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THE MALARIA PROBLEM IN BOMBAY.
I15TItUMI:N7‘AI. AIDS FOlt PARALYTfCS.
persons neutralised the filt.rate; it laboratory animals..Hut no furt,her light has been shed on the central problem-can staphylococci, non-lethal to almost all laboratory animals, when given in large numbers together with any toxic products of growth for some days, kill
some insensitive - was non-toxic to
human beings within 24 hours ? The Commission record two cases from the Brisbane Hospital in which
due to Staphylocaused death within 24 hours (presumably without septic metastases, though this is not stated). Such cases are not common. Neisser6 states that a number of bacteriologists have injected into themselves thin suspensions of staphylococci without producing any effect save local septic abscesses. It is true that the mortality from staphylococcal septicaemia is high-all of 11 patients quoted by the Commission from Sydney records died-but death in these instances followed illness lasting from 3 to 21 days, and autopsy revealed the usual septic processes throughout the body ; this sequence differentiated these cases from those in Bundaberg. Pathologists, while feeling that the conclusion is not in full accord with their previous knowledge and experience, must agree with the Commission that in the absence of further information the deaths must be attributed to the staphylococci.
septic osteomyclitis, apparently
a
coccus
aureus,
THE MALARIA PROBLEM IN BOMBAY. THE history of malaria in Bombay is dishearteningThe city is peculiarly adapted, by its warmth and humidity, to the breeding of mosquitoes, and many localities are infested bv swarms of several varieties.
modern improvements have ,difficult position, and the
complicated
an
already
abundant watersupply, with its accompanying drainage system, has enormously increased the facilities for mosquito breeding. In 1911, after a systematic survey which extended over two years, a comprehensive report on malaria in Bombay was submitted by Dr. C. A. Bentley. This report has been deservedly alluded to on several occasions as classical, but in the interval many changes have occurred, and it was felt advisable to have a further survey before the Municipality committed itself to an expensive campaign. Major G. Covell was appointed to carry out observations, and his reportnow before us sets out the results of a six months’ survey, designed to supplement Dr. Bentlev’s work where conditions had altered in the interval. Practically speaking, only one species of mosquito is concerned in the conveyance of the disease in Bombay, and this (Anuphèles stephensi)breeds in fresh clean water, so that Major Covell can go so far as to remark that the problem of its destruction is entirely separate from that of the provision of adequate .schemes of drainage. This mosquito breeds in wells, cisterns, garden tanks and tubs, leakages from reservoirs, improperly graded roof gutters, empty tins .and other receptacles, hollows in scrap-iron, abandoned buildings, and other similar situations. The larvae will flourish in any depth of water, and in dark places .as well as those exposed to the direct rays of the .sun, and one of the most fertile breeding grounds is furnished by the household wells, which are still unfortunately a feature of many of the older residences of the city. The problem of prevention is largely one of domestic economy, and is tenfold more difficult in a cosmopolitan community where people of not only one but many religions are involved. Strangely enough, the Parsees, in many ways the most advanced community in India, are one of the principal obstacles in this case. Their intensely conservative priests, who are not up to the level of their flock in general education, make use of well water for ceremonial purposes, and this is one of the chief reasons why many well-to-do Parsees refuse to fill in their wells. 6
more
Handbuch der Pathogenen Mikroorganismen, 1927, iv., 470. 7 Malaria in Bombay, 1928. By Major G. Covell, M.D. Lond., I.M.S. Price 2s. 6d.
933
into both Hindu and Mohammedan houses for inspection is deeply resented, and any thorough system of household visitation must be done partly by women. The condition of Bombay as regards malaria seems to be getting progressively worse. Areas little affected 40 years ago are now seriously involved, and some of the best business and residential quarters are heavily infected. Apart from the sinister influence, direct and indirect, of malaria on the general mortality of the city, the financial effect of the excessive sick-rate on the cotton industry and other business interests is very severe, and it is easy to show that the heavy expenditure which would be involved by an extensive antimalarial campaign would be more than justified by the savings which could be expected. To make any scheme effective certain legislative action would be needed to bring under one control not only the areas directly under the municipality but also those administered by the railwaysand port trust, and other more or less independent bodies. It is to be hoped that means may be found to provide the necessary machinery and funds, and that the city of Vandyke Carter, who was the first in India to confirm the epoch-making discovery of Laveran, before long emulate Ismailia and Havana, and its house in order. The solution of the malaria problem in rural areas presents difficulties which under certain conditions may well prove insuperable, but a wealthy city like Bombay has only itself to thank if it continues to labour under this scourge.
Entry
purposes of
may
set
INSTRUMENTAL AIDS FOR PARALYTICS. CASES of extensive incurable paralysis, from whatever arising, can be benefited in two ways by the use of instruments ; first, by the fixation as required of a flail and untrustworthy joint; and, secondly, by devices which utilise in the best possible manner any muscular power that may be still possessed by the patient. It is chiefly for the invention of such devices that the work of Dr. Gabriel Bidou has become famed, not only in France, but throughout the world. His books on mechanotherapy and orthopaedic instruments are well known, and of recent years he has become specially interested in the treatment of paralysed patients. Prof. Georges Guillain enlisted his tion for patients of this type at the Salpetriere, and the results obtained were so remarkable that the Director of the Assistance Publique has made arrangements to create in the near future a special service of functional recuperation under Dr. Bidou’s direction. The principles which guide his treatment have been set out in a little book,l on the title page of which Dr. Bidou’s name appears, though it is only in the preface, contributed by Prof. Guillain, that it is made clear that Dr. Bidou is actually the author. The mathematical and mechanical principles on which Dr. Bidou works, as well as certain applications of them, are well set out. His methods involve the use of a measure of the equivalence of the weight of the limb in question, of a special dynamometer, and of a rule and " nxusculometer " of his own as well as a goniometer. He then describes the application of various special mechanical devices which he has found useful, and also apparatus suitable for various parts of the body, both for support and for the improvement of muscular force. This is thoroughly scientific work and embodies an attempt to treat the problems presented by exact measurement of forces and of the mechanical parts concerned such as joints and limb leverage. Until Dr. Bidou devoted himself to these studies, the design and construction of orthopaedic instruments had been too much a matter of rule-of-thumb, and despite the difficulties of treating living parts in the same way as the dead metal of a machine, the only hope of improvement is in the cause
coopera-
1 Principes Scientifiques de Récupération Fonctionelle des Paralytiques. By Gabriel Bidou. Preface by Prof. Georges Guillain. Paris : Le Livre pour Tous. Pp. 141, with 45 plates. Fr.20.
persons neutralised the filt.rate; it laboratory animals..Hut no furt,her light has been shed on the central problem-can staphylococci, non-lethal to almost all laboratory animals, when given in large numbers together with any toxic products of growth for some days, kill
some insensitive - was non-toxic to
human beings within 24 hours ? The Commission record two cases from the Brisbane Hospital in which
due to Staphylocaused death within 24 hours (presumably without septic metastases, though this is not stated). Such cases are not common. Neisser6 states that a number of bacteriologists have injected into themselves thin suspensions of staphylococci without producing any effect save local septic abscesses. It is true that the mortality from staphylococcal septicaemia is high-all of 11 patients quoted by the Commission from Sydney records died-but death in these instances followed illness lasting from 3 to 21 days, and autopsy revealed the usual septic processes throughout the body ; this sequence differentiated these cases from those in Bundaberg. Pathologists, while feeling that the conclusion is not in full accord with their previous knowledge and experience, must agree with the Commission that in the absence of further information the deaths must be attributed to the staphylococci.
septic osteomyclitis, apparently
a
coccus
aureus,
THE MALARIA PROBLEM IN BOMBAY. THE history of malaria in Bombay is dishearteningThe city is peculiarly adapted, by its warmth and humidity, to the breeding of mosquitoes, and many localities are infested bv swarms of several varieties.
modern improvements have ,difficult position, and the
complicated
an
already
abundant watersupply, with its accompanying drainage system, has enormously increased the facilities for mosquito breeding. In 1911, after a systematic survey which extended over two years, a comprehensive report on malaria in Bombay was submitted by Dr. C. A. Bentley. This report has been deservedly alluded to on several occasions as classical, but in the interval many changes have occurred, and it was felt advisable to have a further survey before the Municipality committed itself to an expensive campaign. Major G. Covell was appointed to carry out observations, and his reportnow before us sets out the results of a six months’ survey, designed to supplement Dr. Bentlev’s work where conditions had altered in the interval. Practically speaking, only one species of mosquito is concerned in the conveyance of the disease in Bombay, and this (Anuphèles stephensi)breeds in fresh clean water, so that Major Covell can go so far as to remark that the problem of its destruction is entirely separate from that of the provision of adequate .schemes of drainage. This mosquito breeds in wells, cisterns, garden tanks and tubs, leakages from reservoirs, improperly graded roof gutters, empty tins .and other receptacles, hollows in scrap-iron, abandoned buildings, and other similar situations. The larvae will flourish in any depth of water, and in dark places .as well as those exposed to the direct rays of the .sun, and one of the most fertile breeding grounds is furnished by the household wells, which are still unfortunately a feature of many of the older residences of the city. The problem of prevention is largely one of domestic economy, and is tenfold more difficult in a cosmopolitan community where people of not only one but many religions are involved. Strangely enough, the Parsees, in many ways the most advanced community in India, are one of the principal obstacles in this case. Their intensely conservative priests, who are not up to the level of their flock in general education, make use of well water for ceremonial purposes, and this is one of the chief reasons why many well-to-do Parsees refuse to fill in their wells. 6
more
Handbuch der Pathogenen Mikroorganismen, 1927, iv., 470. 7 Malaria in Bombay, 1928. By Major G. Covell, M.D. Lond., I.M.S. Price 2s. 6d.
933
into both Hindu and Mohammedan houses for inspection is deeply resented, and any thorough system of household visitation must be done partly by women. The condition of Bombay as regards malaria seems to be getting progressively worse. Areas little affected 40 years ago are now seriously involved, and some of the best business and residential quarters are heavily infected. Apart from the sinister influence, direct and indirect, of malaria on the general mortality of the city, the financial effect of the excessive sick-rate on the cotton industry and other business interests is very severe, and it is easy to show that the heavy expenditure which would be involved by an extensive antimalarial campaign would be more than justified by the savings which could be expected. To make any scheme effective certain legislative action would be needed to bring under one control not only the areas directly under the municipality but also those administered by the railwaysand port trust, and other more or less independent bodies. It is to be hoped that means may be found to provide the necessary machinery and funds, and that the city of Vandyke Carter, who was the first in India to confirm the epoch-making discovery of Laveran, before long emulate Ismailia and Havana, and its house in order. The solution of the malaria problem in rural areas presents difficulties which under certain conditions may well prove insuperable, but a wealthy city like Bombay has only itself to thank if it continues to labour under this scourge.
Entry
purposes of
may
set
INSTRUMENTAL AIDS FOR PARALYTICS. CASES of extensive incurable paralysis, from whatever arising, can be benefited in two ways by the use of instruments ; first, by the fixation as required of a flail and untrustworthy joint; and, secondly, by devices which utilise in the best possible manner any muscular power that may be still possessed by the patient. It is chiefly for the invention of such devices that the work of Dr. Gabriel Bidou has become famed, not only in France, but throughout the world. His books on mechanotherapy and orthopaedic instruments are well known, and of recent years he has become specially interested in the treatment of paralysed patients. Prof. Georges Guillain enlisted his tion for patients of this type at the Salpetriere, and the results obtained were so remarkable that the Director of the Assistance Publique has made arrangements to create in the near future a special service of functional recuperation under Dr. Bidou’s direction. The principles which guide his treatment have been set out in a little book,l on the title page of which Dr. Bidou’s name appears, though it is only in the preface, contributed by Prof. Guillain, that it is made clear that Dr. Bidou is actually the author. The mathematical and mechanical principles on which Dr. Bidou works, as well as certain applications of them, are well set out. His methods involve the use of a measure of the equivalence of the weight of the limb in question, of a special dynamometer, and of a rule and " nxusculometer " of his own as well as a goniometer. He then describes the application of various special mechanical devices which he has found useful, and also apparatus suitable for various parts of the body, both for support and for the improvement of muscular force. This is thoroughly scientific work and embodies an attempt to treat the problems presented by exact measurement of forces and of the mechanical parts concerned such as joints and limb leverage. Until Dr. Bidou devoted himself to these studies, the design and construction of orthopaedic instruments had been too much a matter of rule-of-thumb, and despite the difficulties of treating living parts in the same way as the dead metal of a machine, the only hope of improvement is in the cause
coopera-
1 Principes Scientifiques de Récupération Fonctionelle des Paralytiques. By Gabriel Bidou. Preface by Prof. Georges Guillain. Paris : Le Livre pour Tous. Pp. 141, with 45 plates. Fr.20.