NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Medical Officers of the Army of India.
A transverse section taken still lower down a white zone, shows the inner
hypodermal ring now present and encircling the whole circumference of the root,
while the layer giving rise to the packing cells is now external to the inner
hypodermal ring.
A transverse section further down still, shows the packing cells beginning to
disappear, and mixed up with cells of the outer hypodermal ring, resembling the
outermost cells of that ring in a brown zone. The section in fact, except for the
few packing cells still present, is just like a section through a brown zone.
A longitudinal section made through the junction of a white zone with the
brown zone above it, and extending downwards to the brown zone below, explains
how the different appearances of transverse sections at various levels of the white
zone are brought about, and also how the white zone fades away inferiorly in an
indefinite manner, in contrast to the abrupt way in which it ends above. In a
longitudinal section, as in figure 5 of Plate III, the inner sclerenchymatous hypoder
-mal ring C, traced from above downwards, ceases abruptly just above the upper
margin of the white zone and begins again a little below the upper margin of the
white zone.
The gap thus left between the upper and lower ends of the broken inner
hypodermal ring is occupied by the actively dividing outer cortical layers giving
rise to the packing cells, which latter have their focus of formation in this gap,
overhung by the torn outer hypodermal ring. The actively dividing cortical
layers traced downwards pass external to the lower continuation of the inner
hypodermal ring, and become continuous ultimately with the clear ring of cells,
separating the inner from the outer hypodermal ring. The dense inner layers of
the packing cells become continuous with the inner cells of the outer hypodermal
ring. At the upper end of the white zone the actively dividing cortical layers
give rise to packing cells only, but as the layers are traced downwards, the
thickness of the mass of packing cells diminishes, they gradually become less
irregular in shape, more like the outer cells of the outer hypodermal ring with
which they are mixed up, and ultimately are entirely replaced by the latter in the
lower zone below.
Owing to the looseness of the texture of the packing cells, an extraordinary
amount of air is entangled in their interstices, and it is this which gives the
white appearance of the zone to the naked eye. This air is exceedingly difficult
to get rid of, especially from the inner layers of the packing cells, and it is the
presence of this air in the inner layers of the packing cells which causes the
appearance of the black band seen in figures 4 and 5 of Plate III.
The development of the white zones appears to the writer to lead to the con
-clusion that they are in reality specialised lenticels of unusually large size and
DD
Scientific Memoirs by Medical Officers of the Army of India.
peculiarily regular arrangement, and differing from ordinary lenticels in that the
developing layers are not sharply circumscribed inferiorly.
The abundance of air entangled amongst the packing cells makes it a diffi
-cult matter for water to gain direct access to the tissues through the white zones.
This is probably a provision against the fact that in its natural habitat the
palm is likely to have its roots periodically covered with water.
The root cap shows a division into an inner and an outer portion, but nothing
peculiarly worthy of note was noticed. The appearance of the root cap and the
growing point is represented in figure 9 of Plate III under a low magnification.
The branch roots originate from the pericycle and show nothing worthy of
remark.
As regards cell contents, no starch was detected anywhere. The outer hypo
-dermal ring cells often showed dark granular contents, giving no reaction with any
of the reagents at the writer's disposal.
A few hexagonal tabular crystals were seen in the cortex. Along the strands
of sclerenchyma scattered through the cortex, rows of very small sphaeraphides
were seen, each apparently enclosed in a little intercellular space between the
strand and the surrounding cortical cells.
112
On some Practical Methods of Sanitation in India,
with special reference to Cantonments.
BY
ERNEST ROBERTS, D.P.H. (Carob.)
MAJOR, I.M.S.
The object of this paper, for the opinions expressed in which (save for the
numerous references to authorities quoted) the writer is alone responsible, is to
attempt a review of practical methods of sanitation now generally in vogue in
India, with special reference to those communities over which we may be said to
exercise more or less complete control, and for which pro tanto our responsibility
is greatest ; and to examine the adequacy and scientific sanction of these
methods. In the second place, the biological and chemical forces which are
called into play in the new departure in the methods of sewage " purification "
will be reviewed, in order to elucidate the essential principles that must be observed
in practice. And, lastly, some practical conclusions and suggestions will be offered.
If any apology be thought necessary for inviting the reader to accompany
me over this well-beaten track, at a time when over forty years have elapsed since
the great teacher and inspirer, Parkes, began his ever-memorable work at Netley,
I venture to. invite a consideration of the following facts, and to others that will
appear in the course of the first part of this paper.
Enteric Fever.
During the past ten years the ravages of enteric fever among the British
troops in this country may be estimated by the following statements :—
I.—Enteric fever, ten years-1890-99.
Average
annual
strength.
Number of
cases
reported.
Number of
deaths.
Number
invalided.
British troops in India, 1890-99
...
67,897
16,144
4,250
340
(Not including officers.)
This excludes cases and deaths which occurred during campaigns beyond the Indian frontier.
II.—Total death-rate, and Enteric death—rate, nine* years, 1890-98.
British Army.
Total death rate,
per mille.
Enteric death-rate,
per mille.
Home . Establishment
. . .
. . .
4 . 3 9
24
Indian Establishment
. . .
. . .
15.73
6 . 3 8
* Returns, for 1899 of Home Establishment not yet available.
EE
114
Scientific Memoirs by
Filth Disease.
III.—Ten years' admissions and deaths from all diseases among European
troops in India, to which a " filth" origiiz may be attributed in whole or in part,
1890-99.
Diseases.
Total
admissions.
Total
deaths.
RATIOS PER MILLE OF
AVERAGE ANNUAL
STRENGTH.
Ad.
D.
Cholera
. . .
. . .
. . .
940
679
1.4
1 . 0 0
Enteric fever
...
. . .
. . .
16,144
4,250
23.8
6.26
Dysentery
...
. . .
. . . 18,948
476
27.9
.70
Diarrhœa...
. . .
. . .
16,484
27
24.3
.04
Hepatic abscess*... . . .
. . .
1,312
810
1.9
1.19
TOTAL
. . .
53,829
6,242
79.3
9.19
All Causes
... 970,364
10 48o
1,429.2†
15.44
* Included on account of the evidence which associates it, as a sequeta, with dysentery.
† Although the deaths from these diseases amount to nearly two-thirds of the total, yet the admissions
are a small fraction of the total from " All Causes," but it is to be noted that a ratio per mille of 787.9 of all
admissions was due to the two causes, miz. , "Intermittent Fever" and " Venereal diseases."
The enteric fever millesimal admission and death-rates (23.8 and 6.26)
given above, are for the Army of India, exclusive of Field Service. If, however,
we take 14 of the largest cantonments (and there are only 24 with a daily average
strength of over 1,000 men), having an aggregate average strength of 24,042, we
find an average annual admission rate from this cause, of 34.7 and an average
annual death-rate of 8.9 per mille for the past ten years ; that is to say, approxi-
mately half the actual number of admissions and deaths in little more than one-third
of the total population. Where the aggregation of troops is largest, the rates rise.
It has been calculated by a good authority that the terrible loss of life due
to enteric fever in South Africa in 1900, did not exceed a ratio per mille of io
on the strength. But, beyond the above, the morbidity and death-rates among
British Officers are equally great ; with an average annual strength of 2,000, there
Medical Officers of the Army of India.
were 596 cases and 121 deaths from enteric fever alone, while from all the above
causes combined there were 1,965 cases (98.2 per mille) and 189 deaths (9.4
per mile).
IV.—fails.—During the past ten years, cholera, dysentery and diarrhœa
have together caused 15.0 per cent of the total admissions to hospital, and 35.3
per cent. of the mortality.
V.—Among the general population, for which registration is notoriously defec-
tive, cholera, dysentery and diarrhœa are reported to account for 9.1 per
cent. of the total mortality, a figure which is far below the true facts for where
we have a reliable record we find that the death-rate from dysentery and diarrhœa
among in-patients, in charitable dispensaries, amounts often to over 30 per cent
.
of the total death-rate returned therefrom.
VI .—As regards statement III, the average duration of a case in days varies
somewhat from year to year, but for enteric fever it is not far short of 60 days, for
remittent fever 20 to 30 days, for dysentery 25 to 3o days, for diarrhœa 12 to
13 days, for hepatic abscess 40 to 50 days. I refrain from elaborate calculations
as to the economic loss to the State which the above figures represent.
115
Cost to the State.
Probably, many cases of "Simple Continued" fever, and almost surely of
"Malta" fever, ought to be included among the "filth" diseases, but without
labouring the point we may pass on to affirm the proposition that the prevalence
of enteric fever, cholera, dysentery and diarrhœa connote a failure to secure
a certain standard of hygienic righteousness, and that this failure may be more
definitely attributed to the presence of pollution in the immediate environment,
what Simon has called" habitual empoisonment of the soil" inseparable from
excremental pollution. These are emphatically * * *
"diseases which are in the most absolute sense preventable ; diseases which depend on
the extension of a putrefactive process from matters outside the body to matters inside
the body ; diseases of which the very essence is filth ; * * *diseases
against which there may be found a complete security in the cultivation of public and private
cleanliness."*
It is then altogether unnecessary to affirm to-day that the effective disposal
of the refuse products of life is, both as regards the individual and the community,
the fundamental problem and obligation of hygiene. Upon its successful solution
we depend for the pure air, the pure water and the pure soil, which were the text
of the Hippocratic trilogy, and which sum up, even more to-day, the cardinal
factors of a healthy environment. How do we stand in regard to this obligation?
Leaving out of consideration for the present the special circumstances of
* Simon : Public Health Reports. "The Sanitary State of the People of England," the whole of the
argument of which bears on the point.
Soil pollution.
Indian methods
of disposal.
116
Scientific Memoirs by
Urban population.
certain of the largest centres of population, let us look at what is generally known
as the Indian method of the disposal of that form of refuse from which we have
most to fear. Here the absence of an organic water-supply-drainage system, the
cheapness of labour and the availability of land have indicated and justified the
prevalent method of the surface burial of excreta by what is known as the
" trenching system." We have been fortified in our procedure by the designation
it has received as " Nature's method " in its simplest and most direct form,
and where it is carried out with due regard to all the essential conditions, and
where subsequent cultivation is not delayed, we have perhaps the most simple,
scientific and adequate means of disposal; but it imposes special difficulties
and risks upon the stage of removal. It is equally safe to affirm that this
system, as carried out, has failed to solve the most important problem of Indian,
sanitation, and it is obvious that where a system of this kind falls short of perfect
success, it opens the way to very special dangers in this country. And apart
from the possibility of securing perfection in detail, it is often impossible to avail
ourselves of this method. In the first place, although the great majority of the
population is scattered in small agricultural communities over the enormous area
available, yet there are a large and increasing number of towns with a considerable
number of inhabitants in each. At the last census there were 28 towns each
with a population of from 100,000 to 821,000; 48 towns of from 50,000 to
100,000; 150 towns of from 20,000 to 50,000; 1,407 towns of from 10,000 to
20,000; altogether there were 1,831 communities with a population of 3,000 and
upwards, aggregating approximately 27 million souls. There was, in fact, ten
years ago, as large an urban population as in Great Britain at the same date.
To any one acquainted with the structural conditions of Indian towns, it will
be obvious that, as regards the first three categories at least, comprising a total of
226 communities, the problem of adequate removal and disposal by trenching
presents great difficulties, and in most cases they are insuperable. Indeed it may
be said that where adequate knowledge and control are available, the difficulties
are such as to render the system impracticable; where, as in the case of the
village communities which include go per cent. of the population, " trenching "
might be carried out to the best advantage, the essential knowledge and control
are too often wanting. Here for the most part individual freedom of action
prevails; the excreta are deposited upon the surface of the soil, or where an
advance is attempted upon this primitive absence of method, the collected night-
soil is conveyed just beyond the inhabited site and deposited en masse in more
or less deep excavations in the soil, which is a rough and ready modification
of the cess-pit system, but lacking its admittedly inadequate safeguards.
118
Scientific Memoirs by
Drainage.
Water-supplies.
" Trenching," a
failure.
larger receptacles, water, and not dry earth, is frequently used, and this dangerous
office is done just behind the latrines, with spilling and pollution of the soil.
Next, there is the transfer of the excreta from receptacles to the carts ; and what
is to be said of the carts? Are they ever properly cleansed ; if so, how ? On
their way to the trenching-ground they spill filth and stink abominably, and, as
they cannot be properly cleansed, they continue to stink and attract flies on their
return. Major Davies, R. A. M. C., the first and the most reliable authority, to
whom I am indebted for information on these points, says : "the whole question
of cleaning these fouled articles is most difficult."*
As regards Native Troops, the regulation plan of a movable latrine is an
improvement on the old fixed arrangement ; but they are often not moved, and
consequently the ground around is fouled and gets no purification from
sun-action. When the latrine is moved, it is directed that the site should be
cultivated, but this is often not attempted and is in many places impossible,
owing to the nature of the soil and the want of water. "For Native Troops,
followers, &c., the appliances allowed are quite inadequate, and both soil and
air pollution must result." (Major Davies.)
The arrangements for the removal and disposal of cook-house and lavatory
waste also leave very much to be desired,† and the same may be said of
the whole system of drainage generally ; our methods for the removal of
waste are of a disconnected and piecemeal character ; they are not self-acting and
organically integral, but leave too much to fallible human agency, with the obvious
consequence of soil-pollution, to which the risk from insect pests as vehicles of con
-tagion, is added. The danger is enhanced by the nature of our water-sources;
chiefly wells sunk in the inhabited site and tapping a frequently high and fluctuat
-ing ground water ; and these wells are too often insufficiently protected from the in-
-fluences and vicissitudes of the dramatically changing meteorological conditions,—
at one time drought, dust and high winds, with loosening of surface and subsoil,
at another, the persistent penetrating deluge of the monsoon rains.
If, by very special efforts under favourable circumstances, the soil of the inhab
-ited site is secured against more obvious pollution, what are we to say of the
trenching-grounds? Here again we too often find failure in the carrying out of
the well-known principles by which alone we may deserve immunity from harm,
even if our present knowledge would permit us to in dulge the assurance that once
committed to the soil with the most scrupulous attention to details, all danger is
obviated. A hard and fast rule is applied to the whole of India with its varying
* Letter to present writer.
† Q u a r t e r M a s t e r G e n e r a l ' s l e t t e r , p r e v i o u s r e f e r e n c e .
Medical Officers of the Army of India.
conditions of soil and climate. The best of earth-disposal systems can only give
satisfactory results under the four conditions of—
( a )
a s u i t a b l e s o i l ,
(b) a sufficiency of water for irrigation,
( c) a sui t abl e cl i mat e,
(d) strict attention to all the details, including subsequent cultivation,
which cannot always be carried out at the most dangerous time.
In many places these conditions are not obtainable, and "even where cir
- c u m s t a n c e s a r e m o s t f a v o u r a b l e , t h e b e s t s y s t e m ( t h e " s h a l l o w t r e n c h " ) i s
generally improperly carried out." "There is not enough care or intelligence
given to the supervision of details; I believe there is a good deal of pollution of
air, water and soil, arising from the defective carrying out of the Allahabad
system." (Major Davies.)
The danger of accumulating organic filth in deep pits, and in overcharg
- i n g d e e p t r e n c h e s , i s a n a c c e p t e d c o m m o n p l a c e a n d n e e d s n o e m p h a s i s , b u t
it may well be that under our special meteorological conditions, we have gone too
far to the opposite extreme of surface disposal. But without labouring this point,
the whole question of earth disposal in the neighbourhood of the inhabited site in
this country is open to grave question, in view of the well-accredited results of
recent research, and in view also of the heavy toll we are paying year by year, in
valuable lives lost from bowel diseases in one or other form; and it is unnecessary
to elaborate the thesis that these diseases have the most direct relation to the
presence in the environment of organic filth. The recent contributions to our
knowledge of the question we have stated may be summarised under three
heads, partly eidemiological and partly the result of exac: research.
In the first place we have the long list of carefully investigated cases on which
the accepted view is based that soil polluted with excreta has directly or indirectly
influenced the outbreak of enteric fever—a leaking cesspool, a defective drain pipe
is held to provide sufficient evidence of the cause of an outbreak in England.*
More definitely bearing on our present case is the evidence adduced as re
- g a r d s t h e c a u s e s o f t h e p r e v a l e n c e o f t h e e n t e r i c f e v e r i n M u n i c h ( s e e D r . C h i l d s '
striking paper read before the Epidemiological Society, January 21st, 1898), of
which we may quote the conclusions. "(1) The drinking-water has not played
an important part in producing and reducing the typhoid fever epidemics in Mu
-nich; (2) the great prevalence of the disease there was due to the pollution of the
soil (including specific pollution), modified by certain conditions in the soil which
are correlated with the movements of the subsoil water; (3) the gradual reduction
of the typhoid fever was due to the gradual purification of the soil." We have
* See Corfield, Harveian Lectures, "Disease and defective house sanitation."
Summary of evi--
dence as to soil pol--
lution.
Scientific Memoirs by
italicised the reference to specific pollution, and we need only-refer to Dr. Horton
-Smith's Goulstonian Lectures (1900) for ample evidence of the danger and pre-
valence of undetected sources of such pollution, in ambulatory cases and in
convalescents both as regards the solid and liquid excreta.
Dr. Robertson, the experienced M. O. H. of one of the chief endemic
Typhoid areas in England, has stated his deliberate opinion, that of 20,000 cases
investigated, about 10 per cent. were due to direct infection (as in nursing);
water and milk-borne infection may account for 10 per cent., while 80 per cent
have a dust and filth-borne origin with its nidus in the soil. (British Medical
Journal of August, 1898.)
Again the figures submitted by Dr. Boobyer (M. O. H., Nottingham) as
regards the relative incidence of typhoid fever on communities served by privy
- m i d d e n s , b y t h e p a i l s y s t e m a n d b y w a t e r - c l o s e t s , h a v e a v e r y d e f i n i t e b e a r i n g
on the subject of our means of removal and disposal. The incidence over ten
years was shown to be relatively as follows:—
On midden privy houses 1 case in 37
" pail closet " 1"
120
"
water-closet "1"
558
which affords striking evidence of the importance of complete and rapid removal.
Lastly, it will suffice to invite attention to the address delivered by Sir
R. Thorne-Thorne, late Principal Medical Officer to the Local Government Board,
before the Midland Medical Society (1897) wherein he discusses the prevalence
of endemic typhoid in certain rural areas in England, and draws the inference
of the paramount influence of defective measures of the removal and disposal of
excreta in inducing local soil pollution, and, among the first methods of prevention,
advocates the provision of an impervious covering to the polluted site.
Haffkine has pointed out, in reference to a connexion of enteric fever with the
soil, that the virus may pervade the infected locality for years, and may, in spite
of improvement in the water-supply, cause a continuous incidence of the disease
for which occasionally nothing short of complete evacuation of the locality is an
effective remedy. It is not suggested that there is any mysterious connexion bet
-ween the disease and the soil; the whole danger lies in the defilement, though that
may be influenced in extent or duration by local geological formation, as
contended by Sir C. Cameron in the case of Dublin.* Haffkine further says that
while cholera infection seems to be almost exclusively confined to the water-supply,
in the case of enteric the improvement of the water seems to leave intact a large
number of other sources of danger to which attention has not been sufficiently
directed. It is recognised that enteric fever is not, by any means, solely a water
-borne disease.
* See British Medical Journal, July 1st, 1899, and June 3rd, 1899.
120