NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
76
A perusal of the Preliminary Report of the Public Health Commissioner
for 1939 shows how widespread and intense are Enteric Group infections in the
civil population ; thus :
—
In the N.-W. F. Province, especially in the larger towns, enteric fever
was prevalent and the death rate was nearly doubled in Peshawar :
in Bengal there was a marked increase in urban and rural areas
in the C. P. there were 1,285 recorded deaths and the Commissioner
reports that the incidence of this disease is considerably higher than
recorded mortality figures would indicate : in Bombay the epidemic
of 1938 continued in less severe form into 1939 : in Madras Presi-
dency the disease was widespread and prevalent throughout the
year and in Assam enteric continued in all parts of the province
with a sharp epidemic in one area.
It is therefore obvious that we have a civilian population riddled with Enteric
group infection and yet living in their midst is our military personnel composed
of the same classes and types who only have one man in 2,000 even infected
during the year.
The greater part of this success is unquestionably due to our standard
of protective immunisation by T. A. B. inoculation. The percentage of al
l
ranks protected is as follows :—
British officers . . .
97.4
Indian other ranks . . .
98.6
Followers . . .
99.1
Inoculation in our army is a voluntary procedure, but even so we have nearly
100 per cent who are fully protected. Those shown as unprotected are usually
newly joined recruits, men on long leave or absent for some other cause when
inoculations were being done, or, in the case of Officers, those who through
sheer forgetfulness have failed to attend in time for inoculation.
As further evidence of success the following table shows the relative
proportions of protected and unprotected who have actually been infected or
died.
TABLE 69.
Comparison of incidence in Protected and Unprotected personnel.
Ratio per 1,000 of
respective strength.
Case
mortality
per cent.
Personnel.
Cases.
Deaths.
Protected by T. A. B. . . .
0.4
0.04
10.42
Unprotected . . .
9.1
1.13
12.50
It will be noted that out of the very large numbers of protected men at risk
only 4 in 10,000 were infected and only 4 in 100,000 died, whereas of the small
unprotected group nearly one in every ten went down with infection.
In the case mortality the advantage of T. A. B. protection is also shown
by the above table.
44. Dysentery, Diarrhœa, Colitis and Amoebic Hepatitis.
A very different picture is shown by this preventable group of diseases.
As with British troops, so with Indian the proximity of bazaar areas, suddar
and municipal, plays a predominant part in these fly-borne infections. Indian
troops frequent and buy foodstuffs in these bazaars, but have the counter
-
acting factor of relative immunity compared with British personnel. Even
the slight reduction on the figures of 1938 gives little cause for real satisfaction
as an indication of any real improvement.
77
TABLE 70.
Dysentery, Diarrhœa, Colitis and Hepatitis.
Ratio per 1,000
Dysentery. Diarrhœa. Colitis.
Total. Hepatitis.
1933. . .
15.3
7.9
0.3
23.5
0.6
1934
. . .
13.9
6.3
0.2
20.5
0.7
1935
. . .
12.2
5.6
0.2
17.9
0.5
1936
. . .
11.0
6.2
0.3
17.5
0.6
1937
. . .
12.4
5.4
0.4
18.3
0.5
1938
. . .
17.2
7.5
0.2
24.9
0.6
1939
. . .
17.1
6.3
0.1
23.5
0.5
The monthly incidence during the year is shown in Chart No. XI.
Admissions for different types of dysentery remain very much the same.
They are given below.
Percentage
of
cases.
Dysentery, protozoal
. . .
3.40
Dysentery, Bacillary, proved . . .
66.12
Dysentery, Bacillary, exudate. . .
11.91
Dysentery, Clinical
. . .
18.57
The case mortality on the total of admissions was 0.25 per cent. The
distribution by Commands is given in the table below.
TABLE 71.
Dysentery by Commands—Ratios per 1,000
Commands.
Amœbic.
Bacillary,
proven.
Bacillary,
Exudate.
Clinical.
Northern . . .
0.4
10.5
2.2
2.7
Western . . .
0.4
8.7
1.9
4.1
Eastern . . .
1.2
12.9
1.5
3.6
Southern . . .
0.5
12.9
2.3
3.5
In Commands this group presents a most distressing picture of continuance
at the same level or even of increases.
Eastern Command has shown a steady increase for the past 5 years.
Jhansi had the highest rate ; a fact justifiably attributable to the proximity
of the Municipal trenching grounds and its mass of dysentery-carrying flies.
The municipal trenching ground is now being moved. Southern Command
shows no signs of decrease ; Bombay District had its highest rate for 6 years
the cause being an increase of 19 per 1,000 at Mhow ; and fly-proofing of din-
ing rooms is strongly advocated. Western Independent District shows a
slight decrease to the normal figure ; in Hyderabad Sind 23 out of 37 cases
came from the Territorial unit. Northern Command although showing a slight
78
decrease has no evidence of real reduction from a normal figure of 20 to 24
per 1,000.
In every area it is stressed that this is a fly-borne disease, occurring subse
- q u e n t t o a n y p r e v a l e n c e o f f l i e s a n d d u e t o c a r r i a g e o f i n f e c t i o n f r o m i n s a n i t a r y ,
infected ground and latrines to unprotected feeding places and dining rooms.
The monthly figures and the known facts of insanitary surroundings and nume
- r o u s c a s e s , a c u t e a n d c h r o n i c , i n s u r r o u n d i n g p o p u l a t i o n s c l e a r l y s h o w t h e
correlation between the carrying house fly and the infection of our troops.
Comments on and illustrations of this have been made from Bombay,
Kohat, Peshawar, Rawalpindi, Quetta and Lucknow. Even from Egypt
from Indian units stationed there comment has been received on a marked
prevalence of dysentery and diarrhœa occurring in the autumn associated
with a heavy prevalence of flies.
45. Cholera
In spite of the widespread and, in places, severe epidemic amongst the
civilian population, see paragraph 6 ( c), in the previous 10 years there have
only been 1 or 2 cases in each year except for the small group of cases due to
one isolated outbreak in Waziristan last year. In the present year there has
been only one case, at Fatehgarh.
This marked immunity of Army personnel is unquestionably due to the
protection afforded by good water supplies, hygienic control in cantonments,
the careful watch which is kept over the occurrence of such infectious diseases
and to the immediate application of the appropriate preventive and protective
measures.
46. Diseases of the Digestive System
The admission rate was 56.6 per 1,000 for this group of diseases with 15
deaths and 32 invalids compared with 51 . 7 per 1,000 and 21 deaths in the
previous year.
The most important diseases of this group and a comparison of some of
these diseases over the past three years is given below.
TABLE 72.
Diseases of the Digestive System—Ratio per 1,000.
Tonsillitis. Pharyngitis. Gastritis.
Dyspepsia. Jaundice.
1937 . . .
5.8
16.1
1.0
4.1
1.9
1938 . . .
6.1
19.3
1.1
5.2
2.1
1939 . . .
5.5
24.1
1.2
4.5
2.8
There were over 300 cases of Jaundice this year the cases being of the
catarrhal type with no obvious infective cause.
Taenia infections.—The number of admissions for infection by the Tape
worms was 54 this year compared with 42 of last year. In the present year
the main types were T. saginata 33 cases and T. solium 8 cases. The greatest
number of cases of T. solium were admitted in Northern Command.
Ankylostomiasis.—There were over 700 admissions for this, the majority
being in Northern Command at Jullundur, Bannu and Kohat.
9
Abbottabad.—In a series of Helminth examinations 378 stools of the general
population were examined by the salt concentration method. 138 were found
to contain ova of Helminths, 100 were Ankylostome. Of Recruits, 235 were
examined (210 Gurkha recruits) ; every single stool contained ova of some
kind either Ankylostome or Ascaris.
Of serving soldiers 11 out of 25 had ova.
Of menial hospital personnel, 215 menials, 88 had ova of Ascaris or Anky
-
lostome or both.
Razmak.—During routine carrier examination from 955 examined 337
or 35 . 2 per cent. showed the presence of Ankylostome ova.
Mir Ali.—Ascaris Lumbricoides. One case passed 67 worms at one sitting.
The sight was terrific.
Nowshera.—Guineaworm in men of the Mahratta Light Infantry who come
from infected areas.
Ankylostomiasis mostly in recruits of the Sikhs Battalion.
4 7 . C y s t i c e r c o s i s
There were no admissions during the year amongst Indian Troops or
Followers.
4 8 . O r i e n t a l s o r e
There were nearly 140 admissions for this condition, but a large number
are treated as out-patients. This has been referred to in paragraph 16.
The incidence in four years has been:—
British
troops.
Indian
troops.
1936 . . .
63
448
1937. . .
37
165
1938 . . .
53
391
1939 . . .
19
205
A strenuous spraying campaign has been carried out during 1939 to
endeavour to control this very considerable cause of inefficiency, while protec
-
tion of sores from sandflies or other flies has been ensured by means of plaster
covering.
The record is too short to give any conclusions as to the efficacy of the
preventive measure. Exactly half the cases came from the Cavalry Regiment
which has always been most affected.
The following remarks from Bannu are illuminating in considering the
source of infection.
" There were 10 cases of oriental sore of which 8 were from Animal
Transport Companies."
TABLE 73.
Oriental sore : admissions over 10 years.
Ratios per 1,000
1930.
1931.
1932.
1933.
1934.
1935.
1936.
1937.
1938.
1939.
0• 41
1.21
0.48
0.45
0.88
0.57
1.48
1.37
0.85
1.17
80
49. The Minor Septic and Local injuries Group of diseases.
This prolific combined group produced nearly 16,000 admissions in the
year for British and Indian troops, and the man-days lost comes to nearly
220,000 days.
TABLE 74.
Annual comparison of Minor Septic and Local injury group.
Ratio per 1,000
Year.
Minor
Septic
diseases.
Local
injuries.
Cellulitis.
Boils.
1936 . . .
33.4
52.6
24.5
6.0
1937 . . .
31.4
51.8
23.5
5.4
1938 . . .
34.1
59.8
25.5
5.9
1939 . . .
36.8
57.0
26.1
7.5
There is no indication of any decrease in the admissions for this group.
Southern Command had 837 cases or an increase of 100 on the 1938 figure.
Eastern Command showed a slight decrease but is still high at 107 per 1,000
50. Venereal diseases
This group accounted for approximately 1,000 admissions compared with
837 of the previous year.
TABLE 75.
Comparison of groups of venereal diseases.
Ratio per 1,000
Diseases.
Admissions.
Percentage.
1936.
1937.
1938.
1939. Increase. Decrease.
Gonorrhœa . . .
4.8
3.4
2.9
3.4
0.05
. . .
Syphilis . . .
3.4
3.0
3.1
3.4
0.03
. . .
Soft chancre . . .
1.6
1.7
1.5
1.2
. . .
0 . 0 3
Northern Command.—A steady progressive decrease is noted for which no
reason is apparent.
Southern Command.—Marked increase chiefly in Gonorrhœa difficult to
explain but in case of Motor Drivers was thought to be deliberate to avoid
overseas service. A "Forward" policy of treatment is essential to avoid
unjustified wastage from this cause.
Western Independent District.— A small improvement is shown but figures.
are average. All new Barracks in Quetta are being equipped with P. A.
Rooms.
Bombay District.—Increase: highest figure for at least 6 years, all stations
except Baroda.
Waziristan District.—Lowest figure for at least 11 years and at 4 per 1,000
per year is remarkable.
81
Peshawar District.—Steady fall over 6 years.
8 . 02
7.14
5.44
4.77
5.19
3.80
The tendency for the admissions for the total venereal diseases amongst
Indian troops and followers to remain at a low level is well illustrated by the
following.
TABLE 76
Annual comparison of total venereal
Ratio per 1,000
1929.
12.9
1930.
11 . 1
1931.
10 . 9
1932.
10 . 6
1933.
10 . 8
1934.
9.6
1935.
10 . 1
1936.
9.8
1937.
8.2
1938
7.5
1939.
8.5
51. Scabies
This disease has come into considerable prominence recently. The
admission rate for the year has been 11 . 9 per 1,000.
TABLE 77
Scabies admissions during past 5 years—Ratio per 1,000
1935 . . .
9.6
1936 . . .
7.7
1937 . . .
7.7
1938 . . .
11.2
1939 . . .
11.9
The general rate has been affected by increases in all three Commands.
In Eastern Command of 331 cases 210 were from Meerut District. In Southern
there were 334 cases but the shortness of the treatment means that the average
constantly sick figure is not markedly affected. In Northern there was a slight
increase which brings the admission rate to the second highest recorded. A
decrease in Rawalpindi district was due to a reduction of 16 per 1,000 at Jhe
-
lum, but there is still scope for improvement at 12 per 1,000.
It is a trivial disease but causes the loss of many man-days. It is usually
imported by returning leave men from their homes and needs constant vigi
-
lence for detection at inspections. In Southern Command in one inspection
no less than 16 early cases were detected.
52. Small-pox
The incidence is practically constant at 21 admissions this year and is
remarkably small considering the population at risk. The vaccination state
is very high ; 99 . 6 per cent. being fully protected at the half-yearly October
census.
There were very definite epidemics amongst the civilian populations at
Dera Ismail Khan in Waziristan and other Frontier stations, at Abbotabad
where there were 5 military cases, at Ambala where there were 9 cases in Indian
Other Ranks and their families and in the Central Provinces.
TABLE 78.
Annual comparison of smallpox—Actuals.
1934.
1935.
1936.
1937.
1938.
1939
23
22
20
16
22
21
Cases were extremely scattered ; Ambala (4), Calcutta (2), Meerut (2),
Drosh (2) and 11 other stations only one case each.
83
Pulmonary Tuberculosis, of which there were nearly 220 cases during the-
year has shown a rise of 30 cases and the highest ratio per 1,000 for 9 years..
222 I. Os., I. 0. Rs., and Followers were invalided.
The admission and invaliding rates for Indian Officers and Indian Other-
Ranks and for Followers for the past 5 years has been as follows :-
Indian
officers and other
ranks.
Followers.
1935 . . .
Admissions. Invalids.
Admissions.
1.9
1.66
1.6
1936 . . .
1.7
1.66
1.7
1937 . . .
1.6
1.46
1.6
1938 . . .
1.7
1.43
1.8
1939 . . .
1.9
1.70
1.7
There was a puzzling outbreak of 12 cases at Khajuri Kach and Mir Ali.
Ten served in Khajuri for several months occupying one of the permanent
picquets; 6 were from the Support Platoon, 4 in other platoons and 2 not
closely connected. The Support Platoon occupied the 2nd storey of No. 5
Shinki Piquet. Sanitary conditions were satisfactory but ventilation was res
tricted and there was some overcrowding.
Probably one of the early cases was an open virulent case and contributed
to the spread to all others. The cases of one or two were in dispute as to dis
ability pensions.
The prevalence of Tuberculosis in India.
The opinion of many experienced observers is that tuberculosis in India
is on the increase.
In this connection it may be of interest and possibly of value to examine
the trend of tuberculosis in Indian military and potential military personnel.
The following table shows the incidence of total tuberculosis in the Army in.
India during the past 20 years.
TABLE 81.
Total Tuberculosis in the Army in India.
All Ranks—Ratio per 1,000
Year.
British
Army.
Indian
Army.
1919 . . .
2.2
4.3
1920 . . .
1.6
4.7
1921 . . .
1.2
3.9
1922 . . .
1.0
3.8.
1923 . . .
1.1
3.2
1924 . . .
1.2
3.2
1925 . . .
1.0
3.1
1926 . . .
0.8
2.4.
1927 . . .
1.1
2.7
1928 . . .
0.7
3.3
1929 . . .
1.7
3.8
1930 . . .
1.2
3.5
1931 . . .
1.0
3.3
1932 . . .
1.3
2.4
1933 . . .
1.0
2.1
1934 . . .
1.1
2.1
1935 . . .
1.3
2.4
1936 . . .
1.3
2.0
1937 . . .
1.4
2.0
1938 . . .
1.2
1939 . . .
1.3
84
These figure include pulmonary and non-pulmonary tuberculosis amongst
Officers and all ranks and followers.
It will be observed that during the past 8 years the numbers for the Indian
Army have tended to remain stable with an inclination to decrease.
As a slight guide to the tendency in the civil population the tuberculosis
noted at recruiting centres amongst the recruitable population may be of future
use.
TABLE 82.
Numbers of rejections at Recruiting Centres for Indian Army—Actuals.
1929. . .
103
1930. . .
75
1931. . .
76
1932. . .
51
1933. . .
80
1934. . .
82
1935. . .
192
1936 . . .
187
1937. . .
179
1938. . .
64
1939. . .
90
The factors concerned
are however very
variable.
Pneumonia and Broncho-pneumonia.—The admissions rate for these
remains practically constant. The total admissions were over 600 with 34
deaths, Northern Command producing the highest number while in Southern
Command the admission rates are half those of 12 years ago.
TABLE 83.
Annual comparison of Pneumonia.—Ratio per 1,000
1935.
1936.
1937.
1938.
1939.
Admissions . . .
4 . 9
5.4
5.2
5.0
5.4
Deaths . . .
0 . 51
0.61
0.34
0.43
0.29
Percentage mortality . . .
10 . 42
11 . 38
6.61
8.56
5.39
Although there is an increase in cases, there is a further decrease in deaths
which are now at a lower rate than in any recorded year, an aspect which is
definitely gratifying. The Sulphonamide group of drugs has still further
improved the position in the treatment of this disease so dreaded by Indian
Troops and followers.
The incidence of the diseases of the group is best shown in table form.
TABLE 84.
Year.
Lobar
pneumonia.
Lobular
pneumo-
nia.
Pleurisy. Bron
-chitis.
Pulmonary
tuber-
culosis.
Diphthe-
ria.
Influ-
enza.
Total all
respira-
tory
Diseases.
1934. . .
5.0
1.0
1.8
14.3
1.8
0.1
10.5
34.5
1935. . .
4.0
0.9
1.9
11.3
1.9
0 . 0
5.4
25.4
1936. . .
4.4
0.9
1.9
11.3
1.7
0.1
7.3
27.6
1937. . .
4.2
1.0
1.8
12.6
1.6
0.0
5.7
26.9
1938. . .
4.0
1.0
2.3
12.4
1.6
0.1
4.4
25.8
1939. . .
4.5
0.9
1.7
13.2
1.9
0.0
3.7
25.9
85
56. Effects of
There were 20 admissions which is the highest total for a number of
years. The admission rates for troops for 6 years are shown.
TABLE 85.
Admissions for effects of heat—Ratio per 1,000
1934.
1935.
1936.
1937.
1938.
1939.
0 . 2
0.1
0.1
0.3
0.2
0.2
The majority of cases were admitted at Nowshera (11), Peshawar (3),
Rawalpindi (2). The use of extra salt and its possible effects have been dis
-
cussed in paragraph 26.
Comment is made from Waziristan that it is considered essential that
Indian troops in Armoured Fighting Vehicles should have as heretofore ice
for cooling the vehicle. There have so far been no untoward results due to
the cessation of the issue.
57. Mental Diseases.
The number of admissions for this continues at approximately the same
figure. The majority of cases were admitted in Northern Command with 19
cases.
TABLE 86.
Admissions for Mental diseases—Ratio per 1,000
1934.
1935.
1936.
1937.
1938.
1939.
1 . 0
0.8
0.9
1.0
0.9
1.3
58. Other Diseases
Mumps was much in evidence in Waziristan district, 277 cases at Bannu
and Mir Ali in a Gurkha Battalion which had to be withdrawn from the Shaktu
operations.
Kala Azar.—With over 50 cases of this infection the disease has assumed
a considerable importance. The main feature of course is the difficulty of
diagnosis and the very prolonged hospitalisation which is likely to occur un
-
less treatment is energetically applied at an early stage.
So relatively common is the condition in some areas that all medical
officers in charge of Indian troops should always bear in mind the possibility
of an indefinite obscure case being one of Kala Azar. The incidence during
the past 5 years has been as follows :—
Ratio per 1,000
1935.
1936.
1937.
1938.
1939.
Indian other ranks . . .
0.16
0.29
0.14
0.29
0.48
Poisoning.-77 men of a Mountain Battery at Landikotal were admitted
with symptoms of acute food or chemical poisoning. With extremely energetic
treatment all recovered within 48 hours. Laboratory reports were negative
for bacterial infection but it was found that arsenious oxide was present in the
Halwa to the extent of 9.8 grs. per lb. or 0.14 per cent. Such a dose may be
fatal. No conclusion was reached as to the originator of this attempt.
A case of snake bite is reported from Roorkee occurring in a Havildar of
recruits part of whose duty was to teach recruits what to do in case of snake
bite. In stead of following his own advice to go to the hospital at once
86
tried quack treatment in the bazaar until he collapsed and was brought to
hospital. Comment is made on the depressing fact that little real knowledge
appears to penetrate into people's minds.
59. Recruiting.
The percentage of recruits accepted at the recruiting centres in the year
ending the 31st March 1940 was 54.6 compared with 56.5 per cent. of the
previous year, rejections being 45.4 per cent.
The principal causes of rejection of recruits for this year has been as
follows.
TABLE 87.
Causes of rejection of recruits—Percentages. Over 40,000 recruits were examined
at Recruiting Centres.
Disability.
Percentage
rejected at
Recruiting
Centres.
Percentage re-
jected during.
training at
Depots.
1
2
3
Malaria (enlarged spleen) . . .
2.4
0.01
Tuberculosis (pulmonary) . . .
0.1
0.10
Tuberculosis (other organs). . .
0 . 1
0.10
Venereal diseases . . .
1.2
0.02
Other diseases due to infection . . .
0. 1
0.02
Diseases of the nervous system . . .
0.1
0.10
Defective vision. . .
5.0
0.02
Trachoma. . .
5.6
0.02
Other eye affections . . .
0.7
0.04
Otitis media . . .
3.0
0.04
Defective hearing . . .
0.1
0.02
Other ear diseases . . .
0.6
0.01
Diseases of throat and nose. . .
0 . 3
. . .
V. D. H. . .
.
2.2
0.01
D.A.H. . . .
4.8
0.01
Varicose veins . . .
1.9
0.01
Haemorrhoids . . .
0.5
. . .
Varicocele. . .
0.6
0.01
Other diseases of circulatory system . . .
0. 1
0.01
Anaemia . . .
0.5
. . .
Goitre . . .
1. 3
. . .
Respiratory diseases (excluding tuberculosis) . . .
0.5
0.03
Pyorrhoea . . .
1.1
0.01
Loss or decay of teeth . . .
0.1
. . .
Hernia . . .
0.7
0.01.
Other diseases of digestive system . . .
0.1
0.01
Ankylosis of joints . . .
0.6
. . .
Flat feet . . .
1.3
0.01
Knock knee . . .
1.0
. . .
Curvature of spine . . .
0.3
. . .
Other deformities . . .
1. 6
0.02
Skin diseases . . .
1.1
0.03
Poor physique . . .
0.5
. . .
Other causes . . .
5.2
0.50
Total . . .
45.4
1.00
N.B .—The figures in columns 2 and 3, are in respect of the following only:—
Cavalry.
Artillery.
Sappers and Miners.
Indian Signal Units.
Infantry.