33
The all India figure is really made up of two counter-balancing areas, the
North and West, with a decrease of admissions during the year and the East
and South which by their greater increases have affected the total rate.
In Southern Command there was an increase of 8 per 1,000 and the need for
fly proofing of dining rooms and latrines in cantonments is stressed. In Deccan
District, with Mhow and Nasirabad as the worst stations the admissions have-
increased by 4 per 1,000 to the highest for 6 years. Rs. 15,480 have been
sanctioned for fly-proofing of latrines in cantonments. In this District to troop
movements an increase in infections is attributed, having occurred en route and
becoming evident by the admission of a number of cases 4 or 5 days after arrival
at the new station. In Eastern Command there has been a steady increas
eover the past 3 years attributed definitely to insanitary conditions and fly
borne infection. In Meerut District the dysentery-diarrhœa group has
increased in every principal station to the highest seen over 5 years; this is.
put down as being an infection either through bad sanitation or a water borne
infection. As there has been no water supply at fault in the stations concerned
it points to bad sanitation and sanitary control as being the essential cause of
this increase.
On the other hand in Western Ind. District there has been a decrease in
both Quetta and Karachi. There was an outbreak of diarrhœa at a training
camp involving 250 men of whom 4 had to be admitted to hospital. Owing
to a broken road access was difficult and the cause not traced.
In Northern Command the year shows a decrease of nearly 5 per 1,000 but
a ten year survey shows little real evidence of decrease. " This is bound to be
so as long as we have no effective immunisation as for Enteric and as long as
sanitation remains primitive and conservancy methods remain as they were 35
years ago. Bazar sanitation and excretal disposal shows little signs of
improvement outside cantonments and in many cantonment bazaars is primi-
tive. Flies abound, Carriers abound and the infective material is readily
available in close proximity to lines. Only the introduction of real sanitation
will have any material effect. Modern sewage disposal is expensive ; likewise
fly-proofing of latrines and dining places. For British troops the fly-proofing
of dining rooms is the most important item."
Peshawar District shows a welcome decrease which is part of a steady
decrease from 32 to 11 per 1,000 during the past 6 years. Lahore District also
shows a decrease of 6 per 1,000 and Rawalpindi District 3 per 1,000. But
here 20 cases were from one unit in which " sanitary endeavour was not up to
the mark " ; and 7 cases were infected during train journeys and 4 in camp.
There was a mild epidemic amongst families at Cliffden in the Murree Hills.
Carriers ; Chronic cases.—The very obvious connection between chronic
cases who are the carriers and fresh cases is well shown by the following
examples :—
(i) At Lahore in connection with an epidemic of the dysentery-
diarrhœa group a chronic case, a fruit hawker, was discovered
amongst 27 menials examined.
(ii) In a large cantonment 0 . 07 per cent. of servants were proved as
chronic cases to be carriers of dysentery organisms. Amongst.
these was the head cook of the fashionable hotel at which 50
officers with their wives and children were living.
(iii) Two cases of Officers with dysentery were traced as due to direct.
infection by servants in the hotels in which they were living.