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253
2. The Drugs Enquiry Committee recommended a comprehensive
course of training which would provide a body of skilled pharmacists of
equal standard to those who obtain the qualification of the Pharmaceuti
-
cal Society of Great Britain. The small rate of pay which obtains in all
provinces would not justify a comprehensive course of three years' train
-
ing and neither would it appear that any reasonable increase of salary,
to provide a highly skilled professional worker is possible with the limited
available finances of India. Both Bengal and Madras have instituted
advanced courses in Pharmacy, but they are not popular, mainly because
the prospects for future remunerative employment are poor.
3. The probable solution would be to insist upon a reasonable standard
of general education such as is guaranteed by passing the Matriculation
examination of an Indian University, an adequate course of training, in
-
cluding apprenticeship of not more than 9-12 months, and properly organised
Provincial examinations. A dispensing qualification such as that of the
Apothecaries' Assistants of the United Kingdom would be the best line
on which to make proposals. A useful suggestion came from the Drug
Trade that holders of a B. Sc. of an Indian University after serving the
necessary apprenticeship and passing the compounders' examination would
find a suitable career in higher grade pharmacy appointments.
3. QUININE.
It has been estimated by more than one observer that the number of
persons suffering from malaria in India is about a hundred millions. The
incidence of the disease is much higher in the rural than in the urban
areas. In 1936 the rural death rate from malaria in seven provinces, for
which separate rural and urban figures were available, was 10 . 0 per mille
of the population and the urban 3 . 5 per mine. As nearly 90 per cent.
of the people live in the villages the malaria problem in this country
is essentially rural in character. However, nowhere in the world has
there been evolved a satisfactory method of effectively controlling rural
malaria except at a prohibitive cost. We have therefore to content our
-
selves with attempts to palliate the sufferings of the many millions stricken
by the disease and administration of quinine appears to be the most
satisfactory way of achieving this end. While eradication of malaria
cannot be effected by drug. treatment, mass quininisation is of great
benefit as it reduces morbidity and mortality and also helps to diminish
the economic loss caused to the country by the disease.
2. The problem is not, however, simple. In the first place the
amount of quinine required would be enormous. Taking 45 grains as the
minimum effective dose to relieve symptoms, the Public Health Com
-
missioner estimates that, for a hundred million patients, the annual
requirements of India would be approximately 600,000 lbs. A report on
an enquiry into the quinine requirements of malarious countries by the
Health Organisation of the League of Nations (No. C. H./Malaria/185,
Contributed by Dr. K. C. K. E. Raja, L. R. C. P. & S., D. P. H., D. T. M. & H.
255
competition appears to be remote and, so long as the market price i
s
largely controlled by foreign production, room for abuse of any system
of free or cheap distribution will remain.
5. Lastly, a rigorous enforcement of law for the prevention of sale of
adulterated quinine is essential. There is evidence to show that quinine
pills placed on the market by certain firms contained little or no quinine
and that, even in the case of certain post offices, the five-grain tablets
sold to the public contained smaller quantities of the drug. The law
requires strengthening and, what is more, an efficient organisation for
enforcing the law has to be built up in the provinces.
6. In the foregoing paragraphs the problem has been presented in its
barest outline. For a more detailed exposition of the subject reference
may be made to Colonel A. J. H. Russell's paper, "Quinine Supplies in
India", in the Records of the Malaria Survey of India, December, 1937.
7. In conclusion the position regarding quinine may be summed up
in Colonel Russell's words, "The question of the provision of adequate
treatment for the malarious sick in India is both wide and complex. It
embraces such issues as the advisability of extending cinchona cultiva
-
tion, the most suitable species to be grown, the selection of areas suitable
for their growth, economic repercussions arising from an extension pro
-
gramme, financial considerations, rights under the new constitution,
organisation for the distribution of drugs and probably others that have
not been mentioned. The question is one in which every province and
State in India is intimately and gravely concerned".
MEDICAL STORES DEPARTMENT.
There are four Medical Store Depots, located at Madras, Bombay,
Calcutta and Lahore. They are administered by the Director-General,
Indian Medical Service, on behalf of the Government of India, Defence
Department.
2.
These depots were originally established to ensure the supply of
drugs, instruments and appliances, of uniform quality and pattern for the
Army in India. In course of time their sphere of activity was extended
and by a normal process of evolution civil medical institutions turned to
them as the most reliable source of supply.
3. The Stores were, at first, only distributing centres. It was
however discovered that some of the drugs could be more economically
manufactured in India, than imported from abroad and in consequence
Depots undertook to do pioneer work in manufacturing. The number o
f
items manufactured gradually increased, especially during the War, and
now there are at the Madras and Bombay Depots two modern and up-to-
date factories, employing Indian labour capable of supplying all Govern
-
ment institutions in India with drugs and preparations of British
Pharmacopoeia standard. At each of these factories there is employed
a highly qualified advisory chemist, whose duties include the analytical
examination of every preparation made in the Depot factory and a ll
supplies received from outside to see that they are up to the prescribed
256
standard. They also examine all anaesthetics and drugs liable to deterio
-
ration immediately they are received from Europe and thereafter at
frequent intervals. Further, as soon as it is found that a preparation of
the required standard can be obtained in India at a rate not more than
the cost of manufacture in the Depots, the manufacture of that particular
item is discontinued and it is purchased locally. More than half the
amount provided for purchase of stores is in this way spent on purchases
made in India. Stores worth Rs. 11,52,131 were imported in 1936-37,
while Stores worth Rs. 14,14,796 were purchased in India during the same
period. There are many preparations made nowhere else in India.
For example, in the Madras Depot are made the four preparations of
Oleum Hydnocarpus, used in the modern treatment of leprosy, and it is
believed that this is the only source in India from which these preparations
can be procured at a reasonable rate.
4. It is not the policy of Government to compete with private enter
-
prise, neither is it the intention to make a profit from the Medical Stores
Department although it is desirable that it should be as nearly self-sup
-
porting as possible. Private institutions are not encouraged to obtain their
supplies from Medical Store Depots, but the experience of the past has
proved that the Department was able to make good the deficiencies
required for Civil purposes, and which were due to the failure or irregular
supply of imported drugs.
The Medical Store Depots therefore fulfil a useful and necessary func
-
tion, which may in time of crisis become vital.
257
CHAPTER XI.
Medical and other Cognate Societies.
1. INDIAN RED CROSS SOCIETY.
In August, 1914, when the Great War broke out, India found herself
without a Red Cross organisation. The late Surgeon-General with the
Government of India, Sir Pardey Lukis, devoted himself to the task of
filling the gap. The St. John Ambulance Association was already doing
good work in India, and Sir Pardey Lukis therefore grafted on to it a Red
Cross Branch and so formed what was called the Indian Branch of the
Joint War Committee (British Red Cross Society and St. John Ambulance
Association).
2. Up to the end of 1917 this Committee largely depended upon funds
provided by Great Britain to further its activities for the relief of the sick
and the wounded of the Indian Army in India, Mesopotamia, Palestine and
Egypt. At the end of 1917, the "Our Day" appeal for funds was made by
Lord Chelmsford, in response to which over a crore of rupees were collected.
This generous response enabled the Joint War Committee in India to be
-
come self-supporting, and when the Armistice was signed on November 11,
1919, a portion of the capital subscribed was still unspent.
3. The Indian Red Cross Society Act (Act XV of 1920) was therefore
passed which set up an independent Indian Red Cross Society, and made
provision for the administration of the surplus war funds by the Managing
Body of the new Society.
4. Before leaving the subject of the Great War, a few details of the
work done by the Indian Branch of the Joint War Committee may be of
interest. Over 62 lakhs of rupees were spent in Mesopotamia alone on Red
Cross stores and on transport. There was nothing the army called for which
the Red Cross did not try to supply. When in Baghdad the electric cur
-
rent failed, the Red Cross supplied all hospitals with punkahs manipulated by
small Arab boys. It also set up heatstroke stations which saved many lives
in the heat wave of 1917. It provided ambulance transport for the wounded
and before the end of 1916 there were 33 Red Cross launches on the rivers
of Mesopotamia bringing down the wounded, in addition to many motor
ambulances. In the Afghan Campaign of 1919 the Red Cross was again
active and supplied comforts to all the frontier hospitals.
Organisation and finance.—The Indian Red Cross Society is an essen
-
tially national organization, and it spends all its income in India, or in
countries where the Indian Army may be engaged. The only exception
is occasional contributions which may be made by the Society in response
to International Red Cross appeals.
2. The total membership of the Society at the end of 1936 was 21,663
exclusive of Junior Red Cross members, of whom there were 4,20,650
Contributed by Miss Norah Hill, A. R. R. C.
Q
258
enrolled in 11,360 school groups. Its headquarters are in New Delhi, house
d
in a spacious building donated by H. H. the Nawab of Junagadh. The
Society has branches in every Province in India and in a number of Indian
States, and these branches are again sub-divided into districts, so that
there is a network of Red Cross centres all over India. At the end of 1936
there were 25 Provincial or State Branches, and 232 District and Sub
-
District Branches.
3. According to the provisions of Act XV of 1920, which established the
Indian Red Cross Society, the Managing Body, after meeting expenses of
management at the headquarters distributes all its income from invested
funds among the Branches in the proportion in which the "Our Day" Fund
was originally collected. The amount so distributed in 1936 was Rs. 2,19,600.
Military Activities. —Like other Red Cross Societies, the Indian Society
can never lose sight of its primary obligation to act as an auxiliary to the
Army Medical Services in case of war. In view of this, a mobilization
plan has lately been drawn up, and arrangements are being made whereby
the Central Stores Depot in New Delhi can be expanded in case of need,
and additional Depots opened in other centres.
2. A Red Cross Roll of Nurses for Emergency or War has been organized
and trained nurses on this Roll will be available in time of war.
3. A Voluntary Aid Reserve scheme, to supplement the regular army
nursing service has also been approved by Army Headquarters. Recruits
for this Reserve are drawn from the Nursing Divisions of the St. John
Ambulance Brigade Overseas, and a register of all enrolments is kept at the
Army Headquarters. Members are expected to undergo training in a
military hospital at regular intervals.
4. In peacetime the Society, through its Provincial Branches, supplies
a number of military hospitals with additional comforts for the sick and
wounded, which are much appreciated. The Bengal Branch has a Military
Division, which sends regular parcels of literature, cigarettes, etc. to
troops, especially to those stationed in lonely outposts.
5. Discharged Indian soldiers suffering from chronic diseases, particu
-
larly from tuberculosis, are referred by the Indian Soldiers' Boards to Red
Cross Branches, which follow up the men on discharge, arranging where
possible for their treatment. Over a thousand cases have now been dealt
with in this way. European cases are assisted by headquarters, in co
-
operation with the Ex-Services Association, and a special grant of £500 wa
s
received in October, 1936, from the Joint War Finance Committee,
London, for such cases.
6. The United Provinces Branch has established in the Bhowali Sane
-
torium a Red Cross Ward, which is reserved for ex-soldiers suffering from
tuberculosis, and the 12 beds are nearly always occupied.
259
7. Recently the Society was called upon to supply additional comforts
to the sick and wounded of the Waziristan campaign (1936-37), and among
the articles supplied have been lilo mattresses for stretchers, thermos bottles
for cool drinks, anti-fly campaign materials and the usual hospital re
qui-
sites.
Child Welfare.— The greater part of the Society's income is spent upon
its peacetime programme. It seemed to those who directed the affairs of
the Society in its early days that the first and most crying need was to
teach mothers how to bring up healthy children and so child welfare was
placed in the forefront of its programme.
2. The Maternity and Child Welfare Bureau, established in 1.931 by
amalgamation with the Lady Chelmsford League and Victoria Memorial
Scholarships Fund, has concentrated on Training Schools for Health Visi
-
tors and the training of indigenous dais. The Lady Reading Health School
Delhi, is a central training school for health visitors, and provincial Train
-
ing Schools in Madras, Rangoon and Poona received financial aid in 1937,
while the Bengal Health School, which was closed in 1934, expects to re
-
open in 1938. Financial aid is given to dal training schemes, the object
being to provide a midwifery service suitable for and acceptable to the
mass of the. people particularly in rural areas.
3. Provincial State and District Red Cross Branches spend a consider
-
able portion of their income on maintaining or giving financial support to
local child welfare centres. The staff employed by local committees in
-
cludes trained dais, nurse- dais , midwives, maternity supervisors, health
visitors and sub-assistant surgeons. Some branches concentrate on the
provision of a domiciliary midwifery service, some on the maintenance of
small maternity homes and others on welfare centres, nursery schools and
creches.
4. Another activity of the Maternity and Child Welfare Bureau is the
supervision of army child welfare centres, most of which receive generous
support from Red Cross funds. These centres are run in cantonments for
the wives and children of British and Indian troops. Handsome grants
from the Indian Expeditionary Force Canteen Fund and the Indian Army
Benevolent Fund have supplemented the funds available. Co-operation
between the army authorities and the Bureau in their work has been close
and cordial, and the actual work of supervision locally is undertaken volun
-
tarily by army officers and their wives.
Popular Health Education.— The Society's work to educate the masses
in the prevention- of disease is carried . on by a variety of methods.
Health lectures in many different vernaculars are regularly organised
under Red Cross auspices. Sometimes these are illustrated by films and
lantern slides. Headquarters has its own Cinema Section, which pro
-
duces health films and also owns an extensive Film Circulat
-
ing Library. The Red Cross productions now number 8, whil
e
the library contains 34 standard-size, and 35 sub-standard size films
Q 2
260
which are in constant demand. Lantern slides on all the principal diseases
are produced at headquarters and sold from the Red Cross Central Depot
at New Delhi. This Depot also stocks a large amount of health literature
such as posters, pamphlets and charts, and also literature on Red Cross
organisation.
2. Many large cities in India organise an annual Health Week, often
directly under the auspices of the Red Cross Society. Junior Red Cross
groups also carry on health propaganda at rural fairs. Some Red Cross
Branches (for instance, in Bombay Presidency) have organised travelling
dispensaries which give medical relief to rural areas and also carry on health
propaganda. The King George V Travelling Dispensary in Delhi Province
was established by a grant from the Red Cross portion of the Silver Jubilee
Fund.
Junior Red Cross.—The Junior Red Cross is the school-children's
branch of the Red Cross, and has as its objects the inculcation of health
habits, service to others and intenational friendliness. At the end
of 1936 there were 11,360 school groups with 4,20,650 members. A
large proportion of these groups are in village schools and the members
perform many useful services both inside and outside the school walls,
thus contributing to rural improvement. Members observe the health
rules, take First Aid Training, distribute hand-bills on prevention of
epidemics, organise health dramas, and give occasional aid to the sick
and suffering. Some senior groups exchange correspondence albums
with Junior Red Cross groups in other countries.
2. Through the Junior Red Cross and with the aid of a grant from the
National Institute for the Blind, London, the Society has for several years
been carrying on a campaign to increase knowledge on the prevention of
blindness. Courses for teachers have been organised in training colleges
throughout India, and vernacular pamphlets have been distributed in large
numbers through schools and Red Cross Branches. At present a campaign
for better nutrition is being carried on through Junior Red Cross groups
and posters, slides and a film have been supplied by headquarters.
Assistance to Hospitals.—A large number of civil and mission hospitals
receive regular assistance from Red Cross funds. Sometimes this
assistance takes the form of additional equipment or hospital comforts,
and in other cases financial aid is given to supplement the nursing staff
or provide additional training facilities for nurses.
2. The Bengal Branch spent Rs. 20,000 in 1936 on paying nurses'
salaries in mofussil hospitals which could not otherwise afford them. The
Bihar Branch presented a motor ambulance worth Rs. 4,000 to Patna
General Hospital. Headquarters paid for an operating table costing £45
for St. Joseph's Hospital, Baramulla, Kashmir. These are examples of the
kind of assistance which the Society is able to give hospitals.
Disaster relief activities.—The Society has definitely included relief
work in disasters as one of its main activities. Headquarters has ear
-
marked a sum of three lakhs from the Red Cross share of the Silver
Jubilee Fund to form an "Emergency Relief Fund", the income from
261
which is spent annually on relieving distress caused by disasters. Pro
-
vincial Branches have also formed special "Relief Funds", and a portion
of Red Cross income is annually devoted to this purpose.
2. Mention has already been made of the "Trained Nurses' Roll for
Emergency or War", which supplies personnel for emergencies. These
trained nurses are supplemented by the Ambulance and Nursing Divisions
of the St. John Ambulance Brigade Overseas, whose members are trained
in First Aid and Home Nursing.
3. Red Cross funds are used in time of disaster to supply nurses, hospi
-
tal supplies, clothing and even food if required. Some of the biggest
emergencies with which the Society has had to deal were the Punjab Floods
(1929) when funds to the extent of several lakhs were raised by the Punjab
Red Cross for flood sufferers, Assam floods (1933), the Bihar earthquake
(1934), the Quetta earthquake (1935) and the Bihta Train disaster (1937).
4. The reports of District Branches show that Red Cross assistance is
frequently given in local emergencies due to famines, floods or epidemics,
and all such help is much appreciated.
Conclusion.— The above summary of Red Cross activities shows that the
scope for Red Cross work in India is almost unlimited. Faced with a pro
-
blem of such magnitude as that of coping with disease in India, the Society
has directed its activities towards teaching people how to keep well, rather
than trying to cure them when sick. The provision of medical relief, espe
-
cially for women and children is still far from satisfactory, but steady in
-
sistence on health education should lessen the high incidence of prevent
-
able diseases and the consequent pressure on the hospitals.
2. ST. JOHN AMBULANCE ASSOCIATION (INDIAN COUNCIL) AND
ST. JOHN AMBULANCE BRIGADE OVERSEAS (EMPIRE OF
INDIA).
The work of the St. John Ambulance Association in India dates back to
1909, when the Indian Council was founded, with H. E. the Viceroy as
President and H. E. the Commander-in-Chief as Chairman of the Council.
Its main object is to give instruction to the general public in First Aid,
Home Nursing, Hygiene and Mothercraft. Besides, it also undertakes the
organisation of Ambulance Corps, Invalid Transport Corps, Voluntary Aid
Detachments, and the assistance of the sick and wounded in time of war.
Classes are organised all over India, with the voluntary assistance of
medical officers of the civil and military services and private medical prac-
titioners and certificates, medallions, etc., are issued to those passing the
examinations. Persons thus qualifying then become eligible to join Ambu
-
lance or Nursing Divisions of the St. John Ambulance Brigade Overseas, to
which reference is made in one of the following paragraphs.
2. During the Great War of 1914—1918, over 1,000 nurses and nursing
orderlies were recruited through the St. John Ambulance Association for
military service either in India, at the front or on hospital ships. Apart
from this, members of the St. John Ambulance Brigade rendered voluntary
Contributed by Miss Norah Hill. A. R. R. C.