"
An Officer below the rank of Colonel, who appointed as Our Honorary Physician or Surgeon after retirement from the Service, shall be granted the honorary rank of Colonel." (2) The following shall be substituted for 14 : paragraph " Six of the most meritorious Medical Officers of the Service on the Active. List shall be named Our Honorary Physicians, and six Our Honorary Surgeons. An Officer shall relinquish the appointment of Honorary Physician or may be
Honorary Surgeon
on
retirement."
Given at Our Court at St. James's this eighth day of August 1911, in the Second }ear of Our Reign. By His Majesty's Command, Crewe. The importance of the above modification of the Royal Warrant is that the six Honorary Physicians and six Honorary Surgeons are in future to be chosen (after the present holders have relinquished the appointments) from Officers on the Active List and not from among retired officers as has hitherto been the case (see first page of Quarterly Army List). These appointments will also be given up on retireThis has been the rule in the R.A. M. C. ment. and it is good to find it applied to the I. M. S. OUR IGNORANCE OF DYSENTERY.
(flllTPt ?0|)iCK. THE KING'S PERSONAL STAFF.
The Governor-General in Council is pleased to direct the publication of the following Royal Warrant, dated the 8th August 1911, amending the rules for the promotion and precedence of officers of the Indian Medical Service which were published in Department of Military Supply Notification No. 27, dated the 24th April 1908 :? George, R. I.
Whereas we deem it expedient to amend the rules for the promotion and precedence of Our Indian Medical Service : Our Will and Pleasure is that Our Warrant of the 13th March 1908 be amended in accordance with the following provisions :? (I) The following shall be omitted from paragraph 10 ;
It must be confessed that we are still ignorant of dysentery. It is one of the great diseases of the tropics and responsible for more chronic ill-health than even malaria, much has been written about it for years, yet it cannot be said that we know definitely very much about the relative distribution of the two main types of dysentery, viz., amoebic and bacillary. These thoughts have not been dispelled by a perusal of two recent valuable papers on this protean disease, viz., Dysentery and Liver Abscess in Bombay by Major E. D. W. Greig, i.m.s., and Capt. R. T. Wells. I.M.S.,* and The Dysentery Bacillus by Major E. R. Whitmore (U. S. A.). In the first place, the Scientific Memoir by Major "Greig and Capt. Wells is not complete, is promised, which is notand a later report satisfactory to the practical medical man who wishes to get rid of dysenteiy in his jail or his asylum. We can only hope that this inquiry commenced in 1908 will be continued. It used to be said that ordinary Indian dysentery was mainly bacillary, but apparently this is not so as regards Bombay. The very frequent presence of other intestinal parasite was confirmed in Bombay, the trichomonas being especially frequent. As regards variety, the bacillus dysenteric of Shiga was found on 4 out of 13 cases, and in the remaining nine the bacillus of "
* Scientific Memoirs, India, No. 47(1911); The Dysentery Bacillus, E. R. Whitmore, Major U. S. Army, Philip. J. of Sci., June 1911.
THE INDIAN MEDICAL GAZETTE.
432
Flexner. None of these bacillary cases showed The any indication of liver complication. excretion of the bacilli is intermittent, and they cease to be found as soon stools became as the feculent and blood and mucus disappeared, The use of the sigmoidoscope is recommended in cases of bacillary dysentery as the lower part of the large intestine is most frequently involved. The writers of the Scientific Memoir appear to think that there exists a sufficient amount of knowledge of bacillary dysentery to enable the sanitarian to intelligently apply the method of prevention, but except Major Forster's well known and practical work on dysentery we know of no work done which will give the practical man any clue to prevention and whether the present authors endorse, approve, or are opposed to Major Forster's views does not appear from this memoir. Our authors rightly consider that there are many gaps in our knowledge of the amoebic infection, and we agree with them that the conclusions of Schaudin has been too rigidly accepted as final, for example the view that many free living amoebic may, in suitable culture, become transformed into pathogenic forms is still open to discussion. We cannot and need not here follow Major Greig and Captain Wells throughout the important series of experiments made by them?we can only quote their general conclusions which are briefly as follows :? 1. 2. more
Bacillary dysentery is rare in Bombay. Dysentery associated with amoebae prevalent.
is
amoebae can be cultivated from stools and liver abscess pus and can be grown outside the body in a suitable medium. 4. The prevalence of amoebae shows a marked seasonal variation. 5. The season of greatest prevalence of amoebae in Bombay corresponds to the season of greatest prevalence of dysentery, or shown by the rates of admissions for d}7sentery in Bombay 3.
The
dysentery
jails. 6.
The amoebae cultivated
in
Bombay
are
ent. histolitica, or coli, but are the same or similar to those cultivated by Noc in Cochin not
China. 7. That the same or apparently the same amoebae can be cultivated from tap water. 8. That amoebae can be cultivated from the stools of large number of normal animals. 9. That amoebae from cysts inside and outside the body, and that this cystic stage is important and cases cannot be considered cured till the stools are found to be free of these cysts. 10. Amoebae may be cultivated from the faeces of persons suffering from abscess of the liver, although he at the time shows no signs of
dysentery. 11.
That the evidence at present available a channel by which
indicates that water is
[Nov.,
1911.
amoebae of dysentery may be desseminafced in endemic areas. A high leucoc}7tosis may occur. 12. 13. A moderate leucocytosis if associated with rise of temperature may indicate hepatic invasion. 14. That ipecacuanha, as pointed out by Rogers, will prevent the formation of liver abscess. Jt is pointed out that "growths of amoeboid organisms may appear in association with moulds and other bacteria by exposing plates of uninseminated Musgrave's agar to the air." This disquieting observation certainly points to the need of further investigation being necessary. The other article on dysentery which we have above mentioned is by Major Whitmore and the work was done in the Biological Laboratoiy, Manila, P. I. He gives a brief review of previous work and concludes that the "dysentery bacillus has been divided into four groups by He concludes as the use of sugar media." follows:? 1. In an epidemic of bacillary dysentery with a high death-rate in Luzon it has been shown that the Shiga-Kruse type of dysentery was the causative agent. 2. At the same time the Flexner-Strong type of dysentery bacillus was found in some cases of dysentery around Manila. 3. The bacillus Y, and the Strong type with which Leutz worked was not found. 4. Great care is necessary in deciding types of dysenterj7 bacillus from their reactions in sugar media alone. The above imperfect rdsumds of these two valuable monographs on dysentery will at least have shown that we are still ignorant of much about this variable disease. It is not yet known what is the ordinary type of dysentery ?seen for example in jails, asylums, or in cases at the hospitals. attending The subject is a vitally important one and demands continued investigation. We have ventured to criticise the above valuable work from an entirely practical point of view. We read both articles in the hope of being able to get some clue to prevention, and we cannot say that in this respect we have been satisfied. We have nothing but praise for the high standard of scientific work shown in both the articles we have criticised. THE TRANSMISSION OF GOITRE.
We
reproduce below the interesting note by Major McCarrison, M.D., M.R.C.P., I.M.S., Agency R.
Surgeon, Gilgit, which was communicated to the Royal Society on 1st June last, on the experimental transmission of goitre from man to
animals "
:?
Experiments had repeatedly been carried out on dogs to test the assumption that goitre could be conveyed from man to animals by frecal infection of the .water
LOW FEVER OR DENGUE IN THE UNITED STATES.
Nov., 1911.]
In the present exThe drinking water supplied to these goats was fouled by passing which contained through a specially constructed box, sterilised soil mixed with the f;eces of goitrous indivithis duals. In the case of one batch of six go.its, only In the case of another batch of water was consumed. referred to contained, in seven goats the box above addition to the sterilised soil and fa;ces, 500 earthworms. These were added on the assumption that they might of the act as intermediate hosts to the infecting agent disease. The goats consumed this highly polluted water for 64 days, from October 13th to December 15th, 1910. The results observed were (1) a loss of weight, due doubtless to confinement in a small hut for the 64-days of the experiment ; (-2) that many of them suffered from diarrhcea ; and (3) that 50 per cent, of the animals showed enlargements of the thyroid gland, most marked The thyroids of three control goats on the right side. showed no alteration in size. The enlargement of the thyroid was observed to fluctuate in size considerably, a fact which had previously been noted in the case of experimentally produced goitre in man. The average weight of the normal thyroid of the goat in Gilgit is 1/10,OuO part of the body weight. The enlarged glands of the goat in'the experiment were found to weigh from 1/4,272 to 1/7,000 part of the body drinking fouled water the weight. In both batchessame. results observed were the Microscopical examination of the enlarged organs showed varying degrees of dilatation of the vesicles, scarcity or almost complete disappearance of the masses of cells lying between the vesicles, while no alterations were observed to have taken place in the connective tissue stroma of the enlarged glands. The hypertrophy of the vesicle with colloid, was due wholly to distension and the formation of new vesicles from the intravesicular It is concluded that? masses of cells. (1) An hypertrophy of the thyroid gland of goats can be induced by infecting the water-supply with the fajces of sufferers from goitre. It is at present impossible to state whether this hypertrophy is due to the action of the infecting agent of goitre, or only to the organic impurity of the water thus contaminated. (2) Earthworms do not appear to be concerned in the spread of goitre. (3) The microscopical appearances described are the earliest stages in the formation of parenchymatous
supply,
but with
negative
periments female goats
results.
were
employed.
cOitre." SANDFLIES IN MALTA.
In
Annals of
433
suffer torture from them. Certain blocks of houses are more often infected than others and groundfloor rooms rather than upper rooms. The neighbourhood stone of rocky ground and walls attract them. The day-light retreats of these pests are in dark places, under garments, behind pictures, etc. They can get through mosquito curtains, but the females when gorged with flood are unable to get out. They are frail and delicate animals and cannot stand a breeze, and the use of the Indian punka is recommended. There is a seasonal prevalence, but this largely depends on variations in temperature, humidity and wind. As for prophylactic measures, Mr. Newstead recognises that "the task of suppressing them is an almost insurmountable one," but he makes several suggestions, and he quotes a prescription, for a "repellent" given by Major Crawford, R.A.M.C., which consist of 01. Anisi, one drachm, 01. Eucalypti, one drachm, 01. Terebinth, half a drachm, and Ung. ac. borac, one ounce. All dark portions angles, corners of a room can be sprayed with formalin (1 per cent, solution) with a fine spraying apparatus, and mosquito curtains before bed-time should be sprayed with this solution. Light is important, decorative drapery must be abolished, punkas and electric fans are certainly useful. Traps may be used and as ordinary mosquito nets are useless, nets made of fine strong "chiffon" are needed, but are not practicable in hot weather. Persistent efforts would be necessary to destroy their breeding grounds, but walls should be pointed and crevices in rocks and old walls filled up with cement, etc. The rest of Mr. Newstead's valuable article is taken up with the anatomy, etc., of the genus
children streets
"
or
"
phlebotomus.
Tropical Medicive (August
"LOW COUNTY FEVER OR DENGUE." 1911) Mr. R. Newstead lias a valuable report the In Malta of in which view of Military Surgeon (August 1911) on the papatasi flies H. Halliday, U. S. Army, has an Lieut." C. the differentiated fever of newly the prevalence in many parts of India is .worthy of our attention. interesting contribution to the still unsettled of dengue with various The important species are P. papatasii and P. question of the identity of minor non-continued fevers, described types perniciosns. The breeding places of these insects are very in Europe, India and elsewhere. The "Low County Fever" described by difficult to find, as the larvre are so minute, but in holes and crevices Lieut. Halliday has existed in Beaufort County, found be to they appear in loose rocks and in caves, where the three con- S. C. (U. S. A.), from time immemorial" :? " ditions of presence of organic matter, slight moisIt is characterized in sudden onset"
by
(preceded
about 50% of the cases by a chill), rapid rise of ture, and absence"of light are found. Though so evasive in their early stage these temperature, increased pulse rate, nausea and vomiting, moist and coated tongue,, congestion of visible mucous flies are?found every where in the Maltese Islands, membranes, headache, lumbar pain, muscular soreness, and they outnumber the mosquitoes and the and pain in bones and joints of varying intensity. An " the most vicious of all the females are among eruption occurs in some cases and in the severe type blood-sucking Arthropods." As in the case of epistaxis is often a troublesome symptom." pulex irritans, these flies have their likes and dislikes, and many persons are quite immune to The extreme degree of prostration from the and especially onset is remarkable. but new-comers their bites
434
Lieut. Halliday of the setiology :? 11
THE
gives
the
INDIAN MEDICAL GAZETTE.
following
account
was unusually long, dry and liot, beginning early in April and extending well into November. Very little rain fell during the Summer months Late in September there were heavy rains which tilled all ponds and depressions over the Island with water.
Climate.?The Summer
"Mosquitoes.?The mosquitoes
were
not numerous
or
troublesome until about October, when they greatly increased in number. The reports on collections of mosquitoes made from this post for the past several years, show that Culex fatigans is only reported for the Fall months, the period when this disease prevails. "Sex.?The cases occurring on the post were all males, while those observed among the civilian population, both sexes were eqrally affected. " Age.?The youngest case observed was in a child 5 years of age and the oldest in a man GO years of age. That the disease is propagated by the mosquito seems to be borne out by the fact that those cases occurring on the post were limited almost entirely to the men living in the barracks. Hiese are temporary frame buildings, and owing to numerous cracks around doors, windows and in floors, it was impossible to effectually screen them. Each man used his net while sleeping, but this did not protect during the early hours of the evening. Only one case developed among the occupants of the officers' and non-commissioned officers' quarters. This was a line officer, whose duties required him to be out all day and many times at night, he being the only officer present for duty. No cases occurred among the Hospital Corps. The hospital is a modern brick building, thoroughly screened. That there should have existed such an extensive epidemic among the civilian population is not surprising when it is known that no protection whatever against the mosquito is provided for by the inhabitants of this Island. " Blood Examinations.?The colour index was not disturbed in any case. In all cases several smears and fresh specimens were examined at various stages of the disease for malaria and found negative. Smears from Cases 1 and 2 were also sent to Washington and reported negative from there. An eosinophila was observed in the majority of cases. " Diagnosis. ?The seasonal period in which this disease prevails, and the absence of catarrhal symptoms should serve to differentiate it from influenza. The absence of yellow fever from the States, the slower pulse, jaundice and htematemesis in yellow fever, will exclude it. The only disease with which it is likely to be confused is malaria, and the blood examinations should clear this up. Should there be any doubt as to the correctness of the blood examinations made by the writer, the examinations at the Army Medical School Bacteriological Laboratory, of smears from cases Nos. 1 and 2 should remove all doubt as to these cases at least. " Complications.?No untoward results were observed in the cases admitted to the hospital. Two cases have been reported to me which suffered from a peripheral neuritis of both arms following the disease, and one case which was complicated by partial paralysis of the lower extremities which lasted for ten days. " Convalescence as a rule was rapid, but in a few of the civilian cases it was prolonged, they complaining of soreness of muscles several weeks after temperature had declined to normal. " lielapses.?Several of my hospital cases were readmitted and ran a typical course. Whether these were true relapses or reinfections, I am unable to say, though I am inclined to believe they were in the nature of reinfection."
of study. It is written Y. N. Rege, we quote the
The following account of the value of inoculation against plague at Nagpur is "well deserving
1'Jll.
by Assistant-Surgeon following:?
" History of the epidemic.?The plague broke out for the seventh time at Nagpur last year on the 8th of July. During this epidemic, which extended to the end of the year 19^9, there were according to the municipal registers 7,859 attacks and 7,269 deaths. Out of these numbers only 18U cases and 129 deaths occurred before inoculation was commenced, leaving 7,679 cases and 7,140 deaths as the total number of attacks and deaths. The outbreak assumed an epidemic form in August and reached its height in the week ending 14tli October, during which week the plague mortality was 1,126. The highest daily figures were 214 attacks and 202 deaths on the 6th October, and the monthly total for October reached the record number of 3,525. During the three months of greatest severity it carried away Evacuation was freely resorted to, over 6,000 persons. and nearly three-fourths of the population left the town, but even in the health camps rat mortality was noticed and several indigenous cases occurred. The total number of inoculations performed by the several inoculators during the last epidemic was the highest on record in Nagpur, viz., 22,347, while in 1906 the number did not exceed 1,478. This distinctly shows with what rapidity inoculation has grown in favour in Nagpur. Inoculations at the Empress Mills.?Inoculations at the Empress Mills were commenced under Colonel Andrew Buchanan, i.m.s., the Civil Surgeon, on the 16tli of August 1909 and continued till the Gtli of November 1909. A certain number were inoculated every alternate day, so that during the course of the epidemic the numbers of the inoculated steadily increased, while, on the contrary, the numbers of those not inoculated
decreased," "
Khan Bahadur Bezonji Dadabhoy, the well-known Manager of the Empress Mills, has been ever ready to give encouragement to inoculation and has thereby made preventive inoculation very popular among the mill employes, and by offering them inducements, such as the grant of two days' leave with full wages, he induced them to get themselves inoculated. My enquiry extended over eight weeks from the 21st of August to the lltli
of October 1910, and was limited to the iuoculations performed at the Empress Mills alone." "The statistics thus collected may, therefore, be taken as trustworthy and the relative case incidence and case mortality among the uninocillated in the table given below may be accepted as reasonably accurate. The subjoined table shows in a clear and precise manner the relative protection from plague which may be expected from inoculation. It has been constructed from a summary of 551 investigation sheets referring to plagueinfected households only. The figures are collected from house holds containing protected as well as unprotected members who were exposed to infection and among whom cases of plague subsequently occurred.
O
Uninooulated
f At Inoculated-^I
?
Mills..
Outside
Total
of inoculated
"
INOCULATION AGAINST PLAGUE AT NAGPUR
[Nov.,
! 2,224
33-3G
742
!)-84
702
10
.
131
G
| 11-45
..
SS3
1U
10 08
89
;
1*33 4-58
13-51 ;
94-S2
i
82 35
i0 0
17-97;
99-05
From the facts and figures given above we can come following conclusions (1) that inoculation markedly reduces case incidence, (2) that it also greatly reduces case mortality, (3) that inoculation as such is quite harmless,
to the
Nov., 1911,J
StTRGlCAL IlETUBNS.
(4) that it is also harmless even when a person is the incubation stage, (5) that the temperature reaction after inoculation is, as a rule, of a mild type, (6) that it lias no bad after-effects, and (7) that the attack of plague in an inoculated person is generally of a mild type. I commend the above figures and the conclusions deduced from them for the careful consideration of employers of labour in our principal towns. Plague is more or less endemic in big towns. Past experience has shown that the epidemic has its worst results among the labouring population, who crowd in dingy ill-ventilated localities. Evacuation on an adequate scale is in their case out of the question, and even were it so possible, it does not, without inoculation, afford the same degree of immunity as preventive inoculation even without evacuation provides. No preventive measure at once so cheap and so effective has yet been known to science as inoculation, and I trust that the results of the Nagpur enquiry will convince our Captains of Industry of its striking advantages and persuade them to resort to it in time during an epidemic for conservation of labour and saving of human life."
RETURNS OF SURGICAL OPERATIONS.
This is a question which lias often been discussed and about which there is a difference of opinion especially upon what should be returned as a minor or a major operation, but we think there can be no difference of opinion on the following practical rules which have recently been issued by the Director-General, I. M. S. :? " With Government of India, Home Department letter No. ^ie ^th March 1896, Rules were forwarded for the guidance of all concerned in the preparation of returns of surgical operations. The following rules stated the procedure to be followed in the case of
multiple operations :? Rule 4.?In multiple operations of necessity, such as those in accidents, etc., tli9 principal one is to be returned as the main operation and the subsidiary or secondary ones, such as multiple amputations, setting fractures, reducing dislocations, and others of like importance,
may also be returned as separate operations. Rule 5.?A second operation, performed on a patient when the first is surgically cured, should be returned as a
separate
one.
operations tending to the cure of relief same condition, performed on the same or any subsequent days, should be returned as one operation. 2. These rules are variously interpreted by medical officers. For example, an operation for curetting the uterus is shown by some oilicers as a single operation, and by others as four separate ones, e.g., douching vagina, dilating cervix, curetting uterus, plugging uterine cavity. Again, in a recent case of placenta prcevia, no less than 8 operations were shown, viz., plugging vagina, dilatation of cervix, puncture of membranes, version, podalic extraction, separation of placenta, plugging of uterus, and phlebotomy. Again, Rule G.?All of one and the
the incision of several boils, or the extiaction of several teeth from one individual, are sometimes shown as separate operations in the case of each incision or extraction Such cases evidently transgress the spirit of Rule G above quoted, and render the operation returns of the officer concerned of no value whatever as an index of the amount of work performed by him. 3. It is not possible to draw up hard-and-fast rules to govern all cases ; it may occur that, in the course of an abdominal operation on the ovaries, there is found to be also disease of the appendix ; in such a case, an ?ippendicectomy performed at the time might fairly be
PALUDI8M.
regarded tomy
;
as an
43o
operation
apart from the
if, however, the removal of
a
primary ovariohealthy appendix
necessitated in the course of the general operation, as tor adhesions, it would not be proper to return this as an operation for appendicectomy, any more than the arrest of hemorrhage or closing of the wound. 4. Eye operations, again, are frequently returned in a manner which reflects little credit on the officer concerned. For example, a case of extraction of the lens was recently shown as three operations, viz., incision of cornea, iridectomy, and extraction of lens On the other hand, the removal of a cataract, or of pterygium from both eyes, should be regarded as two operations. 5. It must be understood that the steps of an opera ti?n are not themselves to be shown as separate and that of the .Rule tions, spirit 6, which is perfectly ^ is to be observed." clear, was
opera-
"
PALUDISM."
Apart from the important announcement about an Indian Research Fund the recently received issue of " Paludism " (No. 3; is full of matter valuable to all interested in the campaign ? against malaria. We are very glad to see that the pioneer work done in India in the spread of the use of quinine is properly noticed, but in regard to Bengal we do not think that full justice has been done to the pioneer work of the Government of Bengal under the late Sir Charles Elliot on this matter. This beneficent work was started in Bengal and the other provinces soon followed. The pice packet system was invented in the Central Jail, Alipore; which, for many years, supplied many other provinces with thousands of packets yearly, and the Bengal Jail Department lias shown its interest in the popularisation of continued India by having taken over (from in quinine 1st October 1911) the whole management of the distribution of the quinine manufactured for India in the Cinchona Factory in the Darjeeling hills. As soon as the new plantations are in work in oorder, we hope the Darjeeling and Sikhiin Cin? chona Gardens can be able to supply an enormously increased supply of pure quinine and that there will be no need for some provinces to import quinine from other countries. This is a Swadeshi enterprise which should bo supported by all that have the interests of India at heart. We hope that critics in England who are dissatisfied that India does not eagerly grasp at their panaceas will be brought to realise5 the good work which has been and more than ever now is, being once in India. As we presume this valuable publication is widely circulated among our readers, we need to no more than refer to a few of the papers published. We may particularly call attention to the note on the selection of unit areas for recording data concerning malaria in India- to Major Kenrick's useful paper on the effect of endemic malaria on the birth and death-rate in the Central Provinces. He shows that it is in children that the intensity of the parasitic invasion is fatal and that malaria is usually
THE INDIAN MEDICAL GAZETTE.
436
an indirect cause of death in adults. Lieut.-Colonel Adie lias an interesting note on malaria among the troops and native children in Delhi, and Major Perry reports on the work done in the Jeypore, plateau near Vizagapatam. Major Christophers writes on the identification of culicidse other than anopheles and gives complete identification tables. Lieut.-Colonel Adie's useful method of collecting adult mosquitoes is commended to all workers. Major Christophers lias an interesting report on the existence of a localised centre of KalaAzar in Qolaghafc Sub-Division of Sibsagar?an area just outside the limits of the spread of the great Nowgong epidemic of Kala-Azar. These eases were discovered by Capt. Morison, the Civil Surgeon, and it is satisfactory to see that this little outbreak has been so promptly investigated. Major Christophers has another article on malarioraetiy?and the estimation of the size of enlarged spleens, which, we confess, is too mathematical for us to follow. This issue of Paludism concludes with brief reviews of many interesting papers and monographs on malaria. This new quarterly is improving in every issue and has become indispensable to malaria workers.
only
ACCELERATED PROMOTION IN I. M. S.
It must be admitted by all that the DirectorGeneral is doing and has done all that can be to remove anomalies and difficulties in the way of men qualifying for the accelerated promotion to Majors, I. M. S. The following extract from a despatch of the Secretary, of State will show the latest concession on this matter :? "
I approve the proposal that the sanction conveyed in 19 of my Military Despatch No. 108, dated 2nd December 1910, be given retrospective effect and made applicable to :?
[Nov.,
1911.
referred to Sir David Semple's statement that germs had been found in the fceces of four out of ten heal thy subjects examined. tetanus
A
calls our attention to the from Williamson's Oriental Edition, 18U8 (Vol. 1, p. 251) :?
correspondent
following quotation
Field
Sports
"
In many parts of Bengal the marsh fever is very regular in its attacks on all ages and never fails to carry off a large portion of the inhabitants. I Lave known some villages where for many years not a single person escaped the fever, but which might have been averted by cutting a few drains to carry off the stagnant waters in due time. It was not the business of any one particular person, and so consequently no one would do it."
This is a good instance of the existence of malaria fever in Bengal a century ago.
The following extract from the Government of India Resolution on deaths from wild animals in 1910 is of interest:? " The total mortality amongst human beings caused by snake-bite rose from 21,364 to 22,478. The greatest number of deaths, as usual, occurred in Bengal and the United Provinces where the figures were 7,767 and 5,436, as compared with 7,202 and 4 814, in the previous year, respectively. The next highest mortality occurred in Eastern Bengal and Assam with 2,915 deaths, The greatest variation in the mortality was in Bengal, the United Provinces and Eastern Bengal and Assam In Bengal the increase is particularly noticeable in the Tirhut and Presidency Divisions. The increase in Eastern Bengal and Assam is attributed to snakes being driven by high floods to take refuge in the raised village sites. Both in this province and in the United Provinces a considerable number of cases were treated with the Brunton lancet and permanganate of potash, and a high proportion of them are reported to have recovered. No reliable deduction can. however, be drawn from the use of this lancet, owing to the lack of proof that the bites it was used upon were really those of poisonous snakes."
paragraph
(1) Existing majors of the Indian Medical Service who have not yet completed 16 years' service and have not been able to get study leave ; and (2) Majors of the Indian Medical Service who had already taken study leave and qualified for accelerated promotion while in the rank of major before completing 16 years' service." We may expect some ments of officers' positions
interesting readjust-
accordingly.
We have been asked if the opinion expressed by Lieut.-Colonel Henry Smith, I.M.S., of Amritsar, in the discussion on sterilisation of the skin to the effect (as given in Lancet, August 12th, 19.11, p. 443) that in India 50 per cent, of the men have tetanus bacilli in the blood" is correct. We may certainly assume that Lieut.-Colonel Smith has not been correctly reported. Tetanus is not a bactericsemia. He probably "
Dr. C. Walker (J. of Hygiene, July 1911) has a valuable note oh some experiments on the inoculation of materies morbi through the human skin by flea-bites. His results " are at variance with the view which at prevent meets with most acceptance regarding the mechanism by which fleas transmit the disease " (plague). Certainly further enquiry is needed.
Dr. J. Burnet, of Edinburgh, writes in 1Medical Press (August 16th, 1911) to show that " in his opinion Pellagra and Sprue are one and the same disease". He asks for criticism and further information. Notice.? Will the officer ivho sent us an unsigned article on tetanus infection from an operation wound please send his name? Wt have the article in print for publication, but have not got the name of the author.
An Officer below the rank of Colonel, who appointed as Our Honorary Physician or Surgeon after retirement from the Service, shall be granted the honorary rank of Colonel." (2) The following shall be substituted for 14 : paragraph " Six of the most meritorious Medical Officers of the Service on the Active. List shall be named Our Honorary Physicians, and six Our Honorary Surgeons. An Officer shall relinquish the appointment of Honorary Physician or may be
Honorary Surgeon
on
retirement."
Given at Our Court at St. James's this eighth day of August 1911, in the Second }ear of Our Reign. By His Majesty's Command, Crewe. The importance of the above modification of the Royal Warrant is that the six Honorary Physicians and six Honorary Surgeons are in future to be chosen (after the present holders have relinquished the appointments) from Officers on the Active List and not from among retired officers as has hitherto been the case (see first page of Quarterly Army List). These appointments will also be given up on retireThis has been the rule in the R.A. M. C. ment. and it is good to find it applied to the I. M. S. OUR IGNORANCE OF DYSENTERY.
(flllTPt ?0|)iCK. THE KING'S PERSONAL STAFF.
The Governor-General in Council is pleased to direct the publication of the following Royal Warrant, dated the 8th August 1911, amending the rules for the promotion and precedence of officers of the Indian Medical Service which were published in Department of Military Supply Notification No. 27, dated the 24th April 1908 :? George, R. I.
Whereas we deem it expedient to amend the rules for the promotion and precedence of Our Indian Medical Service : Our Will and Pleasure is that Our Warrant of the 13th March 1908 be amended in accordance with the following provisions :? (I) The following shall be omitted from paragraph 10 ;
It must be confessed that we are still ignorant of dysentery. It is one of the great diseases of the tropics and responsible for more chronic ill-health than even malaria, much has been written about it for years, yet it cannot be said that we know definitely very much about the relative distribution of the two main types of dysentery, viz., amoebic and bacillary. These thoughts have not been dispelled by a perusal of two recent valuable papers on this protean disease, viz., Dysentery and Liver Abscess in Bombay by Major E. D. W. Greig, i.m.s., and Capt. R. T. Wells. I.M.S.,* and The Dysentery Bacillus by Major E. R. Whitmore (U. S. A.). In the first place, the Scientific Memoir by Major "Greig and Capt. Wells is not complete, is promised, which is notand a later report satisfactory to the practical medical man who wishes to get rid of dysenteiy in his jail or his asylum. We can only hope that this inquiry commenced in 1908 will be continued. It used to be said that ordinary Indian dysentery was mainly bacillary, but apparently this is not so as regards Bombay. The very frequent presence of other intestinal parasite was confirmed in Bombay, the trichomonas being especially frequent. As regards variety, the bacillus dysenteric of Shiga was found on 4 out of 13 cases, and in the remaining nine the bacillus of "
* Scientific Memoirs, India, No. 47(1911); The Dysentery Bacillus, E. R. Whitmore, Major U. S. Army, Philip. J. of Sci., June 1911.
THE INDIAN MEDICAL GAZETTE.
432
Flexner. None of these bacillary cases showed The any indication of liver complication. excretion of the bacilli is intermittent, and they cease to be found as soon stools became as the feculent and blood and mucus disappeared, The use of the sigmoidoscope is recommended in cases of bacillary dysentery as the lower part of the large intestine is most frequently involved. The writers of the Scientific Memoir appear to think that there exists a sufficient amount of knowledge of bacillary dysentery to enable the sanitarian to intelligently apply the method of prevention, but except Major Forster's well known and practical work on dysentery we know of no work done which will give the practical man any clue to prevention and whether the present authors endorse, approve, or are opposed to Major Forster's views does not appear from this memoir. Our authors rightly consider that there are many gaps in our knowledge of the amoebic infection, and we agree with them that the conclusions of Schaudin has been too rigidly accepted as final, for example the view that many free living amoebic may, in suitable culture, become transformed into pathogenic forms is still open to discussion. We cannot and need not here follow Major Greig and Captain Wells throughout the important series of experiments made by them?we can only quote their general conclusions which are briefly as follows :? 1. 2. more
Bacillary dysentery is rare in Bombay. Dysentery associated with amoebae prevalent.
is
amoebae can be cultivated from stools and liver abscess pus and can be grown outside the body in a suitable medium. 4. The prevalence of amoebae shows a marked seasonal variation. 5. The season of greatest prevalence of amoebae in Bombay corresponds to the season of greatest prevalence of dysentery, or shown by the rates of admissions for d}7sentery in Bombay 3.
The
dysentery
jails. 6.
The amoebae cultivated
in
Bombay
are
ent. histolitica, or coli, but are the same or similar to those cultivated by Noc in Cochin not
China. 7. That the same or apparently the same amoebae can be cultivated from tap water. 8. That amoebae can be cultivated from the stools of large number of normal animals. 9. That amoebae from cysts inside and outside the body, and that this cystic stage is important and cases cannot be considered cured till the stools are found to be free of these cysts. 10. Amoebae may be cultivated from the faeces of persons suffering from abscess of the liver, although he at the time shows no signs of
dysentery. 11.
That the evidence at present available a channel by which
indicates that water is
[Nov.,
1911.
amoebae of dysentery may be desseminafced in endemic areas. A high leucoc}7tosis may occur. 12. 13. A moderate leucocytosis if associated with rise of temperature may indicate hepatic invasion. 14. That ipecacuanha, as pointed out by Rogers, will prevent the formation of liver abscess. Jt is pointed out that "growths of amoeboid organisms may appear in association with moulds and other bacteria by exposing plates of uninseminated Musgrave's agar to the air." This disquieting observation certainly points to the need of further investigation being necessary. The other article on dysentery which we have above mentioned is by Major Whitmore and the work was done in the Biological Laboratoiy, Manila, P. I. He gives a brief review of previous work and concludes that the "dysentery bacillus has been divided into four groups by He concludes as the use of sugar media." follows:? 1. In an epidemic of bacillary dysentery with a high death-rate in Luzon it has been shown that the Shiga-Kruse type of dysentery was the causative agent. 2. At the same time the Flexner-Strong type of dysentery bacillus was found in some cases of dysentery around Manila. 3. The bacillus Y, and the Strong type with which Leutz worked was not found. 4. Great care is necessary in deciding types of dysenterj7 bacillus from their reactions in sugar media alone. The above imperfect rdsumds of these two valuable monographs on dysentery will at least have shown that we are still ignorant of much about this variable disease. It is not yet known what is the ordinary type of dysentery ?seen for example in jails, asylums, or in cases at the hospitals. attending The subject is a vitally important one and demands continued investigation. We have ventured to criticise the above valuable work from an entirely practical point of view. We read both articles in the hope of being able to get some clue to prevention, and we cannot say that in this respect we have been satisfied. We have nothing but praise for the high standard of scientific work shown in both the articles we have criticised. THE TRANSMISSION OF GOITRE.
We
reproduce below the interesting note by Major McCarrison, M.D., M.R.C.P., I.M.S., Agency R.
Surgeon, Gilgit, which was communicated to the Royal Society on 1st June last, on the experimental transmission of goitre from man to
animals "
:?
Experiments had repeatedly been carried out on dogs to test the assumption that goitre could be conveyed from man to animals by frecal infection of the .water
LOW FEVER OR DENGUE IN THE UNITED STATES.
Nov., 1911.]
In the present exThe drinking water supplied to these goats was fouled by passing which contained through a specially constructed box, sterilised soil mixed with the f;eces of goitrous indivithis duals. In the case of one batch of six go.its, only In the case of another batch of water was consumed. referred to contained, in seven goats the box above addition to the sterilised soil and fa;ces, 500 earthworms. These were added on the assumption that they might of the act as intermediate hosts to the infecting agent disease. The goats consumed this highly polluted water for 64 days, from October 13th to December 15th, 1910. The results observed were (1) a loss of weight, due doubtless to confinement in a small hut for the 64-days of the experiment ; (-2) that many of them suffered from diarrhcea ; and (3) that 50 per cent, of the animals showed enlargements of the thyroid gland, most marked The thyroids of three control goats on the right side. showed no alteration in size. The enlargement of the thyroid was observed to fluctuate in size considerably, a fact which had previously been noted in the case of experimentally produced goitre in man. The average weight of the normal thyroid of the goat in Gilgit is 1/10,OuO part of the body weight. The enlarged glands of the goat in'the experiment were found to weigh from 1/4,272 to 1/7,000 part of the body drinking fouled water the weight. In both batchessame. results observed were the Microscopical examination of the enlarged organs showed varying degrees of dilatation of the vesicles, scarcity or almost complete disappearance of the masses of cells lying between the vesicles, while no alterations were observed to have taken place in the connective tissue stroma of the enlarged glands. The hypertrophy of the vesicle with colloid, was due wholly to distension and the formation of new vesicles from the intravesicular It is concluded that? masses of cells. (1) An hypertrophy of the thyroid gland of goats can be induced by infecting the water-supply with the fajces of sufferers from goitre. It is at present impossible to state whether this hypertrophy is due to the action of the infecting agent of goitre, or only to the organic impurity of the water thus contaminated. (2) Earthworms do not appear to be concerned in the spread of goitre. (3) The microscopical appearances described are the earliest stages in the formation of parenchymatous
supply,
but with
negative
periments female goats
results.
were
employed.
cOitre." SANDFLIES IN MALTA.
In
Annals of
433
suffer torture from them. Certain blocks of houses are more often infected than others and groundfloor rooms rather than upper rooms. The neighbourhood stone of rocky ground and walls attract them. The day-light retreats of these pests are in dark places, under garments, behind pictures, etc. They can get through mosquito curtains, but the females when gorged with flood are unable to get out. They are frail and delicate animals and cannot stand a breeze, and the use of the Indian punka is recommended. There is a seasonal prevalence, but this largely depends on variations in temperature, humidity and wind. As for prophylactic measures, Mr. Newstead recognises that "the task of suppressing them is an almost insurmountable one," but he makes several suggestions, and he quotes a prescription, for a "repellent" given by Major Crawford, R.A.M.C., which consist of 01. Anisi, one drachm, 01. Eucalypti, one drachm, 01. Terebinth, half a drachm, and Ung. ac. borac, one ounce. All dark portions angles, corners of a room can be sprayed with formalin (1 per cent, solution) with a fine spraying apparatus, and mosquito curtains before bed-time should be sprayed with this solution. Light is important, decorative drapery must be abolished, punkas and electric fans are certainly useful. Traps may be used and as ordinary mosquito nets are useless, nets made of fine strong "chiffon" are needed, but are not practicable in hot weather. Persistent efforts would be necessary to destroy their breeding grounds, but walls should be pointed and crevices in rocks and old walls filled up with cement, etc. The rest of Mr. Newstead's valuable article is taken up with the anatomy, etc., of the genus
children streets
"
or
"
phlebotomus.
Tropical Medicive (August
"LOW COUNTY FEVER OR DENGUE." 1911) Mr. R. Newstead lias a valuable report the In Malta of in which view of Military Surgeon (August 1911) on the papatasi flies H. Halliday, U. S. Army, has an Lieut." C. the differentiated fever of newly the prevalence in many parts of India is .worthy of our attention. interesting contribution to the still unsettled of dengue with various The important species are P. papatasii and P. question of the identity of minor non-continued fevers, described types perniciosns. The breeding places of these insects are very in Europe, India and elsewhere. The "Low County Fever" described by difficult to find, as the larvre are so minute, but in holes and crevices Lieut. Halliday has existed in Beaufort County, found be to they appear in loose rocks and in caves, where the three con- S. C. (U. S. A.), from time immemorial" :? " ditions of presence of organic matter, slight moisIt is characterized in sudden onset"
by
(preceded
about 50% of the cases by a chill), rapid rise of ture, and absence"of light are found. Though so evasive in their early stage these temperature, increased pulse rate, nausea and vomiting, moist and coated tongue,, congestion of visible mucous flies are?found every where in the Maltese Islands, membranes, headache, lumbar pain, muscular soreness, and they outnumber the mosquitoes and the and pain in bones and joints of varying intensity. An " the most vicious of all the females are among eruption occurs in some cases and in the severe type blood-sucking Arthropods." As in the case of epistaxis is often a troublesome symptom." pulex irritans, these flies have their likes and dislikes, and many persons are quite immune to The extreme degree of prostration from the and especially onset is remarkable. but new-comers their bites
434
Lieut. Halliday of the setiology :? 11
THE
gives
the
INDIAN MEDICAL GAZETTE.
following
account
was unusually long, dry and liot, beginning early in April and extending well into November. Very little rain fell during the Summer months Late in September there were heavy rains which tilled all ponds and depressions over the Island with water.
Climate.?The Summer
"Mosquitoes.?The mosquitoes
were
not numerous
or
troublesome until about October, when they greatly increased in number. The reports on collections of mosquitoes made from this post for the past several years, show that Culex fatigans is only reported for the Fall months, the period when this disease prevails. "Sex.?The cases occurring on the post were all males, while those observed among the civilian population, both sexes were eqrally affected. " Age.?The youngest case observed was in a child 5 years of age and the oldest in a man GO years of age. That the disease is propagated by the mosquito seems to be borne out by the fact that those cases occurring on the post were limited almost entirely to the men living in the barracks. Hiese are temporary frame buildings, and owing to numerous cracks around doors, windows and in floors, it was impossible to effectually screen them. Each man used his net while sleeping, but this did not protect during the early hours of the evening. Only one case developed among the occupants of the officers' and non-commissioned officers' quarters. This was a line officer, whose duties required him to be out all day and many times at night, he being the only officer present for duty. No cases occurred among the Hospital Corps. The hospital is a modern brick building, thoroughly screened. That there should have existed such an extensive epidemic among the civilian population is not surprising when it is known that no protection whatever against the mosquito is provided for by the inhabitants of this Island. " Blood Examinations.?The colour index was not disturbed in any case. In all cases several smears and fresh specimens were examined at various stages of the disease for malaria and found negative. Smears from Cases 1 and 2 were also sent to Washington and reported negative from there. An eosinophila was observed in the majority of cases. " Diagnosis. ?The seasonal period in which this disease prevails, and the absence of catarrhal symptoms should serve to differentiate it from influenza. The absence of yellow fever from the States, the slower pulse, jaundice and htematemesis in yellow fever, will exclude it. The only disease with which it is likely to be confused is malaria, and the blood examinations should clear this up. Should there be any doubt as to the correctness of the blood examinations made by the writer, the examinations at the Army Medical School Bacteriological Laboratory, of smears from cases Nos. 1 and 2 should remove all doubt as to these cases at least. " Complications.?No untoward results were observed in the cases admitted to the hospital. Two cases have been reported to me which suffered from a peripheral neuritis of both arms following the disease, and one case which was complicated by partial paralysis of the lower extremities which lasted for ten days. " Convalescence as a rule was rapid, but in a few of the civilian cases it was prolonged, they complaining of soreness of muscles several weeks after temperature had declined to normal. " lielapses.?Several of my hospital cases were readmitted and ran a typical course. Whether these were true relapses or reinfections, I am unable to say, though I am inclined to believe they were in the nature of reinfection."
of study. It is written Y. N. Rege, we quote the
The following account of the value of inoculation against plague at Nagpur is "well deserving
1'Jll.
by Assistant-Surgeon following:?
" History of the epidemic.?The plague broke out for the seventh time at Nagpur last year on the 8th of July. During this epidemic, which extended to the end of the year 19^9, there were according to the municipal registers 7,859 attacks and 7,269 deaths. Out of these numbers only 18U cases and 129 deaths occurred before inoculation was commenced, leaving 7,679 cases and 7,140 deaths as the total number of attacks and deaths. The outbreak assumed an epidemic form in August and reached its height in the week ending 14tli October, during which week the plague mortality was 1,126. The highest daily figures were 214 attacks and 202 deaths on the 6th October, and the monthly total for October reached the record number of 3,525. During the three months of greatest severity it carried away Evacuation was freely resorted to, over 6,000 persons. and nearly three-fourths of the population left the town, but even in the health camps rat mortality was noticed and several indigenous cases occurred. The total number of inoculations performed by the several inoculators during the last epidemic was the highest on record in Nagpur, viz., 22,347, while in 1906 the number did not exceed 1,478. This distinctly shows with what rapidity inoculation has grown in favour in Nagpur. Inoculations at the Empress Mills.?Inoculations at the Empress Mills were commenced under Colonel Andrew Buchanan, i.m.s., the Civil Surgeon, on the 16tli of August 1909 and continued till the Gtli of November 1909. A certain number were inoculated every alternate day, so that during the course of the epidemic the numbers of the inoculated steadily increased, while, on the contrary, the numbers of those not inoculated
decreased," "
Khan Bahadur Bezonji Dadabhoy, the well-known Manager of the Empress Mills, has been ever ready to give encouragement to inoculation and has thereby made preventive inoculation very popular among the mill employes, and by offering them inducements, such as the grant of two days' leave with full wages, he induced them to get themselves inoculated. My enquiry extended over eight weeks from the 21st of August to the lltli
of October 1910, and was limited to the iuoculations performed at the Empress Mills alone." "The statistics thus collected may, therefore, be taken as trustworthy and the relative case incidence and case mortality among the uninocillated in the table given below may be accepted as reasonably accurate. The subjoined table shows in a clear and precise manner the relative protection from plague which may be expected from inoculation. It has been constructed from a summary of 551 investigation sheets referring to plagueinfected households only. The figures are collected from house holds containing protected as well as unprotected members who were exposed to infection and among whom cases of plague subsequently occurred.
O
Uninooulated
f At Inoculated-^I
?
Mills..
Outside
Total
of inoculated
"
INOCULATION AGAINST PLAGUE AT NAGPUR
[Nov.,
! 2,224
33-3G
742
!)-84
702
10
.
131
G
| 11-45
..
SS3
1U
10 08
89
;
1*33 4-58
13-51 ;
94-S2
i
82 35
i0 0
17-97;
99-05
From the facts and figures given above we can come following conclusions (1) that inoculation markedly reduces case incidence, (2) that it also greatly reduces case mortality, (3) that inoculation as such is quite harmless,
to the
Nov., 1911,J
StTRGlCAL IlETUBNS.
(4) that it is also harmless even when a person is the incubation stage, (5) that the temperature reaction after inoculation is, as a rule, of a mild type, (6) that it lias no bad after-effects, and (7) that the attack of plague in an inoculated person is generally of a mild type. I commend the above figures and the conclusions deduced from them for the careful consideration of employers of labour in our principal towns. Plague is more or less endemic in big towns. Past experience has shown that the epidemic has its worst results among the labouring population, who crowd in dingy ill-ventilated localities. Evacuation on an adequate scale is in their case out of the question, and even were it so possible, it does not, without inoculation, afford the same degree of immunity as preventive inoculation even without evacuation provides. No preventive measure at once so cheap and so effective has yet been known to science as inoculation, and I trust that the results of the Nagpur enquiry will convince our Captains of Industry of its striking advantages and persuade them to resort to it in time during an epidemic for conservation of labour and saving of human life."
RETURNS OF SURGICAL OPERATIONS.
This is a question which lias often been discussed and about which there is a difference of opinion especially upon what should be returned as a minor or a major operation, but we think there can be no difference of opinion on the following practical rules which have recently been issued by the Director-General, I. M. S. :? " With Government of India, Home Department letter No. ^ie ^th March 1896, Rules were forwarded for the guidance of all concerned in the preparation of returns of surgical operations. The following rules stated the procedure to be followed in the case of
multiple operations :? Rule 4.?In multiple operations of necessity, such as those in accidents, etc., tli9 principal one is to be returned as the main operation and the subsidiary or secondary ones, such as multiple amputations, setting fractures, reducing dislocations, and others of like importance,
may also be returned as separate operations. Rule 5.?A second operation, performed on a patient when the first is surgically cured, should be returned as a
separate
one.
operations tending to the cure of relief same condition, performed on the same or any subsequent days, should be returned as one operation. 2. These rules are variously interpreted by medical officers. For example, an operation for curetting the uterus is shown by some oilicers as a single operation, and by others as four separate ones, e.g., douching vagina, dilating cervix, curetting uterus, plugging uterine cavity. Again, in a recent case of placenta prcevia, no less than 8 operations were shown, viz., plugging vagina, dilatation of cervix, puncture of membranes, version, podalic extraction, separation of placenta, plugging of uterus, and phlebotomy. Again, Rule G.?All of one and the
the incision of several boils, or the extiaction of several teeth from one individual, are sometimes shown as separate operations in the case of each incision or extraction Such cases evidently transgress the spirit of Rule G above quoted, and render the operation returns of the officer concerned of no value whatever as an index of the amount of work performed by him. 3. It is not possible to draw up hard-and-fast rules to govern all cases ; it may occur that, in the course of an abdominal operation on the ovaries, there is found to be also disease of the appendix ; in such a case, an ?ippendicectomy performed at the time might fairly be
PALUDI8M.
regarded tomy
;
as an
43o
operation
apart from the
if, however, the removal of
a
primary ovariohealthy appendix
necessitated in the course of the general operation, as tor adhesions, it would not be proper to return this as an operation for appendicectomy, any more than the arrest of hemorrhage or closing of the wound. 4. Eye operations, again, are frequently returned in a manner which reflects little credit on the officer concerned. For example, a case of extraction of the lens was recently shown as three operations, viz., incision of cornea, iridectomy, and extraction of lens On the other hand, the removal of a cataract, or of pterygium from both eyes, should be regarded as two operations. 5. It must be understood that the steps of an opera ti?n are not themselves to be shown as separate and that of the .Rule tions, spirit 6, which is perfectly ^ is to be observed." clear, was
opera-
"
PALUDISM."
Apart from the important announcement about an Indian Research Fund the recently received issue of " Paludism " (No. 3; is full of matter valuable to all interested in the campaign ? against malaria. We are very glad to see that the pioneer work done in India in the spread of the use of quinine is properly noticed, but in regard to Bengal we do not think that full justice has been done to the pioneer work of the Government of Bengal under the late Sir Charles Elliot on this matter. This beneficent work was started in Bengal and the other provinces soon followed. The pice packet system was invented in the Central Jail, Alipore; which, for many years, supplied many other provinces with thousands of packets yearly, and the Bengal Jail Department lias shown its interest in the popularisation of continued India by having taken over (from in quinine 1st October 1911) the whole management of the distribution of the quinine manufactured for India in the Cinchona Factory in the Darjeeling hills. As soon as the new plantations are in work in oorder, we hope the Darjeeling and Sikhiin Cin? chona Gardens can be able to supply an enormously increased supply of pure quinine and that there will be no need for some provinces to import quinine from other countries. This is a Swadeshi enterprise which should bo supported by all that have the interests of India at heart. We hope that critics in England who are dissatisfied that India does not eagerly grasp at their panaceas will be brought to realise5 the good work which has been and more than ever now is, being once in India. As we presume this valuable publication is widely circulated among our readers, we need to no more than refer to a few of the papers published. We may particularly call attention to the note on the selection of unit areas for recording data concerning malaria in India- to Major Kenrick's useful paper on the effect of endemic malaria on the birth and death-rate in the Central Provinces. He shows that it is in children that the intensity of the parasitic invasion is fatal and that malaria is usually
THE INDIAN MEDICAL GAZETTE.
436
an indirect cause of death in adults. Lieut.-Colonel Adie lias an interesting note on malaria among the troops and native children in Delhi, and Major Perry reports on the work done in the Jeypore, plateau near Vizagapatam. Major Christophers writes on the identification of culicidse other than anopheles and gives complete identification tables. Lieut.-Colonel Adie's useful method of collecting adult mosquitoes is commended to all workers. Major Christophers lias an interesting report on the existence of a localised centre of KalaAzar in Qolaghafc Sub-Division of Sibsagar?an area just outside the limits of the spread of the great Nowgong epidemic of Kala-Azar. These eases were discovered by Capt. Morison, the Civil Surgeon, and it is satisfactory to see that this little outbreak has been so promptly investigated. Major Christophers has another article on malarioraetiy?and the estimation of the size of enlarged spleens, which, we confess, is too mathematical for us to follow. This issue of Paludism concludes with brief reviews of many interesting papers and monographs on malaria. This new quarterly is improving in every issue and has become indispensable to malaria workers.
only
ACCELERATED PROMOTION IN I. M. S.
It must be admitted by all that the DirectorGeneral is doing and has done all that can be to remove anomalies and difficulties in the way of men qualifying for the accelerated promotion to Majors, I. M. S. The following extract from a despatch of the Secretary, of State will show the latest concession on this matter :? "
I approve the proposal that the sanction conveyed in 19 of my Military Despatch No. 108, dated 2nd December 1910, be given retrospective effect and made applicable to :?
[Nov.,
1911.
referred to Sir David Semple's statement that germs had been found in the fceces of four out of ten heal thy subjects examined. tetanus
A
calls our attention to the from Williamson's Oriental Edition, 18U8 (Vol. 1, p. 251) :?
correspondent
following quotation
Field
Sports
"
In many parts of Bengal the marsh fever is very regular in its attacks on all ages and never fails to carry off a large portion of the inhabitants. I Lave known some villages where for many years not a single person escaped the fever, but which might have been averted by cutting a few drains to carry off the stagnant waters in due time. It was not the business of any one particular person, and so consequently no one would do it."
This is a good instance of the existence of malaria fever in Bengal a century ago.
The following extract from the Government of India Resolution on deaths from wild animals in 1910 is of interest:? " The total mortality amongst human beings caused by snake-bite rose from 21,364 to 22,478. The greatest number of deaths, as usual, occurred in Bengal and the United Provinces where the figures were 7,767 and 5,436, as compared with 7,202 and 4 814, in the previous year, respectively. The next highest mortality occurred in Eastern Bengal and Assam with 2,915 deaths, The greatest variation in the mortality was in Bengal, the United Provinces and Eastern Bengal and Assam In Bengal the increase is particularly noticeable in the Tirhut and Presidency Divisions. The increase in Eastern Bengal and Assam is attributed to snakes being driven by high floods to take refuge in the raised village sites. Both in this province and in the United Provinces a considerable number of cases were treated with the Brunton lancet and permanganate of potash, and a high proportion of them are reported to have recovered. No reliable deduction can. however, be drawn from the use of this lancet, owing to the lack of proof that the bites it was used upon were really those of poisonous snakes."
paragraph
(1) Existing majors of the Indian Medical Service who have not yet completed 16 years' service and have not been able to get study leave ; and (2) Majors of the Indian Medical Service who had already taken study leave and qualified for accelerated promotion while in the rank of major before completing 16 years' service." We may expect some ments of officers' positions
interesting readjust-
accordingly.
We have been asked if the opinion expressed by Lieut.-Colonel Henry Smith, I.M.S., of Amritsar, in the discussion on sterilisation of the skin to the effect (as given in Lancet, August 12th, 19.11, p. 443) that in India 50 per cent, of the men have tetanus bacilli in the blood" is correct. We may certainly assume that Lieut.-Colonel Smith has not been correctly reported. Tetanus is not a bactericsemia. He probably "
Dr. C. Walker (J. of Hygiene, July 1911) has a valuable note oh some experiments on the inoculation of materies morbi through the human skin by flea-bites. His results " are at variance with the view which at prevent meets with most acceptance regarding the mechanism by which fleas transmit the disease " (plague). Certainly further enquiry is needed.
Dr. J. Burnet, of Edinburgh, writes in 1Medical Press (August 16th, 1911) to show that " in his opinion Pellagra and Sprue are one and the same disease". He asks for criticism and further information. Notice.? Will the officer ivho sent us an unsigned article on tetanus infection from an operation wound please send his name? Wt have the article in print for publication, but have not got the name of the author.
