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THE MEDICAL ASPECTS OF THE INDIAN PROBLEM
401
THE MEDICAL ASPECTS OF THE INDIAN PROBLEM
of many
and welcome in the federal
or
Australia,
gravis and intermediate strains wholly suppressed on the serumI on primary culture on Lœffler.
system of the U.S.A., and in Great Britain. The treated swab and Simon Commission recommended it (vol. ii., p. 153-5). therefore recommend that the serum-treated swab should The Indian Minister concerned (Sir Fazl-i-I-lusain) be inoculated after 4 hours’ incubation not only on to But it was ruled out by the Finance DepartLœffler but also on to a tellurite plate (Horgan and agreed. ment last 3 4 or McLcod’s year. Indeed, it is doubtful if the concluMarshall’s 5 medium). This may facilitate such Board, dealing as the problem sions of of in culture any for isolation the organisms pure diagnosis, intimate questions of birth and with demands of intermediate virulence test, and the cleterrninatioxr gi,avi8, would have a chance of acceptance by or mitis type. marriage, Preliminary experiments have indicated that not only the local administrations, so long as they emanated serum, but other growth promoting substances such as from a British-controlled central government. glucose broth may be used for the treatment of swabs. The late Director-General, 1.M.S., has written : The value of the " treated swab merits further investiga" It is clear that the growth of population has already tion by those who have access to abundant clinical material. begun to outstrip the increase in the production The vexed question of the use and abuse of the of the necessities of life so that even low standards swab cannot be discussed fully here. It is necessary of economic life must inevitably become still lower to emphasise once more that swabbing must not be unless some economic change is brought about. employed as the primary or chief means of diagnosis. The outlook for the future is gloomy to a degree, Close collaboration between physician and bacterio- not only for the masses of the people who must logist is essential, but the practitioner must remember face the intensified struggle for bare subsistence, that the responsibility for early diagnosis and treat- but also for the upper classes whose incomes depend ment is his alone, and that an early negativereport on the production of surplus crops and other comfrom the bacteriologist may be revised subsequently. modities. If the entire produce of the soil is needed I am, Sir, yours faithfully, to provide for the urgent need of the cultivators, H. J. PARISH. nothing will be left for payment of rent or revenue ... Wellcome Physiological Research Laboratories, Beckenham. and the whole social structure of India must inevitably Feb. 8th. be rudely shaken, if not completely destroyed." What then is proposed to meet this inevitable THE MEDICAL ASPECTS OF THE INDIAN crisis, this pending catastrophe ?’? Mr. Churchill PROBLEM is apparently content to leave the present authority To the Editor ofTHE LANCET at the Centre, with increased powers to the Provinces SIR,—The physical welfare of the Indian masses to go astray. The Government, on the other hand, is of such cardinal importance that I venture to proposes to strengthen the Centre and to throw various responsibilities on the representative Indian draw the attention of our piofession to its prospects under the Government of India Bill, now before authorities from which they cannot escape. This Parliament. surely is the right way, and in committee it will be It seems to be assumed that welfare has been necessary to consider if certain clauses and schedules cannot be improved with this object. the rule under immeasurably improved present In view of the small relative consideration given and that it will deteriorate under native rule. India has certainly been protected from the severer ravages to these matters by most British administrators and by the Joint Select Committees, it is essential and famine ; maternal and infant of war, to emphasise the predominant importance of the lives have been saved by the hundreds of thousands. But the last census showed in consequence an increase welfare of the masses ; to recognise the extreme of population by 34 millions ; while the rice and gravity of the problem of increasing population and wheat crops-the main food-supply-were reduced diminishing nutrition ; and with all the expert by 11 million tons. The medical research workers at guidance we can give them to charge the Indian their conferences in 1923-26 unanimously resolved that people themselves, under their many enlightened India was in a "state of grave emergency " and that would-be rulers, with the solution that has baffled "the greatest cause of poverty and financial stringency British administration, involving, as it must, religious and social conditions, with which Indians alone can in India is loss of eiliciemcy resulting from preventable deal.-I disease." In 1932 it was reported to the Government am, Sir, yours faithfully, of India that " the average duration of life in India FRANCIS FREMANTLE. Ilouse of Commons, Feb. llth. is still about half what it ought to be, the rate of WISDOM TEETH infant-mortality and the morbidity figures are still deplorably high, the increasing prevalence of tuberTo the Editor of THE LANCET culosis and other diseases which are associated with SIR,—In Mr. Bowdler Henry’s most interesting malnutrition suggests that the conditions of life of chart in your last issue of complications attending the people are steadily deteriorating." of wisdom teeth, I observe there is no eruption The late Public Health Commissioner with the to skin eruptions. The following case reference Government of India, in his last annual report, be worthy of mention. A woman, therefore commenting on this problem in his retrospect, says : may 35, suffered from multiple boils for one year. "Unfortunately it has not received that attention aged was followed by an eruption on the face consisting This from the central and provincial Governments which of a discoid patch of lupus erythematosus over the its importance would seem to indicate that it should malar bone of each cheek. Examination for a focus its have; implications are apparently not yet fully of infection revealed only that the wisdom teeth had realised." not and she was suffering from occasional that erupted The Government have, indeed, been repeatedly a dentist who local She was referred to pain. advised to establish a Central Board of Health to and extracted the took a swab teeth, impacted study the subject, to give such guidance to the which on culture showed a streptococcal infection. local administrations as has been found essential The
polar staining partially
may be
Canada,
"
pestilence,
.
3 Jour. of Hyg., 1932, xxxii., 544. 4 Jour. Path. and Bact., 1933, xxxvii., 165. 5 Ibid., 1931, xxxiv., 667.
I am, Sir, yours
faithfully, ELIZABETH HUNT.
Manchester-square, W., Feb. 12th.
THE MEDICAL ASPECTS OF THE INDIAN PROBLEM
of many
and welcome in the federal
or
Australia,
gravis and intermediate strains wholly suppressed on the serumI on primary culture on Lœffler.
system of the U.S.A., and in Great Britain. The treated swab and Simon Commission recommended it (vol. ii., p. 153-5). therefore recommend that the serum-treated swab should The Indian Minister concerned (Sir Fazl-i-I-lusain) be inoculated after 4 hours’ incubation not only on to But it was ruled out by the Finance DepartLœffler but also on to a tellurite plate (Horgan and agreed. ment last 3 4 or McLcod’s year. Indeed, it is doubtful if the concluMarshall’s 5 medium). This may facilitate such Board, dealing as the problem sions of of in culture any for isolation the organisms pure diagnosis, intimate questions of birth and with demands of intermediate virulence test, and the cleterrninatioxr gi,avi8, would have a chance of acceptance by or mitis type. marriage, Preliminary experiments have indicated that not only the local administrations, so long as they emanated serum, but other growth promoting substances such as from a British-controlled central government. glucose broth may be used for the treatment of swabs. The late Director-General, 1.M.S., has written : The value of the " treated swab merits further investiga" It is clear that the growth of population has already tion by those who have access to abundant clinical material. begun to outstrip the increase in the production The vexed question of the use and abuse of the of the necessities of life so that even low standards swab cannot be discussed fully here. It is necessary of economic life must inevitably become still lower to emphasise once more that swabbing must not be unless some economic change is brought about. employed as the primary or chief means of diagnosis. The outlook for the future is gloomy to a degree, Close collaboration between physician and bacterio- not only for the masses of the people who must logist is essential, but the practitioner must remember face the intensified struggle for bare subsistence, that the responsibility for early diagnosis and treat- but also for the upper classes whose incomes depend ment is his alone, and that an early negativereport on the production of surplus crops and other comfrom the bacteriologist may be revised subsequently. modities. If the entire produce of the soil is needed I am, Sir, yours faithfully, to provide for the urgent need of the cultivators, H. J. PARISH. nothing will be left for payment of rent or revenue ... Wellcome Physiological Research Laboratories, Beckenham. and the whole social structure of India must inevitably Feb. 8th. be rudely shaken, if not completely destroyed." What then is proposed to meet this inevitable THE MEDICAL ASPECTS OF THE INDIAN crisis, this pending catastrophe ?’? Mr. Churchill PROBLEM is apparently content to leave the present authority To the Editor ofTHE LANCET at the Centre, with increased powers to the Provinces SIR,—The physical welfare of the Indian masses to go astray. The Government, on the other hand, is of such cardinal importance that I venture to proposes to strengthen the Centre and to throw various responsibilities on the representative Indian draw the attention of our piofession to its prospects under the Government of India Bill, now before authorities from which they cannot escape. This Parliament. surely is the right way, and in committee it will be It seems to be assumed that welfare has been necessary to consider if certain clauses and schedules cannot be improved with this object. the rule under immeasurably improved present In view of the small relative consideration given and that it will deteriorate under native rule. India has certainly been protected from the severer ravages to these matters by most British administrators and by the Joint Select Committees, it is essential and famine ; maternal and infant of war, to emphasise the predominant importance of the lives have been saved by the hundreds of thousands. But the last census showed in consequence an increase welfare of the masses ; to recognise the extreme of population by 34 millions ; while the rice and gravity of the problem of increasing population and wheat crops-the main food-supply-were reduced diminishing nutrition ; and with all the expert by 11 million tons. The medical research workers at guidance we can give them to charge the Indian their conferences in 1923-26 unanimously resolved that people themselves, under their many enlightened India was in a "state of grave emergency " and that would-be rulers, with the solution that has baffled "the greatest cause of poverty and financial stringency British administration, involving, as it must, religious and social conditions, with which Indians alone can in India is loss of eiliciemcy resulting from preventable deal.-I disease." In 1932 it was reported to the Government am, Sir, yours faithfully, of India that " the average duration of life in India FRANCIS FREMANTLE. Ilouse of Commons, Feb. llth. is still about half what it ought to be, the rate of WISDOM TEETH infant-mortality and the morbidity figures are still deplorably high, the increasing prevalence of tuberTo the Editor of THE LANCET culosis and other diseases which are associated with SIR,—In Mr. Bowdler Henry’s most interesting malnutrition suggests that the conditions of life of chart in your last issue of complications attending the people are steadily deteriorating." of wisdom teeth, I observe there is no eruption The late Public Health Commissioner with the to skin eruptions. The following case reference Government of India, in his last annual report, be worthy of mention. A woman, therefore commenting on this problem in his retrospect, says : may 35, suffered from multiple boils for one year. "Unfortunately it has not received that attention aged was followed by an eruption on the face consisting This from the central and provincial Governments which of a discoid patch of lupus erythematosus over the its importance would seem to indicate that it should malar bone of each cheek. Examination for a focus its have; implications are apparently not yet fully of infection revealed only that the wisdom teeth had realised." not and she was suffering from occasional that erupted The Government have, indeed, been repeatedly a dentist who local She was referred to pain. advised to establish a Central Board of Health to and extracted the took a swab teeth, impacted study the subject, to give such guidance to the which on culture showed a streptococcal infection. local administrations as has been found essential The
polar staining partially
may be
Canada,
"
pestilence,
.
3 Jour. of Hyg., 1932, xxxii., 544. 4 Jour. Path. and Bact., 1933, xxxvii., 165. 5 Ibid., 1931, xxxiv., 667.
I am, Sir, yours
faithfully, ELIZABETH HUNT.
Manchester-square, W., Feb. 12th.