on the 12th September and ended on the 27th September, 1935. Sixty-seven thousand four hundred and forty-two pilgrims visited Gaya during the period as compared with 61,000 in the last year. The sanitary arrangements were made on the same lines as in the previous year. The whole of the mela area received piped-water supply from 4 a.m. to 9 p.m. every day during the mela period. One case of cholera occurred in a lodging house. The case was promptly removed to the cholera hospital where the patient was successfully treated. The lodging house was thoroughly disinfected and all the contact cases were given choleraphage as a preventive measure. The disease did not spread. There has been a steady decrease in the number of pilgrims visiting Deoghar during the last four years. Malaria.?Fever appears to be the

chief

cause

of

mortality in the province. Sixty-six thousand nine hundred and sixty-four deaths from fever or 67.6 per cent of the total mortality from all causes were reported to have occurred during the year. A number of diseases in which the rise of temperature is a marked symptom continues to be grouped under the general heading feverIt is, therefore, clear that malaria alone could not have been the only cause of this large number of deaths although the disease undoubtedly accounts directly or indirectly for the bulk of these deaths. Sale of quinine.?Sale of quinine in the various post offices in the province has been in force for many years. The amount purchased annually be cannot regarded as satisfactory. Spleen census.?Eleven thousand two hundred and forty-seven children collected from 771 villages were examined. Out of these 1,448 children were found to be suffering from enlargement of spleen and these came from 342 villages.

'

[Dec.,

1937

Injant mortality.?The rate of infant mortality decreased from 149.95 per thousand in the previous year to 129.2 per thousand during the year under review. The maternity and child-welfare work continued to be satisfactory and the maternity centres rendered useful aid to the public. Some municipalities maintain a midwifery service for their own areas and it is gratifying to note that some of the district boards have realized the importance of the need for training indigenous dais and have launched on schemes for the purpose, though on a moderate scale. Attempts were made to hold baby shows and organize propaganda on maternity and child welfare at melas and exhibitions held in the various urban and rural areas of the province. Epidemic dropsy.?Dropsy in epidemic form broke out in the town of Purulia and the sadr subdivision of the district of Manbhum. Seven hundred and eightytwo persons died in the affected areas. Government and district board epidemic doctors were specially deputed to carry out house to house treatment in the affected villages. The Calcutta School of Tropical Medicine also sent out a field unit to investigate the pathogenesis of the disease. School medical inspection.?Out of 11,166 boys and 550 girls examined as many as 6,212 boys and 427 girls The majority were found to be defective or diseased. of the boys had minor troubles, but major defects of eye and heart were also noticed, besides a few cases of pulmonary tuberculosis. As usual the parents or guardians of boys were informed of the particular defects the boys were suffering from and suggestions were made for their proper treatment.

REPORT OF THE THIRD UNITED PROVINCES MEDICAL CONFERENCE HELD AT ALLAHABAD ON THE 29TH AND 30TH OCTOBER, 1936 The Third United Provinces Medical Conference held on the 29th and 30th October, 1936, in the Kayasth Pathshala buildings, Allahabad. There was a fair attendance of representatives of the medical profession from all over the United Provinces. The Reception Committee, of which Major D. R. Ranjit Singh was the Chairman, made excellent arrangements for board and lodging of delegates in the Royal Hotel, Allahabad, free of charge and no pains were spared to make the guests feel at home. Messrs. King and Company of Allahabad entertained the guests at a tea party on the evening of 29th October, 1936, in the Kayasth Pathshala lawns. The Reception Committee gave a grand banquet at the Royal Hotel which was joined by about 100 members. The Bengal Chemical and Pharmaceutical Company, The Lily Biscuit Company and Poison's Butter Company combined and entertained the members of the conference to a morning breakfast. Messrs. Gray_and Company of Allahabad entertained the members to a lunch in their compound on 30th October, 1936. Some of the members were shown round the Deaf and Dumb Institute which was very instructive. The Scientific Section was also a great success and some very good papers were read and discussed on its two sittings on 29th and 30th October, 1936. An exhibition was also arranged in the_ Kayasth Pathshala buildings where many firms exhibited their was

products.

This is the third year in the life of the United Provinces Medical Association. Two years are far too short a period of existence to permit of an accurate survey of the value of the work thus far accomplished. The president-elect, Captain S. K. Chowdhry, appealed to all qualified men and women to come forward as members of the Indian Medical Association or one of its branches. Finally various resolutions as recommended by the Subject Committee were placed before the open session for its consideration and carried unanimously.

Dec., 1937]

ABSTRACTS FROM REPORTS

QUARTERLY REPORT OF THE MYSORE STATE DEPARTMENT OF HEALTH, OCTOBER TO DECEMBER 1936. BY P. PARTHASARATHY, L.M.S., B.S.Sc., L.R.C.P., L.R.C.S., D.P.H., D.T.M., DIRECTOR OF HEALTH

7g9

In 1935 an Advisory Committee on the Scientific Investigation of Crime was appointed by the Home Secretary under the chairmanship of Lord Trenchard Lord Atkin, Lord Dawson, Sir Bernard Spilsbury and

others asked ratory lished

served

on

the committee.

The committee

was

to advise as to the manner in which the Labo-

for the Scientific Investigation of Crime estabGeneral in the Metropolitan Police College at Hendon The state of public health in the quartei under report. might best be developed in the national interest, with was satisfactory, except for the fact that cholera regard to the desirability of its being in close special assumed epidemic proportions in a few taluks. Smalland effective touch on the one hand with other police pox and plague were practically absent. In view of institutions established in Great Britain or other the fact that cholera had been forecasted months before countries for the like or cognate purposes and on the and all possible precautionary measures were taken in other hand with any Medico-legal or Scientific Institute advance the epidemic has been kept under control. that might be constituted for teaching and research work in forensic medicine or other relevant sciences. Population The committee submitted an interim report which may be summarized as follow:? The estimated populations of the districts and cities as on 1st July, (1) That the Metropolitan Police Laboratory was 19,36, were 6,725,754. now an integral part of the machinery for the investiParturition statistics gation of crime in the metropolitan area. (2) That the instruction given to the rank and file During the quarter 2,950 labour cases were conducted in the 31 maternity hospitals and female dispensaries. of the police force in the application of science to the The number of maternal deaths that occurred among investigation of crime was being appreciated and that these cases was 53 giving a maternity mortality of 17.96 its value was being increasingly realized as a part of the crime-fighting machine. per 1,000 births, as compared with 15.08 in the previous (3) That instruction, post-mortem examinations and quarter. research work for police surgeons could best be served Vital statistics reported for the previous quarter by the establishment in London of a separate National (July to September 1936) Medico-Legal Institute. This then is briefly the Births.?In the quarter under report, a total of 34,686 position of police science in the Western countries. Now let me return to India and see what is being births were reported (exclusive of still-births). The birth rate confuted for the quarter was 20.63 per mille done in the way of imparting scientific instructions of population, as compared with 17.76 in the previous to the police. Each province has its own chemical examiner's laboratory which works in very close contact quarter. with the police. Each province has its own police Still-births.?During the quarter 547 still-births were training school. I am very pleased at having been reported against 495 in the previous quarter. invited to speak to you at the Phillaur Police Training Deaths.?The number of deaths (exclusive of stillSchool to-day. I am_ also_ deeply conscious of the births) reported during the quarter was 22,581 giving a death rate of efficient training that is being given here to the young 13.43, as compared with 12.71 in the previous quarter. policeman before he is drafted out to the district on field work. The finished product which is turned out Maternal mortality.?During the quarter 546 deaths of mothers at childbirth were reported as compared here is excellent but after a few years it requires with 546 in the preceding quarter. The computed rate polishing. These provincial police training schools must of maternal mortality based on the total births inclusive be looked upon as preparatory schools somewhat analoto the military colleges at Sandhurst and of still-births'during the quarter was 15.50 per 1,000 gous Woolwich. You have no Imperial Police Staff College births as against 17.99 in previous quarter. where the senior men with district experience can go Infant mortality.?The number of deaths of infants for more advanced instructions. A course of lectures under one year of age reported during the quarter was and practical demonstration on the identification of 4,021 giving an infant mortality rate of 115.93 per 1,000 individuals, the sketching of the scene of a crime, photobirths, as compared with 110.14 in the previous quarter. graphy, stains such as blood, semen, paints, etc., hairs, firearms, and the science of forensic ballistics, explosives and explosions, counterfeit coins, documents, fires and REPORT OF THE CHEMICAL EXAMINER TO insurance frauds, cocaine smuggling, etc., etc., would GOVERNMENT, PUNJAB, FOR THE YEAR 1936 make for efficiency in your work and give you confidence [We have taken the liberty of reprinting almost when you may be alone in some outlandish district. completely this lecture by Lieut.-Colonel D. R. Thomas, Police work in this country is tropical. It is often o.b.e., i.m.s., which appears as an appendix to his annual dangerous. The police courses given at Scotland Yard report for 1936, because it contains many hints that deal with the problems at home; whereas you require will be of value to medical men called on suddenly instruction in tropical work. I have been intimately to deal with murder.] associated with you in some of your difficulties and I A Lecture Delivered to Senior Police Officers at the have the greatest admiration for the way you tackle Phillaur Training School on the 27th of February difficult problems. If for no other reason than this I 1937 feel that you are entitled to all the help that science can _

_

Police science has received its proper place in the lawful administration of continental countries and the scientific training given to the police force is far in advance of anything given to their brother officers in Great Britain. In France, the detective branch of the police is given a course of lectures in medico-legal subjects as well as practical laboratory work to equip them in their work to detect crime, collect proofs^ and hand the authors up to justice. Similar instructional courses are given in Germany, Italy and Austria. Great Britain has now started a Police College at Hendon. I visited the place when I was on leave in 1934 and I was very impressed with the syllabus of the teaching and the practical instructions that are being given there to the young policeman. So far it only meets the requirements of the metropolitan area, the provinces have no such teaching institution.

' give you. Murder by violence in India.?This type of murder accounts for about 1,200 cases annually. The comparative percentage is higher in the Frontier Province than it is in the Punjab. The average Punjabi is a hottempered individual and acts quickly. He seizes the nearest weapon at hand. It is a pity he does not employ the more noble pugilistic method of attack. His temperament being such, the scene of a murder by violence may be anywhere and is not infrequently out

in the fields. Before proceeding to give you any detailed instructions on how to investigate, I would like you to observe the following golden rules:? (1) Go at once to the scene of the crime. (2) Isolate the spot by putting on a guard.

770 (3) (4) (5) (6) (7) (8) (9)

THE INDIAN MEDICAL GAZETTE

Examine slowly. Be thorough. Take a photograph or make a sketch of the place. Write notes. Consult others. Use imagination. Avoid complicated theories. Remember you are dealing in most cases with simple-minded folk. Now proceed to examine the spot carefully, many clues may be present to the observant eye and they will all be of vital importance in the successful prosecution of the case. There may be evidence of a struggle, buttons may be torn off, pieces of garments may be lying about, footprints and finger-prints may be present, hairs may have been pulled out and possibly the actual weapon may have been discarded. The body of the victim may be lying on the ground. Make every effort to have the body identified. Once you know who the victim is then you can trace his friends and possible enemies. I repeat again that you must make every effort to have the body identified. If you cannot identify the body call in a medical man, he may be able to help you from the examination of the body. A cataract present in the victim's eye, a deformed joint, scars on the body, old fractures of the arm or leg, a missing finger or toe, are some of the peculiarities that may assist in the identification of a body. Then proceed to ask the medical man as to the probable time of death. This information is of importance as it tells you when the murder happened provided the victim died immediately after receiving the wounds. If the weapon is found then proceed to ask if the wounds on the body could be caused by such an instrument. Please do not rush the medical man, give him time to think out the answers to your questions. He may be young and nervous, such questions are not always easy to answer. Be patient and helpful and do not put to him leading questions. Take him absolutely into your confidence and work out the plot together. If the weapon is not found, ask his opinion as to the possible cause of death and the probable means by which it happened. You may be told that it was by a sharp instrument, a blunt instrument or that he would prefer to reserve his opinion pending a post-mortem examination. Before you decide to hand the body over for such an examination, inspect the victim's clothes carefully for possible cuts or tears on the clothes caused by a dagger, a sword or any other instrument. The clothes will naturally be blood-stained in such cases. Examine to see if such marks on the clothes correspond with any wounds on the body and if the weapon is found, examine if the cuts or tears on the clothes could be caused by such a weapon. It is the duty of the medical man to see if the actual wounds can be caused by such a weapon. Go through the pockets of the clothes of the victim and make an inventory of everything found. It is not necessary to send the bloodstained clothes for examination when fatal wounds are present. Then proceed to examine the surrounding area for possible traces of blood, on blades of grass, on the ground, on any adjacent wall or a charpoy. You will realize that a tiny speck of blood about the size of a pin's head is all that is required to identify the origin of the blood. How to collect exhibits.?All exhibits should be carefully handled. They should be collected in one place and a guard put on them. They must not be handed round from one person to another as in this way tiny specks of blood or fine strands of hair become lost. This advice applies to all kinds of exhibits which are to be sent for analysis. How to pack exhibits.?All blood-stained exhibits should be absolutely dry before they are packed. A safe method is to expose them to the sun. Dried blood can be preserved for years, whereas wet blood stains decompose rapidly and become useless for examination. It is for this reason that weapons of offence found weeks afterwards from a canal, or a well or even buried in fairly dry soil, may give the tests for blood. Once the

blood lias dried properly

[Dec., on a

1937

weapon it is very resistent

decomposition. Unfortunately with blood-stained clothes, the fabric itself putrefies and decomposes the

to

dried blood in the same process. Blood found on a blade of grass or on a stone is a better exhibit for examination than blood-stained earth. When bloodstained earth is the only material available, then pare off a little of the surface, say, the size of an ordinary rupee, and pack it carefully in a small box. Do not, as sometimes happens, dig up all the surrounding area and send maunds of powdered earth for examination. It will be almost impossible to find blood in such a bulk. It is like looking for a pin in a hay-stack. Sharp-edged and sharp-pointed weapons should be packed in wooden boxes. If packed in cloth, the edges or the sharp points invariably cut through the cloth during transit and become exposed, and the exposed parts are the most likely places where blood should be

present. If the alleged murderer is found, take charge of his clothes and search his house carefully. You should examine his body for possible blood stains. If suspicious stains are found on his arms or legs, moisten with clean water a piece of white blotting paper or a small swab of cotton-wool and press it on the stain for a few minutes in the hope of transferring the stains on to the paper or cotton-wool. Dry the paper or cotton' wool in the sun and label the exhibits as stains transferred from the body of the accused on to a piece of blotting paper or cotton-wool as the case may be It is rather dangerous to scrape stains off living skin in case of bleeding. In any case do not give him a bath and send the bath water for analysis. On no account should you pare off or manicure his nails. Human nails are meant for scratching the body and blood is often present under the nails of normal beings. Human nails, being living tissue, contain blood, therefore blood found under or in human nails has no medico-legal value. If you cannot get any other proof against the accused beyond clipping his nails then I would advise you to give him up. I have here two gandasas, both covered with blood, one illustrating how the exhibit should be despatched for chemical examination and the other showing how it should not be sent. As you know, a gandasa is a weapon commonly used by murderers in the Punjab. The correct one as shown here illustrates:? (1) A label, correctly numbered and securely tied on for identification in court. (2) There is no writing on the exhibit beyond possibly one signature on a carefully selected spot free from suspected blood stains. (3) There are no labels or wrappers containing writing glued on to the actual exhibit. (4) There are no seals in various shades of sealing wax ornamenting the gandasa. (5) All suspicious stains are left as they were actually found. They must not be encircled with ink or pencil marks. Now let us examine the second gandasa- where every possible obstacle has been added to prevent the chemical examiner from carrying out his examination. Here you have the wrong way of sending a gandasa:? (a) A label glued on the blade with possible blood stains hidden underneath. (b) Signatures of various witnesses in ink or pencil on the other side of the blade of the gandasa mixed up with suspected blood stains. (c) The exhibit is rusty due to its being packed up wet. The rust has mixed with the blood and will therefore interfere with the tests for blood. (d) Some suspicious stains have been encircled with ink or pencil marks. I have here an instrument manufactured by Zeiss called a head magnifier. It magnifies every detail on an exhibit, therefore please do not encircle suspicious stains. The ink or pencil marks often get wet and run into the stains and interfere with the test for blood. (6) All exhibits should be serially numbered, that is, from 1 onwards. Do not number 1(a) and 1(b) or

ABSTRACTS FROM REPORTS

Dec., 1937] 1(1)

or

1(2) for different accused. Such numbers

are

liable to become mixed up. Chemical examiner's report.?(1) Blood can be found and on sending specimens to Calcutta human blood or ' lie blood of some animal can be detected. The origin of the blood could be done in Lahore provided the necessary equipment and staff were forthcoming. However the procedure' works quite satis-

present

factorily. (2) Blood-grouping

in murder cases is not a success The obtaining of sufficient blood in a pure state on exhibits is a difficulty and the taking of blood from the accused for comparison purposes presents further difficulties in India. The test has only a negative value; it cannot help to identify the criminal. (3) Delivery stains may be differentiated from ordinary blood stains by the presence of foetal hairs, epithelial cells and amniotic fluid. (Explain this.) Menstrual blood may also be detected by the presence of epithelial cells. Generally speaking, the opinion given on the above two points has more of a negative value than a positive value. (4) Human hairs can be distinguished from animal hairs. Cut hairs can be distinguished from hairs that have been pulled or torn out. Dyed hairs can be differentiated from natural coloured hairs. It is not possible however to give the age or sex of a person from the examination of hairs but foetal hairs can be differentiated from adult hairs. (5) Bones requiring identification as to origin, age and sex should be sent to the Professor of Anatomy, King Edward Medical College, Lahore. If he cannot identify the bones, then send them to the chemical examiner. If the bones aro not burnt, their origin may be determined by the same test as for blood. (6) Pieces of skin can be identified in my department by the examination of any hairs growing from it. Human hairs only grow from human skin. (7) Pieces of flesh should be submitted in a salt solution and not in alcohol as alcohol coagulates the albumen. This interferes with the serological test. in India.

HENRY LESTER INSTITUTE OF MEDICAL RESEARCH, SHANGHAI. ANNUAL REPORT FOR THE YEAR 1936

Introduction The year 1936 marks the completion of the third full working year of the institute. The reports presented by heads of divisions cover the work of the institute so fully that it seems superfluous to pick out for special comment, in this introductory statement, the achievements of different workers. It will, I think, be the admitted, however, by those who are able to assess our value of these reports, that a steady addition to knowledge is being made in regard to problems mainly of applied research, and that the standard of work has been maintained. Some of the results of these and other researches make us realize that diseases are not specific entities like plants and animals, and that there is a change in the incidence and character of diseases going on, not only in different parts of the world, but also in the same parts of the world at different times. This is so important that I have asked Dr. Maxwell to allow me to publish, as part of this introductory statement, some extracts from the last lecture he gave at the institute. These extracts, of but course, express the personal views of the lecturer, coming as they do from one who has played an important part in the development of modern medicine in China, they should surely challenge our attention. * ' Retrospect and -prospect' 'The last forty years have been momentous in the progress of the medical sciences and it is, of course, * These abstracts from the lecture of such a wellknown figure in Chinese medicine are of such interest to all practitioners in the East that we have taken the liberty of reproducing them in full.

quite impossible to give therefore, confine myself

experiences.

771 a

complete review. I shall, particularly to personal

more

In my hospital days, three diseases were outstandcommon. Typhoid fever was the curse of the medical wards on account of its prevalence, severity, and the enormous amount of heavy nursing it entailed. So many patients suffering from typhoid came to the hospital that a rule had to be made that no more than five were to be in any one ward at once, owing to the strain it imposed on the nursing staff. Twenty-five years later, one of my daughters nursed for a year in the same hospital, and mostly in the medical wards, without ever seeing a case of typhoid. A few years ago, the secretary of the International Nurses' Council was asked to secure training in typhoid nursing for a group of nurses going out to India, and had to reply that practical training in typhoid nursing was almost impossible to get in England, as only when an occasional small and isolated outbreak occurred were there enough cases in any one place to secure the necessary practical teaching. The disease has disappeared largely as a result of the improvement in public health laws, in regard to water and milk. especially ' On the women's side of our out-patient department, one of the commonest diseases was chlorosis, a form of anaemia that was extraordinarily prevalent among girls working in factories and workshops. As a common disease it has now completely disappeared, and this is undoubtedly due to better conditions in factories, shorter hours, more hygienic clothing, and the attraction of the open air and open-air games. ' The third disease to which I should like to refer is tuberculosis. If not as frequent in England then as it is in China now, it was appallingly common, and took a heavy toll of lives. In the past seventy years, it has decreased by more than 75 per cent and this, again, has been due not so much to treatment, as to health education, and to improved economic conditions. 'Let me now turn to the picture of conditions in the Far East when I first came out thirty-six years ago, and to some of the striking changes which have occurred during these years. ' First, in regard to leprosy. Leprosy treatment was absolutely in its infancy and of knowledge of the causes favouring the development of this disease there was none. Segregation was the only form of treatment suggested and was an obsession of physicians and governments alike, an obsession which unhappily has not even yet disappeared. A few years after my arrival in Formosa, Sir Leonard Rogers developed his treatment with salts of chaulmoogra oil for intravenous injection. Since those days the treatment of leprosy has rapidly advanced, not only through the use of the more modern chaulmoogra preparations, but still more by recognition that concurrent diseases, unhealthy living habits, and probably nutritional defects are most important factors in the development of the disease. 'When I first came abroad, the use of emetine in dysentery was unknown. I well remember the coming of emetine, for I said to myself, if this drug is going to do all that it claims, it ought to be able to do it even though no attempt is made to control the diet. I therefore gave my first injection to a woman in my hospital while leaving her to eat the full hospital diet. The case was happily a very favourable one, and the result in rapid clearing up of the disease was so striking that I have never forgotten it. ' Turning to other subjects, it is a striking thing that the history of helminthology in China has, with one or two exceptions, been covered by my period of time in the East. Hookworm was practically unknown, schistosomiasis had never been heard of, the lung fluke was supposed to bo absent, and fasciolopsis confined to the Shaoshing area. It so happened that when I was appointed chairman of the first Research Committee of the China' Medical Association in 1907, we took as our main investigation the distribution of the common helminths, and were thus able to establish the prevalence of these parasites. '

ingly

772

THE INDIAN MEDICAL GAZETTE

[Dec.,

1937

'

la the line of what I have said about typhoid fever in Great Britain, it is especially interesting to note that when I first came East, there was a general tendency either to deny the presence of typhoid in China, or to regard it as a comparatively rare disease. I came out before there were any of the modern laboratory tests for typhoid, but, as I have already indicated, with a considerable experience of the disease, while at wife who been a sister had my St. Bartholomew's, had had a much wider experience still of the nursing side of typhoid; yet in twenty years in Formosa, I doubt whether I saw twenty cases of typhoid fever. In Amoy, where I knew the hospitals '

well, typhoid the

among

foreigners

was

very common,

yet

doctors who diagnosed the disease easily in foreigners, failed to find it in their Chinese patients. That was, say, thirty years ago. Of recent years in the same place, typhoid fever forms one of the largest causes for admission of Chinese patients to the 6ame hospitals, and easily the largest number of deaths. The same story is true all along the coast of China and in many inland cities. The extraordinary fact is also true that whereas when I first came abroad Amoy had the reputation of being the dirtiest city in China and fully deserved it, it now bids fair to being one of the finest cities on the China coast, and has an unrivalled supply of pure water. I can, myself, see no escape from the conclusion that typhoid is enormously on the increase in circumstances where one would have naturally predicted the opposite to be the case. 'The same story is, I believe, true of appendicitis, though here, I believe, the striking increase is most marked in the wealthy cities, and dietetic causes are at least possible. It is still a rarity in the up-country rural same

hospital. Again, '

we

have

an

enormous

increase

in

neuro-

syphilis, especially in the larger cities, but here other explanations come in. During the last quarter of a century a licentious soldiery has over-run the country and syphilis has become common in country areas where it was formerly a rare disease. Further, this, like other infections, has a tendency to affect tissues subject to strain and stress. A century ago, much of the population of China led an almost vegetable exist-

ence, and of nerve strain there was little. With the coming of wholesale brigandage and the appalling destruction by communists causing the unfortunate people to be ever ready to flee in all directions, an entirely new situation of nerve strain has been introduced into the ordinary farmer's homes, and a tendency, formerly absent, has developed for the poison of syphilis to become located in the central nervous system. 'It is a little difficult to know what to say about the future of medicine in China, and all I shall attempt is to suggest special lines along which advance by research might be made. It would seem that, the world over, interest is steadily growing in the problems of nutrition and there is no country where this is more needed than it is here. There is no race in the world which can beat the Chinese as agriculturalists and despite terribly depressed economic conditions, foods of a suitable quality and sufficient in amount are nearly everywhere available. It is to the credit of our institute that we are taking a share in the work of investigating the nutritive value of Chinese food materials. Such knowledge ought to be in the hands of all superintendents of hospitals in China. The hospitals have to handle enormous numbers of patients on a charitable or semi-charitable basis. No study, as far as I know, has been made of the adequacy of the diets supplied. Many of them, I am certain, while adequate in quantity, are far from adequate in quality, and I believe that less costly diets of greater nutritional value might be found to be available. 'The investigation of specific diseases needs to be applied not only to the general conditions of disease, but to the special factors affecting the incidence in this countryThe ideal, of course, is where science and its. application go hand in hand, and to my mind a _

splendid example of t his is the recent work in schistosomiasis involving as it has done the efforts of the immunologist, helminthologist, pathologist, and photographer, as well as those of the surgeon and physician. Perhaps I stress this more, because as an isolated worker I tried earnestly to solve some of the problems involved in splenomegaly as I saw them many years think nearly anyone ago, and failed miserably. I attempting such work alone is bound to fail, but when teams can tackle these problems, I believe there is hardly any problem in medical research in China which could not be successfully handled. I have told you how certain diseases have been practically conquered in the West in the course of a single lifetime, and I have tried to suggest how similar diseases which are actually still

on

the increase

in

the

East

may

be

likewise

overcome, but this is not the whole

story. I hold that the picture I have drawn of disease conquest is not the whole truth. I suggest that while the conquest has been a very real one, it has dominated the picture too much, and that it fails to depict the fact that there have been striking increases as well as decreases in the prevalence of certain types of disease. In other words, while the grosser manifestations of infectious disease have been wellnigh conquered, a very definite increase has occurred and is still going on in degenera-

tive and functional diseases of the nervous system. ' I will go further and suggest that while increasing regard is paid to physical health, little is done for mental health, and still less for spiritual, though the three are undoubtedly associated with each other to build up the complete and healthy man, which is the final object of all medical practice. These are the days when nutrition is the slogan. Increasing attention is being paid, and rightly so, to the need of a balanced nutritional diet, yet the need of a balanced mental diet, even in the developing period of youth, ia largely

neglected. '

I am not preaching a sermon, but lecturing on disease, and I claim that this is more than pertinent to the problem. What we want is all-round health, and that will only be attained when we have culture, and balanced diet, for body, mind and soul alike. Knowledge, research in all its forms, never can be an end in itself, and unless applied with wisdom fails to make for happiness. It is written: "Wisdom is the principal thing, therefore get wisdom and with all "thy getting, get understanding".' With the retirement of Dr. James L. Maxwell, owing to the age limit, the institute has lost one of its founders, and one to whom the director owes a debt of gratitude for his guidance in framing the early policies of the '

institute. In 1923, Dr. Maxwell was appointed to the important post of executive secretary of the China Medical Association, while three years later, he succeeded Dr. Merrins as editor of the China Medical Journal. Dr. Maxwell's first appointment at the institute was that of librarian and head of a division of field research. It was recognized that the research programme of the institute must be linked in some way with the medical work which had been carried on largely by medical missionaries in different parts of China, and that Dr. Maxwell's position as editor of the China Medical Journal, which he continued to hold after joining the institute, would give us this necessary link. Dr. Maxwell has always taken a great interest in mediwas cal publication in China, and only recently appointed the first editor of the Journal of Clinical Medicine published by the Shanghai Medical Society. Apart from these valuable liaisons, Dr. Maxwell has himself taken a special interest in the campaign against leprosy, and has recently published a practical handbook for workers in this country. Although Dr. Maxwell has ceased to be an active member of the institute staff, we are glad to know that he expects to remain in China, and his appointment to the directorship of the Institute of Hospital Technology (Hankow) will, we hope, lead to a better recognition of the need for training hospital technicians. In these days, hospital technicians are almost as

Dec

ABSTRACTS FROM REPORTS

|987|

where clinical research is concerned. In fact, for this work a new type of individual is required, who majr be described as a nurse-technician. [The reports of the numerous divisions are very condensed and hence do not lend themselves to abstraction, but they all indicate great activity and hard work, and research workers in their special subjects are recommended to read the originals as they cannot lail to get ideas from them.]

important

as

nurses,

especially

TRIENNIAL REPORT OF KING EDWARD VII SANATORIUM, BHOWALI, UNITED PROVINCES, FOR 1934, 1935 AND 1936 The sanatorium made steady progress in all directions and maintained its popularity and reputation among the public of the United Provinces and other

parts of Northern India. The sanatorium remained open from the commencement of March to the end of December during the years under report and was closed, as usual, during the months of January and February. Apart from the loss in sanatorium revenue, this temporary closure entailed great hardship on the patients by causing a break in the continuity of their treatment and putting them to unnecessary expenditure of returning to their homes for a short period. Cold by itself does not harm the tuberculous patients. In fact, Bhowali enjoys the best climate during the winter months when, apart from a few cloudy and rainy days, it can be compared with the Swiss climate. While the air is cool during the summer, 'the cold is not felt as acutely during the winter owing to the greater diathermancy' as pointed out by an eminent authority on the subject

(Fishberg).

The sanatorium will remain open as an experimental during the winter of 1937-38. Eleven beds were added to 'B' class accommodation with the result that, in 1936, the accommodation was raised to 122 beds from 111 beds in previous years. Two important improvements took place during the period under report:? measure

(1)

Nursing arrangements.?Until 1932,

no

nursing

arrangements worth the name existed in the sanatorium and this was undoubtedly a great drawback in an otherwise up-to-date institution. In 1933 the committee sanctioned the employment of 2 male and 2 female nurses. In 1935, the strength was raised to 7?4 male and 3 female. This number is still very inadequate for a sanatorium which provides accommodation for 122 patients. It is gratifying that the committee has decided to raise the number of nurses and thus improve the nursing arrangements that exist in the sanatorium at the present moment. (2) Stocking of proprietary drugs in the sanatorium for the use of sanatorium patients.?Tuberculosis is a disease where medication plays a minor part in treatment. The essentials of treatment are regulated life under open-air conditions and plain, wholesome, nourishing food. However, medicines and particularly proprietary drugs have to be prescribed sometimes in order to give mental satisfaction to the patients, if for nothing else. The local shops in Bhowali charge heavily for these proprietary medicines. In order to save the patients from these heavy charges, the committee decided to keep such proprietary drugs in the sanatorium as are frequently prescribed and used by the patients. There is no doubt the patients have appreciated this innovation and are grateful to the committee for it. Our

needs

The pressing needs of the sanatorium at the present

moment are:

(1) A common recreation hall for all patients. (2) Electrification. (3) Adequate and efficient nursing staff. Recreation committee has hall.?The already sanctioned the construction of a recreation hall in two

773

stages and the outer structure will be available for use commencement of 1937. The from the existing Shed will be converted into Harcourt Butler Recreation ' ' for C class accommodation. It a block of six rooms is hoped that the sanatorium will in due course possess a fully-equipped and up-to-date recreation hall worthy of the institution. The donation of Rs. 4,000 from the Silver Jubilee Fund has been utilized in the construction of the outer structure of the hall. Electrification oj the sanatorium.?The committee has already passed a resolution sanctioning the scheme and the Naini Tal Municipal Board is also willing to give the high tension transmission line from the power house at Durgapore to the sanatorium. Nursing staff.?The importance of an adequate and efficient-nursing staff for the sanatorium cannot be overestimated. Nursing forms the backbone of treatment and particularly in a disease like tuberculosis The present staff consists of 3 female and 4 male nurses.

The existing nursing arrangements of this sanatorium very inadequate for 122 patients and in order to maintain the reputation of the sanatorium, the number of nurses should be increased. The committee has accepted my proposal to maintain a staff of at least eleven nurses?6 female and 5 male?who will workunder the supervision of the nursing superintendent. are

An

earnest appeal

conclude this brief report without makin? an earnest appeal to the charitably-minded public of these provinces to extend a helping hand to this which institution has contributed its share deserving in no small measure in the alleviation of the human to in health restoring suffering and many a consumptive and making them a useful member of society. the attention of the medical profession I also invite as also of the general public to the words of Sir William Osier, the great physician that modern age has produced, who said 'The leadership of the battle against this scourge is in your hands. Much has been done, mucn remains fo do. By early diagnosis and prompt, systematic treatment of individual cases bv striving in every possible way to improve the social condition of the poor, by joining actively in the work of the local and national anti-tuberculosis societies vou can help in the most important and the most hopeful campaign ever undertaken by the profession'. I cannot

REPORT ON THE ADMINISTRATION OF THE PUBLIC

HEALTH

CORE, 1935-1936

DEPARTMENT,

TRA VAN-

The number of births during the year under review and the birth rate per mille of the population were 101,888 and 18.31 against 120,215 and 22.00 respectively during the previous year. There were 8,215 infantile deaths giving a rate of 80.63 per mille of live births against 10,082 and 83.86 respectively. The total number of deaths was 58,208 giving a death rate of 10.46 per mille of the population as compared with 57,206 deaths and a death rate of 10.5 in the previous year. As compared with the previous year, a slight increase was noticed in the death rate, but at the same time there was a fall in the birth rate as well as in the rate of infantile mortality. There having occurred 58,208 deaths against 101,888 births, the natural increase to the state of the during the year was 43,680. population The estimated population of the state for the mid-vear was

5,565,951.

The state was subject to epidemics during the whole year. Besides the continued prevalence of malaria and smallpox there were several outbreaks of cholera in different parts of the state and an outbreak of plague for the first time at Alleppey. There were altogether 29 cases and 26 deaths from plague of which 3 cases and 3 deaths occurred outside the town. As a result measures of the prompt preventive adopted the situation became almost normal towards the close of the year.

774

THE INDIAN MEDICAL GAZETTE

Cholera killed 6,056 during the year. The taluks of Kalkulam and Agastisvaram were the areas worst affected by this disease. Government note that as a result of the efficient measures adopted the epidemic was soon brought under control. Government hope that with the increased staff and readjustment of the public-health activities in the taluks of Thovala, Agastisvaram, Kalkulum, Vilavancode and Shencotta since sanctioned, it would be possible to afford better protection from cholera to the people of these taluks. It is seen that, as in the previous years, the highest number of deaths in the year, 15,706, was caused by different kinds of fevers, including malarial fever. Out of the 216,114 persons treated in hospitals for malaria 106 were reported to have died. But the total state incidence due to malaria is not known. Since malaria is prevalent in epidemic form in certain areas and the affected areas are gradually widening, it will be advantageous if the director of public health will furnish statistics for malaria separate from those for other kinds of fever. Similarly separate statistics may be given for typhoid fever also. There were 1,910 cases and 652 deaths from smallpox against 2,806 attacks and 1,074 deaths in the previous year. As against 1,393,396 vaccinations performed in 1935 the total number of vaccinations done in 1936 was only 1,076,729 of which 333,905 were primary and 742,824 secondary. It is noted that, although the vaccination campaign has been conducted ever since the middle of 1934, with a staff of nine sanitary inspectors and more than one hundred and twenty vaccinators, excluding the staff working under local governments in municipal areas, only 73.68 per cent of the population have been afforded protection from smallpox at the end of the year. The work should be expedited and completed as

Vilavancode,

early

as

possible.

The number of vaccinations

performed in all the municipalities was 59,264 against 86,270 in 1935. In the Shencotta municipality 60 per cent of the children still remain unprotected and the sanitary inspector under the municipal council, Shencotta, verified only 31.32 per cent of the vaccinations, while the sanitary inspector under the Changanacherry municipal council verified only 18.94 per cent of the vaccinations against the minimum standard of 50 per cent laid down by the Government. This is unsatisfactory. The municipal

councils concerned should devote better attention to vaccination work. The entomological section with its field stations carried on malaria and filariasis surveys and conducted

[Dec.,

1937

into the incidence and types of infection in the areas surveyed. The filariasis control work in Shertalai made good progress. The mosquitocontrol operations at Alleppey were continued and consequent on the outbreak of plague a rat-flea survey of the town was also undertaken and carried on till the close of the year. The normal activities of the health unit at Neyyattinkara were considerably affected on account of the pre-occupation of the staff in connection with epidemics. There were 209 cases and 131 deaths from cholera, 68 cases and 30 deaths from smallpox, 72 cases and 21 deaths from typhoid and 105 deaths from malaria within the health unit. The rate of infantile mortality rose from 84.52 to 87.92. An experimental scheme for the inspection of primary school children in eight taluks of the state, with a staff of one sub-assistant surgeon for each taluk, was introduced during the year and the work was entrusted to the public-health department. By the end of the year they examined 28,769 pupils attending 200 schools. Defects requiring hospital treatment were discovered in 14,402 pupils of which 10,392 were treated. Three thousand six hundred and fifty-three pupils were found to require specialists' treatment, but only 915 of them received attention. As regards the other suggestions in connection with school medical inspection, such as the provision of midday meals for school children, the alteration of school hours, the provision of pure drinking water and sanitary latrines, the introduction of hygiene as a compulsory subject in schools, etc., the director of public health will address Government separately. Public-health propaganda was carried on as usual. Lecturing campaigns were undertaken for popularizing smallpox vaccination and for the prevention of the epidemics of cholera and plague. The health educational officer and other officers of the department gave altogether 872 health lectures and talks to an audience of about 169,000 persons. The department also distributed a large number of health bulletins, pamphlets and

special investigations

posters.

Rural sanitation continued to receive the attention the public-health department. One new minor conservancy station was opened, eighty-four bored-hole latrines were installed and three tube-wells and eight other new public wells were sunk during the year. Improvement, cleaning and repair of 105 public wells and disinfection of 5,187 wells and 37 tanks were also carried out. of