NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
210
sterilization of infectious cases of leprosy so that no children may be
born to them. None of these three measures is practicable on a large scale
in India at the present time.
10. So far we have dealt chiefly with the results of leprosy research in
the clinic and in the field. We will now mention one of the most difficult
and puzzling fields of medical research, namely, laboratory research in
leprosy. It is extremely doubtful if the lepra bacillus has yet been cul
-tured artificially or whether an animal susceptible to leprosy has yet been
found. One of the chief pieces of leprosy laboratory research done in
Calcutta during the last fifteen years has been to attempt to apply to
the problem of the culture of the leprosy bacillus the more recent advances
in knowledge and technique of bacteriology. A tremendous amount of
work of this kind has been done with negative or inconclusive results.
From time to time encouraging results are obtained, but attempts at
verification and extension of the experiment fail. This line of work is
still being energetically pursued.
11. Animal experiments in human leprosy have been confined to at
-tempts to discover an animal susceptible to leprosy or to find some way
of rendering susceptible to leprosy, animals which are naturally immune.
These attempts have not been successful.
12. A considerable amount of work has been done in studying rat
leprosy, a disease analogous to but separate from human leprosy, and
much knowledge has been gained but it is uncertain how far findings made
regarding rat leprosy and its organism are applicable to human leprosy.
The organism of rat leprosy has not yet been cultured.
13. This is a very brief outline of the lines of leprosy research which
have been followed in India during the last twenty years or so. Most of
the work has been done in connection with the School of Tropical Medicine,
Calcutta, or in connection with the Indian Council of British Empire
Leprosy Relief Association, with grants from the Indian Research Fund
Association, but valuable work has been done by the workers in other
centres which cannot be enumerated here. The work was initiated by
Sir Leonard Rogers, who was later succeeded by Dr. Ernest Muir, who
retired a few years ago and whose work is now carried on by Dr. John
Lowe.
14. The results of this work have been widespread. There is a greatly
increased interest in leprosy taken by the medical profession and by the
general public. Many leprosy institutions have been changed from asylums
for the disabled or dying leper to leprosy hospitals for the study and
treatment of leprosy in all its stages. There are now hundreds of leprosy
clinics for the diagnosis and treatment of leprosy. The leprosy problem
in India is however very vast; it is to a considerable extent a social and
economic problem, and it cannot be said that the problem is being ade
-quately attacked, nor even that it is yet clear what are the best lines of
attack. Much more study of leprosy in India is needed.
211
RABIES AND ANTI-RABIC TREATMENT.
Since the Pasteur Institute, Kasauli, was first opened in 1900 research
on rabies and prophylactic inoculation has been continuously carried out
there. Other centres opened at a later period have also carried ou
t investi-gations on varying scales. Semple, the first Director of the Institute in
Kasauli, was responsible for the introduction in 1911 of a vaccine of different
type from the Pasteur dried cord method which had been used up to that
time. His experimental studies on anti-rabic inoculation led to the intro-
-duction of a dead carbolized vaccine the use of which reduced to a very
large extent the risk of accidents which had occurred when the vaccine
containing live virus was employed. After an extended period of study
of the results of the use of the carbolized vaccine and on the basis of
extensive experimental observations Harvey and Acton were able to show
that the new vaccine gave at least as good or even better protection than
the original Pasteur type under Indian conditions. The introduction of
carbolized vaccine made possible the preparation of anti-rabic vaccine in
plains stations and also the decentralization of treatment to out-centres
where patients could receive treatment with the vaccine sent out from
the Institute where it was manufactured.
2. At the International Conference on Rabies held at Paris in 1927 a
general acceptance of the value of treatment with vaccines in which
the virus was killed with carbolic acid was obtained, and the carbolized
vaccine which had, on a large scale, been first employed in India, had
already been adopted in certain other countries. There has since been a
further extension of the use of Semple's method or modification of it
and carbolized vaccines are now used to a greater extent than Other
types.
3. When the Pasteur Institute was first established at Kasauli about
400 cases were treated in a year in India. The number, from different
centres now reaches about 40,000 and treatment on this scale is only
possible by the use of methods based on researches at Kasauli and other
centres.
4. Research on the pathology of rabies, accidents of treatment and other
points have been carried out extensively in the Institutes in India,
pro-minent workers on the subject besides those already mentioned being
McKendrick and Cornwall.
5.
A recent phase of work was that initiated by Cunningham in 1927
and carried on by his successors at Kasauli on the relative value of different
methods of treatment. High value had been claimed for the other methods
of Alivisatos and Hempt, but it was found that when an equivalent total
of fixed virus brain substance was used carbolized vaccine was equally
efficacious. It was also ascertained that the Paris strain of fixed virus
was of higher value than others. On the basis of these observations
anti-rabic inoculation is now carried out by means of courses of a dosage
and duration fixed in relation to the risks which are assessed for each
case.
Contributed by Colonel J. Taylor, C.I.E., D.S.O., V.H.S., I.M.S.
N 2
213
From 1925 until the present time its history has been one of steady
enlargement and progress and its personnel now includes some 15 research
workers, about half of whom are medically trained, the remainder being
chemists, bio-chemists, etc. The Nutrition Research Laboratories are
now perhaps one of the largest institutions in the world devoted solely to
research in this particular field. The present director is Dr. W. R.
Aykroyd, who took charge when Sir Robert McCarrison retired in 1935.
3. The All-India Institute of Hygiene and Public Health in Calcutta
includes a Department of Biochemistry and Nutrition under a full time
professor (H. E. C. Wilson), and this department is an active centre
of nutrition research. Research is being carried out at a number of univer--
sity laboratories throughout the country, and in institutions such as the
Indian Institute of Science, Bangalore, and the Indian Institute for
Medical Research, Calcutta. A glance at recent numbers of the Indian
Journal of Medical Research will show the great attention which is being
given to nutrition research in India.
4. It is impossible to summarise in a few paragraphs the advance in
knowledge of nutrition which has been achieved. Considerable attention
has been given to the study of the nutritive value of foodstuffs and tables
are now available giving data about the content of most common foods
in calories, protein, fat, carbohydrate, calcium, phosphorus, iron and a
number of vitamins. It may be claimed that with regard to knowledge
of food values, India is now by no means behind other Eastern countries.
Dietary surveys have been carried out in various parts of the country,
and the state of nutrition of children extensively studied. Methods of
improving ordinary Indian diets are being investigated by controlled human
experiments; important information has been obtained by this means.
5. The study of diseases related to nutrition has progressed,
kerato-malacia, stomatitis and epidemic dropsy being among those investigated.
It seems probable that a solution of the problem of epidemic dropsy will
soon be found.
6. Attempts are being made to give practical effect to knowledge
o b t a i n - e d b y s c i e n t i f i c r e s e a r c h . T h e s e i n c l u d e t h e i s s u e o f s u i t a b l e b u l l e t i n s ,
posters and press notes, and the education of health officers. Nutrition
research workers in India may legitimately hope that genuine improvement
in public health will result from their efforts.
GENERAL PROTOZOOLOGY.
T h e r e s e a r c h w o r k o n p r o t o z o o l o g y i n c l u d i n g c o m p a r a t i v e p r o t o z o o l o g y
which has been done in India is indicated in the following summary :—
Christophers (1904) recorded Babesia canis in Indian dogs and (1907)
gave the first description of the life-cycle in the dog and in the vector
Rhipicephalus sanguineus, the dog tick. This work done in the early
days of medical protozoology must be given a high place.
2. Bentley (1905) found a parasite of the white cells of dogs. This
.was later also recorded by James (1905) and was probably the first species
Contributed by Lt.-Col. H. E. Shortt, M.D., I.M.S.
216
vectors of human malaria had been conclusively implicated and had
attracted the attention of a number of workers, like Austin, Theobald and
Giles in England and James and Liston in India. The latter two took
up the study of Anopheline mosquitoes in India and wrote their classic
book in 1904, dealing with the Indian Anophelines recorded up to that
time. This was the first book of its kind giving systematic descriptions
of the different species of all the Indian Anopheline mosquitoes, both
adults and larvae. Theobald and Giles described some of the Indian
species in their well known treatises dealing with the Culicidae of the
world.
2. Since his first visit to India in 1901, Christophers has played a very
important part in the study of the Indian Anopheline mosquitoes. From
the commencement of his service in India he took up the study of the
life-history, bionomics and anatomy of the different species of Anopheline
mosquitoes and for nearly thirty years he carried out exhaustive research
on varied problems connected with them. He published a number of
memoirs dealing with the structure and systematic position of these
insects and contributed a large number of papers on this subject first to
"Paludism" and subsequently to the Indian journal of Medical Research.
Towards the end of his service in India he published the first part of the
Culicidae volume of the "Fauna of British India", which will remain as
a reference book for the Indian Anopheline mosquitoes for many years to
come. He also worked on the anatomy and histology of ticks and early
in his career in India published three memoirs dealing with them.
3. Besides his own work he was instrumental in starting a taxonomic
study of the Culicine mosquitoes of India by Capt. P. J. Barraud, who
made a complete revision of the Indian Culicines, describing a number of
new species. Capt. Barraud finally wrote the second part of the Culicidae
volume of the "Fauna of British India".
4. At the suggestion of Col. S. R. Christophers an inquiry on the
larvae of the Indian Anopheline mosquitoes was started under Dr. Puri,
who made a thorough study of the larvae of all the species occurring in
India, publishing the result of his researches in the form of a memoir
dealing with the inter-relationship and the structure of all the species of
Anopheline mosquitoes occurring in India.
5. A number of workers, like Senior White, Strickland and Iyengar,
have also been engaged in research on the bionomics and structure of the
Indian Anophelines in Bengal, making an intensive study of Eastern
species. They have all made very valuable contributions to our knowledge
of these insects.
6.
Side by side with malaria the transmission of a number of other
tropical diseases had been attracting the attention of other workers in
India. Though very little taxonomic work has been done on fleas in
India, experiments on the transmission of plague by different species of
fleas have been conducted at Bombay by various workers like Liston,
Lamb, Kundhart, Taylor and Chitre, who have contributed a number of
interesting papers on the subject.
218
Malaria at Karnal, at the School of Tropical Medicine at Calcutta and also
al Bangalore but a great deal has yet to be done before a proper under
- s t a n d i n g o f t h e h a b i t s o f t h e d i f f e r e n t i m p o r t a n t i n s e c t s i s a c h i e v e d .
H E L M I N T H O L O G I C A L R E S E A R C H .
Very little research on medical helminthology, except that done at the
Calcutta School of Tropical Medicine, has been carried out in India in
recent years and at this institution the primary object is to produce
results of economic value.
2. One of the principal lines of research there is the continuous
attempt that is being made to improve the treatment of intestinal
h e l m i n t h i c i n f e c t i o n s e s p e c i a l l y t h a t o f h o o k w o r m . W e h a v e n o f a c i l i t i e s
for the preparation of new drugs so have had to depend on other countries,
and for some years a group of American workers have been employed on
synthesising new compounds of possible anthelminthic value. It has
always been the experience of workers in India that reliance cannot be
placed on the figures of these workers in America regarding the curative
effect of the new drugs when administered to Indians, so we try out these
drugs ourselves.
3. Only two promising anthelminthics have been produced recently,
these are tetrachlorethylene and hexylresorcinol. Thorough trial of these
drugs in India has indicated that the former is probably the best drug we
have for treating hookworm infection, when all points of view are taken
into consideration. Hexylresorcinol was not found of much use and had
the additional disadvantages of being expensive and needing rigid dietary
precautions to be effective.
4. The discovery by officers of the R. A. M. C. in England, that
British troops are infected in India with Cysticercus cellulosae, with
relative frequency and that this often leads to incurable and fatal epilepsy
from brain involvement, is a matter of great importance. A study of the
literature on Taenia solium and C. cellulosae in regard to India left the
impression that this condition was not common in this country so the
relatively high rate of infection in British troops is hard to explain on
existing information. Funds and staff were not available for an extensive
survey but inquiries showed that infected pigs are relatively common in
Calcutta slaughterhouses and in those of other places, especially in
Southern India, but human infection is very rarely encountered either
with the adult or larval worm. Tracing back through some infected pigs
killed in Calcutta to the district of their origin and examination of a few
pig breeders soon revealed one case of T. solium infection. This is all
that could be done at the time but it indicates the probability that our
knowledge of the extent of T. solium and C. collulosae infection in India
is very deficient and, in view of its importance, more extended work
should be carried out with the idea of introducing prophylaxis at the
source.
Contributed by Dr. P. A. Maplestone, D.S.O., D. Sc., M.B.B.S.
219
5. Various improvements in laboratory technique have been introduced
such as culturing hookworm larvae under much more natural conditions
than was done before, and a much better method of isolating ascaris
eggs from soil was worked out. Both these procedures will be of value
to anyone working on the epidemiology of these infections.
6. A considerable amount was formerly done on the distribution and
pathology of filariasis and some contributions made to our knowledge of
the subject. Filariasis research is being still carried on, the principal
objective being the discovery of a curative drug. Many drugs including
most of the new heavy metal preparations have been tried without
success, but some advance has been made in the treatment of the
secondary infections common in elephantiasis, by vaccines and some of
the new complex benzene derivatives. During the course of surveys two
new species of microfilariae have been found, one of these Mf. actoni is
new to science and the other Mf. malayi originally reported from the
Dutch East Indies has been found in several parts of India. The adults
of these larvae have not yet been seen.
7. Guinea worm surveys have indicated that the distribution of infec-
tion. does not depend on the presence or absence of certain species of
cyc1ops but rather on the limitation of water supply. The condition is
prevalent where there are relatively few tanks in and around villages, and
it is not seen where there are numerous tanks. It has also been found
that if tank water reaches pH 8 or over, as it often does, cyclops will not
live in it.
8. Work on the control of guinea worm has been successfully carried
out in some villages in Mysore by the introduction of certain species of
fish, which eat cyclops, into village tanks. Experimental work with
guinea worm infection on dogs has also resulted in the finding of several
adult male worms. This has never been done before and the worms will
be described shortly.
9. In the course of the same research it has been found that a small
proportion of the larvae differ from the majority by having a ventral
spike-like process or second tail. The significance of these different
larvae is not yet understood but it has been suggested the variations are
sexual in character.
10. Human infection by migrating Gnathostoma spinigerumlarvae
or adults which is a fairly common condition in Siam and has been seen
once or twice in China, Japan and Malaya, has been recently found four
times in India. These are the first records of this worm as a human
parasite in this country and as they have all been found in Bengal and
all the specimens identified at one place, the Calcutta School, it is
thought that the condition may be commoner than is realised. It is of
s o m e i m p o r t a n c e b e c a u s e t h e s w e l l i n g c a u s e d b y t h e w o r m s i n t h e i r
migration through the tissues may involve vital organs and thus endanger
life, though up to now no deaths have been reported.
2W)
*SNAKE VENOMS.
• A large amount of study on snake venoms and the treatment of snake
bite has been carried out in India. The earlier of the important investiga-
tions were those of Fayrer and Wall and D. D. Cunningham who
studied the actions of the venoms of the principal poisonous snakes.
Large contributions were made to the subject by Lamb in the earlier
years of the present century his work being recorded in the Scientific
Memoir Series No. 2. Subsequent work was carried out by Acton and
:.Knowles between 1912 and 1914 and their observations on many points in-
cluding treatment are accepted as authoritative. Antivenene is prepared
at the Central Research Institute, Kasauli, against the venoms of the
Cobra and Russell's vipers and the methods of its preparation and con-
centration are under continuous study. An inquiry on these venoms was
in progress at the Institute from 1935 to 1936, and their various physio-
logical actions, neurotoxic, haemorrhagic, coagulant and . haemolytic,
were studied in relation to venoms of snakes from different. countries. It
was found that the haemorrhagins of all viper venoms tested were
homologous and that in consequence when a particular viper venom. is
low in neurotoxin and high in haemorrhagin content, the latter being
mainly responsible for the symptoms produced a heterologous anti-viper
venom serum will be of value. The studies on coagulant action of
Russell's viper have resulted in the production of a stable solution for
local haemostatic purposes. The chemical composition of the venom has
:also been determined by this Inquiry.
2. Studied on snake venoms have also been in progress at the Calcutta
School of Tropical Medicine and important contributions made to the
knowledge of their properties and actions.
PHARMACOLOGY INCLUDING INDIGENOUS DRUGS.
Systematic study of pharmacology in India was begun in 1921 when a
.chair in this subject was established at the Calcutta School of Tropical
Medicine. Previous to this attempts were no doubt made from time to time
by individual workers to study the action of well-known indigenous
remedies but in many cases these were limited to sporadic observations and
often uncontrolled clinical trials. Studies on Cobra venom by Acton and
Knowles, and the study of indigenous anthelmintics by Caius and Mhaskar,
though mainly conducted on chemical 'lines, were the only pharmacological
researches of earlier days worthy of note.
2. Since the inception of the Calcutta School, interest has been stimu.
fated in pharmacological research and a number of papers have emanated
from laboratories. all over India. The Calcutta School and the Haffkine
.Institute in Bombay, however, have played the major role in the progress
of pharmacology and from both these centres a steady stream of papers
bearing on various aspects of physiology, pharmacology and biochemistry
has been published. Emphasis appears to have been laid on applied and
*Contributed by Colonel J. Taylor, C.I.E., D.S.O., V.H.S., I.M.S.
tContributed by Colonel R. N. Chopra, C.I.E., M.D., K.H.P., I.M.S.
222
In connection with the helminthological enquiries at the School, con-
siderable attention was paid to the pharmacological and toxicological pro-
perties of a number of anthelmintics, chief amongst which were carbon
tetrachloride, santonin and oil of chenopodium. Besides this a large volume
of data based on laboratory, hospital and field work on various aspects of
the anthelmintics problem was collected in the form of a book entitled
"Anthelmintics in Medical and Veterinary Practice" by R. N. Chopra and
Asa C. Chandler.
II. Researches on the venoms of Indian snakes.
Snake venom enjoyed a great reputation in India as a very potent
remedy in cardiac failure and as a general stimulant. A study of the
pharmacological action of snake venoms was therefore started in 1931, and
had been continued since then. Venoms from Cobra, Russell's viper
(Daboia) and Echis were studied. Contrary to popular belief, the venoms
do not seem to possess any stimulant action on the heart. Cobra venom in
an attenuated form, however, has been found useful in relieving pain in
cancer and in exerting a beneficial influence in chorea, insanity and epi-
lepsy.
III. Researches on the physical properties of blood sera in health and
disease.
In order to explain many pharmacological and toxicological phenomena
which arose in the course of other researches, work was undertaken to
study carefully the physical and biochemical properties of blood sera in
healthy individuals and in different pathological states. Much interesting
and instructive data have been collected in this field and have thrown light
on many hitherto unexplainable and obscure problems. In general, patho-
logical sera show a high viscosity, low surface tension and diminished
buffer action. The electrical properties also show significant changes from
the normal ranges. In kala-azar, the serum proteins undergo marked
changes and the viscosity rises much more than in any other disease like
tuberculosis, syphilis, or leprosy.
IV. Researches on Indian Indigenous drugs.
An important research undertaken was the investigation on scientific
lines, of the claims of the rich materia medica of the Ayurvedic and Unani
systems of medicines, which was financed by the Indian Research Fund
Association.
During the last 12 years this inquiry has done a considerable amount of
work which has not only received local appreciation but international re-
cognition. The Departments of Pharmacology and Chemistry of the School
are now considered an authority on all questions in connection with the
chemistry, pharmacology and therapeutic uses of the Indian indigenous
drugs. It will not be possible here to indicate the extensive work that has
been done. Though no epoch making discoveries have been made, this
inquiry has shown that only a very limited number of indigenous remedies
deserve the reputation they have earned as cures and that quite a large