NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
16
returning leave men, reservists and recruits arriving from their homes already
infected ; in the increased dysentery in certain stations and the relative increase
of unfits in depot stations from which units had departed. In fact so great
has been the effect of this factor that only a perusal of the sections on disease
will show the full effects.
•
After the outbreak of War overcrowding in barracks was common in many
stations. This was in most cases only temporary and produced no ill effects,
medical officers were however watchful and precautions such as " head and
tail " arrangements of beds were put into effect where necessary.
One remarkable result is shown in paragraph 64 dealing with hot weather
precautions in that British troops and their families could be moved by train
during the hot weather months without serious harm, provided adequate pre
cautions were taken throughout the journey. Likewise drafts of young
.British troops arrived during hot weather months without any grevious
consequences.
The manning of defensive posts had a marked effect on the health of troops
because preventive measures against malaria or sandflies or fly borne dysentery
were in some cases not successfully carried through or even not used at all.
Civil disturbances affected two groups of troops ; one in the east where a
small force of troops was out in the Cuttack District for several months and the
other in the west where disturbances at Sukkur in November necessitated the
presence of troops for some weeks. Health remained remarkably good in
spite of troubles with dust, flies and mosquitoes and in spite of camping sites
unsatisfactory from every hygienic point of view.
Principal Diseases affecting British Troops.
7. Malaria.
Considering the conditions malarial admission rates have been satisfactory
for all India. It is true that the admission rate at 58.1 per 1,000 is higher than
the good years 1935-37, but reductions in total strengths during the autumn
partly account for this apparent rise and the early return to the plains and war
activities already referred to in paragraph 6(d) are definitely the cause of the
real increase.
•
The increase for all India is entirely due to " Fresh " cases which have
risen by nearly 11 per 1,000 whereas " Relapses " have decreased by 3 per
1 , 0 0 0 ,
vide Table 14.
The all India incidence of total cases for past years is shown below in Table
12 and even more clearly in graphic form for the past 20 years in chart No. 2.
TABLE 12.
Malarial incidence over past 10 years.
Ratios per 1,000.
British.
Indian.
1913 .
.
.
.
.
.
.
.
. 125.5
100.4
1919 .
.
.
.
.
.
.
.
.
217.8
145.6
1930 .
.
.
.
.
.
.
.
.
118.4
153.4
1931 .
.
.
.
.
.
.
.
.
112.5
149.4
1932 .
.
.
.
.
.
.
.
.
84.1
145.0
1933 .
.
.
.
.
.
.
.
.
103.3
212.2
.1934 .
.
.
.
.
.
.
.
.
67.5
156 5
1935 .
.
.
.
.
.
.
.
.
56.1
125.9
1936 .
.
.
.
.
.
.
.
.
58.0
123.1
1937 .
.
.
.
.
.
.
.
.
44 5
97.9
1938 .
.
.
.
.
.
.
.
.
50.4
109.6
1939 .
.
.
58.1
118.3
18
CHART NO. IV.
MALARIA. BRITISH—
INDIAN—
ADMISSION RATIO PER 1,000 OF STRENGTH.
INDIAN
B R I T I S H
Y E A R
The seasonal incidence of Malaria for British and Indian troops is well
shown in chart No. 5 giving the monthly incidence over the past 5 .years:
MALARIA ALL INDIA
CHART No. V.
BRITISH TROOPS
= — I N D I A N T R O O P S = —
MONTHLY ADMISSION RATIOS PER 1000 OF STRENGTH.
20
In the Western Ind. District a bad malarial year was forecast but very
energetic antimalarial measures were instituted and proved so successful
that the total cases were the lowest for 8 years. " When it is realised that in
the Lora river about 2 miles from and outside cantonments the mosquito
larvae were so thick in July that the water presented a heaving black mass and
35,000 mosquitoes were trapped, the majority being almost equally divided
between Anopheles subpictus, culicifacies and stephensi ; and yet 1939 is the
second lowest malarial year on record ; one must come to the conclusion that
anti-malarial measures were of some avail."
As illustrative of the reduction in cases in large cantonments the following
table is of interest showing the actual admissions at Rawalpindi and Lahore
over a series of years.
TABLE 13.
British Malarial cases in Rawalpindi and Lahore
Actual admissions.
Year.
Rawalpindi.
Lahore.
1924 .
.
.
.
-
.
.
-
.
. .
4370
1925.
.
.
.
.
.
.
.
.
473
2245
1926 .
.
.
.
.
.
.
.
.
469
2479
1927 .
.
.
.
.
.
.
.
.
549
1524
1928 .
.
.
.
-
.
-
-
.
370
886
1929 .
.
.
.
.
.
.
.
.
433
1097
1930 .
.
.
.
.
.
.
.
.
133
1320
1931 .
.
.
.
.
.
.
.
.
86
1047
_
1932 .
.
.
.
.
.
.
.
.
69
679
1933 .
.
.
.
.
.
.
.
.
70
1047
1934 .
.
.
.
.
.
.
.
.
64
371
1935 .
.
.
.
.
.
.
.
.
50
296
1936 .
.
.
.
.
.
.
.
.
106
303
1937 .
.
.
.
.
.
.
.
.
84
171
1938 .
.
.
.
.
.
.
.
.
94
114
1939 .
.
.
.
.
.
.
.
.
4 1
292
It should be noted that at Lahore a considerable proportion of the British
garrison is in barracks in a small enclave in the middle of the town and away
from the protection of cantonment hygiene.
The beneficial results obtained by spraying barracks, quarters and followers
lines with insecticide sprays is becoming more and more evident from reports
from all stations. A systemetic programme of spraying is essential. We have
now succeeded in introducing an official pyrethrum spray solution at cheap rates
for indent purchase from medical stores. This is made available to all anti
malarial officers and may be purchased by individuals for self protection. The
concentrated extract or ready made solution are prepared by Medical Stores
Depots from Empire (Kenya) produced pyrethrum flowers (see paragraph
64-B).
Treatment.—The standard method of treatment detailed in last year
report has been continued with success.
.
As soon as War became likely steps were taken to investigate the possibility
of obtaining Atebrin and Plasmoquine from Empire sources instead of from our
potential enemy. This point received reference in the previous report namely
the extreme unsoundness of a method which relied on enemy firms for its source
of supply.
21
At the outbreak of War stocks were reviewed and enquiries set on foot to
obtain supplies from Empire sources and orders were issued to restrict the use
of Atebrin and Plasmoquine to their legitimate use of treatment of malarial
cases. The British made drug, Tebetren was investigated and a trial was
instituted, but some-what late in the season. The results have been sufficiently
good to encourage further trial.
The prophylactic treatment of troops with atebrin received a large scale
trial in Waziristan, but the results were very indifferent and further use for this.
purpose has been stopped. Details of this trial are given in paragraph 64B.
(c) (iv).
The following Table gives the admissions for " fresh and relapse " cases by
Commands over the past 5 years and shows a satisfactory position for all India
and Southern and Eastern Commands for relapse rates, though in Northern
and Western Commands relapse rates have increased somewhat.
TABLE 14.
Admission ratios per 1,000.
1935.
1936.
1937.
1938.
1939.
Northern Command
Fresh.
44.1
45.6
30.2
34.0
51.8
Relapse.
13. 2
32.8
15.3
22.0
24.0
Total.
57.3
78.5
45.6
56.0
75.8
Eastern Command .
Fresh.
31.4
30.5
14.9
19.4
25.8
Relapse.
13.4
6.3
9.0
13.6
5.9
Total.
44.8
36.8
23.9
33.0
31.8
Southern Command
Fresh.
38.8
36. 3
34. 2
43.7
51.0
Relapse.
10.2
9.0
9.0
16.3
10.8
Total.
48.9
45.3
43.2
60.0
61.8
Western (Ind.) Dist
Fresh.
111.3
56.8
101.5
38.3
43.1
Relapse.
24.8
47.1
22. 0
21.0
25.2
Total.
136.1
103.9
123.5
59.2
68.3
All-India*
.
.
Fresh.
43.1
39.2
32.6
32.6
43.3
Relapse.
13.1
18.7
12. 0
17.8
14.8
Total.
56.1
58.0
44.5
50.4
58.1
*1937 and 1938 do not include Burma.
In Southern Command at Mhow where 31 per cent. of B. T. cases and 19
per cent. of malignant tertian cases relapsed it was particularly noticed that it
is the same individuals who come into hospital year after year and their condi
tion is probably that of reinfection and not relapse.
Malarial situation in Commands.-In Northern Command although there
was a moderate increase in total rates due to increases in fresh and relapse,.
the incidence is markedly less than it was 10-15 years ago. The disease inci
dence has really shown itself in two distinct and contrasting areas. A southern
zone with high rates in Lahore District and Waziristan District, Western.
Ind. District shared in this increa se in prevalence ; and a northern zone with
low rates, Peshawar District with the lowest rates ever recorded, 33 per 1,000,
Rawalpindi District with the remarkable figure of 41 cases and Kohat District
with low rates except for cases imported from Multan. The Rawalpindi
admissions of the past 4 years are worth noting : 106-84-94-41.
In Waziristan there was a heavy outbreak at Razani Camp due to infec
tion from neighbouring uncontrolled villages. In Lahore District including
Multan, Ferozepore, Lahore Cantonment and Ambala light scattered showers,.
high humidity and a late summer which was prolonged well into the late autumn.
22
at a time when troop movements and unusual postings were in progress, were
responsible for definite malarial outbreaks.
In Delhi Province military personnel have shared in, the benefits achieved
by the Malaria Institute of India in the anti-malarial improvements which
have been made round Delhi and New Delhi.
In Eastern Command the excess rains in the U. P. lead to a slight increase
in fresh cases limited chiefly to Meerut District although civil reports show there
was marked prevalence in Orissa and Bengal.
In the South the malarial incidence was rather less than usual in Madras
and Deccan Districts, although civil reports indicate an unusual epidemic in
Madras Presidency. In Bombay District malaria was widespread and pre-
valent in the civil population and military personnel were similarly affected.
Admission rates at Mhow and Jubbulpore were also markedly increased. In
the Bombay area lack of attention to recognised methods of prevention or
lack of discipline were definitely the cause of many admissions ; for example
at one defensive outpost of 32 men nets were not used for the first 4 days
because no means of supporting the nets over the men's beds had been provided,
of this group 32 men were eventually admitted for malaria ; in another case
a surprise visit by the medical officer discovered 11 men in one room and 9 men
•
in another sleeping in a malarious area without their mosquito nets.
In Western Ind. District the rate for malaria has risen from the low record
of last year, but can still be considered as satisfactory as being half that of
practically all previous years. This decline in cases is attributed to the enthu
siastic work of an energetic anti-malarial officer and efficient cantonment and
unit malarial squads.
The incidence in this District has been as follows :—
TABLE 15.
Strength. Admissions. Admission rate
per 1,000
Quetta—
1893
.
.
.
.
.
2098
2475
1171.12
1894
.
.
.
.
.
2219
1919
864.85
1918
.
.
.
.
.
3805
1856
490.00
Western Ind. District —
1933
.
.
.
.
.
..
..
204.00
1934
.
.
.
.
.
..
..
160.47
1935
.
.
.
.
.
..
..
136.10
1936
.
.
.
.
.
..
..
103 90
1937
•
•
•
•
•
. .
..
123.55
1938
.
.
.
.
.
..
..
59.20
1939
•
•
•
•
•
..
..
68.30
Of the larger stations there were only four with malarial rates greater than
the all India rate of 58.1 viz : Razmak with 178.3 per 1,000 due to the infec
tions at Razani ; Meerut with 67.3 included in the generally prevalent infection
in the U. P. ; Poona at 78.6 and Mhow at 98.2 which shared the prevalence of
the Bombay and C. P. areas.
The types of malarial infection by Commands over the past 3 years are
shown below. The number of cases which are diagnosed clinically, 2.8 per
cent. is satisfactory.
23
TABLE 16.
Comparative diagnoses of Malaria by Commands.
(Percentages.)
Command.
Year.
B. T.
M. T.
Q. T.
Mixed.
Clinical.
Northern
.
.
1937
76.42
17.45
0.47
1.41
4.25
1938
77.45
21.07
..
0.37
1.11
1939
73.24
23.82
0.21
0.52
2. 20
Eastern
.
.
1 9 3 7
84.44
11.94
0.83
0.83
1.94
1938
79.36
10.78
0.91
3.90
5.05
1 9 3 9
74.92
18.95
0.29
1 75
4.08
Southern
.
.
1937
65.81
26.13
1.93
3.23
2.90
1938
64.99
23.43
3.91
5.30
2.37
1939
65.33
27.86
1.70
2.48
2.63
Western I. District
1937
69.29
27.07
0.40
1.21
2.02
1938
77.03
14.35
. .
0.96
7.65
1939
68.46
20.13
1.34
4.70
5.37
ALL INDIA
.
1937
73.00
21.32
0.95
1.80
2.94
1938
73.67
19.13
1.47
2.77
2.95
1939
70.73
24.01
0. 76
1 63
2.87
The high relative incidence of Quartan infection and mixed infections in
Southern and Western Commands compared to the other two areas is inter-
esting. M. T. Infections were 14 per 1,000 in both the former and only 3
and 2 per 1,000 in the latter.
8. Sandfly Fever.
This unpleasant and debilitating condition has shown a distinct rise both
for British and Indian troops, a rise of 6 per 1,000 for the former and of 1.
3 p e r 1 , 0 0 0 f o r I n d i a n ; b u t t h e s i c k n e s s t h e r e f r o m i s s t i l l w e l l b e l o w t h e p r e - 1 9 3 7
period when spraying was seriously introduced.
The cause of this increase has been an epidemic at Agra in the Delhi Brigade
Area, where there was a jump of 34 per 1,000, this increase spread to the
Lucknow area ; a marked increase of nearly 8 per 1,000 in the Rawalpindi
District area ; an increase in Lahore District chiefly due to 74 cases
at Sialkot and Ferozepore during the hot weather and a definite prevalence of
the infection in the premonsoon period at Lucknow.
TABLE 17.
Sandfly fever over past 10 years.
Ratios per 1,000.
Year.
British
Troops.
Indian
Troops.
1930 .
.
.
.
.
.
.
.
49.4
12.1
1931
.
.
.
.
.
.
.
.
39.4
16.3
1932 .
.
.
.
.
.
.
40.9
15.2
1933 .
.
.
.
.
.
.
.
40.9
10.4
1934 .
.
.
.
.
.
.
.
36.2
8.3:
1935 .
.
.
.
.
.
.
.
36.5
7.5
1936 .
.
.
.
.
.
.
33.8
10.6
1937
.
.
.
.
.
.
.
.
24.6
.
6.6
1938 .
.
.
.
.
.
.
.
24.8
4.6
1939 .
.
.
.
.
.
.
30.7
6.0
24
At Agra on the 6th September there was an immense downpour, 15 inches
of rain within 2 days which did much damage to mud walls. This was followed
by an epidemic of sandfly fever with as many as 50 admissions from military
personnel in one day. The Delhi Brigade admission rate jumped 34 per 1,000
to 53.5. Energetic measures were adopted including the spraying of buil-
dings with insecticide and the epidemic ceased as abruptly as it had begun.
In the Lucknow area sandfly fever was very prevalent the pre-monsoon
period and was also noted into P. and A. District. The result of these out
breaks was that the sandfly fever admission rate for Eastern Command rose to
35.34 per 1,000.
Rawalpindi District : the rate rose 7.71 per 1,000 to 51, the highest figure
for at least 10 years. But for Northern Command as a whole the incidence has
been low, though slightly increased on 1938, for the third successive year i.e.
since spraying campaigns were introduced. The actual admissions have fallen
from 1260 in 1931 to 654 in the present year and in Peshawar District, which
has been notorious for sandfly fever the admission rate has fallen below 100 per
1,000, viz. 93.29, for the first time. The rate for Landikotal at 107 per 1;000
is satisfactory, but the rate in Peshawar itself is considerably higher at 130.8.
This improvement is again attributed to the spraying campaign which even
at every 4th day is the most potent protective means we have. At 93 per,
1,000 in Peshawar District the admissions for sandfly fever have fallen from 17
per cent. of the total . admissions for all causes in 1938 to 14 per cent. in the
present year.
TABLE 18.
Sandfly fever in Northern Command.
Year.
Admissions
Ratio per
1,000.
1931 .
.
.
.
.
.
.
.
72.16
Spraying campaign was
instituted in Peshawar
District and taken up
gradually in other
Districts.
1 9 3 2 .
.
.
.
.
.
.
.
8 4 . 3 8
1 9 3 3
•
•
•
•
•
.
.
.
85.58
1934 .
.
.
.
.
.
.
.
80.04
1935 .
.
.
.
.
•
.
.
82.37
1936 .
.
.
.
.
.
.
.
80.37
1937 .
.
.
.
.
.
.
.
51.15
:1938 .
.
.
.
.
.
.
.
47.57
1939 .
.
.
.
.
•
.
.
52.39
In Southern Command there was little change : of 33 cases 19 came from
Bombay and 14 from Jubbulpore.
Western Ind. District, however, in contrast to the previous year shows a
decrease of 60 per 1,000 to 54.75 a very much more reasonable figure. It
is too soon to shout that our measures are successful but the reduction has
been is attributed to :
(a) improved housing in the new barracks ;
(b) destruction and removal of old buildings and rubble ;
(c)
increased efficiency of spraying.
25
When things go well we are inclined to forget the natural reductions which
may occur from climatic and other causes and the periodic decrease in the
wave of incidence of all diseases.
It is interesting to note however that a marked or very marked prevalence
of sandflies, Phlebotomus papatassii and others, was recorded in several areas
including Western District. Phlebotomus was particularly noted in the hill
stations of Rawalpindi District, and at Dalhousie but no truly indigenous
cases have occurred, a point worth noting in connection with the conclusion
reached in this connection in the Sandfly fever Enquiry Report.
The Sandfly fever Enquiry at Peshawar, carried out by an officer of the
Royal Army Medical Corps under the auspices of the Director, the King Insti-
tute of Preventive Medicine, Guindy, has been brought to a close ; the officer
concerned having departed on service. A summary of the report is included in
paragraph 64 K.
9. Dengue.
This disease is one of the conditions which appear to show marked annual
Variations. It appears in epidemic form in certain areas and then appears to
die away. In the present year we seem to have encountered the epidemic in
P. and A. District and in Lucknow District which has materially influenced
the all India figures for British troops.
TABLE 19.
The ncidence of Dengue Fever.
Ratios per 1,000.
Admissions.
Year.
British.
Indian.
1933 .
.
.
•
.
•
•
.
•
11.7
2 . 1
1934 .
.
.
.
.
.
.
.
.
6.6
2.5
1935.
.
.
.
.
.
.
.
.
5.0
3.4
1936 .
.
.
.
.
.
.
.
.
4.7
2.5
1937 .
.
.
.
.
.
.
.
.
12.2
5.1
1938
.
,
.
.
.
.
3.9
1.1
1939.
.
.
.
.
.
.
.
.
9.6
1.1
Cases occurred throughout the year but the curve of incidence showed two
peaks ; for British troops in May and August and in August and November for
Indian troops.
The following table shows the monthly incidence for both British and
Indian.
TABLE 20.
(Percentages).
Jan. Feb. Mar. Apl. May. June. July. Aug. Sept. Oct. Nov. Dec.
British
. 6 . 59
2 . 2 9 2 . 87 5 . 73 23 . 21 11 . 17 6 . 88 15 . 47 11 . 17 7 . 74 4.87 2.01
?Indian
. 0 . 76 2 . 29 .. 6 . 87 6.11 6 . 87 10 . 69 22 . 90 16 . 03
7 . 6 3
1 9 . 8 5
. .
26
From Table 19 it will be observed that Indian troops do not show the
marked variations shown by British. The latter may be specially prone to
infection or it may be partly a question of diagnosis. When Dengue is pre
valent there is a tendency to diagnose many obscure mild fevers as such.
Whereas at other times uncertain cases are labelled cold, pharyngitis, influenza
and so on. The presence of a mild, evanescent rash in a two to four day's fever
is much more easy to see on the European than on the Indian skin.
In P. and A. District with 288 admissions, it was at Calcutta, where
there were 268 cases that the epidemic became most marked. Cases
occurred from May to October with 73 admissions in May, but doubt has been
expressed by some medical officers as to the correctness of the diagnosis in this
small epidemic as in some portions of the period mosquitoes were not remark
ably prevalent. In Lucknow there was a similar but lesser influx of cases,
both British and Indian.
There was also a small epidemic at Ambala amongst Officers, their families
and servants. This was an unusual outbreak and appeared to be limited to
certain bungalow areas.
At Lahore too there were some typical dengue cases, 6 were admitted
there and one Lahore case in Dalhousie. Aedes egypti were common in
Lahore at the time, also albopictus and vittatus.
Five cases were reported from Karachi and of the 45 cases admitted and
diagnosed as such in Southern Command 14 each came from Bombay and
Madras.
It will be seen therefore that the condition was widespread tending to
epidemic proportions in the Bengal delta.
10. Fevers of the Typhus Group.
The total sickness from this Group remains much the same as in 1938 viz .,
61 for 1939. British cases have however increased to 30 and Indian decreased
to 31, but the total numbers are very small.
The total numbers from all ranks and classes was 73 and again the cases
fall into two main groups ; the typhus of the Hills which occurs in the autumn
and the Murine typhus (Protens X 19) of the Plains which gives the bulk of
the cases (27 out of 73).
The OX 2 group only produced 8 cases and 7 cases were diagnosed as
typhus group but unclassified.
TABLE 21.
Incidence of Typhus Fever.
Year.
Actuals.
British.
Indian.
Total.
1933
.
. .
.
.
.
.
.
.
23
19
42
1934
.
. .
.
.
.
.
.
.
52
51
103
193
.
. .
.
.
.
.
.
.
19
45
64
1936
.
.
.
.
.
.
.
.
.
44
47
91
1937
.
.
.
.
.
.
.
.
.
25
43
72
1938
.
.
.
.
.
.
.
.
.
23
36
59
1939
.
. .
.
.
.
.
.
.
30
42
72
The distribution of the total cases recorded is shown by Commands in the
following table.
27
TABLE 22.
Regional incidence of Typhus Fever by types in 1939.
Northern Eastern Southern Western Total
Grand
total.
Type.
Br. Ind. Br. Ind. Br. Ind. Br. Ind. Br. Ind.
OXK
.
.
. 7
7 5
2 7
3 ..
.. 19
12
31
OX19
.
.
. ..
11 2 ..
3
11 ..
..
5
22
27
0X2
.
.
. 1
1 ..
1 2
3 ..
..
3
5
8
Unclassified
.
.
..
3 1
2
1
5
7
Total
.
8 19 10
4 14
18 ..
.. 32
41
73
Total 1938 .
7 29 13
9 9
14 ..
.. 29
52
81
A short investigation of Typhus fever in the Dagshai Hills from the B. M. H.,
Dagshai.—The work was undertaken to ascertain whether Trombiculid mites
were possible carriers of tropical typhus of the XK type in the Simla Hills.
This was undertaken by an Officer of the Royal Army Medical Corps who himself
had once been infected in the Simla Hills and been very ill with the disease.
The method adopted was that used in Japan and Sumatra, namely the
collection of mites from the ears of rats and subsequent injection of the ground-
up mites into guinea pigs. 360 rats were trapped of which 97 were infested.
Mites when present in any numbers appear as orange coloured clusters
which are easily seen, the largest number from one rat being 497 and in all 1409
mites were collected. If the mites are required for transfer to other animals
the ears of the chloroformed rats are placed in a petri dish until cold and
encircled with vaseline to prevent escape of the mites. The mites crawl off
and can be removed by a camel's hair brush. For identification, examination
under a dissecting microscope is essential. The species identified were
deliensis and oudemansi.
Collection was also made from stockings or socks worn by coolies working
in the jungle, with subsequent chloroform treatment to extract the mites, a
tedious method and by light treatment which did not give good results.
Subsequently for the actual test of infectivity the collected mites, sent in
moist tubes to the Central Research Institute, Kasauli, were inoculated into
guinea pigs but none contracted typhus.
11. Enteric Group of Fevers
For British Troops this Group has unfortunately risen to over 1 per 1,000
below which it had been for the previous two years. The actual number of
admissions for the disease however remains very satisfactorily low, under 40,
and is half or less that of figures for the preceding years.
Admissions for Indian troops remain remarkably low, at 0.5 per 1,000 of
strength.