ZTbe 3nMan flDcfclcal 6a3ette ffiftp l^eats Hgo LONDON LETTER, Scarlatina in India
(From
the Indian Medical
34,
p.
Gazette, 1899, 414)
Vol.
By a happy coincidence the question of the prevalence of Scarlet Fever in India and other tropical countries has been simultaneously raised in the Journal of Tropical Medicine and in your The subject has been from time to own pages.
time discussed in the Indian Medical Gazette since the year 1870. It has been made quite certain that Scarlatina has been repeatedly imported into India by means of troop-ships, and that in this manner small outbreaks have arisen in military stations and among civil communities, both on hills and plains. It has also been conclusively proved that these epidemics are very limited both in space and time.
It has been inferred that India and other countries possess an immunity as this disease, that is to say, that the microbe which presumably causes it belonging as it seems to do the class of obligatory parasites, does not find in tropical conditions favouring circumstances for life and propagation. Once admitted into the individual, it appears to give rise to the same pathological phenomena as in temperate countries. It must therefore be during the interval of transit from the diseased to the healthy subject that it encounters an environment inimical to either
tropical regards
[Nov., 1949
THE INDIAN MEDICAL GAZETTE
512
existence or virulence or both. The exact truth of its natural history, somatic and extrasomatic, remains to be worked out, but the facts already ascertained justify these provisional conclusions. The curious and really important fact, which the papers to which I have referred place in evidence, is that an eruptive, febrile disease, presenting close if not complete clinical resemblance to Scarlatina, arises sometimes in India de novo, and that occasionally such cases occur in groups and seem I have myself to result from communication. seen such cases singly and in groups in Calcutta and at Darjeeling, and they have been met with by others, as the literature on the subject shows. In these instances the question of importation has been held in view; but the circumstances of their occurrence were, in most cases, such as to render this mode of origin extremely unlikely; and it seems absolutely true that, as in imported cases, so in these autogenous cases the power of infection is exceedingly weak, the incidence very limited, and the duration of outbreak short. The aspect which has been displayed is that of a disease epidemic under favouring condition, which is capable of implantation or even origin de novo but incapable of propagation. The matter is therefore one of profound interest both pathologically and epidemiologically, and it is to be hoped that, as opportunity offers, by general, clinical and bacteriological methods, the points above mooted will be eventually cleared up both as regards India and the tropics
generally. The
Physical Requirements of
the
Public Services An important discussion took place in the section of medicine at the meeting of the British Medical Association at Portsmouth on the medical tests for admission to the Public Services. The time and place were well suited for ventilating questions which concern the efficiency of the services, the anxieties of parents and guardians and the interests of so many youths. The particular subjects of attention were?(1) propriety of existing standards of physical fitness; (2) the methods by which examinations for physical fitness are at present conducted; (3) the uniformity and fairness of such examinations; and (4) the time when they ought to be held whether before or after the literary examination. On these points a considerable variety of opinions were offered, and the only subject on which the section appeared to be unanimous was the stage of the competitive examination at which the testing for physical fitness should be conducted. In effect it was decided that the elimination of the physically unqualified ought to take place before the candidates are subjected to a trial of their intellectual capacity. The reason for this, which seemed to weigh with the section, was that it was cruel to subject youths to the pains of a
literary examination and the disappointment of subsequent rejection, on account of physical incapacity, after they had passed it and perhaps passed it creditably. There is some sense in this view, but it does not wholly express or meet the hardships of the case, for rejection immediately before examination, does not take into account the wasted time, labour and expense of preparation, or the disappointment and demoralizing effect of failure after years of study and expectation, both with a special object. The real truth is that physical fitness should be as far as possible tested and ascertained before a boy commences to study for any particular service in which this is laid down as a necessary qualification. The State cannot be expected to perform a service of this kind for the multitude of youths scattered throughout the Empire who may contemplate preparing themselves for State Employment, nor could it be reasonably held to abide by the results of such early examination, so that a further testing immediately before or after the tiresome
examination would still be necessary. It is the civil practitioner or the retired army or navy surgeon who should be entrusted with this duty; and by a little study of the regulations issued by public departments and boards of examination, it could be fulfilled with sufficient success to indicate whether a boy should undertake the task of preparative study or not just as the report of the headmaster of his school decides, whether he possesses the necessary intellectual capacity and industry for same end. Some public departments?the Admiralty f?r example?pointedly recommended these prc" liminary medical examinations and there can be no doubt that they ought invariably to be made; and if this became the practice, specialists would be forthcoming, who would qualify themselves to give sound advice. In civil life, fitness, if at all enquired into, is considered after for selection employment; but everything depends on the kind of employment and the degree of physical capacity which it demands. In the Army and Navy, physical capacity must necessarily hold a high place, and the question has frequently arisen, whether the element of competition should not apply to this as well as to intellectual endowments by assigning marks for physique, endurance, robustness, agility, and so forth. This has hitherto been found impracticable, and standards have been laid down for the guidance of boards, which cannot be unreasonable nor unfair; nor can boards be accused of applying these with undue severity
physical
pronounced
or
eccentricity.
the Quartan Parasite Mosquito Major Ross has telegraphed from the West Coast of Africa that he has succeeded in cultivating the parasites of quartan fever in anopheles, the genus of mosquito in which the tertian and The Cultivation
of
in the
CURRENT
Nov., 1949j summer-autumn parasites
have already been important announcement, '*!f 111 response to Major Ross's appeal for uciitional workers, Mr. R. Fielding Ould, m.a., *-B(Oxon.), has been deputed to join him at lei'ra Leone, and assist him in carrying on his
grown.
This is
an
lnvestigations.
KENNETH McLEOD.
September,
1899.
TOPICS, ETC.
513
(From
the Indian Medical
34,
p.
Gazette, 1899, 414)
Vol.
By a happy coincidence the question of the prevalence of Scarlet Fever in India and other tropical countries has been simultaneously raised in the Journal of Tropical Medicine and in your The subject has been from time to own pages.
time discussed in the Indian Medical Gazette since the year 1870. It has been made quite certain that Scarlatina has been repeatedly imported into India by means of troop-ships, and that in this manner small outbreaks have arisen in military stations and among civil communities, both on hills and plains. It has also been conclusively proved that these epidemics are very limited both in space and time.
It has been inferred that India and other countries possess an immunity as this disease, that is to say, that the microbe which presumably causes it belonging as it seems to do the class of obligatory parasites, does not find in tropical conditions favouring circumstances for life and propagation. Once admitted into the individual, it appears to give rise to the same pathological phenomena as in temperate countries. It must therefore be during the interval of transit from the diseased to the healthy subject that it encounters an environment inimical to either
tropical regards
[Nov., 1949
THE INDIAN MEDICAL GAZETTE
512
existence or virulence or both. The exact truth of its natural history, somatic and extrasomatic, remains to be worked out, but the facts already ascertained justify these provisional conclusions. The curious and really important fact, which the papers to which I have referred place in evidence, is that an eruptive, febrile disease, presenting close if not complete clinical resemblance to Scarlatina, arises sometimes in India de novo, and that occasionally such cases occur in groups and seem I have myself to result from communication. seen such cases singly and in groups in Calcutta and at Darjeeling, and they have been met with by others, as the literature on the subject shows. In these instances the question of importation has been held in view; but the circumstances of their occurrence were, in most cases, such as to render this mode of origin extremely unlikely; and it seems absolutely true that, as in imported cases, so in these autogenous cases the power of infection is exceedingly weak, the incidence very limited, and the duration of outbreak short. The aspect which has been displayed is that of a disease epidemic under favouring condition, which is capable of implantation or even origin de novo but incapable of propagation. The matter is therefore one of profound interest both pathologically and epidemiologically, and it is to be hoped that, as opportunity offers, by general, clinical and bacteriological methods, the points above mooted will be eventually cleared up both as regards India and the tropics
generally. The
Physical Requirements of
the
Public Services An important discussion took place in the section of medicine at the meeting of the British Medical Association at Portsmouth on the medical tests for admission to the Public Services. The time and place were well suited for ventilating questions which concern the efficiency of the services, the anxieties of parents and guardians and the interests of so many youths. The particular subjects of attention were?(1) propriety of existing standards of physical fitness; (2) the methods by which examinations for physical fitness are at present conducted; (3) the uniformity and fairness of such examinations; and (4) the time when they ought to be held whether before or after the literary examination. On these points a considerable variety of opinions were offered, and the only subject on which the section appeared to be unanimous was the stage of the competitive examination at which the testing for physical fitness should be conducted. In effect it was decided that the elimination of the physically unqualified ought to take place before the candidates are subjected to a trial of their intellectual capacity. The reason for this, which seemed to weigh with the section, was that it was cruel to subject youths to the pains of a
literary examination and the disappointment of subsequent rejection, on account of physical incapacity, after they had passed it and perhaps passed it creditably. There is some sense in this view, but it does not wholly express or meet the hardships of the case, for rejection immediately before examination, does not take into account the wasted time, labour and expense of preparation, or the disappointment and demoralizing effect of failure after years of study and expectation, both with a special object. The real truth is that physical fitness should be as far as possible tested and ascertained before a boy commences to study for any particular service in which this is laid down as a necessary qualification. The State cannot be expected to perform a service of this kind for the multitude of youths scattered throughout the Empire who may contemplate preparing themselves for State Employment, nor could it be reasonably held to abide by the results of such early examination, so that a further testing immediately before or after the tiresome
examination would still be necessary. It is the civil practitioner or the retired army or navy surgeon who should be entrusted with this duty; and by a little study of the regulations issued by public departments and boards of examination, it could be fulfilled with sufficient success to indicate whether a boy should undertake the task of preparative study or not just as the report of the headmaster of his school decides, whether he possesses the necessary intellectual capacity and industry for same end. Some public departments?the Admiralty f?r example?pointedly recommended these prc" liminary medical examinations and there can be no doubt that they ought invariably to be made; and if this became the practice, specialists would be forthcoming, who would qualify themselves to give sound advice. In civil life, fitness, if at all enquired into, is considered after for selection employment; but everything depends on the kind of employment and the degree of physical capacity which it demands. In the Army and Navy, physical capacity must necessarily hold a high place, and the question has frequently arisen, whether the element of competition should not apply to this as well as to intellectual endowments by assigning marks for physique, endurance, robustness, agility, and so forth. This has hitherto been found impracticable, and standards have been laid down for the guidance of boards, which cannot be unreasonable nor unfair; nor can boards be accused of applying these with undue severity
physical
pronounced
or
eccentricity.
the Quartan Parasite Mosquito Major Ross has telegraphed from the West Coast of Africa that he has succeeded in cultivating the parasites of quartan fever in anopheles, the genus of mosquito in which the tertian and The Cultivation
of
in the
CURRENT
Nov., 1949j summer-autumn parasites
have already been important announcement, '*!f 111 response to Major Ross's appeal for uciitional workers, Mr. R. Fielding Ould, m.a., *-B(Oxon.), has been deputed to join him at lei'ra Leone, and assist him in carrying on his
grown.
This is
an
lnvestigations.
KENNETH McLEOD.
September,
1899.
TOPICS, ETC.
513
