Some tuberculosis figures

1942 nearly 2½ million persons, and the general effect on their health was gauged by the mortality figures of Hissar district, which were 20,910 in 1987; 28,505 in 1988; and 87,767 in 1989. The problem facing the public health department was how to maintain the state of nutrition of this large population at a proper level and how to ward off disease--at a minimum of cost. In the first place the whole area was divided into a series of health circles, each in charge of a doctor-a circle including the villages within five miles of a central dispensary. Additional health staff comprised an expert nutrition officer, three medical officers of health, fifty-one sub-assistant-surgeons (of whom nine were experienced medical officers of health, thirtythree sanitary inspectors, twenty-one dispensers, and eighteen vaccinators. Secondly, general preventive measures included the chlorination of water supplies, sanitation of camp areas and the lines of work, the inoculation of nearly 200,000 persons with cholera vaccine, and the vaccination of 250,000 persons against smallpox. Specific measures against deficiency disease included supplies of green vegetables--as far as limited supplies made possible--to those engaged in relief work, and all persons found with definite A and D vitamin deficiency were given cod-liver oil. In addition, 1 oz. of germinated gram pulse per head was distributed free twice a week. This gram contains vitamins A, B, a n d particularly C. Further, Indian gooseberry was used for the treatment and prevention of scurvy. The results of this preventive campaign were more than satisfactory. Within six months the numbers of sick admitted to hospitals decreased by 50 per cent. ; scurvy dropped rapidly and completely disappeared in just over three months; night blindness was considerably reduced, though not so dramatically as in the case of other deficiency diseases; smallpox cases were negligible (for India) ; cholera was absent during the whole of 1989 and up to July, 1940; dysentery cases were few, and there was a reduction of nearly 6,000 deaths in the first half of 1940 (the third year of the famine) as compared with the same period of 1989. The Directo'r of Public Health considers it justifiable to conclude that by the measures he adopted the major epidemic and deficiency diseases were brought under control, even although at the end of June, 1940, general health conditions were still extremely unstable. This story is one which will appeal to every medical officer of health in the Empire ; it is one from which each of us may profit. If space permitted, it would have been well worth while to add details of the Co-operative Health Bureaux which Lieut.-Colonel C. M. Nicol, the Director of Public Health, has been able to start in several rural centres. These institutions, which are evolved, paid for, and run by the villagers themselves, aim at all measures pertaining to hygiene, health and treatment of the sick in the groups of villages which support them. During the three years they have been working they have shown their worth in both curative and preventive directions. A further noteworthy point is that during 1989, for the first time since 1898, when plague broke out in the Punjab, not a single case was recorded in the Province.

PUBLIC HEALTH The whole report indicates determination, enthusiasm and successful effort in many different directions and constitutes a record of which any public health worker might well be proud.

Some Tuberculosis Figures The annual or other reports of medical officers of health to their respective councils are not easily coordinated documents. Some are precise and detailed; others, less so. Some include comments and observations; others give only the skeleton of statistics. In giving statistics, some furnish figures for previous years as well as for the year under review; others offer no such basis for comparison. The size of the authorky seems to bear no relation to the circumstance of the report. It is a fascinating but rather disappointing task to reduce these reports to a common denominator on a given subject--for example, tuberculosis. It would be interesting to extract from this cross-section of public health experience the position with regard to the incidence and mortality of tuberculosis in the second year of war. One of the most important reports in this special field is that of the Central Tuberculosis Officer for Lancashire (Dr. Lissant Cox). It is termed an interim report, which only means that the full report is deferred until the end of the war. There was in Lancashire in 1940 an increase of 105 in the number of new cases of tuberculosis as compared with 1989; the deathrate also went up to 0.46 per thousand of population from 0.44. Staffordshire shows a different picture. In the area of that county council the number of new cases of pulmonary tuberculosis in 1940 was 581, and of non-pulmonary 190, a distinct fall in the number as compared with the previous year, and continuing the decline in the number of primary notifications which has taken place during the last decade. The death-rate from pulmonary tuberculosis in the urban districts of Staffordshire was 0.51, the lowest figure yet recorded. The figures for this county show that approximately one death occurred among seventeen cases, comparing favourably with the expert opinion that for every death there are at least ten persons suffering from the disease. In Durham county, on the other hand, for which we have the report of the medical officer for the quarter ending September, 1941, the death-rate for pulmonary tuberculosis was 0.58 per thousand as compared with 0.49 in the corresponding quarter of 1940. In his report for Lancashire Dr. Cox remarks that there is again a greater prevalence of pulmonary tuberculosis among males than among females. In his county, for every 100 deaths of females there were 149 deaths of males, and a similar proportion held good in notifications. The same applies to Staffordshire, where for every 100 deaths of females there were 187 male deaths. On the other hand, in Durham, for the third quarter of 1941, the number of deaths was equal for the sexes, and in the Welsh borough of Llanelly the female deaths exceeded the male. The figures for Llanelly are, of course, small but a high proportion of female deaths has long been characteristic of Wales. In war-time, too, such ratios are disturbed by migrations of the population. 115