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that the disease is increasing steadily and rather rapidly.
The estimate of just over two million cases of tuberculosis in
India as a whole is probably much too low ; every large town
is known to be very heavily infected, and therefore an estimate
which is based solely on the incidence of the disease in the
agricultural villages must be unduly favourable.
" T u b e r c u l o s i s i s a d i s e a s e w h i c h h a s v e r y s p e c i a l i m p o r t a n c e i n
India for the reasons—(1) it is likely that many villagers have
never come in contact with infection and therefore are "virgin
soil" on which the disease is likely to thrive, (2) the infection
is being steadily spread from the larger towns to the villages,
(3) the disease constitutes a reliable index of the standards of
life which prevail in countries in which it has become estab-
lished for long periods of time ; it spreads rapidly among ill-
nourished and badly housed populations and correspondingly
diminishes when the people are well fed, well housed and
cleanly in their habits."
5. The Public Health Commissioner, while reviewing the tuberculosis
problem in India in his recent annual reports, drew particular attention to
the absence of accurate statistics regarding the incidence of the disease
and emphasised the necessity of tuberculosis surveys for securing reliable
information. His conclusions are briefly set out below :—
"No reliable information is available regarding the extent of tuber-
culosis infection in India. It has been estimated by workers
in Bengal that, in that province alone, there are a million
persons suffering from the disease. This is an alarming
figure but it has to be remembered that it is only an estimate.
It has been suggested that tentative figures for tuberculosis
mortality might be arrived at by assuming that from 10 to 20
per cent. of the deaths under 'fevers' and 20 per cent. of those
under 'respiratory diseases' are actually due to tuberculosis,
but such methods are obviously unsatisfactory. It is more
than desirable that accurate information should be available
and this can be obtained only by making detailed surveys of
sample groups of the population.
" W h i l s t t h e r e i s g e n e r a l a g r e e m e n t a m o n g t u b e r c u l o s i s w o r k e r s t h a t
the rural population is relatively more susceptible to the
infection than those of urban and industrialised areas and that
the facilities for rapid travel, which motor buses have intro-
duced even into the remote corners of rural India, have
enhanced the danger of a progressive spread of the disease,
there is urgent need for more precise information regarding
the special predisposing etiological factors which influence its
spread among different communities. Properly conducted
surveys can provide such information and they must therefore
precede the formulation of effective plans of campaign against
the disease".
6. Other observers estimate an even higher incidence of the disease,
notably Dr. Ukil who, writing about Bengal in 1937, observed :—
"The annual deaths from tuberculosis are estimated to be in the
neighbourhood of 100,000. The number of persons suffering
from this disease, at any given time, is estimated to be 9 times