NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
143
( i i )
P r e m e d i c a t i o n i s e x t e n s i v e l y u s e d b y m a n y a n a e s t h e t i s t s : S o d i u m
bromide grs. 40 and chloral hydrate 1 dr. followed at one hour
before operation by hyoscine 1/100 gr. and morphia 1/6 gr. is one
standard method. Others omit the morphia and use atropine
1/75 gr.
( i i i )
T h e n e e d f o r a d e q u a t e t r a i n i n g o r r e f r e s h e r t r a i n i n g o f s u b - a s s i s t a n t
surgeons is stressed by several anaesthetists and in several centres
instruction has been given to officers and members of the I. M. D.
TABLE 112
Anaesthetics 1939
Anaesthetics.
Total Number.
Chloroform and ether . . .
995
No. 20 . . .
72
Novocaine 2 per cent (local) . . .
649
No. 20 and ether . . .
137
Ethyl chloride (general) . . .
105
Evipan sodium . . .
185
Spinal anaesthesia (stovaine) . . .
56
Ethyl chloride spray . . .
124
Vinestheme . . .
2 Sent as sample
and no good.
C. H. C. L. 3 . . .
1
C. I. E. E. . .
6 0
No. 2 2 0 2 . . .
118
Local . . .
87
Cocaine 5 per cent . . .
25
Nitro oxide, oxygen and ether . . .
626
Nembutol . . .
1
Percaine . . .
213
Stovaine . . .
12
Pantocaine . . .
9
Rectal aether . . .
3
Evipan and nitrous oxide . . .
2
Cocaine 10 per cent. . .
1
Cocaine 4 per cent . . .
12
Cocaine 2 per cent . . .
6
3,501
70. Dental Conditions and Treatment.
(i) Accommodation and equipment.— Two entirely new dental centres.
were opened during the year at Calcutta and Quetta to replace other unsatis
- f a c t o r y a c c o m m o d a t i o n f o r m e r l y u s e d a t t h e s e s t a t i o n s . T h e s e c e n t r e s a r e
modern in design and commodious with good lighting and many other ameni--
ties. Improved accommodation was also effected at many other stations.
Modernization of the equipment was also continued by completing the
provision of essential furniture. Electric storage water heaters and electric
boiling plates were added to the equipment of many centres and provision.
144
was also made to supply electric polishing and grinding lathes to other selected
centres. Many instruments, drugs and sundries were added to the official
scale of equipment for all centres.
Provision was also made to add to the Field Dental Outfits the equip
-ment necessary for the early treatment of maxillo-facial injuries and wounds.
(ii) Oral Hygiene .—Oral hygiene remains good. This can be attributed
to the personal interest of the men following the instruction given to them
during their recruit days, as shown by the fact that many of them report volun
-tarily for dental treatment.
(iii) Dental Treatment.— The high standard of dental treatment afforded
was maintained.
There were a number of cases of impacted mandibular third molars but
cases of Vincent's infection were few.
Sodium-Evipan was found to be of value in the treatment of hospital
cases requiring multiple extractions and for the reduction of fractures of the
mandible.
There were nineteen cases of fracture of the jaw successfully treated.
Four were treated by inter-dental wiring, four by splints and eleven by the
use of skull and chin apparatus and bandaging.
More treatment was afforded to women and children and the numbers
who avail themselves are increasing.
Figures releating to dental treatment are given in the following table :—
TABLE 113
C ategory.
T e e t h e x t r a c t e d .
Teeth
Conserved.
S c a l i n g s c o m p l e t e d .
G i n g i v i t f s o r s t o m a t i t i s t r e a t m e n t s c o m p l e t e d .
S u p p l i e d w i t h n e w d e n t u r e s .
D e n t u r e s s u p p l i e d .
D e n t u r e s r e m o d e l l e d .
D e n t u r e s r e p a i r e d .
W i t h o u t r o o t t r e a t m e n t .
W i t h r o o t t r e a t m e n t .
British
Other ranks . . .
8,962 35,112
110
6,132
359
355
484
385
340
O fficers . . .
30
12
. . .
2
5
. . .
. . .
1
1
Women . . .
1,464
1,360
3
152
51
18
24
4
2
Children . . .
944
715
2
16
23
. . .
. . .
. . .
. . .
Royal Air Force—
Other ranks . . .
321
1,320
29
129
9
14
19
12
20
Officers . . .
17
111
. . .
13
3
. . . . . .
. . .
. . .
Women and children . . .
84
25
. . .
4
2
1
2
. . .
1
Naval ratings . . .
24
5
. . .
. . .
. . .
. . .
. . .
. . .
. . .
Indian ranks . . .
294
33
. . .
10
11
12
14
. . .
3
Total . . .
12,140
38,693
144
6,458
463
400
543
402
367
The total number of attendances for all categories of patients was 37,423.
71. Dermatology.
(i) Dermal Leishmaniasis.— At Quetta an investigation into the treatment
of oriental sore was carried out. The comment in the interim report says
"No conclusions have yet been stated. It would appear that the ideal treat
-ment of oriental sore is still to be discovered."
A comparison of two methods of treatment of Dermal Leishmaniasis.
145
"Scraping" versus "Local injections of an Atebrin solution" has been
carried out.
In the 4 years 1936—1939 (6 months only) 1,170 cases were treated.
Multiple sores were commonest, 35.8 per cent; upper extremity sores were
34 per cent. 63.6 per cent of the total cases were in the Indian Cavalry
Regiment in which unit the syces provided just half (49.2 per cent) of the
cases. It was observed that 3 months to 7 months is the normal incubation
period of a sore, the majority being in the 6th month.
Scraping treatment consists of erradication of the infected sore by a spoon-
like scraper under a short general anaesthesia and subsequent dressing for 1
week by Tannic acid powder, then simple vaseline gauze.
The average duration of treatment by scraping was 4 weeks; 50 per
cent being healed in 3 weeks.
Atebrin injection treatment (Captain I. H. B. Gosh, I.M.S.) consists of:
—
First day: Hot 1 in 5,000 potassium permanganate compresses four
hourly.
Second day: Injection into the base of the sore Atebrin solution 0.05
grammes per c.c.; done radially from at least four points on the
circumference of the sore. No general reactions to the drug
were noted.
Subsequently: Ointment-dressings are applied until healing is establish-
ed. 33 cases were so treated and carefully recorded.
The average healing time was 26 days, 34 per cent healing within 3 weeks
Since local reaction is the aim of the injection treatment a solution of 50
per cent glucose for injection with local application of a tar distillate in collo
-dion might well be as effective.
(ii) Other skin diseases.—These varied in types, fungoid infection classed
as Tinea were among the most common. Typical sets of cases were as
follows:
—
At Rawalpindi: I. A. T. cases 19. Impetigo contagiosa 16. Eczema
10.
At Lahore. Scabies, Tinea ruris and seborrhoea. Here the average
stay in hospital was 12.7 days.
At Calcutta. 62 cases were treated, the majority being Tinea.
At Meerut a case of Sycosis Barbae was treated with Uleron and developed
peripheral neuritis after 4 tablets. He had had some kind of previous treat
-ment. He recovered from both conditions.
(iii) Venereal diseases. —Preventive ablution rooms have improved in
equipment and in the trained personnel in charge thereof. The provision
of ample warm water, adequate lighting and a supply of preventive packets
are the main items of importance. Much attention is given to these rooms by
Commanding Officers and to the subject of prevention of inefficiency by these
preventable diseases. It is considered by some C. Os. that severe measures
imposed on those who acquire venereal disease are the best deterrants; but
others as emphatically consider that the reduction or loss of privileges from
6 to 3 months produces better results in the admissions to hospital.
One aspect of these "Rooms" which requires careful supervision is that
of the records which are maintained showing that the treatment has been
used. Such records must be checked daily to ensure that antedating of the
"chits" is not possible.
Several officers comment on the indifferent response given by Indian
troops to antisyphilitic treatment compared with the 100 per cent successful
treatments for British troops. Various reasons are suggested including the
chances that the treatment prescribed never reaches the patient for whom it is
intended.
(iv) Chancroid.—The effect of the Sulphapyridine drugs on these condi
-tions has been tried out at Poona.
47 cases of chancroid were treated with a routine dose of Sulphonamide
P:2 tablets T. D. S. for 10 days. It was found that their average stay in
hospital was 16 days whereas the average stay of the 47 previous cases not so
treated was 31 days. These results are considered to be due to the inhibitary
action on secondary infections.
72. Mental Diseases.
(i ) Hospital accommodation.—The modern tendency is to do away with
the prison-like accommodation existing from former unenlightened times.
At Lucknow comment is made that at the B. M. H. the mental block is emi
- n e n t l y s u i t e d t o a p r i s o n b u t n o t f o r t r e a t m e n t o f m e n t a l p a t i e n t s w h i l e
at the I. M. H. there is no accommodation for any treatment and no trained
attendants.
The method of "boarding out" mental cases into the medical wards
has been satisfactorily employed in Southern Command.
From Northern Command a plea is made for the treatment of British
mental cases in a Hill station during the hot weather since the majority can
be accommodated in an ordinary ward; also for a rational regard for insane
cases who should be treated as other sick men in that they can no more help
being insane than another patient can help having cancer.
The question of providing a combined British and Indian mental block
has been receiving attention at Quetta.
(ii) It is noted that there has as yet been no obvious increase in mental
.admissions due to war conditions except that the increase in Northern Com
- m a n d o f 1 1 c a s e s a n d t h e r i s e i n a g e i n c i d e n c e i s a t t r i b u t e d t o t h e c a l l i n g u p o f
Reservists many of whom were in a poor state of health.
(iii) Interesting cases.—Two cases of interest were invalided amongst
British troops.
At Quetta.—A sergeant who developed severe hysteria subsequent to a
neuritis following on an A. T. S. injection; and a Fusilier with visual and audi
- t o r y h a l l u c i n a t i o n s .
There was an Indian case of depressive apathy which cleared up after
treatment for ankylostomiasis.
At Rawalpindi .—Organic causes for the mental state are carefully in
- v e s t i g a t e d , o n e c a s e d i a g n o s e d S c h i z o p h e n i a m a d e a d r a m a t i c r e c o v e r y a s
soon as his impacted wisdom tooth had been extracted. General paralysis
of the insane and Tabes were also found as causes of disability in Indian troops,
contrary to popular opinion. Psychotherapy was successfully employed on
two cases of hysteria and cardiazol produced marked improvement in 3 cases
of Schizophrenia pending invalidment. Unfortunately the price of the drug
has increased and availability has decreased.
149
Large alkaline drinks cleared the temporary condition after a week, but a fort
-night later progressive optic atrophy produced total blindness.
A case of remarkable recovery was of a 3 year old girl with thick corneal
opacity after injury by lime which cleared almost completely after 2 months
treatment.
Trauma cases were frequent, including a B. O. R. with a riccochet pellet
from a dog-shooters gun, a boy falling on to a stick, and damage from hockey
sticks, tennis balls and footballs.
Malingering which had been absent last year has reappeared on the out-
break of war, particularly amongst reservists. Night blindness is the com
-monest pretence. It is most catching. 5 cases have been detected and were
awaiting trial in one large station.
Night blindness or alleged night blindness has also been reported from
Southern Command amongst motor drivers after the outbreak of war. Such
complaints are most difficult to refute.
The specialist of the area concerned makes the following observations:—
"Several cases of supposed night blindness have been coming for examina
-tion recently (since the outbreak of war). The interesting points in these
cases are as follows:—
(a) Nearly all these cases are from M. T. Units.
(b) Nearly all are reservists.
(c) At present, no case has shown any pathological evidence in the
fundus.
(d) There has been no evidence of vitamin deficiency.
(e) None of these cases have previously complained of this disability.
Similar cases also came up for examination in Poona, and they all came
under the above categories. The inference is, of course, obvious."
From Lucknow a case of Herpes Zoster Ophthalmicus with very severe
symptoms which cleared up completely with two doses of anti-diphtheritio
serum is reported. Three cases of night blindness, 2 Indian and 1 British,
were carefully investigated, but no direct cause could be found.
From Poona it is noted that Homatropine and Cocaine do not react as
well with Indians as with British patients.
A case of spindle-celled sarcoma of the Choroid in a young British soldier
was diagnosed and enucleation performed.
74. Oto-Rhino-Laryngology.
Accommodation at Rawalpindi and Murree is satisfactory.
The number of attendances and operations has decreased slightly com
-pared with last year, 4,460 and 520 respectively in place of 4,709 and 585.
Waiting lists have been reduced to current cases.
A case of multiple foreign bodies in an Indian boy is noted in which a
stone was lodged firmly in the ear and a "pice" piece in the aesophagus
X-ray showed each clearly in position and removal was successful under general
anaesthesia.
A B. O. R. with a posterior obstruction of the left nostril by a thick mem
-brane was operated upon but the atresia which had been present since birth
recurred in spite of repeated attempts at dilation.
150
In Meerut District there were 568 new cases and 2,700 cases treated as
out-patients. These included 3 emergency Schwartz's mastoidectomies
2 B. O. Rs. and W/O of a British Officer.
Invaliding:—
3 I. O. Rs. for intractable bilateral disease with deafness.
3 B. O. Rs. for sinusitis for which he had been invalided 3 years before.
During the summer the department moved to Landour where electric
power is available and a large number of patients were treated successfully
under good conditions.
The use of R. A. F. transport for emergencies is advocated.
75. Rabies and Antirabic Treatment.
There have been seven cases of Hydrophobia, three British and four
Indian. Of the British cases one was a Corporal R. A. M. C. who knowingly
refused to accept treatment in order to sit for a Corps examination.
Rabies has not been noted as being markedly prevalent in any District
though it was noticeable in Baluchistan and in the Bareilly area.
Antirabic treatment has been administered widely during the year.
We now have 57 treatment centres and if need be vaccine can be sent from any
of these centres to out-lying hospitals for local treatment.
During the year consequent on the closure of the Pasteur Institute at
Kasauli and its amalgamation into the Central Research Institute a new pro
-cedure for the issue and accounting for vaccines has been arranged. Simul
-taneously a new classification of bites and licks and of their treatment has been
published and brought into effect.
Certain Institutes have adopted this new procedure, details of which are
summarised as follows:
—
All bites are classified into three classes, slight, moderate or severe.
Minute details are given concerning the situation of licks, bites, etc., so that no
difficulty whatever can arise as to the class into which any particular cases
should be put.
A five per cent vaccine is issued for the treatment of all classes of cases,
the dosage and length of course corresponding to the class into which the case
has been placed. The treatment recommended is as follows:—
Class I Slight
2 c.c. daily for 7 days (adults and children).
Class II Moderate
5 c.c. daily for 14 days (adults and children).
Class III Severe
5 c.c. daily for 14 days (children).
10 c.c. daily for 14 days (adults).
The above classification and dosage of vaccine has now been adopted
by the Pasteur Institute, Coonoor, and the Haffkine Institute, Bombay, in
addition to the Central Research Institute, Kasauli.
The Pasteur Institutes at Calcutta and Shillong issue their own instruc
- t i o n s c o n c e r n i n g t h e t r e a t m e n t o f c a s e s t r e a t e d w i t h v a c c i n e s u p p l i e d f r o m t h o s e
Institutes.
The method of issue and payment for vaccine varies in each Institute
according to their own regulations. All Military anti-rabic centres conform
to instructions issued by the Institute from which they obtain their vaccine.
151
The following summary shows by Districts the number of anti-rabic
treatments which have been carried out. Full details are given in Part II
of this Report.
Peshawar District . . .
93
Rawalpindi District . . .
133
Lahore District . . .
208
Kohat and Waziristan . . .
106
Northern Command . . .
540
Lucknow District . . .
243
Meerut " . . .
324
P. & A " . . .
58
Delhi Area . . .
78
Eastern Command . . .
703
Bombay District . . .
69
Madras District . . .
31
Deccan District . . .
230
Jubbulpore Area . . .
33
Southern Command . . .
363
Western I. D. . . .
142
Western I. D. . . .
142
Total
.
1,748
76. Women and Children.
A. Diseases and treatment. Families Hospitals (British)
(i) Hospitals, staffs and equipment.—The work in family hospitals and
antenatal work connected with Welfare clinics appears to be steadily increas-
ing. The comment is made in one large typical station that the year has been
a successful one and the staff has produced results of which they may well be
proud.
The new families hospital at Rawalpindi and its counterpart at Murree
continues to allow admission to a large and varied clientelle including the
wives of three Indian Officers. Lady Minto Nurses were frequently required
and a similar number of local nurses were engaged.
Comment is made on the need for more permanent staffs of I. H. C. for
family hospitals, particularly kitchen staffs on whom so much of the well
being of the patients depends.
At Quetta the new families hospital has taken 121 in-patients, over 950
patients have attended as out-patients and to the antenatal clinics, 64 births
took place and 393 successful surgical obstetrical and gynaecological operations
carried out.
In many stations Friedman's pregnancy test has been usefully employed
with a hundred per cent positives.
The use of a Walton-Minnett gas apparatus for analgesia proved of great
value ; the apparatus is simple and cheap.
(ii) Principal diseases. Malaria.—Admissions for women have shown
a remarkable decrease in the northern districts ; for example in Rawalpindi
District the sick rate of 29 per 1,000 of 1938 is reduced to 8 per 1,000
in 1939, a figure never recorded before. This reduction is attributed to (a)
the fact that owing to the war women and children were kept up in the hills
longer than usual ; (b) the general freedom of these northern areas from mala-
r i a : a d m i s s i o n s f o r c h i l d r e n f o r m a l a r i a a r e d o w n t o 6 p e r 1 , 0 0 0 w h e r e a s t h e
dysentery-diarrhoea group produced 56 admissions per 1,000.
The Dysentery-diarrhoea group has as usual been much in evidence often
producing the most severe cases and the greatest tragedies. Many cases re-
quired prolonged treatment and the use of anti-dysenteric serum. The inci-
dence of dysentery-diarrhoea has been heavy in Quetta, Rawalpindi, Lahore,
Lucknow and the Madras Districts. In Lucknow District 50 per cent of all
deaths of children were due to the dysentery-diarrhoea group.
152
The need for early hospital treatment for acute dysentery and diarrhoea
and the special need for pressing the fluid intake in the case of children is
stressed. This is a point to which education at Welfare Centres should give
particular attention.
A further point is to make mothers, nurses and even medical men realise
that the condition in children is more often than not a dysenteric infection
and that this group "dysentery-diarrhoea" should be labelled, called and treat
-ed as "dysentery". The expression used by a mother or medical attendant
"just a touch of diarrhoea" is a misleading euphemism which so often pro
-duces a fatal delay in carrying out the required energetic treatment. Parents
should be made to realise that the child has "dysentery", the infection being
due probably to flies or bad hygienic methods in their own household.
In one fatal case of diarrhoea quoted from Deccan District the child's
ayah was examined and found to be suffering from dysentery, B. flexner
isolated from the stools, and two other children in the same family developed
dysentery.
From Quetta the following observation has been made by the Deputy
Assistant Director of Pathology:—
As in previous years the dysentery season opened with Sonne dysentery
among the women and children. This regularity is most extra
- o r d i n a r y , p a r t i c u l a r l y a s f l y b r e e d i n g i n A p r i l i s s l i g h t . S o m e
of the Sonne dysentery cases were severer than in previous
years.
Diphtheria began in Sabathu at the end of July and 15 cases in all occurred
between the 26th July and 15th September. Early in August all children
were immunised; T. A. F. 3 doses at weekly intervals.
Several of the immunised children developed the disease in mild form
The need for warning parents that immunity takes some time to develop is
stressed.
Chicken pox was markedly prevalent throughout Lahore District and
Rawalpindi. This started as a spring wave in Ferozepore, spread to all the
hill stations and returned in the autumn to plains stations.
(iii) Items of interest.—Two cases of pyloric stenosis are recorded, one
was successfully treated by Ramstedt's operation under local anaesthesia
and the other by dieting and belladonna therapy.
A girl of 8 years who had had two doses of T. A. B. had a severe attack
of Typhoid fever.
A woman aged 40 with acute, severe ring worm of the nails of both hands
was completely cured by the eradication of all nails under general anaesthesia.
10 months later she was cured and her nails had regrown.
An infant aged 8 months was found to have an infection with B. typhi
-murium (B. aerthycke) and was cured.
A girl aged 7 was admitted and treated for chorea. After 10 days she
developed typical typhoid, proved bacteriologically which ran a normal course.
For convalescence she was sent to Wellington and there developed diphtheria
bacteriologically virulent and difficult to eradicate. She recovered com
- p l e t e l y .
Two cases of births at 7 months are mentioned, the infants weighed 4¼
and 4¾ lbs. respectively. They survived and are flourishing.