NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
191
of opinion that institutional maternity service would be out of place in
rural areas for a long time to come, and the only remedy at present is
to supply more trained midwives suitable to the local conditions and of
inferior qualifications than those their sisters in large cities. This can be
achieved by having two separate courses of training for midwives, one for
Large cities in urban areas and the other for rural areas. This question is
before the Nursing Council and I trust the Council will see its way at
an early date to institute two separate courses of training for midwives
to supply the rural areas more trained midwives. The first thing Govern
-ment should do is to have a compulsory registration of all persons practis
- i n g m i d w i f e r y a s m i d w i f e o r d a i , t a k e u p o n t h e r e g i s t e r t h e p r a c t i s i n g
dais by giving them elementary practical training for at least six months,
subject them to an examination (practical only) and, if found successful,
put them on the register; the register should be kept open for at least five
years, if not ten, for these practising dais. The Lady Wilson Village
Maternity Association, the Bombay Presidency Baby and Health Week
Association, and the Bombay Mofussil Maternity Child Welfare and
Health Council, would be of great help to achieve the object, whereby
a system of perpetuating the indigenous dais would be done, away with."
Comparative Statement of births registered and those confined in the
Maternity Institutions in the City of Bombay from the year 1929 to
1937.
Year.
Beds.
Total births regis-
tered.
Number of
confinements
in Maternity
Institutions.
Percentage of women
confined in Maternity
Institutions to total
births.
1929 . . .
813 24,220 Excluding
still
births.
14,245 59.1 Excluding
still
births.
1930 . . .
824 25,329
16,329 63.8
1931 . . .
871 27,204
18,237 67.0
1932 . . .
993 30.914
Including
still
births.
19,633 63.1
Including
still
births.
1933 . . .
1,041 33,264
23,487 70.60
1934 . . .
1,073 36,089
24,635 68.3
1935 . . .
1,133 36,753
25,433 69.2
1936 . . .
1,190 38,334
27,187 70.9
1937 . . .
1,308 37,795
27,758 73.4
192
CHAPTER VIII.
Medical Research in India.
Organized medical research in India may be said to date from 1894
when the Indian Medical Congress submitted resolutions to Government
urging the establishment and endowment of a research institute. Prior
to that date medical officers working on their own initiative and with
limited laboratory resources had from time to time made important contri
¬ b u t i o n s t o t h e k n o w l e d g e o f t r o p i c a l d i s e a s e s . M a n y o f t h e i r s t u d i e s a r e
classical and amongst them may be cited those of Lewis on trypanosomes
and filaria, Vandyke Carter on spirilla, leprosy and mycetoma, Macnamara
on cholera and Fayrer on snakes and snake venoms. Officers were
occasionally deputed in earlier years to study special problems, for
example, D. D. Cunningham and Timothy Lewis in 1869 on public health
problems such as cholera and malaria. In 1889 the Government of India
extended this practice of deputing officers in connection with field inquiries
on the causation and prevention of disease. Giles for example was
deputed to investigate kala-azar and beri-beri, and then cholera and
malaria. This practice was continued and amongst those selected for
special work was W. M. Haffkine who in 1896 studied the subject of
prophylactic inoculation against cholera in Bengal. Haffkine was engaged
on this work when plague first broke out in Bombay and he was amongst
those sent to investigate its causation and prevention. He specially took
up the subject of the preparation of an anti-plague vaccine and worked
at first in the temporary laboratory accommodation which was provided
for him, but in 1899 the Old Government House, Parel, was taken over
as the Plague Research Laboratory and here along with other workers,
who were attached to the Laboratory, he continued his work.
2. The outbreak of plague drew fresh attention to the necessity for
effective provision for medical research and proposals were submitted in
1899 for a central research laboratory and for local laboratories in each
province. Delays arose in acceptance of the scheme but in the meantime
additional officers were deputed to the Plague Research Laboratory for
further investigations on plague and research there on other subjects had
also developed. These workers included Bannerman, Lamb and Liston
whose subsequent work is well-known. At the same time Stephens,
Christophers and James had been deputed on special studies on Malaria
following the work of Ronald Ross who in 1897 had made his classical
discoveries and who had also been placed on special duty by the Govern
¬ment of India to continue his self-appointed task. Although a number
of officers were at this period engaged in whole-time research work, the.
laboratory at Parel, which continues at the present day under the name
of the Haffkine Institute, was the only permanent laboratory available
for their use and the urgency for suitable centres and accommodation
was apparent.
3.
Prior to the development of the scheme for Central and Provincial
Laboratories a scheme for the provision of Pasteur treatment in India,
Contributed by Colonel J. Taylor, C.I.E., D.S.O., V.H.S., I.M.S.
194
Medicine and it was considered that it would also form a centre for
training future medical research workers and for direct research under
the professors of the different subjects who would be appointed. Amongst
these were Acton and Knowles from the Medical Research Department
who took up the duties of professors of Pathology and Protozoology
respectively and whose subsequent work on these subjects is outstanding.
The School conducts research which is financed partly from its own funds
and partly from those of the Indian Research Fund Association. The
importance of the School as a research centre and a centre for training
workers was recognised by the Indian Research Fund Association agreeing
to meet the pay of two professors for a period of years.
8. The other important centre subsequently developed was the All
-India Institute of Hygiene and Public Health which was opened in 1932.
At this centre also research has been provided for and has been
specially active on the subjects of nutrition, malaria and cholera.
2. MEDICAL RESEARCH DEPARTMENT.
The Medical Research Department is open to both I. M. S. and
non-I. M. S. medical officers. The cadre consists of 30 posts, 13 of
which are specified and 17 non-specified, although 4 of the latter are at
present in abeyance. Of the 26 effective appointments, 12* are reserved
for I. M. S. officers in India and 1 in Burma. Out of the remaining 13,
2 appointments namely those of Directors, King Institute, Guindy,
Madras, and Pasteur Institute, Shillong, are also reserved for. I. M. S,
officers who were in civil employment on the 10th May 1928. The rest
of the appointments, which are mentioned below, are open to both I. M. S.
and non-I. M. S. officers:—
Assistant Directors. Haffkine Institute, Parel, Bombay . . .
2
Assistant Director, King Institute. Guindy. Madras . . .
1
Appointments under the Indian Research Fund Association . . .
4
Un-specified appointments . . .
4
Total . . .
11
2. Officers holding un-specified posts are ordinarily attached to Pro
- v i n c i a l I n s t i t u t e s u n d e r t h e o r d e r s o f t h e G o v e r n m e n t o f I n d i a t o a c t a s
understudies and to assist in the carrying out of researches financed by
the Indian Research Fund Association. The authority to make appoint
-ments to specified posts is vested in the Government of India, but pro
-vincial laboratory posts are filled in consultation with the Local Govern
- m e n t s c o n c e r n e d . T h e I n d i a n R e s e a r c h F u n d A s s o c i a t i o n i s r e q u i r e d t o
employ and meet the pay and allowances of 8 officers of the Department.
*Director, Central Research Institute, Kasauli . . .
1
Assistant Directors, Central Research Institute, Kasauli . . .
3
Director, Haffkine Institute, Parel, Bombay . . .
1
Director, Pasteur Institute, Coonoor . . .
1
Director, Pasteur Institute, Kasauli . . .
1
Under Indian Research Fund Association . . .
4
Supernumerary Officer . . .
1
Total . . .
12
195
3. INDIAN RESEARCH FUND ASSOCIATION.
An important milestone in medical research in India was the creation
of the Indian Research Fund Association by the Government of India
in 1911. The cost of maintenance of the Central and Provincial Labo
-ratories at the Pasteur Institutes had been met by the Central and Local
Governments concerned or by the Pasteur Institute Association and
researches had been conducted at these centres on their own resources
or from special grants. The cost of the extended cadre of officers of the
Medical Research Department, consisting of those officers not filling
special specified appointments and of the research work conducted by
them both at existing laboratories and at other centres for which provision.
had not been made, had to be met. The formation of the Association
provided a means for doing this under an elastic method of control.
2. The Government of India gave an annual grant of Rupees five lakhs
to the Association and an additional sum to meet the pay of officers not
filling specified appointments who would be available for whole-time
research work. The Indian Research Fund Association was constituted
as a Local Fund administered by the Government of India. It is now
registered under the Registration of Societies Act (XXI) of 1860 with
the status of a Local Fund not administered by the Government of India.
3. The affairs of the Association are managed by a Governing
B o d y w h i c h h a s t h e f o l l o w i n g c o n s t i t u t i o n : —
President.—The Hon'ble Member of the Governor-General's Execu
-tive Council in charge of the Department of Education,
Health and Lands.
Members—
The Secretary to the Government of India in the Department of
Education, Health and Lands.
The Director-General, Indian Medical Service.
The Public Health Commissioner with the Government of India.
The Director, All-India Institute of Hygiene and Public Health,
Calcutta.
The Director, Central Research Institute, Kasauli.
The Director, School of Tropical Medicine, Calcutta.
The Raja Saheb of Parlakimedi.
One eminent non-medical scientist elected by the Council of the
Indian Science Congress.
Two Representatives elected by the Legislative Assembly.
One Representative elected by the Council of State.
Three Representatives of Medical Faculties of Universities incor-
porated by law in India who have had scientific training and
experience in research or in public health, elected by such
Medical Faculties.
M 2
M 2
197
Statement showing the annual grants from the Government of India to,
invested funds and interests thereon and annual budget grants of, the
Indian Research Fund Association for the past twelve years.
Year.
Annual
grants
from the
Govern-
ment
of
India.
Invested funds.
(Face value).
Interest
on
invested
funds.
Annual
Budget
grants.
Remarks.
Rs.
Rs.
Rs.
Rs.
Since
3rd
February
1937,
Rs.
2,00,000 have
been with -
drawn and
Rs. 1,50,000
are to be
with draw n
during the
course of the
current fin -
ancial year.
1926-27 . . . 6,75,000 52,30,700 (on 1-4-26) . . .
2,11,030 8,34,416
1927-28 . . . 6,75,000 52,30,700 (on 1-4-27) . . .
2,11,030 12,12,654
1928-29 . . . 7,50,000 52,30,700 (on. 1-4-28) . . .
2,11,030 12,66,722
1929-30 . . . 7,50,000 52,30,700 (on 16-3-29)
2,11,030 10,99,963
1930-31 . . . 7,50,000 52,30,700 (on 26-3-30) 2,13,692 11,01,800
1931-32 . . . 7,50,000 52,30,700 (on 22-3-31) 2,10,641 11,94,770
1932-33 . . . 1,50,000 52,30,700 (on 5-3-32) . . .
2,30,042 8,45,460
1933- 34 . . .
1,50,000 52,01,400(on1-3-33) . . . 1,85,375 8,65,384
1934-35 . . . 1,50,000 47,46,700 (on 1-3-34) . . . 1,42,115 8,49,759
1935-36 . . . 1,50,000 44,13,500 (on 22-1-35) 1,90,194 8,05,244
1936-37 . . . 1,50,000 40,13,500 (on 27-1-36) 1,42,000 7,74,145
1937-38 . . . 1,50,000 36,13,500 (on 3-2-37) . . . 1,30,000 7,25,069
9. The Indian Research Fund Association maintains two large organi
- z a t i o n s o f a s e m i - p e r m a n e n t n a t u r e ,v
i z . ,
t h e M a l a r i a S u r v e y o f I n d i a
(now called the Malaria Institute of India) and the Nutrition Research
Laboratories at Coonoor. The major importance of these subjects is
considered to justify a considerable expenditure on them and the retention
over a prolonged period of specially trained and experienced staff for
them. A large Commission on Kala-azar was maintained during the
period when this disease was seriously epidemic and research on Plague,
Cholera, Leprosy and similar subjects has been heavily financed by the
Association.
10. The Scientific Advisory Board appoints Advisory Committees to
assist them in regard to most of the major subjects. Such Committees
have been formed for Malaria, Nutrition, Cholera, Plague, Leprosy, Rabies
and Tuberculosis. All work on these subjects is reviewed by the Advisory
Committees and recommendations made as to future work.
1 198
11. The majority of the Inquiries under the Indian Research Fund
Association are conducted at the, Central and Provincial Laboratories, the
School of Tropical Medicine, Calcutta, and the All-India Institute of
Hygiene and Public Health, Calcutta, or at the Laboratories of the
Malaria Institute or Nutrition Inquiry under the Association. Field
inquiries are conducted from these centres.
12. Grants have also been given for Inquiries conducted at Medical
Colleges and may be given at any suitable centre.
13. The Indian Research Fund Association maintains a library which
is housed at the Central Research Institute, Kasauli, the books and
journals being available for issue on loan to workers under the Association.
Stores are also maintained at the same centre from which equipment may
be lent to Inquiries.
4. THE INDIAN JOURNAL OF MEDICAL RESEARCH AND INDIAN
MEDICAL RESEARCH MEMOIRS.
The Indian Journal of Medical Research which is the official journal of
the Indian Research Fund Association has been published continuously
since July 1913. Four quarterly numbers are published annually approxi
-mating to 300 pages each. The Journal is edited by the Director. Central
Research Institute, Kasauli, with the assistance of an Editorial Committee.
Publication is not confined to workers under the Indian Research Fund
Association or to members of the Medical Research Department but its
pages are freely open to all contributors of articles of medical research
nature dealing with work done in India which are considered to be of a
suitable standard. The Journal has taken its place as one of recognized
scientific value and its pages form a record of medical research in India
during the last 25 years.
Material received for publication which consists of more extended
con-tributions on special subjects which are too large for publication as articles
in the Indian Journal of Medical Research is occasionally produced in the
form of separate Memoirs. This Indian Medical Research Memoir series,
of which 29 volumes have been published, contains many of permanent
value.
5. SUMMARY OF RESEARCH WORK CARRIED OUT ON
SPECIAL SUBJECTS.
The field over which medical research has extended in India is a very
large one and it would be difficult in a review such as this to summarise all
lines of work. An outline of the work on special major subjects is con
t a i n - e d i n t h e n o t e s g i v e n b e l o w .
*MALARIA.
Malaria is believed to have been endemic in India from very early times.
It is generally accepted that this disease constitutes the major health and
* Contributed by Major H. W. Mulligan, M.D., I.M.S.
205
in human cases of plague with encouraging results. With the diminution
of the incidence of plague in India and the difficulty of obtaining sufficient
numbers of cases under hospital conditions it has not been possible to
obtain trials on the scale necessary to obtain full statistical evidence of the
value of the serum.
(c) Epidemiological studies. —It had been observed by the Plague
Research Commission that rats in areas where plague had been severely epi
-demic showed a high resistance to experimental infection while on the
other hand in areas, such as Madras City, which had been free from plague,
the rats were highly susceptible. An investigation has been in progress
at the Haffkine Institute on the relative immunity of rats from places all
over India showing varying degrees of incidence of the disease. The work
has confirmed that the immunity of the rats is roughly proportionate to the
degree of incidence of plague in the areas from which they are collected,
and has also shown that the resistance to infection persists over a prolonged
period of years. These observations suggest the existence of a factor which
is probably responsible for the decline in the incidence of plague. It is
possible that the occurrence of the immunity in the rodent herd may ex
-plain the epidemic cycles of plague and be responsible for its eventual dis
-appearance in certain areas. The basis for this immunity is being studied.
9. Cumbum Valley Enquiry. —As a sequel to a series of rat-flea surveys
of the Madras Presidency the Cumbum Valley was selected as an endemic
area for the study of the "carry over" of plague, and a field unit has work
-ed there since 1930. The most important findings are that climatic condi
- t i o n s i n r a t b u r r o w s a r e m u c h m o r e s u i t a b l e f o r f l e a s u r v i v a l t h a n o r d i n a r y
meteorological observations would suggest, and that Plague-infected starved
fleas may be responsible for the recrudescence of plague after periods of as
long as a month. A development of this enquiry was a field trial of hydro
-gen cyanide gas as a lethal agent for rats and fleas. This method of
combatting plague is now well established in India. The value of rat-proof
grain godowns and the disinfestation of grain has also been studied. This
investigation still continues on a small scale.
KALA-AZAR.
As pointed out by Rogers (1897) there is little doubt that the epidemic
fever in Burdwan between the years 1850 and 1875 was kala-azar. The
accounts of it and its method of spread, by various contemporary
observers, such as Elliot and French, could have been applied, word for
word, to later epidemics after the true causation of kala-azar was known.
2. The disease was investigated in Assam in the 1890s by Rogers and
Ross and, later, by Bentley. By these early workers it was considered,
variously, to be a form of malaria, malaria complicated with other infec
- t i o n s , o r a d i s e a s e a l l i e d t o M a l t a f e v e r .
3. In 1903 Leishman recorded the discovery of the parasite, now
known as Leishmania donovani , Ross 1903, in the spleen of a soldier . who
Contributed by Lt-Col. H. E. Shortt, M.D., I.M.S
208
was the regular consequence of giving infective material by the oral
route They also described (1928) their first series of negative
t r a n s m i s - s i o n e x p e r i m e n t s u s i n g h u m a n v o l u n t e e r s w h i c h w e r e s u b j e c t e d t o v e r y
numerous bites by infected P. argentipes. In the same year Shortt,
Smith, D'Silva and Swaminath recorded the definite presence of L .
denovani in the faeces of kola-azar cases. In 1930, Shortt, Craighead,
Smith and Swaminath described the infection of two hamsters, kept in
close contact with other hamsters infected with kala-azar, and, in the
Same year these, authors described their second series of negative trans
-mission experiments with human volunteers.
8. Shortt, Smith, Swaminath and Krishnan (1931) reported the first
successful transmission of kala-azar to a hamster by the bite of P.
argentipes, a finding subsequently confirmed by Napier, Smith and
Krishnan (1933). In 1932 appeared the second kala-azar memoir, record
-ing the work of the Kala-azar Commission subsequent to the publishing of
the first memoir. Shortt and Swaminath (1935) recorded the finding of
L. donovani in the nasal mucus of cases of Indian kala-azar and (1937)
established the infectivity of these by infecting a hamster by
intra-peritoneal inoculation.
LEPROSY.
Until about the year 1920 there was no organised leprosy research in
India. In previous years from time to time observations on leprosy had
been made and published by various doctors who, among various other
duties, found time to take an interest in leprosy, but the clinical material
:available was poor, consisting chiefly of advanced cases in leper asylums
'and there were no doctors engaged wholly on studying leprosy. In some
laboratories attempts to culture the bacillus of leprosy had been made, but
ithe results were very conflicting and inconclusive.
2. The impetus to organised leprosy research came through Sir Leonard
Rogers in Calcutta. He had for a number of years been experimenting
in the treatment of leprosy with various preparations of chaulmoogra oil.
Promising results of treatment had been reported in Hawaii and Philip
-pine Islands, and Rogers' result also were very promising.
3. Rogers was instrumental in establishing a Leprosy Research
De-'partment in the School of Tropical Medicine, Calcutta, and also in founding
the British Empire Relief Association, with its Indian Council endowed
by funds raised by an appeal made by Lord Reading as Viceroy. These
two organisations have been greatly aided with grants for research from
the Indian Research Fund Association.
4. The earlier phases of research work undertaken by Rogers and later
by Muir, aimed chiefly at determining the value of various forms of treat
-ment chiefly with preparations made from chaulmoogra oil and this involv
-ed goods deal of research in Chemistry. Good results were sometimes
obtained but it soon became clear that treatment had grave limitations.
Contributed by Dr. John Lowe, M.B., Ch. B. (Birm.).