NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
124
The distribution of the various strains of dysentery bacilli throughout
the four Commands during 1939 is shown by laboratories in Table No. 101
and the percentage of each group in each Command in Table No. 102.
TABLE 101
Analysis of types of dysentery bacilli isolated during 1939, and positive results for
E. histolytica
Commands and Laboratories.
G r o u p A - I B - F l e x n e r A n d r e w ' s s t r a i n s V . W . X . Y . Z .
G r o u p A - 2 B o y d ' s s t r a i n s 1 0 3 , 1 0 7 a n d 1 1 9 .
G r o u p B B o y d ' s s t r a i n s 8 8 , 2 8 8 , D . 1 , 2 7 4 .
G r o u p C B - S o n n e .
B - S h i g a .
B - S c h m i t z
.
E n t a m o e b a h i s t o l y t i c a .
T o t a l .
Northern.
Kasauli . . .
5
5
8
25
1
. . .
. . .
44
Peshawar . . . 147
10
13
37
43
18
1
269
Kohat . . .
37
8
6
11
7
15
4
88
Razmak . . .
185
4
4
2
21
14
6
236
Rawalpindi . . .
86
20
22
32
37
6
. . .
203
Lahore . . .
43
. . .
1
14
10
5
10
83
B a n n u . . .
6 4
. . .
13
. . .
10
5
4
96
Sialkot . . .
12
1
3
. . .
4
3
1
24
Ambala . . .
15
. . .
. . .
12
7
1
7
42
Abbottabad . . .
10
4
3
2
4
1
. . .
24
Total .
604
52
73
135
144
68
33
1109
Southern.
Poona . . .
105
14
33
63
31
26
8
280
Colaba . . .
24
3
. . .
1
8
. . .
. . .
36
Bangalore . . .
34
2
. . .
34
13
7
4
94
Trimulgherry . . . .
48
14
25
13
15
10
7
132
Jubbulpore . . .
58
5
18
14
5
5
1
106
Mhow . . .
30
8
16
2
2
1
5
64
Nasirabad . . .
20
1
. . .
7
8
4
4
44
Total .
319
47
92
134
82
53
29
756
Western (I.) District.
Quetta. . .
40
28
33
41
6
11
2
161
Karachi . . .
30
2
2
10
3
1
. . .
48
Tot al .
70
30
35
51
9
12
2
209
Eastern.
Meerut . . .
52
27
26
28
10
6
3
152
Lucknow.. . ...
82
11
13
38
10
4
18
176
Calcutta . . .
64
4
4
26
7
9
9
123
Bareilly . . ..
17
12
11
9
13
2
11
75
Debra Dun . . .
27
1
2
3
4
2
16
55
Jhansi . . .
127
11
17
45
10
25
6
241
Allahabad . . .
33
. . .
. . .
5
9
. . .
2
49
Tot al .
402
66
73
154
63
48
65
871
Total all India
—
1939 . . .
1395
195
273
474
298
181
129
2945
1938 . . .
1254
193
257
457
236
169
223
2789
127
TABLE 104
Command.
OX 19.
OX 2.
OXK.
Northern . . .
14
3
20
Southern . . .
20
9
10
Eastern . . .
2
2
9
Western (I.) District . . .
1
. . .
. . .
Total all India . . .
37
14
39
It was noted that cases of infection with OX 19 and OX 2 occurred fairly
regularly throughout all the months of the year, but 27 out of the 39 cases of
OXK were infected during the months August, September and October. The
greatest number of cases that occurred during any one month was at Dagshai
where 8 infections with OXK were recorded in August.
Investigations have been carried out by various workers both civil and
military in an attempt to discover the vector of these fevers. The louse,
flea, tick and mite have in turn been under suspicion but so far no definite
conclusion has been reached.
Brucella Group infections.—Seventeen cases were diagnosed on serological
grounds throughout the year. In Razmak five cases occurred and as the
suspected source of infection was goats milk obtained surreptitiously by the
troops, a preliminary investigation was carried out by the D. A. D. P. with a
view to determining if brucella infections were common among such animals
in Waziristan.
Samples of blood from 75 female goats were tested for the presence or
absence in the sera of agglutinins of the brucella group of organisms. The
results are tabulated below:—
TABLE 105
Titre obtained.
Number examined. Emulsions employed.
0-25
25-50
50- 100 100-250 250-500
75 . . . B. abortus . . .
64
3
3
1
4
B. melitensis . . .
6
. . .
. . .
. . .
. . .
From the above table it will be seen that female goats suffer from B .
abortus infection to a definite extent, and the number that have been infected
at one time or another is at least 10 per cent. The fact that no significant
rise in the titre against B. melitensis was found in this investigation tends to
confirm the view, which is usually held, that B. melitensis infection does not
occur in Northern India. Although the drinking of unboiled milk in Waziristan
is forbidden, it is thought that the cases of Brucella fever which occur each
year among Indian troops may be due to drinking such milk derived from
unauthorised sources.
Further investigations on the above lines are being carried out during
1940.
Laboratory tests in connection with the diagnosis of syphilis.—The number
of Wassermann tests carried out in the four laboratories (Quetta, Poona,
Rawalpindi , and Meerut) engaged in this work numbered 18,668, and the
number of Kahn tests 13,835. These figures in the case of the former are
1,491 more than last year, and in the case of the latter show an increase of 317.
128
The percentage of haemolysed or septic sera, and broken capsules received
in the above laboratories was exactly the same as last year, only 1.5 per cent
which tends to show that great care must have been taken by hospitals in the
taking and despatch of specimens for examination. The employment of the
Kahn test as a check on the Wassermann test is considered by many to be
most essential, especially from the point of view of technical errors which may
be encountered in the actual performance of the tests. The check is also of
value in the case of diseases which may give a false Wassermann reaction,
and also in cases with no history of syphilis in which the diagnosis is " tonsil-
-litis " or perhaps " dermatitis ". In such cases a doubting medical officer
may not accept the result of a single test with the result that treatment is
delayed ; but, if a positive Wassermann reaction is supported by a positive
Kahn test treatment may be commenced immediately. In the case of syphilis
a positive Wassermann reaction appears earlier than a positive Kahn, but on
the other hand the latter persists longer, and so has a definite advantage as a
control on the effects of treatment.
The District Laboratory, Quetta, has continued the practice of bleeding
guinea pigs for complement only once a month. The Officer Commanding
the laboratory reports that he has had no difficulty in keeping complement
frozen for six weeks or even two months and then still obtaining a satisfactory
titre of 1/50.
The work done in the four laboratories and results obtained are shown
in Tables 106 and 107.
TABLE 106
Wassermann and Kahn tests—1939
Total Wasserman n
tests carried
out.
T o t a l W a s e r m a n n t e s t s c a r r i e d o u t o n b l o o d s c r a f r o m a l l s o u r c e s .
T o t a l W a s s e r m a n n t e s t s o n C . S . F
T o t a l K a h n t e s t s .
P e r c e n t a g e s e r a h æ m o l y s e d a n d s e p t i c .
P e r c e n t a g e c a p s u l e s b r o k e n .
Laboratory.
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 .
Ind.
Br.
Ind.
Br.
Southern Command Labo-
ratory, Poona.
2,293
2,967
5,982
98
5,246
4.36
3.47
0.74
0.30
District
Laboratory,
Rawalpindi.
1,707
4,150
6,047 104
2,541
0.46
1.00
0.75
0.23
District
Laboratory,
Meerut.
1,912
2,094
4,293
73
4,276
4.20
4.50
0.16
0.53
District
Laboratory,
Quetta.
844
936
2,022
49
1,772
0.94
1.35
0.35
1.25
Total. 6,756 10,147 18,344 324
13,835
. . .
. . .
. . .
. . .
TABLE 107
Results of Wassermann tests—1939
Poona.
Rawalpindi.
Meerut.
Quetta.
Negative. Positive. Negative. Positive. Negative. Positive. Negative. Positive.
Syphilis Primary (before
treatment)
. . .
36
297
13
52
16
152
...
3
Syphilis secondary . . .
. . .
60
. . .
7
. . .
43
. . .
14
S y p h i l i s t e r t i a r y . . .
. . .
70
1
8
. . .
84
. . .
17
Syphilis (after treat . . .
* 1 , 6 7 7
315 1,632
556
1,270
175
488
116
Gonorrhæa . . .
12
6
4 3
7
10
. . .
. . .
. . .
* In view of the transfer of units to other commands and overseas, these figures are not absolutely
accurate furthermore, some of the cases are still undergoing treatment.
129
The number of cases diagnosed primary syphilis on a positive Wassermann
reaction is still considered to be too high. In the case of Indian troops there is
little doubt. that many report late for examination having previously obtained
local treatment in the bazaar.
In the case of hospitals situated in a station where no laboratory facilities
exist the practice is still continued of forwarding specimens of sera (taken from
the sore) in capillary tubes to the nearest laboratory for examination. Experi
-
ence has shown that spirochaetes remain alive for many days under these
conditions but medical officers seem to find it very difficult to send suitable
specimens. In a large number of cases the specimens received consisted of
blood only. In 50 cases however out of 300 forwarded for examination posi
- t i v e r e s u l t s w e r e o b t a i n e d a n d e n a b l e d t h e s e p a t i e n t s t o b e t r e a t e d b e f o r e
their Wassermann reaction became positive.
•
The following tables show the method by which primary infections in the
case of British and Indian troops were diagnosed throughout the year by
Commands.
TABLE 108
British Troops
Number of cases of syphilis fresh diagnosed.
Number of
cases of
syphilis
fresh admitted
to Hospital.
By demonstra-
tion of T. pal-
lida.
On Positive
Wassermann
Reaction.
By demonstra
-
tion of T. pal
-
lida and on
positive
Wassermann
Reaction.
Northern Command . . .
61
31
22
8
Eastern Command . . .
92
40
46
5
Southern Command . . .
118
49
55
14
Western (I.) District . . .
16
12
2
2
Total all India. . .
287
132
125
29
TABLE 109
Indian Troops
Number of cases of syphilis fresh diagnosed.
Number of
cases of
syphilis
fresh admitted
to Hospital.
By demonstra-
tion of T.
pallida.
On positive
Wassermann
Reaction.
By demonstra -
tion of T.
pallida and on
positive
Wassermann
Reaction.
Northern Command . . .
122
30
83
9
Eastern Command . . .
99
35
61
3
Southern Command . . .
117
24
75
12
Western (I.) District . . .
18
3
15
. . .
Total all India . . .
356
92
234
24
133
In the case of Wellington a total of 1,075 examinations was carried out
which included all routine examinations normally entrusted to District or
Brigade laboratories. In the case of dysentery specimens showing a typica
l bacillary exudate causative organisms were isolated in 81 per cent. of cases,
and in those with an indefinite exudate in 50 per cent.
In the past it has been the custom for all results obtained by these en
-larged clinical side rooms to be checked by the parent laboratory but in all
cases results were found to be so satisfactory that this practice has been dis
-continued.
In December 1939 another enlarged clinical side room was opened at Wana
and it is anticipated that it will prove itself to be as useful and efficient as those
already established.
Library.—The Medical Directorate's Technical Library has again been
extensively used by many medical officers throughout India, a total of 165
reference books having been issued on loan and 40 new volumes purchased.
Medical Co-operation. —It is again very satisfactory to note this year that
practically all officers commanding hospitals have made special reference in
their annual medical transactions concerning the close liaison between the
pathologist and the medical officers in charge of cases. It is undoubtedly due
to this liaison that the results throughout the year have again been so satisfac
-tory.
66. Medicine.
(i) Malaria being one of the commonest conditions receives considerable
attention from the therapeutic side. The standard course of treatment, which
is recommended but not compulsory, is:—
British troops
—
Atebrin
0.3 grammes daily for 7 days. Interval of three days.
Plasmoquine
0.03 grammes daily for 5 days.
Indian troops—
Atebrin
0.3 grammes daily for 7 days. Interval of three days.
Plasmoquine
0.02 grammes daily for 5 days.
In quite a number of stations medical officers prefer to use an initial
treatment of Quinine grs. X T. D. S. until the case is afebrile or for two days
prior to the exhibition of Atebrin.
In some cases Atebrin musonate has been used for a similar purpose.
In the majority an iron and arsenic tonic is added for convalescence.
One case of temporary acute mania after Atebrin is recorded for a Sepoy
in Southern Command.
Results from this treatment appear to be definitely satisfactory as indi
-cated by the reduction of malaria in British troops and general fall in its inci
-dence. One pessimistic medical specialist however considers the relapse rate
is much higher than it is generally held to be. He estimates the figure at 31
per cent. for benign tertian and 19 per cent for malignant tertian cases in British
troops.
Several observers have commented to the effect that "It is remarkable
that the same individuals come into hospital with malaria each succeeding
season. It would appear that such cases never develop immunity".
Another explanation may of course be that these individuals are "infec
-tion-prone" from carelessness or deliberate disregard of precautions.
134
A drug called Tebetren has been tried for treatment, but preliminary
reports do not indicate any remarkable success.
Malignant tertian malaria was considerably in evidence in certain areas
and quartan cases were reported. Some of the malignant cases were definitely
connected with infection at Kathgodam on the way to or from Ranikhet.
(ii)
Dysentery.—Of Bacillary dysentery Flexner has of course formed the
bulk, but Shiga and other groups were present to about 10—15 per cent. of
cases.
Amoebic dysentery and amoebic hepatitis were particularly noted in
Southern Command and from Lucknow District.
Routine sodium sulphate treatment with high protein diet has sufficed
for the ordinary bacillary dysentery, though serum treatment was needed
in the more severe cases (Shiga). Yatren was used by some both for bacillary
and amoebic types. Bismuth Emetine Iodide was successfully used for the
amoebic cases and hepatitis.
In one chronic case with four months history no organism could be isolated
in hospital although the laboratory was next door and the patients serum
agglutinated a Boyd organism to 1 in 125. After discharge from hospital an
organism was isolated from a stool specimen sent in buffered glycerine from
an out station.
(iii)
Sancfly fever.—An epidemic was reported from Lucknow which pro
-duced 160 admissions for British Troops between May and October. The type
was mild, fever 3—4 days with some saddle back temperatures. P. papatassii
were prevalent throughout the season, but the type of fever changed to that
of dengue later in the season, though there was no rash. At this time Aedes
egypti were very prevalent for a while. Differential diagnosis is by no means
easy.
In Quetta the average pyrexial period proved to be 2½ to 3 days and the
average stay in hospital 8.2 days.
From the comments made on these cases of short fevers; sandfly fever,
dengue, sellar fever, influenza, it is obvious that our methods of diagnosis are
far from accurate and much may depend on the whim of the individual.
(iv)
Jaundice was noted from many places but all cases were considered
to be jaundice of the simple catarrhal type often with a history of chill or expo
-sure after considerable heating or of indiscretions of diet.
Digestive diseases and peptic ulcers were treated with many methods
and particular comment is made on the difficulty of post hospital dieting for
the unmarried soldier. In some cases ration money has been issued for the
purchase of meals.
A case of complete atrophy of the whole of the intestinal mucosa from
mouth to rectum in a child aged 18 months of undetermined cause is men
-tioned.
Typhoid fever cases from Bannu included one so typical that he formed a
valuable lesson to orderlies under training.
(v)
Kala-azar cases of long standing with severe anaemia were treated
successfully at Lahore with Urea Stibamine after neostibosan had been used.
The medical specialist concerned considers the former gives better and more
lasting results than Neostibosan. But at Bangalore a case was successfully
treated with Neostibosan.
139
(v) Blood transfusion .—Comment is made that the service has improved
but it is difficult to persuade donors to give blood even with the grant of con
-
cessions such as leave, etc. A central blood donor fund and payments for
gifts of blood has been recommended and is in process of arrangement.
(vi) Operating theatres are steadily being improved as also is equipment
although surgeons are inclined to complain of the quality of the latter. Light
-
ing is a difficulty particularly where electric light is not available.
Stubb's shadowless lamp has been authorised for a number of hospitals.
An indigenous operating table made by a firm at Multan has been reported
on as satisfactory in every way.
—Heating or cooling of theatres is also a problem when external tempera
-
tures may vary from 20° F. to 115° F.
Cooling plants were installed as a trial by a civilian firm from Delhi for
the Surgical Ward and Operating theatre at the B. M. H., Meerut, which have
proved to be a great success, all work being carried out under better condi
-
tions and the patients benefitting by better results. Perspiration was reduced,
fatigue diminished and cases healed by first intention. This theatre could
also be utilised for the treatment of heat stroke. It had been hoped to make
this plant permanent for the theatre, but funds not being available the perma-
- n e n t i n s t a l l a t i o n h a s h a d t o b e p o s t p o n e d .
TABLE 110
Surgical Operations—1939
Operations.
Total
Number.
Re-
covered.
Invalided.
Died.
Remarks.
King's Commissioned
Officers (British Service).
Ear, nose and throat . . .
2
2
. . .
. . .
Digestive . . .
58
58
. . .
. . .
Genito-urinary . . .
9
8
1
. . .
Bones, joints, muscles, fas-
ciæ and bursae.
59
58
1
. . .
Skin and subcutaneous tis-
sues.
74
73
. . .
. . .
1 to U. K. for
skin graft.
Tumours and cysts . . .
19
19
. . .
. . .
Blood vessels . . .
12
12
. . .
. . .
King's Commissioned
Officers (Indian Army).
Digestive . . .
78
77
. . .
1
Blood transfusion.
1
. . .
. . .
Bones and joints . . .
55
47
4
1
3 still in hospi-
tal.
Skin and subcutaneous tis-
sues. . .
108
108
. . .
. . .
Injuries . . .
2
2
. . .
. . .
Tumours and cysts . . .
2
2
. . .
. . .
Genito-urinary . . .
3
3
. . .
. . .
British women and children.
Ear, nose and throat . . .
60
60
. . .
. . .
D I g e s t i v e . . .
48
. . .
. . .
Bones and joints. . .
35
34
. . .
. . .
Breast. . .
4
. . .
. . .
Genito-urinary tract . . .
50
50
. . .
. . .
Skin and subcutaneous tis-
sues. . .
42
42
. . .
. . .
Tumours and cysts . . .
4
4
. . .
. . .
Blood transfusion . . .
1
1
. . .
. . .
140
Operations.
Total
Number.
Re-
covered.
Invalided.
Died.
Re ma r k s .
Warrant Officers, N. C.
Officers and men of the
British Army.
Eye .
.
.
. .
10
1
. .
..
Ear, nose and throat
.
52
52
Blood vessels
.
. .
51
50
1
..
Glands
.
.
.
.
26
26
..
..
Respiratory
.
. .
22
22
..
Digestive .
.
.
.
490
484
1
5
Male genitalia and urinary .
178
178
Skin and subcutaneous tis-
sues.
825
824
1
..
Tumours and cysts .
.
77
77
..
. .
Limbs
.
.
. .
6
5
1
Bones and joints
.
.
620
617
2
1
G. S. Wounds .
.
.
26
25
1
British all others (R. N. and
R. A. F., etc.).
Eye .
.
.
.
.
13
13
. .
Ear, nose and throat .
.
14
14
..
..
Blood vessels
.
.
.
1
1
Digestive .
.
.
.
155
152
1
2
Genito-urinary .
.
.
68
68
Bones and joints
. .
122
118
2
2
Skin and subcutaneous tis-
sues.
235
234
. .
1
Tumours and cysts .
.
15
14
..
1
Blood transfusions
.
.
1
1
. .
Lymphatic system .
.
5
5
. .
. .
G. S. wounds
.
.
.
1
1
..
..
Indian other ranks.
Ear, nose and throat .
.
55
55
..
. .
Digestive .
.
.
.
273
265
..
8
Genito-urinary . . .
134
134
Bones and joints
.
.
493
486
3
2
2 patients have
been boarded
out.
Skin and subcutaneous tis-
sues.
842
842
..
..
Tumours and cysts .
.
79
79
..
..
Respiratory system .
5
4
1
Blood transfusions
.
6
6
..
. .
Eye .
.
.
.
33
33
..
..
G. S. wounds
.
.
68
54
4
8
2 still in hos-
pital.
Lymphatic system
.
33
32
1
..
141
68. Radiology.
There has been a general increase in the work done, in some cases this has
more than doubled in the past 5 years. A summary is given below and the
complete table will be found in Part II.
Film papers are now used to a great extent especially for positioning
fractures after treatment. But comment is made that the definition is often
not so good with papers and that they do not store well owing to the tendency
to curl.
Portable X-ray sets have repeatedly proved their value. In places where
such are not available there is a strong demand for the provision of these sets.
The examination of pulmonary cases, pyelography, control and examina
-tion of stomach contents after barium meals are types of X-ray work which
are increasing in our hospitals.
At Rawalpindi 7 Nursing Sepoys of the I. H. C. were trained and qualified
in electric message.
At Quetta the new X-ray and electro-therapeutic block was taken into
use and found to be eminently satisfactory.
Cases of interest were:—
1. A B. O. R. aged 23 with Marie Strumpell's spondilitis.
2. A B. O. R. aged 22 with Freibergs infarction.
3. A Sapper aged 35 with history of old injury. Radiogram showed a
fusion of the 1st and 2nd right ribs into a broad plaque of bone
and joining the sternum by a broad cartilage, deformity of the
lower edge of the 7th cervical vertebra and a solution of conti
-nuity of the 1st rib suggesting ununited fracture.
TABLE 111
Summary of X-ray examinations for the year 1939
[Compiled from I. A. F. (Medical)-27.]
No. of patients examined—
British . . .
14,194
Indian . . .
12,390
Civilian . . .
2,007
Number and nature of examination carried out—
Bones and
Joints.
Injury . . .
16,403
Disease . . .
2,869
Sinuses . . .
853
Teeth . . .
1,221
Lungs . . .
4,056
Heart . . .
195
Gastro intestinal . . .
665
Liver and gall bladder . . .
389
Urinary tract . . .
1,041
Genital tract . . .
217
Miscellaneous . . .
629
Foreign body . . .
74
142
Class in which a contrast medium was used and nature of medium—
Barium . . .
598
Uroselectan B . . .
131
Shadacol . . .
174
Perabrodil . . .
4 1
Pregnancy . . .
1 1 9
Lipiodol . . .
30
Miscellaneous information—
No. of ordinary film used . . .
34,745
No. of dental films . . .
5,287
No. of exposures . . .
53,893
No. of X-Ray papers . . .
4,112
No. of screen examinations . . .
7 3 8
69. Anaesthetics.
The number of anaesthetics is given below and shows an increase of 462
—
(i) The methods employed vary considerably with the predeliction
of the anaesthetist and of the surgeon. Chloroform and Ether
1 to 4 followed by open ether is often the stock method. Ship
way's apparatus has given valuable service in some stations.
Magill's gas and Oxygen apparatus was favoured in the Western
(Ind.) District. In Rawalpindi and Murree nitrous oxide and
oxygen, with or without ether and with novocaine for local
infiltration has been the standard method. Here spinal anaes--
thesia has not been used so much as previously, whereas at
Bannu, Poona, Razmak and Bombay spinal anaesthesia using
- P e r c a i n e 1 / 5 , 0 0 0 ( H y p o b a r i c s o l u t i o n o f H o w a r d ) , 1 0 — 1 4 c . c .
was much favoured. Sodium evipan was employed with satis
- f a c t i o n f o r a s e r i e s o f c a s e s i n s e v e r a l l a r g e s t a t i o n s . R e c t a l
anaesthesia with Paraldehyde or Avertin has also been used over
a series of cases. The Specialist in Razmak considers the results
are good in giving prolonged post-operative rest with diminished
shock, but at Quetta objection is made because it fails in some
individuals and the method has been abandoned except for
children.
One ease is recorded of post-stovaine neuritis of the lower cord ele
- m e n t s c o n t r o l l i n g t h e s c r o t a l - g l u t e a l a r e a s a n d t h e r e c t u m a n d
bladder. Very slow partial recovery is proceeding. This un
- u s u a l c o m p l i c a t i o n i s c o n s i d e r e d t o b e d u e t o a p e r s o n a l h y p e r -
sensibility.
Investigation is in progress on the use and results of Nembutal-Hyos
-cine as a pre-operative sedative. Results are encouraging but
not yet complete. So far the use of these drugs shows that at
least 75 per cent are completely or to a great extent given amensia
before the operations.
Di-vinyl ether was used on 4 occasions but it is costly and scarce.
Results are good. Three cubic centimetres in a closed inhaler
gives deep anaesthia for 70—90 seconds—induction under 1
minute and recovery with no vomiting immediately after removal
of the mask. A locally made modification of Goldman's inhaler
was used.