NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
41
Local injuries, which include sprains, abrasions, contusions and open
injuries, taken as a whole accounted for nearly 450 less British admissions than
in the previous year. There were 3 more deaths than in 1938 but 10 more
than in 1937.
Resin Poisoning.—The question of resin poisoning in Gymnasia was raised.
This is a definite trouble unless precautions are taken ; hands become cracked
and septic with the repeated use by many, of one apparatus and much applica
tion of resin. Cleansing of hands and liquid disinfection of the apparatus is
recommended.
1 8. Venereal Diseases.
These diseases which gave an increase of 3 per 1,000 the previous year,
have again shown a further increase of 8.9 per 1,000 to 52.4 per 1,000. The
admission rate is now 19 per 1,000 more than it was 7 years ago. The position
is most simply shown by the following chart VIII.
The amount of inefficiency produced by these diseases is certainly a dis
t u r b i n g f e a t u r e a n d m o r e s o i n t h a t t h i s a p p e a r s t o b e o n t h e i n c r e a s e a n d i s
likely to go still further during the war period. The following extracts from
comments by Hygiene Officers are worth recording but still do not get away
from the need for serious attention to preventive measures.
" We bring out young men in the prime of life to India. We devote all our
attention to keeping them fighting fit, with plenty of spare time and then afford
them no femine society of their own class. No wonder they succumb to
temptation."
" The more one considers the question the more one is convinced that
V. D. is one of the few diseases for which the patient is entirely responsible
himself, and in which the medical profession are most helpless. Whatever
precautions are enforced and whatever prophylaxis is offered the final court
of appeal is the man himself who can nullify all these measures by just ignoring
them ."
The loss of man days through these diseases can be taken to be approxi
mately as follows over a 5 year period for British troops.
1935.
1936.
1937.
1938.
1939.
Days lost from duty
. .
87,673
79,759
84,516
72,328
51,465
It should be remembered however that there have been reductions of
strength which account for the reduction shown above.
The worst stations in India for V. D. are shown in the following table.
TABLE 36.
Station.
Ratio per
1,000.
Hyderabad .
.
.
.
.
.
.
.
.
.
113.9
Cawnpore .
.
.
.
.
.
.
.
'
'
109.4
Jullundur
.
.
.
.
.
.
.
'
'
'
97. 6
Barrackpor
.
.
.
.
.
.
.
.
.
88 . 8
Jubbulpore .
.
.
.
.
.
.
.
.
.
83.9
Madras
.
.
.
.
.
'
.
'
.
"
80.9
Karachi
.
.
.
.
-
.
.
.
.
80.2
Poona .
.
.
.
.
77.5
Secunderabad
.
.
.
.
.
.
.
.
.
75 6
42
CHART No. VIII.
BRITISH—
INDIAN—
VENEREAL DISEASES.
ADMISSION RATIO PER 1000 OF STRENGTH.
INDIAN.
BRITISH.
YEAR.
43
TABLE 36—contd.
Station.
Ratio per
1,000.
Lucknow. .
.
.
.
.
. .
.
.
73.5
Ferozepore .
.
.
.
.
.
. .
.
73.1
Bombay. .
.
.
.
.
.
. .
.
68. 7
Lahore. .
.
.
.
.
.
. .
.
66.3
Calcutta
. .
.
.
.
.
.
.
.
.
64. 0
Wellington. .
.
.
.
.
.
. .
.
61.0
Agra.
.
.
.
.
.
.
.
.
. .
6 0 . 8
Bangalore .
.
.
.
.
.
.
.
.
58.8
Meerut.
.
.
.
.
.
.
.
.
.
56.8
Bareilly .
.
.
.
.
.
.
.
.
.
56.1
Delhi.
.
.
.
.
.
.
.
.
.
52.8
NOTE.—In 1938 there were only 13 large stations in which the rate was over 50 per
1,000 ; This year 20 stations.
Three areas show a decrease in cases and rates, viz.: (i) Western District
(Quetta and Karachi) : (ii) P. and A. District where the ratio has fallen by
15 per 1,000 to 53.36, the lowest since 1934 ; Calcutta shows a drop of 44 per
1,000 while Barrackpore, Dinapore and Port Blair show lesser decreases : ( iii)
Bombay which has an unenviable reputation for venereal but the admission
rate fell by 25 per 1,000. As these are all large town areas the question imme
diately arises is this reduction due to local civilian treatment of cases.
That there is a marked difference between stations because of the idiocyn
crasies of different units is well shown by the Field Regiments R. A. at
Secunderabad. The one present in 1938 had 4 cases of V. D. whereas the one
present in 1939 produced 33 admissions.
Increases are shown by all the other Command figures.
In Northern a slight increase of 2 per 1,000 to 37.4, there being no tendency
to decrease over the past decade and the past three years being the worst. In
Southern a large and regrettable increase of 13.1 to 65.5 per 1,000 ; admissions
for Syphilis and Soft chancre have increased whereas Gonorhoea has decreased.
Does this mean much increase in local private treatment with the Sulpho
pyridine group of drugs ? In Eastern too there has been steady regrettable
increase of 11.1 to 55.0 per 1,000 ; the rate being higher than the all Indian
rate. In contrast to P. and A District mentioned above Lucknow District
shows a well marked rise of 20 per 1,000 giving the highest rate for 5 years :
this was due to the Battalion which came from the Frontier to Cawnpore and
produced 50 admissions.
The problem remains a difficult and disappointing one. There are a variety
of probable causes :—
(i) One is undoubtedly the restless feeling induced by the War and
frequent moves and arrivals of units to new stations.
(ii) At the outbreak of war there was a very definite shortage of
" P r e v e n t i v e p a c k e t s " t o w h i c h i s a t t r i b u t e d s o m e o f t h e c a s e s o f
the disease. These packets have been available at a scale of 1 per
man per year. This may be sufficient in out-stations but in towns
where temptations are many and frequent the scale is obviously
ridiculously inadequate. No limit of this type should have been
placed on the free issue of these packets. They have now been
arranged for on an as required scale.
44.
(iii) The presence of ample facilities and temptations leading to infec-
tion, with a lack of social amenities and European companion-
ship outside barracks during long years of service is undoubtedly
one of the causes.
(iv) The new drug treatment is also having an effect. This can be
obtained readily from local practitioners at a cost very small
compared with the penalties inflicted on the unfortunate man
who acquires the disease and presents himself for official treat-
ment. The very presence of this drug for the treatment of
Gonorrhœa may induce a relaxation of the average man's fear of
the disease and its consequences. This knowledge of the effects
of Sulphanilamide drugs is said to have a definite influence.
Troops now believe that they can be readily cured without ill
effects should they become infected. The result is a decrease in
certain areas of admissions for frank cases of Gonorrhœa and an
increase in cases of urethritis without the infecting organism
being present. In addition we have the added danger of over
dosage with a dangerous drug. On the other hand, the bright
side of this picture is the remarkable shortening of hospitalisation
which has resulted from the use of these drugs in treatment a
reduction of hospitalization from 64 days to 18 or even 14 or 12
days.
(v)
P r e v e n t i v e a b l u t i o n r o o m s a r e m a i n t a i n e d i n a l l u n i t s , w e l l e q u i p p e d
and staffed reasonably well. But considered opinion states
that certainly 50 per cent. or even 80 per cent. of the men
who are infected have never made any attempt to use the facili-
ties provided. Experienced Officers assert that a simple thorough
washing with soap and water in reasonable time will be effective
as a preventive measure. This is available at P. A. Rooms but
is not used by the majority of those who acquire infection.
Ksenior hygiene officer with experience of the methods employed in the
U. S. A. Army points out how effective are their far more drastic measures but
is of opinion that methods as drastic would not be acceptable to the British
Army.
The problem of venereal disease and its prevention is undoubtedly serious
and needs the attention of all officers particularly those in immediate command
of troops, The considered opinion of an experienced battalion commander is
worth quoting from Rawalpindi.
" I am of the opinion that the increases in admissions to hospitals on account
of venereal disease are due to three main causes in so far as the unit under my
command is concerned.
(1) The change of station from ...... , where little facilities existed for
contracting this disease, to Rawalpindi where soldiers are
encouraged by tonga drivers and others to visit brothels.
(2) The removal by the War Office of the 6 months forfeiture of profici-
ency pay and the substitution of three months. I stated last year
that I believed this measure would have this result and I hoped
it would not be brought in. Although I do not suggest that men
take risk merely because the penalty is reduced, I do believe that
the general opinion is that the military authorities now are not
so anxious as they were that venereal disease should not exist.
45
(3) The various increases in pay and reduction of expenses which enables
soldiers to go out of barracks far more often than formerly."
The relative proportions of the diseases of the venereal group are shown in
the following table.
TABLE 37.
V enereal diseases for 7 years by groups.
Ratios per 1,000.
Gonorrhœa.
Syphilis.
Soft
chancre.
Total
venereal
diseases.
1933 B. O. Rs.
.
. .
23.2
4.9
5.0
33.4
I. Os. & I. 0. Rs.
.
.
4.7
3.9
2.2
10.8
1934 B. O. Rs. .
_.
.
.
25.2
4.5
4.1
34.1
I. Os. & I. O. Rs.
.
.
4.2
3.5
1.9
9.6
1935 B. O. Rs.
.
.
.
25.8
6.0
6.8
38.8
I. Os. & I. O. Rs.
.
.
4.6
3.7
1 . 8
10.1
1936 B. O. Rs.
.
.
.
25.7
4.1
4.6
34.4
I. Os. & I. O. Rs.
.
.
4.8
3.4
1.6
9.8
1937 B. O. Rs.
.
.
.
28.4
5.8
5.7
40.5
I. Os. & I. O. Rs.
.
.
3.4
3.0
1.7
8.1
1938 B. O. Rs.
.
.
.
28.0
7.6
7.9
43.5
I. Os. & I. O. Rs.
.
.
2.9
3.1
I.5
7.5
1939 B. O. Rs.
.
.
32.7
8.4
10.2
52.4
I. Os. & I. O. Rs.
.
.
3.4
3.4
1.2
8.5
The contrast between admissions from British and Indian troops is very
marked, but does not necessarily mean a similar absence of actual infection.
The difference in the proportion of admissions far Syphilis and for Gonorrhœa
in the two is also significant, suggesting that Gonorrhœa to the Indian is hardly
worth reporting whereas Syphilis requires full treatment or that mercury cream
is used by the British and aborts a proportion of Syphilis infections without
affecting those of Gonorrhœa.
The seasonal variation of these diseases over the past 5 years is given by
Chart No. IX which shows the annual rise in the post holiday period and the
rise after movements of troops has been taking place and the rise after the
o u t b r e a k o f
W a r .
This preventable disease continues to cause unnecessary admissions to
hospital. The numbers have fallen by 4 this year.
In Eastern Command there has been little change, 19 cases. In Rawal
pindi District there was a satisfactory reduction, one case instead of 13 as last
year.
TABLE 38.
Scabies. Ratios per 1,000
B. O. Rs. I. O. Rs.
1935
.
.
.
.
.
.
.
.
.
1.4
9.6
1936 .
.
.
.
.
.
.
.
.
1.7
7.7
1937 .
.
.
.
.
.
.
.
.
1.4
7.7
1938 .
.
.
.
.
.
.
.
.
1.9
10.2
1939 .
.
.
.
.
.
.
. .
2.2
11.9
46
CHART NO. IX.
B R I T I S H T R O O P S = —
I N D I A N T
R O O P S = —
VENEREAL DISEASES, ALL INDIA.
MONTHLY ADMISSION RATIOS PER 1000 OF STRENGTH.
47
20. Small pox
The protective state acquired by vaccination remains at a satisfactory level.
Forgetfulness is still a case of neglect of this simple precaution.
Owing to the period of 3 years being the limit of protection after vaccina
tion allowed by Port Health authorities in places out of India an amendment
was issued to our own vaccination rules for all troops proceeding abroad.
Orders were issued that all officers and troops proceeding abroad must have
been protected by vaccination not less than 12 days or more than 3 years at
the time of reaching the port of disembarkation.
TABLE 39.
Half yearly state of vaccination of British troops and families.
Percentage protected.
On 30th
April.
On 31st
October.
British Officers .
.
.
.
.
.
.
.
.
99.81
99.52
British Other Ranks .
.
.
.
.
.
.
99.91
99.28
Women and Children
•
•
•
•
•
•
•
99.70
97.32
There was a reduction of 6 cases of smallpox compared with the previous
year. British other ranks produced cases at Delhi, Meerut, Cawnpore and
Sialkot but there were no deaths. There were no cases amongst British Offi
cers and their families and there was only one case in B. 0. Rs.' wives at
Meerut.
This is all the more remarkable in view of the marked prevalence of small-
pox in many areas of the country [see paragraph 6 ( b )]. For example at Ambala
there was a small epidemic in the Railway colony, 67 cases and 11 deaths, but
there were no British cases in the station.
21. Cerebrospinal Fever.
There were only 3 cases, one of which died at Meerut, the recovery cases
were at Razmak and Jubbulpore.
Special attention was directed to the likelihood of cases occurring when the
Relative Humidity was rising. Little such correlation was observed but
climatic changes are often very localised and perhaps not accurately recorded.
From previous experience there is an obvious correlation.
There was an increase of 9 cases amongst Indian troops, the majority in
Northern Command.
22. Poliomyelitis.
With only 3 cases this infection does really very little damage even in our
susceptible populations. In 1938 there were 6 cases. It is the dramatic
onset and high mortality which draws public attention to this disease.
Amongst Indian troops there were 2 cases in lieu of none of the previous
year.
The British cases were at Rawalpindi and Peshawar in June and Lucknow
in September ; the Indian cases were at Poona and Quetta in July and August.
48
Owing to the fame which has been. achieved by the use of the "Iron Lung"
much attention has been directed to this condition although it is relatively
unimportant. For comments on the " Iron Lung " see paragraph 66 (viii).
23. Respiratory Diseases.
The slight increase in the rate per 1,000 of the past 5 years has been main
tained giving a steady rise during these years for all three types of the main
respiratory group. Whereas Indian troops have shown an almost similar
decrease. The British increase has been more apparent than real in that there
has been a reduction of nearly 50 actual admissions.
With a decrease in Northern and Eastern Commands the slight general
rise is due to increases in Southern Command.
There have been no epidemics to account for this except for very localised
outbreaks labelled " Influenza " in Southern Command. There were 111 cases
of Influenza admitted, but a note is made to the effect that nearly all are from
seaport towns at a time when Dengue was prevalent.
In Madras District there were 34 admissions for Influenza immediately
after the arrival of a fresh British Battalion and finally there were 46 cases from
British troops and 11 from Indian troops.
The influence of the Sulphapyridine group of drugs in the treatment of
these cases has been commented on as being one of the outstanding features of
success.
TABLE 40.
Respiratory Diseases by types.
Ratios per 1,000.
Diseases of bronchi
and broncheoles.
Diseases of larnyx
and trachea.
Pneumonia lobar
and lobular.
B. 0. Rs. I. Os. &
I. O. Rs.
B. O. Rs. I. Os. &
I. O. Rs.
B. O. Rs. I. Os. &
I. O. Rs.
1934
.
.
.
14.8
15.0
1.0
1.0
3.9
6.0
1935
.
.
.
15.5
11.9
1.2
1.0
4.2
4.9
1936
.
.
.
16.8
11.9
0.8
0.9
3.5
5.4
1937
.
.
.
17.2
13.3
1.3
0.9
3.2
5.2
1938
.
.
.
18.2
12.7
1.3
0.7
3.3
5.0
1939
.
.
.
19.3
14.0
1.8
0.9
4.7
2.8
These rates per 1,000 for British troops each showing a slight increase
represent an actual reduction of nearly 50 cases owing to the general reduc
tion in strengths during the year.
There was, however, an increase of 61 cases of pneumonia compared with
the preceding year but the deaths were only 5 compared with 10 of the previous
year. This definite increase in pneumonia is due to admissions in Southern and
Northern Commands. In Eastern Command there was a definite decrease in
the disease, noted as being one of the few bright spots of the annual résumé ;
but in Southern there were 30 cases with no deaths and in Northern there was a
sharp but not extensive increase. It is interesting to note that in Waziristan,
where British troops were either in Razmak, at 7,000 feet, or in camp at Razani
at 5,000 feet the pneumonic rate was the lowest in the Command at only 1.10
per 1,000.
49
Lobular Pneumonia. and Pleuresy with 91 cases between them remained
at the usual figure. Bronchitis gave us 87 cases less than in 1938 and there
were NO cases of Empyema.
The monthly admissions for the pneumonic group are shown below.
TABLE 41.
Monthly incidence of Pneumonic Group—for 1939.
Jan. Feb. Mar. Apr.
M a y . June July Aug. Sept. Oct. Nov. Dec.
Lobar Pneumonia—
B. O. Rs.
.
. 29 11
5
6
10
10 10
8
8 12 10
18
I. Os. & I. O. Rs.
. 103 45 46 35 31
28 18 14 24 44 35 90
Lobular Pneumonia—
B. O. Rs. .
.
.
3
3
4
2
2
1
. . . 2
1
1 ...
4
I. Os. & I. O. Rs.
.
17 12 11
9
5
8
4
3
7
5 15 15
The total influenza admissions showed a reduction of 235 cases on the
previous year and tonsillitis and pharyngitis, which should be included in this
group rather than under digestive diseases, showed a reduction of 127 cases
Tonsillitis has increased steadily in Eastern Command for the past 3 years.
24. Tuberculosis.
There was a decrease of 11 cases of pulmonary type but 5 more non-
pulmonary during the year. In part this is due to the departure of certain
units in which cases had previously been recorded.
During the year records by units were checked to ascertain whether any
direct connection could be traced between cases in one station or in one group
of barracks or in one particular unit. Although it is obvious that there must
be connection between cases in certain units which produce several cases a
year, the length of time before symptoms become manifest combined with
frequent moves of individuals and companies makes it impossible to trace any
direct connection in the average case.
In Eastern Command there was a definite increase to 14 cases of pul-
monary type, the highest being P. and A. District. In Northern Command on
the other hand there has been a further decrease in the disease down to 0.72
per 1,000, a satisfactory feature as this is the lowest figure recorded.
Table No. 42 shows that as far as military populations are concerned there
is no steady increase in the disease which appears to be occurring amongst the
civilian population of India.
TABLE 42.
Incidence of Tuberculosis amongst British and Indian troops over a 6 year period
(Ratios per 1,000.)
Year.
British
troops.
Indian
troops.
1934
.
.
.
.
. .
.
.
.
.
.
1.1
2.1
1935
.
.
.
.
. .
.
.
.
.
.
1.3
2.4
1936
.
.
.
.
. .
.
.
.
.
.
1.3
2.0
1937
.
.
.
.
. .
.
.
.
.
.
1.4
2.0
1938
.
.
.
.
. .
.
.
.
.
.
1.2
2.1
1939
.
.
.
.
.
.
.
.
.
.
.
1.3
2.2
50
25. Diphtheria.
There has been a continued increase in this disease to 64 amongst British
personnel making a continued rise over the past 3 years, a marked contrast
to the cases amongst Indian troops which have again, only 2 admissions for the
year.
TABLE 43.
Admissions for Diphtheria over 6 years (Ratios per 1,000).
British
Troops.
Indian
Troops.
1934 .
.
.
.
.
.
.
•
•
1.2
0.1
1935 .
.
.
.
.
.
.
.
.
1.3
0.0
1936 .
.
.
.
.
.
.
.
.
1.3
0.1
1937 .
.
.
.
.
.
.
.
.
0.8
0.0
1938 .
.
.
.
.
.
.
.
.
1.2
0.1
1939 .
.
.
.
.
.
.
•
1.8
0.0
This is due to increases in Southern and Eastern Commands whereas in
Northern the rate has decreased to the low figure of 1 . 04 per 1,000.
The general incidence is best shown by the following table :—
TABLE 44.
Diphtheria by Commands in categories.
British service.
Northern
Command.
Western
(I.) Dist.
Eastern
Command.
Souther n
Command,
Officers and Other Ranks
.
.
.
14
..
31
29
B. 0. Rs. wives
.
.
.
.
.
1
..
2
2
B. 0. Rs. children .
.
.
.
.
1
. .
3
17
Total 1939
.
.
.
.
•
•
3
• •
36
48
Total 1938
.
.
.
.
.
•
38
13
18
59
In Northern Command three special centres of infection are noted. In
Lahore District, 11 cases in all, 4 came from a camp at Malot, the first case being
cutaneous diphtheria. At Sialkot also cutaneous cases were reported, 2 virulent
and others non-virulent and 7 Nursing Orderlies temporarily harboured K. L. B.
in their throats. In the Simla Hills at Sabathu there were 15 cases amongst
British children also one woman and one N. C. 0. contact developed the disease
a month later. For this outbreak T. A. F. immunisation was given to the
whole child population. Several of those recently immunised developed the
disease. This point is worth recording in that parents need to be warned
when T. A. F. immunisation is being undertaken that the immunity therefrom
takes time to develop.
In Eastern Command there was a small sharp epidemic amongst the men
of the Field Regiment R. A. at Meerut with extensions during the summer and
autumn to Dulikhet and Lucknow. There were also sporadic cases at Bareilly
and Chakrata.
In Southern Command 8 cases came from Wellington and 10 from Madras,
here also obviously interconnected outbreaks. This is the second time in 6
years that there has been an epidemic in this area.
51
26. Effects of Heat.
There has been a satisfactory reduction in cases and even better reduction
in deaths which are usually high in this group. The slight increase in Heat
Exhaustion in recent years is partly due to the greater tendency to diagnose
this condition in mild cases of general malaise in the hot weather months.
This absence of any marked increase in the Effects of Heat for British
personnel is all the more satisfactory in that the whole of the hot weather
months saw frequent moves of troops. by rail and road, the manning of unusual
defence posts and a premature return of British troops from Hill stations to
the Plains.
TABLE 45.
Effects of Heat.
Heat stroke.
Heat exhaustion.
Cases. Deaths.
Cases.
Deaths:
1936
.
.
•
•
•
•
•
13
3
39
1
1937
.
.
•
•
•
.
.
15
6
37
2
1938
.
.
.
•
•
.
•
22
6
65
6
1939
.
.
.
. •
. •
13
2
67
2
Eastern Command is the area which shows an increase of Heat Exhaustion,
16 cases with 1 death, 13 of these occurred in Lucknow. There was however
a decrease in Heat Stroke, 5 cases with 1 death. In Southern there were only
2 cases all told with 1 death in Bombay.
In Northern Command the rate reduced to 3.1 per 1,000 but the 1938-39
period is well above normal. This was due to 10 cases in Rawalpindi which
included one elderly Warrant Officer, the only serious case, who was taken off
the train in a collapsed state. Deaths this year have been exceptionally low,
1 out of 39 cases or 2.7 compared to 14.29 per 1,000 of 1938.
The value of increased salt intake which was stressed in our 1938 report
was shown at Cawnpore where the hot weather was long and trying with
record temperatures but a low relative humidity. The value of increased salt
consumption in the prevention of heat-stroke was stressed. Only one case of
Heat Exhaustion was . admitted. There were other cases with slight tempe
ratures but they were not dealt with as cases of " Heat ".
In a large station in Peshawar District a patient for Gonorrhoea developed
heat-stroke in hospital and died rapidly. He was shown to be a chronic
alcoholic (8 pints of beer.and much whisky daily) with typical alcoholic stomach
and liver. His heart showed the typical wooden heart of heat-stroke.
The seasonal incidence of Heat Stroke and Heat Exhaustion are shown
below.
TABLE 46.
Seasonal incidence of Heat Effects. (British Troops).
Jan.
A. D.
Feb.
A. D.
Mar.
A. D.
Apr.
A. D.
May.
A. D.
June.
A. D.
July.
A. D.
Aug.
A. D.
Sep.
A. D.
Oct.
A.D.
Nov.
A. D.
Dec.
A. D.
Heat stroke. ..
. .
. . . .
. . . .
. . . . 3 .. 2 1 4 .. 1 1 1 .. .. ..
. . . .
. . . .
,, e x h a u s
tion.
. . . .
. . . .
. . . .
. . . . 4 .. 18 2 15 ..
8 . . 6 .. 2 ..
. . . .
. . . .