7
PRINCIPAL DISEASES AFFECTING THE ,BRITISH ARMY.
4. Summary of Interesting features of the year.
(a) Malaria remains at a most satisfactorily low level inspite of the
aftermath of the 1937 Frontier operations.
(b) Although officially there were no operations in progress, war condi-
tions prevailed in Waziristan throughout the year and yet ad-
mission rates were remarkably small.
(c) Cholera was epidemic in many parts of the country, but the incid-
ence amongst military personnel, except for one restricted out-
break, was negligible. There were only one British case and 42
Indian cases-.
(d) The Enteric Group of fevers which are endemic throughout the coun-
try and in places epidemic, have been now reduced to less than
1 per 1,000 over the whole year both for British and Indian troops.
(e) The Dysentery-Diarrhœa group for which there are no specific
preventive measures shows no signs of reduction.
(f) Sandfly fever is at last showing signs that effective preventive mea-
sures can be employed. The most satisfactory measure is that
of Spraying
(g)
Of Respiratory diseases there was no epidemic and the incidence
tends to remain level, but that of Tuberculosis has decreased.
5. Factors which may have affected the incidence of disease amongst troops.
(a) Climatic conditions.—As a whole rainfall was only in excess in eastern
India and the Bombay Deccan ; defective in the rest of the country, but-marked-
ly defective in the Punjab, Sind and Rajputana.
In the winter and spring rain was excessive in southern and ample in
northern India ; but in defect in central and Deccan districts.
Mean temperatures were high in the south. In the north-west after a
pronounced cold spell in the latter half of March and early April, markedly
high temperatures ensued in May. These conditions would favour a decrease
in fly-breeding but excess sandfly prevalence in the north and mosquitoes in
the south and east.
The monsoon was defective over the west and north, particularly in the
Delhi-Lahore area, where famine conditions later supervened with tempera-
tures above normal, and average to excessive in the east.
The autumn was dry and warm with a hot spell of 10 degrees above nor-
mal in the north which persisted into late November, being terminated by a
cold snap on the 27th of that month ; conditions definitely favourable to a
somewhat reduced but very prolonged malarial and sandfly infective period.
(b) Seasonal incidence of main diseases.—The main diseases have followed
their normal fluctuations with one or two exceptions. Malaria was prolonged
into the autumn in northern India due to the late warmth. Sandfly fever also
showed a prolonged season. The fly borne groups of dysentery, diarrhœa and
enteritis were definitely associated with the normal fly seasons. Respiratory
diseases including Cerebro-spinal fever were associated with colder climatic
changes and the rise in humidity. But the predominance of pneumonia in the
hot weather was definite. Heat stroke and heat exhaustion were increased by
high summer temperatures combined with high relative humidity.
The component of all these, that is the curve of incidence, is most simply
illustrated by the graph for the year for all sickness of British and Indian
. troops.