NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Owing to certain circumstances very large quantities were held in stock
of which the acidity was found to be 12—14 points. In the open market
acidity is often higher than this. It was therefore decided that the absolute
maximum limit of acidity at issue should be raised to 14 points to save waste
of stocks, but that the 9 points limit should be retained at the Centre and 11
points as the normal upper limit.
In the meantime a close watch would be kept on troops receiving these
relatively high acidity Ghis to note any harmful effects.
Reports received at the end of the year show that there have been no
harmful results up to date from issues of Ghi of an acidity up to 14 points
and that the decision to avoid the waste of large quantities was fully justified.
It should be pointed out however that issue of high acidity ghi over long.
periods might show a very different result. The results of mal-nutrition
are always slow in manifestation and the results of a short observation would
not justify any permanent departure from established standards.
The method of standardisation and of recording our Ghi is as follows.
(iii) The standardisation of Ghi .—The methods of stating the standard
appear to vary in the different Provinces. The military method which is
employed by the Government Agent and his analysts is to state the acid value
in terms of "points".
By "points of acidity" is meant the number of millilitres of N/10 standard
alkali solution required to neutralise the fatty acids in 10 grammes of the
dissolved fat (indicator being phenophthalein).
The figure obtained may be recorded thus:—
(a) Converted to indicate the proportion of free fatty acid present
in the Ghi in terms of a particular acid.
( b ) C o n v e r t e d t o i n d i c a t e a n " a c i d v a l u e " i n t e r m s o f t h e n u m b e r o f
milligrammes of potassium hydrate required to neutralise the
free fatty acids in one gramme of Ghi.
( c ) R e c o r d e d d i r e c t l y i n " P o i n t s " .
(a) and (b) are scientific, are legal, but are puzzling to the trader.
(c) is simple and legal if properly defined by declaring the proportion of
oleic acid represented by the point.
The appended table shows the value of fat in terms of points." Under
9 points" compares almost exactly with the "acid value" of 5.
TABLE 94
ml. of N/10 alkali solution neutralizing
the free fatty acids in 10 grms. of ghi. "Points of
acidity."
Derived from Column 1.
"Acid value"
(mg. KOH neutra-
lizing the free
fatty acids in 1
grm. of ghi).
Percentage of
free fatty acids
in terms of oleic.
acid.
1 . . .
1
0.561
0.28226
2 . . .
2
1.122
0.56452
3 . . .
3
1.683
0.84678
4 . . .
4
2.244
1.12904
5 . . .
5
2.805
1.41130
6 . . .
6
3.366
1.69356
7 . . .
7
3.927
1.97582
8 . . .
8
4.488
2.25808
9 . . .
9
5.049
2.54034
10 . . .
10
5.610
2.82260
11 . . .
11
6.171
3.10486
12 . . .
12
6.722
3.38712
108
LAHORE.
CHART No. XII.
TRAIN TRAVELLING THROUGH SIND OR CENTRAL INDIA.
THROUGH SIND—
T H P O U G H C E N T R A L
I N D I A . —
HIGHEST MAXIMUM
AVERAGE DAILY MAXIMUM
MEAN 17.00 HOUR TEMPERATURE.
LAHORE
KARACH
ANORA
.
B O M B A Y .
KARACHI
MANORA
B0MBAY.
LAHORE
KARACHI
MANO
RA.
BOMBAY.
NOTR:- AN APPROXIMATE DANGER ZONE IS SHOWN FOR EACH TYPE OF TEMPERATURE.
110
( b ) E x t r a i s s u e o f
s a l t . — F u r t h e r e x p e r i m e n t s c a r r i e d o u t i n 1 9 3 9 a p p e a r
to show that an extra issue of salt was of definite benefit in the
case of Indian Troops, as the following statistics indicate :—
TABLE 95
Ratios per 1,000
A v e r a g e s t r e n g t h . P r i c k l y h e a t .
B o i l s .
H e a d a c h e .
C o n s t i p a t i o n .
H e a t E x h a u s t i o n .
A l l c a u s e s .
On extra salt .
4,426
0.45
34.79
5.65
17 . 62
1.13 350.88
Without extra salt .
4,482
2.90
44.62
3.35
19.63
7.14 415.22
It should be noted that the subjects of the experiment were in different
stations. The conclusions are therefore apt to be misleading.
I. Sanitation in Cantonments and Barracks
( i ) I n s p i t e o f m a n y i m p r o v e m e n t s o v e r t h e p a s t 3 0 y e a r s a n d i n s p i t e o f
repeated attempts at modernisation in many stations the disposal of excreta,
of sullage water and of refuse has remained primitive and more in keeping
with camp sanitation that that required for modern barracks. This is partly
because such methods are understood by the class which deals with conser--
vancy and refuse disposal and the old methods of disposal go on from one
generation of inhabitants to the next, partly because the introduction of
modern sanitation, though probably cheaper in the end and though certainly
more satisfactory in its results, needs the outlay of capital funds, an outlay
against which so often stenuous objection is raised.
However it is pleasing to note that in some cases at least a visit after some
15 or 20 years shows actual changes for the better, even in the more primitive
methods of sanitation.
( i i ) S e w a g e d i s p o s a l . —
In quite a number of stations now modern sanita--
tion and methods of refuse disposal are being steadily introduced with appre-
ciable benefit. In some, such as Quetta, Poona, Calcutta, Delhi and Bombay
a full type of sewage disposal is provided ; in others local water borne sewage
to septic tank and final underground disposal is found to be more economical.
This type is now being provided for all new quarters and for lines as occasion
arises. In Quetta the D. A. D. H. has inspected after test some 1,000 pipe
lines and manholes.
In Sialkot this septic-tank-subsoil-disposal has been taken into use to
deal with the night soil and urine from group latrines. The method consists
in providing duplicate septic tanks with a capacity of 1 foot run per seat,
having a width of 2½ and depth of 4 feet. A dumping hopper closed by a
sloped metal cover and protected by a glazed pipe water-seal leads to the
septic tanks. Effluent is dealt with by means of subsoil irrigation into agri
-cultural pipes placed over channels of 2 to 3 feet of broken brick. The dis-
- p o s a l c h a n n e l s a r e f i r m l y c o v e r e d i n a n d a r e p r o v i d e d a t a b o u t 1 5 f t . r u n p e r
seat. It is essential that not less than 5 gallons of water per seat per day
113
holes to the space between them. The frame is fitted in place of a window in
the cookhouse or dining room.
Reports on this have now been received and vary from "most useful"
and "excellent traps" to "poor", "ineffective" and "useless".
As a whole they appear to be definitely of use provided they are properly
made, provided no adventitious methods of escape are allowed to the captured
flies and provided the trap does not appear definitely darker from the inside
of the room than do the other fly proofed windows.
(v) Composting.—The Indore process although very sound in theory
has not taken on readily in many places, in some it is most successful.
At Secunderabad the method was given an extensive trial over 2 years
after an outlay of Rs. 17,000 on ground and prepared platforms etc. This.
was given up for the following reasons :
—
1. Difficulty in selling the final product.
2. Difficulty in controlling the process in very wet or very dry weather.
3. Inability to prevent fly-breeding.
At Fort Sandeman dry refuse is disposed of in the military area by burn-
ing but the civil authorities have installed the composting method as the
method of disposal for all refuse and filth.
This is in charge of a trained supervisor who has six coolies to help him
and the whole plant is well run and free from offence. The compost is sold
as manure and practically pays for the upkeep of the system.
Conclusion.—The secret of success appears to lie in having a thoroughly
trained supervisor and suitable terrain for the sale of the final product.
(vi ) Bore Hole latrines.—These have been taken into use in some places
with success. They offer a most valuable method of safe excretal disposal..
Evidence is accruing that pollution of subsoil water in normal soils is very
limited from this type of disposal. Two points appear to be essential for
success :—
1. The bore should reach subsoil water or nearly so.
2. Proper surface fittings should be provided.
This type of latrine was found to be filled up rapidly with stones in Jullundur
Cantonment but was most successfully employed by an Indian Battalion in
the same place having been constructed by the unit themselves.
J. Water Supplies
( i ) A great improvement has taken place in the past 25 years and good
controlled pipe supplies are now available in the majority of stations. But
even now stations of Brigade size may be without a deep, safe supply. For
example, Jhelum with a shallow well supply the project of a piped supply
still remains at the top of the list of works, requiring Rs. 80,000 to provide
a safe supply. Abbottabad has had a measure of success in that safe chemical
treatment is now provided and a filtration plant may not be required.
At Lahore a review of the whole pipe distribution system has been made
since 1938. It was found that whereas the cast iron pipes were sound the
galvanised pipes were badly corroded owing to saltpetre in the ground
Rs. 10,000 has been spent on renewing parts of the system and another
Rs. 20,000 will be required to complete the work. The pipes are now being
laid wrapped in hessian coverings, soaked in Toron-antisaltpetre emulsion
117
Serum and C. S. F. from a case of sandfly fever collected on the 1st and
2nd day of the disease respectively were tested for the presence of virus. It
was found to be present in both as judged by lesions obtained on egg mem
-branes.
65. PATHOLOGY.
The routine work again showed an annual increase during 1939. A
total of 2,36,528 specimens were sent for laboratory examination during
the year, 14,744 more than last year. This annual increase which has now
taken place for some years past is considered to be due to the following three
main factors:
—
(a) A greater appreciation by medical officers of the value of labora
-tory reports as an aid to clinical diagnosis, with the result that
more specimens are sent from the wards to the laboratory for
examination.
(b) A greater realization by all of the importance of the control of water
and milk purification by laboratory tests.
(c) A greater ability, as the result of steadily improving equipment
on the part of laboratories to undertake the more complicated
investigations.
A larger number of examinations was also carried out in clinical side
rooms of hospitals in connection with malaria, dysentery cases and chemical
examinations of urine, etc. In the reports for the past two years it was point
-ed out that a considerable number of examinations at present carried out in
laboratories could be done equally well in clinical side rooms if their equip
-ment was slightly increased. Owing to the present war however this matter
has been temporarily dropped.
Enteric Group of Fevers and Salmonella infections. —Repeated Widal
tests were carried out on "bacteriologically undiagnosed" so called enteric
group cases. A total of 42 cases were diagnosed "group" infection through
-out the year which represented 19 British and 23 Indian. Of these, 18 were
serologically negative and were diagnosed on clinical grounds only. The great
majority of cases as noted last year were mild in type with few symptoms
other than pyrexia and a slow pulse. The average pyrexial period for the
above cases was 15 days. In last year's report it was pointed out that the
diagnosis of enteric group in the absence of definite serological findings was too
readily made. The same remark applies to the year under review and clini
-cians still seem to shrink from the term P. U. O., and are apparently most
anxious to avoid the stigma which is fancied by some to adhere to this con-
clusion which is scientific provided the case has been thoroughly investigated
and all bacteriological evidence etc., is negative. In this case P. U. O. or pyrexia
of unknown origin is a perfectly sound diagnosis. In this connection it is
pointed out however that the results of Widal tests carried out on these cases
is not one hundred per cent efficient, and in some cases results obtained in
inoculated individuals are of small value.
In carrying out the above tests TO and AO suspensions supplied by the
Enteric Laboratory, Kasauli, were universally employed by Military Labora
-tories.
118
The serological findings in the following 8 bacteriologically proved cases
show the uncertainty of the Widal reaction against 0 antigen in inoculated
persons :—
TABLE 96
Diagnosis.
Widal Tests.
1
2
3
4
5
6
TO
AO
TO
AO
TO
AO
TO
AO
TO
AO
TO AO
Typhoid fever . . .
0
120
0
0
0
0
. . .
. . . . . . . . .
. . . . . .
Typhoid . . ..
20
0
80
0
20
0
0
0
20
0
80
20
Typhoid . . .
80
0
80
0
40
20
40
40
. . .
. . .
. . .
. . .
Typhoid . . .
0
0
0
0
40
20
40
20
. . .
. . .
. . .
. . .
Typhoid . . .
0
0
0
0
0
0
20
0
20
0
. . .
. . .
Paratyphoid A
40
80
40
20
80
0
80
20
. . .
. . .
. . .
. . .
Paratyphoid A
30
30
15
30
15
30
. . .
. . .
. . .
. . .
. .
. . .
Paratyphoid A
0
0
30
60
20
0
. . .
. . .
. . .
. . .
. . .
. . .
•
A steadily rising titre to TO and AO antigen is very definitely suggestive
of an infection by an organism of the enteric group, but a negative or low
titre even repeated on several occasions is no proof that the disease is not
enteric. It may also be added that one or more high titres, unless part of a
steadily rising curve, are no evidence, for or against a fever of the enteric
group.
An investigation concerning the production of Vi antibodies in the blood
during an attack of typhoid fever and during the carrier stage was again
undertaken by all military laboratories in India. Suspensions of Vi strains.
were as last year prepared and issued by the Officer-in-Charge of the Enteric
Laboratory, Kasauli. In order to arrive at some definite conclusions a ques
-
tionnaire was prepared and issued to all Laboratores. Replies were correlated
by the Officer-in-Charge of the Enteric Laboratory, Kasauli, and are given
below. The investigation is still in progress and all opinions about to be
expressed are only tentative as the number of examinations completed is
insufficient on which to form a definite opinion.
( i ) Are Vi antibodies present in the serum of inoculated and uninoculated
individuals in health ?
This investigation was only taken up by a few laboratories. The results
obtained are shown in Tables 97 and 98.
T
ABLE 97
V
i antibody content in healthy uninoculated personnel
No. of cases examined.
Vi titre
0 to
1/10
1/20
1/40
1/80
1/160
Percent Per cent Per cent Per cent Per cent
275 . . .
80
9
8
2
1
119
TABLE 98
Vi antibody content in healthy inoculated personnel
No. of cases examined.
Vi titre
0 t o
1/10
1/20
1/40
1/80
1/160
Per cent Per cent Per cent Per cent Per cent
79 . . .
89.2
7.2
3.6
. . .
. . .
From the above tables it will be seen that both in inoculated and un
-inoculated personnel, the Vi content of the serum is extremely low—below
1/20 in 80 per cent in the case of uninoculated individuals: and also below
1/20 in 89 per cent in the case of inoculated individuals. As the uninoculated
individuals were menials or Indian recruits, a possible explanation for the
higher VI content in this class might be a previous attack of typhoid fever
resulting in residual agglutinins.
This investigation is being continued during the current year and labor
a-tories have been requested to start the dilutions at 1 in 5 in all future tests.
(ii) Are Vi antibodies invariably demonstrable in diagnosed cases of ty
-phoid fever?
The results of Vi agglutination tests in bacteriologically proved cases of
typhoid fever are shown in Table 99 below .
TABLE 99
Vi titre
No. of cases
examined. Nil.
1/10
1/20
1/40 1/80
1/160
1/320
1/640
Per cent Per cent Per cent Per cent Per cent Per cent Per cent Per cent
46 . . .
17
. . .
. . .
13
13
25
25
7
From the above table it will be seen that in cases of typhoid fever, 83
per cent of the cases show a Vi titre of 1 in 40: while 70 per cent show a titre
of 1 in 80 or over. The significance of these figures is apparent on referring
to Tables 97 and 98, which show that in health, the Vi titre in 90 to 95 per cent
of individuals is 1 in 20 or less.
(iii ) From a scrutiny of completed tests what is the characteristic of the
Vi agglutination curve?
Judging from a scrutiny of the completed tests carried out in proved
cases of typhoid fever, there does not appear to be any one well defined type
of curve such as used to be found with "H"agglutination tests in uninoculat
- e d i n d i v i d u a l s . T h e i n i t i a l r i s e m a y o c c u r w i t h i n t h e f i r s t w e e k , o r b e d e l a y e d
until the third week or even longer.
Consecutive tests showed at first a rising titre, either rapid or gradual,
until the peak was reached, when the curve declined as the temperature fell.
A saddle back type of curve was occasionally noticed, showing a double rise.
This may possibly have been due to a relapse.
I .
121
In the case of Indian troops necessary examinations in order to exclude
the carrier condition are undertaken by local military laboratories.
Organisms of the Enteric Group were isolated from the urine of patients
on 26 occasions.
In last year's report several cases of Typhoid and Paratyphoid infection
exhibited unusual features and were described, this year only two such cases
arose. In one B. typhosum and B. Paratyphosum A were isolated from the
blood culture, and in another B. typhosum and B. dysenteriac Shiga were
isolated from the faeces.
Organisms sent to the Enteric Laboratory, Kasauli, for confirmation or identi
- f i c a t i o n . —
O n e
h u n d r e d a n d s e v e n t y - f o u r o r g a n i s m s w e r e s e n t t o t h e E n t e r i c
Laboratory during the year and were classified as follows :—
Bacterium typhosum. . .
1 0 9
Bacterium paratyphosum A
. . .
39
Bacterium paratyphosum B
. . .
4
Bacterium enteritidis
. . .
3
Bacterium reading . . .
1
Bacterium typhi-murium. . .
1
Bacterium faecalis alkaligenes . . .
5
Br. melitensis . . .
1
Neisseria intracellularis
. . .
1
Coli and paracoligroups . . .
16
The above is a considerable reduction, as compared with last year when
a total of 246 cultures were received from outstations. The chief reductions
are among the Enteric Group of organisms, and absence of organisms isolated
from cases of cholera.
The preliminary identification tests on the whole were well carried out
by military laboratories, although the percentage of paracolon organisms for
- w a r d e d w a s f a i r l y h i g h . M a n y o f t h e m t u r n e d o u t t o b e l a t e l a c t o s e f e r m e n t o r s ;
and the explanation appeared to be that the original identification was based
on a rapid slide agglutination, together with a too short incubation period to
permit of a correct determination of biochemical reactions.
Many organisms of the paracolon group produce a varying degree of gra-
nularity when tested by slide agglutination with a typhoid or paratyphoid
serum of high titre, which, unless subsequently proved by Dreyer's technique,
leads to an erroneous conclusion.
As regards the biochemical reaction, the Officer in charge Enteric Labora-
tory points out, that sugars made from varying brands of peptone take vary
- i n g p e r i o d s b e f o r e d e v e l o p i n g t h e t y p i c a l r e a c t i o n s o f t h e o r g a n i s m u n d e r t e s t .
In his experience it was found that sugars made with nutrient broth gave quick-
er and more regular, biochemical reactions than those made with peptone of
poor quality. Apart from being more dependable the above procedure has the
additional advantage of economy.
In addition to the causative organisms of enteric fever, five other orga
- . n i s m s o f t h e S a l m o n e l l a g r o u p w e r e i s o l a t e d d u r i n g t h e y e a r . N o a t y p i c a l
members were discovered.
Five organisms, classified as B. faecalis alkaligenes were received and con
- f i r m e d b y t h e E n t e r i c L a b o r a t o r y d u r i n g t h e y e a r . A l l t h e c a s e s f r o m w h i c h
the organisms were isolated were widely scattered and apparently sporadic.
1 2
122
In one District four cases of infection with B. columbensis occurred.
Three of the cases developed antibodies to a maximum titre between 100 and
250, and one to 500. One Indian other rank had a severe attack of the relaps
-ing variety. The remaining three cases had urinary complications. Auto
-genous vaccines were employed in treatment in a strength of 250 million orga
-nisms per c.c. with beneficial results.
Dysentery .—Specimens from 4,171 cases of dysentery and 3,104 cases of
diarrhœa were bacteriologically examined during the year 1939. A total
of 16,062 bacteriological examinations were carried out in connection with
these cases, a slightly lower figure than last year. There were 129 cases of
amoebic dysentery and 15 cases of mixed bacillary and amoebic infection.
Typical bacillary exudates were present microscopically in 58 per cent of the
cases which curiously is exactly the same percentage as last year.
The percentage of isolation of organisms from cases with typical exudates
varied in different laboratories from 95 per cent to 51 per cent. The results
on the whole were most satisfactory and percentage of isolations was very much
higher than last year. Table No. 100 shows percentage of isolations by com
-mands.
TABLE 100
Comparative statement showing percentage of isolations of dysentery organisms
by Commands—1939
Typical Bacillary Exudate.
Indefinite Exudate.
Percentage of total
cases from which
dysentery organism
were isolated.
Commands.
T o t a l c a s e s .
N o . o f c a s e s .
P e r c e n t a g e o f t o t a l c a s e s .
N o . o f c a s e s f r o m w h i c h o r g a n i s m i s o l a t e d .
P e r c e n t a g e o f C o l . 5 w i t h C o l . 3 .
N o . o f c a s e s .
P e r c e n t a g e o f t o t a l c a s e s .
N o . o f c a s e s f r o m w h i c h o r g a n i s m s i s o l a t e d .
P e r c e n t a g e o f C o l . 9 w i t h C o l . 7 .
T y p i c a l B a c i l l a r y E x u d a t e .
I n d e f i n i t e E x u d a t e .
T o t a l .
1
2
3
4
5
6
7
8
9 10
11
12
13
Eastern Command . . .
1,275 683 53.56 595 87.11 592 46.43 235 39.69 46.66 18.50 65.16
Northern Command .
. 1,477 919 62.20 790 86.00 558 37.80 300 53.76 53.49 20.99 74.48
Southern Command . . .
1,076 716 66.54 549 76.68 360 33.45 162 45.00 51.02 15.06 66.08
Western (I.) District . . .
343 179 52.19 156 87.15 164 47.81
58 35.37 45.48
1 6 . 9 1 62.39
The increased percentage of isolations of dysentery organisms is, it is felt
largely due to the employment of buffered glycerine and saline solution when
taking specimens for examination. This method was described by Major A,
Sacks, R.A.M.C., in the Journal of the Royal Army Medical Corps, October,
1939.
It consists of 30 per cent glycerine in normal saline, adjusted with sodium
phosphate to a reaction of pH8, and tinted with phenol-red. This mixture
is put up in 10 c.c. quantities in small screw-capped bottles, and should only
be used if it is of a pink colour. The development of acid, which is liable to
occur in glycerine, and is fatal to the dysentery bacillus, is shown by a change in
colour from pink to yellow.