NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
5
The diseases chiefly responsible were :-
TABLE No. 7.
Average constantly sick.
Gonorrhœa . . .
3 . 11
Malaria . . .
2.15
Cellulitis . . .
1.47
Dysentery . . .
1.26
Fractures . . .
0.99
Tonsillitis . . .
0.78
Soft chancre . . .
0.73
Syphilis . . .
0.67
Bronchitis . . .
0.63
Impetigo contagiosa . . .
0.57
Sprain and strain . . .
0.54
Appendicitis . . .
0.52
Sandfly fever . . .
0.47
Diarrhœa . . .
0.43
Influenza . . .
0.37
Synovitis . . .
0.33
Jaundice catarrhal . . .
0.33
Contusions . . .
0.33
Pulmonary tuberculosis . . .
0.31
Pneumonia . . .
0 . 30
Gastritis acute . . .
0.29
Out-patients.—1604. 9 per 1,000 of the strength were treated as out
-patients. The average daily number under treatment was 24.66 per 1,000.
The combined ratio of constantly sick in hospital and under treatment as
out-patients was 52.27 per 1,000 of the strength, compared with 50 . 80 in
1937.
The actual loss to the Army in India in working days was 822,195 days
compared with 878,997 in 1937.
The seasonal admission rates for certain disease groups and the admission
and death ratios per 1,000 of the strength for all causes and certain important
diseases for stations with a strength of 1,000 and upwards compared with all
India, are shown in the following tables
TABLE No. 8.
Monthly incidence of admissions, all causes, and of the principal diseases.
Month.
Ratias per 1,000.
All
causes.
Malaria.
Dysentery
Diarrhœa
Group.
Minor
Septic.
Local
injuries.
Venereal.
January . . .
44.7
1 .5
1.6
4.7
5.4
5.3
February . . .
35.7
1.1
1.9
3.7
4.6
3. 5
March . . .
44.2
1.6
3.7
4.1
5.7
3.0
April . . .
49.7
2.9
6.3
4.0
5.9
3.4
May . . .
53.2
3.5
4.6
4.2
5.2
3.0
June . . .
56.4
4.4
4.7
5.2
5.5
2.6
July . . .
63.4
4.8
6.3
6.3
5.8
3.2
August . . .
59. 6
6.6
5.0
5.3
5.3
3.5
September . . .
51.7
7.1
2.2
4.7
4.6
3.9
October . . .
55.3
7.3
2.7
5.3
5.5
4.3
November . . .
50.0
7.9
3.0
4.5
5.4
3.9
December . . .
41.9
2.4
1.7
4.8
5.5
3. 6
8
BRITISH —
INDIAN
----•
ALL INDIA
T o t a l A d m i s s i o n s A l l C a u s e R a t i o p e r 1 0 0 0 o f S t r e n g t h .
1938
J A N . F E B .
M A R .
APL
M A Y .
J U N .
J U L .
AUG.
S E P .
O C T .
N O V .
DEC.
INDIAN
BRITISH
10
The following note by an experienced officer is worth quoting :-
" Perusal of the clinical records of the cases placed on the dangerousl
y i l l l i s t a n d o f c a s e s o f o u t s t a n d i n g i n t e r e s t d i s c l o s e t h a t t h e
standard of professional ability displayed by medical officers and
nursing staffs of hospitals is of a very high order. It also helps.
one to realise that today the combined recourses of the medical
services of the Army in India place at the disposal of the soldier
and his family and the sepoy and his family (for them the work
is only now commencing) a proficiency in treatment and care
equal, bearing in mind the physical standard of the population
and the incidence of disease to which they are liable, to the
voluntary hospital in the United Kingdom and only at the call
of the very wealthy in civil life. Statistics speak for the high
degree of preventive medicine attained ".
6. Malaria.
The incidence during 1938 has been definitely higher than that of 1937
which was the lowest figure recorded for troops in India ; but it is even now
lower than that of any other previous year and is half of that occurring ten
years ago. The increase for all India which is 6 per 1,000 is due entirely to the
rise in admissions for relapses, the fresh cases remaining exactly the same.
The majority of the increase in relapses is attributed directly to the return of
infected troops from Waziristan, and may therefore be regarded as an after-
math of the Waziristan operation of the previous year.
But there have been total increases in other Commands which are very
largely off set by a spectacular reduction in Western Independent District
(Western Command).
TABLE No. 10.
Malarial incidence over past 10 years.
(Ratios per 1,000).
1913 . . .
British.
125.5
Indian.
100.4
1919 . . .
217.8
145.6
1929 . . .
116.0
175.3
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
In every malarious country there are three main factors which govern the
incidence of malaria amongst troops :
—
( a ) a n n u a l v a r i a t i o n s i n c l i m a t e , s o m e y e a r s b e i n g p e c u l i a r l y f a v o u r -
able, others not. In a terrain the size of India many local
variations are likely to occur which affect the issue. The rela--
tively dry summer and autumn of the north and west, noted in
paragraph 4 (a), were in favour of the low incidence recorded
later in Northern and Western Commands ; but the prolongation
of the warm weather into the late autumn definitely caused a
shift of the peak of fresh infections to a late period in the year
instead of the normal peak in August-September.
( b ) t h e e f f i c i e n c y o f o u r a n t i - m o s q u i t o m e a s u r e s , w h i c h m a y b e h e l p e d
or hindered by climate, by the amount of funds available and by
operations or any abnormal movements.
( c ) t h e e f f i c i e n c y o f o u r m a l a r i a l t r e a t m e n t .
11
That the reductions noted in Table No. 10 are not fortuitous and wholly de
pendent on favourable conditions is shown more clearly in the graph below
which covers a period of 20 years and includes bad climatic years (1933) and
several years of frontier operations.
INDIAN –
MALARIA
ADMISSION RATIO PER 1000 OF StRENGTH
INDIAN
BRITISH
YEAR
12
There is no doubt that anti-mosquito measures in 'practically all canton-
ments have reached a very high degree of efficiency and are carried out with
enthusiasm. For troops in cantonments this is certainly, in part at least, the
cause of this satisfactory fall in admissions. The considerably higher incid-
ence amongst Indian troops compared with British is in part due to the fact
that the former tend to go out of the protected cantonment into infested bazaar
areas and also proceed on leave away from cantonments. The value of spray-
ing as a cheap and efficient anti-mosquito measure in cantonments and camps
has been fully proved during the past 2-3 years and is considered to account
for the continued reduction in admissions.
It is a noticeable feature that groups of infection in particular units are
often specifically attributed, and rightly so, to some particular camp, held
away from the safety of cantonments. Lahore Cantonment is a good example
of the efficiency of measures now adopted within cantonments. These mea
-sures are considered later in this report.
TABLE No. 11.
British malarial cases in Lahore. The dreaded Mian Mir.
Year.
Total
admissions.
Ratio
per
1,000.
1924 . . .
4,370
617.70
1925 . . .
2,245
415.76
1926 . . .
2,479
384.17
1927 . . .
1,524
232.06
1928 . . .
886
117.80
1929 . . .
1,097
153.37
1930 . . .
1,320
183.25
1931. . .
1,047
147.26
1932 . . .
679
98.27
1933 . . .
1,047
146.69
1934 . . .
371
53.36
1935 . . .
296
42.18
1936 . . .
303
44.22
1937 . . .
171
26.21
1938 . . .
114
19.67
The efficiency of Malarial treatment.—This has been greatly enhanced by
the use of the newer synthatic drugs, atebrin and plasmoquine. This was
referred to in the report last year. Not only is the patient cured more quickly,
but his bood is cleared of parasites more quickly and completely. This not
only reduces the number of relapses, but also reduces the reservoir of possible
infections in the barrack area. British troops demonstrate this more clearly
than Indian troops who frequent infected bazaars and home villages.
As both these drugs are of foreign manufacture, it is high time that manu-
facturing firms within the Empire should take up the production of similarly
effective drugs. (This was written before the outbreak of War).
Amongst the troops who were engaged in the Waziristan operations 1937,
there was a definite increase in relapse cases during the present year ; increases
being noted amongst returned troops at Lucknow, Jhansi, Ferozepore, Hyder-
abad (Sind), Jhelum, and Rawalpindi . This point is also shown in the figures
for relapse cases in Table No. 12 given below. This does not necessarily
imply failure of the methods of treatment. The increase in the relapses in
these troops is really due to the much greater opportunities for infection during
the operations and difficulties in ensuring adequate treatment for every case.
13
During the year a circular was issued explaining the advantages and
disadvantages Of Quinine, atebrin and plasmoquine. In spite of the adverse
criticism on the results of treatment with plasmoquine given in the Report of
the Health Organisation of the League of Nations in 1933 on the work done
in military hospitals in India, 1931, our methods were continued. Our results
have fully justified the method and opinions now expressed are the reverse of
those expressed in 1933.
The standard treatment is now as follows, though experienced medical
officers are always entitled to adopt any form of treatment they may wish.
British Troops
—
Atebrin 0.3 grammes daily for 7 days.
Three days interval.
Plasmoquine 0.03 grammes daily for 5 days.
Indian Troops receive only 0.02
grammes plasmoquine.
Atebrin musonate, after extensive trial in Waziristan, has been shown to give
marked relief for the journey to hospital; the dose being 0.3 grammes on two
successive days.
The following table gives the admissions for fresh and relapse cases by
Commands over a 6-year period. The increase in fresh cases in the wetter
Eastern and Southern Commands, the increase in relapse cases in Northern
Command and in the All India figure, the general reduction in admissions,
both fresh and relapse over the period and the compensatory reduction in
Western Independent District in the present year are clearly shown.
TABLE No. 12.
Admission ratios per 1,000.
1933.
1934.
1935.
1936.
1 9 3 7 .
1938.
Northern Command
Fresh.
120.2
40.2
44.1
45.6
30.2
34.0
Relapse.
39.6
35.6
13.2
32.8
15.3
22. 0
Total.
159.8
75.8
57.3
78.5
45.6
56.0
Eastern Command.
Fresh.
43.8
33.7
31.4
30.5
14.9
19.4
Relapse.
18.8
14.4
13.4
6.3
9.0
1 3 . 6
T o t a l .
62.6
48.1
44.8
36.8
23.9
33.0
Southern Command.
F r e s h .
48.5
41.6
38.8
36.3
34.2
43.7
Relapse.
12.2
13.7
10.2
9.0
9.0
16.3
T o t a l .
60.6
55.3
48.9
45.3
43.2
60.0
Western (Ind.)Dist
. Western Command.
Fresh.
175.9
100.5
111.3
56.8 101.5
38.3
Relapse.
28.1
59.9
24.8
47.1
22.0
21.0
T o t a l .
204.0
160.4
136.1
103.9 123.5
59.2
All-India*.
Fresh.
79.1
43.3
43.1
39.2
32.6
32.6
Relapse.
24.2
24.2
13.1
18.7
12.0
17.8
Total.
103.3
67.5
56.1
58.0
44.5
50.4
Malarial situation in Commands.—The outstanding feature is in Western
Independent District where the admission rate is lower than any other recorded
hitherto and is less than half that of the past few years.
*1937 and 1938 do not include Burma.
14
TABLE No. 13.
Western Independent District
Malarial admission rate per 1,000
Year.
Rate.
1933
204.00
1934
160.47
1935
136.10
1936
103.90
1937
123.55
1938
59.20
Compare this with Quetta in previous years.
Strength. Admissions. Admission
Rate.
1893 . . .
2,098
2,475
1,171.12 per 1,000
1894
. . .
2,219
1,919
864.85
„
191
8 . . .
3,805
1,856
490.00
"
There was a spectacular fall in fresh admissions in August and September
attributed to the anti-malarial work of British and Indian units.
"The excellent work put in by all units has been more than justified by
the reduction of sickness in their ranks" writes the president of the anti
-malarial Committee.
Units themselves and Brigade Commanders have little doubt that the
result is due to their own. anti-malarial measures, although the smaller rainfall
of 1938 increased the prevalence of mosquitœs in general. But there was also
a decline in the civilian malaria in the Quetta area although A superpictus,
the recognised carrier of the area, was shown to be sufficiently prevalent to
cause ample infection. As a part of these anti-malarial measures notorious
camp sites and routes to training camps have been changed.
The anti-malarial work in Quetta has been carried out by an enthusiast
and under a keen Station Commander. The history of cases is most carefully
recorded to determine the source of infection and possibility of relapse. The
reduction in cases is largely attributed to greatly increased spraying of all
barracks.
In Northern Command the malarial admission rate drops for the second
year in succession below first place in the list of commonest diseases and,
although the admission rate is nearly 11 per 1,000 more than in the war year
of 1937, it is the second lowest rate recorded in at least 14 years.
The monthly graph of incidence was definitely abnormal. The rise com-
menced in April but the peak was in November, a most unnatural feature, due
to the warm weather.
The increase is mainly due to relapse cases and these have been attributed
to Waziristan, 1937, infection. This was so at Jhelum and Rawalpindi;
while at Ferozepore a batch of 17 cases, admitted immediately after arrival,
appeared to be definitely due to infection at Bannu Rest camp.
In 14 years the admission rate has fallen steadily from 291 per 1,000 to
45 and 56 per 1,000 respectively in 1937 and 1938.
In Southern Command the continuous decrease of the past 4 years has been
broken by an increase in which all districts participated. Malaria has been
on the increase each year lately at Mhow [see paragraph 5 ( c)] and Kamptee,
and a large increase at Ahmednagar is also stated to be due to excessive rain-
-fall.
15
Secunderabad, a practically non-malarious station, has shown a large
increase due to the British Regiment who produced 90 out of the 98 cases as
a result of infection in Waziristan.
In Eastern Command, where excess rainfall was noted, all districts show
an increase. Delhi Brigade Area shows the high rate of 117.5 per 1,000 the
greater part of this being attributed to relapses in the British Regiment
who returned from Waziristan, having been infected at Damdil. An
increase in Meerut District is also noted attributed to the practice of allowing
men from the hill station of Chakrata to go on leave to Kalsi Camp which lies
in the foot hills (terai) ; an incongruous procedure for troops placed in " cold
storage " and which, if allowed, requires the strictest antimalarial pre
- c a u t i o n s .
In all India there were only 4 stations with strengths of over 500 in which
the malarial admissions exceeded 100 per 1,000 viz . Lucknow 154.1 ; Delhi
117.5 ; Razmak 106.5 and Rawalpindi 102.8. Razmak is really a non
-malarious station but constant columns on " Hard Scale " into the low mal
a - r i o u s v a l l e y s a c c o u n t f o r t h e i n f e c t i o n s .
The types of infection by Commands over the past 3 years is shown in
table No. 14 below. The small proportion diagnosed clinically from the total
cases is satisfactory.
TABLE No. 14.
Comparative diagnosis of Malaria by Commands.
Malaria.
Year.
B . T .
M. T.
Q . T .
Mixed. Clinical Total.
Northern Command
1 9 3 6
1,087
172
3
11
51
1,324
1937
486
111
3
9
27
636
1938
625
170
. .
3
9
807
Eastern Command .
1936.
440
99
2
8
28
577
1937
304
43
3
3
7
360
1938
346
47
4
17
22
436
Southern Command.
1936
409
178
32
17
23
659
1937
408
162
12
20
18
620
1938
466
168
28
38
17
718
Western Command .
1936
297
23
1
7
5
333
1937
343
134
2
6
10
495
1938
161
3 0
. .
2
16
209
Total . .
1936
2,233
472
38
43
107
2,893
1937
1,541
450
20
38
62
2,111
1938
1,598
415
32
60
64
2,170
7. Sandfly fever.
The All-India admission rate for this unpleasant and debilitating, mild
fever, which exacts quite a heavy toll, has remained practically stationary for
British troops and has been still further reduced for Indian troops.
The general rate would have been distinctly less in this year had not
Western (Ind.) District produced 178 admissions instead of the 5 cases shown
the previous year, because in Northern and Eastern Commands there was a
further reduction on last year's satisfactory figures, while Southern Command
showed no marked change.
16
TABLE No. 15
Sandfly fevers over past 10 years—Ratio per 1,000
Year.
British
Troops
Indian.
Troops
1929 . . .
43.2
18.6
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
In Eastern Command the disease has been considerably less. Lucknow
District has given the highest figures, but even here there is a reduction com-
- p a r e d w i t h 1 9 3 7 .
The marked increase in Western (Independent) District has already been
noted ; but the Deputy Assistant Director of Hygiene in his report states that
the diagnosis of this disease is somewhat subject to fashion. In 1937 there
had been a tendency to diagnose the minor fevers as "common cold".
In the present year Quetta had 121 cases, Karachi 25 and Hyderabad 12
cases of Sandfly fever. In post-earthquake-Quetta ample opportunities exist
for Sandfly breeding in the 7 warmer months, while at Karachi and Hyderabad.
infection occurs practically all the year round.
In connection with Leishmaniasis (see paragraph 15) Government provided
an expert to investigate the conditions in Quetta and a grant of Rs. 2,000 was
given for anti-sandfly measures in the area. The large scale anti-mosquito
spraying must also have had some effect in reducing sandfly prevalence.
In Northern Command the very welcome reduction shown first in 1937
has been more than maintained, the rate being 46 . 57 against 51 . 15 of 1937.
Peshawar. District continued its previous decrease and Lahore District is now
showing good results.
TABLE No. 16
Sandfly fever in Northern Command.
Year
Admissions
Ratio per
1,000
1931 . . .
72.16
1932 . . .
84.38
1933 . . .
85.58
1934 . . .
80.04
1935 . . .
82.37
1936 . . .
80.37
1937 . . .
51.15
1938 . . .
47.57
Spraying campaign was
instituted in Peshawar
District and taken up
gradually in other
Districts.
17
The years 1937-38 may have been peculiarly adverse to sandfly breeding, but
there is no evidence that this was the cause of the reduction which has appeared
since the very vigorous spraying campaign was started. The Western Inde
-pendent District figures in fact show the contrary. In both these years the
British troops in Landikotal, the hot bed of sandfly fever infection, were un
-
salted troops and a high incidence of infection might well have been anticipat
-
ed. Yet the incidence here has been one-third that of previous years. The
conclusion is reached that anti-sandfly measures must be responsible for this
welcome reduction of the disease. During these two years an energetic anti-
sandfly campaign has been waged under the personal encouragement of the
Peshawar District Commander who took the keenest interest in all measures
which could be made effective.
It is considered that the most important anti-sandfly measure adopted
was that of regular spraying of barracks. It is easy to argue "post hoc ergo
propter hoc", but the one factor which is now present when the incidence has
been reduced and was not present before is this "regular spraying of
barracks."
Sandfly fever enquiry at Peshawar.— A military medical officer, appointed
under the Director, The King Institute of Preventive Medicine, Guindy, has
been working throughout the year on sandflies and the transmission of sandfly
fever. Some useful work has been accomplished, but as yet no great progress
has been achieved. The work continues.
8. Dengue
There has been a very marked reduction in the incidence compared with
that of the previous year, 166 cases as compared with 644, and the present
rate is less than any for at least 6 years. This is due to reductions in Eastern
and Southern Commands in which the rates have been one quarter and one
half respectively of those for 1937.
In Eastern Command the majority of the cases occurred in the Presidency
and Assam District, but there was no repitition of the Calcutta epidemic of the
previous year.
In Southern Command small epidemics were noted at Bangalore, Mhow
and St. Thomas' Mount, Madras. At Bangalore an increased allotment of
funds for anti-mosquito measures allowed extra anti-mosquito work to be
carried through with most successful results which, it is hoped, will be con
-tinued yearly. British cases were reduced from 23 to 3 and Indian admissions
from 80 to 25.
TABLE No. 17
The incidence of Dengue Fever.
Year
Admissions—Ratio per 1,000.
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
18
Cases occurred throughout the year but the peak of the curve of incidence was
in November.
Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec.
British . . .
11
3
5
5
3
4
7
2
15
29
57
22
Indian . . .
87
3
2
2
. .
4
2
2
10
1
2
4
9. Fevers of the Typhus Group
The incidence remains much the same this year with a slight decrease for
both British and Indian troops and cases have been widely scattered.
TABLE No. 18
Incidence of Typhus Fever—Actuals
Year.
British.
Indian.
Total.
1933 . . .
23
19
42
1934 . . .
52
51
103
1935 . . .
19
45
64
1936 . . .
44
47
91
1937 . . .
29
43
72
1938 . . .
23
36
59
There were however a total of 81 cases in all, including all ranks and classes.
The cases fall into two main groups : Scrub Typhus (Proteus OXK), the typhus
of the Hills, which occurs chiefly in the autumn, and Murine Typhus (Proteus
X 19), the disease of the Plains which gives nearly half of the total cases of this
group (35 out of 81).
In addition the OX 2 group has increased, cases being diagnosed in each
of the Commands.
Finally there remain 2 cases diagnosed as of this group but not classified
by serological results under any of the three types.
The distribution of the total 81 cases recorded is shown below by Com-
mands.
TABLE No. 19
Regional indicence of Typhus Fever by types in 1938
Northern Eastern Southern Western Total
Grand
total
Type.
Br. Ind. Br. Ind. Br. Ind. Br. Ind. Br. Ind.
OXK . . .
3
6
8
7
3
. .
. .
. .
14
13
27
X19 . . .
3
22
1
2
1
6
. .
. .
5
30
35
OX2. . .
1
1
4
. .
3
8
. .
. .
8
9
17
Unclassified . . .
. .
. .
. .
. .
2
. .
. .
. .
2
. .
2
Total . . .
7
29 13
9
9
14
. . . .
29
52
81
Total 1937 . . . 16
15
7
5
8
24
. .
2 31
46
77