HAND BOOK OF HYGIENE & PUBLIC HEALTH Published by Sirs V nCDI HbII ilazaftr Amritsar First Sditioti Second Edition Third Edition Fourth Edition Fifth Edition Sixth Edition ■4 1955 1956 1957 JP59 1982 r' Frmted by Allied Prmteis at Mshva Bhatatya Press New Delhi All Rights Ilesencd No part of It may be dupMeatisd or reproduced without tlte prior written permission of the publishers Pric* R« 13 0) HAND BOOK OF fllYGIENE & PUBLIC HEALTH (HiLUSTRATED) jf?OJ? MEDICAL & PUBLIC HEALTH STUDENTS by YASH PAL BEDt MBJJB (Pb) DOM S (Eng ), D P H (Lend >, L M (Dub > Fbrmcr Dean of Hygiene and Vaccine Institute Punjab, and Professor of Preventive and Social Medicine. Medical College Amritsar, Examiner in Hygiene and Public ' Health. Ui^vcrsUy of Punjab and Punjab State Medical Faculty; Extemal Examiner in Universities of Delhi, Agra, Patna, Bihar, Rajputana & Bombay, Medical Officer of Health, Amritsar Sixni EDITION : Cotnposhlon— Physveal psoperUes Imputltves of cir— Due to Respiration, Combustion, Do* ''omposltlon of Organic Matter — Dust and Bacteria— Examination of Air— Kata Thermo- meter — Eupatheoscope, and Eupathemeters Effective Temperature — Ventilation — Amount of air required— Cubic Space — Floor space— Sistems of Ventilation — Natural and Artificial— Vital Capacity— Air borne Epi- demics — Healing of rooms — Artificial cool* ^ ing — Air conditioning V/ III Disposal of refuse—*^ Scavenging — Conservancy System — Collec- tion, Removal and disposal of Refuse — Incineration, Dumplng-^ompostlng — Sort- ing— Collection. Removal and Disposal of Human Excreta, Latrines — Public latrines — Trenching— Incineration — Different Methods of Composting Water carriage sys em — Sewage— Sullage— House Drainage— Water closets— Different types— Sollpipe — House- drain — Manhole — Varieties of traps — Test- ing of drainage system— Sewers— Inspection — Cleansing and Ventilation of Sewers, I S 46 86 CHAPTER PAGE Cx) V, Disposal of sewage— Methods, By Dllttlion— Discharge into the Sea or River— By Purification— Direct land treatmert— Intermittent Downward Filtra- tion — Broad Irrigation or Sew age Farming — Biological Treatment— Septic tanks— Con- tact beds — Percolating filters,^ — ^^ter beds —Activated Sludge Proe^s—Simplex System y —Characters of a good Effluent J03 Food and nuintioR — Essential constituents of Food— Carbohy- drates — Fat grometerS—Wlnds — Weathercock — Anemo- meter — Sunshine Recorder, Clouds — Rain Gauge — 1C8 yxx. Medical Inspection of schools — Object of School Health Service— School Building— Ventilation— Lighting — Warming of rooms — Furniture — Sanitary' Conveni- ences, Water Supply— School Health Service —Duties of School Medical Officer— School Clinics Health Education— Special and Open '■^Aic Schools, Child Guidance Clinics 173 Materelly and child welfare — Infant Mortality rate— Maternal Mortality CHAPTER PAGE rate Causes and Prevention o£ High Infant and itatemal Mortality Rales—Duties of a Lady Health Vidtor— Welfare Centre — Staff — Scope of Maternity and Child welfare work — ^Prenatal, Natal and Post natal work y-ProVision of Lady Health Visitors— Mid wives — Nurses dais and Trained Dais personal hygiene— *1 Habit— Indlge:>tlon — Constipation — Control of weight —.Fatigue — Anger — Sleep — Insomnia— C^^tltution — Hcr^ity— Environ- ment — Idiosyntrasj — Cleanliness — Baths — Hair— Teeth — Nalls — ^Eyes — Ears — External Genitalia— Posture— Exercise Clothing — Sex Education Xn Offensive trades and occopatlonai poisoning— Offensive Trades— Keeping of animals — Slaughtering of animals — Blood Boiling- Bone BoiIIng—Cut Scraping— Fat and Tallow. Melting— S0J5> Manufacturing— FeUmongerlng or Leather Dressing— Brick and lime Kilns— Smoke Nuisance, Paper Making — Rice Milla— Oil Mills — Sugar Factories — Dusty Trades — Occupational Polsomng— Lead— Mercury — Phosphorua— Arsenic Poisoning— Brass Founders Ague- Chromate— Tobacco Carbon monoxide— Carbon bisulphide— Sulphuretted Hydrogen •-Sulphurdloxide — Arsenluretled Hydrogen y — Chlorine — Hydrochloric acid gass — Ammonia — Benzene — Aniline Infection and Carriers of infection— ^ Its Prevention and Control — Infection — Contagion — Fomites — ^Epidemic — Endemic Sporadic— Pandemic — Epidemic — Exotic — Incubation Period — Period of Infectivlty— Disease Carriers— Channels of Infection Modes of Transmisston of Infection- Quarantine — ^Immunity— Natural and Ac- quired— Notification— Isolation — Isolation Hospital— House Isolation — Disinfection — Classification of Disinfectants — Steam Disinfecting Station — Steam Disinfectors— / Standardisation of disinfectants— Chemical yT disinfectants Gaseous disinfectants— yXIV. Insects and parasites— V Insects Classification, Wingless— Fleas — Uce Bed Bugs— Ticks— Winged — Mosquitoes, Sandfly— House fly— Tsetsefiy CHAPTER PAGE ~ Helminths — Hematodes— or Round Worms ' — Ascarls Lumbriroides — 0:^rls Vermt cularls— TrichtneJla Splrall'i— Wuchereria Bancrofti— Fllarla Medinemis— Ancylosto- mum Duodenale— or Hookworm — Cestodes — Taenia Scdium — Taenia Saginata — Bothrlocephalos Latus— Hymenolepsis Kana — ^Taenia Echinococcus— T^^matodcs-Dlsto- ^ mum Hepalicum— Bllharala or Schistosoma / HaemotiOblum SSi / X\ Preventable Diseases — Malaria — Kalazar — Dengue — \eliow xever — Sand fly fe?er— Relapsing fevCrs—Typhus {evers — Plague — Enteric fevers — Cholera — Diphtheria — Smallpox — Chickenpox — Measles — Mumps — Acute Polimyeiitls — Cere brospmal fever— The Common Cold — In fluenra— Whooping Cough— TuberCulosi#— Bcri Ben— HabJe«— Anthrax— Malta fever— Foot and Mouth Disease— Glanders— Leprosy .Trachoma— Veneral Disease^Telanus M3 /^yL Village Sanitation— Afoss Education— Rural Town Planning- Water supply— Conservancy— Disposal of Dead— Sup^dslon of Articles of Food and Drink Xf* SanlialloQ at Fairs and Festivals— Planning Arrangement*— Accommodation- Medical Sanitary Arrangements — ^ater Supply— Efficient Conservancy— Food Supply —Inoculation against Cholera— Inspection posts — Handling of Prostitutes 37T ymil -^Ileallh Education — Evolution of Health Education — Definition —Underlying principles— Methods of Edu cation — Interviews — Talks and Discussions — Audio Visual Aids — Care and 'Utilisation — General Principles of Visual Aids lit XIX Public Health Administration— Ministry of Health— State Health System- Shore Committee Report — Medical Census — ^Medical and Health Education— Defectives — Family Planning— Hospital Social Service —Public Health Hurse— India and Inter national Assistance— World Health Organlsa- tlon— UN ICEP^Flrst Five 'Vear Plan— HAPTER (xiil) PAGE Five Year Plan— National Mfliana Con Programme— TubcTCulosls themes— amunjty Development Projects 3&0 \ XX il Medicine— lal Medicine — Social Medicine in England wining m Social medicine In Medical rcallon— Health Centre — Definl^on and lorical Evolution of Society — Historical ilutlon of Physician and Medicme— He aeration of the Physician— Control* of Heal Profession ~ Registration of slcian — Social Security Health insurance jidia-*-EmplQyecs State Health insurance leme — ^Benerus — Rehabilitation y XXI i Statistics — Ustlcs— Vital Statistics-Importance — irces— Registration— Census — Estimated sulatlon— Specific Population— Rates & tios— Birth rate— Crude Annual Birth ie— Fertility Rale— Still Birth— Death te— Crude Annual Death Bate— Specific \th Rate— Age Specific Death Bate— Vital ex Infant Mortality Bate Neonatal ttahty Rate— Maternal Mortality Rate— Inatal MortaUt} Rate — Abortion Rote, bidity Rate— Ca'e Fatality Rate— Mean \ at Death— Expectation of LUe— Life Ics— Vital Statistic of India and Punjab obulation Dlagramatlc Representation 482 XXll Tal Hygiene— nltlon — Mental Disorders — Psychosis or jiltles — Neurosis or Psychoneurosis— homatlc Disorder® — Mental Deficiencies hopathlc Personalities — Behaviour Dls rs — Causations of Mental Illnesses — rention of Mental Disorders — Promotion cental Health — personal — Rules of tal Hygiene for Infants and Children — lie Heallh Programme— In Maternity ice— I d Infant and Preschool Child — solchiid — Sex Information — Back is in School— Delinquency in Children, lal Health— Problems of Adolescents — rbdstralive Aspects of Mental Health aces Special Schools for Backward Uren ^8® LIST OF ILLUSTRATIONS No PAGE 1 DllTerent varieties oJ wells 12 2 How wells get infected from surface pollution 14 3 Contamination of well from cesspool, as a result of excessive pumping ^ 14 4 A properly protected well 16 5 Section of slow sandfilter 20 6 A complete system of water supply 25 7 Permutlt water softener 30 8 Ultra violet rays sterillsatton of water 35 11 Katadyn bead type steriliser 36 10 Pasteur chamberland filter 37 U Bcrkefeld filter 38 12 Kata thermometer dr; and wet 51 13 llinkcs birds window, Louvres ventbator Coopers window Ventilator, Hopper window inlet 37 14 Shetlngham s Valve Tobins tube EUlsons brick, Mckinnell s roof ventilator 59 16 Sketch of various provisions for ventilation 60 IG Double wheelbarrow 70 17 An ordinary incinerator 72 18 Night soli or crawIey cart 74 19 Bored hole latrine 75 20 Public latrine four seated (half section and elevation) 78 21 Long* hopper closet 90 22 Wash out closet 00 23 Siphonlc closet 00 24 Wash down Closet 01 as Wat«r cVeset Eastern typ« Western type 91 26 Trough closet 02 27 Siphon flushing cistern 93 28 Three closets at different levels explaining sipbonlc action 94 23 Inspection chambe** 05 30 S and P traps 06 31 Gully trap 0"^ (xvx) •’O PAGL 32 A complete system of house drainase JOO 3Z Section of septic tank installation for a house J07 34 Activated Sludge Process 109 35 Nutrition chan 112 36 Damp proof course and dry area 165 37 Six s thermometer 172 38 Solar Radiation or Vacuum thermometer 173 39 Tcrreslrlai Tliermometer 173 40 Wet and dry bulb Thermometer i7t 41 Robin'Ons anemometer and Weather Vane Ho 43- Sunshine recorder 176 43 Ram Gauge 17" 44 Desks 181 45 Steam Disinfector with cradle 254 46 Lelcana Sack Dlalnfector 47 Serbian Barrel Disinfector 255 49 Sucket for generating formaldfh)de 26] 49 Paraform lamp 261 50 Human ratnea 26a $1 Body Iou steal activities of the body arc ad- justed satisfactorily to the cnviroimienc To be m health means much more than fi-ecdora from diseases and discomfort Ii inclu- des normal funct onmg of all parts of human organism resulting inphysical strength and vigour, mental stabilit)^ and satisfaction with life J. F Williams defines it as the quality of life that enables the individual tolne most and to serve best Th s definition suggests that health is capable of enrichment or dctcnoracion, that health at its best is a more realistic concept for all reasons than the mere avoidance of disease, and that the proper goal of all health teaching is the finest ku d of individual living According to World Health Organisation, health is (defined os *'a state of complete physical, mental and social uellbeiog and not merely the absence of disease or mfinmty ” Health implies a sufficient reserve of physical strength, agility and endurance, as well as mental poise to meet the demands of every day life The healthy individual n characterised by — 1 Seme of wcUbemg 2 Ability to work elBcicnlly and with enthusiasm. 3 Cheerfulness 4 Self confidence 5 Self-control G Absence of disease and physical discomfort. 7 A wholesome mental attitude 0 rrcedoni from unnecessary anxiety 9 Courage to face realil>, and ability to act witli others in harmonious groups 10 Wholesome fatigue at the end of diy with restful un- disturbed sleep at night There irc lanous levels or degrees of health, like success and wealth, it is alw lys tclauve and must be though* of in terms of the age of the mdividuil Perfect health is an abstraction, bj n I means an auiinab'c condition Optimum Health is ihe highest level of health attatmblc b> the individual The main, mcnl of optjnum henlth is an objective for which each indivi- dual should strive INTRODtJCTION 3 Each individual’s health is in a large measure, his o^vn res- ponsibility'. Life does not oive us health any more than it owes us success. Health is not an inalienable right nor does it come to us as a matter of chance. It is a goal to be achieved. Life can be of great significance, if the necessary efibrt is put forth to attain a high level of physical and mental weil-betng. Wise attention and confomiance to nature’s code ef health offers a good reward, whcicas neglect of her requirements takes the toll not only in wrecked bodies but also in diseased minds. Factors that influence health t — ^Thc health of an indivi- dual depends partly on his inhenianre and chiefly on understan- ding of those factors that influence health and the proper use of knowledge gained through such understanding. The individual who covets a full, ncli and wholesome life, must include in his programme of living an adequate amount of : — V ffl) Wholesome food (b) Physical activity, outdoor play, adopted to his indivi- dual capacity, interest and needs. (c) Good body carriage. (d) Proper care of feet. (») Preventive and therapeutic, dental and medical services whenever needed. (/) Ample sleep each night under healthful conditions. A suitable occu[ta(ion. (A) Proper use of leisure time. (ij Wholesome mental attitude towards life. Apart from these, there is no magic prescription, nor any secret formula that can promise health. Good health is out of reach, if one turns a deaf ear to cardinal requirements of nature. Adjustment to Environment : — In order to exist, living organisms must adjust themselves to particular locations in which they dwcH, that is to their environment The process of living involves constant adjustment and readjustment to environmental factors. Man, as well as other living beings, is inseparably dependant upon and thoroughly interwoven with cnvirorjnent. The cijvironment of modern man is partly natural and partly man-made, and consists of physical, biologic and social, .tutme*' -Xi.l«.tltP-vuim.'*mLIiis.&vid .fiwl -sh^ltn^ xlatluny^nd all the things he uses. Among the pli}sual factors arc climate, air, light, sunshine, temperature, food, water, buildings and their contents and the numerous mechanical devices, which modern man lias learned to produce. ' The biologic factors consist of the animals and plants including disease pioducing microorganisms, in his surroundings. 4 HYGIENE AND TXIBLIC ItCALTH Tlie social /tutors include customs, beliefs, ideas, peculiarities and >sa>s of living of humaiWbeing with whom he comes into contact The medical /actors consist of services needed by every one, c g control of insect pests, control of communictblc diseases and the existence of matemitj and child uelfare services, school, medical services, hospitals etc Because man is a socnl organism, his adaptation ■'to the complex social and economic order, characteristic of modern Civilisation is as necessary as adapta- tion to his non-social surroundings Since fci> cm iromncnt factors are static, life is a continuous process of adjustment and readjustment to an ever changing environment The comp- lexity of the environment of modern man places a strain on his powers of adjustment and calls for intelligence and effort to maKc proper adaptations The present unsettled cond'tion of the \sorld adds to these problems Education m general increases thi, individual's capacity to In c his life uudersiandtngly, i e to make proper adjusimcius to his total enNironmcnt health education enables him to make the necessary adjustments to attain the highest level ofhcalth for u Kick he ts biologically capable ■ To attain buoyant licalth, the indiiidml must learn to cope successfully, mth liis phys.cal, biological and social environ- ments If he IS successful in this achievement, lie has acquired the art of living healthfully Adjustment is the price of life Positive Healths — It is clear that health connotes dynaiH c or positive conception as opposed to the negative one, “Positive HcaUli" has been suggested to brmg home to he individual that through his own mmaiivc “somcUuns;’ can be generated and developed m his body which vmH give him the maximum utility of body and mind The criterion of a healthy human being is his joy of life The bodv may show no 5 gn of disease ind environment may be favounible, hut unless iheie is also a “will to live” acliicvcmcnts will be few We must stimulate the will to be healthy Without “self help” to live healthy, it is impossible for anvone to draw the best of hfc Real wealth of a country does not consist in its mineral wealth and other natural resources but in its happy men and women A sick man is a liability while healthy man is an issct to the country In this coimection one is reminded of the famous lines of Goldsmtih, “lU fares the land to hastening ills a prey, where wuilih accmnulales and men decay ” In Uic promotion of positive health the medical profession have a viinl role to play They have to change thcir ctmcvpt of Tiiedical practice which begins and ends VMth ilio care of sick patient TJiey have to be physicians for the hcaliiiy Tlicy IKTBODXJCTION 5 must catch the disease before it shows itself Periodical medical check up, examination of school children, life insurance examinations are he on the patient but also on the circumstances under which his illnc's arose He will ha\ c to think his patient as hum^ii being with day to dav social problems It IS evident the hcaUh in the prevailing concept is more than the prevention of aiseasi- or tnc correction of defrets It IS of utmost importance tliat the posituc side of hedtibe developed Thus life will be made iuller, richer and happier In this noble task of budding a healthy notion, ilic pnysicnn s role, m propagating the message of hcaho, is a vital one It is hoped that the medical profession will not be found wanting to take up the leadership m the crusaae for health In order to fulfj the concept of positive health or health at optimum level, medicine has to lake into consideration, all the contingencies of nnn during his nfc cycle btgmning m the womb of the mother till his death, not as an individual but as a member of the family and a membei ol the society Previously, health promotion of the individual of the family was considcied to be a man’s own busmess The wew now has changed and every child born is a potential comtnu- nuv asset and hence should be conserved, protected and developed Medicine lias to function m a wide sphere for the physical, mental and social wellbeing of the cemmumty. CHAPTFR. I WATER Wiihout water there wmiW be no hfc For this reason in early tunes habitat on used to be near rivers likes and springs Water conslituies nearly tuo Uurds of the totil vscight of the body, re 79% of blood 00% of bratn ard muscles and 10% even of bones It js required both for rmcrtial and external cleanliness of the body Usually it is util sed as a solvent and diluent in the body Its mam functions are —that it (0) Replaces loss of fluids from tissues (1) Maintains the fluidity of I food and lymph fc) Helps elimination of waste materials of the body (d) Acts as 1 vehicle for dissolved food (f) Helps m the secretion of digestive juices (j) Regulates body tempcmiurc and acts us a distributor of body heat Qaantity of Water Requred by Man —The m nunum amount of water rc^pnrd for an ordmary town, with water carriage system and industries requiring water is 30 gallons per head of population per day for all purposes It has been estimated as follows — (a) DrmVmg and cooking I gallon \b) Washing clothes utensils tnd houses, ablution and bathing 11 gallons (c) Water closeis 5 gallons {d) Trade and Industry 5 gallons (<) Mun cipal sircctwatcnng public baths flush ng sew'rs and extinguishing fires 5 gallons (/) An mal drinking and cleansing of stables 3 gallons In hospitals 40 50 gallons of water per head must be supplied daily The amount required daily for domestic u»c vanes greatly and depends upon the habits and standard of living of people, existence of water carnage system and the presence of domestic animals On m average a horse requires about 15 gnilons and a cow ]2galloru of water per day with a little variation depending uponUie prevailing season and the size of tlie animal Qmm/ty iff ^upptecd per A««? per a? Ai!Urr^ towns IS as foUovkS — 1 StmK 15 gallons per head 2 Calcutta GO „ ,f „ WATER 7 3 Lahore 30 gallons per head 4 London 35 , „ „ 5 Edmburg 50 „ „ 6 New York 100 150 7 Tokyo 48 , Sources of Water — As a matter of fact all water is pnmanlj derived from ocean In tropical regirns, evaporation of water into air is so great that it lias been estimated that about 700 gallons of water are evaporated every ntnute fiom each square mile of ocean surface Water reaches earth in the form of ram hail snow dew or mist from water vapours m the atmosphere derived mainly from ctaporatonof the sea from lakes rivers and other waters of the land Sea water contains sodium cnloride and land waters contain a lot of dissolved and suspended impunlies, but they •evaporate in the form of pure distilled water which reaches earth again m the form of ram snow or hail This conoensed water fiom the air is pure except for a few impurities that are absorbed from the atmosphere Fate of the Rain Water —On reaching t**® surface of •the earth (rt) Part of ram water is evaporated depend ng upon tlie temperature of the an The higher the temperature the greater is the evaporation (t) A portion of it runs 'iway at once in tlie direction of th* natural fall of the ground and gets collected m small streams which form rivers and finally it runs into the sea (f) Part of It percolates into the earth and serves as underground water and is m'lde ava table to the surface of the earth in the form of wells or springs (d) A portion cf It due to the configuration of the earth collects on the surface in the fbrm of ponds lakes etc and from such collections evaporation takes place Hails rapidly melt and act as ram Snow may, however, h* for sometime before it melts One po nt of sanitary import ance IS that infective materials may lie for a lonjr time without "being destroyed in snow and when it melts infection may be •carried to drinking ivater Sources of Water Supply The chief «ourccs of water supply are — 1 Ram water or snow water and artificial lakes j 2 Surface water i c streams canals nvers, tanks and ponds 8 HVGIEVE ASTD rOBLTC HEVLTII 3 Upland surface water and lakes 4 Ground Avatcr i c wells and springs 5 Sea Water 1 RATV \TER. AlHhe world o\er man denves his water supply from rain- fall In some places in India, it » used as a source of water supph, where rainfall is heavy and water of springs and iicJls is brackish This source is not depended upon cveept where more satisfactory supplies are not available, as for instance m Malta and Gibraltor A good example of tins seem is seen m operation at Lawrence school, Sanawar near Kas iiih hilJs in India Tlic Ram waiter is collected there from roofs and impervious surfaces, made of cement and stored m reservoirs m such a quantity as may not run short of U, even during the per ods of draught Ram water, although pure to start svith, receives impurities from the atmosphere such as dust, soot, suspended matter and eaen microbes, gases like In drogen sulphide, carbon dioaide, ammonia, nitrogen, oxygen, etc The first ram which falls on roofs and other impervious materials will be contaminated with dirt, including birds’ droppings eggs of mscccs, dust, etc over the roofs and other collecting surfaces henever it IS to be used for drinking purposes, arrange- ments should be made to exclude from the water storage tank Of the reservoir, the first portion of the ram that falls For this purpose any mechanical arrangement such as “Roberts ' or ‘ Gibbs” ram water separator may be fixed to the ram water pipe It allows the first portion of the ram water to run waste To prevent contamination of the stored ram writer, the rc- servou- Should be such as can bii cleaned easily and protected from surface poUution, for leaves, animal excreta or oihci im- purities might find access mio tt A tap or a pump must he provided for drawing the water from it and on no account the public IS to be aUowad to dip their own receptacles which may be contaminated and become the means of miroduction of dis- ease genns If the reservoir or tank is to he made underground It should he built either of sound masonry brick work or cement Ram water, if properly collected and. stored, is a gfwd water It is soft as it contams no (or Very little) mineral salts dissolved m a The a.dvantagc ta that it is suitable for cooking, washing and bathing purposes However, its one serious draw- back IS that being solt, it is liable to corrode lead pipes and thereby cause lead poisoning In tropics, aedts {ste§omjtia) breeds m artificial cisterns Iioldmg ram water WATER 9 A rainfall of 1** in depth corrcspon^'s to about 4 67 gallons on one sq yd or 22,617 gallons (101 tons) on each aqrc of land The amount of water that can be collected from a roof m a year IS calculated as follows — The area of the roof m sq feetxhalf the amount of rainfall in inchess=galIons of water per year 2 WRrtCB WATER Ram water on reaching the ground or the melted snow from hills begins to flow and is seen as a river, caml, stream, lake orj a pond and IS called Sui face Water These are waters which dram from the surface Ihe great advantage of these sources of ■water is that they can supply a very large amount of water The disadvantages are that they represent ram long timeafter it has fallen, and has trivelled a very long distance The river water IS fairly pure and unpolluted at its source but during its course it becomes more or less polluted as most rivers and streams serve as tlic natural sew er of the region they dram Consequently, they contain suspended materials, which arc harmful mcchamcally I As a matter of principle river water is softer than ground water but contains sufficiently large amount of organic rattler in it All rivers are very muddv and contain much suspended matter Some of the tr butanes of the Indus contain minute particles of mica m suspension, wh ch causes irritation of the bowels They may contain harmlul metals dissolved m them, as foi example the rivers of Wazirstan contain rragncsium sulphate, avhich if* taken causes irritation of bowels Rivers, streams and canals being open water courses, are freely used by the people for wqsli mg, bathing and so forth They get polluted by human and am mal excreta cither accidently oi purposely Trade effluLnts arc ’ also d scharged from the factories Dead bodies are burnt on the banks of ri\ ers These are other soui ces of pollution The runnmg water m rivers, canals and streams is natural- ly purified to a certain extent due to sunlight, b\ deposition due to sedimentation and by dilution The shallow and small rivers which dry up in summers are dangerous from the sanitary pomt of view The proper remedy IS to prevent vvaiful pollution of rivers, streams and canals For this purpose an act called ‘River Pol lution Preventive Act is enforced in England A similar acc should be enacted m India also To minimise the risk of excretal contamination of a nverr for water supply, the water should be taken fiom a point ofthcl river, above and not below the spot, where sewage and other im- purities arc discharged into the river., Of course, there is certain pollution even higher up, but m the course of us flow it under- goes self purification by scdira-ntation of the. solid matter, and ^ liv oxygenation of the organic matter on account of oxjgen pre sent m the water The sun, too, has a purlfving action due t(f. 10 mCIEKE AND PUBUC IIE^LTH hts actinic ra^s and the amountof such, purification depends upon -depth, magnitude and the rate offlow of the river The ultra violet ravs of the sun how\er cannot penetrate water when it IS turbid Another precaution to be observed is, that t\ater should be taken from the ritcr at least 20 SO ft as\a> from the ban'^, where the contamination is comparatwcly less This object can be achieved bj using a p pe attached to a hand pump The yield of water of i nver can be estimated bv finding out its width over a known distance md its average depth The product of both these (factors) gives the sectional area The mean velocity js 4/5 of the surface velocity The yield of the nver is the product of velocity and the sectional area It can also be found out by rivukt method In this case viatcr is allowed tu pass through a channel o( known dimensions The yi*ld of the river is the product of velocity and depth The water from the nver, canal or the stream >s collected m large reservoirs or settling tanks These should be protected from contamination The capacity of these storage reservoirs should be such as to hold a week s water supply Subsequently the water IS fiUcrcd to get rid ofbictena and suspended impurities It may be further stcrihstd by chlormauon by other methods to bring the water to a verv high standard oi purity Taoks or Poods —These arc a good source of witer I suppK, in some villages m India if kept free from pollution In these tanks water undergoes natural purification In an ideal tank or a pond the following points should be attended to — 1 The soil for cvravation should be n good sod having good surroundings Avoid madcsoil and loose sandy sod having filthy ponds and cesspits There should be no insanifiry or borehole htrmcs in the vicinity 2 It should be property fenced Trees should be planted at a distance to keep away the calile and dirt 3 It should be fairly deep and large and preferably of i rectangular shape having an area of about an Tcrc Banks should be properly sloped and covered with grass The surround- ing area, should have a low embankment to prevent my other water getting access into the tank, except the rtm water 4 All bathing and washing should be strictly forbidden IMorcovcr, steps and ghats should not be provided in the tank 5 Arrangement should be niidc for drawing water ftom a ‘platform by mems of a hand-pump ^ fi Weeds and algae should be removed regularly VS'hcn- cver water m the tank or pond deteriorates, it should be emptied -out and re excavated, as growth of algae makes the water unpleasant to uste AVATER 1 7 Jute steeping should not be allowed in the tanks / 3 rPI.\ND S0RPACB AVATER This IS the water, which runs on the sides oT hills, slopes and valleys and is taken ofT as watcrsupply, before such water -collects to form big streams and rivers Water may be collected m the form of natural lakes as m the city of Glasgow or in arti- ficially constructed lal cs as has been done m the cities like Bombay, Madras and Darjiling The area from which this water is collected is called the * Catchment area ” Tne water supplied to Simla 18 an example of thlsTcJnd of water suppiv At a short distance from Simla proper, there is a r dge of low hilU, called the Mahasu ridge which drams into a deep “Nali” between the Tidge and Simla The ram wa^or flows along the slope of the r dge, which is well wooden ant! constitutes the catchment area. ■The water thus collected is called the upland surface water An upland surface water is good because it is pure rain ■water, which has travelled a short distance over the earth The dangers are — («) Excreta of humanbeing m catchment area may find Its way into the water, and m'cet u with pathogenic amcroorgamsms As such the catchment area should be strictly reserved and only those should be allowed to enter it, whose business IS to look after the water arrangements In spite of strictest precautions there still remains a possibdity of coota- tmmation {b) Excreta of animals may pollute the water supply, there* fore grazing of cattle and herds of animals m the catchment area should be prohibited (c) Freshly collected water may corrode lead It forms an easily soluble hydrate of lead, which remains on the inner sur- face of lead pipes, cisterns, etc and on becoming detached, en- ters water If the water is acidic m reaction, the lead is actually dissolved and when consumed will give rise to lead poisoning (d) In some ettchment areas the ground contains peat which is a decayed vegetable substance and is commonly used t as fuel It contains acids Such as humic and ulmic, which make the reaction ofavater acidic U also imparts brownish or yellow* jsh colour to the water As for example, there are deposits of peat in Vne cmdrimcrti area kn ’I'tW, as a resu’i't prolonged draught, the water in the Sheffield rcsc'-voir ran very low The peaty acids derived from the catcliment area were not diluted, so the reaction of the water became ver> much acidic -and It gave r sc to epidemic of diarrhoea It dissolved lead m that water and caused a severe Icadpoisomng epidemic The upland surface water needs purification by filtration and * :Stcrilisation by chlorination 12 HICIHNU PUBLIC KBALTII Yield of the catchment area can be found hv E Pole’s fonnula --Q.=‘62 15 A (4/5 R—E) ^ssgallons per day Wliere A=arca in acres R=avcrage rainfell lor three driest consecutive years ns=loss ol inches m evaporation Lakes — Thev arc simpl> natural collections of upland sur- face water m a \aliej with a high ground at its outlets, whicli I checks all water escaping at once, c g Lock Katrine Lake vs hich < 1 is utilised for the water supply m Glasgow When collected from unpopulated htU^ districts, such water, hcvng usually soft 'and contains hut little chlorine, affords an cxce’icni stipplv It docs not contain ammonia, nitrates and nitrites more than the proportion m which they arc usuattv found m ram water It \howcvcr contains more dissolved matter than ram water Water collected from lowland suffices usually contains much peaty matter as well as phosphates and nitrates, washed from manu'cs of cultivated fields This js why tt becomes yellow or brownish tn appearance The lake water requires CltratiiJn before drinking 4. onoUM) WtTEU Wells i—Thcsc are a rtificial holes or pits dug into the earth t o reaclt the underground water iei,^ i n ey c oastttute u V£i y im porta n t sou rce o > w/ii^Is u pph m I n dim_\1Da ye3 There arc Ibuc-vatieties of wells —(a) itha lioto l >W/r_aie those which do not penetrate an unpermeahle stratum Th^ simply tap the ground abater, tyin g betw een the _surftcc niul li rst i mpcrmeabjc 'ttraium Die vvater of “these wells gets polluted, either (ram svrr3cej)rttcr_pr_from contamination of subsod wate r r«g 1 — Oiffarwit var oii« of wt*3U B— Slwllow well P— IXep A— \rtegfnn vrtW BjDjnj—tt at«r bairins Str*t« CjCgC,— InirmnesW* Slrn » WATCH 13 le H\GIEKi. AND PUBLIC HEALTH Cone of Inflnence* — ^\Vith thcdra\vmgofv''Herihc level m the well falls, resu’ung ma tendcnc> of the water toflowuuo It from the surrounding area Thc,-irca wltfim wKch thcJcfcl IS lowered is called the * Circle or Cone of Influence * Springs — These natural o utlets of ground % Tc^i^uc h i« under pr essure , due^o the appioacn ol ~^the fii V impermcahle stratum to iltc surface Thc-^c can therefore be considered is ru-itural wells out cropping at places where the geological con dmons are fasourab’e Varieties of Springs fhc) are — I Surfaet Springs or Shal lo I Springs or Land Springs — These tic outlets ol limited col- lection of ground mier rest iig on the superficial impervious prnics or Ivirmcs,! stables etc, she uid nt l be si uatetl n »i tue springs The springs J sliould be protected b\ a mas n ry iructure to oroiect surface contamination Tin. hvduulc im is a useful apparatus for lifting small quantmes w »ttr (lom a fl source such as stream or a spring 5 SDttw-FR Distilled sea water is used for dnnl mg purposes, on board the ships and in places like Aden whtie wells happen to be brackish and the ram does not fall even for several years Dis- tilled water is fiat to taste as all gases aec driven from it byl boding and it is consequently unpalatable So aeration of the waier should be done by allowing it to trickle tlown through a long column of wood charcoal, if u is required for drinking pur- poses As It acts on lead, copper, zinc, and iron, none should be exposed to its action m condensing apparatus Silver and tin linings arc the best for the pipes and t&c vessels used in tnc dis- tillation apoaratus PURIFICATION OF WATER Impure water may be purified fay either of the following methods A Natuial (I) Pounding or Storage (2) Oxidation and Settlement B Artificial I Physical (al Distillation [b) Boiling II Chemical f«J Precipitation (i) Disinfection or Sierihsauon in rUiration (o) blow sand filtration 20 mOIFNE rOBllC HEALTH fA) Rapid nicchan '•ai filtration (f) Domestic filtration Filtration of Water Sufiply on a large scale — \\ aier » got nd of the suspended xnauers, the ota, c\sts, spores and boctcria by the use of filters tsbicn are oft''efollou rg tnt> types — (a) Slow Sand rdters (A) Rapid Mechanical Fil*crs Slouo Sand Fillratim — This system t'as first introduced m England aliout moi-c than a century back and it is therefore often termed as English System The ran water from the source, usuallv a ri\ cr, canal or a stream is collected and stored m large open rcseraoirs knosvn at irttlwig Tot and tt allowed to remain there for a period of 24 to 4fl hours The solid matters m suspension gravita c to the bottom The colour ol water is dis- charged and Its bacterial count is reduced Storage of water for a pcricd of about 3 4 weeks renders the wntcrsujiply pretty safe prior tt filtration This process of sedimentatirn can be hastened by adding a coagulant such as alum or sulpnaie of ammonia which is specially done m rainy 'cason when the water becomes turbid, in specialty constructed circular jniaing troughs, before Its enir incc to the settling tanks This process of sedimentation has a great influence on bacterial life their number is generally rciluccd by 90% The water is now allowed to circulatt slowly from a higher level anil then to graduate from above into the filtcrbeds dowamatds FiltcTbcds are v«-atcr tight rectangular masonary tank or reservoirs, usually arranged side by side and ordinarily kept WATER 21 open These arc usuallj about 9-12 feet deep They are filled up from below up^vards as follows — 1 There are two layers of bricks placed one above the other on their edges, which are arranged m the form of drams and channels for the passage of filtered water Over the bricks, layers of the following materials are arranged systematically one after the other 2 6' to 12* gra\ cl, broken stones or pebbles (size I J' cubes) 3 Coarse sand 6' to 12* 1 Fine sand 36* 5 Water from settling tanks 36' Thickness of these materials vanes at different places but an important thing is that the thickness of sand layer is never less than one foot To ensure u ti'brm filtration, these filter beds are provided with valves at outlets and inlets The size of the filter depends upon — 1 The size of the community to be supplied with water 2 The quantity of water per head to be supplied The action of slow sand filter is threefold —I Mechanteal Obstruetion ar Physical — The suspended impurities are strained off by the upper portion of the filter 2 Chmxeal — The organic matter in the water is oxidised by the presence of air and the nitrifying micro organisms m the sand 3 Real Biological Action tt earned on tn the Vital Layer — After the filter bed has been working for 2*3 days, a thm green slimy gelatinous layer of algae and fungi etc , called the Mtal layer forms on the surface of the superficial layer of sand This layer retains all the bacteria of the water so it should not be disturbed Denser the film becomes in course of tunc, slower becomes the rate of filtration and greater becomes the pressure head necessary to ensure delivery of the requisite amount of water So after some time, when this layer gets thick, a few inches (usually \ to 1') of sand at the top is scraped off, remoted, washed md replaced usually at an interval of 6-8 week* But when after repeated cleansing, the fine layer of sand gctsxcduced to 16-18 inches, it becomes necessary to restore and renew the bed This is usually done after an interval of 3 years For efficient filtration of water through these filters, the rate of flow should not exceed 4 \ertical inches per hour The rate of flow may be increased if the filtered water is subsequently to be treated with chlorine or Its compounds The type of sand used Ins an important bearing on the process of filtration It must be fine but it should be neither too fine nor too coarse The, new filter takes about 3 days’ time to w'Ork As it takc;s about 3 days to form vital layer on the surface, so the water 22 mGir:>,'E and ‘foblic health tssuirtgfrom tlie filter isnllowcd to run waste until the bictrno- logjcil ctiminatron of wAter shows lint the efficient filtniion IS taking place As U ts ncrc'sarv for the filter w lx out of use it miersiU, the water \sor>.s must hi\e it Ictst two or even more filter beds so tint one is Alwt'.s ua Itble fo use In Calcutta water suppiv at Pa'ta \\atcr Works there are t fiUcj liitls a ih a capacit> of one m linn gallors and 8 filter Ixils u ih a np c tv of 3 ntihon gallons tach Watci should be test* d f r batter ong cal raamnia/ri Iv draiving a simple oj uat~r ever) week to see that the filters are working properh t e, arresting thi passage of bat ten i eflicicmij An adequately filtertd water should not erntain more than 1 2 bacillus coli per 100 cc ^afitd Wfiiamcai Ftlitrs — Thc^ arc less expenstse, simple and eas> m manipulation and require a % cry small area of space They are small and fixed jnstdc a covered shed They consist of large wooden, iron or concrete cylinders about 7 feet deep containing a filtering media consisting of quartz or sand, 4 to 5 feet tn thickness, supported on broken pieces of stones or pebbles They arc capable of filtering tvater at a \ cry high rale i / , 100-130 gallons per sq feet per 24 hours or 150 inches or more per hour They may be either of pressure or grayity t\pe In pressure filters, the chamber is closed anti the coagulated water istlrncn through the sand under ns own head of pressure ^Vhcrcas m gray it j filters, the water is passed through a coagulating basin to open filter through which it gratitaics In this process of rapid filtration the following steps arc mvolt cd — 1 Coagulation and /bmiation of * floe” 2 Filtration In this system, the place of the vita! layer of slow sand filter is taken, by a filtering layer actificlalty made by producing a flocculcni precipitate, which with colloidal siU settles mg head becomes insuflicienl to draw water at the standard rate through the sand The remedv is to increase the working or iihration head b) lowering the sdl until even a diiTcrencc of level of about 18' to 21' is reached Coroptrativc Study of Slow Sand and Rapid Mechanical Filtrat on — Slow Sand Filter j Rapid Mechanical Filter 1 This is an old and English Method 2 A large piece of land is required 3 Initial cost is high for installation 4 Suitable for clear or slightly turbid waters 5 Provision of settling tanks IS a necessuv 6 No coagulant is neces SV) 7 Water is filtered slowly through the fJtcr bed 8 The action m the f her isph>sical chemical and biological 9 Delivery rate is sIoh 1 1 , 2i to 4 million gallons per acre per day 10 Cleaned by scraping off superficial layer of sand, washing and replacing It after dry mg Tlie re- newal and resetting of filter IS required after 3 years 11 There IS a dangerofeon tamiiiation from lafxior- CfS 12 Algae growth hunpers the action 13 Results are good and uniform so chlorination of M-ater is not a ncces stty This is more recent and an American Method Very little space is required Initial cost IS less but running expenses are more Suiublc for turbid waters Provision of settling tanks is not necessary Coagulant such as aluminium sulphate is necessary Water is filtered rapidly Working process is mainly mechanical Delivery rate is ripid le, 100-200 million gallons per acre per hour Cleaned very quicklv by meclnnical agitation of sand bed by compressed air and b) o reverse current of filter cd water No renewal or resetting is required There fs no such danger Algae docs dot grow Results arc not so good and uniform so there is the necessity of stcnJismg water with chlorine CHLORONOHE WATER 25 CHUORlN^-nOM Co*cw.AnoN FB.TcmTiofi stewusatioh «iton*c6 Tig C— ' cflmp’elo flyiitpin of water supply 30 HYGIEVE AVO FGBLIC IlEALTIl ■^Gri \tl ulilo Crate) lune (CaO) and ciustic soda (NaOH) is sometimes employed (Lime Sodi Process) (p) Base exchapse — TJie softening of permanent harrl w^tcr can be done on a large scale or for domestic purposes by fthcrvng the water through t Pctmutit Media Natural zeo* hie called green sand or glu — comic (Pcrmutit is <\mhcijc zeolite containing sod um and alummiiiin sibcaic when the calcium ami magnesium pre«nt in the hard \ aier an rcplicfd bj sodium t inch pisses iff in the outflow \ I US O -i-C iSO, \l Si O -Xa.SOj The penn uu. w^ier a »hn i con- sists of a tl isrd ct luidi « al nnk Its uppii p rt coniains a rhamber wlicresali lution sajt muiialK piepand In rej,eneraiion pm- poses Its lower portion lomuns a bed uf pennutit The efficienct of the permu tit griduall) lessens, so it is necessary to regenerate us so dium base by passing through the medium a strong soluuou of common salt By mass action sodium displaces calcium and magnesium and the life of the filter IS completely renewed CaAl,Si,0,4-2Nja=NajAl,Si,0,+CaCi, ilfrtab ui sofiifurt — (I) Lead is most imjiortant The follow- mg kinds of water act on lead — (a) Soft water bv virtue of the dissolved oxygen forms oxy- hydrate of lead which IS dissolved more rapidly by aciduhtcd tvater Peaty waters arc acidic m chxractcr and so dissolve lead from lead pipes They have more plumbo-solvcncy than mine- ral acids (b) \Vaters containing nitrates or nitrites m solution or in excess of carbsin dioxide fc) Upland surface waters containing humic and ulmic acid (d) Distilled water and muddy river water ' The following kinds of water do not act on lead — (a) Hard water contamtng lime and magnesia (i) Water containing silica » Plambism — It results from the prolonged use of ivatrr con- taining lead Taking of waicr containing lead in the propor- x-rorTDOtit UsUT 6o(tner WATER 31 tion of 0 09 parts of lead m 100,000 parts of water has proved fatal Water should not contain more than l/20th gram of lead per gallon ^Thc chief symptoms of lead poisonmg produced from taking repeated doses of lead are — Anaemia, constipa- tion, colic, wnst-drop and other manifestations of peripheral neuritis as well as depression, renal disease and finally death (5) Iron conUtned in the strata of earth may find its ivaj into the water supply It m'^y be derived from rusting of the inner coating of pipes when iron p pcs are used It gives rise to dyspepsia and constipation The presence of not more tlian OOl part of iron per 100 000 parts of water is to be allowed m drinking water (3) ttiav be found m water m sma’l quantities It g ves rise to obstinate Constipation Such water should be condemned Zinc is however, ran ly present III water m a pioportion consi tiered to be dangerous [•/) riiiorine ma\ be found m detp well waiei svhen boied in bauxite or other phosphatic strata The water causes dental dvstcnphv, with moulmg of the enamel of tbv teeth m cluldren 3 Organic irnpurtties ait derived fiom animal and vegetable kingdom These are important from the point of view of htalih because they include the impurities derived from contamination jjfsvater by excreta and urine which ma> contain disease germs capable of living and multiplying m water and communicating the efiseases to the people, who happen to drink that water These are called \vater»bornc diseases e g cholera, dysentery, enteric fever, incjudiug typhoid and various paratyphoids A and B and epidemic diarrhoea Poliomyelitis (infantile paralysis) is sometimes considered to be due to taking water contaminated with faeces by the agency of hies Entozoal diseases due to distoma hcpaticum, ascaris lumfari- coides, etc may be contracted by drinking water containing eggs, larvae, etc of these parasites Bilharziasis and guinea worm infection occurs due to infected water McCamson’s view is that goitre is due to the presence m water of a microorganism, which produces toxin in the intes- tines of a man which acts on the thyroid gland and enlarges it, 4/i '(t/icnc(, 'tiL uva'rtn 'in 'afuL In infants the condition of crctcnism charactensed by stunt- ing of body growth mental backwardness etc , is caused lodme deficiency It has therefore become a common practice now a-days to incorporate minute qumtitics of iodine m the ^vatcf Supply of such an area or m common salt Detection of actual disease germs present in water supplies after these have been enormously diluted with water and other 34 mOIEVE AVO PUBLIC HEALTH. IS attached to the apparatus, the gas is conducted through the Chlorotiome to nearlj t!ie bottom of the absorption tower, this glaacd earthenware tower is filled at the top with a vrater dis mbulingtray and packed with pumice stone A small trickle of'M.'ater is uruformU distributed over the layer of pumice stone and in its downward flow absorbs the measured quantity of chlorine gas The chlorinated water then flow's through a chlo- rine resisting rubber or carthcnw-ire pipe and ts uniformly dis- tributed through the mam body of the water to be disinfected There are several adt-mtages of sterilising tvaterwith ehlo nnc gas, over the hypochlorite lAliliion, especially when a large quantity of water IS 10 be sterilised daily which are ns foUotvs — 1 Chlorine gas, in pure form and in a concentrated state can be stored for a very long period sviiliout detenorn- tion while hypochlorite of lime deteriorates soon 2 The gas occupies \ cry much less spate 3 A precise dose can be administered without any difllcuhy 4 Labour cost is reduced to the minimum degree 5 Dry chlorine gas lias no effect on metals but svhen it comes m contact with moisture it sets up virulent corro sion imroedistcly (d) Sups, which are capable of pissing through the rod cr\stal or quartz tube 4 hatadjnSilcer Proctss — Certain mctils, in infimtcsimal doses, act as powerful germicides which have been described as “Ohgod} nimic Action ’ Katidyn is the name given to an acti- vated form of sih cr, which js made to deposit on particles of sand In this process, minute quantities of silver go into solu- tion m the form ofsiher ions which attract oxygen from the air dissolved in water and bac teria are killed by oligodynamic action Se\ cral types of appliances arca\ailable for sterilising svatcr by this process, the simplest ves- sels used for the purpose are white glazed sterilised bottles or red porous earthenware pitchers Tlie water is passed through a filter containing this kandyn sand and is sterilised withm 2—12 hours DifTcrcm types of instruments are available The ‘bead-’ iype steriliser contains the elements in the form of katadyn covered beads threaded on silver ivire Yorthis treatment only clear water is used It also remotes odours Pg O-KaUltnJjeadtype 5 AdsoTbents — Since times Steriliser immemorial charcoal has been used as a medium of filtration f>r the remoaal ofbacicm odour, colour etc , from the water Now a day s acti\ aicd carbon is being used for sterilising municipal water supplies m many towns If used for a long time u loses its porous character, by clogging m its interstices a jelly hkc mass But it can be reactivated by treating it wath a hot solution of sodium hydroxide or with steam Domestic Purificatioo of Water — In those places where waterworks cannot be constructed water may be purified on small scales by the following methods — 1 Dutillalion — This method is used m chemical laV)Oni- toncs on board the ships and places like Aden The distilled water, being flat and msipid oaving to loss of dissolved gases, requires to be aerated before use It also acts readily on meUils WATER 37 such as zinc, copper, lead, etc 2 Bailing — This removes solid such as chaffe, obnoxious gases and organic matter and Icills pathogenic organ- isms Boiling involves a large expenditure on tuci Boiled water is flat and tasteless It should be aerated before use It is adopted as a precautionary measure m the presence of an epide- mic of water borne diseases 3 Fillers — («) Slramng through Cloth — It is objectionable as it cannot prevent passage of bacteria, foul gases and finely divided solid particles Besides, the cloth is not usually kept clean (i) The other filtering materials used are charcoal, sand, sihcated carbon, porous iron, etc Charcoal is very much used as a filtering medium It is, however, not the best, as it absorbs impurities from the water or air and becomes a source of infec- tion if not often cleaned with boding water (c) Filtralion of water by ‘Three Pitcher System — ^Three pitchers are placed one above the other on a wooden stand The top pitcher containing sand, is filled with water which percolates through a hole made at its bottom, along with a piece of cloth or cotton plugged into the hole, into the second pitcher which con- tains a mixture of sand and vegetable charcoal Water passing through the layers of sand and charcoal percolates through a hole at its bottom into tiic third, viz , the lowest pitcher This last pitcher now contains filtered water It is very difficult to look after the cleanliness of the contents of these pitchers in private houses Hence this system of pitcher filtrition is not recom- mended (f) Domestic Filters — ^They should be made up of porcelain, clay and infusorial earth and moulded into bougies or candles They must 1 cep back all germs The essential features of a good filter are — 1 It should be strong, compact, simple , all parts being easily accessible for cleansing 2 It should be efficient to keep back all germs 3 It should be cheap and its purifyirlg power fairly lasting 4 The filtering medium should not require frequent changing 5 It should not impart anything in- jurious to water The mam types of filters are — 1 Pasteur s ChamberUmd Filter —-This is made of fine glazed porcelain and consists of porous tubes or bougies These tubes can be Fi« 10 Paalcnr a Chamber land Filter 38 mOIENE AlfD FDBUC HEALTH screwed on to a tap They should be cleaned bj brushing with hot water and then steri hsed by boding witcr Mudd> svatcr should be first cleared b> passing it through closely packed coarse sand filter This filter holds bnck all kinds of bactena present m water but docs not affect the chemical composition of the t-onstituents dissolved in water mechanical It is a fairly rcUablc filter 2 The Berktfeld Filler — It consists of a cylinder made of infusoria! earth better known as ‘ Kiesclgurh The c> Imdcr or candle wears thin by constant cleansing and gradually ceases to filter efficicnil) It is more rapid m act on and It does not require an additional pressure Candle should be sterilised by boiling after every third day (r) Chemieals — The following che- micals arc used for purifying water — • 1 Alum —It IS largely used to punfy muddy wrater I— “I grains are sulfi cient to add to each gallon of water Alum when added to water containing calcium carbonate, which is present m all V aters is decomposed and insoluble salts of calcium sulplntc and aluminium hydrate are precipinted carrying with them suspended impunnes bacteria, and leaving the punlied water clear 2 Copper su/phaU in the proportion of 0 1 to 0 25 pvrts to 1 000 000 parts of water prevents the growth of tlgac tnd other vegetable growths which give rise to odours and unpleasant taste of stagmniwttcr It is put in linen bags attached to ropes and strings and drawn through the water to be treated It has, however no effect on organisms of water borne diseases for oc ample cholera typhoid dysentery etc Copper Chlondc is con sidcrcd more efficacious to stem them 3 CoUmm Oxide {QuteKltnt) — Some people prefer slaked lime to ord nary lime flic quantity of slaked hme for sterilising water is pfoportiomtel) reduced if the contact of silt with the W'lter IS to be prolonged 6 gmms of slaked 1 me wiU sterilise a gillon of soft water Quicklime is cheap casili procurable and IS highly recommended for disinfecting the water of a well or a tank at the time of nn outbreak of cholera m v illagcs It hastens the process of preetp tatlon of iron in the i atcr It should lowcverbc noted that whiting chalk or carbonate of lime arc useless for the purpose 4 Chlorine — Uhen added to water in strength of 1 m 2 WATER 39 milljons parts, chJonne gas is said to kjll all disease producing germs This is i verv cheap and convenient method instead of chlorine gas, bleaching posvderor hypochlorite of lime may' be used m proportion of 30 grams to 100 gallons Some times chlora mine (NiHCl) which is produced bv the action of ammonia on chlorine is used instead of chlorine alone For domestic purposes prepare a stOwk solut on by taking one tea spoonful or one drachm of bJeachingpowder and miving with a p nt r:e 20 ozs of water 5 drops of this stock solution arc added to a pint mz 20 ozs of svater and allowed to stand for 30 minutes Some tablets have been manufactured with various names as Halazone, Chlordc chlor etc , for chlorination of water on a small scale 5 Bromvit — 06 grains of bromine when dissolved in potassium bromide and added to a litre of water kill bacteria in five minutes The offensive smell of bromine may be removed by further treatment of \vater With sodium sulphite and sodium carbonate solution G Jodyie IS used in doses of 2 parts per million to destroy micro organisms present m water Sodium hyposulphite should be added after 15 minutes to neutralise the free lodme of sodium which renders water fit for drinking 7 ^tsjietd Tabltts —A 2 grains tablet of iodine and lodate of sodium and the same quantity of cunc acid when added to 4 gallons onvater will kill cholera and typhoid germs ma few minutes The free lodme present in the iiater may be removed by the addition of sodium hyposulphite 8 Potassium PemanganaU — It oxidises organic matter and also serves as a deodorant 0 5 parts of this salt added to 100,000 parts of water is sufficient to destroy 98% of micro organisms m 4 to 6 hours It was largely used for disir‘'ection of wells 4—6 ozs of it is used for a well, so that water will give a proportion of J oz per 1000 gallons of water m the well It is better to treat the water of the well with the chemical in the evening so that it may be ready for use the following morning, when it should have a faint piiA tinge, if the dose has been right If smell reappears m the well water after 2 or 3 days potassium permanganate treatment should be repeated It is however not suitable for sterilising large volumes of %vater Examination of Water — For hygiemcpurposes the exami- nation of avater is generally done under the following heads — A Physical examination B Chemical Examination G Microscopical Examination D Bacteriological Examination Collection of Sample — ^Forchemicalanalysis.watcrshould be collected m a four pints Winchester quart bottle with a stop- per The bottle should be cleaned with dilute acid and then ^0 inaiEVE Ai»D PUBLIC HE VLTn \N-a5htd thoroughly \silh good tap v,atcr Before it »s hUcd t^uh the sample it should be rinsed 3 tunes with the ivatcr to be collected In case of ftatriejj/tt>n sterilised glass stoppered bottles holding about U 02s of tvater should be used If simple IS taken from the tap, the tip should be cleansed wth a cloth and thoroughly Dimed Before the sterilised bottle is opened, the neck and tiic stopper should be Samed tvitli a spirit lamp and stopper remoicd Mith sieriltsed forceps the bottle filled and the stopper again passed through the flame, before being replac- ed The sample must be sent to the Itboralory m an ice box iMthoui delay and should be examined in a bacteriological lalxiri- tor) ivithin SIX hours of collection Heat ard delay will cause multiplication of some bactern and death of others and some clipnical changes >>111 take place In taking the sample the follouing rules should be obser- ved — (а) If Trom a tap, it should be taken from the lowest tap and the water should flo>v for fi\e minutes before the simple w collected (б) The contents of a cistern arc no criterion of the purity or othenMse of a water supply The specimen must be taken direct from the mam (e) When taken from a well, river, or a lake take the sam* pie by placing the battle well under the surface 1 e a foot below the surface, and suflicicntly awai) from the bank {d) In case of a well pump the water out for an hour or two and then wait for the well to get refilled so as to get a genu- ine sample of ground water, whicli has remained stagnant for a long time m the well There IS a special bottle with a float for taking a sample of water from the rncr, tank or well, which is provided with a con- trivance by which the stopper docs not come out, till the mouth of the bottle does not reach well below the surface After filling the bottle the stopper is to be replaced and secured by a rubber cap No scaling wax or grease shoul I be applied to the stopper Label the tiotde with a number and send to the laboratory as expeditiously as possible The follow- ing information should always be furnished with the sample of water — ! (i] Number written on the battle coatatamg the sample 6) Time and date of collection of sample e) Source of water whether from a river, well or tank rf) Geological fonnationof the neighbourhood of the source of water so far as known (r) Description of supply should include the following factors WATER 41 in the case of well, its depth, diameter, strata, through ^hich U IS sunk, mode of its use and the depth of \vater etc , should be noted (/) Possibilities of impurities getting into the well i e, cess- pool, manure heap etc (5) Metcrcological conditions whether there had been any recent rainfall or flood etc (h) Statem'^nt of an out break of any water borne disease in the neighbourhood or any special reasons required for ana- lysis A Physical Hxamioatloo — Note the colour, clearness, lustre or brilliance, taste and smell This by no means be attri- buted as iinal and should not form the basis of opinion B Chemical Analysis Of Water —Analysis is made to determine — • 1 The amount of inorganic salts m solution, which deter- mines the hardness of water and types of hardness 2 The nature and amount of organic pollution 3 The percentage and amounts of poisonous metals The chemist determines reaction, the type and degree of hardness, the presence of chlorides, nitrites, nitrates, ammonia (free and albuminoid) and the metals such as lead, copper, iron, calcium etc , before giving opinion The complex nitrogenous constituents of excreta as well as dead animaU and vegetable remains are broken by force of nature mto simpler bodies This is a process of fermentation carried on by various bacteria always present in the soil and the chemical changes, though complex, consist largely of oxidation Certain stages in the process are marked b> the formation of simple products stated m the order of their appearance as am- monia, nitrites and nitrates By examining ivater for their presence as ivell as their amount the chemist can form some idea of the extent of organic pollution of Water and as to whether such a pollution was recent m origin or not If the pollution was recent there will be pre- ponderance of ammonia and nitntes than nitrogen m the form of nitrates This is important as by the time the stage of nitrates formation is reached, no pathogenic bactena can survive in the tvatcr From the relative quantities of such nitrogenous products present in the water, the chemist can also form an idea, whether the organic pollution was mainly xegctable or ammal in origin The former has little significance from the sanitary point of view but the evidence of the latter md)cates the danger to health As sodium chloride is present m urine, the analyst, for examining the water for evidence of excrctal products always examines the 42 mCTE'TE AVD PUBLIC HEALTH quantitj of chlondes present, but he must remember that thej might hive entered, the water from other sources i c , sea water, if the tvatcr supply hippms to be near the sea or is derived from certain sfnta of the earth containing chlorides If-epeited ex* ammattons of water show a constant quantity of chlorides ind then there IS a sudden mere ise m the imouni, tt excites i sus- picion that contiminition with sewage might have occurred C Microscopical examination of water — ^Thc simple is centrifuged and the deposit is seen under 1 m croscopc The presence of spores of m>celia if found is due to contamination ofwater with selvage and the most suspicious elements ire the remnants ofvegecablcs used for food and fibres of cotton, imen, wool etr Animal substances i c , woo}, hair, yellow elastic tissue etc , generally indicate recent contamination D Bacteriological examination of water — ^Themamob' ject of bacteriological examination of water, is to find whether cx- cretal pollution it present A single examination is of \alue only when a water IS so bad is to justify condemnation A routine examination consists of plate count and presumplit c cob acroge- nous count, IS organisms of coliform group have been found to be most us^ul for this purpose The sewage bactern can be divided into two groups rt: “ (a) Organisms of intestinal origin i e , faecal coliform grouPi faecil streptococci and pathogenic organisms, e g , v ibrio cholera, Bacterium dysentery, Bacterium tvTbosum etc (b) Sewage bactern proper c g , proicus group of orgnnirni etc. Slandard for filtrrtd pipe u,aUT — (a) Excellent water s=No coliform bacteria in 100 cc (b) Satisfactory watcr=al to 2 coliform bactern m 100 cc (c) Suspicious uaters= 3 to 10 coliform bactern in 100 cc Tube wells and deep wells should confirm to the ibove standards It is very difficult to lay standards for shallow wells and tinlcs Pobbe Swimmiag Oath* — Of recent y cirs there his been a public demand for hrge number of swimming bulls , many of which ire privately run Model baths should be such ns to allow easy cleansing The maq;m of tlic bath should slope awav so as to pret ent conumi naewnhy ditty water The tuefacc should be kept free of growths and deposits There should be i channel round the bath for the bathers to spit into There should be ample iirinil and water closet accommodation, iJong with shower biths and dressing rooms Thcic should aJso be a fool bath with hypochlontc solution WATER 43 No bather be allowed to enter the bath, without a previous soaping, shower bath and foot bath Fouling the water by spit- ting or passing urine in the bath arc highly objectionable No person having any intestinal infection, contagious disease or shm disease (including fungus infection of feet) sore eves, running cars etc , should be allowed to use a public bath until completely free from infection At swimming baths the water should have good transparency, showing up the bottom and the sides of the ponds clearly The water should conform to the standard of drinking water i e , Bacillus coll absent in 1 c c , no other organisms to exceed 1 000 per c c They should have cither a ivater supply which ensures a continuous fresh flow through the bath or more commonly, a system whereby the water m the bath circulates continuously from the bath through a Alter and back again to the bath Most baths are now chlorinated continuously during the whole period of bathing and the dose should be sufficient to maintain the strength from 0 3 to 0 5 part per million parts as a bigger dose will be irritating to eyes, the nose and the skin Filtration through B^tadyn or treatment by ozone is also useful. Over dosage of ozone should be avoided As there is no proper arrangement for purification of water in swimming baths so the following diseases arc attributed to their use — Conjunctivitis sinusitis, otitismcdia and in- fectious sore throat Rarely typhoid fever, dysentery, skm diseases vulvovaginitis and trachoma Jiave also been traced Poliomyelitis may be contracted in swimming pools Certain skin and respiratory diseases, swimmers itch and venereal diseas- es are also sometimes contracted \Vater Borne Diseases — I Diseases caused by micro- organisms — ^Thc commonest diseases are intestinal namely typhoid, paratyTihoid, dysentery, diarrhoea and cholera The virus of infantile piralysis is excreted in faeces and there is a good deal of evidence to show that U may be water borne 2 Diseases caused bv parasitic ova — ^The eggs or deve- loped embryos of the egg> of round wonns and tapeworms are usually carried by water Entzoa! diseases as nematodes flukes, filharzia, guinea tvorm and hook ivorm infections arc carried through water The cyst of amoeba causes amoebic dysentery In addition svater forms the medium in which the mosquitoes which traiismic malaria and yellow fever lay their eggs 3 Diseases caused by Inorganic matter — ^Diarrhoea may be caused by excessive amount of sulphates and poisoning may occur from lead or other metais Obstinate constipation may 44 inOIEVC AKP PCTBLTC HEALTH occur due to excess of iron m water Certam inorganic salts such as iodides and fluorides are essential far health Deficient) of tlic fonner gi\ es rise to goitre and that of the latter to dental canes in childhood ashdit an excess appears to cause brmlc bones svith a tendency to spontaneous fractures 4 Diseases caused by organic matter Diarrhoea and gastric disturbances arc occasionally due to an excess of i egeta- blc matter in avalcr or to entrance of scuage from drams Hy giene of Ice Making — Ice may become contaminated at tlic factory or during delivery The water used for us manufiio turc must be aboae suspicion No icc factory should be licen- sed unless llie asaitcr to be used for manufacture of ice is pure and a'.holesome Tlic ice should be sampled at the factory for bacteriological exatnmation from tun" to time The containers m %\hich avater is froaen should be scrupulously clean The) should be scrubbed out Mcckjy and sterilised by steaming The avorkmen should wear clean overalls during the work and clean- liness as regards their hands and nails should be observed Adequate latrine accommodation should be provided for the staff No typhoid earner should be employ cd in the ice factory Spitting should be proliibited Delivciy should be effected m closed vans There IS aluciys a possibility of pollution of ice even in a wellconducted estabhslim-nt The public should neier keep foodstufls m direct contact with ice or put ice into drinks to cool Uiera rood stuffs or drinks should be cooled bv being kept in an teed chest m which there arc ttvo separate compartments, one for ice and other for the foods Aerated Water Factories — Three processes are involved in the preparation of aerated waters (a) the cleaning of bottles (fi) the pripiration of syrups (c) the bottling of the products During any of these, nuisance or danger to public health may arise So these factories must be licensed It is preferable to have separate rooms for each of these processes The factory should be uell ht and aentilated and free from flies All uorkers must wear scrupulously clean clothes and observe cleinliness re- garding their hands and nads The floor should be made up of smooth impermeable inatcnal and flushed regularly at the end of day’s work The internal wailU should be painted with \vatep« proof paints Adequate lavatory and washing accommodation wuh soap and nail brushes should be provided for workers sepa- rately from the factory Bottle uathuig — ^Three tanks should be provided for wish- ing the boliles The first of those is filled wuh pure water to which wishing soda has been added,—! or to a gallon of water All bottles on return to the factory arc immersed in this solu- WATER 45 tion to soak. When the labels have come olF, the bottles are transferred after having been wellscrubbed with brush to the ^ second tank which contains clean water mixed with potassium permanganate. They arc scrubbed internally with good bottle brushes, rinsed out and placed in third tank tvith plane water. Here they are again rinsed, inverted on a draining rack and allowed to dry. Syrup room : — It must be fly proof. It should have a tabic having a smooth, clean and washable top. Strainers should be washed daily in clean water, boiled and kept in a dust proof Cupboard when not in use- Syrup containers should be kept in an ant and flyproof cupboard. The water supply of the factory must be above suspicion, preferably from the municipal water- supply. Boiilmg : — There are two types of bottles in use. The crown capped bottles arc hygienic because the whole of the top of the bottle is covered over by tnc cap. Capping machines are needed for the insertion of the caps. There are nvo types, one fed with a supply of caps autoraacically, which are best and die other re- quiring the insertion by hand, of each cap, winch may be infec- ted by the forefingers. The other types of bottles, made gas. tight by means of a glass ball fitting against a rubber ring are most insanitary and extremely difflcuU to clean. The use of such bottles should be abolished. CHAPTER II AIR AND VENTIIATION Air >$ absolutcl> necessary for the maintenance of life The two miin functions of the air ire intcrclnngc of gnscs m the process of respiration and regulation of body temperature Air is a mechanical mmurc of gases Pure air his approxi- mately the following composition — Oxygen 20 95‘*,» Carbon dioxide 0 03 to 0 04% Nitrogen 79 0®,, ^Valcr vapour Vanes wnth temperature Ammonia 1 Ozone and V Vanablcv m traces Argon J In the open air this composition remains rcmirkibiy cons- tant, owing to diffusion of air currents and due to the fact that the plants by virtue of their chlorophyll, lal c up cirb-iri dioxide from the air, and give off oxygen thus compensating for the consumption of oxygen and firmtiion of carbon dioxide which IS alwi) s f,oini, on is a result of ihe existence of anim tl hie, com bustion etc Ox\g n is in cssent al constituent of ur necessiry Jbr all life, the mrrt niirogen iimpK acts as a diluent of oxygen, the only exception to t!i s ruic be ng ccrli n types orbictena which thrive in the absenve of oxsgcn anaerob c bacteria Water vapour is always present in the air Its amount vines •widely and depends chiefly up>n the quiniuy of water available for ev iporation i r , on rainfill It is present more il sea than at land At certa n tcmpcriturc atr can hold only a dcitiiite amount of W’atcr vapours The air is s iid to be saturated when item hold no more amount of water vipours it i nirticuhr temperature and at ilvat point us humidity is said to uc IQ0®o About 65 p c to 7o p c humidity is consid-rcd as best for health Physical properties of air / CharU s lau — 1 he volume i gis or mixture of ti*cs of the atmosphere vines dirrrily as the ibsoluie Icmpcniurc provided ns pressure rrm iins constant Absolute lemp*r iiure 11 obtaired by adding the figure 273 to ih- temp-rat ire expres sed n Centigrade degrees Air on acc imt of cxosiivion due to heat necessarily becom-s iightcr und ihercJorc tends to rise up and cold a r rush-s to uk its pl»c- lbs phenorarnon is to a larj,e extent the cause oltle blowing of winds Ventila- tion alsa m many cis-$ dep nils upon this principle In air analyi s also effects of temperaturr on the atr must be rcm-ni bered ind taken into consideration 47 AIR AND VENTILATION 2 BorkV ia«J “The volume of ait vanes inversely in propokion'to it. pr-=ur= provided the temperature rema.os kw .—Air diffuses in accordance to Gtahm's Law in, “Gases diffuse at aerate inversely proportional to the ’‘^“¥h^?owe*ofalr^T“ffu;e through the brlelc tvallt of build- * - ^Pndnor imnortance m ventilation, but it is animpor- ings ctc.,isof m P, composition of air as constant P|:^mgrmpurrdm«heneve^^^^^ The factors reg 5 ^ dilutes, sweeps uniform and gets replaced by pure air. “™'(b) The rain, which washes rhe air and removes gases as S paygen'*ond"’Se, which oxidise the organic matter present in the air. „ present in green leaves of the 1 f^'^b^erhs carbon front carbon dioxide of the atmosphere &SoffrerJx;ge/°Bu.a.nighr.his process gets reversed. ® Issipisrides of air The chief impurities in the air are due to :— 1. Respiration. ty 2. Combustion. 3. Decomposition of o*”?**^**^ » 4. Dust. . 5, Bacteria. . ifl^ikiptred-au^d etp^^r TOO parts i- Oxygen - “■« ',1^09 Sbo"n dioxide"; 0.03to0.0t 4« Water Vapour Varies Saturated temperature Vanes At body temp On an average a man respires about 18 lime* .» “tnite and at ea°h breathing an adult gives ou- about 22 cubic mches (500 fe 1 of air The expired air contains about 4.4% carbon dioxide ,i,7o that orcsent in the fresh air. It loses about the same more P'”™ ‘o„ an average about 10 ounces of water Vapours L givei? olffrora the lungs of a man within 24 hours, Xreas ikm excretes about 20 to 30 ounces within the ro>d Period. Respiration also raises the teinperature of the air. When ihe amount of carbon dioxide in the air of a parucular room rises 40 mCHli’E AND rUBLTO HEALTH from Its normal percentage, 1 1 0 to 0 0G% the air becomes perceptibly stuffy to a person entering from fresh air and the occupants of the room begin to suffer from the usual sj^mpioms complained of in o% er crowded rooms t g drou'siness, headache, nausea, \omiiing, etc ronmerlv it was thought that these symp- toms were caused cntireh by the changes in the air bj respira- tion, but now It has been established that the ncrcasc of carbon dioxide or the decrease of oxygen, or anj of other changes men- tioned above that accompany the increaseof carbon dioxide from 0 taking the bottle alotag with you Throw out its tvater and the air will automatically rush. into it Cork it Neutralise It with hmc water or baryta water and test its alkalinity Kata Thermotueter —It is comrived by Leonard Hill and consistsofa large bulbed spint thermometer graduated from 95 degree to 100 degree F and it is meant for measuring rates of cooling Two such instrofflents arc generally used — I J)ry Kata — -In this jnstnunent the bulb j$ uncovered and It records the cooling power of air obtained by radiation and convection 2 WetKaia —In this instrument the bulb IS covered with a piece of wet silk cloth or fine cotton It records the cooling power of the air obtained hy radiation convection and evaporation Reading — «The bulbs are immersed in test water of about loO degree F tempera turc until the spirit rises mto the small bulb at the top of the instrument The excess of water is then jerked off the wet bulb and the other part ofilie instrument is sub sequemly dried with a piece of cloth The time required for alcohol to fall from 100* r to 95* F is noted lu seconds by a stop watch At least four such readings are taken with each thermometer The firsi reading is discarded and the average of other three is taken Each thermometer has a factor and is marked with a letter F on the stem The factor divided by the number of seconds occupied in 5 degree drop gives the rate of cooling expressed m nuHicaloncs per sq cm per second A fresh comfortable room has a dry kata cooling power of 5 to 6 and wet kata cooling power of 16 to 18 » < 6 to 18 imUicaloncs of heat arc lost pCr sq era of surface Jicr second If the room 15 prcceptibly cool the figure Will be 8 and 22 whefeas these figurib uill come down to 4 and 15 in case the room happens to be warm and stuffy Dry tVet Fg 12 ^atn Tl f'rmoTOPlCT Dry & Uot Eupatheoscope and Eupatlicomctcr — These ire ilie latest types of comfort indicators Ihc former u rather cumbersome so the Eupathcometer is common!) used It consis s 52 HYGIVE AVD rUDLIC HEALTIT of tMO ihcrmomcters filled >Mth spirit, one having^ a gla»i bulb and the o her silver meia! bulb Heat the bulb of each thermo- meter with warm water, till the spirit flies up m the top bulb Wipe out the bulb, dry n, and suspend ihe black tbermometer Stand at a place as far from the instrument as is cortvenicnt and f bseive the fall of spirit from the upper mark on the scale to the lower mark Use a special stop watch to time this and read f om he small «cale \ow suipend the silvered instrument at d nine us coohrg \o e the reading upon the silver seal" of the wa'ch Thr iquvaiii t mpera uie in degfeis FahTcnheit i\ obta 1 cd bv addi uj tl c two readirgi together Thus the stop ■wa rh vhiv -s 3o whrn the black ibcrroometcr tools m SO srronds and 20 if the silvered thermom ter cools in 27 seconds Ilrncc ibeefjuvat r I rnpcniuTe « 3a4-20=s55®F rhrrc or four such readii 1,1 >1 luld be taken a^d the av mge obtained directive I emperature —It is defined as ihit tempenture of saturated motionless air which would produce the same sensation ofcooircss as lliai produced h> (he combination of temper turr, Immidit) nnd airrootion under obscrvition Places or zones w th efTrctivc temperatures from GS'T to 70*F ma) be safelv tcitned is ctimfirl zones VENmATION It his been defined is the * Saenct ^ mainlining atmos nhenc condiiiom w! ich are comfortainc and licilthfuCtU-lhe lunnin bo3>.’ Ivtorol \tr’u!attcn meats the removal or dilution of the atmosphere vvhirh has become stagnim wiim md moist thrriugh the vKiacirig processes b) iir which is compintivcly drier, cooler and in motion In order to idmit fresh air into the houses, it is necessar) to tike into consideration the vemihtion of streets and stir rounding of the buildings also which is cillcd External iVnfi/j- brtt Tins IS ensured by making the streets wide and straight, keeping picnt) of open spaces md parks especially m the congested part of the towtssndh) budding the houses dctiched or scparite from each other I his can also be helped by water- ing the streets to h> down the dust to prevent nuisance from smoke at d bj speedy remov il of street and other refuse Satisfactory ventilation must conform to certain condition*, which ate c.s follows — 1 It mutt suppb pure iirfiom without ,2 It must keep the w wsthtn the room at a proper tem- perature and hiimiditj and should maintain a conimuous circu- bition Ain AKD VENTILATIOV 53 It must be able to re m ove ^^ fT ses, odou rs, bncie na, dust, etc . which 'contimlriate the air and dilute antT remove the im- purities produced inside the room through vitiating processes EfTects of Living in StrxflTy, Overcrowded and lUventila- ted Rooms — The physical changes noticeable m vitiated air arc therefore rise in temperature*^) increased humidity (3)^ stillness These are apt to produce headache, inability to j:on- centrate, drowsuiMS, lassitude, depressTon of spirits, loss of appe- Tifc, a tendency to catch cold eaUly and diminished resistance to Irircciious diseases ‘’ItTsonclif the causes of the prevalence of rickets in children It has been proved beyond doubt that tuber- culosis of Jungs is especially related to overcrowding and insuffi- cient ventilation Amount of Air Required for Ventilation — ^The amount of air required for efficient ventilation vanes and largely depends upon factors like size of the room, the numb er of jwsons o_ccu- pymg the room Tnd amo unt of impuritiFs present^in the air requiring BHuiion and dispersion Ventilation, aids onlv mTIie removal of products of respiration and combustion Whatever may be the unpunties, presence of carbon dioxide is regarded as the chief index of ventilation When the amount of carbon dioxide present m air increases ftpm fi fU % tn 0 06% _ stuffin ess begir^ to be perceptible 1 Ke limit of 0 06®/o 1 1 , addition of not more th*an O 02% caiiion di- oxide IS regarded as a permissible limit of respiratory impurity It has been assumed that air \ itiated to the extent of 0 2 per thou sand, which is still fresh and does not differ senstbl) to smell from the outer atmosphere, can be breathed with impunity, but no further vitiation should be allowed Ideal \cnIilation may be said to be existing only when the supply of sufficient pure air to a room is ensured to prevent the amount of rcspiratorj_carbon dioxide increising beyond a limit 2 par ts per tho usan d par ts The pcrmlsnbtc Ilmir of*th1s impurity'ls iield lo^bc 0 2" parts per thousand or 0 0002 cubic ft of carbon dioxide per cubic ft of air Equation D= — — Amount of carbon Dcln cry of the amount dioxide exhaled of fresh air available* m cubic feel Respiratory impurity If E*0 6 and R*0 0002 per cubic foot of air 5*1 HYOIEKi: AJTD PUBLIC HEALTH Each individual requires 300(^cu^(^e« o*" airpcrbour so that ihc'Tespiratorj impuruj maj not cxcccvFO 2 part per 1000 pans Cubic Space — A person requires gcncralJjr 3000 cubic feet of air per hour It can be supphecl w itheut causing a draught by changing the air three tunes per hour and as such 1000 cubic feet of space is alloucd to each person If on]> 300 cubic feet of space per head be allovrcd then the air of the room vvfll hav e to be changed at the rate of 10 times per hour which conscquentlj, in co’d ucaiber, wnlJ cause an in- tolerable draught. It «hould be noted that where the available cubic space is large there is a comparatively lesser need of fre- quentl> changing the air The TniTumum cubic space allowed per head is as follows — Soldiers . . ... 600 cubic feet Army hospitals . 1200 „ „ Infectious diseases hospitals 2000 „ ,, Lodgmg houses occupied day and night 400 „ „ Lodgmg houses occupied at night only . . 300 „ „ School rooms m countnes bavong warm donate throughout the year .. 100 ,, „ School rooms m cold countnes 200>300 „ „ Floor Space —VentiUtion depends upon the fact thatthe wanned Mtiated air nsef up, except in v«y ho weather The wansair, after nstng about 12 feet high, gets cooled and falls down again. So in calculating cubic space, an> h«ght above 12 feet shotdd be discarded This does not mean that the rooms should not be more than 12 feet high la the Pun^b dunng very hot weather, the rooms with a height of 20 feet or more, are very good Moreover, if mechanical methods of \cnuIauoa are adopted, height above 12 feet u regarded as useful By keep- ing 12 feet as the Imut of height. It Will follow that the floor qsace would be equal to i/l2ih of the total cubic space Amount of Fresh Air Required by Animals —A horse or a cow ought to be provided WTth about 10,000 to 20,000 cubic feet of air per hour, uj the ratio or20to25 cubic feel per hour per Ib of body weighl. AmonntofFresh Air Bec|uired for Artificial Lights — ^As candles, kerosene oil lamps, coal gas burners, etc , consume oxy- gen of the air while burning so these mun also be taken into con- sideration while arranging lor provision for their ventilation. For an ordinary oil lamp and a gas burner 2000 and 2250 cubic f'*ct of air arc required per hour rcspecuvely, Electnc bghi u consi- dered as best from hygienic point of vnew as it has practically CO effect on the air of the room. All oilier lights arc more or AIR ANT> VENTILATION 55 less dependant upon the absorption of oxygen from the air and vitiate the atmosphere bj certain products which affect the health to a greater or lesser degree Amount of Fresh Air Required for the Sick — On an ave- rage 3750 cubic ftei of air per hour is required for a sick person S\ STEMS or VENTILATION A — ^Natural Ventilation — This is greatly achieved by building houses Jjaving sufficient open space and by having a large number of windows opening direct into the open air It largclv depends on the following three natural forces — (a) Diffusion oj gases -^ases diffuse inversely as the square root of them densities so the air of a room diffuses through the cracks and crevices of various doors and windows of a room even though they arc closed But under ordinary cir cumstances, the diffusion if there be any, is very small So one cannot depend upon diffusion alone Diffiision causes the gase- ous impuntics of the respired air to mix up with the fresh air of the room until homogemty is established Diffusion however, does not affea the suspended matter present m the air which tends to fall back towards the earth m a still atmosphere, due to force of gravity (i) Effect of differences of temperature —When air is heated It expands and becomes lighter This hot air rises up and the cold fresh air rushes in to take its place If the air of a room be heated by fire or gets heated from the products of respiration of men and animals or be made more or less moist it tends to expand and rises up or escapes through all available open ngs cracks or crevices The outer colder air rushes in through outer openings until temperature of both out- side and inside air becomes equal Therefore in all methods of ventilation based upon this force, suitable and adequate tn]cts for fresh air and outlets for the escape of impure air must be provided This method is more relied upon in cold countries where coalfircs are used and thc/ixicrnal and internal differ- ence of temperature of the room is relatively high (c) PcrJJation and Aspiration — .Winds arc very powerful \ cnlihting ngents and thev act m two ways viz , (i) by perflation and (u) b) their ispirating action Perflation means the scUing up masses of air in motion and forcing them through i^cn doors windows and porous bricks into the room as a result of movement of natural air currents By means of this force the building can be rapidly and continuously flushed with fresh air Cross ventilation means free perflation between windows and other openings, 36 HTGIEVE AM> PUBLIC HEALTH pLiced opposite to each other But na.ural cross ventilation is rot feasible in the case of houses having back to back construc- tion In i\arm climates, as in India, s»hcrc the inside and out- side tempemure of a room is more or less the same, \ cniilation u promoted by perflating action of the air through doors and ^vmdo^^•s and as such care aliould be taken that as fat as possible these should be facing each other The only drawbtek against the ssind as a ventilating agent IS that the ro(AeTO“nts arc very uncertam and thus they arc difBcult to regulate This method has been advantageously utibsed in the v entilauon of holds and cabins of the ships at sea Breeze is produced on account of the ship’s motion, which IS conducted below by means of tubes and the vitiated air escapes through its vanous openmgs Asp^ralwn means the suction aaion of the wmd which draws air out of a space, c-ea'ing therein a partial va'^uum and thus fresh air rushes in, to take us place and a continuous cur rent in perpendicular direction is thus set up Inlets and ontlets — The openings through which p*o““Ss oT V cntiJation IS carried out are known as inleu £nd_iiutlcts Inlets are istended for the entrance of pure air~'aDd the out- lets fo* the escape of v mated air In tropical countries, during hot weather, particularly when the humidity u high and there is air sugnation, ventilation becnines imperfect. Eleanc fans are therefore used Ibr 'igiiat- tng the af of the room whteh cause evapora ion of perspiratioiti imparting thereby a feeling of comlbrt In addition, these fans hdp circulation of atr of the room and force the vitiated air out through the ventilators etc They may be used m the form of ceiling fans or table fans Thev are also sometimes called as agitator Janx Iq warmer chmaics the doors and windows pmvidc all the necessary ventilation Free ventilation between windows and other openings placed opposite to each other and at the same height ensurrs cioss vemitauon and it should be encouraged In colder climates the doors and windows have to be often kept closed and therefore special arrangements must be made for providing inlets Usuallv the chimney of the room serves the puiposc of an outlet, but if it happens to he insufficient for he purpose, then other outlets mus* be provided m the room InUts — The area of inlets per head should be about 24 square inches and the total udet area should be always greater than the total outlet area m order to reduce the ten- dency for draught. Inlets should be provided preferably at a height ofS feet above the floor level so that the entering cold air IS admitted at about the level of the head of a person sitting m a room These should be placed in such a position that the AIR AND TENTH ATION 57 air supplied is pure and not polluted before admission The in- coming air should be given an upward direction so that it slowly comes down and becomes slightly tvarm during the pro- Zig 13 cess The object being to prevent cold draught coming to the feci- Whatever devices may be employed as inlets ihcse^should 58 mCIENB AND PUBLIC “HEALTH be so arranged tint they take in fresh air direct from the outer atmosphere These Should be constnictcd m a conical design, their Wider mouths being placed towards the room and the narrower towards the extenor ^ Inlets commotilj used in Cold countries arc — J DoaiteSath It tnrfou) — It has a provision of air space between the two sashes Sashes can be worked up and dawn on pullcjs fitted m a frame The air isgncn an upward direction and it enters the room abo\e the level of heads of the persons occupj mg the loom 2 LouvrfS or veniilatort — These are made on tlie princi- pal of ventilation blinds Theseran be opened or closed at will by providing some mechanical arrangement 3 Cooper's Venhlatort — ^These consist of a senes of apertures provided in the glass pane of a window and arc arranged in a circle These are capable of getting closed by a circular glass disc also provided with apertures and are movable on a point This mechanism breaks the intensity of the entering current of the air and lessens the tendency to- wards draught 4 Uatlon Hopper's InUl —In this mechanism a hinge at the upper part of the window is made tolhll inwards by moving m a fram?, which has side checks to obviate lateral movements of the air In this 8> stem air is deflected upwards m a slant- ing direction by the liopper 6 Shenngham's valots —These are windov-zs provided near the ceiling of lUe room and their wedges project inside the room and guide the nir upwards C Tobin's lube — It is a short verucal tube made of metal or viood which leads from the floor uplo the wall to ahrghtof 4 to 6 feet Its lower end opens into the outside air Inside the tube a valve IS provided which can be closed or opened it will 7 Elluons bncks — ^Thesc arc bricks with a thickness of inches and arc pierced by means of holes which taper from a diameter of IJ inches on inside t,o 1^5th of an. inch on the outside 8 MeckpinelFs ventilator — In this mechanism the inlet and ihe outlet are combmed together It is placed m the roof It consists of two tubes, one tube placed inside the other The inner lube IS meant for the extraction of foul and vitiated air Tive outer tube acts as an inlet It is well adopted for large buddings such as schools, churches, halls, theatres, etc which have no upper floors or storeys, prcfcnbly in the hot countries OutUis — ^These ace meant for the escape of impure air and should be made of the same size as the inlets Asa general AIB iJJD ygNTILiTIOV 59 Fig 14 principle the outlets should be provided opposite to the ?nlets These arc best provided at the upper pirt of the room Rooms vnth sloping roofs can have outlets m the form of ndge opening along the entire top as »n the ease of Indian huts The various kmds of outlets comuiouly used arc — 1 ilacktmeirt venliiator 2 Chimney Flue — ^This is the usual outlet for the vitiated air commonly seen m the Indian houses 60 HYGlEJfE ^ND PUBLIC JIEALTH 3 Itxdge Openuxg — Rooms With sloping roofs are generally provided with such outlets Sketch of vorious pro\t8ioBS for ventilelion. A— SssH irmdow, B— llopper inlet C — Ridge \ealilater, Loiiv'retl outlet, E — Maekinnell’e ventiletor, F->ShoriDgDta'a vaI\o, G — Elliion’e brick, U— Tobin’s Tube i Cou./j These arc seen in the roofs of raiKvtys and trams by which the foul air i$ aspirated while the vehicle is in motion B — Artificial Ventilation —Natural sources of vcnlilalion are not considered praaicablc in Europe and in the case of large buildings where a number of people arc congregated for a con- siderabl> long period and where chimiic conditions do not per- mit free use of open doors and windows Consequently arti- fiaal ventilation is iargelv resorted to, m phees such as theatres, cinemas, examination halls and schools In this system mechanical means arc used to facilitate the renewal of air The s> stems of artificial vcntitation are as follows — Plenum or Propulsion System — In this sj stem the air ^ f orced into a r oom _ by m cciiamcaJJ'Qiices.^like-revohjiig fans Ijioivn as blower’s sicamJii^ic d coils, ste am jcls^ etc Airis forced under pressure and consequently alP^oors and windows arc kept closed The motor power is installed in a central chamber The air i$ washed in a tvater screen or filtered through a viscous filler, then wanned or cooled, accordmgto the AIR ANI> VENTILATION G1 season and finally humified. It is driven along passages to the inlets of the rooms. The air in this method is introduced at a low level near the floors, so that the breathing line is completely bathed by the incoming air. This method has many advan- tages I— *^(i) The incoming air can be delivered at any level and at any rale. It can be warmed in cold sveather by passing through pipes. /(ill) It can be cooled and humified bv passing through sprays of\Nater. ''(iv) Air can be filtered and made free from dust bv passing it Through the filtering screens ors\ool On the whole It is an excellent method The great objec- tion for adopting this mechanism, especially in schools, is that the windows have to be kept closed in this system, which is likely to create the bad habit of keeping windows shut, in the students, elsewhere also. This system is however used, to advantage m public halls, factories and printing presses. A- Vacaum or Extraction System:— It consists of the mechanical suction or extraction of the air out of the rooms by means of ducts communicating with the mam shah In which motor power is derived from an electric fan. This method is employed in factories, for the special purpose of providing local exhausts to carry dangerous dusts or fumes away from work rooms or benches. Generally the fans are used for extraction as they can be regulated easily and the amount of their draught can be controlled. Two types of fans arc used for this purpose pit:., high pressure fans and low pressure fans. In coal mines ventilation is done by means of furnaces. The vitiated air is exhausted through a chimney. The hot air being lighter and having been reduced in density goes up through the chimney and fresh air rushes in, to take its place. Apart from the objections common to the artificial methods of ventilation, the main objections to it are ; — V (i) The extraction of air from all the rooms is not uniform. The rooms situated near the upcast shaft have the air extracted well, but those situated at some distance may have a compara- tively Hitle or no extraction at all, (li) It is very difficult to regulate the incoming air, although suitable inlcu are provided, vet air tends to be sucked m through all cracks and holes and may result in the creation of an undesirable draught. Moreover, air from privies, latrines and other undesirable places also gets sucked in. 62 rCYaiEVE AND POBLIC HEALTH (ui) It 03 not possible to • heat or cool the incoming air Theatres, publichalls, hospital* and mines arc often ventilated on this extraction prinaple ^ 3 Balance or Combmfcd System — This is probably the most satisfactory method It is a combination of the Plenum and the Vacuum systems This system is largely used In air condt- tiomng where condutoned aic under controlled conditions of temperature and humidity is driven into the room, b> means of ducts Warmed fresh air is delivered at a height of about 7 feet from the floor, by the Plenum method (i r , a fan as used to force the air in) and all the outlets arc connected with an upcast shaft, where extraction is done by means of a fan or a furnace In England this method is used m the exammaiion hall of the University of Cambridge and also m the House of Commons Advantages of ArtifictatVenttlaMn — ^Thc air can be uarmed, cooled, Altered or humified before allowing it to enter the buildmg It can be supplied at any rate and at any level inside the room Objections to the Arltficut Methods of Venttlalm arc as follows — (t) These methods arc expensive (li) These can be rarely adopted to the existing buildings In order that the m*thods may prove to be successful, these should be designed as a part of the building at the tune of its construction (m) The artificial system of ventilation, being expensive, can only be adopted in large buildings on co>operattve basis or by persons who are very rich (ip) These require skilled supervision as where machinery IS employed, skiUea mechanics are abo required (o) None of the artificial methods of ventilation can ever make the air of a room feel at fresh and invigorating as that by the incoming of a good draught by keeping the doors and wmdovk-s of the room opened Methods of Ventilation Suitable for India — In India, where the climate on the svholc is a settled one, and there being absence of strong ivinds, natural ventilation will always prove to be the best knethod '-~'l Ventilation < f DtieUvrg Homes — ^Thc natural method of ventilation is eflicicnt, cheap and satisfactory Any of the various mkt and outlet devices may be employed to achieve clTectivc ventilation m die houses When coni fires become universal i« use, Tobin's tubes and chimncvs, Will have o be provided to serve Os micts and outlets respectively Under the present conduions the best that can be done to achieve the object IS to introduce Ihe free use of windows and to rely upon AIR AND VENTILATrON 63 some opcnmRS provided near the ceiling of theTOom to Serve as outlets — 2 ^ Vcnhlalion of Schools '-The- class rooms should be ade tjuatcly Ncntilated as air of rooms may become vitiated on account of respiration of students and teachers, by the putre- faction of animal or vegetable matter and the dirt from shoes etc Besides, there is the danger of germs of communicable diseases located in the respiratory tract of students being added to the exhaled matter The natural methods of ventilation should be relied upon m the case of school buildings In plan- ning buildings for the schools, windows an d-doora^oul d be s o arranged, as to piovide a cros sed draught The perflation action oftlie wind can be efrcciively utilised by opening windows facing the wind This action is considerably enhanced when windows and doOrs on the opposite side of the rooms are also kept open The rooms arc thereby rapidly and continuously flushed with fresh air and it becomes feasible to renew the air of a room at the rate of 100 times an hour Such a method is of unquestionable utility for rapidly changing the air of an unoccu- pied class room and may generally be put m operation In inhabited roonw during the summ er season, when the temperature inside an ^otiistde the_h ou^e.appcax5Dates, Sher7hgh^m^s~vaives or Tobin s jubesm'^also be emp lo yed S chool ventilation should be further assisted by adi^ting 'administrative measures also No lesson shou ld be contmue d mo re than a n ho ur_apd g n interval ol iUIo 15 minutes should elapse between two consecu tive lessons During this period the class room should be kept empty The outgoing teacher should be held responsible for ascertaining that all v/indows and doors of the class room are flung open as soon as it is vacated The incoming teacher may close as many windows of the class room as he considers necessary, depending upon the prevailing weather conditions and the temperature Tins gives the room a flush of pure air for about 10 15 minutes 3 Public Buildings — Natural methods of ventilation are rarely considered satisfactory for public buildings where people are congregated for considerably, long periods eg theatres lecture rooms and examination halls In such cases adoption of artificial methods ol ventilation arc considered as desirable BSicseacy of 'Ventilation ol an Inha'bited Hoorn — The following points should be kq>t m view — i Ma>e the iisit at the time of maximum contamination ^ g in a sleeping room, just before the person rises Note the ^ense impression 2 Calculate the cubic space of the room, by the following formula — Length ’X breadth x height » Cubic area 64 H\GrE^F AKD PUBLIC HEALTH Dcauct the cubic space occupied by solid articles in the room such as big trunks solid furniture etc 3 Asceitain the number of occupants of the room The total amount of cubic feet of atr per hour supplied can be calculated thus — Number of accupants X allowance of cubic feet of air per hour per head 4 Floor space per head is ascertained 5 The rate of \eloc ly ofair can be ascertained by means of an memometer 6 The inlet provision foi*fiesh air is considered as 21 squire inches for each person The direction of iir currents must be dcteiminrd which can be conveniently done b) examining the siluition of inicvs and outlets of the room These can be distm guished by obserting the direction of smoke emanating from smouldering brown paper 7 Efliciency of proper ventilation can be tested by smell test or by PattenkofTer s test (if lime or baryta water test) Estimate the percentage of COt air 8 Find out the number of artificial lights used m the room and the amount of fresh atr required lor these per hour 9 The number of bac ena, or dust particles m a room may be estimated b) a Slit Sampler Vital Capacity— 'This is knowm as the 'respiratory capacity’ or extreme dilTeren lal capacity' and denotes the maximum volume of air that can be expired after maximum inspiration It usually ranges from 3000 to 5000 cc but the amount vanes according to age, height and vigour of the pTson concerned Airborne Epidemtes — Infections spread through atr either from inhahtion of dust or by droplet infection and the mam diseases produced therefrom arc tuberculosis and pulmonary form of anthrax Due to inhalation of particles of dust in various factories it may give rise to silicosis, sidcrosis, nnthra cosis etc Smallpox mumps measles diphtheria, scarlet fever and some virus diseases arc also air borne HEATING OF ROOMS This is commonly done by the combustion of some sort of fuel and the heat produced thereby is distributed by the followring methods — 1 Orndvction — ^As a general principle solids arc good conductors of heat while liquids and gases are bad ones Good conductors rapidly transmit heat to the sur- rounding air and to the artides they come into contact with 2 Radialion — By this process heat is transmitted through air m straight lines on all side* With equal intensity Ain AND VENTILATION 65 3. Convection : — Tn this case heat is transmitted through gases and liquids. The common methods of heating houses or buildings are ; — (а) Open fire places : — Where wood, charcoal or coal is used. This method is extremely popular. Coal yields a good deal of smoke and is a serious cause of atmospheric pollution. Coke and anthracite arc more solid and smokeless. The advantage of open fire places is that they are cheerful in appearance and forms a useful attraction for the family. The disadvantage is the hcatingof tJieroomis unequal , most of the heat falls on that objects nearest the fire. The lieai is uneven as the fire burns, alternately bright and dies down and needs replenishing of the fuel. (б) Closed fires or stoves : — ^These stoves arc made of cast^ iron in which coal, coke, paraffin, etc. are used as fuel. They give a more uniform heat because they heat by convection. The disadvantages are that they arc less cheerful and not as efficient for ventilation as open fucs. They dry the air. (e) Heating by hot air, hat water and steam : — These methods are not commonly used in India. In case of hot air, mechanical methods arc used to heat the air, which is used for wanning the buildings. When hot water or steam is used, it is circulated from a central source to the various parts of the buildings and is called central heating. (d) Electric Fires or Radiators : — heat by radiation. They have advantage of being clean, easily regulated and do not give off any impurities ; but if used continuously, arc more expensive form of heating than modem solid fuel fires. Their one disad- vantage is that they dry the air. (r) Panel healing'. — In this system heating units are embed- ded during construction of the building in the floors, ceiling and walls. This method is generally used in schools, hospitals and other public places. ARTIFICIAL COOLING It has been found that artificial cooling in tropical countries like India is not a luxury but an absolute necessity. It applies more particularly to certain industrial processes where an im- proved product and higher rate of production are obtained if atmospheric conditions arc controlled to suit the process. The workers work under more comfortable conditions and so their efficiency and output is increased. It has also been adopted in several hospitals particularly in operation theatres, restaurants, cinema halls, etc. This is done by the following methods (1) Closing doors and windows during day time and fixing blue cloth over glass panes. 66 HYGIENE AND PUBUC HEALTH (2) Fans and Pankhas (3) KliusKhus tallies or chicks — These are used as a screen during summers Phey are kepi continuously saturated \vith\saier The dr> air of the atmosphere causes e\aporation and the heat of the room is absorbed and thus it keeps the room cool This process is all right for Northern India where the air IS hot and dry but « is not suitable for places like Bombay, Calcutta Madras cic where the climate is hot and moist It will reduce the temperature bu» will increase the relative humi- dit> and thus will increase discomfort (4) Supplj ing cold air from outside (5) Refrigeration, condensation and rarefaction Air Gondttiotung — During summer season discomfort and inconvenience is experienced due to high temperature and humi- dity so m air conditioning reduction of both temperature and Immidity is considered necessary In addition it is necessary to control the purity and movement of the air CemfoTt — In Tropical countries after adetjuate air conditioning, the air of a room should have y temperature of about 70®— 72or and rclamc humidity 60% Tins vanes due to certain factors such as the individual, the nature of the clothes he IS wearing and hiS stMe of health One who is well dressed and fat may feci hot, while \ poorly dressed slim person may feel cold The problems of air cooling m the tropics differ m principle according to the local conditions of wctlher md climate In Northern India the iir m hot weather is excessively hot over 100®F, but IS dry , a reduction m temperature alone will give comfort, even if nccompanicd by a rise m relative humidity In hot moist ehmaics, on seaports like Calcutta, Bombay and Madras discomfort is experienced both by high tcmpcraiure and high humidity Reduction m both temperature and humidity is therefore necessary PTinciple — ^Thc hot air drawn through a layer of fine water jets and while passing through it e%aporate8 the water and thereby becomes cooler due to the loss of heat absorbed by water during Its process of evaporation The cool air in this process gets saturated with moisture and excess of moisture is subsc qucntly removed by pass ng it oter or ihroigh a cold surface 1 he air 15 taken and delivered mto the rooms through ducts During Its passage through the ducts, it gets warmed on account of absorption of heat from the air of the room or the hall by means of outlets which lead it back to the cooling machine wl ere it can be cooled again Ait conditionid room — In the construction of the wall some AIR AND VENTILATION 67 liollow spaces are left to admit the conditioned air and to take the same back, after having been into the room. Several types of plants arc in the market, though they woik on the same principle. LIGHTING The lighting of building may be natural or artificial. J^atural light should be used where possible both for economy^ and for tts benefic ial efiect on h ealth. It is obtained by windows which should have an area of atleast one tenth of floor space. The rays of sun include light rays, heat*rays and invisible ultra voilct rays, ATiiJuial lighting should provide adequacy, co nsistenc y and uniformity of illununatidn ^vithout flic kering or glare, and an abs ence o f shadows. Taght may be produced by the co mbustio n of substances which bum with a flame or by cle^lnc-xurrent. All forms of artificial light, lieat a room and all svith the excep- tion of electric light, vitiate when artificial light js being used. More ventilation is therefore required when artificial light is being used. The commonest form of artificial lights arc as follows {. Candles j— These arc most ancient form of lighting. They give a very soft and poor light wltli a certain amount of flicker. They are portable and useful in emergencies, but a source of danger as their flame is naked. The standard candles Weigh one sixth of a pound, burning 120 grains of wax per hour. The electric unit - the Walt - is being equivalent to 0*0 candle power. 2. Paraffin Lamps: — ^They arc used in houses whcic there is no electricity. They involve a great deal of labour in cleaning, tjimmmg and filling the lamps They have the dis- advantage of blackening the svalls or ceilings and giving slight smell of petroleum. The metal burner is well perforated to allow admixture of air with the paraffin vapour, to ensure a good combustion. The flame is shielded by a chimney . 3. Gas Lighting Ckial gas used to be burnt on a fishtail burner but now the light is obtained by heating an incandescent burner wuh the lighted gas. Ifthcrc is not enough oxygen for complete combustion of coal gas, carbon monoxide may be formed and this gas is highly dangerous. Moreover the great danger of coal gas is tiie risk of us escape, causing explosions or death from carbon monoxide poisoning. « 4. Llcctric Ughting : — It docs not involve combustion and therefore no oxygen is taken from the air and no svaste substances arc produced. It resembles solar light that it contains violet .and ultraviolet rays and it produces very little 68 HTGIEVE AND JUBLIC HEALTH hc'»t Fluorescent electric lighting is adracatecl for certain purposes where a steady light, with a rninimum of shadow is required 111 Effects of Bad Lighting —The most common arc — E>e strain, headache, tendency of postural deformity such as wr> neck, round shoulders, poking head and lateral deviation of spine of ttsnpct, great Uahihty to accidents, slovcnij habits and lack of tidiness and order The quality of tvork as wtU as the quantity suffers School Lighting * — This must be satisfoctory because the contuiued strain of trying to see in an inadequate light is especially harmful tojoung children The light should enter, if possible over the left shoulder of the student and there should be an absence of glare from the blackboard and from the school books Artificial Lighting of Workshops and Factories' — It lits been found in industry that inadequate lighting is un> economical, as the output tends to fall and there is mcreased accident rate If lighting is below a certain level, the workers complain of discomfort and eye strain Foor lighting in coal mines IS an important cause of imner’s nystagmus The illumination sliould be good as well as adequate It should be constant and uniform There should he no flicker or Ollier vatiation, glare should be avoided and bright light shadows eliminated No worker should be permuted to gaze directly or at a bright light and every means should be taken to see that glaring light docs not enter the eye even obhqucl} Shadowlcss lighting IS essential for certain types of fine work Windows should be kept clean CHAPTER HI DISPOSAL OF REFUSE In every to^vn public health largely depends on the c/H- clcncy M'lih ^vhich all waste products are collected, removed, and disposed. The waste-products which rer^uire removal from human habitation are : — 1. Excrctal refuse ue., faeces and urine.* 2. Wastewater from houses, works and manufacturies 3. Refuse : (a) Dry refuse from houses, such as ashes, house dust, cinders, pieces of wood, iron, etc. (&) Solid and liquid refuse from stables, cow- sheds, slaughter-houses etc, (c) Street sweepings, such as rags, horse and cowdung, etc. (d) Garbage, leaves, vegeubles, rotten fruits etc. 4. Dead animals. sy Scavenging It means the collection and the removal of the town and domestic refuse and other wastematerial, svhich Is not carried away by 8e\sers. This is done by manual labour. - Conservancy System This means collection and removal of human excreta from privies, dry closets, latrines, etc , by manual labour. Household and Street Refuse This includes dry refuse from houses, streets and roads. It comprises mineral matter from sweepings, ashes, organic matters, waste scrapings of tvood, paper and garden refuse, mainly consisting of leaves and other vege- table matter. Trade Refuse : — It consists of refuse from any of the manu- facturing trades or business concerns. Consequences of Incomplete Removal of House and Street Sweepings aret— •!. The contamination of the soil and I>ollution of subsoil water from which drinking water is derived. 2. riy breeding. 3. Dissemination of filth diseases 4. h'rds, eatiie etc, scatter ikff refuse a.od increase nuisance. /Collection, Removal and Disposal of Refuse t — It con- sists mainly of household, stable, cattle shed and street refuse, *rn the case of odalt European^ it omoants to eboat 4 oza of eoliil end SO ore. of flnid each day. 'Whale oo ]bdisn, owing to hia \eEetarian diet paascs 8 10 otft. or more, on average IS out. of soiid excreta. In India water U used instead of paper and ihu ohlDlion iraUr together with hquld excreta is about 80 ota. 70 mOIEXE AXD IJCBLIC HEA-LTn The nahirc of refuse depends upon the habits of the population, (fl) HousthoU 'R^ust —Collection * The standard method is to put all domestic refuse into galvanised iron cans or tin tubs provided ivith handles and well-fitting hds the object of which IS to prevent blowing away of refuse by wind and to heep out the rainwater, as on account of the organic matter contained there- in, the domestic refuse will ferment and putrefj thus producing a bad smell, which action is hastened by the presence of mois- ture It nm\ also provide food for rats, vermin etc The ltd of the tub ako prevents fiics from geitmg m and breeding in tlie refuse It should be provided with a nm at the base so as to raise the bottom of the bin from the ground just to prevent its rotting due to dampness of the ground A still furllicr improve- ment IS to place the bm on a stand made of two crossed pieces of wood and a top These dust bins or im tubs should have handles on each side and should be of sucli sizes as can be handled easily by the conservancy staff Moreover, these should be suitably placed so that they can be reached conveniently by the conscnancy staff without causing annoyance to Uie inhibitants These should be emptied out daily, once in winter and twice m the hot w eatlier, in countries like India Fjg lO^Poubla borrow Remoiml — The refuse should be collected in properly cov wed, hand carls refuse carts, provided with closed hds to prev ent the refuse from being blown out by air (6) Special Hefuse (» e fmm slahltt, ca'tle sheds etc ) — It consists of grass, straw mixed with dung and moistened with urine It ferments rapidiv giving rise to objectionable smell The more it is disturbed the more it emits smell The method adopted for its removal in England is that on iron conservancy cart IS tept m the proximity, t r , m the premises and this refuse 1 $ et once pad cd into the cart whicli is removed at frequent in- terv als as and when rctpiircd nnd an empty one left in its place Such carts can also be made m this country. DISPOSAL OF BEI'DSE 71 {c)'^Streel Refuse — It consists of droppings of animals, horses, and other cattle together tsith mineral matter swept along with street sweepings In the towns of England, this is collected by conservancy staff from the streets and placed in dustbins suitably placed along the street In India, dustbins made with corrugated iron should be placed on raised concrete platforms, away from the dwelling houses They should be of standard sire and provided wnth handles for lifting The street sivcepings should be collected m th<»e dustbins ✓ i/Removal — 1 his is done m the Punjab through different agencies such as bullockearts, donkeys, etc In good muni- cipalities co\ cred carts are used for this purpose They arc also being gradually replaced by trucks and tippers fitted witii mechanical means of tilting for quick and speedy removal of the refuse, as is done m England and other Western countries The refuse should be removed daily both morning and evening In. England conservancy staff removes it ai night, so that they may not be of any nuisance to the residents of that locality Disposal of Refuse —The refuse after collect on should be disposed of m such a way that It docs not create any nuisance riicre are 4 ways for its disposal — 1 InetntTalion — It is one of the best methods of disposal of refuse It ts rendered harmless by burning and the refuse is reduced to one fourth of its original weight The organic mattei IS transformed into carbon dioxide and nitrogen The residue left behind after the burning off the refuse is a mass of hard material called chnkcts This is usually utilised for road making, iftci geulng it thoroughly powdered and mixed with lime 1 he mixture thus produced has a great cementing action /■An incinerator or the Destructor Furnace consists essentially of the following pans — (i) A furnace or a combustion chamber, built of fire proof bricks with cement Immgs _,(u) A suitable arrangement with a platform for upping the refuse through a senes of iceding holes through which the rufuse falls into the cells below v'/jii) The stokers for raking the refuse fonvard to the fire (iv) A baffle plate so placed that all fumes arc driven through the hottest part of the incinerator or combu'- lion cnimbcr, before passing up through the chimney . Vanous patterns of incinerators tiz. , double cell Meldrum and single cell Horscfall destructors arc available in the market They all work on the same pnnaplc v^hc chief ad\ antages of incmcrat on are that the cost of carting is mmitniscd to a very large extent li js reduced to one fourth of its original volume and residual ash or the cimker can 72 II\aiENE AND PUBLIC HEALTH be used far mal-jng roads, mortar, cement or filter beds The only disads'aftlage \s that the refuse jn the jncmcrators docs not burn properly during rains due to too much moisture contained m St The chimney of the incinerator should be sufiicicnlly tall and the dmughl of the air should be adequate for efficient com bustion, failing which the incinerator will give off oJTcnsivc smoke ivhich 'vill obviously create nuisance 2 Dumping — In this method the refuse is generally utilised m filling up empty pits or hoUous, insanitary tanks or m reclaim- ing lovvlying tanks When these arc filled up b> the refuse, the j,round IS called ‘ madesoil” It creates a great nuisance (u the iieighiKJUrhood on account of the production of oiTcttsivc gases, breeding of flies, harbounng of rats and other vermin The hnd selected should be situated outside the limits of the towi it 100-150 feet av, ay from the nearest habitation, as accumula- tion of fihh IS liable to pollute the water supplj of the area If dumping is done under proper supcr\ ision and during drj season, U 18 called “controlled^ dumping ” In this method the "ork of filling up should be started from one end ind gradually pushed on to tlie other end Refuse material should be deposit- ed in Wyers but not m any ease exceeding sue feet m depth and should be covered with about 9 inches thick layer of earth No refuse should be left uncovered for more than 72 hours Lach layer of refuse along with tlic layer of earthlyingoverit should be allowed to settle, before the next layer s deposited upon it Filling should be done i feet nbo\e the level of the surround- ing area to allow subsequent settlement When the work of filling is completed, cultivation should be done for about 10 years before the site is used for cons- truction of residential houses 3 Composi Vormolim ~This method is used mainly in the loinis where refuse has to be dis- posed off with night sod and its mam object is to cons ert the waste matter into humus or compost of high manurnl value 4 Sorting —This method con- sists of sorting the refuse into 3 parts — (e) Ihfev — It consists of cm- F«6 It— An ordinary (ncmerawr DISPOSAL OF llEFUSD 73 t In this system the excreta has to be collected and renoved by manual labour. This method is universally adopted through- •oui the East and was at one time adopted throughout the world, but in Europe and m some large cities in India, it has now been replaced by water carriage system. It is, however, still in vogue m Europe at least for small communities which arc unable to meet the high cost of water carnage system The cfTicient working of this systan is of great importance. The principle aimed at is that filth, refuse and all other putresdbk matters should not lie exposed to flies orallowed to contaminate the sources of water and should be transported and disposed of, safely without causing, even the least possible nuisance. v^. Privy System •—The privy is meant forprivateuse.lt is simply a place where excreta is deposited until removed. It should be situated on the ground floor of a house, at a distance • of about six feet from a living room and about 40 feet from the nearest well or any other source of water supply* It should consist of a brick built and cement lined cliambcr and should be of a small size and provided with ap.operscat. The object of cement lining is to make ir water froof, so that the contents should not permeate the ground and contaminate the underground water. It should be well ventilated and have a provision for an adequate supply of air and an external wall to permit light and ventilation. It should be protected from files by providing wiregauzc to the windows and doors so that they may not be a source of spreading infection of disease germs as of dysentery, typhoid, cholera, etc. Privv system is most objectionable as it gives rise to nuisance of smell especially when it is cleaned out and there is a danger of fly breeding also. This privy system is the sim- plest, but at the same time most insanitary of all systems Besides, there is likelihood of leakage and thus contaminating the soil and subsoil water. 2. Pail System. — This Is an improvement over privy system, nierc a pail or any other removable receptacle is placed 74 mCITSE AXD PUBLIC HELATH tmdemcavh the scat^vh^chis ranoved as soon as possible after the- use of Uic pm y, and immcdiatclv after that emptied out by the sweeper in a storage pail provided wth a -well fitimg lid and is cleaned and kept ready for reuse In Indian houses, this removable receptacle is commonh made of iron sheet and somnimcs earthen ware fummafas arc also used for this pur- pose Various shapes of these receptacles are used Sometimes tt\o such receptacles, by keeping one in front of the other, are used m each compartment for collecting unne and faeces separately 1 Ins ts done when unite and faeces are to be disposed off separately This separate system has many ad\ aniages If the liquid and solid matters arc collected in separate receptacles the process of decomposition is stou Consequently the latrines become comparatnclv less offensive This system also prevents the possibility of splashing to a large extent, and over flowing of receptacles which generally happens when the latimc is used by a large family '■ 3 The Commode — Its use is scry common in Europeans and rich families m India, pirticularly at places where there is no adequate water cacctage system It consists essentially of a iiinged wooden seat provided with a big circular hole m its centre under which a removable enamelled iron porcelain or iron receptacle is placed The pad from the commode is removed by the sweeper immediately after use It is taken off by him in a basket to the place of secondary collection Here the con- tents of (he patl arc emptied out mio a large collecting drum The pad is cleaned and refitted to the wooden scat Inmost houses some suitable disinfectant is also supplied to the sweeper for Scrupulous cleaning of the pad r f • 1 S— N gt t EO I or Crawloj Cnrt DISPOSAL or REFUSE 75* From the secondarj' collecting dntm the night.soil is rcmo^'ccT by the conservancy staff by either of the following ways (i) The collecting drum is emptied into a cra^sIey cart, which consists of an iron tank, mounted on wheels and drawn by bullocks. (ft) The collecting drum is removed in a cart and another drum left in Us place. v^4. Earth Closet: — This is an improvement over the pad sy stem to the extent that mechanical arrangements are pro\ ided for depositing a large quantity of earth into the pail after use. The earth acts as a deodcrant, prevents the emittance of foul smell, and well mixed with faeces, ensures complete disintegration in a short tune ,✓5. The Well or Pit laitrine • — A pit or a wclIUke hole 10-20 feet deep is dug m the jfround. Xt ' tlie top of }i a 'masonary platform, having a provision of a scat and a superstructure, is built. In such a privy the septic tank action goes on and the mghtsoil is Uquihed. This system is objecuonable from sanitary point of view as not only foul gases are evolved but there is a risk of pollution of water supply of the surrounding area through soakage, especially after a rise in the level of subsoil water during rainy season. »^^6. Boredhole Latrine : — This is a modification of a well privy. It consists of a circular hole of 14-16 inches m diamercr sunk 18-20 feet deep or under the ground until the surface of subsoil water is reached. The opening of the hole is covered at the top with a con- crete slab of about 2 feet 9 inches in diameter for squatting purposes. It is provided wjih a central slot 51' wide and 12' to 15' long and is fitted with footrests on either side. The whole structure is enclosed with mud or a brick wall about 5 or G feet high for screen- ing purposes. Care should however, betaken that the hole penetrates about 2-3 feet below' the surface left out of suljsoil water, Fig. 19 Boredtiole latrine A— Supergtrue turo B — Squatting ptato C — Ooncreto cylinder D— Bamboo banket E-Water. 76 n3iGrEN*E 420) FOBUC UFALTII ■which helps to dissolve the excreta and m setting up septic nnk action This dilution of excreta with vvntcr is very essential A lining of split up bamboo » put inside the wall of the latrine hole, to prevent the earth from collapsing or falling in That IS why It is essential that the latrine should be sunt in a hard soil These latrines have been much used during anti hooicworm campaigns launched in diifcrcni countries A small quantity of pestnne should be sprinkled or a solution of crude oil 4 parts and kerosene oil one part sprwed into the hole of the latrine once a week to keep xv aj flics Dugwell Latnne — It ts another fonn of a well privy is comnionl> advocated in rural areas for preventing which the spread of hookworm mfeciion It consists of a pu 1_5 fe et deep with a dnmetcrof 3 feet It tsprovded with I inch water seal and a squatting pine of 3j feet diameter It can be flushed with half a gallon of water Septic lank action takes place One latrine is enough for 3 years for a family of 5 persons A super structure made of mud bricks and bamljoo matting is provided for privacy purposes It is better than Ijorcdhole htnne because ^ ni It IS free from fly breeding (2) There is no pollution of subsoil water (3) It does not give out oflenstve gases and smell due to pre sence of waierseal (4) It can be constructed with a spade No speoal imple mentis required as say anaugarforabontl hole htnne (5) It 1 $ cheaper Well or pit bored hole and dugwcll latrines should not be constructed withm 50-100 ft from anv source of water supply When they are filled up to ft from the ground hvel tliiy should be filled with earth and new ones should be constructed These latnnes arc useful for small vdlagcs isolated houses and teagardens They are cheap and if properly constructed last long 8 Trench Latnnes, Shallow Type — These consist ol rows of parallel trenches The trenches arc J feet long, one foot wide md I to 2 feet deep and arc dug at a distance of two feet aw ty from each other Ihcscmay be provided with privacy screens The faeces urine and ablution water fall directly into the trench Ihe trench should be filled up by the excavated ennh after use Trenches arc suitable as a temporar} measure dar/ng hirs m rural area 9 Trench Latrinex, Deep Type — Lach trench should he about 3 ft deep and <• f a suitable length usually 13 ft The sides should be riv cited with sandbags wircnctimg tr bamboo mat img to prevent collapsing A fly proof wooden superstructure DIBl’OSAL OF KEFTJSE 77 with a hinged Jid opening is placed m position o\er the top The seats arc properly screen^ The person using the trench latnne should place one foot on each side of the trench He should squ-tt in such n iva^ that the faeces and unne fall directly into the trench Chemical Closet — This consists of a scat resting on the top of a tank which is filled with a solution of caustic soda and phenol and co\ered with a layer of crude oil The excreta falls into this solution, winch gets disintegrated in soda solution Phenol kills bacteria and the oil acts as a deodcrant When the tanks get filled up, they are emptied and the contents are either taken out and thrmvn or discharged into a dump hole Chemical closets are of two types — Porlable ekemteal closet —It occupies comparatively little space and js th-iefore very suitable for use in motor co- aches, small ships, aircrafts etc It can also be installed in houses where there is no water carriage system It IS m the form of a pail closet where receptacle is placed inside a portable metal container Chemicals in the form of an emulsion arc placed mside the pail which comple- tely co\cr the excreta It subsequently deodenzes, liquifies and sterilizes, rendering the excreta harmless, which IS aftenvards disposed off into the earth through a Simple soakage pit Permanent ekemteal closet —In the case of permanent camps, sports grounds and country houses where there is no water carnage system, permanent chemical closets arc installed It dilTcrs from the portable type that ex- creta instead of collected into a movable pail falls into a tank which is pcrmancntlv installed v» XI Aqua Privy — It is a raimature septic tank consisting of a masonary tank or a watertanfc reservoir of an approximate size3ftx25ft protided with a ft long tube merged into the tank A platform and a scat is provided on the lop The effluent IS allow cd to percolate mto the sod or taken out m a receptacle and used for irrigation purposes Water is to be add- ed every time during and after its use and the ventilation tube IS to be kept open to provide exit for the ’foul gases ^12 Public -Lajaines j— These are meant Jhr jiublic use These may be constructed temporary or permanent as the need be The temporary ones arc generally used m fairs, melas, camps, etc , commonly in dry parts of India The receptacle for mghtsoil IS placed on the ground and the latrines are provided with masonary footrests These require no plinth or roof They have corrugated iron sheet partitions The site should be high and there is no other masonary construction The permanent 7C inOIE-VP ANT) PUIJUC nEVLTJl Uatrmes should ne\cr be located Within a distance of 20 ft from Any dwelUng house, public road Of wrtUm a distance of oO fen /rom any source of svater $uppl> Constnielton —The floor should be cemented or made SMfh any other impervious material so as to be water proof It should be properly sloped bad ward upto an open channel leading to a collecting pit dug at one of the corners of the latrmc In the pit a removable bucket is placed and connected to a delivery ^pipc to catch the surface drainage of the latrine It should be * roofed over to provide shelter from Sun and ram and be pro- vided with p avacy screens These privacy screens should stop short about one foot from the cemented floor all around to nllow free ventilation The roof should be sloped or curved to facilitate the draining of ram water The walls may be cither ofbnckworfcor corrugated iron They should preferabl> be pigeonholed towards the upper half for proper ventilation, or else provided with ventilators The scats should be arranged in a row A flap door IS provided at the back for removal of the bucket by the sweeper The standard t^pe scat of latrine is simply an elcv ated platform of galvanized iron w ith foot rests, a central hole and under the hole a bucket, a pail or a tuna/i is placed It must be lunger than the size of the hole, so as to obviate the possibility of excreta missing the bucket The scat must be kept clean and occasional!) coal tarred to prevent the ammciniacal fermentation from decomposition of the urine Foot rests must be made in the right position and they should not be unduly vvide apart so that the faeces may fall direct into the receptacle below In orderto prevent splaslung, the rcecptaclc should be placed directly below the opening at a dutance of about 2 3 feet although m some cases this distance may be even more In Order that a latrine be kept clean a sweeper must He SO— Publio iatriti«foiirteat«(i(h«]r»e£ttoi> iS;e« al on) DISPOSAL OP nEFTBE ‘79 be constantly present, especially during the time when latrine remains much in use. The duty of the sweeper should be to empty the pail into the collecting drum and after cleaning the pail to Keep it back at its place. There must be dry earth stored near the latrine which should be sprinkled in the pail in order to avoid the excreta adhering it. If pails are not kept clean, they uill emit foul smell due to the decomposition of urine, etc.. Similarly if the surface drainage is not attended to, there will be a constant nuisance from smell and it will provide a breeding place for the flics, but if proper bds arc provided on the drains, these dangers will get considerably minimised. The storage or collecting drums arc either removed in a cart or their contents emptied out into a crawIey cart. It IS said that these latrines arc not much used as the pub- lic has a dislike for them, because they are allowed to remain imcleaned for liours and even days together. Two sweepers arc required to adequately look after the cleanliness of each set of latrines if they are to be kept constantly clean, whereas, if left othenvise, being unclean, they will not be much used by the public Removal of NightsoU The collection of nightsoil is done by manual labour by the sweepers who empty the privy pans into collecting drums provided with lids, which arc carried direct to the place of disposal or their contents transferred into the nightsoil carts at the depots. The pail depots or transfer- stations should be situated at a sufGcicnt distance from human habitation. The collection of nightsoil should be done in the early hours of the morning and if possible, once agam in the afternoon. Urine and washivatcr should also be removed in the nightsoil carts for disposal thereof at a far off place. Disposal of Nightsoil ; — This can be done by any of the following methods in conservancy system : — — ^Trenching : — This is a standard method which is com- pulsorily adopted ju all the cantonments and military stations m India, but this system is not very much resorted to by most of the municipalities probably because it does not brmg any money and a difliculty is experienced by the authorities m pro- curing land near ihc towms, for this particular purpose. Selection of Site /or Trenches -.—‘The ground for the trenches should be selected at a convement distance fiom the town and should not be too ciosc to it. The ground should be at a higher level because the loiv lying land is liable to be encroached upon by floods during rainy season or may become water logged. It should be loamy and alluvial but should not be sandy. It should not be situated in the neighbourhood of a source of watersupply 80 IIYOIEXE ANP PUBLIC HEALTH but should be at least 300 yards away from it. Moreover it should be about 600 >ards astay from ail human habitation. The ground, should be sitUiited on one side of the town away from the prevailing winds and should be separated from the toivn by means of some rapidly growing trees. The approach to the trenching grounds, should be ea5> and accessible, preferably by a coal tarred road. Puparation of Trenching ground The sel ected ar ea is levelled and drained and is then dmded mu> 12 parts, thus earmarking one part for each month of the >ear It should be intersected with properly plahn'ed mCtal roads to be used for the carts. The plot which is once trenched should not be uscd^ain for making trenches for at least lwo_ycars. Emphasis should be la'd on the following points in the man- agement of an ideal trenching ground •— ■“1. 1 here should be an adequate arrangement for the syste- matic drainage of ram water *^2 There should be a provision for one or two roads for the carts to reach right up to the trenches. ^*3. Some source of water supply should be made available in the neighbourhood of the trenching ground to facilitate the washing of caru and buckets y4. The excreta after filling into the trenches should be im* mediately covered with earth to prexent the breeding of {lies. . 5. The carts and other appliances should be cleaned periodically with liquid disinfectants like crude oil 6. Cultivation should not be allowed at least for 3 months after the trenching It is preferable that dhoop grass be culti- vated first. Jiinds of Trenches : — I . Shallow : — These arc dug 2 Jeet wide and 9 iilClics deep. In these trenches a 2 inches thick layer of filth is spread, the bottom of the trenches having been loosened. It is then covered with earth. 2'^ Deep '. — These arc also 2 feet wide out arc from l2 inches to 18 inches in depth. These should be situated 2 feet apart from each other. In these trenches 8 inches thick layer of filth can be spread and then covered with excavated earth. '-■3. Allahabad System of Trenchit^ i — This is really the shal- low trench system and is used in cantonments. Each trench is 16 feet long ond 5 feet broad but it is only 3 inches deep. The base of the trench is dug up and the soil loosened to the depth of 9 inches The filth is then put into the trench and thoroughly mixed up with the loosened earth. Tlic trench is finally filled up with cartli. DISPOSAL 01 KEFU8E 81 Area vj Ground Required — In shallow trenching system 180 y square feet of the area of the ground per day xs required for a fiopulatiort of 1000 This area includes the trenches as xicllas the ground bet\\cen them used for making roads, etc 1 1 acres ofland is required for making such tjrpe of trenches to cope up with requirements of a population of 1000 for full one year In deep trenching system one fourth of the above area is required or about one third area ofland per year per 1000 popu- lation This calculation will permit trenches being left undis- turbed for a year Filling of Trenches — ^These aic laid out m a line and the nightsoil IS poured down into them from the storage pails or Crawley carts by hand labour These are filled up with earth dug out from them so that they appear like elevated mounds and prevent pits being formed when the earth settles dovm subse- quently Cullipoliou of the Trenchinggrounds — Three months after the filling up of the trenches, the ground should be ploughed and Sown with any suitable crop Practically any crop will grow but the general rule adopted is, that the vegetables usually eaten tmcooked should not be grown In the Punjab, tobacco, sugai cane, lucemgrass, etc , are usually sown The objection to growing vegetables is based upon the assumption that they may pick up infection from the soil It has also been stated that the eggs of intestinal parasites, i e , worms may be earned by vegetables grown in the trenching grounds In verv dry climate, the trenching ground should be irrigated to prevent soil becom- ing dry and hard Moreover, deep trenches should always be employed, otherwise the Wind may blow away the surface and expose the trenches to flybreeding This is the mam objection put to fhc Allahabad system of trenching The ordinary house fly, quickly lay-s its eggs on human excreta and if the trench happens to be superficial, then the hatching larvae will have no difTicuUy m devdopmg into adults wnich would be congenitally infected with pathogenic germs, le , typhoid etc , and may retain the germs for some lime in their bodies Shallow trenching is preferable because deep trenching requires very deep ploughing to yield minunal value of filth In \ ery w ct countries, it is not possible to carrv out trenching system dunng the rainy season In such cases, the only plan to o\ ercome this difficulty is to have large elevated cesspits built on the trenching ground, where filth can be stored until the rainy season IS over and then it can be disposed off subsequently by trenching m the usual way Object of Trenching — Soil is a great bacteriological laboratory and the bacteria present m the soil very rapidly break up the 82 mOlENE AND nJBUC HEALTH organic constituents of the mgliisoil into simple non- putrcfiable compounds which arc used up by the plants in thr process of metabolism Various gases arc given off m this process but these arc absorbed by the pores of the earth and so once the filth has been buried underground, it gets satisfactonly and economically disposed off without causing any nuisance owang to Its foul smell Expcnmcnls reveal that the soil bacteria or the nitnf>ing organisms which are most active m breaking up the filth and converting the organic nitrogen in the excreta into nitrates are contained m the superficial layers of the soil and this IS the greatest requirement of shallow trenching system because the process is quick The deeper the trenches the slotver is the process In the case of deep pits, the filth may remain unaltered for years together, because the deep layer of earth contains very few bacteria In addition the bacteria of the soil very quickly ktU all pathogenic geims present in faeces and the unne Dangers ofTrenthing —These a c — (i) Pollution of the ground water and wells (it) If trenches arc not sulEcienily deep, eggs of flics, which have been laid on the faeces may develop (til) Superfiaal trenching of human excreta may lead to the exposure of nightsoil, m consequence of earth gettmg dried and blown away (w) If not properly supervised, It may give nse to the nui- sance of obnoxious smell , II Taciaeratioa of oughtsoil —If properly carried out m a well designed furnace it ivill be found to be sanitary and the danger of polluting water supply or the air through its smoke vapours will be reduced to the miiumum The incineration of nightsoil may or may not be combined widr the incineration of streetrefuse Where strcctrefuse contains a large proportion of dry grass, straw, rags, paper scrapings, etc , these may serve as fuel Tlie incinerator should be installed near the latnnes or near tlie paildepot Tbc sweeper should be present there constantly The night soil sliould always be placed on tlie fire in small quantities at a tinie A shed for the collection of dry fuel should be constructed near tlic uicmcralor The incinerator IS set going by placing a small quantity of little dry refuse and setung It on lire When ihc combustion has proceeded for somelime then the contents of latrine pans etc , are poured over the smouldering material For the efficient working of the m cincrator, the chimney should be large and sufiicicntly high Moreover, the number of Bir mleis must be adequate to ensure good draught It u preferable to render the smoke inodorous cither by providing a bafUc plate or by placing a horizontal, grid DISPOSAL OP REFCSE 83 below the entry of flue. On the whole this method requires supervision and is costly. y in. Compost or “Mamire” Makizig :-~Composting is tlie process of biological fermentation and decomposition by which bulky organic refuse (may be animal or vegetable in origin) is changed into manure through the agency of living organisms such as bacteria, protozoa, actmomycetes, fungi etc. The townwaste consists of nightsoU and urine, kitchen waste, sullage and sludge, while in the rural areas it mainly consists of cowdung, urine, cropwastc and houscwastc. The essential requirements of proper composting arc : — k/\. Suitahiecatbon-nitrogenratio30 • 1. The dry refuse ob- tained from the tosvn and household sweepings is usually deflcient in nitrogen, while nightsoil and cowdung arc rich in it. For pro- per composting, a suitable admixture of the two viz., the dry re- fuse and nightsoil or cowdung will be desirable. An admixture of about equal weights of the refuse and nightsoil would give the desirable carbon-nitrogen ratio of 30 : 1. If the proportion of night, soil is less, the decomposition will be slow. But when it is more than the actual requirements then there is a danger of loss of nitrogen taking place. Presence of a suitable amount of moisture is essential for its proper decomposition. The quantity of water should be as much as can be retained by the material. If the amount of moisture is deficient the rate of decomposition would be slow, but if tliere happens to be an excess of moisture, there would be danger of water logging ivith consequent loss of nitrogen. Aeration of the mghtsoil m initial stages is beneficial but excessive aeration promotes rapid decomposition, resulting in unnecessary loss of the material and its nutrients. For pro- per decomposition, the mass should be neither too compact nor logse. Procedure The following procedure is recommended for the preparation of compost manure m different cases ground : — It should be situated at a distance of about 2 to 4 furlongs away from the nearest habitation. To avoid obnoxi- ous smell coming into the town, it should not be located on the windward side. Trenches : — The size of trenches should be adjusted atxording to the amount of refuse likely to be available daily so that one or more trenches arc completely filled up on any day. The breadth of trench should be 6 to 8 feet, so tliat an average size cart or truck could be emptied into the trench conveniently. Tlie dcplli of the trenches should be about 3 feet. Given the breadth and the depth, the length of the trenches should be 84 maiENE AND PDOUO IILALTlt adjusted to suit the amount of material likely to be a%~tihble Trenches arc arranged in iws, so that longer sides ate parallel and shorter ends arc in the same line There is an inier- lenmg space of 4 /o R feet oclwcen one trcncli and the other A Suinhic earth “buntP should be protidcd on all sides of the trenches to prexenl ram w'alcr from flonmg in ^ (c) AUtfiods af WnLmg — (t) For Places Where Refuse and Tkighlsoil are Collected in a Mixed State — The material containing proper proportion of refuse and niglitsoil (i e equal w eight of each) should lie dumped directly into tlie trench \Vlulc the cart IS being emptied into the trench two men should be deputed (one on each side) for raking up and spreading the material evcnlj in the trench mth long handled nkes After tlic material is propcrlt raked and spread over, a sufficient amount of water is added to moisten the matcral The addition of uaier should be done before another cartload IS emptied into the trench This procedure is carried on till the trench is filled up to 6-9 inches abosc the ground level, then a thin covering of earth or old manure, varying from I to 2 inches thick should be cvcnlj spread o\cr tlie material (ii) For Places Where Nxghtsoil and Refuse ere Collected Stparaielj —In this case at first a la^er of 9 inches thick dry refuse (free from brickbats and other ineit matcrnl) i» spread over bottom of the trench Then a layer of 2-3 inches emulsion of night soil is spread over it by means of long handled "pkandas" This is follovvcd by another layer of dry refuse and alternate layering repeated with night soiV and dry refuse Mtt the ttench is filled up to 0-12 nu^cs abov e the ground level The top layer in alt cases being the dry refuse which is covered over with 1-2 inches thick layer of dry earth This top-most layer of earth will prevent loss of moisture, breeding of flics and smdl nuisance If the earth covering IS more than 2 indies thick, it is likely to hinder the proper aeration of the mass After a period of about 2-4 weeks the material m Uic trenches would stulc down by 6-8 inches In this case vf need be, some more fresh material can be put on the top and again cov cred w iih a thin lay cr of earth (d) Aftercare — During the hot weather there is a danger of the ucnclvcd material getting dry and ihcccfocc some vratcr should be evenly sprinkled over the filled trenches from time to time The compost should oe ready for use vnlhin four to SIX months depending upon the type of material used and the prevailing season. DISPOSAL OF REFUSE 85 (^) Sanitary and Economic Aspects of Composting If the system of composting is adopted as a routine method for disposal of habitation wastes, not only a large quantity of good quality manure is made available for cultivators but the sanitation of the towns also gets improved considerably. The smell and fly nuisance is also greatly reduced. During the process of composting considerable heat (60“— 70®C) is produced in the mass and this destroys most of pathogenic organisms, fly larvae, wecdsceds and other obnoxious constituents and thus renders the resultant material practically inocuous. In most cases the income from the sale of refuse after composting is much more titan it is from the sale of the ^a^v refuse. Compost in Bunglaws tl'here Land is Available i e., on a Small Seale : — Select a piece of land in the farthest comer of the compound and dig a trench 10-15 feet long 2-3 feet wide with a depth of 3 feet on one side and 3| feet on the other aide. Get a small uooden plank or an iron sheet partition made for the purpose of demarcating a portion of the trench and fixing it at a distance of about 2 feet from the shallower end. Put dry refuse in the demarcated portion upto a depth of 9-12 Inches and instruct the sweeper to deposit a day’s output of night soil on this layer of refuse wastes. Cover the mgiitsoil layer immediately with another 942 inches thick layer of raw refuse wastes and sprinkle about ^ to ^ inch thick layer of dry earth, ft would be advantageous if a dusting of some common insecticide like gammexane is given before adding the cartli. The above procedure should be daily repeated, but on the second day the sweeper should first spread over the mghisoil on the first day’s deposit and then cover it over with the raw refuse svastes together with the insecticide and earth dust. This procedure should be repeated daily till the demarcated portion IS filled upto a level of about IJ feet above the ground level, when a dusting of inscctidde be given again and the top covered with 2-3 inches thick layer of caith. After the demarcated portion is filled up as described above, the partition should be shifted to demarcate the next 1-2 feet portion of the (rencfi and a similar procedure repeated till the whole trcncli is filled up and sealed as described above. After first trench is filled up, another trencli of the same dimensions is dug parallel to the first one. The time taken in filling up the trend: would vary according to the number of the family members, and their liabits. Normally a trench 15 feet long, 2 to 3 feet wide and 3 feet deep should be enough fv*ouId be ready in the first trench. Different modified processes of trenching have been tried at various places by different persons, nicy arc as folloivs : — 1- Bangalore Method. 2. Indore Method. 3. Calcutta ToUygunge Method. 4. HoivTah Method. 1. Bangalore Melkei : — It is advocated by all-India Institute of Hygiene, This is also called the hot fermentation process. In this method the length of the trench is divided into compart- ments each of wludv would roughly lake one day’s supply ofniglu- soil and refuse. About l,000cubic feet of trench space would be sufficient for every 10,000 of population and about 1500 to 2000 tons per year of compost will be produced. 2. Jniore Method : — In this process allemate layers of refuse and Tughtsoil, three inches deep each, are placed in shallow brick bned pits to a deptli of two feci six inches, If necessary these layers arc sbghily moistened during the filling process. The d^Msited material is turned to and fro by a wooden rake at intervals of 14 dajs. At the end of two montlis the mass ts temoved from the pit and stocked in reciangular heaps 10 feet broad at the base, 9 feet at the top and S feet 6 inches high and allowed to ripen for a month, after which it ripens and becomes rc.ady for manurmg the fields 3. Calcutta ToUjgunge Method A pit approximately 4S feet by 27 fect is constructed at the municipal trenclung ground area by excavating 15 inches of the soil and piling the cut earth on the untouciied side, so that the finished depth is 2 feet 3 inches. A 3 inches brick lining is laid in and Uie edges protected by a brick curb Division walls are constnicted to make 5 compartments of 400 cubic fect capacity. Besides, aeration and drainage channels are provided m the floor and die area around tlie pit protected with bnck soling. In one of the compartments, a 6 mciies thick layer of fresh rubbish is laid down and covered with a layer of nighisoil, which is again covered with a layer of refuse from the platform and the whole is lightly mixed, till all the nightsovl is taken up A six indies thick layer of rubbisli is again deposited and the process is repeated till the pit gets filled up The filling of one compartment should be completed witlun two days. Within 5 days from the start, the pit contents must be turned to and fro by means of a long rake to ensure complcic mixing. It should be turned over a second time after a furilicr period of ten days Subsequently two weeks later it c-m be remo- ved and stocked and the whole process thus taking about one month. The heaps arc left in the open to ripen bll required and DISPOSAL 01 REFUSE 87 are ready for use at any time, after they are allowed to ripen for another one month Disadvantages of the conservancy system — ^These arc as follows — 1 The nightsoil remains in privies and latrines for a Jong tune and putrefaction starts before removal This gives rise to nuisance due to smell, atmospheric and soilpollution 2 Nightsoii carts emit foul smell when wheeled on the roads, so m some places they arc moved on the roads at night 3 Latrines at different places cause inconvenience 4 Conversion of unstable inorganic compounds of excreta mfo stable organic matters requires anaerobic conditions and an open place 5 Insamtary conditions prevail due to employment of human agency for the removal of excremental matter 6 It IS not economical from financial point of view as it is very slow and involves dependency on labour at various stages as compared to the automatic functiomng of water carnage system 7 The wear and tear of the nightsoil carts, pads and other appliances is very great 8 This system is manifested with the dangersYof conta- mination of air and >»ater and spread of infecuon through^flies etc 5 Hats may breed in the open privies where in addition to excreta there is generally an abundance of general house hold refuse. CHAPTFR IV WATER CARRIAGE SYSTEM In ihc majority of tar^c toxrtu m England ind m the highly advanced tQ\%'n3 m India, human cv3tcr. Paris oj a Walerclosel It consists of the following ; — 1. Closet proper with the basin and a trap. 2. Flushing Apparatus Varieties of WalercioseU : They are : — '^1. Pan Closet : — It consists of (u) a basm, shaped like an inverted cone, "(S) a pan which guards the outlet of the basin and is opened or closed by a lever mechanism which is also connected with the Hush. The pan when closed always contains some water, (f) A container or a receiver m which the pan opens and throws the contents into (d) the trap, underneath the floor with which the container is connected. It is not considered as a good closet Iiccausc (i) Its mcclvanism is not simple and may go out of order. {ill When the pan opens, it solashcs the excreta all around into the interior of the container and on the under surface of the pan. The excreta, sticks, decomposes and gives rise to oflensive odours which enter the room when the pan is opened. (lit) It requires a large quantity of water for cleansing pur- poses and even then it is not sufBciently cleansed. Its use is not advocated on account of Us drawbacks. In fact, its use is prohi- bited in some places by enforcing model hy»!aws. 2. Valve Closet j — It Is similar to pancloset but instead ot the pan, there if a movable valve lixecl to a metal Ixrx by means of a hinge which opens out on raising the handle. Its lowest part is connected with a siphon trap leading to the soilpipe, immediately after each visit, the closet should be Hushed ivilh plenty of water. Arrangements should also be made for an afler- Ilush for the supply of water into basin after the handle is released. The advantages claimed in this form of closet are — (o) It is noiseless, (ft) All excreta falls in water, therefore closet remains always clean, (e) When thcvalve is opened, the water and excreta form a very powerful preliminary flush, thus keeping it cfcan. Disadvantages arc : — (i) It produces splashing, (ti) On account of dislocation there may be leaking of the valve, which at once destroys the utility of the closet, as the faeces fall intlictalvc, which being rough cannot be cleaned adequately. In consequence of tbc leakage of water, there is no watcrscal, whiclt leads to the emission of foul smell from the chamber below the \alve. 90 HXOIENE AKD PUBLIC KEALT!! 3. long Ihppsr Oout It consisti of a long inverted ttoncwarc cone, connected below vrith a trap ^vhich retains aulH- oent quantity of AVaier Being % ^ long, about 16’, the solid excreta » M~* adfaerea to the sides nhich are % Basin m apt to become fouled to a great ^ m extent and therefore a great force ^ m of water is required to flush it % jj vrcli It IS dtffi'uU to flush it 1. t properly because the force of H ■ water is broken and water whirls B Mg % round and round l_ I The pan, the valve and the I I long hopper closets are no doubt I | cheap, but being unhygienic and c-.. , * their worxmg imsatisfactory their '' " use has now been discarded Pi^ Sl—LongUopperClosei 4 ii^atAoul Cloul —It is coos> trueted of a stoneivare basin so shap* ed that a small quantity of water re- mains in it to receive the excreta which IS flushed out over the edge of the batui into a trap below As the excreta has to be flushed over to this edge, a powerful flush is required for its deansing This form of closet is not without defects for fcrnl matters oHen stick on the edge of the basin and the water contained therein is not alwap enough to cover tliexn 5 Sipkome or the Jenn- tng'j CentuTj/ Qesel • — It re- sembles washdovm closet, with the difTcrence that the ascendmg arm of tlie siphon trap IS continued ujiwards so that the water m the basin stands at a comparatively higher let cl and a deeper seal is formed The descending ann terminates into a second siphon before it wins the soil pipe. When the closet is used siphon action is started "by the jidiow of tratcr both through the siphon pipe and WATFR CARRIAGE SYSTEM 91 the main pipe, the former dischargings water into descending arm of the siphon and the latter into the flushing nm to the basin This form of closet is comparatively clean though ex- pensive It IS better in the sense that it works ivith a very sliort pull of chain 6 Wash-down or (he Short Hopper Closet —It is most com monly used nowadays and m fact this type of closet has eliminated all other types as it fulfils alt tlie requirements of an ideal closet It consists of a short inverted cone. With almost vertical back, whicli dips into the water contained in the trap for about two inches to form the waterseal , excreta falls directly in 54— Waab down Closet the water of the trap and gets cleaned by a flush It has flush- ing rim by which tfic sides are kept clean 7, Modijxed Indian tjpe of Chset In India, majority of the people are tn the habit of squatting at the tune of de/accation, therefore the basin or the pan is provided with two footrests, one ■92 jnClEN> AND IDBMC lIE-XrTIZ flush \Mth the floor of the dMei companmcM The floor nnd the foot rests arc made of ‘hard smooth impcr\ious material such as tiles 01 cement S Trough Closet It consists of i Jong metal, masonary or earthcnu'arc trough placed on an inclined plane under the seats of the closet placed side by side for the reception of ex •creta The trough retains a ctitam amount of ^^ater by means ■of a tmr at its lower end and the excreti arc expelled by a volume of water and earned vway tluougK a tnp placed atthc r«js T«asU Closet end of trough There can be aflected an improvement in trough closet, b> protiding separate partitions and pans attached to a common discharge pipe Jts advantages arc — (i) A 8 nglc appiratus can serve for the use of several per* sons at one ard the same time (ii) It IS cheaper and nrely goes out of order (in) Economy m the amount of waier required for flushing This foiin of closet IS particulirb suitable for schools, hos pnals or jails Bui it has the drawback that even with the utmost care it is not possible to maintain such a standard of cleanliness as can be secured s>hcrc separate basins art used Dtdet — In India most of the peonle use wTiter instead of paper for cleansing purposes and this ihluiion water spoils the scat and foot rests To obviate this an appliance liiQwn as has been introduced for washing the anal region and pen ncum It IS provided with flushing and circulating rim, nn open stream outflow and a plug outlet It is generally connected to the waste pipe and not directly to soil pipe or dram Stpation of the W'learctosrl —It should be situated near the •outer wall of the house The floor should be made up of white tiles which should he earned ttraund the wall also uplo a height of 3 feet (dic dadow) Tlie closet should be mounted bare, WATER CARRL4G1: SYSTEM 9 ? without any wooden structure and supply pipe should be kept free on the wall and painted white. There must be provided a window opening directl) into the open air. The rest of the %s*all should be distempered with a waterproof paint. The room, should contain nothing else except the svatcrclosct. The practice of putting a bath tub in the same room is now being stopped The water closet is connected to the soiIpi;^e by a S shaped bend called the trap. 2. Flushing Apparatus : — Water for flushing the water closet is provided by means of separate flushing cisterns which are limited in their capacity (tU. 2 gallons). The sv'ater closet is constructed to work with that amount and the cistern is placed above the closet at a height of not less than four feet and is connected directly to the closet at the flushing nm Tlxc cistern is connected to the house svatcrsupply and is controlled by a ball %’alve. Thp cistern delivers us water by siphon action and is set in motion by pulling a chain and let going it. The flush- ing rim must go all around the closet, and for the satisfactory operation of the flush system it must be distributed over the entire surface of the closet. B. — Soilpxpe : — It is .n circular pipe carrying the contents of the water closet to the house drain. It is made of cast iron or milled lead. It has an internal diameter of about 4 inches. It is carried clear of the window 6 to 8 ft, above the roof for escape of foul gases. Its end may be covered with wire gauze dome. To prevent oxidation or rusting, iron soilpipes arc coated either with a paint containing magnetic oxide of iron called BarfT's process or may be dipped in Angus Smith’s Varnish, which is composed of pitch, asphalt and tallow. Lead pipes can be more conveniently and expeditiously erected. These pipes should preferably be fixed on the shady side of the house so that the 94 HIGIEN’E AND FUBUO HEALTH joints may not be damaged m the heat of the sun The soil pipe should be placed against the outer nail of house so that it miy be easily inspected and extended beyond the loof To allow a free circulatioa of at” and the escape of foul gases generated, the loose end of the pipe should open over a disconnecting trap outside the house More- over lU upper end should he carried on to at least 5 ft above the roof of the house It has been found through etpericnce that the sotlpipe should open directly into the bouscdrain without an intervention of a trap, as it imposes a useless barrier to the sewage and prevents the soil pipe acting as a drain ventilator Antuiphonage Pipe . — \Vhcn the soil pipe happens to be common for the various closets constructed for the dificrcht storeys of a muUistoreycd building and are placed one above the other there is always a risk of the water being sucked in or siphoned from the traps of lower closets at the time when the tip^r ones are Hushed This siphonic action can be pretented by carrymga ventilating pipe, called anti siphonage p»pe, from beyond the trap of every closet, tlirough the house wall and is connected Vvtth a vertical pipe 2 mchccs to 2i inches in diameter placed along the Side of the soilpipe, after it has received the aniisiphonagc pipe from the highest water closet. C — Honscdraln — It is an underground pipe, connecting the soilpipcs mill the sewer It also receives waste water from the house or the compound and the ram water The mam house dram is made up of glazed stoneware or earthenware socketted pipes, 2 ft in length, or when placed under the road it is made from socketted castiron pipes coated inside with a paint containing magnetic oxide of iron (Hirff’s process^ Stoneware pipes aic connected with cement and cast iron pipes arc caulked with nioltenlead It is laid on a bed of concrete m a straight course, With the socket end looking towards the house and the spigot end towards the fewer It should be iaidvMtIiout any mgles or bends on a smooth inclined plane to facilitate easy transit of its contents Its interior should be pet^ WATER OARBIAOE SYSTESI 95 fectly smooth to prevent accumulation of filth. Housewast^ kitchen and rain tvater pipes drain in the bouse drain at an acute angle and never at right angles. The joints should be made both air and ^vatcr proof;' Moreover, these pipe connection* should be made in the direction of flow of the contents of the •pipe. A four inches drain should have a fall of 1 in 40 and a. six inches drain a fall oflinGO. «'lt should also be pro\ndcd vnth inspection openings of manholcchambcrs at convenient in- tervals. It should be noted that a small drain is more liable to selfcleansing than a large one but care should he taken that it is wide enough to prevent blocking and to carry oil all the sewage of the house as well as rain water. ’ l-'Thc house drain should not be allowed to pass through rar under a house. Tliere should be a proper arrangement for flushing the bouse drain. The icquircment of a good house drain arc : — (a) Perfectly fitting joints to eliminate the danger of leakage of any sewage or foul gases. (b) The provision of a proper flushing arrangement. (c) A fall to provide velocity to the current. ((Q The pipes should have smooth internal surface. («) The pipes should have Y joints i.c., they should fonaaa . acute angle and not right angle. (/) It should be easily accessible. ^..0.-*lsspectloa Cfltatnber or Disconaectiisg Chamber or hfosthole : — It is a square shaped, brick built and cement Hiari Nil. A\l> IITDLTO Ufc,\LTlI OG lined underground chamber Tlie mam housedram is continued along the floor of the chamber in a half channelled glazed pipc> iihich discharges nsclf mio an intercepting trap The branch drams and the subsidiary drains arc also made of glazed cJianncllcd pipes and arc connected to the mam channel The chamber IS closed bj an iron lid and from ns iidc a \cntilating shaft proiidcd with a mica flap. Jets the air in bill not out At the distal end of the chamber, an inlcrcepimg trap is proiidcd which lias on it in inspection irm which is closed bj a Iid The object being to permit roddmg of the short length, of pipe leading from the trap to the sewer This intercepting trap prevents reflux of foul gases from the sewer and the cmrmcc of sewer rats mlo house drains, but iUov.5 a free circuhtKii of ur through the dram and soilpipe The house dram must be adetjuaicly \ cnldalcd at irtterv als by pros idmg an air shaft passing upto gratings at the surface of the ground or these ma) be carried awa> to the side of the house to prevent nuisance Arrangement for the mitts anti outlets should be made to ensure free circuhvon of fresh air E —Traps —A trap « l> t„p consists of a pipe, bent upon Itself m such a way so as to retain certain amount of water m the bend It prevents the reflux of sewer air or ^ gas into thc^ liousc and '•••«&>' t— acts as a barrier and is elTcciid b) watcrscal Jig 30— S&rTr«p» Qualities of a Good Trap — Itsliould be constructed of strong, smooin and non absarbciit material It sliould be provided with a liasc so that u mav be firmly fixed up to l rcveiii u from getting out of position It should not corrode. It slouldbcfice from all angles and comers so as not to allow rcadit> the accu mulation of flUh It should lie sclfclcansing It should liavc a watcrscal 1 1* to 2* and the body of the trap should br smaller in section than inlet and outlet It should not be liable to silt and should haie an opening for cleaning etc A trap IS apt t< be unsealed and may fail to perform its func tions due to followit g icasOns — J Lvaporaiton of the ttaler seal — If a trap is little used or the home Tcmams \acam and tlie use of the trap IS discontinued for sometime It may be also due to the bend being too shallow ? By mtmentim for fiashih^ italtr being maintained to tlic vcrticaUinc, in difrcrcni storeys of a multistorcjed builduig and iC the closet in the upper storey is flushed, then water of the WATKil CARBIIOE system 97 traps in thecJoseis fiUcd in lower storeys will get aspirated. This is prevented by the provision of anttstphonage pipe. - 3, '"By momtntum. of Jbishing Witer being maintained to the very end of Hushing, due to sudden and violent discharge of water. 4. -By bsckwsfd passage of gases when the dram is not adequately ventilated. 5. By capillary action caused by foreign substances like pieces of cotton, thread, jute, etc. which may be caught in the trap and act as siphon. The remedy is adequate flushing. 6, yTraps may also be rendered useless on account of getting blocked with deposit of solid matter due to imperfect setting or insufficient fall mthc house drain vVariettes of Traps — These are as follows ; — 1. '•''Siphon Trap ; — It is simply a bent tube placed under the basins of each water closet. It is of the P or S type trap accord- ing to the outward or downward direction of the outlet, It is the best type of trap as it maintains siphonic action and keeps a constant level of water. In this case water collects at the lower bend ofS and the water seal should be lJ'to2* deep,-' Aati D type of trap is generally condemned as it is not selfclcansmg. 2. './Gully Trap This is interposed between QuHy trap rainwater and wastewater pipes and the underground house drains in court yards. It is made up of iron or glazed earthen-ware. It is fitted at a distance of about 18 inches from the Wall of the house and is intended to arrest the solid suspended matter in its downward passage and allows the rain or muddy water to flow into the drain. It is required to be cleaned Tir. 31 periodically. V The most convenient is Dean’s Ouiiytrap Gully trap which contains a removable bucket or a trpe for collecting solid materials, which may be removed periodically The Bell trap is not a good type because in this case the water seal is easily broken, bimilarly the use of midfeather trap has been discarded on account of its tmperfeci functioning. 3. ■yCrease Trap : — It is fitted to the kitchen sink to prevent the choking of drams, due to collecting and congealing therein of grease. The trap is made up of earthenware or iron and contains a large volume of svater which allows the grease contained in it to float to the surface and solidify and thus .arrests its inward flow, and allowing the dirty tvatcr to flow away from its under surface, y Testing of Drainage System: — Testing of drainage system is always necessary. Tnesc are frequently tested after laying new 08 incrtNE WD lUBur iieaitii house drams and pcnodicallv m the case of all old ones The tests whicJj arc coniraonl) used irc — 1 ]\ aler Test or HjrdrosUHu Test — This is rsjicciali) used m new drainage works or when ihcj arc still being constructed To carr\ it out plug the lov\cr end of the svastc or sod pipe with a suitable wai«r light plug and then (ill it gridiiall> with water Tlu n iC thr lc\cl of tl c water fills or if the drain does not fill at. all. It indicates a dcfcri ii some jioini ard the point should bccaieliillj ixinuned But if the water level reniams stationary I ir an hour or two the drain* under observation are sound and w ucrtight 2 Chemital or S tnl fnt — Pour out a small quaniiiv of s me volatile oil like that of peppermint oil in fl bucket of hot waici and divclurge it tliiough a watcrclostt or clfAvn the pipe fioin tl e highest available point If on examination a peculiar smell of pepptimint IS perceived ihis will indicate the situation of the defect This test is lowcvcr not very reliable Tlic opeiator must be careful not to soil hit clothes with the oil odwrwuc he will carry die tmcll with him all over the house Another method is to use glass capsules containing Calcium phosphide or Phosphorus and Asafoctida Dense white fumes are produced when it comes m contact with water and «irc dcticted when they emerge out through t derectivc ;oin ora crack m the dram 3 Smoke T runuc HEVLTH covers having a traj or a dirt bo^ below a to catch dirt and stones Oc , with the idea that the air uhich escapes through these would be rapidlj diluted b> fresh air and rendered niofh-n$i\c Thc^ ate tnstaUed at a distance of IQO ^ards Some of them act as mitts and the others ns outlets' Disndvartogts of sej.ets are ns follows — (i) Sewers might cause cfllmia to enter into houses But howitcr, if they are properly constructed, Hushed, trapped and Ncmilntcd, this mny be prevented ( 11 ^ i^iy leakage may contaimnatc water supply A sewer may begin leaking on account of various reasons ci; from sinking of foundation ericlcdor faulty jouits of pipes or by penetration of roots of trees through crncks etc {kO Accidents m sewers — Workmen who enter parts of a sewerage system for cleansing them, sometimes die being asphyxiated by poisonous gases from the sewers Prtmilions io 6e taken btfan cfeaniine fht saicrs —These arc — ^i'^ Six of the manholes along with the whole length of llic sewer should be uncovered at least 2 hours belbrc any one enters therein/ (it) Test the atmosphere of the sewer ijy Icumg m a lighted I’lnp and sec that it bums bnghtly*^ The workers in sewer should not be allowed to remain fur more than half an hour at a time ni the sewer (w) If a worker m the sewer, gets ill or becomes unconscious, he should be at once taken out and |,i\ cn artificial respiration and medical aid to restore him (jj) At least two Of more workmen should enter tJie sewer at a time They should be fastened by a stout rojic They should work under the supervision of the chief sanitary tnsp'cior {it) Ihe worJ should be earned out bciw ten sunnsc and sunset and never during the night ^ Pnenmatic System of Sevrage Removal —In this system two sets of pipes ire used nz , pi[»c3 with smaller diameter for the removal of waste water and the piprs with larger diameter (5 inches) for the rtraovil of sewage In low lying areas where removal of sewage by gravitation scheme cannot be cflincnvly rarned out, for want of proper gradient, some other methanical meat 5 ire to be adopted In such cases periodical jiumpins to raise the sewage to a higher lead should b- resorted to lorihis purpose an aulomauc iippiraius such as Shone s Tjectof IS uollutcd. -- > In India ihcriveis arc much larger, but even here the discharge of crude sewage should he prohibited. Such a discharge is liable to proa c much more injurious, if the discharge of the sewage is alloivcd to take jilace at a jioinl up the stream so that the people living belowr are constrained to use the polluted water.'' ' Before discharging the sewage into the sea oi a river it should- be ascertained whether the diluton* will be sufiicient or not. Comparatively less dilution is required in llic case of a rapidly flowing river than in the case ol a stagnant river. The volume of water should be enough to permit, aerobic bacterial action which will effect the complete break down of the organic ' 1 04 iiYoir\E A\D ruBuc nr \i tu imtfrr ind il the Same time i\ill not kill fish The current must be sufficient f» pre\ ent silting tip of the sirc-im and there should not be -any possibility of the floating mileri-ils getting deposited on the shore (B) Sewage Disposal by Purification — The difTcrent methods of sets jgc punficalion may be described ns follows — 1 Direct land trcawrent fa) Intemmtcnt doniivsrd filtration (i) Broad irrigation or seii'agc farming 2 Chemical treittncnt of sewage 1 Biologic.lI treatment (a) Septic laiui (b) Actuated shidge process 1 Disposal by Direct I.and Treatment —It can be done intvs’ow‘a>s — (e) Intermittent Downward Filtration Method —By this TOCtlvoel tev.age k yiurtfied by the action of tod which acts at a mechanical filter and for tins purpose a porous sod should be leldcted Sand clay and peat -ire unsatisfactory and chalk « dangerous for tins purpose The purification is chiefly elTccted by the sodbactena or the nitrify mg organi'ms which exist in large numbers in the superficul layers of ail -*o«ls especially in land rich m oTgaTticTnnttrr, aided by those contained m the sewage T1 esc bacteria require air and oxygen for their deve lopment and on account of ^ceding of the organic substances of die sewage, €•»«€ their oxidation Here the earth is made to act m much the some way as a sjndrdier is used for watcrpurification The growing of crops if practised at all, should be a matter of secondary importance For successful filiration the land should be prepared in a fashion ofbeds The bottom of the beJ should be properly drained by means of porous cardicRw arc drams laid at a dcptli of 6 feet and about 10 feet apan from each oilier The surface of the land should be levelled and must have a proper slope to allow the equal distribution of sewage over the whole area The sewage should be distribiitrd through surface chvrjicls The land should be divided into 4 sections so that each section may receive the sewage for 6 hours and liAvc an interval fir aeration for about IB hours 1 he surface of e icli section should be laid out in ridges and furrovs and cultivation may be earned on the ridges while sewage is pcimitied to flow down tlie furrows Ihceffluem which cwmes out of die subsoil drain, is I ure and docs not putrefy and can be discharged into any river or stream The method u s mpic and worji efficiently where DISPOSAI. OF SFW’ACK 105 -plenty of suitable porous soil >s available. One acre of land is sufficient for treating the sewage of about 3000 persons. - ..(b) Broad Irrigation or Sewage Farnaing . — A consider- ably large plot of land is required for this system and it is generally adopted where a suitable land is available near rhe neighbour- hood of a town The soil should be porous and the land selected low enough to allow the sewage to flow by gravitation.' The untreated sewage is used to imgato a given area of land on. which crops, etc., are grown and the ordinary procewes of agriculture are carried out. If proper extent of land is not available and the land be overdosed with sewage, it becomes “Sewage Sick” and will not grow ony crop at all. *"80 a consider- ably large area of land is required for efficient manipulation of (his system. The grovdng ot crops is the main consideration. V The land should be used for growing fodder for horses and cattle and other crops rather than the production of vegetables. The sewage should be discharged on the land in a fre^ condition and the coarse portions should be removed by pred- pilatjon or sedimentation. Irrigation of sewage should not be continuous but must be tmermUtem, so that the aeration of the soil can take place during the period of intermission. The land IS laid out in the ridge and the furrow S)stemandthe sewage flows down the centre of the ridge tosvards the furrow.* One acre of land IS required for about JOO persons in temperate climates. In Amritsar, the sewage is run to the direction of the land belonging to ccnaui aemmdars, justlikc a water course, who use It as an ordinary canal water. Thi? is a source of revenue to the municipality In*this system, however, there is this drawback that during the ramy season it is difficult to take care of sewage and prevent water-logging. '2. Chemioal TreatxD«Bt of Sewage This is effected by the addition of certain chemical agents such as lime, alum, aluraino ferric, mixture of lime and alum, etc. These chemicals act as preclpilants and carry down suspended matter with some dissolved organic impurities of the sewage. . Crude sewage is at first collected in large tanks made of • cement called settling tanks, the solid matter gras’itatcs leaving a comparatively clear fluid at the top. This fluid is then treated wiih certain chemical agents which act as predpiiants. The sludge or the precipitate, is then pressed into cakes and sold as manure. The clear, supernatant fluid, at the top is called effluent- This may either be discharged into a stream or a river -or carried along drains into land for the purpose of irrigation. The disadvantages of this method are numerous. The sludge is very bulky and lias very little manuring value. Thexllluent 106 n\GII.\E ANTS PUBLIC IIFILTIC IS not safe as it is not free frtwn pathogenic organisms So this mclhoti IS not much idoptctl nov% The chemicals conimonly lued for this purpose arc — (i) Lxme — 12-I6 grams of lime arc added to each gallon of sevvage It combines null carbonic acid of the sewage forming an insoluble carlionatc of c&lcnim and also 'Mth some of the sewage, the precipitate falls to the bottom forming sludge 7 his method IS cheap and simple The disadvantages arc that the effluent is rendered more alkaline and more put- rcsciblc and the sludge is bully and dccomj osable (ti) AUm or AUminmm SutphaU — 5»J0 grams is used for a galton of sewage This causes a ftocculcnt prectpiuic whiclv entangles and carries down most of the suspended organic matter present m the sewage (irj) Lime end Alum —5 grams of each of the chemicals are added to a gallon of sewage This method Is more efficient dun lime or alum alone (w) Amine protett — Sewage is treated with a muclurc of hme and a smalt tjuanui^ of bnne An amme »* formed, whiclt acts as a deodorant or an antiseptic and renders the sludge also antiseptic ^ iJ C Protest —The chcamcals used ate alumitvofemc blood, cla> and charcoal They produce a precipitate which causes sedimentation of the dissolved solids present m the sewage (ri') Iron su'phale or Copperas — It forms a precipitate of Iiydrated protoxide of iron, when added to alkalme sewage or to the sewage which h»s been previously ti rated wiUi Ume Usually 3 to “i grains of it arc sufTi-ient t(j treat one gallon of scivage 3 Biological Treatment — •niis process reduces the com plex organic matter present m excreta inio simple siilHUanccs by the action of bacterial and other microorganisms Their main action depends ujion the tvvo kinds of bacteria present m sew age le aerobic and anaerobic The anaerobic bacteria arc clwefly concerned in reducing organic substances mm simple com pou ids In breaking down digesting and hcjuifyfug them, which arc ammonia and amm mncal coatpounds 1 he Bcrobic b cirna convert a pro-ess of nitrification (hr ammomacal suhi taners into nitrites and nitrates The disposal of ni>,htsoil b> trenching sewage farming, nc , ate hiologiral mrihods as the ultimate results are obtained through the baciena present m 'he sod Tig 33 Secltoa of Mptio tank installation for s house. The digestion chamber is an underground, airtight, rectan- gular tank made of bricks. It may be kept open or closed but in India it should be closed to suit its climatic conditions It has an mlet pipe connecting the luo chambers at a distance of ] to IJ feci above the bottom for receiving the sewage, and an outlet pipe for the discharge ofcniucnt. The capacity of the tank slioulcl be equivalent to 24 hours flow of sewage. \ In the scpiic tank proper, some of the solid organic cons- tituents settle at the bottom and the scum about 2"»6' thick is formed whicli floats at the surface, which should not be dis- turbed. Under the scum, anaerobic mil roorganims grow and multiply in tiie tank .and bring about material liquid action of the suspended organic solid matters and split them into soluble and unstable compounds. The black deposit of the sludge accu- mulates at the bottom of the tank, which is generally small. As soon as It becomes O'- 1 2* in thickness, it should be removed and deposited m trenches. TIic scum further undergoes digestive changes ouing to the action of anaerobic bacteria and the orga- nic matter is do.ompoicd into water, nitrites, nitrates and gase- ous products, such as carbon dioxide, ammonia, marsh gas. sul- phuretted hydrogen, etc. These gases ma> he employed eiihci toe heating or after carburctung for lighting purposes. The flow^ 108 HYGIKVn AVD rUDi-IC IIJ of st%\ igc m the must be stow, aud it should be kept m the tank for aLout 24 hours, so that the bacteria mav have sufTi- cicm tunc to act on the scwigc IhcefBueni from a septic tank n generally dirk m colour, v.ilh fare'll smell and contains eggs of intestiml pansUcs, such as hooku'oims and as such it should not be dischirgcd into i Ti\ er or a svmm without further punfir-ition. U is thercfoTC earned to cither contact beds or filter 1 eds where aerobic niinfi ■cation lakes place Here the aerobic organisms convert the different ammonia rompounds into oxidised nitrogenous subs tanccs of harmless character » r , mlrates In septic tank instaJ lation, no disinfectant should be used (a) Contact Bid — is a masonary tank and fcctangwHr m shape and may be of any depth, but a depth of 3 to 4 feet gives the best results Its Loitom is made uo of concrete and slopes fiom us centre to the sides winch is surrounded by a dram for collecting and carrying away the c/Tlucnt Coitactbcdis filled up with a layer of fine, hard, furnace clinker, quartz or gravel catigin™ ftom 1|1* lo2* in thickness to present a relalivcly large and rou^h surface for the growth of bactena The material should t e removed, washed niid replaced pcriodieAll) >- Ihecfllucnt fiom a septic tank, which i» generally dark m colour, is distributed and allowed to remain for a fixed period generally 2*4 hours It should not take more than half an hour to get Itself filled or emptied out U should be so arranged that cacli bed should be allowed rest for C hours after 4 hours func* tiomngso that the bed maybe properly ?critcd, otherwise the organisms may die Bacteria, chiefiy acrolnr, and otlicr suspended solids adhere to the filtering media ITie bacteria act on dissolved organic materials, oxidising them to muaies It requires somcvsccks fc r a contact bed to become efficient i e to acquire a suitable I actenal flora and its useful life is from 5 to 8 years, when it becomes clogged (A) Pertolaling FJtrr, TncUiag Filter or FUler Bed — It works on the same principle as contact bed and is used for the same purpose although Hie method of application of llic clarified sewage IS different In the filler, oxidation is assisted by aerobic bacterial action and the cflluent ts non putresciblc These filters arc arcttlar or rectangular m shape usually 6 feel dcqi and consist of a bed of porous materi il like jAama cinder, etc , graded from abo\e downwards, over which the efflu- ent or clarified sewage is sprinkled through fixed sprinklers, mechanical travelling sprinllcrs, dnpping trays etc , to ensure uniform distiibution While passing ihrougli the filter, the «ewage rapidly coats the filtering medium v>ith bacterial growth. DISPOSAL OP Sn^^ACn 109 which IS gdaUtious m nature When properly designed and worked out, these filters practically require no attention except that their surface requires scraping about once a month It is comparatively cheaper and more effi icnt than a contact bed -^Thc final effluent is generally discharged into a river or a stream or it ma> be treated on the (and So vi hen it is discharged mtoamcr or a stream it is necessary to eliminate the danger of transmitting water borne diseases by proper disinfection This is done by using bleaching pouder or chJorinc gas m some form or the other The fluid should be clear and devoid of smell It should be nonputresciblc, having practically no suspended im purities contained in it (h) Activated Sludge Process or Bioaeration Process — TTiis is an aerobic process of disposal of sewage and is claimed to be the most satisfactory method It is worked out on the same principle as the contact beds but a higher standard of efflcicncy IS aimed at in this process The sesvage is first passed through rough screens made of \crucal bars fitted at a distance of about 2' apart from each other to get rid of gross solids, such as stones, bncks, etc , from entering to the mam aerating tanks Thesc>vage is here treated Fig 3 1 Activated Sludge process with compressed air, in gusts through porous tile dilTuscrs at tlie boitcm of the niik , or by means of other devices such ns per- forated pipes, mcclnnical agitators or paddles Hie seivageis disintegrated md liquified with fonnation of fine emulsion which rises at the lop Subsequently it is pissed through grease col- lecting chamber where any grease collected at the top of the liquid is trapped The treated sewage rs driw'ii oflT fi om the botiom and led into 1 mixing chamber Here it is mixed mtomaiely with 15% aeiivatcdor ripened sludge, to 80% of raw srwnge by thoioughly agittting Then it is passed into final aeration chamber where / 110 jnouvi AND PUBIIC IIEVLTII the air IS forcctl in b\ dt/Tust-rs, al the rate of J 2 cubic A per £,allon, so that it rises in the form of mmuic 1 ubblcs in the 5c»ni,c I’racUcall) m infinite surface of contact is produced This IS done for &-Q hours liU all the ammonia in the sc\\agc IS oxidised into mlralrs “Ihe Cfobic in croorgan sms increase m iiumbcis and a-ti\n> and brcaV up organic matter of the senate till all the ammonia is oxidised into nitrates causing for matt mol sludge >shn.h settles down al the Iwitom as a prcci pitatc ind a d'-ar non putrcsciblc liquid comes otcrihc top The sludge wht h settles down is charged wiut mtcrcyargatt sttu, which ate larrtcd down with iq to the bottom and is then called as afhtaUdoT tiptntd 'lodge Portion of this ariitaicd sludgi can 1 c used o% cr aiidoter igain for the actit anon of frish sew- igc Ihc sludge oblaimd item this prortssin looff nsivc and IS an inaciobic bacterial culture It is therefore used m the proic's whidi takes place III the two stages In the first stage the organic matter is broken down and carbon is converted into cariK n dioxide rite d< posit from the scrccnint, chamber is u cd in Jillmg up depressions, pus etc as it is inorganic in imturc The ij!ud|,c fiorti the pnmarv tank and the secondary settling tank IS mixed and IS npei ed m digcsttnc cliambcr Ihcsc are Circular metallic tanks winch arc heated by liurntng gas or petrol and kept at a umpi-raturc of 6D r Hie sludge is thus rendered innocuous and lianniess and is then dried into cakes and sold-as mnnurr Here the liquid becomes almost stable but the process IS continued till nitrates are formed File cfllucnt IS drawn off and run into a suitable out fall ITicrc being an enormous amount of sludge a great difReuIt> is rxpcm need m Its disposal because it contains a very lirgr quamu> oftvatcr Since Uic sludge is rich m nitrogen and phojpliates it is iiidtscd as a valuable manure after getting nd ofwaier The sludge is therefore dewatered by air dr> mg on sand beds or b> some other means, and made into cakes and is sold f r use as a manure Adtanlascs pf ActnaUj SI tdge Method — 1 'I he cfflutm IS fully oNtdised and is clear, being free from colloids 2 Piinfication is rapid and perfect 3 Putrefaction is quickly stopped and die system is free Jrom tlic nuisance ol flics 4 Ilic sludge IS inoffensive and fonc a valuable mamirr 5 A small aria of land is required and skilled manage* mcni with a small staff cun easily manage the work DI&POSAL OP SLRAG2. /U An actuated sludge plant has been installed at Jamshedpur in India It is aimed to rover a population of about one and a half lac and to purify about 5 lac gallons of sewage duly Chara'^ers of a Good Sewage^ EQlnent — 1 It should be clear, bright and free from deposit 2 It should have no faeca) smel} When a sruall hving Fish IS kept m It, It «hould not readily die 3 It must not contain more than 3 pans per 100,000 parts of suspended matters 4 It must not take up more tlian tsvo parts of dissolved oxvgcn per 100,000 parts kept at a unilbim temperature 5 It must not contain more than 0 1 part of organic ammo- nia per 100,000 parts 6 ^Vhcn incubated at a temperature of CO® F, m a closed vessel, for t s\cck, it must not undergo any further decomposition CHAPTER VI FOOD AND NUTRITION The science of Nutrition deals %itK foodvaluca foodpro cessing, Its digcslion, absorption and metibolism m the Widy. Grovb-lhdevclopmcni and hcnllhpromotton m the mdividisa), the family and the nation, dqicnd to a mijor degree, on the use of the nghl kinds of food Nutrition has been established as one of tlieinosl important environmental factors cHecting health A person IS what he cals In order to undersnnd this close relationship between food and health, it is necessar) to study foodfictors and their functions Food as a whole serves three mam functions — (t) It provides the nxaterial needed for growth and upkeep of the body I ven after growth IS stopped, the body continues to change throghout life Tissues are continually wearing out, and these must be changed or repaired >ig 35— thowInK food ftoiorj or naircnla ail dor fuact-oci In ll »• toily. FOOD AND NUTRITION 113 (»e) It provides the body fuels or energy^bods, which on oxidation supply licat a id worl energy Even while at bed rest, some energy is being expended on respiratory, circulatory -ind other body processes (in) It provides the materials which regulate and maintain Iwdy functions and processes They regulate the way in which the various parts of die body act, and protec*" the body from disease Man IS omnivorous H** selects his food from both an mil and vegetable kingdami since the structures and fun''tioa of his body are sue i that it can co wcmcntly digest and assimilate their products A man by nature b a m^ai eater or vegetarian his food consists essentially of the following s x factors kown as nutrients, which arc classih'd according to th»ir functions 1 Carbohydrates — Starches and sugars arc grouped under this nead Wncat ncc mHz'*, barley, cereals, potatoes, sweet potato's, turnips rootvegetables arc rich m starches, while sugarcane, beetroot and fruits contain the sugars The original source of all starches and sugars is green plants When plants have excessive sugar and need to store it, as reserve supply of food, plant body is capable of changing the sugar into starch Carbohydrates are abundantly present m foods All carbohy draies have to be changed to glucose and fructose before they can be absorbed into tne I ody Chemically carbohydrates are composed of carbon hydrogen and oxygen as the name implies The carbohydrates are of three types Polysacthorides or vanous starches which are converted into two molecules saccharides t e , canc sugar, beet sugar, milk sugar and milt sugar These on. further digestion change into single molecule monosaccharide* glucose and fructose The carbohydrates are cheap sources of energy In the active muscles the glucose IS oxidised lor the production of energy and avarmth Glucose which cannot be used unmediitcly, is converted into gl) cogen and stored m U»c liver and muscles or ronverted into lat and stored under die skin 2 Fats; — Fats are composed chem call/ of carbon, hydro- gen and oxygen only in ddTcrciit proportion to what is contain- ed in Carbohydrates There is less of oxygen m fats than in carbohydrates The true fats arc glycerides of fatty acids Butter, ghee vegetable and hydiogcnatcd oif animal fats are examples Fats arc a form ol conc’’ntratcd food and like car- bohydrate' tliey arc used as body fuels for the production of heat and energy Weight Ibr weight &ts yield more than double the heat energy as compared to carbohydrates As fat' arc not soluble m water the process of digestion changes the fats into an emulsion fonn for their absorption into the body L quid fats and 114 ii\cn-NT A' D PTOLic nr^LTn lIio»e ^shtch mrlt nt bod> tauperature are scmrwh'it Ixricr cigcsted than thoHc %\h»ch art niiirh harder A£t ridi diet ilcvs the process of di^csuon ard gives -i feeling of heaviness and fulness In the bod) the f l whicli cannot be mnicdiiteJ) used, « deposited as adtposc ussut untkr tl c sUn loo much reserve of tt stenge can lumptr ihc toCt on ofa person’s body and hotly organs, and thus be i reil danger Cenam tmsaturated C tiy lads m fits are considered essentid for health Fat soluble vitanurs an prc'rnt in inunal fats 3 Proteans — ^Their chnntcil composition is carbon, h) dro- gen, ox^gtii, nitrogen, pliovploius and sulphur Tissues mus- cles and organs enz^Tnes and honnoics are piotein in nature For tins reason, protci is arc ol gi cal importance in the food The nitrogen m the proteins, is needed for the important work of building nnd repairing protoplasm for bodj cells, tissues and oignns The bod> carnol stoic excess piottm, constqutrtlj the body utilizes w'lal il needs, and the excess protein is used as i body fuel Tlic nitrogen waste of this prott n is excreted b> the kidneys TIic proitinmolcculc IS very complex Jl is made up of simple compounds, calkd mmtiacids There arc 23 known amino acids each witli 1 speciliciume Indie processor diges- tion proteiTjnoIccule isbiokcndowm throuj,h thestage of proteoses, pepwnts and peptides into immoacids Afier absojption Uicse ammoacids igain cemb nc to foim the protons needed by the various parts of the bodi Ibc body can s>TtUxcsizc more than Jialf ol iliesc ammoacids frrm other foims, but there are midc from food These tight csscntral smino aads arc — 1 Trjptonhanc 2 Lvsme 3 Methionine - 4 Threonine 5 Phcn>Hlinmc b Lrucinc 7 Isolciicinc 0 V lime The presence of these eight essential ammoacids m adequate amount distinguishes the animal protein ns complete or first class as opposed to the genrmny incomplete or second chss vegr- fiblc proteins, which lick m one or more nf these cssenti tl imiiio- acids The biological V ihic of ej,gprotrin IS the highest, miikpio- tem comes next A mixed diet containing both animal and vege- table proteins, will meet die need of essential immoaads Protemrich foods arc milk, Icanmcat, fish, poultry, eggs, nuts, legumes, beans and pulses lOOD \KD Mm.ITION 115 4^ Mineral Salts — ^These form about I/2jD h j)art _pf the CTilirc body weight and are essential for tfie iiutntenanre and growth of the body Tne> also miintam the normal o^notic pressure m the fluids and tissues of the body besides playing an important pan m the aciJalkali regulation of the body The alkali fonnmg elements are calcium potassium, sodium iron and man- ganese The acid forming elem-nts are p'hosp‘’iorous, sulphur and clilorme The main functions of salts m the body are — • ''''J To mimtain tone ol mastics, nerves and blood •*^2 To stimalate digestive secreitoas -^3 To help general growth of the body 4 To help to maintain acidalkah balance 5 To maintain rigid s ructurcs of body such as bones, teeth etc The folio ving mineral salts are most important from nutrition point of \ lew Catemm — It is the clnef constituent of bones and teeth controls rythmc activities of heart and contractile mus cles It IS required in mach greater amount during the periods of pregnancy and lactation Its daily requirement lor an average adult IS l_^gtn jind 15 gms for lactating mother Calcium m’tabolisin is cTos-Iy related o phosp torus and vitamiii D Its tlefi leney leads to poor devclopai at of bones and teeth rickets osteomalacia, delayed blood coagulation and low calcium tetany The best sources of lime salts are mtik, cliecse, eggs, dark green leafy ^gctablcs and dried beans Phosphorus —It is contained m every cell of the body It is essential for the multiplication of cells and the growth of the bodj It works with calcium in bones and teeth Its daily requircm*nt in the diet is 1 5 gms biitjnnre of it is required during pregnancy Its deficiency is characterised by softenmg ofbones stunted growth chanjes in the reaction of the blood and deprcssionof vital processes Its chief sources are cheese, yolk of eggs oilm'*al, almonds, nuts, peas and beans, whole ivhcat, liver, railfe potitocs etc Iron — It IS the miin constituent of haemoglobin of blood and nuclei of the cells It is also present in the muscles ind other tissues in minute quantity It acts as nn ox>gcn earner to the lungs and tissues and plays an important pan in the oxidation ssidcatilysisofcnaym-s Its daily reqwroTi-ntJS 13 m IhgraTTt- mgs An adult man has about 3 to 3 3 gms of iron out of which 2 4 to 2 7 gms exist m the fonn of haemoglobin Its d*riciency causes anaemia Its chief sources are liver, red meat, eggs, pulses, cereals, onions, lettuce, dried frutts, dates, figs and resins JoJjne — Itis an essential constituent of thyroid gland Its iodine rich s»cretion thyroxin, regulates the m-tabahsm Its daily requiremmt is 150 mpns Its d-ficicncy causes goitre Its chief sources arc scafxsh, codiiveroii, omons and fresh vegetables J16 mOlENE AND PUBLIC HL VLTll Iodised table salt supplies the lodme m endemic goitre areas Sodium Cftlonde — It mimtams osmotic pressure m blood and other tissuefluids It js cssenliaJ for the maintrmnecof PH ions concentration It forms gastncjuicc and bde Tts_j;hily ^iiircincnt IS 10 to ISgrams Its deficiency leads to cramps, nursed general svenkness, menial hssilude, d>$pT7ea on exertion and he'll cxhaution 0 Ctppir — It helps m the formation of haemoglobin of blood along with iron Its daily requirement is 2 mgm for nu adult 7 CWorinr — It is tici cssnry to mtintam the composition of blood and also m the formation of hydro-hlonc acid m the body It IS found in commonsalt, bananas, tomatoes, lettuce and green leafy \cgciahlcs 5 Vitamins —These arc complex organic siihsLances con- tained m food and are very essential for the normal gronth and nuinbun of arumaU In fact they arc vital accessory fcxxl factors and recent observations of diseases m men and evpenmems on animals lw\ c shown tint these diseases result from deficiencv m the diet of certain constituents of fresh vegetables and animal food* railed vitamins The part played by them m the metabolism Is not precisely clear hut some of the vitamins h-»vc been identified at components of enzyme system They are present m various foods m mmutequantiurs and diet devoid of vitamins, if taken for some penod giv cs rise to certain discuses known as deficiency dise4a5e» and may ultimately even cause death They do not supply energy but arc simple protccuvc foods llic number of vaia- xnms gcncraUy accepted is increasing from year to year but at present only six need be considered in relation to nmntiou of man Amouns of vitamins arc generally measiT'-cd m terms of International Units (I U ) Tins »mit is not the same for all Miamms but IS in rccordancc with a standard laid dmvn bv the League of Nations b fore 2nd world war Oassificut an of I’iiamtnf — The viumms m^y be classified av folic ws — A — Fat soluble B — AVater soluble, A. — Fat Soluble Vitamins —They art — I \ ilamn A or Jot SchilU A — It is essential for maintaining the mtegruv of the cpithclnllipings tliroughout the bodv for new rcllgrowtli and for \mial purple. It is nmiinfective and growahprornrting vitamin Its dcficienry causes the following elfects — (i) Ret lids grow h and lowers resistance to baaertal infection FOOD AND NUTRITJOS 1J7 ftQ Xerosis, Xerophthalmia, or dryness and infection (ill) Nightblindness (m) Atrophy of the cells of the salivary glands and mucous membrane of the intestines (a) Dryness of skin or Kerabmsation of epithelial tissues, a condition resembling ‘Toad skin” occurs (p») Formation of phosphitic calc«li (m) Respiratory infections like common colds, bronchitis etc Provitamin A is present in abundance m the yellow pigment of plants known as Carotene which has liccn isolated m die pure form Fatsolublc Vitamin A is pre'cnt m milk butter ghee, fishfit, codhvei oil liver. Kidneys mutton eggs and other animal fats Carotene m green and ycllmv vci^ctables and fruits carrots cabbage, mangoes and papaya arc rich sources It is not stal le at )ngh temperature wlien the oxidation processes destroy It But It is not destroyed by ordinary cooking, altliough if cooking is prolonged or if the food is exposed to air it is destroyed Human requuement for vitamin A is 5000 mtema tional units foi adults daily, being equivalent to 1 2 microgramrae of carotene V 2 Ti/dmm D or FalsolubU D or Antirackatic Vilamtn — This IS essential for the calcification of bones and teeth and prevention and cure of rickets and ostcomahcia It is thermos tabic i e It withstands a high temperature ninjjred It is pretenc m ctrgvolfc codhvcioil butterfit and ghee etc Calciferol (C-sAjaOH) IS a preparation produced by the irradiation of erijOStcroI with uftraviolet rays nnd is termed ns vitamin Dj Naturally it is produced m the shin by the action of ray s of sun A liberal supply of \itamm D to rnothers during gestation nnd larlalion renders their children less susceptible to ncKcts More over n corrects improper balance m calcium and phosphorus intake and if necessary for their absorption Its deficiency leads to rickets in children and osteomalacia in adults particularly among women observing purdah or persons duelling m dark houses where sunshine is not accessible Daily requirement of this vitamin m children and adults is 400 lOOO Ir tcmattonal Units 3 Vitamin C or /tnbsteri/iljr Vtlnmtn — It is also a fat soluble \ itamm It is stable to heat, bght and air It promotes reproduction It is present m wheat, ccrcalcmhryos green leas es of plants and in some vegetable oils Tocopherol an oil extracted from wJieat germ IS the most potent knovm source of Vitamin E Its role III human natritum is doubtful Its deficiency leads to death of foetus m uterus and slwihty m males and females m the lovver animals i I Itamm A or Coa^'ation Vitamin — It is essential for the normal coagulation of the blood Its sources arc green leaves 110 mClEVr A%T3 PUBLIC IILATTII spinncli, caulino\scr, ctbba^e, orrottops cnts, wlint so>nbein- oil Aiuinals coniam Iiulc \itamm K, lhoii 5 h small ninounts arc present tii « and niiJfc Tljc p m of the plants v^}lIch contain chloropinli tiMnllj have the largest mount of viLram K Its mam lunction is the fuinution of prrtlrtmlim Its dfiu-icncy leads tf» li\p< prothirmbintm *> ocrurrercc of Jntiiioril aS« in Uic slin in nneunn (i) Dimii ution of nerve cxcii biUiv letdirp to pcrephrral ncuniis In |>oaesihcsn and pam along the wrv c ininlvS rr Ic ds to ben ben reurnis intesiiml aioi\,mmiaI depte«tun xnavinva Upltvs n wnportmt p\rt m the wi Ivntion ofcaibolndi ites Neiveus '^snmrndlhe i nri ire the oig ns wlucii art tnos- trophy, ri 2 ;idity and dcrmatit»%m lais (d) BioUn VilaiTiin H —It is related to fat and carbohydrate metabohsm Its chief sources arc liver, eggs, yeast and cereals («) Foltc acid Vlamm AJ — iis stjnulatcs f rmation of white blond c*lh It IS important for haemcpoictic factor It is present m liver, yeast and lcaf> veg tables (J) hostlol l\{ojte An'i ahpccta fa hr) —It is associated in someway w th the metabolism or transport of fat It is import ant for anti alopecia factor (g) Vitamin Uj, (or Anhpemtcious factor ‘inaemia fa tor) —It is derived from liver and cures pcminous anaemia in veiy small doses (A) Para arruno btnzct /l«d helps tissue oxidat on 2 Vitamin C or Antiscorbu c I'itamn —It is chiefly present m all liviij tissues, flesh fruits as oranges lemmas black currentf tomitos, tumpj patato-s fresh green vegetables and m*at Amla (jrhyllantfms embltca) and country guavas are very ri Ji sources ol this vitamn Amla is indeed one of the nchest natural sources of vitamm C It grows abundantly in Indian forests and is obtainable m almost unlimited quantities from January to April every year The f esa jui e cont,.iu» nearly twenty times as much vitamin C as orange juice and a single flout IS equivalent m \ i-;min comtnl to one or two oranges It h^-s been syntn-tlcally minufacturrd and term'd as ofeorAic aa{ or ctoilamie aetd Tnc vitamin is destroyed bv p olong'd healing and in preservation of fruits It is an'i scorpj ic vitamin. It is css'ntial for miintaimag capillary integrity and foe lonnition of inter- cellular substance It is essmtial for the maturat on of red blood corpuscles Its deli lea^y leads lo ajurvy, anaemia, bad teeth, offensive brcidi, spongy gums, loss orv\ ight, delaying healing of wounds and hamoah34,es The average daily reqauement of this vitamin is oO mgs 3 Vitamin P — It occurs natural’y along \ uh vitamin Cm fresh fruits, particularly lemons It helps in p ev enting capdhry permeability and us deficiency leads to purpura, spontaneous 120 inGicNE AVP ruurrc ncALTn capillarj hacmonhagca anti infiltration of lungs resembling tuberculosis 6 Water — ^Tliis is an iinpoitant const tuent of food It represents the major portion r f most food st ITs like fniits, vege- tables and miK But as these sources ire insufficient to cope up Vrith IxkIv requirements water must be taken enher pLim or m the form of other heveriges Water is necessary to mike up the losses caused I ^ its eicrction in breath sw rat unne faeces nnd also to renew all the \inou5 flu ds ind Solid organs rfthc Irody. into ihc ernst tutions of wh eh it largely enters Tt serves as i %t\uclc for ibe solution and e'llutwm of the solid foods whereby these are more eisilv eli^estcd and ass milalcd It is also cssen- inl for elimnalion of many waste produc s A saii^fictory clitly allowance ol water needed bs i person ii two quaits for an adult cirr)irg tn roimal lilt The mount of water needed by etcry inditidual gcncralh \ancs depending upon the outside tempera- ture and to the extent up to winch the himnn hotly is subjected to the manual labour I he use of temperature arc! humidity of air increases the nccessm 1 >t intake of water An mstifTicicm intake of water leads to the creation tf disturbance in cirrulit on, of heal reculiiing wechaiii ro and m the retention of procluetsof Jiictaboli tu On the other hand abundant intake of drinking water prt moles the circulation of fl iid and increases tlic activity ofkidncys with free sceretion of untie Some important uses of water are — 1 As a soK CPt for transportation of nutrient about die body 2 As help in regulaiing body icmpciature through evapora- tion from lungs and skm 3 As an aid in tmoving wastes of metabolism in ibc urine 4 As an aid in functions like osmosis Classtflcation of Foods — They are class Ced according to their Aincliors under the fillowing heads — 1 producing /oods — ^Tliesc constitute fats and car- bohydrates Ilicy arc also called protein spircrs Proteins also prod icc energy to sc me extent 2 llody bufdms foadt — flicy are proteins, minerals and water 3 /*rof«t fi 5 «r pietnlwt foedt — T hesc coustitutc inorganic SdUs and \itamim Plus group also includes proteins and water Metabolism and Diet Requirements The chemical clianecs Uiat take place in the body cells are aery ccimplcx and the sum total of all these processes is called FOOD A\T> WTBinON 12J mrtabolism This includes the breakup down or digestjon of food into simple substances and their use m the cells, including the burning of fuel foods chiefly sugnr with oxygen, the formation of waste products and their elimination from the bod> Metabolic Rate {M R ) —This term is used to express the rate at which the cells of the body work and bum sugar and oxy- gen It irines in diffl-rcnt people depending upon their activity (whirh IS controlled largelv by the thyroid gland) and their occupation The Basal Metabolic Rate —It denotes the energy required by the body when in a state of complete mental and physical rest and when no food has been taken for 12 hours Tlie basil metabolic rate vanes -iccording to many factors The larger the surface of area of the individual (he higher the rate because most of the heat is lost through the skin For the same reason less heat is lost in hot surroundings The basal meubohe rale m the tropics is probably I? ger cent lowei than m the temperate climates Children have relatively higher rates than adults and males have higher rates than females P regna ncy increases the rate due to foetal requirements Constant ^ernsc increases the rate apart from energy required for thc~exercise Mental excitement, feyefTand thyrotoxicons all increase the rate In addition to the basal metabolic requirements the mdividul requirements vary according to activiiy c g , a manual labourer requires more energy than a sedentary worker Food Calorie J— Energy is measured as Jjeat ind the unit of Jicat is the calorie Tt is customary to express the energy value ordilTerent food materials m terms of calorics A calorie is the amount of heat required to raise the temperature of one gram of water I® C from 15*G to IG^C In metabolism a /sc wi"* da s-d“niifv occupation fo' 16 hours and raiumuiq m bed for 8 b nirs need 2170 calories per day Tlie araaum offo-j 1 iiccrstara tlep“nds upo i various factors sucJi as weight nmaiint of tnutcuhr worit do ic, age, sex chnn e etc, n.icli of us requires so nitnv cMoncs for eacli pound of our w eight. If real immia* labourers arc ex luded tins will work out )G to 21 calories for men nnd i* to 20 calories for utsmen per pound weight Man valae nnd famtly coefficient • — In mixed population variation m i^e, sex b i,hi const tuiion nnd viork arc to be con- sidered The sixndxul tnilc individual is taken as one unit and the vvonun as 0 90 unit Famtly coefficient — It is the rcHtivc cnerfiy requircmcnl of VI lou* m jnbrn of n houseliold m terms of such units expressed asmanviluc H-nce bv nun v due is m ant the relative energy rcqmrnn*nl of Van >«v mdixidunh tikmg an nvcrxgc nduU man as one unit DifTcrent fnctiom for tliirrrcnt members of the funiU expressed in ctmparison to the uiut is known as f-mily co-efliarnt Scale of Average Caloric Requirement? in India A'^cor- dmg to H-xIth B lUctin \u 23 the scale of coefTi lent xnd caloric rcquircmmis is as follows — Ct>efflr 00* Caf r cs rpit i ml Adult mile 1 0 21)00 Adult fimalr 0 9 2100 l’ii.i,uam woman \ 2 2b00 Nursing mo hr- 1 5 3k00 Child 12 lo 13 ye: ns 00 2-100 , 10 toil 07 loco fl to 9 OG 1000 . Glo 7 „ 05 1300 , 4 ti> 5 , 0 1 1000 Adi liond Ci’ati' • — Tjt»< cf wurk Oil0» ro«iu EsfttnyW ivr h tur oi VVwk I iqhl 0-75 Domcsicwork, cleri- cal work Modcratr 7a-150 Agriculture work lie ivv 150-300 Saw mg \ cry Heavy 300 and upward Sports, di gtng etc FOOD AND NUTRITION 123 Balanced Diet • — This should contain all the food factors m suitable proportion to produce the necessary calorics and to supply mricml for growah and tnuntcn-cc to tlie body system without b“mi» bulky or unduly bnj m size The proportion of the typ-s of food vanes with age and circumstances The fats and proteins should be derived from animal and vegetable sources, and all the d IT rent m neral salts and vitamins should be pre sent m sufFi lent quantities The food should also sau fy the taste and the desire of the p-rson who eats the food It should have cnou"h rouqhage to promote p-ristalsis Diet {the daily intake 0 / find) lieqj r^d for Ordiniry Person of an Average Size Doing Ordinary Work should consist of the following — Factors ^ ^ Daily Requirements 1 Proteins 75 to 100 grams or 3 to 3 5 ozs 2 Carboh) drates ‘ 400 to 5 )0 , or 1 1 to ! 8 ozs 3 Tats 75 to 100 01 3 to 3 5 ozs 4 Inorganic salts ~ 7 ! i) Sodumchloridcv^lOto 15 gms ii) Pnosphorus 1 5 gms 111) Calcium 1 gm ivj Iron 15 m^s ■ v) loJine ISOmgmsy yi) Copper I 5 mgrns 5 Vitamins — ( I ) Vitamin A 5000 I U (it ) Vitamin D 1000 I U (ill) Vi <»mm P, I 2 mgms (iv) Vitamin B. 2 0m^i (v) Nicotinic Acid 12ni and to jnppl) llic need* ofihe foetus Tlic nutritive FOOD AND I^CTftITIO^ !25 rcquireiTicnts of a pregnant vkoinen must be estimated on the basis of her nutritive status, weight, stage of pregnancy and daily activity It should also a/Tord a reserve for the period of lacta- tion D'lrmg first three months the protein intake should be rc- (luced as constitutional disturbances arc more common"Hiinng this period, which can be done by reducing meats and pulses and increasing the qmniiiy of milk As sucli in addition to a well balanced diet, the pregnant and nursing mothers should have a diet, which contains an ade quatc nraount of protective foods, proteins, minerals especially iron, calcium, iodine and vitnmuis A high protein intake is essential during second half of pregnancy which also promotes lactition Incase of lactatmg mothers the child gets its protein and other nutritive essentials from mother’s milk The proteins m the diet of the hcCating mother should be of the highest possible biological value and should be m the form of milk, eggs, lish__and meat 1 he demand of the infant for vitamin A and B complex is lugher than that for other vitamins The mother’s diet should contain an excess of these vitamins for supply to tlie infant in breast’s milk Vitamin C and D ore scanty m breast’s milk, these should be given to the infants early m the life m the form of cod liver oil and orange juice A pregnant ivoman requires at least 2600 calones and a lactatmg mother 3000 calorics per day J)ul far Vrfgneht Mather Diet for Ladaltng Malhtr Atta or, T Rice f 12oz$ Atta or, 1 Rice j 1 2 ozs Dal 2 5 ozs Dai 3 ozs Milk 20 Milk 32 , TisJi 3 „ Fish 3 Vegetables leafy 4 „ Vegetables leafy 4 „ Root 2 „ „ Root 2 ,, non Icafv 4 „ „ non leafy 4 „ Oil and ghee 1 5 Oil and ghee 15 „ I runs 2 „ Fruits 2 „ Sugar 2 •> Sugar 2 Salt and condiments 1 » Salt and condiments T » Diet far Infants and Children — ^An adequate qjantitv of pr6*"^ t cin_r nust be supplied for die building ol tissues Besides, irou'.-^ 'xliould be s^phed for the hactnoglobm of the blood, and CT lcj iun -- and phosplIorusXor bone growth and better tcctV Calcium is also essential for the proper functioning of nervous svstem An. adequate amount of v iiamms is also an essential part of our diet 126 mOILM VSD 1U1II.IC IIEALTrt Milk » ihc b'st food for infants and cluldren H'lmanmlk fjmi$S"s p a-* ir-illv all the nuinrnts required by the infjnis A* il n freefrom birmrul In icm, so in> intestinal disturbances arc less frequent in breast fed bsbi-s It is easOj diges cd Malnutrition IS itio'C prc\al nt amongst artifi lall^ fed infants tlian among the breast fed Improper feed i»g and underfeeding arc tbc chief ctuscs Breast fctdmg should be encouraged to asoid many of the mmor nutritional disturbances during mfanev Faults of Indian «liet — great mijirity of people in Ind a and Pakutan h\c on ditt made up mo tl> nndsometmes almost entirely, of vegetable foodatufls Millions of them d» not get enough ol these or they get too much of some a"d too liitic of others 1 he consequences nrc^hai their diet has very commonly a number of senous (auUs •^(1) The caloricvaluc is frequently too loiv *^2) The total amount of protein is often iiisuinuent >/(3^ Animal protein is often scanty and sometuncs entirely absent (4) The to al amount of fit is frequently too lov» atid aniiml fat IS scanty or lacking “fa) Carbohydrates, rich staples — pjrti cularly rtce or s^heai— frequently from SO to 90% of whole diet tvtiic.h thercfoie contains too much starch m proportion to other essentials (6)''Defi-icncy of one or more ^^muieral elements panictiUrly calcium and iron is frequent ( 7 ) One or more of the vitamins ii frequently deficient particularly m diet, of v\hich tlie staple article is polished nee or topioca or a miMiire of both “tS) Besides all this, the diet lacks variety These faults, of course arc found in tlie diet of poorer classes But faulty diets are not peculiar to the poorer classes they arc met also amongst the well to do classes , for prrjvidices, ignorance aad liabil often prev cut the proper choice of health giving foods Nntritional Surveys — These may be categorised under 4 headings — (1) Gcncial indications (2) Gioaslh (3) ^^initc clinical signs (4) LaSoratory InvesiigaUons "" ' H General Indications — ^TTicy arc — (a) Conditions of subcutaneous tissue (b) The muscular tone — Palpate for firmness (c) Facial expression, bnghi or apatheiic (d) AIcnncss (c) Carnage slack or slovenly (f i Movement — ^ctivc or sluggisl; (g) Interest anpes of diets consumed Quantity dietary surveys are more important and more dilTic ill to carry out Typ cal families arc selected and their co operation is necessary The member of each family, together with their height, weight and occupations arc recorded All food stuffs as prepared for cooking, arc noted and weighed All food prepared for meals but wasted or given to domestic animals must also be weighed Thus the hind oi quality of all C-kkIs act tally consumed by each family is determined These nirvcys arc conveniently made Jbr periods of not more than ten days CocfTicicnt for each ■child according to age arc used to record the diets m man unit value DIGESTION or FOOD The function of digestion is to break down the complex large insoluble molecules of the various foods into soluble molecules which can be absorbed from the intestinal mucus membrane Carbohydrates fats and proteins are mainly in need of digestion The digestive luices o enzymes find it difficult to break the cell barrier and a preliminary cooking helps in loosening -or breaking the cell membranes The carbohydrates have to be changed into simple sugars the fats broken down into on emulsion and the proteins simplified into aminoacids Part of the change is accomplished mechanically by the teeth and the muscular motion of the stomach and the intes- tines, but the major part ts played through the chcimcal action of the digestive enzymes D gcstion Starts in the mouth The teeth chew the food mto small bus and mix it with saliva, with the help of tongue Saliva, a s*crction of the salivary glands is alkaline in reaction It mo stens and lubricates the fo^ and its enzyme ptyahn, or sali- vary amylase, acts on the starchy foods to partially hydrolyse the starches into two molecule sugars There ts no action on fats and protans m the mouUi 128 men sy \*«> rtniK jif \ltii Softenrd food nfter the action in the mouth is sw'aMowcd into the csoplngus ind p opeUed b> the wave like movemnus, nud reaches the stomach m a sc-tics nf spurts Digestion Table Lacalion in body Gietndt S/crtlton Enzyvuj C/tarzrs JvfoutJ) Salnarv Snhva (alkal ne) Salivary Amvhsc Starrlj to Maltose Sugar Gullet or csoplwnis Mucous Mucus Lubricant Stomach 1 Gastric j i Acid gbnds 1 Gastrie fluid [ (icidc) H>dr. chloric tnd Pepsin Kesinrji Proteins to peptones Coagubtfs casein St muhtes glands ' DissoKes ; insoluble m neral matter Small Intestines (a) Dtioden im i Liser j bile (alkaline) rmul«jfifs fats I’ancrcns bancreatic 1 fluid 1 falkahtie) ! Irapsin Anulasr I ipase Proteins to am noacids Starch to maltose sugar Fata to filiv aads S. pl>cerinc (b) Ileum Intestinal IiUesimal fluid (alkaline} i 1 Mnltase [ Suerasc 1 1 I-actase ' rrcpsiii 1 Maltose in glucose C.tnc sugar i togluct JO [ I.actose to [ glucose i Pepior cs to -m noscid* The stnnncH is a strong musculir o gan nnd the strong contmetm »5 mix and bicik, dcn\niler»d further The icidty of the stomach h>drocJi one ncid id's mv bacteria etc present in th'- fcwl and stops the action of the alNalinc salna Tlic heat melt* the f Its The cii7)Tne pepsin acting m il c presence of hs drochlonc 'FOOD AIJD XLTniTION J29 acjcl b'eaks do^vn protems into proteoses and peptones A second enz>'me rennen acts upon imlk> causing it to curdle, an action which will aid us digestion Peristalsis carries, this partially digested food called chyme, after a variable time through the pyloric sphincter into the first part of the duodenum The alkalinity in this part of the small intestines soon over comes the gastric acidity The bile and the pancreatic juices arc poured into this part of the duodenum from the openings of the bile duct and the pancreatic duct Bile js partly a lyaste substance of the liver, it is not any enzyme but it aids the enzymte aaion of the pincrcatic lipase The bdq salts help to break up the droplets of fat into an emulsion The parcrcatic juicc contains three enzymes — lipase for splitting fats into fatty acids, amylase for further breakdown of sugar, and trypsin to attack the partially digested proteins From the duodenum, the hquid Food passes to small mtcscines by peristalsis, where digestion is completed, through the intcsti nal digestive enzymes The intestinal crepsin completes the digestion of proteins into ammoaetds the maltasc, lactase and sucrasc act on specific sugars to bteak them into glucose and fructose, and the fat splitting enzyme completes the change m fats into an emulsion form Absorption of the dissolved and simple nutrients takes place in the small intestines Within the small mtestmes arc found millions of small fingerlike projections called villi, whidi increase die absorption area of the intestinal wall The digested food is absorbed by osmosis into the tiny blood vessels of each villus The fat droplets are not absorbed m this way They are carried through lacteals via the lymphatic system to the thoracic duct and into the circulating blood Tough cellulose fibres do not breal down and consequently pass along with other bus of undigested products into the large intestines This bulk of undigested matter finally reaches the rectum, and at icgular intervals IS voided in the form of faeces Conditions Regarding Diet to Maintain Health — ^The food should be readily digestible It should be fresh and flavour' mg so as to stimulate appetite It must not he stale, undercooked or overcooked Articles of rod should be changed from time to time It should be taken at regtilat hours The habit of taking too much food at a time sboulp be disco iraged as this results m disordered digestion and assmulaiion It isalvsays safe to leave off witli an appetite Large quantity of water should not be takcmlongwith meals as it dilutes the gastric and other diges- tive juices 130 inaiFVL AND nmiic heai^th Excess oj' Food — ^\Vhrn excess of food is taken, the orgaas concerned in die metabolic jwocesscs have too much Nvork to do The blood becomes surcharged \Mlh oxiditablc matter The task of excreting the excess is undertaken matnl^r b> kidneys and the amount of svork throuTi on them is out ofprojxirtion to their capacity, so suboxulation xnd deficient excretion xesuhs Fcr- menfuive and putrefactive processes arc stt up leading to dyspeptic troubles Some of the products of putrefaction are absorbed into tlie s\ stein and lead to symptoms of autointoxi- cation uhicli arc — Hndtche, foul breath, torpor and indigetion If nn cxrrss in the foorl is prolonged fir sonic tmcit will cause gisiroinicstinal d sturbances diseases of liter, lidncysand nnencs (artcr nsclcios s) a gnicrxl nse of blood pressure etc. It mav mxnifest uric icid in the system Many ofthese trouUes result from o\rr ening and many h\cs arc shortened, as in-in cuts hisouai grave bt Ins teeth hsjJfeienej of F of Uaden iiniiot —This is seen during times ii ^caicity of food and if contmurd for a long time res ilts m loss of weight general debility and anaemia Taking ofinbaifTi tent fiod leads ii partial starvation and lowers the power or rrsutan r to distast pattieiilarly to tuberculosis In the eav*' of ch Idren they beernne dull and easily fatigued Thev li) not dev cl p properK and arc retarded m growth and remain uudrrwright A nun may recover completely from starvaiun if rot continued fi»r too long a period It has been proved tltat one can survive abstinancc of food except water for ft month without much p“rmancnt harm Diseases Caused by Faulty Dieting and Deficiency Diseases i — The diet can prove to be unbalanced due to any of the following causes — (a) an inadequate sjpply of inorganic constituents (b) an inadequate supply of proteins (e) lack of vitamins Theie troulUs are as folhus — . Causes riTects 1 Disproportionate quanti- Digestive troubles tics of proteins, fats and carbohy drates 2 Excess tsT proteins xn dirt Dyspepsia albuminurea 3 Lxccis of starchy and Gor^lencc, dyspepsia and fatty foods duarrhoca 4 Protein deficiency m Nutritional oedema, Syn infancy drome or Kwasluorlar FOOD ANT> l^tJTKlTION 131 5 Deficiency of iron 6 Deficiency of iodine in ivaler 7 Deficiency of vitamin A 8 Deficiency of vitamin or Aneurine HydrocJilO’ ride 9 D fricncy of vitamin B, or Riboflavin 10 Deficiency of vitamin G 11 Deficiency of viiamm D 12 Deficiency of vitamin C 13 Deficiency of water 14 Deficiency of tryptopha- nes of protein and Nicoti- nic acid Cooking of Food • — It is necessary as it makes tJie articles of food moie digestible and palatable It would make some of the vegetable dietary articles softer, agrecabl- and easy to masticate, •which are too lurd for d gesuon if taken raw Great variety m llic presentation of the food can be obtained and monotony avoided Appetite and digestion arc thereby stimulated and the food IS rendered more attractuc to sight, taste and smell The process of cooking helps to delay the putrcfacuon and decomposi- tion of food, for cooked food keeps longer than uncooked Certain patliogcmc microorganisms with which the food may be infected arc killed by cooking due to high temperature Defects of Cooking s — Carbohydrates like starch grams in flour, potatoes, ncc, cereals etc , swell up and burst leading to the gelatinizatjon of starch granules The protein coagulates (as in wlute of an egg) and shrinks when heated Fats, of course ire not nflcctcd on moderate heating except that the solid fats hquify on application ofheat and solidify again on cooling The effect of hcit on dilTcrcnt Vitamins is different as some are destroyed on heating, wliile otliers do not Tliorough cooking kills the cysticcrci m,jneasly beef and pork and IS a valued defence against pork contammg trichinella Vitamin D is thermostable -ind therefore ordinary cooking causes no loss to it, although addition of washing soda destroys this Vitamin to a considerable extent Vitamin A is not destroyed m food cooked m the absence of oxygen Both vitamin Bj and Anaemia Goitre Xerosis, Xerophthalmia, dry skin, arrest of development, night blindness, cattarah and bronclio-pncumonia Slow growth m children, Neuritis, Ben Ben Angular stomatitis, erosion of tongue, ocular mamfestations Scurvy Rickets, in children, Ostpo- malicia, and Denial canes Sterility Disturbances of circulation and heat regulating mccliamsm PcIIigra i32 inoiFNF v^D punric m \LTjr B« show rcinarLibIc resistance to licit, proMded the medium acidic Vitamin C bemq scrnimc to heat is destroyed b\ modcrite heating The hcil stability of Mtimm C depends upon the absence of oxygen and tile presence of nciditv In tvholepitatoes, vitamin 0 will withstand boding for half an hour but mm«hed and whipped potatoes it is soon destroyed In citrus fruits and tomatojuicc \itamin G is claimed to be proof to heat of processing The DifTerent Methods of Cooking are * — / Boiling -xlt makes the food more digestible, though it becomes less tasty A large proportion of mineral salts conLamed in vegetable foods being soluble in water, are tost 2 Jiaastin:; — It was done formerly by exposing articles directly to Hre but noiv roasting and baking which are Similar methods arc done m an oven The heat may be applied by means of coal, oil, gas or other fuels or electricity As a method of cooking, roastmir is po- pular in many parts of the world for roa*ted meat is generally rea- dily digestible Koasted food ts more tasty It retains all nutri- tive puces 3 Frjun^ —Tins method, m which food is placed m hot fat or oil, IS the quickest method of cooking because the melted fat is brought to a high tonperaiurc and food placed m it is quickly heated There are two methods of frying, sliallow and deep In the former only saFicicnt fat or oil n used to cover the bottom ofthe pan In the latter the pan contains a large amount of fat or oil and the fix>d IS actually boded in the fat Unless the fat is at a high temperature it d prepared in this wav is not so easily digestible as it contains a large amount of oily or fatly matter, although by doing so it becomes tasty / SUaming —This principle is applied in cookers It is best as It docs not involve loss of any of the nutritious ingredients Food Poisoning — kood may be injurious on account of the presence of — ^ Chemicals surli as metals from tins ortnjunius preservatives Cheap enamciwarcs may contain antimony and if the enamel comes in contact with fruit the fnmaculs nu\ dissolve the nntiinony and cause poivMimg Tiic use of rommer- ciat acid contamiiig arsenic has resulted in an epidemic of arsenical poisoning in beer dnnker* 2 Parasites or their cysts such os tape worms and ntusclc- worms *^3 Bacteria or tiieir loxms FOOD ;VKD NUTRITION 133 poisonous fungi such as toadstools which may be mistaken for mushrooms. Bacterial Poisoning:— It may exhibit every grade of seventy from slight indisposition to a fatal issue. It gives nsc to acute gas- troenteritis due to bacterial Infection of articles of food ^nd drink or toxic substances produced in the food by tlie bacteria having irritant effect on the gastro-intesiinal mucosa This is mainly of 3 types ; — (a) Infective T^pe : —It is due to the growth wilhm the body of bacteria of the salmonella group taken with the contaminated food Hke meat, fish, eggs, milk and stored food. The organisms responsible for this type of poisoning be longs to salmonella group are Baci/fttf £nirid« (gartner’s bacillus) Bacillus Suipestifer and Bacillus Typhimunum. They arc nonsporing and destroyed by heat but the endotoxins arc not killed by heat and can withstand a temperature of 100®C The symptoms produced are acute gastro-intesiinal irritation t e. vomiting, diarrhoea, and pain in the alidomcn and collapse. They appear after a dcfiiiite incubation period of about 8 hours. The Slaphylccactus has been associated with outbreaks of foodpoisomng %yhich have been traced to icecreams, milk, pastries, cakes etc. (6) Tovtii T^pe This is due to the ingestion of certain -substances formed as a result of the multiplication of bacteria before ingestion The Common ways in hich food is infected arc 1. Infected animals may be used for food. 2. Infected anunals may excrete specific orgamsms to con- taminate foods, which arc kept unprotected. 3. Human earners may contaminate food by handling, as they may carry infection generally Salmandlapatatyphtisiis bacillus ■and Salmonellatyphimurium. The foods concerned arc tinned meat or fish. Since ducks may be Infected with Bacillus Tjphimarium and Bacillus EnUriies; their meat may also be infected and cause food poisoning. (c) Botulism : — It is a sever neurologic disease caused by ingesung ncurotoxins produced by the growth of Clostridium Botu- linum in imderprocesscd preserved (tinned) foods, sausages, can- ned fruits, preserved pickles etc. The modem food processing is now a days designed to eliminate the heat resistant botulmum spores in foods and liius the disease In no longer common now. The toxin is produced in foods containing proteins and never in fresh foods, it is also caused by soil contamination of foods. The symptoms ofbotulism appear within 12-48 hours. The incubation period may be as short as 4 hours and as long as 3 days, depend- ing upon the dosage, conditions of eating and severity of infection. They are chiefly nervous In dbaractef and consist of distorted 13t ANT> IFBLIC HL\LTir Vision, diplopia, ptosis panil)sis of accommodation dysphagia and tLmmishcd salnary secretions Gastrointestinal symptoms mav occur but arc slight and transitory in nature Constipation may result from paresis of the intestines Death occurs m 4 to G days due to failure of heart or respiration Closind um U'tUh another anaerobic organism causes only mild symptoms How to investigate an outbreak of food poisoning — * 1 Ascertain the time when the symptoms appear -iflcr the in gcsiion of food If Uic inlcrv-al is long, then n is due to infective bacilli as they take some Lmc to produce the tovn If symptimis appear rapidly then tlie wmptoms arc due to pre formed totmi 2 Ascertain the symptoms and the number of persons affected 3 Secure simples of foods available whicli arc likely to have caused the outbreak of the disease md prepare acroluc and anaerobic cultures followed by feeding and inoculation tests 4 Conduct laboratory examination of specanen of ficccs and vomit passed by the patient in acute stage 5 Try blood taken after one week fir agglutination test with known cultures of organisns 6 If any case proves fatal postmortem ntalenal from the spleen bver, small and large intestines and the kidneys should be taken and bacicnolo.,icalIy exanymed, then valuable mf mu- tion regard ng naurc of infection mav be obtained \TCfT%BLI- lOOBS They contain large pTOpoition of carbohy ilr ilts ami aim nl all the vitamins proteins and fats Tliey are rUssified unde the following heads — I Ccrcnls ^ 2. Pulses 5 Roots and Tubers 4 Green Vegetables 5 kruits^Nuts 6 I ungi 1 Cereals — ^They arc m the form of seeds uluch contain a large quantity of nutritive materia! condensed in a nnall bulk and mineral substances like plinsphatea of oalcnon magnesium etc, vMtli a small amount of iron and silica I he cereals are ncJi nitrogenous substances starch and ccllilose but arc poor m frt The seeds arc usually ground into meal, vshich when mixed with water f >rms a tern’ccous ma« knovsn as dough from which breads etc, arc prepared These cereals ire relatively rich in carbo- hydrates and should iiit be used alone but they should be eaten vviUi Ollier fxjds ncli in fat and protuns As a rule they are easily absorbed ilic cereals most cmrononly used are Wlicat nee, barlcv, maize, millets oats etc FOOD ^ND NLTBITION 135 JVAeal — It IS the most important of all seeds and is exten- sively used over the world It is a staple food m certain parts of India ^ It contains 60-70% starch, 8-12% gluten and 15% water The seeds have an outer envelope called pericarp, which is very hard It is composed mainly of cellulose and mineral matter and forms about 13% of the gram A middle layer called endospennor kcmal consists chiefly of starch It forms 85% of the grain The germ or embryo foims about lJ%of the entire grim It is rich in protein and fat rioiir IS prepared by grinding up wheat The whole gram is always used, so it is rarely lacLing in Vitamin Bj It is customary to reject the outer envelope Ii constitutes, what is called bran, which IS used lor feeding ammals such as horses, etc , Bran con- tains a very large proportion of nitrogen and fat nz 15 and 3 5% respectively It is rich in mineral matter ard cellulose In Europe there is a tendency of grinding up wholeseed When this is done, the result is not flour, but is termed as whole wheatflour The only objection to the wliolcwhcaiflour is that the bran is indigestible, irritating and may cause diarrhoea m people having weak digestion The removal of bnn renders the flour fine m texture and white m colour, but deprives it of most of Its nutritious and fatty parts \VIicre it can be tolerated, it is •of great advantage, as it promotes evacuation of bowels It is mote TiutTitious than white flout The flour is divided into 3 portions — (a) Sujee is the coarse gram derived from the outer coat of wheat It contains a high proportion of proteins and mineral salts and vitamin B| (t) Atta is the next fine layer of gram It is rich in starch (c) Miida — It is fine white flour and is produced from the innermost layer of wheat gram It is deficient m all vitamins A good quality flour should be white or yellowish in colour and must not have a musty odour, nor it should feel gritty to touch while rubbed between fingers if flour IS not properly stored m a dry place, it is liable to- become infected with moulds, which can easily be detected with naked c> c Wheat IS a ‘heat producing food’, it is more suitable for cold climates or for clunates that are cold during most part of the year round It is very suitable, therefore for people who live in. Northern India 136 ]l\Ga\f \\V llBLICin^ITU Tnd Pakistan "infi for them it it i strcnifthening food but u is less suitiblc as tlie onU ccreil food m the Southern and hotter ptrt of tudii lifce — It IS a sinple Ibod in some parts of India, os Denial and Madns In composition it is poorest in pnnciiis, fits and nuncnl rn'iitcr, out of all the ccfctU Its chief constituent is stirch uhith ts in a ver> dii;cstiblc firm It is diRcstcd within 3 1- hours Rcing nth m starch il is citen uiih nitros’cnous and fatis substances, like pulses lish ghcc etc to stipply l!ie defi cicncv m jirotcms and fats The bulkmess of ncc eater s diet gives rise to two ijnporlint consequences tends to prevent the absorption from the imestmes ol th*" proteins and vitamins contained in other foods eaten vviih it as dais or pidsrs it IS apt to cause distension of tlic stomich indl>oueIs viiiJi fer tnemaiion of their cmiiems and ilie resultant iiuligcsnon and lionel complaints This only occurs v hen great bulk of the diet IS coni|»scd of lice When it is ctltii in less amounts as when one meal of the day consists of atla aiwl another of rice, tt constitutes an excellent food riie outer la)ef or pericarp contains vitamin B| and its com plelc I emov al may giv e nve to ben ben m rice c Uing population Hicc does not contain viiam n A and D Rice IS consumed after subjecting to eilber handpounding or milling The praenre of band pounding vs as, in v ogue liefoTc the installation of ntcchame il devices the sole means oi treating rice for removini, bran layers Nfachme milling since its introdtir lion in India, I as become of increasing imjvott him m tice in diisiry It has gradual!) b H him)} ousted handmilling to a considerable extent It is to be noted however (Jiat in villages of India rice IS still hand pounded, but the ncc prepared m the market is usually machinemincd When ncc IS dehusked, the shell IS removed leaving behind the lanbryo attached to tbc test of the gram In mnehme mill- ing iipto Jo®, ‘’f thiamine may be lost m llie bran, but m ham! pounding the loss n about 2j% There is no doubt that hand pounthng of ncc is better than smlhng Patbotlinq fif R {i — Dus consms of soaking paddv m cold or uann water for V aiying lengths of time, followed by steaming till the gram becomes soft and partly or wholly cooked Fhe excess water is dnimcd olT and paddy is spread nut to dry Dried parboiled paddv IS then husked giving a product knowai as par boiled nee The gram is slightly coloured birder linn the on ginal ncc gram and may possess an odour There arc some other methods of processing ncc and ]vidd>, acrordmg to which paddy If treated Sons to give products reads to be CQiuumcd without fiinhcr cooking Tlicy do not foim jiart lOOD AJ*D VUIJIITION 137 •of regular meals, hut arc constituents of betisecnmcal snacks "They enhance the palaiabihty Good nee should be entire, clean, uellhusked and nonfer- ■mcnting It should be preferably from the last harvest as new nee >s apt to cause indigestion and diarrhoea Old nee is digested easily The process of polishing removes major portion ofphosphorus and considerable portion of nutrient protein, in addition to essential vitamins The practice of nashtng nee before cooking removes considerable part of residual phosphorus. Best metiiod of cooking rice is by steaming Rice should be stored m dry and cold rooms If stored m hot damp godoivns, It ferments becomes mouldy and pioduces toxin tnd may cause epidemic dropsy Rice is often preserved by mixing iime witliit When soaled m water the diseased grams show a whitisli spot rermentctl nee is waim to feel Barley ijob'i —This is very nutniious and is charactensed by ns richness m mineral sabs and fat but is poor m gluten, so It IS unsuued for making bread pcarllnrley is used to prepare barley water which is used as a demulcent beverage for sick anti infants Malt is barley m its mcipiant stage of germination Maize er Indian Corn —This is used m some parts of India It IS as nutritious as wheat and richer in fats than all cereals exceot oats It contains 10% pmtcins, 65% carbohydrates, 5% fits, I‘2% salts and 14% water Mawe is poor m certam ammoacids such as try ptophane It is dcficicni in \ itamins, the antiscorbutic and antipcUagra factors being absent and an ex- clusive use of maiJ-c may cause pellagra It is dcficiem in gluten so It does not form bread easily But this difficulty can be over- come by mixing it with mtfk, eggs, etc Com flour is maize flour which has been deprived of its peculiar flavour by a weak solu- tion of soda ’ Millel ijoar or Bajra) — is less nutritious than wheat, ^nd IS sometimes eaten as porridge or in the form of thick chappaties or bread It is midway between wheat and nee so far its nutritive value is concerned Oats or Jao — These -ire highly nutritious but are inferior lowhc-it 1 hey arc deficient in vit-unin A and D and gluten Oats aie used as oatmeal porridge and should be eaten with plenty of milk 2 Pulses — These are mostly legumes and arc richer m nitrogenous substances than other vegetable foods Pulses include peas, beans, and lentils The vegetable protein, which they con- tain is called Icgumm or vegetable casein, which is not so easily digcstiblcas milx protein Compared to meat, pulses are defi- cient m fat In ilieir fresh state they com tin vitamins A B and G, but when dned they lose vitamm C 1S8 Il\a«M ANU rtllUC in A5TII Pulscj nrc used in India m The form of “DaV Owing tcv dieir ncitncss m proteins the) ate called ' Poor man’s meat,’* pulses also contain a good deal of cirboli) dntcs but little hi r!ie> tontam sails of potash lone -sod sulphur The laiicr pro- duces much flatus Pulses, m dned state, contain no antiscor butic propemes but if dned seeds arc soaked m water for 14 hours and allowed to Rcrminatc for n day or two, the^ again develop Mtamm C I hey most not be allowed to beemne dry after germination or ihcir antiscorbut e properiits will d sap- pear Gcnnimtrd poises snav be mrd in diet, when other xnti scorlutics such as fresh mm vcgclabJes or fniits are tint avail able nnd where no Irmon luice can be obtained Pulses produce a feeling of heaviness bem^ rich in puna bodies, sliould not be given 10 persons sufTmng from g»ot or rheumatism hft'f or Afatoor 1 1 dal w hen taken Ibr a long tunc gtv es rise to tram of s)Tnptoini called T ath>riim te sjmpioms of spastic paraplegia of lower limbs wiili increased knee jtrks Dcromiwscd pulses should not be used othenvise they will give rise to sj-mptoms of vomiting and purging Se^a ISfan —It is c\ter»ivcl> used in China and Japan II liasvcr> high protein and fit contents a large amount of mine* nl matter and ilmost complete ibsenccof starch Iron content ofsoja beam varies from 7 to 30 mg per 100 gm* "rhe protein i* ofgtxid qualit) and c.isil) digestible It contains large quantities of vitamm ll| but no vitamin Cant! D Amiikfrotn soj’abcan >s prqured to resonble llic coinixisition of cow s milk 3 noots and Tubera —These arc reserves of nutriment for the use ol the plant itself They exist ehicflj m the fonn of starch about 00®o proteins and fats bemg practically abstnt TJicy arc inurh inft-rior JO cereals and pulses in nutritive value as they arc poor in proteins Thej arc therefore not suitabicfor taking m l.ar),c quairtitics forming maui pan of anv diet They contain some mineral matters wliich are mainly salts of potash The fommon fonn of tubers are carrots potatoes beet root, radish, onions arrowrooi sago and tapioca nre iirh m carbohvdmtes and contain starch 22''«. protein 2"o and a trace nffii (O lb*oI 'Ihcvarcn good source of vilammi U ami C and contain imu and pho«phonis that is vvliy ihtv me iiniveisally used as wholesome and palatable d»«rv articles Jnv inf, muclt nutritive value Sleamuig of potatoes i» i better way of eoiAing liian lunlmi, but their peel (skin) should not be prcvimislv removed because by such rMiuvalmuch of the nitrogen and minerals arc lost Ihe aim sciwbuur viianun »s destroyed bv prolonged heaiiiig Camltf larript ard rajtsh ronlam vitawm C but they have bulc nutritive value They are used as frevh vej,etab!es root) AKD MJTRITJ02* 139 ArrottTool, sago and tapioca arc made from tubers and con- tain starch Arrowoot is prepared from tubers of the plant Maranta arundinacea It contains about 82% of pure starch Sago 18 obtained from pith of sago plant, whereas tapioca is obtained from the tubers of Mamhol uiilisnna As they arc easily digested and absorbed hence thty are generally used for invalid cookery They arc also used in preparation of puddings 4 Green Vegetables s — They consist of leaves, buds, young shoots, leafy stalks and often iJie entire plants In compos- tion they consist of 90% water, 2% nitrogenous substances or pro- teins, 4% starch and k% fats They contain large amount of alkaline salts which act as “buffets’* and maintain the alkalinity of the blood They supply vitamin A, B„ Bj and C so ihcir inclu Sion IS essential in an ideal dictarj Green vegetables arc rich in cellulose and so add bulk and are of viJuc m chronic constipa- tion So far as possible, they should be eaten raw as salad A good rough indication of carotene content of Ica^y vegetables ts their tenderness or say greenness The greener the bettt. and the fresher the better Ordinary cooking docs not destroy the carotene present in vegetables, although it is not stable at high temperatures Dried vegetables arc practically useless as they are not antiscorbutics Green vegetables are deficient in fat, which can be made up by cooking them m oil or phec, which adds to their taste as well Tliose vegetables which are grown on soil treated with sewage water are liable to give rise to typhoid, cholera and dysentery, and may convey parasitic infection 5 Fruits and Nuts s — Frvils —They contain a large amount of sugar, vegetable acids and salts According to their nutritive value fruits have been divided by Hutchison into food fruits and flavouring fruits Food fruits arc those which afford nutriment and include bananas, dates, figs, grapes, rcangocs, etc Their nutritive value depends on the presence of carbohydrates which exist in the form of sugar and commonly sjiown as levulose or fruit sugar Certain fruits such as apples, Icmans and oranges arc rich in potassium s ilts, lane and magnesia and contain anti-scorbutic vitamins The flavouring fruits arc oranges, pineapples etc They have got no nutritive value but arc used for thcir sweetness and flavour They are stimulants of tlie appetite and of the flow ofthe digestive juices, their odour, sweetness and flavour adds to their value as foods They promote healthy action of bowel* and the removal of ivastc products from the body Ihcy are valuable because • — 1 They are coohng and quench thirst UQ mGtt\K A5,l> PUBUO HPALIH 2 Thev contain imponanl mincnl siUsof pottsh combined with \cgcublc salts 3 f*hey hi\r inti scorbutic* prr^pcrtics bcinj the nchcst sources of Vitamm C and for this reason they arc mclnd- cd m cluldfcns' dietary especially m bottle fed niftnts Ihc> prevent scurvy 4 riicy prcveii consiipition. N'utr — Ihcv differ from fruits as they have luqlier nutritive value, being rich in proteins and fits They are not easily digested 111 the\ coniam much cellulose Nuts contain less i^arlKihvdnies ami arc bcUei suited for diabetics They are rich in Miamiii B bui com »in vtrv little sitamm A and no vitainmC 1 heir » eomnicncc m the deeper part of the meat csp'^cially near the bone And so the odour may not be apparent I h'Tcfnrc, in ease of A suspected meat. It is adwabic to push an iron skesver right into the meat pull it out and smell it Putrefied meat IS cxirtmcl) dangcions asposanous substances gel develop d whicli introduce sudden and fatal illnesses due to ptomaine poisotiing Symptnms oj Vlomame Pottarirz — Thc> arc vomiting, abdominal pain diarrhoea, colic cramps severe prostration ind death It IS belies td ih u pt inuine dcvciopes m bad ineit and fish T hesc m croorg imsnu produce {xnsons in the liodics of the persons v\ho have taken u Presence of DuolltiJ Cuffl-n luis been istoci tied in several outbreaks D stajtd —The ft sh of ammals sulTcring from diseases such IS uuhmx rabies gl indirs, gen ra) tuberculosis, sloutd be cnridcinncd (ogeihsr with Uiosc. animals killed by accidents and iigliirnii g I In rbseasej meat should be sclecii.d and prevented fiom sending into (he market The diicf diseases aic — \ Tubtriulain —It IS practicallv common m cattle and pigs in the European countries It is rare in sheep goats and other cattle m India It is practically always present m lymphatic glands On pleura It pioduccs slnn> deposits like bunch of pc-irls, while m Ivanphatic glands it produces lumps of cheesy material Muscles practically never get alTccrcd and it is extrtancly doubtful if eating meal •» nlfcctcd, spreads tuber culosis In tubercular animals when disease is generalised, the whole carcase should be condeniiicd as unfit for butruin con sumpt on as meat js likely to be poor m quality and unwholesome even if It docs not convey tuberculosis The following arc the recommendations of the Royal Com* mission on Tuberculosis as a guide to meat inspectors — I 1 he entire carcase and all the organs may be seized and destroy e pitdlic iiCALTn too much % icuum All leaking md non*airtight tins should be condemned 2 On palpation — If patrcfiction has set m and gas has formed u gi' cs a springy feel with a sense of resistance 5 On percjsiton —If the note is tympantne, it indatates unsound im due to fonnatjon of gas while adult note indicates a sound tm J On sAakn^ —A sound tm svill proju'-c no sound but if the conlenis arc pjtrefi d and arc portuliy liquid then a loose sloppy sound will b“ detected Eggs -A hen’s eggwcighs npproximaicly 2 ozs and consists of i0®o outer covering or shell, C0% white, and 30% joDc. It is the safest of all animal foods as no infection can be transmit siblc through It It is food containing all the proximate pnna- pies of food except carbohydrates necessary for the groivlh and development of the bodi It is a protective food containing first class proteins It consists of an outer shell With Its interior white and yolk The shell consists of car^ruitc of lun', the white is made up wholly of proteins the chief being eggalbumen and the yolk contains less proteins and a large amount of fat , besides, it contains lecithin, viiilm and ilic organic compounds of plio*. phorus lime andiron It is ricliin calcium salts and aniinetK ntic and anuracluiic siiamms Eggs nre easily digestible and ire almost completely absorb- ed m the mtcsuncs, only 3% of residue is left The digest- ibility of eggs depends u^n the form in whiclithey are eaten. The length of time t-ikcti m the stomach, in case of ddferent forms of eggprcparalions is as ToHotvs — 2 Light boiled eggs 1} hours 2 Raw eggs 2? hours 2 poached eggs cooked in butler 2j hours 2 Eggs hard boiled 3 hours 2 Eggs omelette 3 hours Treshness of eggs can be tested (1) by holding them in a hand m front of a candle in dark hresh ones being more transparent in the centre and stile ones arc transparent at ihar exirtinilics This process of testing tlie eggs is known as Candling <2) bj putting them in silt solu ion, (2 Ozs to a pmi or 10%) fresh ones wiU sink whereas stale eggs will float. I-ggs cm be presen cd for a long time by preventing the entrance of air through their pores, by smearing tlie shell, when fresh with wax, gum buitrr, lard oil or sodium silicate and this process is knowm as glazing Besides, can be kept afresh for FOOD AND NUTRITION 147 about 2*3 months at a temperature of 32®F provided that the re- lative humidity of the atmosphere surrounding them is controll- ed to prevent the growth of moulds. MUk : —It is a food material of special importance. It is a complete and ideal food and contains all the proximate principles of a wcUbalanced diet. It forms the only diet of children upto the age of a year or so. It is the best source of calcium in diet both on account of quality and the valuable form in which it exists. Milk contains the following proximate principles : — 1. Proteins: — 3.5% of total weight, consisting of 3% Giseinogen, 0 4% Lactalbumin, and 0.1% Lactglobuhn. 2. Carbohydrates 'Lactose or milksugar 4 to 5% 3. Fats In the form of glycerides in suspension, 3.5 to 4%. Whenmtik is allowed to stand, fat rises to the surface as cream. 4. Vitamins : — It contains all the vitamins except vitamin E. In summer, cows if fed on grass, produce milk con- taininglargc amount of vitamins B, C and D. But in ttfinter amount of vitamin A .and D is much reduced. 5. Mineral salts : -Phosphates and chlorides of calcixun, potassium and sodium. It is poor in iron 6. Enzymes: — Amylolytic, proteolytic and lypolytic. Average composition of various tAiILs is as follows Kind of milk Proltins CarhohydraUs Fats Salts fVater Cow 3.5 4.8 3.7 0.7 87 Human 2.6 62 3.1 0.3 87 Ass l.S 5.5 J.25 0.3 87 Goat 3.6 4.0 4.2 0.6 87 Gaseinogen predominates in cow’s and buffalo’s milk with lactalbumin in human mdk. Ass’s and goat’s milk resemble human milk more closely, but fail as a substitute. Ass’s milk has very little proteins and fats, and goat’s milk contains too much of fats as compared to cow’s milk. Specific gravity of cow’s and buffalo’s milk is 1032. Lactomttcr svas used to determine the specific gravity. It proved to be rallacious, as addition of water lowers the specific graivry and extraction of fat, before sale, increases the SpKcfic gravity. So addition of svater, after extraction of fat, ivdl not show any changewhatsoever so Jar lacto meter reading is concerned. To arrive at a definite conclusion, a quantitative analy’sis is necessary which is done by Shixntdst’s Method. By this method 'all the fatjs extracted from a known quantity of milk, by solvent ether and then the ether from tlus extract is allowed to evapo- HQ maiENf \ND PUBLIC ll> ALTH rate This fat is rompletrl) t’ried and then eighed 1 iic best inctJiod IS Lc/Tmann Beam’s proress Solids other than fat an. estimated b\ esaporatmg to com- plete drjTicssa knoMO ssciijhiof milJ and that ^^eJgiIln{, ton! solids, subtracting the fat prexiously dacrnimed from percentage of solids, wluch iji'cs pcrcrfititjc of solids otlicr than fit Methadt of rrfsncatton of Milk —These are as follons — V ] Bv/ini; — This method u comrronly adopted in Indian Iiouses as the boded tndk coigxiletes slonK as the organisms svhicfi prcKhicc Iictif acid will be reduced ui number 1 hr p iiho genic oigamsms (but not spores) s%ill be killed TbecJiangrs sshicli occur in milk lAcr boiling are Ta) The protein of milk IS altered Lactalburain coagulates, if kiplitQO'^C for half an hour The cascmogtii becomes moie digestible Ail I at emulsion is destroyed and globules coalesce together ..(c) Mineral salts, such as calcium phosphorus and magne- Slum arc precipitated and a portion of citrate is lost ^(d) VitommCis Ion and partial loss of titamin B occurs (e) CnzsTnes and all mieroorgaiu ms arc destJO>cd (f) Caioon dioxide IS expelled arU cnramchzatton of lactose occurs at tcmpefattirc over 212*F J i'/ert/isatiiifi -This pt done by raising the temperature to lOQ'C and then b> mamiamiiiR wfor ISmmutciin closed »ten- Used tesscli It kills all microorganisms and their spores The disadtatuage IS that Vitamin CandU are destroyed to one lialf and one third of their original toment I he biological value of proteins is said to he but sliglulv redured It is unimtablc for feeding infants 3 PasifiiTisaiton — This method i' as discos cretl b> arrmcls Chemisl knoisis as Louis Pasteur who mitially dc\ iscd a method of J ircvcming the souring of wme or beer b) means of some sort of icat treatment In the case of milk, this »s the best incUiod of making milk safe for use as a food It destroys any pathogenic organisms vshich may be present and reduces the number of lactic acid producing organnms TIus is done by r using the temperature of milk to 145 150T for half an hour and then rapidly cooling it to SS'r This process neither desuov t the enzyane s, nor alters tlie taste, flavour and nutritive va'ucof tmlk except the arliscotbuuc vitanun which is destroyed at I25“r> other vitammv arc not afiected There are various methods of pastcunsalion of milk home of which are as lullotvs Holder t methad ‘ —Ihu is roimdercd most satisrteiory In this rtl^hod milk is kept at H5T for 30 minutes Subsequently milk is passed over cliillm or coolers and the desired umpcratiirc of 55T is atfaintd It is then bottled and sealed FOOD AVD KUTRITIOV 149 “ Flash method" (or high temperature, short time method) It IS done m Flash, Danish or Rotary Pasteurizers Milk is momentarily exposed to a high temperature of 155®-160°r fora few seconds (i e 16 seconds) and then suddenly cooled to 55*r In It the idea IS to kill the microorganisms in milk This is an American method and is not considered reliable ^ 3. "Vat method ’ — Milk is treated in a double walled vat by steam to requisite temperature and kept in the vat as a holding device for half an hour It is then cooled b> allowing cold water to circulate through the double wall or coil of the vat Test of pesteuTtsahon — (phosphatase test) This is a calori- metric test to 1 siimatc the eIH“iency of pasteurisation Principle of the test IS destruction of phosphatase enzyme by requisite tem- perature of pasteurisation If milk is treated to a lower tempera- ture and for a shorter p-riod, the enzyme remains in a greater percentage to give a positive test Method of preservation of milk by pasteurisation, although universally recommended and adopted is not without disadvan- tages It, while destroys some organisms, has no eJTcct on toxins It, enables stale milk to be sold and leads to sanitary neglect tn the production of milk JLaeltcaetd bacillus which restrains develop- ment of other orgamsms is killed, so milk is liable to become toxic on keeping Drying or Desiccation —Milk is passed over heated rollers, where it is evaporated and athmfilm is formed, which 18 scraped and passed through a sieve so as to reduce it to a fine powder The milk prepared from this powder is of umfonn composition, free from all dangerous orgaiusms and is easily digested by infants, as the curd formed in their stomach is more Ilocculent and fincl> divided than that of the fresh cow’s milk. The \ntamm content of dried milk is variable Vitamin C is reduced ^ 5 Condensed MtlK , — Milk is usually pasteurised and is gradually heated under pressure m vacuum pans, till its watery portion IS evaporated and it is reduced to l/3rd of its original water contents It is imported in sealed tins It is of 4 kinds — fe) Full cream (unsweetened) fA) Full cream (sweetened) (e) Skimmed (unsweetened) (d) Skimmed (sweetened) Afilkjdt Milk solids percentage percentage 90 31 0 9 0 38 0 — 20 0 — 26 0 Skimmed condensed milk (sweetened and unsweetened) is not to be used for babies It must appear on the labels of the tms. 150 A^D PUBLIC nBALTH V C AdilUsn Cif themutth — •TJic* antiseptics usuallv used for the prcscn*atton of null: sserp salicylic icid, bone acid, borix, sulphurous netd, faitrulin md hydrogen peroxide Tliciruse now IS prolubilcd b> Ijsv Diseases Cor’'ejtd br AttU. — MdJc confiins bacillus I'Ciic a id which sours or ferments mdL If sour tndh is given to clddrc/i it lull ^vc rise to xomitins, fhitiinire and dnrrhoca It IS 1 common cause of infant mortality m children The diseases which ire commonly transrptttcd to man by the use of contaminated milk are — .T ubcrcdlosts tjplioid pin- typhoid, cliolen dysentery, diphtheria milla'T’cvcr, septic sore tlroit scarlet fever and foot and mouth disease Milk, circfi 11) and freshly collected, is sterile, hut the market mdi- contains i large number of microorginisms derived from — 1 Covv’s tests or udder 2 Hinds of miller 3 Dust or blowing air 4 Vessels used 5 From impure witcr used for washing cans C Adulteration of mdk Most of the organisms are hinnless but some of diem are pathogenic ind give rise to outbreaks of epidemics Thecon^ moftTTicroorgamtms ire — t Tubercle Bacillus —It gets into the milk m ihefullowing •ways — j[tf) krom the cow itself, if she is suffering from tuber- culosis Tuberadar ulcer on teits or the udder Jr) Some ttib-Tcular person coughing over milk (/) Hies conveying infection from tubercular sputum or other tiiberciiLir miienal Tlic English Rov il Commission on Tuberculosis has come to the conclusion tlul 30"„ of tuberculosis m children is cauied by taking the infected milk The remedies arc ~(a) \ctcrimr> examination of rows (i) Excliisi >n of tiibcicular persons from the milk trade (c) I xclusiou of fives by the proMStou of proper Uds to rcccp- tadcs ard fiy pro< f doors iiid windows (d) Ccmpiilsory nntil cation ofall foui* of diseiscs of udder In order to rndicilcbovmr tuberculosis ilie fillov^mg steps should be taken Provision of open iir sheds (b) Q lartcriy nupeciion ofeows and pcrfjtjnmg ol Tubrf culm lest ifier everv six months (r) ‘'laugftering ofall infected lajvme arul thrjr part al compensation si ould be pud to tl e owners (if) Rendering bovine urmune to the disew roOD ANI> KOTUITION 151 v^2 T/fihoid BactUus — It may find access into milk by any of the following ways — '^) rroTi tlic hands of tKc typhoid earners '^6) Gimed from typhoid iniectcd stools by flics (c) Contaminated water used m adultcratmg milk Remedies proposed arc — •/a) Exclusion of typhoid earners from the trad* ■hi) Proper p otection from flics (e) Strict legislation and punishment for adulteration 3 Cholera Vibrio — ^It may find its svay into mdk m exactly the same way as typhoid bacillus and the rem dies arc also the same In the case of cholera it often happ ns that attendants on cholera patients may handle milk for sale and thus directly contaminate the milk c g if the grwala suiters from an attack of cholera his wife would attend upon him in remot mg stools vomits, etc Her hands will, therefore get contaminated svith the disease germs Now she also happens to handle the milk which w sold to the public The result will therefore be a set ere outbreak of cholera amongst tlie customers of the gotv'ala '•/‘i DjfStnlery —It is also spread by nulk and the infection IS passed on to the milk in the same way as in lyplioid f ver 5 Scarlet Fever — It rs spread by taking infected milk The milk in infeacd by the following ways — -^(a) Through a previous ease in the dairy '^{b) Milk kept m the same room m winch clothings or dis charges of the sick arc lying r ^c) Ulcerated teats mcluded by scarlctmal virus m the process of milking by a mild unrecognisable ulcer, impart infection to such a milk 6 \falta Fever — It is spread by taking goats milk The germs get into the milk from the g lai s blood So milk is coma TOinatcd in goat s bod> Remedy — Proper examination of all the goals or systematic boiling of all goat’s miik Ckaracteristtes of a Milk Borne epidemic — The onset is sud den with an explosive outburst and declines rap*clly if milk from the infected shop or dairy is stopped The cases occur only jJi those Jious s which tak* r Ik fiom a pan cular infecicd iliop or a dairy The numo^ oJ eases vanes but all the eases occ IT stmulianeoiisly Those who bod milk for a Jong time do not catch the disease Ihosewlo t*.kc more milk suffer the most Clildrcn b mg fed on milk arc more frequently attacked ihah adults For the Same reason tlie outbreaks arc more com tnon lonongst rich people who dnnk Hulk more freely tlian the poor 152 Jt^kCJUVr Wt> PUBLIC JlJuy\l.Tll Control oT Milk Supply of a Tovm —Tins i« done under ihcfol5o\vmg heads — Cateciicn Slcre/’e atd Dutuhittan cf Milk — ^Tlus it only of nnportance in ease of large towns and mnti cipaUues At present lU India the arrangements are \cry imrcUahlc Nothing can be done cictp rnforcmg str^nsem legislation The herd should he suujected to insp*TtiQn h> a vetennaxy offi er to nisurc tha the mdk is not uken from diseased araraau This can he done h\ - (0) Cjmpcllng all prtiducers of milk to get ihcm'clves re^ 3 ered (1) rheir prerrusrs are lo b- also registered In children tubcrctiloiii is siiread to i la'ge esetent by taking mf-Tl-d tnilL so tubcxculm test of animals must be peifomied period callv and onU those free fiom tuberculosis should be us“d In Punjab cn tie -^re generally corsideretj to be frcclroro tuberculosis Cixsh/Jt —These should never be pimutted lo be com tmaed vvuhm the limits of towns b*came — (а) The animals are nuisance to ihc imfRc (б) Th* sheds are instnuary and produce nuisance from smell and provide places for breeding of flies (c) 1 he sheds are necessarily dtrk and the nnimah do not get proper exercise, if they a'e iLallfed For th sc reasons m towns in rng'antJ keeping of MimtaU vnihm certain Iwn ts of mimicipal boundaries is prohibited The proper lighting and Ventilation should be made the subject of legislation Th s js done in Fngland under the Daircs, Covrsheds and Milkshops Order, which provides that — 1 AH cnwsh'‘ds should have plenty of light and should I>e provided With adet}uatc ventilation 2 Ihcflxir should be made of Cement or oth'r impervious material and properly s'opcd lo a central elrain 3 Flic bjildinp should b* occasionally whitcwaslicd 4 THtc should b** a provision for a liberal supply of watei for frequnitly washing the shed and the dram 5 Arrangements sliould be made for the quick removal o daii^ onne, etc Tkt Milking Of Calhetto^p/ Milk —1 TTie milker slwuld l>c frtc from any disease whatsoever and should possess a certificate tliat he has nor sufltTCd from typJvidfrvcr and tixtt he IS not a typhoid earner, as lypItouJ earners arc particulsfly apt to transfer the baciU to nulk through ihur hands lOOD AND NUTKITJON 153 Before milking, he should wear an overall over lus clothes and this ovcmll should be daily changed by another which has been previously sterilised b> boiling v-S The milkman should \vash hts hands thoroughly with ordinary boiled water before milking the cattle *^4 The best out of all methods is milking of cattle by means of a machme but t!i s can only be done in case of large herds of ■cattle ■^5 Milking may I e done n cowsheds although it is prefer -able to do m special milking sheds 6 Cows should have dean udders wh ell should be washed btfore tmlkmg 7 Milk from a diseased coh with sores on its udder or teats must be condemned JttcepiacUs for AUlk — These must ? c kept scrupulously dean and uaslicd thoroughly with boiling water before and after use as remnants of milk \mU contain lacticacid bacilli and so tend to set up the souring or acid fermentation of the milk- They should have well fitted lids to keep off dust and flies The ■sanitary pads should not have openings exceeding 8' in diameter After imlkmg, one of the following two things generally iiappen — (i) The collected milk IS sent to the tovsiis after fillmg m large receptacles and then disposed off by rctailsale (»'} Milk is reta ned and butter, cream ghee, etc , are manu- factured therefrom When milk IS to be sent to the town for sale the method of transport m England and in some towns m India is to run the milk into large conical vessels havme a broad base and provided with stout handles on their cither sides and tight fitting locked lids The alternative in the case of small dealers, vsTjuId he to run the milk m a metal drum mounted on wheels and p ovided With a tap This can be drawn by arumals or hand pushed to the town When milk is dealt wnth locally, such a can or drum should be kept scrupulously clean and washed with boiling water iielbrc and after use The phcc where business regarding the sale of milk is done, IS legally termed as a dairy An ideal dairy must comply with the following regulations These also apply to milk shops m tovsTis or whercever they may be situated — It should not be in proximity to refuse heaps or other •breeding places of flics '-'2 Its walls must be made of cement or any other impcr- inous material 154 incit-M \^D rtmic m vlth S II must be well IiL,I)tedtft at least one square fool of glass for CTcry 1 00 cubic feel of space 4 It must be pro\i Jed will flvpfoof wire gauze doors and windovs IQ keep ou flics as flies are great mechanical earners of pathogenic germs fiom faeces lo the milk 5 There must be a good and ample water suppl) available in the dair^ 6 No ptiV) or latttnc should be permitted under the same roof 7 The milk be stored in proper receptacles provided with lids or coTcrs to keep out dust lhc> must be kepi clean and washed wath boiling water after use S MiK should never be taken out bv means of mcasiirm!; Tcsiels but should be run into them They should be provided with handles and should be cleansed datlv with boding water 9 All dames and milk shops must be registered and should be open to inspection, as and when required Infant feeding —The num food of mast jnfmts is breast Bulk Human milk yields 20 calories p*r ounce so that an average mfa’ti m the second month fed exclusively at the breast would req lire 20 ounces of mtlk iday, 4 ounces p*r feed ifitis fed 5 limes in 2V hours The breast imli secreted rarely exceeds 30 ounces per day and from 6 mamlu onwards solid food maybe Supplied to prov iile the necessary ca’ones Artificially fed infants require slightly more milk than brea t fed infants. For liand fed infants under 9 months of age if cow $ mdk i$ used it should iic d luted with waier and mdksugar should be added The dense clotting to some extent shcjld be avoided by adding som* itijcdaginous svibstviice to the mil., such ns barlcywaicr, well boded and strained whicJi ba* the niech3tuc.tl efTeci of prev cntin-’ the particles of casein coming too clo'c together and the nird tlius formed IS looser and is more easily attacked by d^csiive juices Hionani^edi^w 3 milk IS novv very lin,cl> used in th'* icedmg of infants Tim principle to be observed in the hunums ing process is to prrp.arc a Bind which shall have the ronipow tionof human jiidk as fir is the conjiituenti arc conecriied, wljich shall all) b* devoid of liinnful organic lih To cfTcc: tins the insoluble rssemogcii of cow s milk must be reduced to the proporticu pr«*em in human milk tlic amount of lactoic mint bp iDcreajrd to the right proponion and the rrsultuig mixture be pasteurised Add one part of cow s milk to one part of water, then add o’l'' ounce rf erdmurv enunfu-’ lined Cream and one ounce of milksut,ar to rverv p ni of diluted milk Vitamin C in some f''im mas be gi\PK from 2nd month onward, about 10 cc for2l tea sp^^onfil) of orange or tomato juice will usii illy supply tl is amount FOOD Ahn SUTRITION 155 DifTcrent Designations of Milk in England — 1 Ctrlijud M:!k — milk must be denied from animals which are fice from disease and tuberculin tested after every six months The milk must be bottled immediately and must not be treated with heat It should not contain more than 30 OOO bactena per c c and no Baallus coU should be present in 0 1 c c 2 Grade A Milk {Tuberctthn Tested) — The milk must be from animals free from disease and tuberculin tested after every SIX months Th" milk must not contain more than 200 000 bacteria per c c and no BaciHus coli m 0 01 c c 3 Grade A Milk — ^Thc cows should be examined every three months and the milk must not contain more than 2C0 CCO- bactena per c c nor any Baallus colt m 0 01 c c 4 Pasteurised Milk — It should be pasteurised by the usual way It should not he pasteurised more than once It must not contain more than 100 000 bsctcria per c c nor Baeilltis call in 0 01 c c Derived Milks — 1 Standardised Milk —By adjusting milk m suclt a way that It contains 3 7% fat by adding or subtracimt the cream as the need be 2 Reconstituted Milk —Condensed or dried milk is reconsti- tuted to the equivalent composition of fresh milk by the addition of water and vitamin C 3 Homogenised Milk — It is so made ihit the fat does not separate out and does not rise to the surface as cream on stand* mg The fat globules ire reduced in size and the mdk becomes homogeneous in consistency 4 Skimmed Milk — It is prqsarrd by skimming of milk by hand It usually contains 1% of mdk fat It should contain not less than 8 7% of total milk solids 5 \tacf me Skimmed Aiilk or Separated Milk — It is milk from, which cream has been remov''d in a centrifugal m^chme It contains milkfat less than hand skimmed milk but contains same amount of total solids Cream — It is prepared by allowing the milk to stand so diat buitcrfat may rise to the top and ih^n removing the lop layer The fit or cream may be separated from m Ik mcrhanicady through a centrifuge machine known as a •'^cpirator Cream may contain about 50% of fat a* i^auist 3 5 to 5% m the milk Butter — It IS most nutritious and eisilv digestible form of all fats and is very suitiblc for patients suffering from pFith sis or from many forms of dyspepsia It is best for diddrcn while 158 U\GK\C ^ND rtBGlC ItEALTll It ccniaini inoTti tanmc aad and \olaijlc Oil and less cafTcine than the hlaci tea In sliort, the flavourortca depend* on iW wla utcoils and the sunitilalmg property ts due to an alkaloid knwn as “caHcjnc ’ which may be present upto an extent of 5% m its leaves Fxcmsivc use of tea leads to bad digestion as the tannin present » liable to coagulate its atbumJious ingredients and thus make the ^ood dilHcuU to digest It causes indigestion, msomnii Sind neurasthenia In moderate quantities it acts as a stimulant and restorative (ij Coffet — The roasted coffee contains I to 2®i of caffeine, a small amount of caffcol and a large amount of tannic acid It acts os a stimalant cv. ing to caffeii e present in it It also contains fat suqar, etc It is prepifcd by roasting seeds of tajea arabtea to chocoKtcbrowTi colour and then ground into powder Its chief idultcmnt particularly in I rcnch coffee, ts clucory Caff o! or the aromatic oil detcriorites rapidl) on heating It may be of interest to note that neither tea nor coffee has any calorific value, if only pure infusion is taken r>od value is attached to these beverages only when an> sugar ormdkare added (e) Oxoa —This is a powder> prcpaniion, prepared by roasting and grinding cocoabcans It is nutritive ns well as stimulating It is liked by some persons as it has a palatable taste Chocolate is a pre^rationofit, which is made IVotn npe -seeds of cocoabcans aficr they have been sweetened, dnra, roasted and dcprired of their shells 3 Alcohol and Liquors — Tlie term alcohol is used to cot cr a wide group of chemical substances but die one which is referred to under alcnholic beverages is ciliy) alcohol (C}Ht01I) It IS produced by fermentation of yeast of monosachande sugars, glucose and fructose CgHjiO, « 2aiI,OH + SCO, Glucose Lthyl alcohol Carbon dioxide Alcohols and liquors contain from 2-50% of alcohol Hicy arc — I Beer or Malt Liquors —Contain 3-7% alcohol They arc prepared from fermentation of malt and hops Cider it Ptrrj arc made by die fermentation of the sugar dkA applies w, ^btca.«. esC cs.d« and die pears in the case of perrj U. Spirit* 1 — These are prqixred bv clisliUabon of alcohol produced by fermentation of various saccharines or starchy matcnxls *>ame of diemalnxanetict of spirits arc —(a) ll’Swij, contains A2% alcohol It ss prepared from mahed barley, cereals. lOOD AND ^UTJlIalO^^ 159 rye, etc It should not be less than two years old and should be free from disagreeable smell Brandy contains 48 to 54% alcohol It i5 a distilled wnc prepared from grapes It is the least injurious form of spirit ^ v^c) Rum contains 5^to 60% alcohol It is prepared from fermentation of molasses or from sugarcane (d) Cm is obtained by fermentation of rye and malt and flavoured with juniper hemes, cardamoms and other aromatics It contains 40-50% of alcohol in Wines ~ They arc the result of yeast fennentation of saccharine fruit juices eg grapes No yeast is added to the liquor as m the milemg ofbecr, as yeast spores are always present m the skm of grapes Lighter wines generally contam J0% of alcohol and the heavier upto 20 or even 25% Since yeast spores present m the skin of grapes cease to bring about further fermenta- tion, when the conccntiation of alcohol reaches upto 15%, the higher fermentation is obtained by adding extra alcohol to the •wine i e it is fortified They are daret, burgundy, sherry, porimne, ekampugntt etc Alcohol u freely absorbed from stomach and reaches the blood stream therefore it requires no digestion It is a stimulant m small doses The disadvantage is that it leads to habit for- miuon and so shortens life In such cases it is apt to delay digestion give rise to degeneration of alimentary tract, gastritis, tmcstinal cattarh, cirrhosis of liver kidnc>s, etc It has imtant local action and acts as narcotic Two p-r cent of the alcohol taken is lost by the lungs and the reraiining quantity is ox dised by the tissues After taking excessive doses it can be traced m the unne also Alcohol is not a food but is useful m some conditions of exliaustion or wastmg diseases It may give energy and may lead to muscular activity, but total output of work is reduced It cannot replace protem as it does not contam any mtrogen and has no power to build tissue It is a protem sparer and pre- vents tissues waste Frmt dnnks —When made from fresh fruits such as oranges or lemons, fruit drmks arc both palatable and a valuable source of Vitamin G If sugar is added they provide a source of energy which 15 quickly absorbed into the blood stream The so called fruit dririks made from chemcal powders and some of liquid fruit drmks sold commercially have no nutritive value other than dissolved sugar, for they contam no Vitunin C Condiments — They are a-cessory foods such as chillies, mustard, pepper, vmegar, etc Except common salt, they have IGO inciJVT vNn lonrit iiMLTit Imic or no foot! \alucbu« thrj roaie the food more paLitable and arcconducivem stimulat on of «Ii% tr> gJandJ Thej t'tritc the salivary, gijtfic and pancreatic secreiiojjt lhc> also improve the appearance of food Thc> expel flatus Mustard Oil — It w extensively used in India It enters mto thcdirtTyormutoftheiHoph both rich and poor It is pre- pared by expression of secils ol ninstird It IS cxiensitclj adul- tented svitb som form of m neral oil or irg'nione oil obtained from the seeds of Argeirora nuxuana I« ts a weed uhicli grosss wildm jungles even on bunds of eulinatcil lands Certain unsoanltlcj cuts nuke it their buss ness to collect irgcroone seed and mix h \wili musinrtl seed esp ci tUy bl tek in ntard llo h nre bUtI in colour and bcnct an umv »r\ cnsiomer may not easily detect adultcratjnn, of the seed The practice of nduUerj lion is itdartaus and d ngcrous to public heahji llii* lias been shoven to pve rise to symptt mi rescmblu g epedem c dropsy chapter vn SOIL AND BUILDING SITES The health of a locality is often influenced by the nature of Soils or Alluvial Soils — Owing to the retention of water m these sods, they are cold and damp Alluvial sods arc found in the deltas of big rivers like the Ganges 3 Granitie Metamorphic and Trap Rocks — ^These arc con sidercd as healthy sites for the houses as they arc dry owing to good drainage and dopy nature of the soil Wcuthered granite ishowcscr an exception to Uus rule as it becomes softened and absorbs water 4 Chalky Sandstone limestone and Magnesium Limestone Soils — As these soils are dry, they arc considered as healthy sods 162 mnUNF AM* PDBUC S Gra^tllj Soils — Iheie ate the hcalthicsi of allUieioiU, ♦jnless they arc water logj cd 0 J^amt Soils —Such type of sod* arc mixture of sand, clay and humus 7 FilUd cr hfaie Sotb — ^Wheii depressions of Uie ground are filled up wnli refuse, the resulting soil is called * Made boil' Tlic refuse undergoes fermentation and putrcficuon with for- nwuon of certain gnscs and gi\es rise to miismce of obnoxious smell Such soils are not considered suitable for the constnictlon of buiIdiiifjS thereupon Crotmd Water — This is much more importmt thxn the ground air Its depth vtries greatlv and if dcicnnincd b) tlir depth ol the first mipcrsious strata If the level of ground water for any reason, g« is s cry high then that particular xrct should be regarded ns unhralthv i wo diseases ilicumtSism and tuber* culosis arc pariicuUrly xisociated with the high level of the groundwater I he mtximum height fixed f r the ground water IS 10 feel and if that is exteeded thoi the area should be con sidcred xi unsuitable for bmldmg sues The grotmd water alTeet* the health m two ways — 1 U supplies water to all the sliallow wells If ti is jxillmcd, It may give rise to diseases 2 If Its le\cl rises it gives rue to dampness m houses resuUiug in rheumatism, catiarh, neuralgi i and buig trouhlcs It should be rnnonbered however, that the presence of moisture in the soil fnouri the decomposition of piitrrfiablr material* Therefore n drysoil is comparatirely cleaner and its ground air purer tlian in the case of a damp one The level of subsoil or groundwater can lie lowered by launching proper engineering schemes to a safe level Drainage may have to be earn* d out on a very large scale and nv rrs or w itci courses mat have to be tpened up nr porous earthenware pij>cs called a ncultural pipes may have to he laid on alirge scale at the depth of lOfrciand through them the grotintl water over that level is dra'iied* away m the dirrction of the lope of the latwl In hrt clinutrs trceplantation Ins rendered the p! ires healthy Thr vrj,ctition nbstrarts large quintitv of w >lrr fr m the soil wlvirU gels evaporated offf om ih«* green If IN ea fu \Kp> tus trees alisotb w »{(r II time* the amount of ruufill rv r ih' irea vhchtlry cover riicichavc Ijceri grown m manv nala nous dirtrirt* far pirj*ose of mi hrm" tl ran more I a li > and the results haic been very fausfactory Ihe t^routt l\ atcr level nves due to rarul irn; atjon and some lime* may giv i rise to tvatcrlt*«^in^ SOIL -AND BUlLDINa SITES 1-63 Gr ound air ; — It diflcrs from the atmospheric air. It is ^ ralfy moist and always impure and the amount of moisture tads upon the proxinuty of ground tvater to the surface of Sil. If this is a few feet deep from the surface of the ground, ar gets saturated with moisture. But the ground near the ^ of the earth is in most parts of the world, moist even ^ draught, owing to the capillary achon of soil and fflon tScing place from the surface of the ground water, mpuritics of the ground air are due to the dccomposi- Sirjous orgamc matters, which arc washed into the soil Sn or which arc naturally present in some marshysoUs, %us products of decomposition arc ammonia, ammonium *R\cth3nc and sulphuretted hydrogen. The impurities of ' \cvcn in virgmsoils, arc shown by a great diminution ^d an enormous increase in carbondioxidc. In the ^d of houses, the foulness of ground air is due to the nination and this may be of a most dangerous type, acsspools, sewers, drains, animal filth and possibly sions pollulc the Water and air present in the soil. 0rmit decomposing animals and dead bodies to Kjar pollution, whilst the organic effluvia arising 'jirtls” seriously imperU the heaUh of inmates of the >c them. It is important that such ground air be prevented from oozing out by rendermg the basements of Louses jmpennc.able. Dis eases Attrib rrtable to SoU : — The soil has been held rcs- ponslblc for the spread bf'mfcctious diseases sucit as enteric fever, cholera, amoebic dysentery and tuberculosis. Some pathogenic germs are present in the soil S'.hich causes anthrax, tetanus, malignant oedema, etc. Animal parasites of man arc deposited in the soil -which reinfect man duringone of the stages of their Jifccjclc. The infection contracted directly from soil polluted with human excreta is chiefly hookivorm. Diarrhoea is’ associated with lowlying alluvial soil, whereas incidence of rhcumaiisin» cattarh and pulmonary diseases in- cluding tuberculosis arc associated with dampness of soil. HOUSES AND BUILD INCS Before constructing a house or a building, it is most essen- tia! 'that a suitable and healthy site be selected for its construc- tion! In its scleaion consideration should be dixmcss, uarmili, light and air. The height of the ground water snoiild be deter- mined. If it is higher tlu»u 10 feet from the surface, the site should be condemned, unless the level of ground water can be 1C4 n\(J:t\P AM) lOBLIO IIE,\LXII Jo>vercd by dramage Cla) and alluvia) lods should be nwidcd « they arc damp and cold *nic best soils arc rock and wcU- draincd gravel Madesoil is unsuitable as it is iwllutcd by sewage or refuse Places where refuse is thrown or a^hich arc situated near the irenchmggrounds or factories should be avoided The site sliould not be near the marshes, paddy {tclds, stables cowsheds etc The budding should l)e open on the Hast and South to allow free passage of light and air and sho ild be exposed to the sun Since trees cause evaporation and drv the ground lliere should be \cgct itioii growing near the house, hut it should not be so close as to cla np the bouse by obsinictiiig light and air Consinirtton of back to baek bouses sliould be discouraged, as cross ventilation is imixissiblc m sticli houses and the rooms, arc natural)) dark and iH ventilaicci lUqinrtrnfnti an4 Siandards ef rtlnrtt_^_a Co''d ihutt — A reason ibly comfonablc home should be free from se/ious damp- ness It should Inv e adeejuate ficihncs for washing and pre paring food Iisliould be satisfactorily lighted and ventilated It should be properly drained and provided "ith adequate iini tary conveniences tg sinks «nc It should have been built on ideal giound surrounded by Ueakhv environments It should be in a good state of repairs It should have a proper provision fir storage of fuel and a food store There should be provision for adequate nriiacy for the individual vvjth ample oppcrtimities for normal fimtl) and community life I here should also be lulhnait space in tlic sleeping rooms to miriimue the chjij.ers of •ontact infection Constrwiion of Houser or JiutlJMgs -—This should be dane on j roper sanitary lines A house si oiild be dr>, pmperlv liglited and ventilated The tbllowang points si e liome in mmd at the timeof comliuction — rcimdaUo n •— Tt must alivays be solid uid substantial so as fo' sustain the combined deadload of the budding and th* supcnniposcd load It shriild be dug up and n bed of good Cement concrete be trade lo cover the whole site of tlie I oiite and should extend 6* bejaind the foolini>sof the walls on ever) side The dejnliof tlir concrete should depend upon the weight of tl r wall, winch has to be supported and in no case should be less tlian 18’ Dan-pntsj of Heusti —It w caused due to 3 major cauies — i d) Kism^ damp b) rermiating drnip r) Roof leaks fiOXL AVB AVItDISQ SITES 163 The nsmg damp can be prevented by providing adequate drainage of site, concreting the surface of floor and provid mg damp proof courses, whereas percolating damp can be prevented by covering the external walls with cement or glazed tiles or even rejomting the gaps in the brickwork with cement or any other impermeable material Similarly roof leaks should be properly attended to, jnorder to prevent moisture oozing from the roofs J)amp proof courne — A layer of impervious material should be laid honzontally along the entire thickness of each wall above the point where the ivall leaves the earth but beloiv the level of the floor It imposes a barrier to the upward progress of moisture By the capillary action the bricks ab sorb moisture from the soil even ns far as the upper rooms and consequently make the house damp and unhealthy The material used for this purpose must be impermeable to moisture and sufliaently strong to wiih-stand sveight The following material may be used — 1 Sheet of lead ■2 A layer of asphalt 2' tluck 3 TVo hyers of slates 4 Damp proof or well tarred bncks 3 Stones 1' thick, made with stone ell ps ce ment and stone dust In very damp marshy •districts it IS advisable to raise tlie house above the ground on arches open to nr IViil/f should F g 36— Damp proof eourso be constructed of bricks, & dry area Slones concrete or wood The bnck wails of the iiouses sljould be dry and full of air The bncks should be properly bounded Ordinary bricks are porous and very absorbent The stock size bnck of 9x41- X3 indies is capable of absorbing ns much as 16 ounces oi water Slone is non absorbent and is Ic-ist nflcctcd by changes m tcmperntiire Timber is durable and warm but the danger of Arc 15 a, great disadvantage Concrete is often rcmforccd with steel rods md ties introduced into its substance The walls of the houses should be plastered frtnn outside and inside ThcwalJs »n die rooms are lime washed or oil painted The clurnneys jaorPNT -WW rUBLIO 1 66 jliould be consinjctctl durui^ tfection of hoiiscvinUs Tlicy re- quire roost careful coniideralion in order tbit llicyTtr\> fiiuclion properly IJity should icrmiiialc above the lut;hcj{ uljomin^ roof If the will of a borne « bmU directly m contact VMth the soil llip wnll IV liable to get saturated with moijtiirc from the «oil "nie room IjoimSed bv that wall Villi therefore I>e d impetJ Wlicn room is built on i culling in a steep lull side its lower Inckrofim happened to be damp firthis leason Simtlarly if a house Ins gat a Inscmnu, it iv also Idety to become tlamp Thu-cfirc ii IS nrrrssaiy that tlieri shotild alwavs be an an space beiwren such under groui d w ills nnd sod ITic n'^cJsory air spare is called ‘ dry area ind must b~ dnmed below to prevent w ilrr collectini, in it and it should br open above to keep the irta fresh and dry VlooTt — llielnsc of the lloor must have m impcrnie"ble 1 tj cr ol concrete or trinent to prevent dampness nsiiig frs m the sod below and as i valuable pr uettion jv^auui dry rot which is caused by the av.cncv of a t«nv,Ms vvluiji ln« the effect of re duemg timber to powder humUrly the fl >ors should be tnideof wnpertneablc material wbirh ran lie washed Ilicy ate i,cricia!l>, mndeul bricks with cement coiicrete glared tiles or wood /foo/i — These slimild be sulTiciemlv hiph ntul rainj rtMif and roav be flu or sloping fhev sh ultl be pmvidetl wnih pnpr> gutters widi asiiciiUe I ill and sprouts Jir rapid removal nf ram water tioon and IJin/eis Ivcry room romt have Si'fTt ent nuroher of doors and windows to allow free \ cmilation (mss vcntil uiori stioiilcl he encourage J 1 hey should be provided with Wire gauze /i-inf fjpsms aid ffedropms —They vh>uM be of adetpivte Size to pciroil the asseroJily «f fmiiiy with rtrof rt liiry should fe placed so as to secure the maxirnum sunhchi and out lock should be pleasant as die circumstanees will p-rmit Venti lation is of gre it imcoriinec A fi qilare vhnuld be jirovidcil which forms a jiermanem means c f vrmil ilio i Jnkhm —It should d'» be built nn a deta bed side to prevent smoke from entering into the rrsiden*ul r< ms It should ini he neir a privv ft shonld be flvpro' f and yiieca floored Fooiiskrtt pr Ijtrdnt arc essential feature nf every fi use they should be phred wn North side wberrver yjossiblc nr vi vivv n c be pro(cct*'d from full heat of the sui Good b^biine and proper vciuilation are iftdtsfKaisil ie and m rural iirei nwre sptcc 1 ir food sir nge is desiril le than m the tovms soil/ AND DUIIDING ‘’IflS 167 FutUtore • — ^It should be sufHcten!t to hold adequate quamii>' of fuel and it should be m the same block as of the outside water closet or kitchen Woierelostls or Ptiphj — These should be built in a detached portion *of the building and should be at a sufTicient distance from the living room and the kitchen There should be proper arrangement for the disposal of dcyrclusc wastewater and excreta Walersu p pl y — There should be proper irrangrmcm of watcrsupply either from taps or co ered deep wells open Space — There should be sufiicicnt open spice around each building A backspicc of at least 10 feet should be kept open Housing and Healt h — Poor housing and poor health ha\c long been associated For more than a centurv, observers have pointed to tins ph'Tiom“non as a basic reason for considctmg housing as a public health problem It is impossible in state m definite quantitative terms exactly how much and what kind* of illness are caused by p'wr liousmg Obviously poor housing is only one of the factors involved m the t>piral health picture found m slums* Certam di seases __are ^t nore conu«onl> seen in ursuitable ho mes. .t ^phofd.and paratvTslioid arc twice as common Tn Rouses withtnii proper arrangement of latrmcs , common commun cable diseases of childhood occur more frequently and at earlier ages in crowded^than in uncrowded houses , tuberculosis, pneumonia and inJluenzU aic more prevalent Secondary cases ol tubcrcu- loJis are flO per cent h gher m ciouded than m uncrowded houses despite like lucomos Disabling home hold accidents are like wise higher in pcAir houses Delap dacrd conditions, lUvcntilatmn, faulty ^as con nectiorts aruni^dcquatc light, all contribute to it Standards of proper housing have recently been formulated These standards relate to llie prevention of disease tnd to the prolongation of life and contribute to positive health Comfort, privacy and pride m one’s home arc emphasised m the modern concept of community planning The mumcipahucs have framed budding byelaws The object of these bjeldws IS to prevent these buildings from be coming menace to health the safetv, the welfare and the morals ol the public CHAPTER VIH CLIMATOLOGY AND METEOROLOGY Defuution — Climaie niiy be defined ts the nvcrafc cw- dition f>f jhc leather It an> panicular phee over a conJidcnLIy long period of tim'* (Siy 20 to 30 ye vs) cakmg into consideraiwn abjol ite exirwnes means and how often these ore domed from, in thecveoftcnperaiure, rinfall atmojphenr pressure, sun- shine hnmdnv fg tmitetc This if a particwlv area Im a hea%'7rimfaU it %sjn hr spoten ofas having a mo»l ciimatc or if It remains usually Ik t it uotdd be tcnnnl is in area bavuij a hoi climite It depends upon the followins fictors — t Th' altitutlc or distance from cquilor 2 Distil c< from the aei 3 I/ieiItttudc or heii.Iit above sealevel d prevailing winds Eiist and North East winds arc amw p.irni\cly cold whereas South \\cst winds are min- bearmg 5 Amount < f humidity present in the atr 6 Nature of the soil 7 Proiimity of rnomiiams ind hills 6 Runfill The human liodv possesses marvellous power of adiptabllity to vino IS external carwluiotis occasioned by clvingci of chraatf and »f IS 11 and transition fmm cold to hpn dtvntssto humidity, and vices efsi In ill cises normal temperature is raimtamrd and Ijodily funcuc n$ ire properly pcr/brmetl Effect of CUmate on Health of the People — Ohmitlc cotsdiitons hive an importim enVci on heilth as is evidenced by the geographinl distribmion ind seasonal prevalence of the disease Tljc chinite is an important factor in determining the character sties of races of mankind It also cnccM tn the ranatioB of pigm*ntation in the skin Acchmitisat on n elTected by slow process of changes taking place e ther in the indivtduil «r in the mcc by connhunonal rnodif cations brought alimit by the successive grntfat ons \ ariou! ineicorolog cal conditions benr in importvit inflii enceonvhmuc and health rjffctt pj Ital Ch’ic/ on thr —It dtisei diminution oT tnciabob»tn sole«sanw ml cf fond ts taken U dimivivbes the ntc ot resp mtiun, retards e! minatiori of cvbondioxide from the lungs ind deerrises the amount r f urn m the uni e It c\u«es red jcti n m ihe * xyRcniition of blond and dmfiiiirTi sif d gesiivc jyjv cr \ft reover, die t* Im cl tniie rrrvcs are enervated the skin beer mts ictive and excretes profuse scat CLIilATOLOaV AND METEOROLOGY 169 ttjon Continued residence in tropical countries may bring about a languor both mental and physical, premature senility and •general lowering of the expectation of life Ejfecls of Cold ClimaU on the Body — It causes increased ■metabolism, so food is taken m large quantities Oxygenation of "bfood elimination of carbon dioxide and excretion of unne arc increased the amount of siveit is reduced to mmiToiint and the digestive power IS sharpened There is an mcrcase in both bodily and mental actwiiy Cold season, we know from expen- ence is more pleasant and invigorating and it tones up the muscles of the bodi The expectation of life increases in cold climates Effects ( fHu mtdil y on Hea lth — A large amount of humidity present in the air o/TerTa cluck to the evaporation fiom the lungs and skin It lias vcr> little drying power and therefore the moisture from the '■km and the lungs is evaporated with great difficulty, thus hindering the process of perspiration and impair ing normal functioning of the skin Moist climate is less healthy (liandryone as it favours the growth and development of miert>« •«rgani«ms and hastens putrefactive changes Tor good hfcalth, 75 per cent of humidity is best Effects ^of i ^erm Jifout _Atr__on the Body —Evaporation ■cannot take place easily and so perspiration is not dried It lowers the health and working efficiency to a great extent and renders one susceptible to sunstroke There js a loss of appetite and disinclination to mental and physical work The native races ofhumid tropical lands arc indolent and unprogresstve Effects of Cold and Damp Air on Health — There is a rapid loss ol heat and chilling of the body It predisposes to tlit alTcc- tJons of respiratory passages rheumatism circulation and kidneys Effects of Warm Dry Air on Body — A relatively dry air Xecls better than moist air almost teinperaturcs When the air 1 * dry and warm the rate of evaporation from the body is greatly increased Effects of Cold and Dry Air on the Body — All the body functions are more active breathing is deeper and more frequent, the circulation of the Iilord is increased, processes of digestion, assimilation and metiloh m arc stimulated This climate is irorc bracing and invigorating The skin becomes dry and cliapped Effects of Hish Alltlude on Climate —There is diminished atmospheric pressure, rarrfacton, ara pnnty ifair, and humidity of the air IS lessened There is considci -vble mere isc of sunlight, On account of brisk hfowirg of the air hforcr v cr, there is a large ■amount of oionc present in tlie air and it is also free from germs J70 K\Q^! M vvo runi.ic iii'Ki rn and dirt Tlir icnpemtiire }»Mcr As n KcHfral rule temper'*- turc fall* -xboul I*I f^reverj SOOfectof altuudc or 1' Jatuude, and pressure falls, about 1 lb for eiienr 1000 ftct iscriit A condition kno\m aj “\roiiniam Sictnesj” is considered to be du** to the mnt^ ol tl r aiiijosplicfc mid diminution of oxjtjen ai pre-« hciglns TUe s^-nrpiom^ arc deep bmtlung tjuick j«lsc, c^nosis imism, iicadriche, mCestinii disturbances nnd fttnlnij, Illeedm^ fiurit tbe nose rin^m;; in the ears ind pilpinitn of heart arc not itifrrrjiicnt ssTiiptoms I fft tt iiis sulTi nni? ffoiu phthisis m incipient stage Piters shelter* cd fromioid ssinds should be selected fir rcsidcniial purposes It It ilso d for persr ns s«nef\n„ fnjm inictnn tja'inodic mthma ntlhotn ctnpfnsema and elinmic pirurisv High altitude ishoncscr h ul fir p'rsons sufTenng front clironic bronchitis rm* pli>ieina bronrhiretasis diseases of bean and great vissch, afTecii >ns nfk dnc7s beer and those of the brain and spinal totd I Jfetit of Incttastd Almof/heru P/fssur/ on Health —1 hi* is sprn in places bVr mines, submarine voiVt and bridges 1 h«e 1 * an inrrcasrd rption of oavgrn In blood 1 ht f IPects hnossai «is C aural s dwate arc found m the iturLers working m cottiprislerralrdnntber* The s)'mp oms are piin m the ears, «tcruriatmgpiin III joints and iniisejts vcrti,o rpigasirie jciui and V itmun^ Tliere nia> be app-atance ot headache giddiness cjMst ixjs juraly is etc ’vimetimrs death tiia) txxur from mlcr- iial Iiacntorriiaqct Tbr-e symptoms do not app-ar, sshen the men arr working ins dc but appear rapidly whtn tiny ertne outside tt^-ciracrd pressure of throw sidr air causes swd Jew libe- ration tf ahsorlicd gases from the tissues and blood of the wt rLrrs To prevent this, ffmimprrssion slioidd he ilonr (.radinllv li\ jiro- s idiiif, one or more locks on the exit pass >gr I ff ets of Rainfall on Chnate —It w ashes down miptinties and niicrobis eonl imrd in the aif ilms r-mlennc the AinHopbcre cool fresh iud mvim rating U reduces die am » spheric piosurc rjftcU of \ (iitniion or Chrnetf egciati >n in moderation imprtpvrs iiie.clutu,t.c bv keep mg tK^ arr cool artl ct^tutah c and coumcr let* the elTects cf rldiJlioit fo in earth IShere there IS ro \ej,etaii >n as in deserts itl'adsto a great aanition I he deserts aic \er* I r t durn r tic day nnic but temper itiire falls diir ni* the night vei) cuiH dcrably iwiipg to rapi 1 raihw m ■ CLIMATOLOGY AND MFTroROLOO\ 171 In cold climates, the trees and shrubs obstruct the passage of the rays of the sun falling direct to the soil, which i«, there- fore, liable to be cold and moist but they may prove to be of great help m protecting the place against the cold winds In hot cUmites, the c\aporation of water from the leaves of the trees tends to dry the soils and lower the temperature The ground is sheltei ed from the dir'ct rays of the sun by the leaves of the trees and thus keep the place cool Hence the heat of summer is reduced, and the cold of winter IS tempered with by the presence of trees Places grown with trees have comparatively lower tanperaturc than other dry places having no vegetable groivth thereupon In very dense forests the air js generally stagnant ML‘l>OROLOC\ It IS a science which deals with the atmosnhcnc phenomena in relation to weather and climmc Weather —It denotes general cond tion of mr at any stated period or time or more scientifically it may be defined as the state ot atmosphere at any particular time m relation to its temperature Msibility, humidity, precipitation or any other meteorological phenomena Atmospheric pressure —It is determined by means of i barometer The most commonly used is a FozIiaj _S tM dard UaromeUr Tirsl the reading of the attached thermometer is noted In this type of barometer the cistern is made of a pliable base of leather, winch can be raised or lowered by means of a scrciv Before taking a reading, the level of mercury in the cistcm must be adjusted A sliding vernier is also attached to U The Vernier is adjusted by means of the rack and pmion at the side of the barometer The barometer roust be fixed m a properly lighted room protected from sun and ram Another barometer used ix Aneroid BarometeT It contains no mercury It consists of a small lx)X, which is exhausted of air and contains a senes of springs The pressure is communicated by these springs on the dial, which has been graduated bv com- parison with a standard mercurial barometer When the atmos phene pressure increases, the spring IS pulled down, whereas if the pressure tfimmishcs, the spring rises up “nns insirummt is easy for transport and is used for recording altitudes Temperature — Tins ts ascertained by an instalment called thermometer There arc three kinds of t hermometers w Inch are commonly used They arc as follows — J^ame oj /A«rmi7mf/fr point Boilino points 1 lahrenheu 32 212 2 Centigrade 0 100 3 Reaumur 0 fO 172 jacitNL K\D rtniic iiuLTir Several kinds of ihcrmomctert nre used m India These are — 1 Sunward or Dry BaVt Z^trmonrUr —It is an ordinary themiometfr 2 \fa*»77ijwi Thttmornttn — U is used for TCKisicnng the highest temp raturc attained m the da> or an> other penod 1 he therniomeier is laid m a horizontal iMSition In the stem of the thermometer part ol the mercur> column is separated by air When the temper iiurc rises the mercuiy catpsiids aid pushes this broken column fnns ud Bui this column docs not recede ivhrn the icmpeniure falls and the maut mercury column contracts The reading taken md cites the miximim temperature during the day 3 Tht Minimm Thtrrrameter — It is used for recording the loucst ttniperatiire during the mgl t or at tl c iimcof the early hours of inomm(, A smalt glass index is enclosed in the spate ishch fills the bulb and a part of the stem When setting tie instrument the index is first brought tt> the top of the column of the spirit and ilic instrument placed m a horizontal potinon When trie temperature rises, the ipini «pmds and lloi -s twst the index but tUicn the temperature fills the spirit contracts and carries the index along uith II The lourst tcmpcntiire is thus rcf,(»tcred flic insiru ment cm be readjuited by tilting 4 i?ix j V/ajcurum and Jlfjrimuffi Thtrmom/ier —It is t coinbinit on of maximum and minimum ihermom'ters and RU es 1 double rcidmg It is n U shaped tube h uing a bulb at each end TJic m ddic portion of it contains mer- cury Both the tulics afa>ve tl c mercurv and one of the bulbs contains alcolnl ard apirtoflhc other bulb coniams alcohrl vapour and air lu each stem there is an iron iiulrx which cm be tnoicd nnil ad juMed Wf x •m'ivTifs ViVdi v\\e tv't of temperature alcol ol expands and pushes sheneicury md sv th si the iidex il^o j,tis pus| r the Ollier stf m NS ith the fill of irmpeniure the olcolol ron tracts md the merrury fills and it pushes up die index ui the other column In this ^ «- 3 * S » • TJ^fmer’rVf CLIMATOLOt,\ \M> MEli-OIiOLOG\ ITS ivay, tJic highest and the lowest temperatures arc recorded by the indices in the right and left limbs respective!) 3 Solar Radiation or Vacuum Tkermometer — It is used for measuring the intensity of heat gisenofTor radiated by the sun. It IS a mercurial sclf-regiMering thermometer having a bulb coated with lampblack to absorb the rays ol the sun The bulb is placed in a glass case in order to prevent the coating from being washed away by ram The instrument is placed honzontally about 4 ft above the ground, away from the walls and the trees, and exposed to the direct rays of the sun The difference between the maximum temperature in the sun ^nd m the shade IS the amount of solar radiation ‘‘indicated during the day” or of the power of the ravs of the sun 6 Terrestrial Thermometer — It is a minimum shade ihei- momclcr placed dose to the ground, the bulb resting on the grass about 4* above the ground The difference between this minimum r Ig 30— T«rfwir»*l 'n>''TinoTi)eler temperature and the air minimum m the shade IS the amount of terrestnal radiation Hamidity — Tins denotes the amount of moisture present m Uieatr The nr absorbs moisture b> evaporation of water from the surface of ocean and other surface collections of water. The amount of water vapour absorbed by air depends on its temptra- 174 mGrF^^ AND Pt'RLIC ULALTir tur. The htghfT the temperature the greater is the amount of \^itrr vipour it can hold at tlial temperature Aisdlule — The actui! amount of moisture present m a given \oIumc of nir IS called “absolute humidity” It is cx. pressed m gr-mmes per cubic feet i e the weight of moisture contained in a kuos'in volume of moist air luhtff /fjmidilj — It IS the ratio expressed as percentage of water v-ipours actuaUj present m the air at any giscn tern pemiurc, to the nmouni that would be present, when the nr of same soliime, IS Saturated at the same temperature Thus if the maximum anioiml It taken as 100 and the atmosphere contains only half that amount wcaay that relitivc hiimidiiy is SO®* Dro Poirt —When warm, moist un saturated air is cooled to i point, at which further ronlmg will emsc coiidrnsa tion the icmpcraiurc is known as thedav point It 15 the tnnpcii'iire si whici air becemes saturated with moisture —The amount of mois lure preseii m the air is registered by wans of hygrometers These are of two types / f direct and indirect hygrometers rheir examples are asfolloavs — 1, Direct — -ftf) D miell s Hygrometer it/') RegnaiiUs Hygiomcter (<} Dine 5 Hygrometer 1 Irdtral — (a) Wet and Dry Ilulb 1 liermomctrr (I') Psa chromcmr nV< and Dry IJu'b Tkeitri'r-etn — In tins type of ihrrmjmeter, iwo tlieimo. meters are mounted side bs side on n stmd It IS used to measure the prrsiitrr r f acyucuvis aajioura m the air The aari bulb IS kept rons'ariih jnom h\ means of a pua e of mudiri cloth wr-pprd around it and dippir^ into a nnall sesse) containing waiCT I h s water «m c\ ilNirauon, aliwitlis h*'M. from the tlenwarvetev with tlie re'iilt tint the Icniperatiirr liidcitrd by til s tlierinotneter is mitcli lower thin that given by the dry rme The d Ter enrcmihetwo howeter, deoend* on the rapuf ty luihwlich th'* e\ap»rati)n pro fig tO-Wai *rl Atj Colb il^men^wr CLIMATOLOGY AND METEOUOLOGI 175 cecds and the rate of evaporation depends upon the temperature and the humidity present m the air If die air is dry, the. evaporation will be rapid and the temperature of the -^et bulb •will be much below than of the dry one This difference ciiab'tcs 6ne, by means of tables, to obtam the percentage of humidity, the Dew point and the vapour pressure of tlie air The instrument should be kept m the shade and protected from th>: air currents and direct sunshine Kata Thermometer —It is used to measure the cooling power of the au: at a given time and place Winds — These arc produced by the dis- turbance of equilibrium of the two masses of air m a freely mobile atmos- phere The causes of these duturbanccs are the difference m atmos- plicnc pressure brought about by changes in temperature and mois- ture aided by physical and other factors of the two masses of air Weather Cock or Wea- ther Vane — It is an m strument by means of which the direction of the wind IS indicitcd It consists of a balanced lever, turning on a verti- cil axis, the broad end of which is exposed to the prevailing current of the wind while the narrower end points to the direction from which thewmdmaybeblowing It is fixed on highest point oflhe budding Anemometer —The pressure and velocity of winds are recorded b) this instrument These arc of several varieties One Commonly used varict> anemometer is Robinson’s Wind Anc- tnoracter It comiMS of a metal wuh hollow hcmuplicric cups fixed It their ends and rcvohing horizontilJ) on i \ cnical axis, which by imngcmcnt of screws, records the movements on a dill 500 of Its revolutions make up a mile The velocity can be deduced therefrom This nstniincnt should be kept clean and properly oiled It should be fixed at l--asl 20 ft high from 176 inOlfNf AND PUBLIC nrAITil the ground The avenge \cIoatj of %\mds ts from 6 to 0 milcj- per hour Sonshhie Recorder — Tlie hour? of bright surnhinc arc recorded by tins mslrumetrt Vinous t>'pe5 of junshinc reoirderj •j? , Campbell, Stokes, Mclcod s, Jordon s, Isohcl s tit , are avid* tlilcrnlhc market Hie standard t>pcof sunshine recorder emstttsof a glist sphere onwhxch the rt^s fall and the image i* received on a stnp or a millboard, at the proper focal distance and makes a burnt track when the sun shtn"^ The sunshin* should be measured in liours and tenths of an hour and not tn mmutes I g 4Z—*- Mt »• Clouds — 1 h's'* coimn of nasiet « f viprmrs condensed into minute nntcr panicles i>Iii h fliat in the air m the higher regions of aim jjphcrc ininll) fioin one to four miles jl»\e the surface of earth A clf udiine is the level below which the firmation of clouds rarely takes place Classification of clouds — (A) — Highest clouds — With height GfXX) metres — / Ci/ruT — Diey nre white and fraihrry looking They are probably comp'ised of small panicles ice 2 Cim stretut CLTMAlOl0G\ AND OTTI OKOLOOY 177 (B) Clouds of mean alututlc — With height 3000 to 7000 metres — 1 Cumitlut or heaped up masses resting on straight bands and having appearance of hills or mountain' They arc most common in summer and during the day (G) Low clouds — With height below 2000 metres — 1 Slraljs or honzonolxt bands — ^These arc horizontal sheets whicJi are seen at sunset and disaj^ear at sunrisr They foretell fmc weather Tliesc arc lowest m elevation 2 Jivnbus — They are dark masses discharging ram or snow Besides these which arc primary forms there arc several combinations of these clouds Mist — ^It signifies susp-nded liquid droplets generated by conden^atjon from gaseous state or by breaking up a liquid nto a d spers-d stale Gencrallv it is spoken of as a cloud near the earth * Dew —In th s ease atmospheric moisture gets precipitated or condensed on the solid substances on the surface of the ground Tltc dew point denotes the temperature at wh eh water vapour, already present m the moisture, is tlie maximum quan- tity, the air can hold or m other words u is the temper iture at which air becomes saturated with moisture Fog —It IS a cloud resting on the earth and occurs wlicn the surface of the ground ts warmer than the air in contact svith « The hoi air rises to be condensed into fog llauiiall — Rain is (he result of moisture condensing and coalescing to form drops of svatcr and the rainfall includes all moisture fall ng in parti culatc drops Tins is measured by an instrument called Ram Gaugt which consists of a copper funnel leading to a receiver made of glass Die funnel has a sharp nm and usually five inches in dnmcltr The ram having been collected in the receiver ts measured m a glass cylinder, svh eh is graduated to correspond with 1/lOOth of an inch of ninfall I he reading is generally taken at 9 A M daily The ram gauge should be fixed m the ground to such a slip li, that the edge of the nm remains at least 12' Furcd m iheord mr^ mj An inch of ta nfiU represenw 22 €17 gallon* or lOl tons of water per acre or 1 67 gallons per stjuire jard Roughly one foot ol tnoiv rna} be taken to reptcsci t 1' of rauifall CHAPTER IX MEDICAL INSPECTION OF SCHOOLS As the school children arc the future citizens on whom the progress and welfare o'" a country depends it is of paramount importance that they should be educated under sanitary and wholesome conditions Moreover, the impression^ formed by the children m their childhood are deep and lasting ■Unfonunatcly m this country, subject of school hygiene had rather been neglected Althouf^h of late years schools of a more sanitary type have sprung into existence as compared to those m vogue previously, but the conditions at present are still far from satisfactory Keeping in view tlie ever increasing number of scholars, it is evidently clear, that unless active and energetic measures are taken to safeguard their health in every possible way, the future generations arc likely to suffer physically and consequently mentally It is high time therefore that something u done to tackle the problem of school hygiene eflectively The objects of the Scliool Health Service arc as follows — (Q to build schools on modem sanitary lines y{tt) to appomt suitable medical mspeciors or school medical officers ✓fill) to make provts on of an adequate system of medical inspection of all children at least thrice during the school life or ofiencr to asccnam the health condi tions of students and to detect the presence of con tagious diseases and physical defects among them and suggest their remedies (ip) to establish school clinics -^(p) to segregate cases of infectious diseases and cstabli«h centres for the prevention of the spread of thc'c diseases (pi) to teach the practiccof hygiene and hcaltliful living to students both in the school and at home Site — The school should be centrally situated easily acces- sible to students and should be situated at a d stance of at least 60 feet from the mam street so as to ehm natc the nuisance of noise which Uistraas the attention of pup Is and teachers and prevents them from concentrating on their stud cs The site should be elevated and well drained and should not be over- shadowed by tall buildings or trees If possible a field or a pub- lic park bhottld adjoin u The area of the school should be one acre for 1000 students A play ground should be provided at the rate of 20 square ft per child, which could also be convcmcntly utilised if need be for open air teaching 1(50 WDjbmir inuTii Bnxldiag — ^Tiic school l>u\Mmg should not cNcrctI \\st> store)* m hcjaht ts a rnulrmorc) rd building is dilTicuh ta csacu-itr m cases of ouib eak of fire or in the event occurrence nf an iccidcn* As rt «ardi the of ilic hutldinij tt should l>r of ihe pisil on ij-pc constructed like the \\-o''d “L'’»nNsIucU the rli>s nxnns open into the vcrantlih .me! the h til it qtiite separate Ihii sort of tT tnscinent provides tdeejuate \rnti- litiou I r , ur anti light to rU the rootjis t>f the builduig Comdors should hcGioUfe-t wide and the v.od h of the sn»t* cose sh «ild ht aiwut I feet with 0 dr>orwav tpcnins: ou side, provided tithe lyittom of the 5*tirct«c as n facilititis the escape of children m ease of tn outbreak of lire Laeh and even ptaof the school huddmg should he constructed fire pnxif vs i-'r av potable hr«eeovef, u should be prtuidcd with a neccisarv picca driin surrounding the plinth At rcpnrdi euhic spvec, a tn niinum of tlie 150 cubic feet per pupillns been I vid down Ml 1 nghnd The fip>o- spare should be from 10 to la squvn. feel so that from 1500 to llKX) cubHfret of freshvir p-r held is iimccl at Tlie height of clmrooms should not be less ihanlSfett CHss rooms ihntild be (ui the sides, vwav fmm roads and should prefctahl) face Sou'll or SouthLast for sunlight Pachofthe rooms should be able to accomiiioditc 2 jO() cbddrcii Rooms should prertfabK be rectan!6pjUr, the width being two thirds of the length A cleat «pacr of not less than 7| feet eatendmg ahe full width of the room should be left for the teacher Ihere slnidd be left about one foot of open space between the lavi row ol desks and the viull and a gangway of notices than I } feet from J to 6 feet. rioors should be made of imprnneahlr matcrnl w ith smooth surface to facilnate cas> cleansing 1 he interior wall* should be p unted or distempered to pcnnii regular vt vshm^ Ventilation — I’ltijirc ventdatian dunmUlics the chanc< i of mfeoion, lessens fiiigueand eyestrain I'amnnn ofanifitial ventiiaiioii sh luld be avoided IVmdo w should hr placed on the njipiaitf sides of the rnom and all of theaeiliDild bemideto opi n if p jwihle, to llir external air Morcov er, tfifsc should be siilTi icntly wide and the vent lators a* far as fKjssibfe sh'iuld reach a\ high as the ceding of the room IJgbtlng — Nitural ligh inp should be p-ovulcd to the school buildirt, bv the pniviv otioT a large n irtber of u lut iwi and ventilators lVr]x>ft;rnorthc glastarca p ovided m the wall* should be onrsLatli of tlir Pj' bulb thermometer should be hxecl in every class room and permissible range of dry bulb should be 60" to 65® V and wet bulb 58® to 61®F. IVarmtnn nf Class Rooms : — ^Hot w’ater pipes are the best for the purpose if need be. Fnrmture : — ^Thc most important item of furniture for the classrooms is seats and desks. Single scats arc considered best. In order of preference, come the dual seats. In the former case each child can be accommodated with the size that is mote suitable for him. Moreover, the spread of mfectious disease-, and verminous conditions can be cheeked by providing single scats to students. The Sheffield type of continuous desk with six separate scats is preferable to a long common scat and a desk. Requirements of a Good Seat The scat should hold two thirds of the thigh. The from edge of the seat should be round* cd and its hciglit from the floor should be such, that when the child’s feet arc resting on the ground, the legs are in the vertical posttlon and the thighs in the horizontal position. In other words, the height of the seat should be such that the feet should not remain suspended in the air and the scholar should he able to rest his elbows without raising or depressing the shoulders. There should be a provision for backrests suitably curved to the body reaching the level of the shoulder blade Ihfsks yhouJfJ 1 a? from 15* to IS* broad, anil slope at an angle of 15® and 45* for writing and reading respectively. It should be vertically dutant from the scat. The edge of the writing surface should almost fall m a straight vertical line with the edge of the seat. The slight overlap is rather better than the gap. Desks arc classified into three varieties depending upon the rela- tionship to the scats ; — 1. Z^odesk ’. — -When the edge of the desk is vertically • 111 line with the edge of the seat. 2. Afuttis desk ; — When it overliangs it. 3. Plus desk : — ^VVhen there is a gap between the two. Zero and tacaus desks arc suitable foe reading and writing". 182 niciENC AN*n rni*Lic Scats and dcil.s slinuMhe ndjuucd totlic rwjnifcrncaw of scholars tw cc a > car for ih** prevent on of cve'irnm nmj fa Jjuc As^Hi grow rnoit beu\cenihc igc* of J2loH and bo)-» between HtolO o >pccta) care should be taVen dunng tlicic ages Math ■»{ — These should not he spread t n the floor» when desks and seats arc uicd, as ihcv nre not hv'gjcnic Black ISoarJi a d \Japt —Black boards should hive dull surface Maps also should no be glazed Posttiee — C ire should be taken lint the siuden s do not acqj re pi)siril defects dun i their sfJio>»llife loo much stoop ng leids to rn>op i eomric » the chen mterrcrcs with resp niion runes the »pinc ind puis stntn on tl c heart Provision of meals — Meals ire general!) not provided in jchwih in ill s counirv h ts rtcommended tint it least one lucil sh uid be provid d espcciill) in p itmr> «chooJ«, free to p-xir cijcj iiidon pivincnt t* the others Iliis nv*il should con nn protective ( »jds in sufli cn q iintuy Milk and frit a arc especially rccirnimcnUed f >r ilus puf 7 v>sc There should I « licenced vendors wJ o keep the irt ries eJe in and covered freun Ihcs u cl dust Sanitary Conveniences — Provejion should be mide for privies and unnals which should p efcnbl) b" placed m the playgriiind Uriiwli shoul I be cons ructrd of glired parcehin and should be provid d with autumi le flishn^ irraiiL,ctnent There should be apovmon of at least 5 cl nett and in equal number ot u mils ior cverv lOil studema N >nc of the closets should be mnillcri willj more thin one aeit \Sa^rrT:lrrtelv dtc of course the hest irrar^emeiH, bn in rases where vsater carnage system h not in vi gue conservancy nmngemerts should be midc In die case of pnucs i sweep-r should be engaged to clean the privy ifier each visit The disposal < f niehtsoil must he rceuUrly aitcndcd to If funds illov?, latnnes with tcyrtc Jink irramemrir, nii> be set up under s inable iimtiry cond lions ■yVaterisapply — Drink ng witcr should be p ojwrly protect edfromrettin coniatn nated In plices where there it no publ c venter iipjsl), the well or the rank s’vj ihl I r pericKl cillj inspect eti ind 1 sample of v%tter taken (or chemical md Iwctcriol sfi cal examination The use of i comn n glass n cum) )cr iho ild 1 c av» idrtl It IS better to drink v^-iier il rrcllt from the tap Drink ng fountain, v*hirh delivers ijct tipwaftl tmv be i i ailed vvli'-rc jyjssthle Cleansing of Sehootn — Slihe end o*" die da) s work all she schwlnxiins should be n»*rm Olive a week the fiimiurr ireoiru iNSprciiov op sctioois 105 should be taken out of the rooms and the floors scrupulously scrubbed and swept Every effbrt should be made to prevent a dusty atmosphere in schools School Health Service — Vf-dical m^n with special expert enceof infectious and skin diseases, should be appointed Thev should have knowledge of examning the eyes, cars throat and nose Appointment of one m-dical insp ctor for 5 000 children is the standard aimed at Besides, dentists, and ophthalmologists arc also required Notle«than3 m p-ct ons should be made dunng the schooiltfe of a child i r , — fa) Shortly after the admission (b) Bettvecn the ages of 8 and 9 (c) Shortly before leaving the school Defective children require m>re thin 3 (i e frequent) inspections The medical inspector should be d"lcgated with the power to exclude any student from school for the following reasons — (a) To prevent the spread of infectious diseases, \b) If the children arc unclean and v rmmous, {€) If the children have any mental or physical defect. X>atie8 of the School Medical O0iser or Medical Inspector — 1 He should render advice requ r ng the selection of sites and making of plans for the building o'* new schooU 2 He should penod callv inspect all school prem ses with special reference to lighting, ventilation and other sanitary installations and see that these buildings are repaired annually and whitewashed once in sue months 3 He should inquire into the cases of outbreaks of infectious diseases m schools and take all necessary steps to arrest their spread 4 He should advise periodic dismfcction of all school buildings 5 He should examine all students attending the School and keep a record of their health and also submit monthly as well as annual health reports 6 He should draw up a system of physical exercise for the school 7 He should note the elTects of desks on the posture of the students 8 He should exam ne every child who is reported to be suflcrjig from any disease, defector injury and give necessary directions 9 He should give instructions to teachers regarding common ailments and defects of scholars by lectures and demon- strations and give first aid and hygiene training to the school children J86 lIYOIEi.E .ANTJ PUBLIC IIEVLTII 2 Rectification of sanitary defects, not as a matter of mere routine 3 SicknciS m teacher’s ratnil> mvalvmg risk to students Special Schools — These ma> be opened for mentally dcfec- tivci, for the blind, tile deaf and the dumb In some areas, special residential schcols are availabtc for epileptic and cripple chddrcn OpenaiT Schools — ^TTicse arc cstabhdicd in certain countries for ncak children suffering from adenoids, tonsils, rickets, malnmniion or anaemia, lor convalescents from pneunonn, measles atwl other di, dehoquency oi ner- vous mamfestaiions ol some kind The t>pical childgtntlancc clinic IS run on a team basis wuh (a) the Child Ps>ch'wnsi the Lducitioml Ps\chologist (c) Ps^ehiatric Socialworkcr (d) Psvchotherapist In many cases a littic simple advise to the paierts suffices, m others simple thcrapeuiic measures tilth some play theiapy may be neecssarv In the more setere cases, however the child mav be re<|uiicd to leave his home and u then sent to a hoarding scliool or hostel and attends a different school, while obtaining treatment at the school or hostel CHAPTER X Maternity and child welfare It IS a seivicc m'lintamcd for the supervision of health of mothers and children It is only n the recent years that tho importance of this branch of public health has bre i fully rea- lised in Western countries In India maternity and child wel- fare and ns associated activities arc still m infancy To have a proper idea of our present backwardnes-, one should look at the infint mortality and maternal mortality rates in India and compare them with the corresponding figures of England and USA Infant mortalily rate —It is number— o f death? m a year, under one year ol age per 1,000 births ' MaUrnal mortalilj/ rate —It is the number of dc^hs of women due to, or asso''iaicd with, preg nancy and c hild birth per 1,000 birUts In theory the rate should be expressed per 1 000 pregnancies but complete not fication of pregnancy could never be achieved, so we must be contented with current rates India Lngland USA Infant mortality rate 127 (1050) 30 (IOjO) 29 (1950) Maternal mortality rate 20 (191 d) 0 63 (19j1) 0 9 (1949) Abortton —It indicates cTcpulsion of foetus from any cause before It IS viable, i s, before the 28ih week of pregnancy. Slt(( JJiTth — It 5 gnifics the birth of dead foetus at a period at which It IS viable Causes of /n/m — This is the most important single cause or matemalraortahty Then comes anaemia cclampsm and other toxaemias, shocL ante and post partum Iiaemorriiage and embolism Abortion i> responsible for certain proportion of nmcmal deaths oiving to seps s or other nuscs Precention oj Hi''h Irfan' end \fa/rnjai Morlali^ RaUs — The foUowmg hicasufcs should be adopted — 1 Appomtrnrnt of lad} healthiisitors Thev arc trained miawnes, \\hoha\c obta ned Lady Ilcillh Visitors’ flip oraa bv undergoing naming in a Hcahh Scliool for \ period of one md a half years 2 t'mvisiort of iftatcrnity and child welfare centres ind chines for moihers t e , education of mothers mmolher craft in general, and expectant mothers in pirticular 3 Opening of infant mtlikdepots u here milk is given free or a’ nominal pnee to the poor i I' oviding meals for poor expertant and nursing mothers 5 Openmg o'" cr«A« or divmiTsenes for factory o’" working women Here working mothers can lease their babies to be iookedafter whilst they arc away for ihcir work 6 Sfatemtt} hospitals and nursin{,home5 should be provided 7 Opening of schools for training of indigenous da« midwwes and ladyhealthMsnota No untrained dai should be allowed to practice 3 Publishing of leaflets Rising instructions regarding ihr maternity and chtlduclfarr work and delivering Ketures and conducing classes m connection with child welfare wxirk Duties of a Lady Health Visitor — She should be a tram- •cd woman holding a diploma Her duties are as follows — 1 Amc or Prenatal work — She \isiu mothers in iheir homes, instructions to cxpectantmoihcrs, advising them htnv to remain healthy during preg nancy and make prelimmarv and necessary prepan tions for the coming esem ■'2 Systcinaucally stsitmg and supervising all children bom in their area and aI«o attending to rheir mothers This IS called postnatal work ' 3 She attends the matermiv and child welfare centre One lady health visitor is enough for 200 to 2 10 biirhi per annum She has under her care aliout COO to 700 preschool children 4 She iirprovei the home conditions of mothers by ren- dering help and advice MNri-ICMI-i AM» CniLTl ^V1 IF\RF 189 5 She v^cighs the children who attend the welfare centre periodical!) A steady increase m the weight of children being a sure indication of good health and progress 6 She instructs mothers regarding infant feeding and mothcrcraft, (generally abjiit the dress, bath etc ) 7 She treats minor ailments of infants and iheir moihci s 6 She helps ihcmidwscs and dais m case of dilTicuIt labour IVelfare C^Ktre — ^These arc established under the supcrvi iion of Medical Officers of Health The essential provision for such a centre is a s cl! q nbfied lady health visitor, who is assist cd by a named dai The centre should cons st of — 1 A « aiting room 2 A consultation room 3 A small dispensar) 4 A ivctgli ng room 3 A la\atory adjoin ng the waiimg room 6 Stair quarters foj the ladv healthvisitor and trained dai m close prox miiy to the vrel fare centre The staff should consist of — / A laly healthmitor — One lady health aiutor can annually auend to about 200 — 240 births, 200 infants and about 600 — 700 per school children A ladysupennXtndei I —She is a voluntary honorary lady worker, who can afford to spare some time to assist the lady health vis tor m her work •^Z Avistltng lady mcdicaloffcer — attends the centre once or twice a week She is a specialist in diseases of avomen and children and runs antenatal and bah) clinics 4 Dots — One or two irainrddais or mid waves arc attached to the centre to render assisian e at the time of delivery to poor and deserving mothers 5 Sfitaalists — In some of the centres venereal ortho, pacdic or dental specialists also attend the ccntic once or twice a fortnight The Jadj hcahln isitor obtains reports of bjrths from the office of the registrar of births regarding her area and then assisted by a few voluntary lady v orkers or tramctl dais attaciicd to the centre visits their 1 omes and giws practical advice and stimulation to ensure that the child istukd over the dangerous period of its first 12 months of bfe Mothers should be well advised to attend the centre periodically which should be easy ofncccssand if possible there should be opened a tvcJfare centre- 190 inOICNL AND PDDLIC KEILTH mthe lady health Msitor s area The chief \'aluc of the centre iS 10 provide medical and hygienic ndvicciothe mothers who should be urged and persuaded to bring their children to the cen re for periodical checkup svhether they arc ill or not If possible the s'lme medical man and m this country the same medical woman should attend at suitable uuuvals, say twice a weeJ' There should be arrangemem m the centre for weighing and raeisunng babies and lo- carrying out tcsifecds etc The watting hall should be used formothcr’s meelmgs hold ing demonstrations and delncnng lectures to mo hers The walb should be decorated with instructivcdiagrams and charts Lcnlleis m dificrem languigcs should be giving instructions regardJig maternity and child welfare wnrC Annual baby shows ma) be held in the centre In some centres provision for cheap meals for poor expectant and nursing laolliers need to be made Milk should be supplied free or at nominal cost to needy mothers and children Provision of trained zmdivvcsand dsisfor the poor and needy mothers at the tune of confuiement should also be made In some centres dental or venereal climes and clinics for orthopaedic work, and ultraviolet treatment are also provided Scope of Matenuty and Quid Welfasre Work —It ts — (fl) Prenatal or Antenatal (before delivery) (6) Natal (at delivery) (<) Postnatal (after delivery) (a) Prenatal or Antenatal ^Vork — Provision should be made for the pccgn^ni or expectant mothers to be unde expert iDcdtcal advice and for this purpose prenatal exarmnattoQ be held weekly at maternity or health centres or it a recognised place If necessary, pelvic measurements he talcn to take note of the prevalence ol rickets and pelvic malfornuiion Urme should be tested mall cases and careful record kept to know of eclampsia The bloodprcssurc is also noted In these cluucs many of the maternal diseases which bring about death m newly bom children can be diagnosed and treated 1 reaimcnt of m nor ailments of women and children is done m the centre AnicJes like va icoscbandagrs, pessaries, and drugs like castor oil should be sold to the mothers at con price They should be examined every month for first six montlu and every fortnight from sixth ttwnth onward A minimum of three medical examinations arc necessary "I he first complete cxammaiion should be done between l5Ui and sixteenth week of pregnancy to ensure that woman is fit for the strain and detect such abnoimahues as syphilis, tuberculosis, early toxaemia and MATLRMTi AND CHILD WE LI IP E 191 anacmt'i Her daily routine is to be chalked out The second cxammation is done about 32nd to 36th week to diagnose the ■presentation, position and to carry out obstetnc manipiilition, which may be necessary The third examination on 38cii or 39th ucek IS directed for the detection of nny disp oportion between the head and the peUns Unne and blood pressure exammation IS also earned out, each tune the mother visits the clinic Lady hcalihvisi ors should periodically visit the homes of expectant mo hers, particularly ii they arc not regularly attend mg the centre Provis on of maternity hospitals should be made in which all comphcaicd cases of pregnancy should be dealt with by the ex- pert medical staff The other activities arc grouptcachmg of the expectant mothers regarding mode of 1 vmg care of bowels nourishment, •work, exercise bath etc Arrangement should be made for the 1 -supply of extra nourishment and maicrniiy ouJit to poor deserving moihcfi Clmic meant foe antenatalcarc should perform the following functions To render advice to expectant mothers regarding the special Itygicnc of their condition and prepare them for confinemeiit •> *^2 To diagnose serious troubles bke cardiac and pulmonary diseases, etc 3 To render advice on minor disabiljiics of pregnancy, dyspepsia constipation etc 4 To examine urine and palpate abdomen Internal examination should be conducted only where indicated by history or any particular symptom (b) Natal Work — 1 Domtabary Midwtfrry — A skilled and prompt assistance should be available to the expectant mother during confinement at home which can only be done by providing trained midwives or dats who should always be avail- able m the centre They should be provid d residential quarters near the maternity centre so that iheir services be available at all hours This service is less expensive, and simple to arrange It IS safe for normal confinement even in the housing conditions which are not ideal, but it is unsafe for even minor obstetric interference Tor domiciliary work in urban areas, a provision of one midwife for 100 births is aimed at, but m rural areas, due to great distances and poor means of communication the provision should be more generous Medical and consuUantaid, transport arrangements and sterilized maternity outfits are essential to complete domiciliary midwifery service 192 A'JD Il>nLlL HF\LriI 2 Inttiij to'iil Stm s — Ittsnccdc'l fo- abnoTniHabour^ for normallabaur of piinp»r.i aad for imthers whose home^ conditions arc not suiliblc for dstniciliary radivifcry Sick uomcn with contracted peUis cr those suJTerin" from anv other abtionna\itv irvoJvmg dan^T to life of the mother or infant are confined at a inaternii> hospital 3 J\ uTSitig hovies should be p ovidcd for the confinement o^midivifcry coses (e) postnatal Work — I The reg strar of births notifies the birth to the ladv heokhvisuor in her area She should resort to home v s tins* and urdertake the treatment of compli cations found whether m mother or m the child She should tram the mother rcgirdirj infant fecdnsind the method of vveantt «■ the child bhe should also deal iv ill the p oblcms of clothing bsihing teething habittra ning ond m nor ailments 2 The lady health visitor should visit ctcr> infmtoncea month and cich child b'tween I and 5 years of age at least once m every thret months 3 Baby or infant elm cs should be opened where sjottema tic advice should be given to the children regarding their welfare uptn the age they are not adm tted to a school 4 Dental and venereal clinics should be opened at suitable places 5 Arrangement should be mide for the sale of clothings to the poor ivomcn ot cost price 6 Provision of milk and food depots for mothers where milk should be supplied to cxpcctontmothcrs infants and imrsingmothcrs at nominal charges m deserving cases 7 Creches or da) nurseries should be provided for working mothers where they can leave their Inbics to be looked after by nurses before going to their work. 8 Treatment in hospital under the expert medical advice, of the complications after labour either to mother as pucrp*ral sepsis or to infant as oiililhalmii neonatorum prem iiunty, etc Provision of Lady ilcalUs Visitors, Midwives, Nurse dais and Traineddais — In the Punjab state, the Punjab Nurses Registration Council mamtams nrigistcr where all quaIJicd ladv health visitors midwivcs nursrdais and traincddnia irc reg s tered It IS rsicntnJ that quililird inldw ves and dais be attach rd to th'’ inatcrnitv and cb Id ivelfire centres whrrt people who require their services sliiuld apply In a complicated case r f where puerperal sepsis takes p’ ic- the miiluife or fhi. dai at once calls for a quahfiej med cal manor woman to do the nr'*dfnl and to render rxp-rt medical advice 7 he Punjab purses Reg i trat on Council supTvises tliur vvork in the state JIVTCRNHY A>ID CHILD WFIFVP.r 193 Training — (a) Lady health visitor — The preliminary quahficition required from a candidate for admission to the Lady Health Visitoi’s Course, is that she siiould have pissed matriculation CKaminilio i with full Subjects and und rgone training in midwifery foi }ears m a recognised hospital After this she joins a He lUh School where she obtains a diploma of Health Visitor course after undergoing further training tor years (i) AfiJivt/e — Sh'* should have pissed anglo vern icular middle exnminat on but preferably be i mitncualute She undergoes U jears training in a recognised hospital (c) J^ursedai — Prelim nary quahfic ition for admission in this course IS that girl should h ivc pissed anglovcrn icular middle cximmation By joining ihc cours' she undeigors 2 years training m a recognised liospiwl She has to appear and pass thr midwtves examination also (rf) Train'd lais or Indtgenojsdats —Preliminary q^uah- Jications for udtnjsion in this cou'sc are that the applicant should!)" a litcrait woman, intelligent and should have special aptitude for this kind of work She is tiamcd !)> tlit lady health visitor m maicrnitv and child w Ifarc rentrej and receives training for about one yeirwluic she has to personally conduct herself at least 6 maternity cases and also attend certain number on'Ttutes and clcmonsiiations In all th^'* cases, th* exunmations arc arrang d liy the Nurses Registration Gauacil , To sum up — Health vis tors should pay their first vis t to the newly bom mfmt 10 days afterbirth when m normal cases the services of the m dw Ic arc no longt.r required The mother should b^ p-'rsuad d to bring her child to the consultation centre rcguhrly once a fo'tniglit or onct a month as couhidcred ncccssiry Periodic visits should be paid by the health visnors subsequently to the homes of mfants until they urt, about one year old rrcqucnl \isits arc necessary, if the infant is not progressing satisfactorily, where mother is mclmcd to be negligent and the infant is not brought regularly at the centre for medical check up After first year of bfe, th- house where ihefimly resides be Visited from time to time to ascertain if the child is progres- sing satisfictorily and the mo her should be persuaded to bring the child p-rioilically to th^ centic iF his licalth is found unsatis‘‘actory Piymg of subsequent visits may cease at the age of 5 years or earlier u the child has been admitted m the school Register and the relevant records atcimiulatcd by this time ri-gardin^ the condition of hcaltli of the child at vjinous 194 intniM: avu iliilic ntvJ.TJi ages should be passed on or jtiiric a\a>lablc to the school medical inspector B) adopting thcabosc sjstem of periodical checkups many of the disnbling eases of carl} childhood ma> be prevented and the child enabled to begin the school life, with the best pros- pects of dtnv ing maximum benefit from education. CHAPTCR XI PERSONAL HYGIENE Personal hygiene miy be defined as that branch of hygiene %vhich concerns itstlf with the adjustments which the md.vidual must r^kxr to preserve and improve the health of his bod> and mind Health may be defined as the quality of life that enables thchndividual to live most and to serve best ^ — O' can be im perilled either by doing or by neglecting to do certain things Health IS capable of enrichment or deterioration, that hfe at Its best IS a more realistic concept for all persons than the mere a\ oidanct of disease and that the proper goal of all health tcaclung IS the finest kind of individual living Personal hygiene is not only concerned with matters pertaining to health ■ol a person but also includes certain personal factors conducive to good health They are habits, constitution, heredity, idio- syncracy, temperament, cleanliness, sleep, clothing, exercise, sex, etc The mam object of personal hygiene is to maintain a high standard of health Habit —This plays an important part in the preservation of health Habits can not be learnt out of books, they must be developed and practised in daily living They are more diflicult to change, tiian the) arc to form Habit is called second nature, because it ts readily formed, groNvs by practice and eventually becomes part and parcel of nature and part of individual’s life and charac^, thus making its eradication, a matter of great difiicuUy person may dehbentely repeat actions, until they may become a habit or the) may subtly •grow from unconscious responses to stimuli, so that he may not know when they began as IS often done through unconscious imitation. The development of good habits will influence the child m right action and right thinking proper health habits constitute the only sound foundation upon which to build perma- nent ph>sical ana mental health, for it is what we do habitually that determines the level of health we attain Habits are largely responsible for determining one’s quality of life should be regular and healthy, with regard 'to the hours ofmeafs, the evacuation orbowefs, the professional nvork nnd the use of rcstoratiTc drugs‘^lhis subject may be dealt with under various heads — ^''7 Calling and Drtnhng — ’It is essential to form a regular habit regarding eating and drinking Only wholesome food should be taken Meals should be taken after due intervals, at ■fixed hours and quantities compatible with one’s work It is a "bad habit to overload the stomach One must always vsait for 196 iriciFM AND rum i( irtAiTu a true nppctitc The food should be taken for %vhich the appciue parlirularty craves for ♦'It^owldbc properly masticated and eaten slow 1> *' Every tnorsel should be bitten 32 tunes Boliin? o'" unchcivcd morsels should not be done Reading should be a%oidcd svhilc taking meals It k desimble that there b* agree- able society at tJic time of taking mials Intellectual i%-ork, C5p'*ciall) hard stud) should not be done after a h'-asy meal Children may be easily huri due to lack of food but modi ration m eating is of grtat importance loi the old persons ns prfxrtsses m their bodies arc much slosvcr at tint age • Iter should not be taken along with menis, but should be taken frtcK heovccn principal meals It is a good habit to take a glass ol cold uatcr early m the morning on rising iiom the bed Infants like adults rcqurcivUtr and suffer from thirst and so should be gnen sips ot w iter to drink •1/foA / — It is a food and a narcotic but its food value is very limited It cati rcplaci an cqutvalcnt amount of carbo- hydr it or fat ■■nd economise p otiins But it cm definitely neither be stored in ilie body, nor ut I ^ed 1 jr ft pair Although on certain oteasions if used m small doses it mi). aid dii,esiion or induce sleep In t It has t devitili^ iig a« tion up in the tissues the symptom of which range (rom some impumirm of fui etion to itivf les ons The fceluig «J exhilataiion that follows n mild doi< of alcohol is due to paralysis of Jii her nerves centres that normally piovide inhibit on With ihest centres shut out from the i~Il is an evil It leads to intoxication If prolonged, may help to cause piles Ii is reasonable to eliminate waste matter from ahmemarytract as soon as possible One good motion a day is useful and practicable ideal to aim at A habit of using medicines to relieve constipation is harmful In habitual users of purgatives, the enure iiuesiinal rhythm is upset Movement of bowels is, very largely a reflex and training should atm, at a very early age, at establishing the reflex Call to evacuate the rectum should not be ignored as the neglect to do so IS the chief cause of constipation Other factors arc lack of exercise msudicicnt intake of fluids and a diet containing too little roughage and too lade fat Hurried eating habits and too little rest may also contribute to this condition Poor posture leads to bending of the body fbnvard and crowding of the abdominal organs This position leads to weaken the muscles of the abdomen and to cause a sagging of the organs ivhich results m constipation Displacement or diseases of abdominal organs may also be a cause of constipation Constipation, if not too firmly established can be corrected by modification m diet and habits Presence of vitaminBcomplcx in adequate amount in the diet is now regarded as essential to the activity of the bowels and the best way to secure Jt is to eat wholemeal bread salads, vegetables and fruits One should cultivate the habit of evaniating the bowels at the same time each day If a regular habit is not lormed, consti pation IS bound to occur and this wiU produce indigestion and piles and will lend to induce appendicitis Regulation of elimi- nation of wiste maienaU from the body is helped liy 1 Drinking a glass of water earlv m the morning 2 Going to the toilet rrgularlv ‘ 3 Taking exercise rcgularlv out of doors 4 Enting some coarse bulky foods e g , grccnvcgclablcs, bran, whoIegrainc^eaU fiuits w ih ihetr skins 200 irYCrUKE I'UBLIU JlEALrJl ‘■'^Control of Weight * — Obesity or ovenveight 35 anabnoimai and dangerous condition m^hich there is stored a large surplus offit Within the body '-^ts accumulation bcjoiid the normal limit may be due to endoenne dysfunction causing an abnormally low metabolic rate, but m a large majority of eases, it is due either to excessive intake of food or to a deficient utilisation of the food than to produce energy. ,_^rat in food IS the most common cause of ovcnicight, which at first may cause merely discomfort and htcr on may inenanre life. It increases susceptibility to diabetes, kidney diseases, heart, failure, diseases of arteries, liver and gall bladder dtseascs,cere bral haemorrhage and a number of other ailments* Excessive weight of 10 percent above the normal increases the mortality toll about 20 percent and the greater the amount of surplus weight, the higher the dcathtoll Efforts should be made for the prevention bf obesity and for correction of ovenvcight The p'incipic underlying is that weight should not he rcsincied by interfering waih the normal development of bone rnd muscle. Obesity ran be prevented in those taking too rich food, by merrasrd exercise, orjn those tak* mg too little exercise, by food restriction The correct method of control is select on of food and by restriction cf its amount, lloth Eits and caibohydraies tf not combusted, accumulate ns fat So a nonfaltenirg dirt may provide proteins liberally, but should restrict frts and carbohydrates Hulk which saiislirs hunffpr, is achieved by the use ol foods rich m \\.alcr, poor m cathohvdralei and fats, with considerable proportion of material which cannot be absorbed Such foods inciudr iron fruits and leafy veget ibles Froicif feeds should not be reduced m amount unless the indivi* du”! used ilam in excess Siaichv foods should not be entirely chmirmtcd, for the store dfot i« oxidised much more rradilv and s.frlv III :hc presence of c»r]x»hvdr..tes If the daily food itiiakr is ktpt about 500 caloiiev below the energy needs of the body , a loss of onr pound of weight awcrkniav bt .■'frected Surli a diet irv forces the bodv «o oxidise its own fat to meet the daily energy needs \N ill jxiwrr and persca cr .mcc arc required to carrv througii .a r« during programme tia’i!;ers nf Ktd ictn^ — It 1 $ dangerous to reduce weight rrpidlv, rcductiofi of wciglitmorc than J pound prrdiy is un- safe llapid reduction of^i Irids to the production ol fativ atids m excessive atnoimis ''^Jiese .acids c‘*nnot be iicutniised .’s r.pdiy as thev .ire foinudaud therefore m iv lower ilkjhnc rcsriveof the body sufiiriemh to g vc tiio to the condition of acidosis \Shcnfrtt »s oxidised slowly m the Iwdy vsuh other foods It does noth ccomc toxic. •^Food restriction is sometimes resoricd to b\ girls .and young women with a desire to become ahm. This should be condemned rEKSOXAL mCIENE 201 in those, ^vho are noitnal or belovv normal in weight because the} irc liable to develop iubcrcti!osj^''Thc use of drugs Idee thyroid extract, dmiirophenol etc , is exceedingly dangerous and their use for this purpose should be prohibited '—Tfequcntly advertised remedies for weightrcdiiction, by act- ing as mctibolic stimulant or strong laxatives must be avoided * — UndtTweisht — ^The main causes arc insufficient amount of food, an unbalanced diet too little sleep, chronic infections and -worry If the individual is undernourished, he may look pale, have poor posture, flabby muscles, dark circles under his eye, ■decreased appetite and he often shou-x irritability Fatigue — The blood supplies fuel and oxygen to the active muscles and carries off the waste materials formed by the activity of the muscles If the activity continues for too long or happens to be too strenuous, the blood cannot carry auay iiastematter suflicientl) fast Therefore wastematena's accumulate in the muscles and make them tired The feeling of ivcanness is known as fatigue Fatigue reduces both the quantity and quality of work one normillv cm do Worry infrequently is a fore runner of fatigue A person cannot do his best when worried De^refi of Fatigue —Fatigue m one part of the body follows •ovcractivity of one group of muscles such as in arm raising The ^iftercfTccts of such overexercise can result n pain, soreness m 4irm muscles, etc Sometimes larger group of muscles are affected as in swinimmg, climbing, wrestling In this case fatigue afierts the ■whole body Ovcrfiiiguc results when wc use up pliysical and nervous energy faster than it is restored Oviraclu ily at work or play e5 1 he wise people have learnt the art •ofaio dmgf-itiguc I here arc just two secrets to avoid fatigue, ■to h\ e and work at a sustained pace, without strain, without •overdoing md Without Jjioiung the meaning of liligiie These arc — (n) Taking a Inlanccd Mtaraumuncralnch diet (i) Knowing tlic art of relaxation Reltf/from Fatigue — TJic nccumuHtcd wistcs and poisons ■of fatigue arc c'lrucd ofTby the blood during rest and sleep The ■Worn out cells arc rtp ured and normal energy is restored Vigor- ous exercise, even to the point of being ured is brncfi'-ial if notmal cnerg^ is restored bv rest and sleep Afler strenuous exercise a hot show cr or tub bath IS helpful in removing fatigue 202 - n\oiiNr \\0 PtbLK nF\Trn The heat increases pcnpiration and helps the Lodv to get rid of the poisons of fatigue Light massage (fuhhing) from c’ctrcmitics towards the body will help in removing the waste products from the tissues of the broken down muscles and reheve latiguc A'ler hard exercise, a good rub down is a necessary part of training routine In the ease of extreme fatigue the muscles become sore and painful Exercise increases the pain In such cas"s the muscles should be given rest Warm and hot baths wiU give some relief Anger — It has been found that It occurs more often before meals that tense persons are susceptible that one can not bc*- comc angry when relaxed that laughter helps to aioid anger * If the respansi to anger can be postponed for a few minutes the emotions which it arouses can be handled m a more mature way Lxcrcisr or even a wdk may help v-Kdl your anger before it kills you It docs kill indeed An angry man is alwa>s full of iwison, TJie results of the rage ale *— • ' ^ 1 Increase in blood pressure is vers often caused by out* breaks of temper 2 1 here is rise in pulse rate and sweat secretion 3 Bloodpressure drops when there is de ears f r ah nit 15 hours and so on With 1 gradual leductton to 12 hou s at 11 \ cars and 1 1 hown at 12 years flic inftni should be regulu l> fed and ex-rptm^ these leedmg hours he vhouUl be illowtd tj sleep comfortablv Lark of sound deep indicates lUhealth of PERSONAL inCTCNF 203 infants “VS well as of adults A bo) or a girl up to an age of 13 > cars ought to enjov at least 8 hours sleep For an active industrious youth nothing less than 6 hours continuous sound sleep IS enough Midday Sleep — In hot climates there is a tendency to indolence and lethargy During mtddav, a short nap, especially in the summer, if taken by those \vho arc particularly engaged m doing active v\ork m the morning proves not only to be refreshing but also invigorating For those who are engaged m mental woik, sound sleep is as necessary as those engaged in physical work Those above 60 need more sleep than thej needed in the middle lift or they should spend at least 8 hours l>ing on the bed comfortably with ill portions of the bodj resting on or about the same Ictel, so as to save their hearts from the strain of pumpmg blood against the /brcc of grat it> Weak, debilitated, sick persons and convalesients require more sleep and thc> need 1> mg down on the bed for a longer period than health) ones The best time to sleep is the night time because it is quiet at that moment and all the external stinnih arc absent ‘-'The bed room should be wcUvcniilatcd and should be- preferably situated on the upper store) Its doors and windows shodld be kept open but dr-iughis should be prevented The bed should be firm and elastic with a neat and clean bedding It is injurious to sleep on the floor as there is a danger ofbeing bitten by scorpions, snakes and other poisonous insects and also there is a danger of contracting rheumatism To woo sleep certain things arc helpful — exercise carried not further than tiredness, and ccrtaml) not to the pomt of exhaustion, a due allow incc of fresh air during theda\, avoidance of a hca\) meal within several hours at the time of going to bed of heavv smoking and of mental excitement, a regular hour for retiring, a comfortable bed, warm feet, good acntilation and absence of external stimuli ' Two persons should not sleep in the same bed as they w ill inhale each others’ breath The use of double bed should be d iscouraged The old proverb ** F.artv to beo and carK to rise " sliould iiurHc lorgoTtcn A mosfiuiionct slunHd 'atwa>s be used alTngllT SOWc tkopie, hoi^vcr, l^ccl stuffy inside a net and avoid using it ^ Drugs should never be used to induce sleep except m illness and tfiat also with discretion Sleeplessness or Insomnia — It is a\cr) frequent condi- tion and one inrompalible with physical md mental health 1 here arc mmv fictors that may cause sleeplessness Emotional excitement at bed tunc, improper food, insufficient amount of exercise, studying late at night, mability to ban from mmd the 20 4 in OTCNE AMI PUHLIC Hr VLTH events of the day, constipation or Horrj mg over real or prospec- tive troubles may keep one avsake Dnnkmg cofTce at the evening meal afTects some people liy delaying the onset of sleep Insomnia is more prevalent among brain workers than amongst those v\ho do physical work Insomnia in many cases can be overcome by one or more of the following methods — 1 Having regular bed lime 2 Assuming a calm mental and emotional attitude on retiring 3 Taking physical exercise at bedtune such as brisk walk in the open air 4 Drinking a glass of hot milkjust before going to bed j Thoroughly relaxing the muscles of the body 6 Reading a short story before going to bed to divert the tram of thought away from the daily cares 7 Taking a fifteen minutes tub bath with the water at about 93*F An individual troubled witli insomnia should not pemut himself to worry about it Worying about it may do more harm than the loss of sleep Freedom from anxiety removes a large measure the harmful results of loss of sleep and produces an attitude of mdifTcrcnce which tends to induce slctp Constitoaon — Individual variatons m constitution exist m difTcrent persons Srmc are strong and robust, while others are feeble and weak Moreover, power of resistance to disca-e also vanes from man to man and is dependant upon the ct iistitiiiion of the individual A man^ with strong and robust constitution does not fall so easy a prey to an attack of a disease as docs a person having a poir comimnion The constiUiuon of a person IS partly acquired and partly inherited A strong conslitiiiion may get cnft,cb!cd under unhygienic conditions, whi'e a dchcaic constitution may improve vinder bygvenic conditions Heredity — Tins bears a great influence upon the health rf an individual ^Vlitn the body cells tluidc and multiply the pattern of their genes is pissed on c vrrying with it us ancestral characteristics Thus ihr proportion of people who hive blue or brown eyes is determined in this way Similarly ccrrain diseases like gout, insanity syphil s lacmrphihi colour bhndiiesj epilepsy myopia etc arc transmuted to the offsprings in this way Mental peculiarities and similarity of features arc olicn inhcrii''d Environment — In genenj the environment enibod es tlircc aspects namch the physical, the soenJ and the biological The physical environment conuiwtes the varying IFESONAI IIYGIEM:. 205 range of natural factors like climate, soils, plains, forests, moun' tains, Jakes, rivets rainfall etc It also consists in adoptation and construction of man as lepresentcd in items like apartment houses, cultivated fields, use of cletincity, radios motionpictures, news- papers and other countless implements devices ol an industrial age On the other hand the social aspect of the environment is represented bj the people and tlieir actions “Ihe Jitter art in- dicative of traditions, customs superstitions which mm has created Simdarly biological environment comprises plants and iiumals includuig those bacteria and parasites which cause disease Idiosyncrasy — ^By this term is meant a peculiar susccptibi hty of some persons to be influenced by certain morbid agencies or medicinal prepantions eg the appeannee of ncttlcrash on llic bodies of some meribers ol \ pirticuhr family as a result of taking shellfish Food idiosyncrasy is hereditary ,^^CfeaijIiness — This is very essential for tlje upl cep oF oai health and for the normal growth of our body There is a proverb ‘ Cleanliness is next to Godliness Dirt is not only liarmrul but it is antigonisiic even to our very existence Therefore special emphasis should belaid on cltanJintss with regards lo the food we eat the air we bicaihc and lhewater,.wc drink ^ bkin cleanliness is dcsinbJc fiom ihc acsihetic as well ns hy"icnic standpoint It makes fn bodiU comfort and sell respect In India skin is of immcns- value as a lot of p-rspira tion ind txcrttion of solids take place tluough its innumerable minute pores As a matter of fact i great dta of the work of lungs and kidneys is performed bv the skin Htncc it is most necessary to keep tlic akin ficc from dirt so ihat the sweat glands may fuuction properly Ccitiin parts of ihebodv like innpits, give out an unpleasant odoui from then secret ons and sorujuirc scrupulous cleansing rcgulirlv Glc.'iising of skin ind the removal of us sebaceous Secretions ol the skin is best affected by soip and water — In India anointin g of the body with certain vegetable oils i$ a very popular’cu^m It keeps the body cool, renders the skin soft and supple and supplies fit to the body By kneading and rubbing the bod} , the rirrulation of the blood is quickened and the muscles ore exercised It makes the man cheerful and icfresl ed Bnths — These nre not only very necessary for clcanfincss- but also for ihcir bcncficicnt aetionrn the skin and intcmil organs A bitli should be taken early m tlic morning or in the middle of the diy , before tnkm^ meals It should not b“ taken immednicls after meals or niter exhaustion due to fatigue 2Q5 U\GIC\t. \M> PtCLlC IIFUTU Balhs ma> be classifi^'d as under Cold Dath 1 cpid Bath Warm Bath Hot Bath 33" to 65T BO" to OO’P 90° to 9Q°r 98° to 100°F ColdUatk — Voung healthy persons should use told utter for a bull as It IS invigortung, more rcfresliiug trid \erj stimu- lating to the nervous system, the circulation and the metabolism It tends to impro\ c the texture, lone, ftrmness and colour of skm and stimulates the circulation of the blood ifiroughout the bod) It stimulates the skm and increases the power of the bod) to react to sanation m temperature Cold baths should be taken as qu ckl) as possible and bod) covered immcdtaicl)' aftemards The hrst effect produced by taking a coldbalh is to chill the surface of the liody and that of a shock follow ed b) constriction of superficial blood vessels, but the vessels dilate vef) soon giving the feeling of warmth and pleasure to the individual U'erm Dath —In u the temperature is approximate!) that of the body It is of value chiefly to cleanse the skin, particularly when soap IS used It does not have much stunulating effect on akin or the circuiauon It soothes the nervous system and may be used to inrite sleep, if taken just before retiring Hot Baik —It lias a temperature above that of the Ixid) It raises the temperature of the surface of body and causes the bloodvessels of (he skm to dilate It thus causes hyperemia through the skm b) withdrawing a large quantity of blood from the interior organs If a hot bath is long continued, faintuess as well as harmful disturbances of the iicat regulating mechanism may occur There is a danger of ciiilling of the body due to dilated skm vessels and so it is not advisable to go out m the cold Vigorous rubbing of body with a rough and dry towel, after taking a bath, ts very bencfiaal, as it acts as a massage to the skm and provides a certain amount of bodily exercise and excites circulation of the blood in the skin U gives splendid feeling of glow and well being Hair — ^They should be I epl thoroughly clean and should always be kept combed and dressed Proper and thorough cleansing vs rctjuircd both by men and women T he scaln need s a good blood supply and misiagmg for a few niinutct dvily » ■ ot great tiencUt sicsn nr is sutmnating and n> towiiliouC a Jni (except in great iicat) is good Iftlic hair arc not properh looked after, diseases like ringworm and dvndruff invy arise Lice may appear if they arc kept untidy and dirty A dry scalp, scliorrliocx sicca, is a conduion of * dandruff ‘ « < , cpiihclul scales arc shed m excess Oily or soft snip slnrapoos should be used An oily scalp, scboirhoti oleosa, « a condition of over iehsonm, maiLMi 207 aicti\e seb'iceous glands Shampoos should be drying so thcv uill contain spmt It is necessary to wash the hair once i week with soap and water Oil should not be used too frequenllv It may, however be used once a week after uashing the hair with soap to restore the natural grease One should ahsavs practice to shave oneself, and as far possible avoid going to barber s shop for the purpose The Mouth — In mouth there are many varieties of bacteria always present and as a rule a healthy mouth is capable of dealing with these Under conditions of sepsis however such as carious teeth septic tonsils, unhealthy raucous membrane or infected sinuses, the stream of bacteria are constantly pouring into the moutii find their ideal conditions for growth, helped by remains of food The tongue becomes coated and sordcs collect around teeth and bps Such a mouth may give rise to parotitis, otitusmedta, infected sinuses pyorrhoea, digestive troubles, infection of respiratory passages and via general circu- lation, rheumatic conditions and remote septic foci. The mouth should be well rinsed with some pleasant mouth wash, such as giycennc of thymol and a httle of it should be used gargling m the morning and at night after taking last meal or dnnk Teeth — A tooth is a hard structure composed of dentin and enamel covering the dentin, although resembles bone, but is much harder The enamel of the tooth, js the hardest tissue in the body It covers only the exposed surface of the tooth, as Within the jawbone the denun of the tooth is covered with a cement like material, called cementura A proper wholesome diet is necessary not only for building of strong teeth, but also toward off dental diseases Milk, eggs, tomatoes, guavas, amlas and other citrus fruits including green leafy vegetables rich m vitamin C content should be in- cluded m our daily diet If the diet happens to be lacking m mtncrils and vitamin C, children may sufler from structural de- fects of teeth gums and bones Fully grown teeth also require balanced nourishment for their maintenance A set of sound teeth IS a valuable asset because it contribu- t prs-ivdjag a.vc fBcicnt chewing apparatus Defective teeth make dilficult or impossible the proper mastication of food and when teeth arc infected the health of the body may become seriously impaired So it is very essential that the teeth should be rcgularl) and thoroughly clcmcd to ensure good digestion They should be scrupulously cleaned at least twice a day, the first thing m the morning and the hst tiling at night with a brush of moderate hardness The brush should neither be very hard nor vcr> soft Anv place 200 ir\afrM iudlic iw \lth between the teeth where the food gets lodged habitually' an 1 whence u is not rem ed promptly and regularly, is quite sun to decay sooner or later The teeth nrelv deem on a fuIK exposed surface If there arc cavities m the teeth they should be proTnpily gotfiU'-ciup If they arc ahogclhtr decayed anti canoui they should bcremjvcd at once lest they sp eid drew toothers Wnen the teeth ‘all away ittificnt teeth sh mid be used if one can ifTord « > do so D pasit of t irtir upon the tectli should rcLciyc due 'ittcntion and m this ease the teeth rcqutic scaling or els" the r»ots vyill bt-com- exposed uhieh will cveniuilU miLe the teeth loose Ciild cn often sufT fiom cann either on acemnt o'" d“fi icncy of Vu inun D ir due to ac«l f >rmmg b veten v formed on a c >uni of feiwcnt iiion of carb)}i)di itcs Lsp cnlly amongst children eating ol sivects cho dates tofTns and chewing gums ttc , arc ihr p omoimg raus s of dent il canes or decay of teeth, betaus starch and su, ir undergo IciaientaCion m the mouth and ire com erted int k aculs Acid acts children whicfi acts as a nourishing $ubsmuie8 r>f candtes Rec m studies indicate that sweet and carbon tt( d aerated liivt also desiructitc effect on the cnim il ol teeth which should therefor also be atuiilLc! In tropics one lias to br verv cireiiil about the o eurrclic of pyorrhoci alveolafii amo ig adults Bleeding or nicer i an of gu ns arc the prccurs ) 5 of fnonhoca and dental caries and a dcntjsi sh mid be al onceion ulted on the app-arance « f afore said svmptoms I’yonlion iv tssentnlly a disease which is characterised by tlic formation of pus p lekcts between the teeth surf ices ami gums where gums rcclv di ire and become a source jJ danger to the Irodv Smccfcrmj from ilie pyorrhoea may threaten die danger of po sonmg even the whole body, these „erms irom the pyorrhoci pactits can reach my part of (he bod\ md gne i re t) conditions like di rstivc disorders pan m joints eve tioiblc heart and kidney ibsrascs etc Moreover apart from these ailments pyorrhoea Inv it« soml aspects loo Pockets of pus and gnus give rise to fiul breath vvnicU vary lead to ivindance of socivl relations and loss of friends ^ A good tooth pot der or a tooth paste should b- used daily with a brush A dcntifr cc (ontainmgsoap mtl i fine pewder in some lonn or other assi«ts (Q smie extent lie cUansmg attion of the demifncr astlcsebavea sori of polishing action The disinTcctanis present in these s the difTruky ot keeping tlion clean and the s ime brush IS generally used for a conuderably long urn* If the tooth brush IS to be used, It should be kept dry m a clean glass bottle, whtn not in u»e and should be kept m boding water fur some time after use It should be frequently changed ▼In India a green neemorktkir suck is used for cleaning teeth which is very good Irom the hygienic point of view u The longue should be cleaned by a tongue cleanser every morning ■^The Hands —These should be kept free from crocks and roughness due to cold wind or constant use of antiseptic solu- tioni Glycmnc (diluicd) on account of us action of drawing fluid to u, or some skin cream which will prevent cvaporatioa Should be used u lul cracks heal *^The feet —These must be kept scrupulously clean by daily bath and cuieiu! drying beiwcrrt the loes^ The feet contain many sivcai glands, and excessive sweat- ing or Iijpendrosis necessitates frequent washing and change of Socks or stockings Bromidrosis is excessive sweating with offensive odour and soreness ol feet The odour is due to dc- coinposuion of sweat Tor this condition the feet should be washed several iim'*s a day m bine avid solution, dried dabbed With methylated spirit and powdered wuli surUi and boric powder Stockings and shoes must be changed each time , used stockings uaslad and shoes micd Cork soles arc good and should be vvashed with a spirit lotion Corns — These arc caused by pressure of badly fitting shoes The epidermis Ui ckc-ns and becomes homy and grows inward to a point If they occur between the toes, they aic kept moist and arc ‘ soft corns” 210 jacib\t \\i> itunr ni-\i,Tii Callosilies — These are foimed as a result of pointed sUq« The great toe becomes bent m, produem^ an anf’Ic at the junc- non of mctatarsoplnbngial joint The herd of U e rnctrwrsal ts thus a projecting point on the inner border of the foot and is exposed to pressure A callosity forms on tins point of pressure ind the bursa underneath breotnes (JironicaHy ii llamtd These ccndilions may be rvoided by svearmg s iiia dc shoes The U(hof the fcot — The inner bon% irch should be l^ mein s fn m the ground Dropped arch is \ci> painful and is caused bv uam of tone 111 iht leg muscles w th sirctchini: of the supporting landons and Iigrraems under the nth Tlic clue/ rtnic^ies are massage of Itg muscles a built up sole, raised ^ to 4 It ell on the inner side , arch supports i«dVails —Natb require to l>e kept clean and should be cut short p< tiodrally c,thcrv.isc di»t viill lodt,e under them and may carry lufiction As a majority ol Indians cst ilirir metis smli their bauds and do not use spwns and forks, the> *hou>d be very careful iboux the rcj,tdar cle^mmq of the nub Tlie Imgcra should ncNcr be introduced into the mouiii and nose IhtinL of nails iMth die teeth 1$ also an unclean habit and is particularly datgpious in tropics, as ilic mttsunal inlrciions arc \ery likely to be cained m this t«ay to the human system locrails should be eut horizontally, because if ctined the skin around them uill be pressed over the nijl and the pressure of the nail on this en- folding s|cm uil! catiic symptoms usually attributed to ti grou jng toe nail ’ HypnlTef hud nails — ^Thesc arc bard, homy, Uiickened and oft yellowish or bJicki’h colour They should be treated as soon 15 conrlitmti starts, by soaking in a solution of soda bicar- bonate and cartfulfiling •^Eyes — The eye IS tlie highly spccjalisetl receptor of the optic nerve Its rrccliRnism enables the ligh* waves to reach the optic nerve cnthngv producing sight •^yes of the school children should Ic periodically examined and defects corrected and treated Children viith such defects as myopia and those whose vision is liable to deteriorate should be kept under constant supervision and stmablc work chosen for them, Tears have considerable bactenridal power and arc less injurious to conjunctiva than any lotion Ircquent bathing of eyes should not be encouraged Disinfectant lotions should be used only when prescribed ^ *vchool children should be taught tl c importance of looking after the eyes The liglrt m the class room should be satisfictory and the print of the hooka should be large enough to prevent PERSONAL HYGIENE 211 eyestrain. All inflammation or accidents to the eye should receive immediate attention- Ovcrindulgence in alcohol and tobacco may lead to hUndnessj^ Sore eye is an infectious disease and fairly widespread m villages all over the country. The infection is present In the discharge of the eyes and is transmitted to the healthy persons tlirough handkerchiefs or towels soiled with discharge by direct contact wUh the eye of an infected person. Indirectly the infection is spread through flies. The common belief, that it is caused by eating heat producing foods like su eets, Jaggery (gur) etc., is not true. When the germs of sore eye infects an individual, the then transparent covciingof the eye called conjunctiva is damaged or it may get hurt by particles of foreign bodies such as dust particles and the eves may therefore get red and watery. In due course of lime a discharge secretes from the eyes vshichis infective and dise.asc producing. Trwimmf It consists in washing the eyes with mercury’ lotion and putting albucid locula or penicillin eye drops. If the eyes are glued together, they should be washed with boric acid lotion made of one tcaspooniul of boric acid in two cups of boil* ed water. Prevention I . One should avoid open cases of sore eye as the disease is highly infectious. 2, CJjiJdren with sore eye should never be allowed to j»it up with the others. 3. Mothers should not use the ends of "dhotics” or “sarees” to wipe away the eye discharge of their children. 4, riics should not be allowed to sit on sore eye. 5. Persons infected wuh sore eye should be asked to use separate handkerchiefs, towels etc. Ears : — ^They require proper care and attention. The child with running ears is in constant danger of deafness or mastoiditis. Wax in ear, sometimes gives rise to partial deafness, so it should be removed by syringing. If dirt is allowed to collect for some tune, it may develop into a large hard plug causing earache, boils and even deafness. No attempt should be made to remove wax by prodding by any sharp pencil, hairpin or any pointed instru- ment. The best way is (o put a dmp of warm oil like olive, mustard or coconut oil or glycerine (if available) for a fesv days. '' It will sofien the hard wax and bringdt to the surficc wluch can be conveniently removed by mushn cloth or through syringing. The child with a running car, or perforation in drum should^lug his ear with cotton vmol before entering a swimming pool for a bath. The infliction of chastisement by “boxing” sx person’s cars should be heavily punished. 212 mCICNB rCTHtlC IIE\r.TH External Genitals — The scxualorgans require cleansing even more than most of other parts of the Iwdy In the ctse of uncircumscfibcd mile Ofgan the foreskin should be rrtneted m the bath and the secretions svashed If tins is not regular!)' done, smegma collects and undergoes bactcrialdecomposuion, with consequent irniation which ina> lead to masturbation In the Case of females, the vulva should be washed in the iKith Commencement of menstruation is not a reason for stopp- ing baths but rather calls for their greater frequenc) Girls in their childhood should be taught to wip- the anus from before backward and not m the res erse direction so as to avoid intro- ducing faccai organisms into the vulva ^ Posture — ^By posture is meant the characteristic form in which the body is maintained during its various activities There IS no single good posture known Goodness of posture consists in alignment of pins m relaxation rather than tension and readmess for action' It may be added that tnc postures often recommend cd are sufT, awkward and undesirable The postur* ofthc soldier on parade is generally taken as an tdeal one, but it is a misiaLen concept Correei mechanical use of body peimits the internal organs to function efficiently Good posture is a desirable social asset because of its aesthetic vjluc The human body makes a po»jr showing when a part of its anatomy is out of alignment v- The causes of faulty posture are — - 1 Inherited structural irregularities '*2 Malnutrition, which brings with It, msulTteient muscular power prop"rly to balance the body against the force of ♦ gnvit) r-S Light or constricting garments worn during preadoJes- cent and adolescent ages ^ 4 Incorrect foot wear especiallj shors with high heals •" 5 Insufficient physical activity which icsults in muscular imulTiciency, and lack of wholesome mental attitude to- wards life 6 O cupa'ion which confines the body m an improp t pos- ture for many hours a day Incorrect posture may jmerftre with the functioning of the diaphragm causing it to sag downwards, thus seriouslv 1 m I ng liic amplitude of movements Limitmgthe action of the dia- phragm effects the flow of blood in the large veins because die diaaphragm docs not p-odtirt the neccssar) pumping action to cause rapid return of blood The sagging of <1 aphragm d splaces the heart and abdominal organs by forcing them downward and forwnrd This mav cause circulatory and digestive disturbances and in women may cause displacement of uterus, ovaries and other pelvic organs PEKSONAL HYOIENE 213 common and troublesome fault of posture is an increase of lumbar curvature This condition, known as lordosis or '‘sway back", IS accompanied by a for\Vard and doivnward tilt of pelvic organs and protrusion of the abdomen In this position the last lumbar vertebra rests at too sharp an angle on the sacrum, pro duang a iveak joint at this place This results in a general strain on the muscles and ligaments of the lumbar region, produc- ing pain, faulty posture is a frequent cause of low back pain which is a common ailment of modem man w A common structural change in the spinal column is kyphosis or “round back’ which may result from a stooping posture habitually mtintamed In this condition thoracic curve IS increased, the shoulders and head arc bent forward and the chest IS flat Lateral curvature of Spine, knmvn as scoliosis is a condition m which the spine deviates side ways'll! usually starts as a simple functional lateral deviation If untreated it usually progresses to a double curve and finally the vertebrae and nbs become permanently altered in shape -^n individual may have both kyphosis and lordosis at the same timc-^ Exercise —Exercise is very essential for the normal groivth and development of the body and the perfect maintenance of health Attainment of bodily strength is essential to achieve success in life A strong man can work with great vigour and zeal and withstand cares and snares of life better than another who IS comparatively weak m constitution 4— ** Effects of exercise —The effects of exercise on various systems arc as follows —Retpiratory sysUm -—During exercise the number of respirations is increased and breathing becomes deeper The pulmonary arculation is quickened and brings into use all the iir sacs of the lungs There is a considerable increase in llie amount of oxigen mlnlcd nd carbon dioxide and viaicr xapours exhaled Outdoor cxcicisc plays an important role m prevention of tuberculosis — l Circulatory sj stem — Active exercise increases the force and frequency of the heart Blood and l>mph circulates more freely tliiough the \shoIc bo Oxygenation of the blond is very much mcreastd Lack of muscular activity tends the blood to stagnate in the abdominal viscera .Exercise is beneficial to the normal heart for u kc^s rt well nounslicd, in good tone and prolongs ns usefulness-^ '■'^luscular system — The nutrition of the muscles 1$ improved, which contributes to ihcir growth and energy Without ex<"rcisc, muscles become pale and flabby and begin to waste and wither away. ^Cutaneous system — ^Thercis a marked increase of perspira- tion owing to the increased action of the skin 214 mriJ NF A^P PCBLIC IILVLIH iUme7ilaTy sjstent — Hxcrcisc Iirmg^ about la increased nssimiladon of food and thus creates a demand Har ftjod The appetue IS improved and the action of bowels is stimulated It plaj s an important role in the prevention of constipation - — Urinary systim — Qinnlit} of urine is diminished, though the amount of urea and tine acid remuna unaltered _ w J\ervous s}sttm — The mind is refreshed and the powers of observation, precision and tolerance arc developed ■- "" Lffttts of txttsjm txnctit — It causes either nervous or muscular fatigue or even both It causes breathlessness palpua* tton and I )7>ertroph) ol left ventricle and renders pulst becomes cntirelv exhausted Ihisfjctis of paramount jni portance, especially when the persons taking carrcisc happen to be raw or untrained It should not be too sirtnuous for the age, pliyncaJ development and the training of a person After the ag e f j qf40 years intense exercise mav do I arm to j ar rsons not acru s I ( toined IQ v igorous priysicaLacit uis Exercise siiould be taken m open air nd this is most esseit tuil tor people vath sedentary habits who have to work all the day long in do ed buddings After exercise, a w »rm bath should be tikcii to vsasii the dried secretion from the skm nr the liody be sponged and should he carefully rubbed with a towel so that the skin may not renum damp and duty owint, to the mcre.»vcd action of sweat glands - Exercise should be done m early hours of the inommg or m the evening It should not he taken withm two hours ol i heav-y ^ meal One should not eat too soon either before or after exercise The risk of gcitmL cliiJl, however, increases after exercise and dicreforc the surface of the hodv, which is exposed during cxricise requires lo be covered and protected from undue loss of heat Clothing — Unlike animal* man has not developed oaiural means of proicclion from heat cold and atmosphene phenomena He has neither fur or feathers nor a thick layer of fat under the skm Thus he has lo provide himseir with clotnuig and shelter Clothing serves os a protective covering In modern life m the case of a civilized man only aliout 20% of lus surf ice is iiormally exposed to air The kind and the extent of clothing worn have a difcei Iiearing on human wiJll beim. PEnSONVI IIYGII NT 215 The principal objects of clothing arc — • 1 To afTord protection to the body ngamst effects of heat and cold and to protect the body fiom external in- juries 2 To assist m the maintenance of body heat 3 For decency and personal decoration 4 Clolhing influences metabolic change If insufficient clothing IS uorn during cold weather the metabolism IS increased in an effort to maintain normil body heat ouch loss of heat is in other words los» of cncrg\ A perfect dress should fulfil the above requirements The materials used for clothing are derived from animal and vege- table kingdoms Those derived from animal sources arc wool, feathers, fur, leather, silk whereas cotton, Jmen irtificnl silk or Rayon, Jute Gutta pi»rclu and Indiafubbcr are derived from products of vegetable kingdom fyeal — It IS a Lad conductor of heat and i good absorbent of moisture for which reasons u is regarded as superio to other materials for making garments for the winter , It imprisons a certain amount of air beiw'*eii its interstices thus preventing rapid loss of heat through it It form* a v^luablc garment during winter as it is i macb belter retainer of heat Owing toils characteristic p'opTty of absorbing moisiu-c woollen gumems should he worn imm dately after taking hard exercise when the body IS stiU under p‘*rsptration to avoid catching chill due to lowering of the body temperature on account of evaporation of perspiration Even after heavy sweating woollen garments feel dr>, whereas garments made of cotton or Imcn would be percep- tibly wet to touch Evaporaiion of water from clothing causes great cooling of the body and cooling from this cause is compara lively less with the garments made of woo), than with iii) other material Woollen underdress is particularly suited for the old, delicate and rheumatic persons The disadvantage ofwoolis tliat its fibres 'brink and become 'tiffon washing and thus lose ihcir hygroscopic power, and becomes less absorbent after fre- t^uent washing They arc less clcnn as they show less outward signs of dirt Woollen garments, being compiralively rough, may cause skin nffLCtions when worn immediately next to the skin, but they cm be tolcntcd by habit Furs ■ — ^They arc skins of ccrtxm animals They arc very W'arm and afford protection to the body against cold and wind Feathers — ^Thesc ore used for stuffing qiuits, pillows and allied articles, and more often for purposes of ornamentation Zee/Aff —It IS prepared fiom stmi of large animals, a pro cess of tanfung renders the skin Ilex blc this is used as a 216 iiyoijm: ant» Puni^ic healtu clothing rn \er> cold counmcs »o protect the bcxJy agamst cold, v.ind and ram, but It cannot be used as an undcicloihmg as u prc% ems the Ncntilation of iJie au next lo the slcin otvmg to its being iion*poroiis It gets stiff tihen dficd after trashing Leather is chiefly used for /botuear Silk — It is obtaii cd f»om secretion of silknorm t^hich covers it m the crvsalis stage It is a bad conductor of heat and Jess absorbent of moisture than tvool, but It IS better tlnii cotton It IS soft, smonili and gives a soothmg feeling to tjic skm and is therefore the best imicrial for undetMcars Cotton — It IS a good conducioi of heat and docs not absorb moisture so u IS not a sood matt ml for underclothing, for m case of perspiration It becoinis wet and consequenU) may cause chill It IS cheap and durable and does not shitnk on u-nsJiing In tvhai is called cellular cotton cloth, tJiere arc large interspaces between the fibies, which hold air and oil dcCQum of air being a bad conductor of heat this cloth proves to be svanncf llian oidi- nary cloth It is less h)groscopic thin mooI Linen ‘—It it manufaciuied from the fl-ix fibres It is expen- sive It js m no way superior to ctnion though pleasant to touch It IS a good conductor of heat and a bad ausoibcnt of moisture India-rubber —It is obtained from the *ap of certain tropical trees groumg pjriicutvl} in Af'ic-t ai d the Last Indies It is elastic and tnipcrmeable to tiatei hence u is latgcly used for miking water pioof sheets AThfirial Stik or Hoyon —It is mide from cellulose, ft u a suhsiuiitr for cotton and occiSionalK a subsumte for silk both ns untlciclothuig and overcloihcs Hie idsantiges ire that it m toinparaiis el\ inrj.pni»ne, n »s a slightly viimei niattml than cotion and romparaiivrlj light in nright It possesses an adian- tagr o\er silk that It permits itht moirt njs of light to pi»* ihiouc'li It I he duadvini’ces are that ti docs not ivish well and leqiiircs ver> considerible circ in dying and ironing _7«/e — Jute IS a coirsrr rniiinil th m linen It is rarely used for rloihing (jut is used for m thing sickirg and some \ irieties of cheap carpus Gutta Frrcba — H is «in)ilef to Indnrubber and is chiefly used for m ikiiig the uatcrprtiof soles tflwus }s^lon — It IS a i>ii*lieiic prepiniion and IS i subiliiulc for silk 1 he Tdvintiges aie lint It is easily wished anil dries qmekly. It docs not need Jronmg and takes little sp’Cr m jijckinp Unless accidemlv tmn or burnt it wear* mdcfinucly A dvtadvaiwagc is that dicjnajortiy of n>Ions arc non-abiorbcnt. FLBSONAt H1C^F^F 217 General remarks on clotbing — Clothes should be made of such material as \vouId preserve body heat m winter as well as in summer and should be so designed as would maintain the ■utiifbim temperature of the whole body They should alw'ays be changed according to the requirements of different seasons of the year In hot weather loose, light garments oflight or white colour are more suitable as they reflect more of the heat rays of the sun Black and blue colours absorb heat very readily and so the outer garments made from these colours should never be worn while going out Children and old people are parti- cularly susceptible to the changes of temperature and are more •prone to suffer from congestion or inflammation of the internal organs Particular care should therefore be taken in matter oftheir dress The young and active arc how ever, well able to adapt themselves to climatic variations they respond to the stimulus of cold by greater muscular aciuits Great care should be exercised m using coloure d^ clothes, as they arc imparted colour with aniline d>cs They urilalT the skin, cause skin affections such as eczema and sometimes even poison the system Xlndenvears which are worn next to the skin should be clean and changed frequently and should be loose and porous and should absorb moisture well and permit its ready esaporaton They should m no iviv interfere wiih healihy action of the skin The ust of flannel underwears nt xi to the skm lessens the lia- bility to Qitacki of chill The sime set of clothes should not be used both during the ■ds? w well as the nighr There should be two .ible to explain the meaning and consequences of venereal disca is The policy of Silence about sex matters to which youn^ lioys and girls have been so much subjected, generally leads to crude and loutish notion or strange or fiarsome concepts of sexual organs and S'xlift The hygiene of sexual organs and the sex problems should he grasped wuh frankness by Uie young person* of today although it was quite impossible in the latter decades of llic nineteenth century Before the onset of puberty, the bodily changes winch will slowly occur should be explained The first menstruation in t girl or the first nocturnal emission in lioy, if they happen with out warning may inflict lasting mental inj iry The nuinhcr nf nocturnal emissions vanes greatly but up to four a month need not be considered abnormal At a later stage the question of sexual intercourse must be dealt with 1 here arc some problems after marriage A few words of tmielyadvicc by the parents or family doctor or friends to a prospective bride or bridegroom can do much to save amarriai,e from shipwreck, for it is absolutely tnic that a marnage may b- PLUSOWI HYOIENF 219 ruined and the couple made unhnpp) and miserable for vears or for life on the first niqht ofthe honey moon If (he bndc goes to her marnagebed ignorant of the nature of the sexual act, die first intercourse is little more than a rape Any mother ^vho allows her daughter to undergo such an experience is little short of criminal The bridegroom should also be informed about the difiicultirs of a bride s first intercourse, and if he loves her, wall be prepared to overcome his desires and to woo her afresh with gentleness and not seize her as of nglrt In youth the temptation to illicit intercourse is strong The youngmen and youngladics should be advased to keep their bodies undefiJed for thrir future wife or husband Hard and Strenuous work, exercise, pride in a healthy body and avoidance- of evil companions, suggestive literature and alcohol, all help m the fight ofmmd and body against sexual instinct CHAPTER XII OFFENSIVE TRADES K OCCUPATIONAL POISONING According lo Collier, Industrial Hygiene has been defined as "the study arid appUcatioa of the principles and practice of modem m-dicinc and hygiene to the special problems o! health and disease as they are met with m mdustry Genatn trades, which chiefly deal with the ammal matter, require to be supervised by sanitary officials as due to the nui-* sance of sm*n and efllatia which IS given olT from them they might act inju'iously on the health of the people engaged in that trade and those living m the locality, where that trade is earned on Under the circumiiances the mumcipahues in llie towns have framed byelaws for the piopT carrying on of these trades which art* as follows — 1 Keeping of Animals — In rural areas keeping of animals i* not likely to cause mich nu sance It i» only in towns, that they ma> prove to be a source of nuisance to the inhabitants o' the house where the an mils are kep and to the persons rcsid mg m the neighbourhood of that ho ISC Ifihe animals arc kept in overcrowded, ilHemlated and badlydrimcd locabucs in towns then owing to the decomposition of food grains and puirc faction and sotl age of urine dung, etc m the ground it migltt serve as a breed ng place for the fl cs etc .The stables fir keep* mg animals should be built at a distance of about 100 ft auay from the mh biied area These should be built on lijgicnic principles 1 he discharges should be received m covered vessels and $1 oiild be washed and cleaned daily In pig sties the food si oold be snared in impervious vessels provided with proper covers Cencrally the pigstirs ore main tamed in a verj lihhy slate Keeping of poultry * r hens ducks etc in a lious" is also a source ot nuisance and pfople living m small louses sltuld not be allowed to keep these m their houses for breeding purposes 2 Slaughtering of Animals — This should onl> I e allowed m pub jc slaughter houses for which following point* should be noted — 1 A slaughter I ousc should be situated outside the town RMa> finm the inhabited area (under no circumsianccs it should t e situated withm ICO ft of tlir inhabited irca) 2 It should be open lo outside air on at least two sidrs 3 it should be alKJvcthe ground level and there should be a compound atnund it 4 Tlicrc should l>c m> living room o\ er the sLvughter Iiouic OFFENSIVE TRADES & OCCUPATIONAL POISONING 221' V 5. There should be available an abtindant supply of water. ^ 6. The floor should be pucca and made of an impermeable material having a proper slope and a channd leading, to a gully provided with a trap to prevent emanation of oliensivc gases from entering the slaughter house. '^7. The trails should be made of impervious material. The corners of the slaughter-house should be rounded. There should be no direct communication between a watciclosct or privy with the slaughter-house. --S. Wiregauze doors and windows should be provided with selfclosing mechanism. -10. The employees of the slaughterhouse should wear . overalls and should be clean and tidy. '^11. Persons suffering from infccuous diseases should not be allowed to handle meat. '"iQ. Butchers who handle diseased meat, should wash their ' hands with some disinfectant solution and all instru- ments should be thoroughly stcnlised after use. "13. All refuse, oiTil msac, manure, etc., should be placed t in vessels which are properly covered. Skins, etc., should be removed as soon as possible after slaughter- ing of the animals. Dogs should not be allowed to roam about in or around- the slaughter-houses. Blojid boiling : — Blood collected from slaughterhouses is utilised Tor the following purposes : — (a) Preparing blood manure. {(>) Refining sugar. (c) Making blood albumin. (d) Manufacturing turkey red pigment. '-^Blood is boiled with an admixture of commercial sulphuric acid to bring It into thick consistency. On boiling it emits - slckcnjog smeii. '‘O^reeauttons — (1) Blood should be collected and stored in clc.m and airtight vessels to prevent the escape of offensive gases. ^'(2) The boiling should be done in a place where suitable arrangement is made for the discharge of gaseous products, through a chimney, the height of tshich should be above the height of inhabitable buddings of the vicinity. ^ •^3) The floor, vessels, etc., should be kept scrupulously clean./ 2?2 inriENF A\i> rt-KLic Hr\x.Tit 4. Bone Boiling — It is dom. for the roUoinng puqws-s — (a) Preparation of phoiphilic manure particularly for tea gardens (A) Preparation of gcKtme, glue and fat (c) Manufacture of handles of knives, i-tc Precoutinns — (I) The premises should nc t lemcd daiK and all refuse should be collected and removed therefrom (2) The ra'v Ixines should be stored in a siiiiiblc shed {3) Coiling should be done m steam lackctcd pans provided uuh a very high chimney for cmamting olfcnsivc gases (4) W ills md floors of the room vi here Ixuling is done should he kept in good order and the wills should be limeuashrd twice a year (5) I resh ind dry bones should be treated with lime before they are stored 5 Gat Scraping — It is done for the purpose of making siusageskin, catgii' etc The sm.ill intestines of pigs and sheep are first wished clraiicd ind softened by striking m silt solution for a few days and then scraped with a wedge shap''d piece of wood until only 1 little of the muscular coat and the peritoneal covering ire left These arc finally wished ind dried The process u very olTcnsive Precautions — (I) The floors and wills where gulscraping is done should be made of imperv lous niateoal, (2) Proper drainage arrangcincnls should he provided (3) The tables should have marblrtops (4) Prompt removal of the waste materials (5) Proper washing and cleansing of the premises (G) Prolonged storage should be avoided 6 Fat and Tallow Mrltiag, Soap Manafactnring — The fats arc derived from beef imilion poik, kuciicnwajtcs etc It 15 utilised in the maniiracturc of randies, soaps, leather dres sings and grease fur lubricating machinery In the soap inaitu* facturing process, fat is boiled with on atkah Thesr arc melted m the pans over open fire or free sicim or m strim jacketed pans Nuisance of obnoxious smell may arise from — (o) Improper conveyance or storage of material (4) Storage of residue (e) General filihincss and unsuitability of the premises^ due to vipowfs arising during the proress of meUing* or boiling of the fit OFFEX81VE TRADES L OCCUPATIONAL TOISONINO 223 Precoultons : — (I) The process should not be carried out near the populated locality. v^(2) By use of steam jacketed pan the nuisance of foul smell is considerably lessened. ^ 7. Fell Mongering, Tanning or Lcallier Dressing ; — ^All these processrs-arc very olTcnsitc. So these trades should not be carried out near a thickly populated locality . The building tvhere tanning is done should have a compound ifall at least 6 feet high. All oITensive materials should be con\e>cd m non- absorbent, cowretl receptacles and should be irpt m a special closed room ventilated b> providing air shafts There should be eatisfactory method of disposal of dirt, scrapings of flesh and tvastc water. 8. Brick and Lime Kilns : — Organic effluvia, carbon di- oxide, carbon monoxide, sulphur dioxide and hjdrogcn sulphide arc given off. These should be installed far away fiom the inhabi- ted locality. ‘^The brick kilns should be provided ^Mth proper flues and should be worked at night only. Availability of a sufG- cient jimount of water is necessary m the vicinity of the brick kilns. 9. Smoke Nuisance ; — Large volume of smoke comes out from the chimneys of factories and the dwcllmghouscs. Thu smoke gives rise to a great nuisance, which can be prevented by installing all factories away from die inhabited area and by having properly constructed furnaces, boilers and chimneys and as well ■as by substituting gas or electricity for coal for heating purposes. Paper Malting :—^aper is manufactured from such substances as cotton, linen, rags, ssastepaper, straw, bamboo, esparto grass, etc Nuisance is caused cliiefly by alkahwastc, which should not be allowed to run in any stream.^-^hc collection and storage of the rasv material is also a source of danger to the health. ll.'''^ice Mills The effluent in which paddy is soaked is putresciblc a.nd gives out foul smell. It should not be discharged near the inhabited area and should I^chlorinated before allowing h to run into any river or a stream; Steps s*hould be taken to install necessary protective machinery against the dissemination of dust V'12. OilMiils: — They should be well-lighted and ventilated. Their floors should be made of impermeable material. The oil and crushed seeds should be stored m covered vessels. There is a nuisance of smell from the oil seeds, oil cakes and the noise pro- duced from Uie running of the propellers and therefore these mills should be installed sufTicicnily a\yay from human habitation. l/i3. Sugar Factories ;-=4 tic factory washings containing cane sugar ferment and decompose readily and give out foul smelL 224 H'iGIESE WO rUULIC'JlPALTU So the eOIuent should be chlorinated before it is used for irrigotton. purposes it should not be allowed 10 run into a river as it will pollute the ^vatcr and may kill fish y yW Dttstjr Trades — Certain industries give use to consi derable amount uf dust, whici) cause \arious forms ofbodil) aiU ments and troubles Catstant inhalation of duu gives rise to- pneumoconiosis, coaMust amhrao>sis, stonedust sihcusis, asbestos asbcsiosts, iron siderosis, and cottondust byssinosis They also- cause diseases of throat, eyes and skin. Various microorganisms e g , of tuberculosis and anthrax are conveyed through them Industrial dust ma^ be mineral, vegetable or animal m origin The dusty trades -and occupaitons arcjute ilsx, textile industries, lead, copp-r, iron, cemmt and Urn worxs, handling of leather, ailk, ivool, cotton, pspec and dnlling, cutting of stones, bones hams, flour nulls, etc The most dusty processes are carding .ind spinning Workers in jute, cotton and flour industries suffer front breathlessness, develop symptoms of asthma and weakness of chest Millstone cutters, stonemasons, pearicutters, sandpiper makers, koifegrmders, hairdressers and lurdyert generally snlfer from lung diseases Workers in gold mines inhale rockdust and suffer fronv siheosis Miichmikefi suffer from necrosis of jaw due to inhalation offumes of phosphorus Those who prepare glass mirrors suffer from mercurial poisoning Workers in lead and plumbers ire exposed to lead poisoning Pfceauhons — The amount of dust may be lessened by the use ofoil, water or steam NThr nuisance cimed b> the escape of dust panicles should be prcvtiitcd by prondn^ special boxes lor t/ic machinen i he dust should be fcmoved by sp'^cul means f g bv suction fms or by sp-ci il veniiliimg art mg ra-nts Lxiracuon tubes or m »gnc- tic shields ms> b' used In addition to these the vsorkers sliuuld use respirators Uoo! Sstur's DiUttft — It occurs in p'Tsons who arc emp- I05 cd Ic tn th“ brass works Protective cbihmg should be p-ovided to workers 6 Chromate Poisoning —Persons engaged m manurac- ture of chromate and bichromate of potass urn and sodium suffer from chronic ulcers on knuckles or at the rootol nails Giro- mate poisoning pariirularly affects nasal septum of the workers sjff ling from it. The prevenliic measures arc, frequent cleansing of the premises provision of local exhausts to draw off the mist the ■careful dressing of abrasions the use of ointments or rubber gloves and the Hcanng of masks Workers should be provided With facilities for baths and ablution 7 Tobacco Poisoning —The persons working m the manufacture of tobacco suffer from nausea, giddmcss and imla- tion of eyes POISOVOUa OASES AKD FOilES 1 Carbon Dioxide — It is given off in the process of fer- tn-ntation in breweries papTworks Iira*kilns sewers and cer- tain chem Cal processes It occurs m mines, lim- and bnek kilns, in deep wells and cells etc Distress ng symptoms arise, if the percentage of carbon dioxide increases more than 7 to 3% lU sympasms are headache, cliillmess, and symptoms of dyspnoea, leading to unconsciousness and death Oxygen inhala- tion should be resorted to as a remedial measure 228 HYGIENE AJCD PCBUC HEALTH 2. Carbon Monoside —It is a colourl«s, odourless and tasteless gas produced by the combustion of carbonaceous matena! It causes distressing »>n}ptoms ifprcsenl to the extent of 0 I %, where as exposure to the gas if present m the aircni’tb ofO 4%, jnav cause death, by combination with the !ncmos;!obm of the red bfood cells to form a stable compound called carbox)- haanoglo-bin It is also lound in “after damp’* of mines This gas IS found in gas works, blasting furnaces, coVe otcni, cement and brick kilns, process of soda manufacture, m motor exhausts and m manufacture of wood charcoal The gas is most poisonous and acts on the tissues of the body by preventing oxygen fiom reaching up o them Sjf/nfitams — In acute cases loss of moor power and loss of consciousness occurs There ma> be attacks of pneumonia accom- panied with haemorrhage into central nervous system /n less acute eases — Dizziness, xomitmg and palpitation of heart are seen Seriuelxc are paralysis, loss of tnemorv and m n few cases dementia The blood assumes cherry red colour In order to eliminate the danger of carbon monoxide poisoning, provis on of free ventilation and preseniiou of leaks is riscninl SVorKcrs engaged m dangerous places eg , where leaks arc occur- ring, should invariably wear oxygen helmets Those ifTected should be treated with ariilicial respirauon (Slnfcr’s method) and alto oxygtnmliahtton, tf possible 3. Carbon Bisnlpblde —This is med in the immifietiire- of w-itcrproofs as a soKentoffats, coutchoue, India rubber, phos- pliciTws, sulyAiWT atwi m the prcpamiou ol cciluhvie fot MwCvrial silks It is Very poisonous even in minute doses at air eontainirig one p irt of gas in One million pxrts of air is considered to be toxic Sjfmptams of Poisontng — They inelude heidiche, giddiness, irem irs, hy'lcrn, atrophy and fitly degeneration of muscles and connective tissues svith loss of fat It also causes hxemoly sis In some cases neuritis or paralysis of mus-Ics occur 1 hrre may he manta or dementia Preeajtions — Workers Jiould l»e examined medically once a month They should not take their meals in work rooms Car- bon bisulphide sliould be kepi m covered vessels and fumes arising from them should be removed by extraction fins 4 . Solphoretted Hydrogen — This gis Ins x prculnr smell nd IS dangerous to liciltli even if present in tlie rit o of 0 2 to0!% It IS found m chemirxl works, in rleamu'; I>e*ileis. in *oaii ficuirirs and m treatmcivl ot sulphunc ac*d toreroivc Imces of arsenic therefrom It is srme times also found in Sewers, privies, fdth and manure heaps It l* calletl “Stink- •OFFE^SIVi: TRADES & OCODPATIONAL POISOJTmG 229 •damp” m mines where it is produced from the decomposition of jyritcs Symptom — ^They arc bndache, gastric disturbances, nausea When inhaled for longer periods it causes convulsions, paralysis, coma and death For remediable cares, the measures arc artificial respiration and the administration of oxygen 5. Sulphur Dioxide Poisoning — It may occur m those "Workers who are engaged in the manufacture of sulphuric acid, process of ore burning and bleaching of cotton Sjmptsnu — Sufibcation, dyspnoea, coryza, cough, opacity of cornea, cynosis, opacity and convulsions 6. Ar POBLIC HtVLTIT and the use of overtll protectj\c i,lovcs nprons etc hforcoNer, scrupulous person*.! cleanliness siiould be < bscr% cd 10 Aniline — It is used in the mnnufacturc of tl)cs Sjmpioms — They ire due tocumulatne acuon of the and ic on hiim..n s>stcin TJ ey arc eczematous tdccnuoni couc'li, ladijcardia nervous symptoms insooini-i blindness and tnahg nant diJc.isc of bladder The prcvcniixc measures are local exhi ist ventdalion mecha meal mmipuJalJon periodical medical examination ind al e ration nf cmployTuent Washing ficilitics should be mide use of and protcciii c clothing worn Holes Regardiag the Welfare of Jadustnal Workers — They arc as follows — Hours ef uork — The Royal Commission of Labour in India m 1531 bas fixed the following worJcine hours for the i ■orlters irt (hefactones —Formtn 54 hours weekly and the dail) Imt ten- hours Feruiflmmthe rcsipenod should mdude the loutsbtiieta 10 a tn to 5 p m For eh l^reniixi work should not exceed 7| I ours per day and the restpenod should include the hours between 7 n m to- 5-30 p m In view of climatic conditions poor phjs tpic and nitritioml dcfciencjcs the workers shoitidlitve a m d day rest fir it least an hour exdus ve of i orkit^ hours The n ght dutj sho ild not be continuous for more than a fortnight Prru>dic \nspntion of the workers speciall) ihc cl Idren, adolcsccrts ai d female wokers should be earned out b) a sur- geon The san tary inspection of lie premises should ihobc period cally carried out Acetdentx ire \cr) common m factorns and taken I glv toll of Iniman life Certain diseases and injuries are enn mon to workmen eg sp na! curvnturc varicose vc ns inj incs to ejes due to pieces of stone ormetals impairment of v mon eye strain etc 1 hese accidents should be prevented ns fir as poi ible and idequntc care s) ould be lilcn to sircguardthe incs of workers i orking j« the factories rcncine si ould Ic done around the d ingcrous parts of the math ncry and guard* il ould be provided where most dangerous type of mne i i cry i* ii siallcd The best results arc oblii ed Iron: thoJc mcti od* ivhrre the protective app-jritus is not under the control of the wx) kmnn XTiere should be i provn on of resuscitnlion eq i pment nnd mcm^ of escape in case of fire OFFENSIVE TRADES & OCCUPATIONAL POISONING 231 Ltghlwg — Adequate natural Jightmg should be arranged m iaclones, varying with the -ftarorc and character of work Artifi- cial lighting IS undesirabl^smcrit IS more productfvc oF visual fatigue than natural lighii^ When artifiaal lights are use^ preference is tq be given to clectnc light Fluorescent lighting IS particularly suitable as it ts economical and avoids casting shadows and contrasts Insufficient lighting increases ircidencc of accidents, injures eyes and leads to general insanitary condi tiohs In mmes, defective hghtuig gives nse to nystagmus among wojkcrs Injuries to the eyes may be due to splashes of dangerous chcimcals entering tlve eyes or may be due to rays haimful lo the eyes It is very essential that suitable goggles be \yom while working Suitable guards should be fitted for machines ^tnitlatun — Adequate ventilation is necessary Cross ventilation ~ Air sfagna^on and pollution of atmos p l^re shouTcTSe-iivoided as they give nse to industrial fatigue "Any^efects ot ventilation In a factory will be productive of an increased liability to loss of tunc due to respiratory complaints such as coidjind influenaa In large factories some times mecha meal systentof ventilation is_provided CUsnUnett — Proper cleanliness of the and the surroundings of the factory should be maintained It must be specnlly attended to mdqsty trades and m textile mills Many a time vacuum cleaners and dust removing plants are installed m •omc factoncs Provision of washing places tilth adequate supply of ivater is obligatory m dusty trades Workers must attend to bodily cleanliness and use protective clothing Drinking JVattr — An adequate and wholesome supply must be supplied m all works, the best provision j s iliat of a bubbling fountain so arranged that the only drinker s lips do not come in contact with the spout, the common drinking tumbler spreads infection Sanilarj) Accemmocfalion ■ — Must be provided at the rate of one convcmcncc for c\ cry 25 females and for every twenty five upto 100 males, above which number of the proportion may be reduced Adequate number of urinals be provided Cdiicalm of IVorkmen hike Nature of Dangers — AH work mai should be educated to knosv about the danger of ilic material svilh which they come into contact Precautionary placards should be fitted at prominent places Workers should be impart- ed training m First Aid and the method of artificial rcspiraiion The) should be familiar wth the precautions to be observed if they arc handling some poisonous matcnal 232 inOITNE AKD PtJBLIC IlEALTII Ifjmidiij — Tlicre should be kept auet and dr> bulb Uier> momelcr m ever) ficiory Woikjrg m liiunjd sheds causes deteriorating effect on the health of y\orkcn Otlier factors requiring consideration arc — (а) Proper Jious ng (б) Go^ nutrition, maintenance of canttcns, regular meal hours , control of sale of food (e) Maternitj 1 enefit to female workers Six ivccls leave f ir women both before and after confinement (d) Credics or day nurseries /or cluldren of the woiking V, omen (e) First aid training of workers CHAPTER XlII INFECTION, CARRIERS OF INFECTION, ITS PREVENTION AND CONTROL Infection — infectjon js meant the introduction into the "body of Some pathogciiit microorganisms which are capable of anuUiplymg wilhia It, at the «\pcnsc of ihe host without coming into contact -vviih the patient They produce tovns Diseases depending on such infection are called mfeettous diseases Infectious Agent —A microoigamsm, bacterium protozoon, -helmcmh, spirochete fungus virus or otiiT capable of producing infection and under favourable circumstances of host, and environ- ment having tlic capacity to produce infectious disease Contamination — The presence of an infectious agent on a body surface or on or m an iiiammate object or substance Contagion —It means the material which carries the infec- tion eg m smallpox contagion IS earned through air In svphilis a close contact is necessary for infection to til happen not to dc\ clop the ducase i e they ate nonsusccpUblc to it or m other ivorUs are resistant to infection while others may develop the disease m various dcgress/if seven!) from mild to extremely severe Those who do not develop the disease arc called immune or nonsusccptible 238 ItYQlESr ^VD PUBLIC nTALTII of '"™ ■’ ''‘’™ Na^l Ixnmnmly _Ii „ ,hc rcj staficc offered by the body under the noruMl eond.uons „„hout rn> exterrul sl.muUtton of previous mfcction Thu ii either possessed from birth or acquired duntij, gruwth It may be — (i) Sj>KUi Imm mtjr e g hens agu at tetanus . tlo^ s rats ■mu mice against tuberculosis * ' (lO foetal Immunity , g negroes to > cllow fever (ill) Inai la tttl Immuottjr ,e,a«r;l{"Tsr,',’' Vb- ae,„.red.„two,yay. (a) ,UI,r, -Ami bodies are formed due to reaction of persons s o, III tissues m sequir.ii; resistanee nod?e"n, are arm el) stimulated to prodiiee antibodies by natural or iii fieml inems I e , germs of a prev ous cluneal or stibclm.r-ht ?„r s.? ‘ ^ as a result ol moculu on iv th gcrrai or their products ^ (b) Paul t -—It IS acquired by introduction from Uiihout cf mtibodics induced in some other immune jierson or a™ mlS It mat take place in three ways — I A mother supplies immune bodies to her foetus ^ mmunifod’"'" “fhlietaU, Protectivo measure, prorluced iu the body a-alo.t “h“bolyXm5„cri'’""'=''’^' P'--"- svb, to blood eeUs''pos.ess™“„c,rcbnB“^nd''lnsestmrrnf^ organisms * blood s' ru^rr;;," ef„Tt“'„:';!:\v,rc;d7"^ ■" in the,' ae,™"’°‘''" 1 Aetli e Acquired Immuulty t— This may be s— {a) ^aiuTdl Actfe Accautd tmmjrt l* —Tr, .m— i an atUick of infectious disease confers upon a nerson ^'*'’'**^*' rnioum of immunity from a second attack , g , -!>) Arhjaal All:-/ Aej-rirrd /e-na.il, _I, „ a,,, Sid from b'eren;o?7u:i“"“‘"™^ •“b.lanee, INFECTION 239 Antigen — It is a substance which stimulates the body to produce protcaivc materials called antibodies They arc protective entities produced as a result of stimulation of the body by antigenic substances Antigens commonly used to produce immimitv in man arc of 3 types, namely — I Living altenua ed organisms against smallpox and rabies ^ 2 Killed organisms against typhoid cholera whooping cough etc 3 Toxins agimst diphtheria scarlet fever etc 2 Passive acquired immunity — If scrum of an anunal containing antibodies is injected into a susceptible animal it confers immunity This immunity is of a short duration and IS of particular value m treatment, chiefly for tid ng over a cn is when antibodies are lacking m the blood of the patient Antisera are of 3 types — (7) Aniiha ieml Serum — When bacterial cell body is used It has the power to agglutinate and kill the bacteria e g , antistrcptococcal aniimcningococcal and aniiphgue scnun (2) Anliloxtc Serum —In this type filtered toxin of bacteria is used It has power to neutralise toxins of the cganisms eg , anti diphtheritic and ami tetanic serum (3) Convalescent or Antiviral Sera —In virus diseases like measles and poliomyelitis the scrum of convalescent cases contains specific antibodies for the virus They have been used for passive immunisation Allergy — It is a hy^icrscnsitivily to some fore gn protein introduced into the body by inject on or occasianallv, in an article of diet Small amoimt of this protein will produce a violent reaction on the part of the patient Asthma hay fever, migraine and some forms of eczema and urticaria arc examples of allergic conditions Anaplylaxis —In a patient with an allergic tendency the giving of a scrum will cause an alteration to develop in hts tissues withir 10 to 14 days which renders them intolerant of a second dose This condition is known as anapnylaxis It may last indefinitely, but it wi’I produce no symptoms unless another dose of the serum is given In human beings the symptomsofsevere shock may supervene quickly and be followed some days later by rashes, joint pains and oedema The shock may even terminate fatally but fortu nately anaphylaxis IS a very rare condition In order to avoid anaphylacuc shock any patient who has previously been given scrum IS tested fir sensitivity before serum is again admmis* 240 I1\CIFVE ANO rimuo IIFVLTII itercd A dose ujtJallj — ^2 c c — is injected intnclermall} If the patirni IS sensitive, redness -•ntl swelling at the site or inoculation will npp ar within a few minutes and wall develop into a wheal m lest than an hour Such a pitient must be desensitised bj mjcclint* from 5 to I c c of scrum subcuianeouslj This IS followed eithci the whole therapeutic dose from 4 t & hours later or b> giving divided doses at hourly mi'rvals until the full amount Inv been injected A h>p‘'deTmc injection of adrenalin administered at the same time will lessen Mic danger of anap i>lactic shock Stnm Jtaihft a id Sentm Sukness — Serum rashes «omc tun^ occur in people with an allergic lendenc) from 7 to 11 di>» after the injection has been given The rash may be just a simple urticana nr u may simulate that of scarlet fever or of measles and all tvrpes may be present m the same person The distribution however, is difTcreni from that of a specific mfectiouj fever for it usuallv commences near the site of tnnculatiotu Serum rashes give rise to great irritation for whidi cjlimme lotion lus " soothing eficci, but they utuvlly fade vvuhm a da> or two and there maj be no other symptoms Sometunes the patient has a ccriaiii de'»ree ol pvrexia acconip nicd by pa ns m joints and muscles fins condition in which the rash i$ only one symptom u knovin as sermn sickness and it is much more common than auaplnhxis occurring in about 10 percent of Uiose given injections of scrum Htrd Immunity —By this term is me ml innnunity of a group of people or a community taken as a whole Local Imrrurity — Hus lemi was formerly employed by iJcifcJAa to ilcnote the rrsistnnce which »s oiTcred by tissue cells to the infecting agents Diseases for avhlch Artificial Active Immunity is Acquired — (fl) By living attenuated organisms — (i') \ a.cinalion asaii t mall pot — Artificial active acquired immunity u obtained against the diseave bv Vaccination {li) H C G \a eirahon laitrevhsiS (ill) \acctne cams! jelha Jraer — ^5 c c of bving atte- nuated virus \ imne is given Immunity devclips will n 10«14 days and lasts f r 2A years (i-) 1 occine fl” intt pla/pu — (Vogel and O ten) Pro phvhclic lao ulaiion is d nc wiifi avirutent living IMICTION 241 (4) Bjr killed o gii ismi — ^i) Typhoid feo^r — A B Varcinc ‘'(ij) Cholera — \ ittcholcra V iccirn. (i«) Plague —HilTlcm s Vaccine modified by Sokh-y (ip) Tvphiis — Wi'litsi d Blanc’s Vaccine (p) li\biti — \nt rabic Vaccine (') By bacterial filtrates or extracts — («■) Diphtheria — (a) APT (ilum prccip tated loxoid) (i) TAP (toxoid antitoKii n ICC lie-) (c) TAM (toxoid antitoxir m x ure) (d) r T (fo tnol toxoid) («) Tetanus — TT (tetanus tex » d) (in) Scarlet fever — oOO skin test d )ses mcrcising to 80 000 or 100 to -iduli life (adopted from tlie diary publisiicd by Medical College Amiitsar for the year 1961), is given on the next pages Notification — By this term is meant immediate lutim t on regarding occurierice of every case of an mf ctious disease to the health authority of that locality It may be the municipal m dical oOiccr of health or district medical ofliccr o'" health Advantages of Prompt Pfotifholion — 1 It enables the auihormes to isolate the patient to treat him and to do necessary dis nfcction 2 It helps to prevent the spread of mfcction by promptly taking m-asurcs and thus safeguard the rest of the community by inoculation e^ vacci nation for smallpos^ TAB and an icholera mocula tions arc administered to the public on the outbicak of enteric fever and cholera infect ons respectively 3 The real and original source of infect oa can h** found out The distribution of the cast or cases m the 240 H^OIESF AND rmjLIO irr\LTIl Itcrcd A small dose usuall) — 2 c c — is injected intndcrnnlly Iftiic p\tifntis sctisiuvc redness ••nd $\sclUn^ at the sue of mocuUtion will app'ir xsiiltm s frxv mtnutrs md will dcvclojy into a xvheal in less than in hour Such a patient must be desensitised by mjr ctiti:» from 5 to I c c of senim stibcuiancousl) Tins IS followed euhci by the xt hole therapeutic dose from 4 t 6 hours later or bygixmi* divided doses at hourly mtervih until the fuU amount has been injected A h>podermic injection of adrenalin administered it the same time xvil! lessen the danger of anaphvljctic shock Serun Rashes and Stmm Stekress — Scrum rashes some times occur m people with an allctj,ic tcndenc> from 7 to 11 days after the injection has been given The rash ina> be just a simple urticaria or it may similne lint of scarlet fever or of measles and all types may be present m the same person The distribution however, is duTcrem from that of a specific infectious fever for it usually commences near the site of inooil iiion Scrum rashes givens- to great imiation, for which cal inline lotion his - soothing efTcct, but they nsuxllv fide withm a day or two md there may be no oiher symptems Sometimes the patient has a certain degree of pvrexia accomixanied by pirns m joint* and muscles fits comlitmn m which the rash is onix one symptom is kn iw-n as scrum sickness and it is much more cotnmonUiiit anaphy lax s occurring ir about 10 percent of those given injections of serum Herd Immiintl^ — By this term is me tnt immunity of n group of people or a community iikcti as n whole Loca' Imm-intj — This term was formerly employed by HtSTedi-M to denote the resistance which « offered by tissue cells to the infecting agents Diseases for ovhich Artificlftl Active Immanlly I* Acquired — (a) By living attenuated organisms — (i) I (irfiiwstion < ♦mafifox — Artificial active acquired imminity is obtained against the disciic by vaccination (n^ D C C \ aesinaSion ai^antst luiirnihstSt (iii) lacctne egairst yfltap ft~ft —5 c c of living atte- nuated virus \ iccine u given Immumiy dcvcl ps wnhm 10 14 rJays and lasu f r 2-*! years (i") IVriv csjiarf ph-Jt — (Vogel and Oten) Pro phylactic mo illation is dine with avirulent living plagii- bacilli m Jawa \t id agascar etc Iramiaity lasts for SIX months to a year I^^ECTIOV 241 "'(6) By killei o'gii ismJ — ■^(0 Typhoid fevT — A B Varctne ‘'(»0 Cholera — \ uicUolera Vaccine (m) Plague — K iffkm s Vacr ne imdified by Sokh*y (w) Tvpkus — 'W a id Blanc s Vaccine (p) liilftes — Anirabic Vaceme (') By bartrrial filtrates or Extracts — •-(i) Diphtheria —{a) APT (ilum precip tated tox^ld) (i) TAP (toxoid antitoKi i fl^cc ile^) (f) TAM (toxoid antiioxir mjc urc) (d) FT (foimol loxoid) (lO Telatus — TT (tetanus tcx> d) (m) Scarlet fever — lOl) skm test doses increismg to 80 000 or 100 000 skii lest doses an- given sub- cutaneously m course of fi/e injertjorj sub cutancously ImmunMy develops ivitliiii tsvo weeks and lasts from 1 5 years Diseases la wbicb Artificial Passive Immunity is Acquired — w(t) By Convalescent Serum — In measles, convalescent serum and gammaglobulins give good results It has also been tried m poliomyelitis (ii) By antitoxic Serum —In tetanus, scarlet fever, diphtheria (ui) /iMlilKKbTial Strum — It is not of any proohylaclic value The chart regarding the recommended schedule of routine immunisation and vaccination fiom infancy to adult life (idoptcd from the diary published by Medical College Airuttsar for the year 1961), is given on the next pages Notification — By this term is meant immediate imim t on regarding occuncnceof every case of an mf ciious disease to the health authority of that locality It may be the m micipal m-dical officer of health or district med cal officer o^ health Adianlages of Prompt PToliJLalion — 1 It enables the authorities to isolate the patient to treat bun and to do necessary dis nfcction 2 U helps to prevent the sprfid of infection by promptly taxing m*asurcs ind thus safegturd the rest of the cimnunity by inoculation eg vacci- nation for smiUpax TAB and an*icholcra iriocula lions are administered to the public on the outbicak of enteric fever and cholera infections respectively 3 The rctl and original source of uifcci on can be found out The distribution of the case or cases m the 242 mCIE-SF ANP rCBLIC lTE.\l.Tn Rcroznended Scbedale ofRontinc Ixnmtniizatlon Age Jmrnunjzing Route of Admjnjjjn Agent tion INFECTIOJI 243 & Vaccination from Infancy to Adnit Life Dose Protective Contraindication Period As per direc- tion on. the vial or tubc« 4-5 years As per direc- tion by the manufactur- ers. About S years. (i) Pertusis Vaccine may not be given to children with positive family his- tory of epilepsy or with convulsions on slight rise of ismpTature to prevent post-vaccinai encephalitis. (ii) Triple Antigen should be post- poned during an epidemic of Polio. One drop. ] 3 years (In- ternation- ally accep- ted) In- gcneral practice every 4-5 years. Septic skin conditions like boils scab- ies, eczema, erysipelas, Diarrhoea, Dysentery, Fever, Severe Anaemia, 1st 3 months of pregnancy and in any family where other children arc sufier- ing from skin infections. As per direc- tion by the manufacturer. 4-5 years (Salk work) Do not perform operations in the oral cavity (tooth extraction, removal of tonsil etc.) during an epidemic of polio. As per direc- tion by the manufacturer. About 3 years. As described previously. As per direo- tion by the mauuTacturcr. About 3 years. 244 Il\GlCVE A\T> ILBItC 1U:,\I.TU Rccomendeil Schedole of Xlootiae Immunization 1 itesn ' 1 Age Immunizing Agent Route of Adm msira tion 7 After exposure tour dwing Vaccinia 1 Multiple rpidemcof smiU/pox A ^ Small pox \ accmation i should be performed every three years virus 1 PiiiKturcs or M lit p(c 1 pressures 8 t By 5 years of age or go 2 3 TAB { Subcutan d ses at mtcrxal of iO 14 (Typhoid , cous or ' days P,.ra A 5. I/M Para B ) 1 Every year (as per old concq)i) or every 3 years as ]^r ' recent work TAD I/D oriuly cutaneous 9 ' 5 years BCG Multiple 10 years Booster punctures 15 years 20 years doses. or I/D N B I (a) Accordit g to went trend nnd as per rccom mcndalion of the Amcncin Puldic Health Association, York, Poijo Vaccine can be combined u lli D P T and this procedure saves time, monc) and inconicniencc (b) Oral Polio Vaceme has been tried lucccirfuUy on millions of the cliddrcn by now and may replace Salk saccine 2 Plague Cholera and Influenza Vaccines aregisen svbencvcr there is actual danger of tlirse diseases As a normal routine they arc not yicn INFECTION 245 & Vaccination from Infancy to Adult Life — concld Contra ind ication One drop 3 years As previously described 02 cc, 04 c c. 0 4 c c , 1 I/D 0 1 c c to 0 2 c c S/C or I/M 0 5 c c 1 year (as per previous con cept), but latest work indicates that immunity may last for 3 years or so As previously indicated i i 1 As per certain authorities do not give TAB dun the later part of incubation period of t\phoid because of the possibility of danger duringnegaiive pliasc 4 5 years Do not g ve it to people who are tuberculin positive Before giving BCG as Booster dose alway s do tuberculin test 3 Recently mumps vaccine has been tned with reasona- ble degree of success 4 Yellow fever inoculation is only given to those International passengers who are proceeding to certain areas in Africa and Soutli America 5 Normal Gamma Globulins have the value of producing modtfled measles (when given be- tween 4th & 6ih day of the incubation period) and modifymg or suppressing attack of infec- tious hapaitUs 24C mCIE.SX AND PUBLIC HEALTH disinct or the louu ii known 4 It enablci to control the spread of mfccfion through schools Of other centres by c'ccluding r^embers of inr arc as follows — Cholcn, smallpos;, hickenrox, plague, cntenc fever, d^semer), diphtheria, mumps, tuhcrculotis, scarlctfcver, Icpros), mlluenza, whooping cough, cerebnvspixu! fev-r, puerperal fever, trysipclos, sprue, measles, yellow frver, relapsing fever, typhus etc IKAj sha/lj n?‘Jj — I A medical practitioner, who examines a case and diagnoses It to be a case of infectious diicise It is better '0 notify even if It 11 a doubtful one lor this omission, aaion under \Iun cipal Act can be taken against him 2 Any guardian or a relation of a ease who ji attending on him 3 A ly p-rson living ill the jam** house I Manager of a hotel or a-i instnu ion where* case of an infectious dis-aic occurs Isolation — It IS th^ scparatiMi, for the peris I of c«tntBJ’’i* cahthry o'" uifertcd person, ff^m other persons in *u_h places and under such conditions as willpfrvenl the direct or irulirrct ron ve> ince ofan infccttous arent frOns infcortcd p'TSoni to other persons who are fiiscep iblc or jwhot may spread the agent to I^PEOT^ON 247 of infectious diseases The period of isolation should usually be the period, till, Jie is not infective to others An ihfectiVL case may be isolated in tsvo ways — (i) In an infccuous diseases or isolation hospitth (ti) horn*, called house isolation Isala'io’t H) ptial — ^In all towns, it is necessary to provide hospital accormiidatibn for the isolation and tieatm nt ol cas s of infectious diseases In England the standard aim'’d at is pro» jsion of one bed for i 000 of the inhabitants Th- esscntnl features of an isolation hospital are that the s'te should be dry, healthy and wclldramcd It should b“ away Irom the corgested area but should have a convenient approach S*pirate wards should be provided for d»n‘ercnt infectious disease* Each patient should have 1 H- sq feet floor space and 6000 cubic feet oi Ircsh j air per hour There *liould be a proper .irringcm-nt fo the supoly of pure \>ater, removal of excreta and urme and d s nfee tion of soiled efothes m which provision of a steam dismlector is essential It must be provided with an ambulance car for rcrai va] of infectious disease case' to the hospit 0 If that js no' possi- ble, a rubbcnvhcclcd stretcher or even a countrywai t be provided, which can bt disinfected after bringing the patient to tne haspi- lal There should be capacious open land ni the hospital com- pound or just adjacent to the hospital where tonporary huts or wards can be constructed or tents be pitched at the time of the outbreak of an epidemic Barrier J/urjws; —This is suitable for the nursing of all conditions where direct or indirect contact ts necessary for the transmission of the infection There may be a screen which marks the * barrier” between one patient and another, but a visible line of demarcation is not necessary A. gown hangs by the bedside to don before touching the pacicm, ho bed or his belongings Each patient has his own thermom'-ter, feeding utensils and washing and toilet requisites Even the tempera- turc chart has its own pencil attached After any attention to the patient the nurse remotes her gotvn thoroughly scrubs her hands and nails, rinsing them m a disinfectant solution such as Dcitol where this appears n-cessary CubuU ^jrstnq — ^Partitions separate the beds from each other and from the centre of the ward The) are usually aboat 7 feet in height and arc, made almost entirely of glass, wiich makes for a good light and i Hows lor ojjcrvuion oj ru_ paiitat at all tim«s These cubicles have a comma i airspace only above the parlilinn, prevent droplet or air borne mf c loa from one patient to another Wten ihs pirtitioa to lie celling so that the patient isquicC shut o f bom othen, the system IS known as * rAumi/r rurjiiig** Each cubicle or chamocr snuld 240 m«IFNr 1\D It-BLIC llEVITll conlam a %s“ish tjasm ard have a s\sjng door The nursing tcchi ique >s tiie satne as >n bed isolition. Bed Jsslation — Thu is \erj similir to barrier nursinij except that feeding and todet requisitrsare not fcrpl scparatcl> tor each paiieni but are sieribsed immediately iiKcr use and arc then Icpl w tth other gencml cqutpmenc of the U ard House Isota inn or U me or Prtpate Jsolelten — It is done m patients own pruatr houses Ihc follouimj points should be obserxed — 1 The sich room should be detached, preferably, in the tipper stores 2 AM unnecessary furniture should be removed 3 A sheet soaked in n disinftctant such at 1 in 2f) solution of carlxilic acid should be bung up in front of the door as a curtain It anil help m anesung contagion ui the case of air- borne diseases and It avill act more cflcciucly as a danger signal to warn off the vis tors 4 The Windows ahouldbc kept open asmuch asposwble to ensure scntilatiori 5 Only attendants or nurses should be allowed to go in the sick room They must svash their hands in some dis nfectant solution befure leasing the sick room The outer dress of the attendants should be easily wasliableand should be charged on going out of the room 6 Tlie attendants should be selected from am ngthe persons who have had the di»ea$e or have acquired immunity by prophylactic inoculaiiori against the disease 7 The soiled clothes of the patient should be immersed m a dismfcctarn solution and afterwards boded, to disiuftci them 0 nscrcia and rttnnants of food should be received m a vessel coniamtng a strorg disinfcciaiii solution and should be buried in the ground and burnt away 9 Ant fi) and antimosqurto measures must be taken to exclude flics and mosquitoes fnim the sick room 10 riic utensil] must be disinfected properly after leaving the sick room U kircshcmll be kept burning m the sick toura or m its vetandah for ciessrovii g the waste niaicrials contamit~atcU with discharges etc , oi the jMtient 12 Visitors should not be allowed to enter the sick room bui if necessary il Quid spe ik *o the tick through the curtain ai the door or through the wuidowa 13 Ciiildren, clerks or workers from the infected house should nut I c nllowed to go to their respective ttutituuons INFECIION 240 14 When the danger of infection is faeheved to have ceased, •the patient s lould be welh^ashcd and bath“d thoroughly with soap and witennd gu cn a complete change of clothes, before he IS allowed to mix up v/uh other persons 15 In case of dca h the dead body should be completely covered in a >heet soared in corrosive sublimate or oirbohe lotion Subsequently, it should be buried or cremated as soon ■as possible 16 The sich room should be thoroughly disinfected after ha\mg been vacated by the patient It is necessary to remark that unless the patient and the Xamily give the most viUtng mutual assistance it is very difTicult to carry out these measures m private houses and even m hospi- tals Sanitary officials and medical men should therefore endea- •vour to induce the patients and their friends to consent to the removal of cases of infect ous diseases to an isolation hospital if there is one where they can he better cared for, and oe Jess dangerous to their family members and other neighbours It ■must he borne m mind t’eat even imperfect and incomplete isolation 13 better than none and may aid a good deal m check- Jng the spread of conununicablc diseases DISINFLCTION By this term is meant the process of application of a disin fcctant f r a sufficient length of time and in adequate quantity -and strength so as to kill the specific organisms of mtcctious -diseases Concurrent disinfection — Is the application of disinfec tion immediately after the discharge of inlcctious materials from the body of an infected person and the immediate application of •disinfection to articles soiled with m ectious mitcrial Terminal Disinfection — 1.» tl c process of rendering the personal clothing and immediate phys cal eiiviroiuncnt oi the panent free from the possibility of conveying micciion toothers •alter the patient lias ceased to be a source oJ mlcction Sterilization — Is the destruction of all microbial life * f , microorganisms and their spares by physical and chemical -means Fumigation — Is the process by which the destruction of in 'ccts and animals is accon pi shed by the employment of gaseous or volatile agents It is very useful inprc\cming tlic spread of 'nseetbome diseases ^ Disinfestation — Means any jwoecss by which insects and -^iroals capable of transmuting infection may be destroyed , 248 moiENE AVD innuc hevlth contain a wash basin and ha\c a s«mg door The nursing tccluaquc is the s^me os in bed tsolatioo. Htd Isshlton — ^Thisis\er) similar to bamer nursing except that feed ng and loiJet requisites are not bept separately for each patient but are sterilised immediately alter use and are then kept with other general equipment of the Ward Ho tst holaUnn or Jhme or Private holahon — It is done in patients own pniatc houses The following points should be observed — I The sick room should be detached, preferably, m tlic upper «tore> 2 All unnecessary funutorc should be removed 3 A sheet soaked in a disinfectant such as 1 m 20 solution of carbolic acid should be hung up m front of the door as a curtain It will he'p m arresting contagion in the case of air- borne diseases and tt wiU act more effecivvely as a danger signal to uarn off the visitors 4 The windows should be kept open as much as possible to ensure tcmdation 5 Only attendants or nurses should be allowed to go in the sick room They must trash their hands in some dis nfectant solution before leaving the sick room The outer dress of the attendants should be easily washable and should be changed on going out of the room 6 The attendants should be selected from amtng the persons who have liad the di case or have acquired immunity by prophylact c inoculation igaimt the disease 7 The soiled clothes of the patient should be immersed m a disinfectant solution and afeenvards bulled, to disinfect dicm 8 Excreta and rrmmnts of food should be received m a vessel conn ning a strong dis nfeciant solution and should be buned in the ground and burnt away 9 Ant flv and mtunosquito measures must be taken to exclude flies and mosquitoes from the sick room 10 The utensils must be disinfected properly after leaving the sick room 1 1 Fire shoul I be kept burning m the sick room or in its verandah for cJestrovii g ttic waste materials contanunaicd with discharges etc oi the jiaiicni 12 Visitors sivould not be affowed to enter the sick room but if necessary should speak 'o the sick through tlie curtain at the door or through the windows 13 Children, clerks or workers from the infected house should not be allowed (o go to tbeir respective imtnuuons INrCClION 249 14 When the danger of infection is believed to have ceased, 'the patient should be ivelhvashcd and bath-d thoroughly with soap and water and given a complete change of clothes, before he IS allowed to tmx up with other persons 15 In case of dea*h, the dead body should be completf’Iy covered in a sheet soaked m corrosive sublimate or carbolic lotion Subsequently, it should be buried or cremated as soon -as possible 16 The sick room should be thoroughly disinfected aAer •having been vacated by the patient It is necessary to remark that unless the patient and the Xamily give the most willmg mutual assistance, it is very difilculi to carry out these measures in private houses and even in hospi- tals Sanitary officials and medical men should therefore endca- -vour to induce the patients md their friends to consent to the removal of cases of irfectious diseases to an isolation hospital if there is one, where they can be bciicr cared for, and be less dangerous to their family members and other neighbours It tnust be borne m mmd t''at even imperfect and incomplete isolauon is better than none and may aid ^ good deal m check- ang the spread of communicable diseases DISINFI-CTION By this term is meant the process of application of a disin- fectant fra sufRciem length of time and m adequate quantity ■and strength so as to kill the specific organisms of mlcciious diseases Concurrent disinfection — Is the application of disinfec- tion immediately nfier the discharge of injections maicrnls from the b( dy of an infected person, and the immediate application of •dismfcciion to articles soiled with in'ectious ijuierial Terminal Disinfection — Is the process ot rendering the jjcrsonai clothing and immediate physical environment oi the patient Iree from the possibility of conveying inlcction to others alter the patient has ceased to be a source ol infection Stenluation — Is the destruction of all microbial life t e , microorganisms and Ibcir spares by physical and chemical •means Fumigation — Is the process by which the destruction of in- sects and animals is accomphshed by the employment of gaseous or volatile agents It is very useful mprevcniing the spread of mscctbonic diseases ^ Disinfestat on — Means any process by which insects and -animals capable of transmiiiing i^cction may be destroyed , 250 THGIEXE A2fD TtmtlC llEALTll Dctousing — Is the process of killing Uce and their eggs ot persons or m their apj*arcl Disinfectant — It is a substacc* which destroys pathogenw microbes, virus fungi or protozoa Germicide —It is a substance or an agent which destroys germs Disinfectant and germicide arc interchangeable terms Bacteriostatic — is a substance which mhibils the growth of microorganisms Antiseptic — It sa substance which pres ents decomposi tion and iciards or prc\cms the growth and iciivjty of m cro- organ sms hut does not necessarily destroy them or tt delays or prevents decomposition and fermentation without destroying the m cioorganisms causing the process tg sugar in jams and salt m hsh, etc Some disinfcctan s in weaker soltitioti act as ant- stptics 1 1 , bvclilonde of mercurs and funtialm m the ratio of 1 in 30 000 and 1 1 1 5 000 respectively Asepsis — A state of asepsis is said to etist woen an. article i» absolutciv '’ree from pathogenic m croorgan sms md Oieir spores Suclt an article is said to be sterile Deodorant —It is a substance having the power to destroy Or to neutralise the unpleasant odour of the organic nva ter undergoing fcimcntatio i or putrefaction r g ciiarcoaJ Some- deodorants destroy ofTeiisivc odours simply by substifuiingan agreeable or a strong smell without destroy uig the organisms giving rise to puircf ictive odours Volatile oils having ] unmeet, odours arc rot deodorants They s mply cover one 'mrJl over the other Tormalin is both disinfectant and a deodorant Classification of Dismfectaots —They arc divided jatt> three groips — (1) "»aturil — Ircshairand sunlight (II} Phys cal — (fl} Dry Hen — I Buinmg by Fire 2 Hot Dry Air (b) Moist Heat — I Boiling 2 Steam (HI) Clicm cals — (a) Solids (b) L qu ds (0 Cases {a) Aerosols (t) Natural Disinfectants — Fresh air and sunl ghj des troy infection and 1 mit t^e spread of infectious diseases By drying the microorgaii sms are attenuated and their mu'iliiAica lion 1 $ inhibited Oxvgcn of the air plays an important part m killing micro organisms Sunl ght IS a strong germicide due to the actinic nys espe ciaUy ultraviolet ray s The action of the actinic rays on the atmosphere is such that they foitn ozone and hydrogen peroxide INFLCTION 251 which .re pOMcrfl ox.d.s.ng agents The yellow and the red rays of the sun however possess no dismfectm^ pow (n) Physical Distnfeetanta —(a) DT em —This IS the best means of disinfeetion „ s^idl ployed for articles ol small value Cheap d-strueior furnace and should not be do P Qjjojgra and infected dwellings or huts may he burn V „„h enteric infected excreta should be burnt by mi*ing sawdust and kerosene oil Sputum and other discharg best destroyed by bumitig 2 Hot Dry dir —It has a very main- power and to destroy spores high t-™P' nearly all f tbrics lamed for a long time at a stretch ''h"" „,ful for ho It IS not employed for this reason Indtarubhrr etc , the dismfcction ol leather goods books which are spoiled by the '™ „me.ent (b) Moist Heat —I. Boihig e,- kilUn-r^ ordinary methoi Bothng for 10 ..nld fol- a" least half genrn, but for spores boiling should he con u an hour Clothes stained w * « °d or fauie^ w-ished with soap and tlien boiled nfecimg woollen will remam behind Doiling s "»• ifV,d,K b-d pans material as it shrmks Linen han'Jh"' j. ^ this m-thod St' ^a“sl‘e"„? Th‘.:1meSr - » -5= hut is commonly used on a small scab riurrcnt Steam 2 tom -It IS used m three ivass -(a) Current (4) Satuiated Steam (r) Superhtatrd Steam „tdmarv (a) Cut, 1,1 SHUT, '> almosphe.ie pressure of 376 at a t P ^ ^^rp^rJL'rs'le’am " H “ms gr.h?sa‘m- dis.nfectutg pow r as ““"dijr'steam disiufeetor eh^P a„h outs-t hut esp-n- stve m the long run because it consumes more , (4) ^atoledtorm -Whenste^w^t-neramdjiy water tn a closed acss-1 t g m “ * "j . [on—r th- p-rioj for issues and accumulates und-r pres .hc-pressure Tnc steam winch water ts boded the Smamr ^lUte thmpre^u so generated is called saturated steam It tsn^j^ m small volume hut is also at n 1^1^ r^^ ttcam always a definite relationship \u^ pressure, is at and Its temperature, f S s 252 moiE'n: A2 ?d pubiic hdalth i20®C Steam upto 5 lbs pressure is Jow pressure steam and when pressure is increased to 10 lbs then it is called high pressure steam Wlien current strain or saturated steam comes into contact wth cooler art cles, it immcdiaieJy gets condensed and m doing so, parts with Us latent hea» and shrinks to l/1600ih part of ns volume Thus a partial vacuum is created which is at once filled by more steam from behind and soon It thus raises the tern* pernturc in tl e vicinity to a high degree This proct-ss of con densing will continue until the temperature of whole of the bundle of the articles to be disinfected is raised to that of the steam When the disinfect on is complete, no further condensa tion of steam occurs Saturated steam is better tha n supe rheat ed steam because it is n ^r'to^irs condensatio n point and has g ot more rapicT p mver of pcn^ctrati on ~ (e) SupnheaUd SUam — It can be generated m tsvo svays •— 1 If steam is heated without raising the pressure the temperature of steam is highly raised, it is called Superheated Steam 2 It may also be generated by boiling salmc soluiton which bods at a higher temperature than ordinary water It has got properties s milar to those of dry gas and has no \alue as a a sinfeotant as It has lost its physical character as vapour It cannot condense until it has parted with its super heat Before using a physical dis nfectant its efiects on colour and texliii" of the ariicles to be duinfectcd must be cons dered Woollen goods as well as those composed of cotton and linen will not stand high temperature Most fabrics will stand a tern jjcraturc of 1 10®C without uidciytoing any permanent injury Cotton and linen will bear I I0*C dry heat for hours but 1I2*C moist heat only for half an hour Colton is scorched at a tern perature of ISO^G Scorching occurs comparatively sooner with woollen material I26®C moist heat applied for 30 mirmcs turns white woollen blankets yellow and d mmishesihe tens le strength of hair and causes shrinkage Steam Disinfecting Station — It should fulhl the following requirements — It should be easily accessible It should have a sanofitsoivn for bringing infected articles for disinfection Separate sheds should be prcMded for vans to bring mfccicd anicles and for these to return the disinfected articles The in- fected articles can be tiansportcd in long canvas bags having distinguishing ni mbers, woven inio them or permanently stamp- •ed on them The advantage of putting articles in bags with numbers on them is that the owner on disinfected side can pre I\1 CCTIO'V 253 sent his token and receive the articles after disinfection Infected articles should be put in bags, svhich are stiich-d and taken to the disinfecting station m ipropeily closed imlined \an The whole bag is put in the dismlccior w ihouc open ng Hutldrng — The building should b- constructed on improved sanitary principles The lloor should be of marbleslabs tiles or polishedcement , wads shouM have tiled dadovi, te 4i icet ot white tiles from the floor and rest of the will s'lould b dis tempered with a white water proof paint All angles should be rounded and no projections perm ited for accumulation of dust Window space should be ample to provide JulJ iignt and admit free ventilation The actual building is constructed in two halves which m no way should directly communicate with each other except through the disinfectingmachinc One half is the infected side, meant for receiving infected clothes, articles etc Into this side, opens one end of the disinfector The workers on this end should wear overalls and the infected clothings beddings etc , should be run into the disinfector over a trollv or a sliding cage The door of the disinfector is closed and steam let in When the disinfection is complete, the disinfector is opened from the other half of the shed and the disinfected clothes, bedding, etc are taken out and returned to their owners A difFcrcnt van, with a separate garage should be used for this purpose There should be some arrangement for ascertaining the efficiency of the disinfector A rtw egg is placed m the centre of the bundle of clothes, and this is seen after the disinfection If It IS completely boiled, it indicates that thorough disinfection has taken place If it is not completely boded, it indicates that the steam has not reached the centre of the bundle of clothes It can also be tested by placing a culture of suitable micro- organisms and finding out whether they have been killed, by recording thermometers or the use of a metal couple which makes contact and indicates that a certain temperature has been reached DifTerent Varieties of Disinfectors — J Il'jiAuiglon Lion’s (Afanloue a/iif /ifliofl) Iligi Pressure Dtsinfechr — In this t>pe saturated steam underpressure is used With a temperature of IIS'C to 120®G It is an elongated cylin- der, oval m section, with a door at each end The dismfcctmg- chamber 15 surrounded by a jacket and the steam is obtained by a separate boiler, the pressure at which u works is 15 to 2 > lbs per square incli There is an arrangement of producing a vacuum by asptmmg air out of the chamber In working it, steam is first admitted into the jacket to heat the chamber inside so that the steam maj not be quickly condensed Then a 254 DYGILNE ANT) FUHUC XlEXLTn v^cul-Ia js produced for about 20 m nutes Subsequently the itesm IS aatni ted insidt ll e cj amber for about 20 miruies after vA ich vacuum is again made A currcr t of 1 ot air is passed u i^StosmP a oteetor w ih Crsdlo the d sinfector to dry the clothes The disinfecting chamber is luHiciently large to adm t bedd ngs etc and js biult m the par tiiion •vi'aU bclwccD two rooms 2 Threik r Current SUam Duoi/eclor —It is n lowpressurc dis nfcctor and docs not require the mstaUat on of a separate boiler It consists of a chamber surrounded b> a jickct In this jacket steam is generated from a saline solut on usually calcium chloride •which nuscs the boiling point of water above ICO C without any exira pressure The bo Icr is fed i ith water from a cistern The time requ red for exposure of the infected art cles is usually 30 minutes The apparatus is s mple cheap •and II best suited for use m small hospitals and munic pal ties Although It IS a low pressure mechanism yet the steam is very hot as It is g ven off from water aver I00®G 3 Leeans WX D sinfeetor — It is a currentstcamdisinfcctor It 15 light simple and comparatively a cheap apparatus It consists of a long sack made of some material impm uus to steam such as canvas, a boiler, a J ose pipe and a stove The INFECTION 255 sack is suspended like a bell, the open lower end has a purse string mouth, and the closed end is upward. The tnfcctod*c!othings are suspended by means of hooks. Steam is admitted at the top through the hose pipe as long as necessary, which is generated in a small boiler heated with a stove. Exposure for 30-60 minutes is sufTicient for disinfection. It is easily portable and can be carried on a bicycle; and ts used in some municipalities. 4. Sirbian Darrel : — It was first introduced in Serbia and Bulgaria during tlie typhus campaign and is the best method of steam disinfection and distnfcsta* tion of lice from clothes. It consists of a barrel with perforated bottom which rests on a sandbag collar to prevent the escape of steam which enters the barrel through the perforated holes from a metal tank containing water, upon which it rests. The top oi the barrel Is' covered wah a removable lid with hooks to hang infected articles, clothes etc. The barrel with the boiler is placed on brick work frame form- ing the furnace After about an hour’s cjqsosure to steam, the articles will be satisfactorily disinfected and disinfested. It is a type of disinfector in which currenr steam ir us«d (ni)' Chemteal Disin- fectants : — The manner in which the chemical disin- fectants act is not fully understood as yet. They chiefly act by o.xidisjng and coagulating the protoplasm Fig. 48 Loleaa’a S,Z:k Dlsmfector Fig. 47 —Serbian Barrel Dlalnfedor 256 H'iGlLVE AND PUBLIC KLALTU of bacteria They also act by ionic coagulatiori desiccation^ eniuUoid action, absorpton etc Tticy are used for tn-- following purposes — J To disinfect or deodorise faeces urmc, sputum etc 2 To wash the floor and wrall* 3 To wash iron and wooden articles which cannot other wise be disinfected 4 To disinfect hands in surgical operations and cutting instruments which are spoiled by boiling 5 Gaseous disinfectants are used for disinfecting houses and buddings Jirquiremenls aj a Good Dtttiifeclant — 1 It should be homo- genious and should liavc definite efli lency for a particular type of organism 2 It should be a powerful germicide, rapid in action, having a great power of p'^netraiion 3 It should be stable m presence of organic matter It should not be rendered inert m the presence ol faeces 4 It should not have any injurious effect on human tissues and material submitted for d smfection 5 It should preferably be soluble m water and should form a uniform emulsion in all proportions 6 It should be fairly cheap and should not act on metals, bleach pigments or spoil fabrics and should be neither toxic nor caustic 7 It should be high solvent for grease ,.£mndardisatloQ of Disiofcctants — Two methods are used for th s purpose — 1 Rthal Walker or Carhltc And Co ejjinent Usl — In this test carbolic acid is used as a standard disinfco tant and Bacillus tiphostis 24 hours culture, as the test organ- isms The result of the tests of other dismfictants arc expressed m terms of their power, compared to the standard of mh biting the growth of the same organisms within the same tune J his is called the carbolic acid co-cfiicjent of a particular dis nfcctant Method — I Taf e several tubes containing 5 c c ofthcdis mfectant m different dilutions 2 To each test tube add 5 drops of the culture of bacillus typhosus Shake the tubes well *1 After every 21 minutes prepare sub cultures from these inoculated tubes intoSec broth for 15 minutes eg 2| 5 7^, 10 12^ and 15 minutes re, mall 6 senes of sub cultures arc made INFECTION 257 4 For 48 hours incubate all sub culU res at 37*0 and note the presence or absence of the growth 5 Carry out the same process within the same time, with same culture, ssith dilutions of carbolic acid 6 See from the table of results, tlie two dilutions having the same clTcct in the same time and therefrom calculate the carbolic acid coefficient of the disinfectant Tie Brtlisk Admtraltly Aletkod for Standardisation of Du vfectani — It is the best method and is done as follows — 1 lOcc of the disinfectant is diluted to 1000 c c with sterile, artificial sea water (32 gros of Tidmari s sea sail dissolved in 1 litre of water) and allowed to stand for 24 hours A portion of this mxtnre is removed from the middle with a pipette for test purposes The standard is crystallised phenol, also dissolved in ariificnl sea water and the test organism is bacillus typhosus 24 hours* culture m nutneiit broth at 37“C 2 Organisms remain m contact with the disinfectantfor 10 minutes the temperature of the broth and the room being JO’C and 18°G respectively 3 The germicidal value of the disinfectant is determined m the presence of a dcdnite amount of organic matter consist ingofgehtine and finely ground nee starch (0 5% ofgelaltnc and 05% efnee starch in suspens on in sterile water) 4 0 25 cc of the culture is added m 5 c c of the above solution and 5 c c of the disinfectant and the mixture shaken thoroughly After IQ minutes, a sub culture is made m broth and IS incubated for 48 hours at and the presence or absence of the growth is noted The folloving chemica’s are generally used as disinfectants — 1 P cubic feet space 2 — 3 lbs of poudered sulphur is put in a pot placed in a tub of water The sulphur is moistened with alcohol and Ignited Sulphur canoles may be used in place of powdered sulphur (J) The same amount of sulphur powder be sprinkled over Ignited charcoal The walls and floors should be sprinkled with water (e) Cla) ton’s apparatus •>-In it, sulphur dioxide and Sulphur inoxide are generated Sulphur is burnt m an iron generator ‘Ibis gas has great penctrat- tng power It ts chiefly used for the destruction of vermin particularly rats bugs Jice etc ■ 3 Cklonfie ^as — It tsa disinfcctantand deodoriser as it has ap aflin ty for hydrogen, when it bberatts nascent oxygen which has a great affinity for organic maitcf and bacteria A certain amount of moisture is also required for disinfecting th room successfully with chlorine gas It is more irritant to eye* than sulphur dioxide and bleaches all vegetable and amhne dyes It IS produced by the action of one lb of sulphuric acid or hydrochloric acid on two lbs of bleaching powder for disin- fecting 11.00 cubic feet of space 4 Creiol Jiintgafton — ^For 1000 cubic feet of space about 6 ozs of cresol is poured over smouldering cowdung cakes about 20 in number placed in a big iron pan m the centre of the room Tins method was used freely for disinfecting plague stricken houses in Punjab and proved to be of great value m killing rat fleas In buddings basing high roofs it is better to fix up a cloth across the room about 10 — 12 feet from the floor in order to prevent dense fumes of cresol diffusing higher up The object being to allow the dense fumes produced to act mainly on the floor The fumes are absolutely safe for all art clcs, furniture etc. It neilber tamishes metal nor bleaches &bncs It IS non irritating to eyes, easily produced and is in- INFECTION 26S rxpccsivc. ft’is ahvajrs preferable to use more than one pan in a biff room. 5. Hyiroejanw aetd gat ;--Thn gas has no action on bacteria. It tr Jargel/ used to destroy rats, fleas, and other verram, on board ihe ships, and pumped into rat holes in com* bating plague cpjdcin c. It is highly penetrative, is chemically inactive and has no bleachuig or tarnishing properties. It has practically replaced sulphur dioxide as a fum gant in the Umted States of America. The gas ts highly poisonous and should not be used to disinfect any room unless the whole house is got evacuated. It should be used by a trained operator. It is gtneraltd by : — • (a) For^ disinfecting 1000 cubic feet space, 5 ozs. of potassium cyanide, 71 ozs of sulphuric acid, and 10 ozs of water are mixed and the gas ts generated. (b) Cyanogen chloride and zvklon B are used. (e) Cyanogas is largely pumped in rat holes by a cyano- gas pump The gas is slmvly evolved and kills rats. 1 lb. of cyanogas powder is required for disinfecting 1000 cubic feet of space. Dism/fff iinmerxed ?n _ phenol solution 1 m 4ft yr mercurt* chloride I in 1.000. 2. Clinical thermometer sh ould be kept in -php.nol so Niti^n 1 Ifi iiiCZ . ' 264 HYGIE^E AND PUBLIC HEALTH 3 Fee ding-, eo u nm fnt. uteojiN and crockery should he boded or s calded ~ " 4 Rcniams o f food sho uld be destroyed b v burn ng 3 Nasril. faTirtn!, /-amr di^r.Tiarofi nr should be taken up m gauze swabs and destroyed by 6 Sputum should be received in gauze s^vabs or paper “ spmuin cups and destroyed bv -biirmi;^ In tuberculosis hospital It should be mi«fcd \tith solution 1 in -20 and allowed to stand for two hours betorc disposal into dram or else placed m a stcfibsing autoclave fo r 20 minutes 7 — (a) Mix with equal volume of pheno l sohjlian I in 2^ or Bleaching powder and stir with a Wooden stick and allow it to stand for two hours (b) Sterilise m a steam steriliser 8 should be treated with nhepoLsahitton 1 m 20 and allowed to stand for half an hour 9 yextiies -—If so led with albuminous discharge, they should be cleaned wit h snip Except blankets, they should be boiled or disiniectetf with _stq^ . £13^^- may be soaked in^LioJ KMwbolic acid sotiinon lo t' 12 hours or sprayed wit h tormalin or fomalde hvde gat Terminal Disinfectants — ! Bao Ls hnnts- furs, feathers etc arc best disinfected by exposure to 3% iormaldehsde for 3 hnurs-pi-th ey a rc rendered unnuble bv siei m'~~' ^ 2 Dead bodies of persons who have died of an infectious disease should be wrapped in a sheet soaked m a powerful disinfectant Cremation is very desirable in such cases and which should be hastened 3 Bedding or body linen be disinfected b v steam . 4 ,^flamicj3isinfccted by fuimration . 5 Floor and wall Su rfaces May be sprayed with .coal jon or with a 2% soliit on of formalin CHAPTER XVI INSECTS AND PARASITES INSECTS Injccis arc intjmatelj' related to man They coiMtitutc a group of arthropods who have bilateral symmetrical bodies, jointed appendages, %'nth heart situated dorsally, and nervous system ventrally Their bodies arc covered with a tough skin called exoskelalon and are divided into 3 parts namely the head provided with two antennae (vtz , /filers), the eyes and the mouth parts, the thonx composed of three segments with three pairs of legs and two pairs of wings, and an abdomen composed for 9 to 11 segments They have distinct sexes and are repro- duced from eggs They have visual organs m form of compound or simple eyes They are not piovidcd with lungs, but they simply breathe by means of a special type of tubular organs called trachea, which communicate with the external air by lateral openings called spiracles Claaslficadoa — ! Wingless — J Fleas 2 Licc 3 Bed bugs 2 V/inged ~ 1 Mosquitoes 2 Sand flies 3 House flies 4 Tsetse flies W1^0L•ESS IhSECTS 1 Fleas —They belong to the order of si^Aortn/itrrfl They arc tvinglcss insects 2 — 3mm long with laterally flattened hard, » humous bodies consisting of head, thorax and abdomen They are of small size and have bright colour A flea lias ypairs of legs Vaneties — ^Therc are hund> reds 6r varieties but from the hygienic point of view the follow- ing are important — 'Acnopsylia cueopis,"A, asUi, X brazihensis They are Indian rat fleas Xenopsylla chcopis IS the common rat-flea m India and conveys plague Xenopsylla Astia is Tot a carrier of plague It is found in Madras and Colombo Fig 60— Humao rat-flea 266 HYOIBNE ANO POBLIO HEALTH (4) Nosopiyllus or eeratophyllu* rascialus (Europeao or temprrate climate rat flea) "V (r) Ctsnoccphalua felis and cams (cat and dOg flea) Fleas home eptimtes They arc • — Bubonic plague, endemic tminne and typhus Life hwJprir — A female flea lays 8—12 eggs at a time singly in the hair of the host, which are oval, smooth, white and thev soon fall to the ground In summers within 2 — 4 days and in wmter in. 1 to 2 weeks time, the eggs ha»ch up and hairy larvae appear The larva is very active and thrives on organic matters and develops into a pupa m 2 wedts* nme by spinning a cocoon In which It pupates It takes another 2 weeks for a pupa to develop into an adult flea Habits — ^They prefer darkness and are very sensuivc to light T hev frerly multiply In absence of rats, when starved, Oiey bite man The males carry plague to rats more readily than hmalea They themselves travel about 20 — 30 yards but may travel far away if earned by a host or m the beddings or clothing of men or m gram sacks They can jump upto 3 inches and crawl even upio 8* They are very active nhen prevailing temperature is50*F or so They are most common m dirty and desert* ed places and in places resided by people of unclean habits 2 Uce —They arc small wingless ectopaiasiiics with hard chltinous coveimg and having three pairs of legs, each provided with a single claw They li/e entirely on mammalian blood Body louse {female) *Fi2 52 — Crab louse (femele) Vanetus — 1 PtdKuhs capihs (Head IauSc) 2 Peduulus kumamu corpons (Body Louse) or PedtmUs VtshmenU 3 Pktkjrvs pubts (Pubic or crab louse) or Phthtnif Ingutnalis tNSEOIB AKD pARASrTEa 26T Loose ieme diseases —I. Typhm, 2. Trench Fctct 3 Relapsing Fever Tlit-rc are two conditions for which head lice are often responsible — 1 Swollen glands at the back of the neck and ear. 2 Impetigo due to scratching and infection of the sores. Lt/e history — A female louse, within 48 hours of assuming adult lorm, produces nits or e^s They arc attached by the cement, secreted by the female, to the hair They arc oval, I greyish white specks and provided with an operculum or granu- lated op' The larva emerges m 6 days, begins feeding almost at once In about 7 days tunc during which 3 moults occur, ihe insects become adults A louse takes 15 days’ period to comp- lete us cycle from an egg to the adult stage Habilt — The average life of a louse is from 35*^0 days Both male and female lice are blood suclers Infecnon is due to scratching the faeces of the hce into the skin In addition, their bites are irritating, causing disturbed and msufticient sleep, especially in children They may givense to impetigo at d other lufecuons like dermatitis, etc , through secondary infection 3 Bed bnga -—They belong to the order of Htmipura and comprise a larg* number of specie s A bed bug measures f;oro 3 to 5 nans m length and 1 5 to 2 5mms mbreadth It is dark brotvn, compressed and th n, so It makes us way into narrow cracks Both male and fctnale bugs bue Its strong beak tnGicis o painful wound They prefer human blood and in its absence wilt feed on blood of rats and domestic animals They are nocturnal m iheir habits, retiring during the day in hiding places No insect is more difficult to eradicate from an infested building than the bed bug The mom diOiculty is to get at it Bed bug can live upto a year e\ en ivithout food Varuhes — 1. Cimr* lectularius in temperate climates (Indian, bed bug) 2 Ctmex ksmifilerus in tropics, or 3 Ctmex rotunJatus (Indian bed bug) Fiji 53— Bed bug (doTval view) 268 HYOIENE AND FOBLIC HEILTH Diseaset conveyed — ^There is no disease which can be directly attributable* to these but they cause irritation and annoyance and loss of sleep Li/e hulary — Several times a year, the female lays from 1 — 12 eggs amounting to 200 or ni ire during her life time The eggs hatch m 7 to 10 days Larva moults soon after a blood meal, if available and attains first nymphal condition and caches the adult stage after four subsequent moults In another two weeks it becomes sexually mature The life cycle takes about 8 to 10 weeks Ticks — As a class of teioparasiUt they arc found most abundant m warm countries as cold ts unfavourable to them They arc very important blood suckers and play an important pan in the transmission of disease They attack all kinds of vertebrates, mamm iha, reptiles etc The bite though not pamful at the time causes lasting irritation As both males and females bite, both are transmitters of the duease The female hands dQ^vn the contagion to her progeny Thtv differ from insects m having four pairs of legs only ttvo pairs of mouth parti and havmg no antennae They are nocturnal m their habits, so they remain concealed during the day Dueaus tont^ed —These arc lick relapsing fever and rocky mountain spotted fever or tick fever Lt/e history —A female tick lays 5000 eggs in a mass on the ground After 2—3 sveeks larvae hatch out These attach tliemselves to a su t ible host and feed, drop to the ground, moult and become nymphs The nymph clunbs on the blade of grass, waits to attach itself again to a host, feeds, drops and moults again to become an adult The I fe history is completed in 1 to 2 years Having thus reached maturity, the sexes unite After fertilisation the male dies, while the fern le proceeds to feed on the blood of her host for the development other ova As it is dilBcuU to find a suitable host, ticks can fast for a long time They have been found alive even after a fast of 4 years Mites — SanopUs icchio —This is the itch mite The male 1 $ 0 2 mm and female 04 mm long Both males and females have two pars of antenor legs carrymg pedicles with suckers The fenwlc has two pairs of posterior legs with long bristles , but the hindcrmon pair of legs m males have pedicles Life Htslo^ — ^The female burrows into the skin and lays upto fony eggs along the burrow The larvae arc hexapod njmphs Some of these mould to become adult males OUiers become second stage n>mphs which in turn moults and become adult females The period from the egg to the adult female is about fourteen days The adult lives for four weeks Diseases caused • — Scabies or itrh INSECTS AND PARASITES 269 RINGED INSECTS 1. Mosquitoes — They belong to the order diptcra, and grouped under family eulmJag and sub*fanJily eulutnae They arc distinguished by the presence of scales on ihcir wings and proboscis They are often referred as “bitmg flies” but thc> are mfact piercing insects, for the jtws of the female arc transformed mto a needle like process with which to penetrate the skin when a blood meal is required The important anatomical characters of the adult mos- quitoes are — 1 Ptohoicts — Bears various markings which vary accord- ing to the species 2 Antenna — In the male they arc plumose and m the female they are pilose 3 Pclpi — Are four jo ntftl and r>a) be very short or as long as or even longer than the pioboscis A Thorax —Bears scales and markings which vary according to the species 5 — Tnc arrangement and the coloration of the scales depend upon particular species 6 Abdomen — It has eight segments and may show coloured bars Ventius —The important varieties of mosquitoes in India which transmit the disease, arc as follows — A— Anopheles — 1 A minimus — It is a vector m North Bengal, Dear, As^am and Souiliern India It breeds m clear unpolluted slowly running water, with grassy edge, as in a stream or an irrigation channel It also breed" in wells and cisterns 2 A JluwatiUs — It IS a vector m foot hill areas, from North West Frontier to Asvam and other parts of India such as South India, M}sore and Travancore It also breeds in clear unpolluted water like A minimus and m slowly running water, streams, drams, etc 3 A culiitfacies —It is a vector, widely distributed in India cxcipt in Bengal, Asxam and Jaipur hilly tracts It is found particularly in North West India It breeds in clear water, m irrigation channels, in slugg sh streams often vwth sandy margins and on little vegetation m sheets of fresh ram water It also breeds in ncc fields, burrow pits, shallow wells and jxiqIs 270 HTOIENE AND PUBLIC EEALTB 4 A sUpkertn — It IS essentially an Indian species and ts%%idely distributed m India especially m Western and North West India, urban areas of Galcutta, Delhi, Bombay and Madras It breeds in wells, cisterns, fountains, receptacles, etc In rural areas it breeds in pools, margins of streams, in seepages and marshy areas, m springs, shallow wells and gaidcn pus containing seepage water It can also breed in salt water 5 A pkl pptnensu —It is a vector in West and Southern Bengal Assam and Southern India particularly in rural areas It breeds in tanks, ponds, dobas but never m nee fields 6 A tunJa}CUS — It causes malaria in coastal area of Bengal, Oiissa, Andamans, Nicobtrs Eastern part of Calcutta and Bengal It breeds on bnckish water, fish ponds, salt lakes, cic 7 A suptrpictus —It is t vector of limited distribution in India and does not play an important role in tran$m4sion of malatia in India It has a marked preference for running tvatex exposed to sunlight occurring mostly along the edges of streams and rivers It also breeds in marshv areas open irnga> tion channels, wells, springs ana reservoirs 8 A etmulant and A varuna —They are vectors m Assam and Bengal They are weak earners and breed in stagnant waters of all types B Cniex — CuUx fati gsns — They frequently breed m cesipoois, guUyiraps, drams, masonary tanks, earthenware vessels and in collections of water around houses "ind stables They are responsible for the propagation of filana C Aedfs (Ugypu or Sugo myxa Jaicxata — They are res poQitble for the transnussion of dengue and yellow fever They breed m small ariiRual collet* tions of water, such as barrels p,^ tS4— A«dM A*itypd puddles, osterru, old tins, broken tms etc. TTicy are domestic 1NSECT3 AND yAN^SlTEB 27 1 rn ihetf habit and arc therefore very dangerous They seldom fly far away from breeding places Life history of mosquitoes — The male mosquito feeds oh vegetables Mlicrc as the firaale feeds on the blood of the host Dunng the course of the season, the female mosquito may lay eggs several times and several hundreds at each time The male mosquito lives rareU more than 1 to 3 weeks The female may live upto 4 months or more Mosquitoes prefer dark to light colours The anopheles type of mosquitoes avoid both heat and light ind therefore during the day they remain con- cealed in the corners of rooms etc At night they come out from their hiding places lo search of their food The females bite men and animils as th<*y are blood suckers ind that is why their proboscis is particularly modified for piercing the skin Provision of the blood meal is essential for the female mosquito before produemg a batch of eggs Anopheles mosquito does not make any noise while flying a^ut The bite of anopheles is not very painful Mosquitoes b tc voraciously when the relative humidity of the atmosphere is high Dunng winter, in cold countries and in the hottest months m tropics, the female adults hibernate m sheltered places This is known as aestivation Anopheles do not seem to fly more than i to ^ mile, from their breeding places, but if the breedmg is profuse, habitation scarce and the direction of wind favourable, it may go even upto li to 2 miles Life cycle —The female mosquito, after sucking blood lays eggs on the surface of water The anopheles female lays lOU- 250 eggs in each batch They arc boat shaped and are deposited singly They arc difficult to be detected with the naked eye and resemble minute specks of dust m appearance. In ease of female culcx, hundreds of eggS, usually 200 to 500 arc laid at a lime and are cemented together m the fonn of rafts In 2 3 days the eggs batch out and a small wormlikc larva appears from each egg It consists of a flattened head, tvith a pair of large eyes, a globular thorax and abdomen but no legs The head has got strong mandibles for biting They have got respiratory apertures 1 hesc larvae feed greedily on vegetables They arc found in stagnant pools and slow running streams Anopheles larvae arc provided with palmate hair and they float- parallel to the surface of water The larvae of culex and aedes have syphon tubes, so they bang almost vertically with then heads downwards The larva casts its skin 2 or 3 tunes and fmalU attains its full sire m 8 10 days, when it changes into a comma shaped 272 monr^iE and public health creature called pupa It has got a large globular body and a small tail It is very active and swrnis rapidly by lashing its bmder part about It does not breathe through its tail hke the larva but does so b> means of tubes which project on the dorsal side It has no mouth and hence U does not eat In 2 3 days it splits np and an adult mosquito or the imago emerges It has a rounded head with prominent e>c3, tv o antennae, »wo palpi a prominent suctorial or piercing organ — the proboscis an oval chest about the s ze of head to wh ch is LIFE HISTORY Of MOSQUITO ANOPHELES I CULEX' INSECTS AND PAKASITES 273 ;attacJjcd a pair of wings and three pairs of jointed legs. The abdomen is segmented consisting of lO segments of which however only 9 can be distinguished. The males are r plumes on either side. Distinguishing features of Anopheles and Culex. Anopheles CuUx (i) Adult ; — (0 Resting attitude : — ^Thc head, thorax and abdomen are in a straight line (except A Gulicifacics) (ii) Proboscis : — in one Ime with body and head. Palpi as long as probos- cis in both sexes but clubbed terminally in males. ■(in) Scutellum ; bar shaped, (p) Wings ; — frequently spotted. ifw) Sc.i!es no scales on belly. [b) Breed in clean, fresh water. Some prefer still ^vatcr, wliile others prefer running water. Some breed m saltish and bracUsh waters. •(c) Eggs s-boat shaped, laid singly 100 — 200 m num- ber, ollcn form pat- . terns, on the surface of water, e.g , triangular and star shaped. id) Larva i — small head. Has no respiratory sy- phon or breatlung tubes. Lies horizontally with the surface of water. Has palmate hair (except A. urn- JtTOSUs ) . (<) Hump backed attitude, with body more or less parallel to the surface. Head or body arc in- clined at an angle to one another. («) Not in line with the body. (iti) Very short and two knob like in females. (h) Trilobcd. (e) Plain (ai) Scales on belly. (^) In still water, cess pools, gully traps, drams, earthenware vessels, around houses .and stables, often in collections of dirty waters. (c) Ovate or cigar shaped. Laid in batches. 200- 500 in number, found cemented together in rafts of hundreds of eggs. (<£) Large head, lias a loug conspicuous syphon tube It lies at an angle with the sur- face of water. It hangs downwards when it breathes. Has no pal- mate hair. ^274 HYGIENn AKD PUBtlO HEALTII {/) Pupa -Breathing trum- (r) Breathing trumpets are pets arc funnel shaped long and narrow Acccs- Acccssory paddle hair sory paddle hair grown grown above the ongin besides the paddle hair of the paddle hair ormaj be absent jiedes aegjpit or Ste^omyia jasetatt or tiger moiqui o — Thu IS a dotnesuc mosquito and ts characteristically marked with black and white stripes It has unhanded proboscis white mark- on the dorsum of thorax called l^rc, and the cioss bands on the abdomen It is recognised b\ the bioad fiat imbricated scales compleielj covenngthc head and abdomen, which are invariably present on the middle lobe and licqucntl) on the lateral k be of the scutcllum also The scales impart a satiny appearance which 13 characteristic Thev are snosiy are blicA The syphon of the larva u short and dirk in colour 2 Housefly —The commonest vanet> of liottse fly t» called J/utra domrr/tro It belongs to the famil) musetJae, ot order diptera It is tn length, having mouse grey colour and 4 narrow bhek stripes on thorax It has got a proboscis which. IS not capable of piercing but is used for sucking food It breeds chicfiy on human and animal excreta part cularly horse manure, cow dung, deca)ing and fermenting vegetable ana animal matter, carcases and putrefying filth which piovide« food and home for maggots It cannot breed m very dry materials LtftcycU — A female house flv Ja}s 120 — 500 eggs at a time and four such batches m 3 season. The favourite sue is on the surface of fermenting vegetable matter or fresh dung of horse,, pig or man The progeny of a single house fly ivill number 432,000 m seven weeks The eggs look III c tiny grains of polished rice The development depends upon the atmospheric tem- perature and the characteristics and tempcrilure of food The larvae or maggots — ^Within 1 to 2 days the eggs liatclt into white legless crawbng creatures called miggots Thc> grow rapidly and burrow inio food material on which ihcy feed Tiie maggots shun light and disippeir during the day and come out at night They cat v oraciously The Pupa or ClrysaUs — In about 3 — 5 dai s, the lirvi enters into resting stage It is passed within a barrel shaped shell usuallj in length, which is oval, brown and quite immovable The adult fy — In 5 to 7 divs, dep"nding upon the tem- perature, It ruptures and a full grown fly comes ou , which liJSECTS AND PADASITES 275 has a shrunken appearance and incapable of flying. The wing* soon spread out, the outer covering ofthe body and legs harden and the fly looks quite normal. The duration ofthe cycle is 10 — 20 days, depending upon the temperature. The greater the temperature, the quicker the cycle. pig. 60— LifactagosAfSooeofly. Moit oflnfuixon : — A house fly does not bite and therefore cannot inoculate a person in a direct manner. The house fly is a mechanical carrier of disease. Its hairy body, legs anti wings become covered with filth on svhich it feeds or crawls. This material which may be infected with pathogenic germs is frequently deposited subsequently on human food. Furthermore, in the fly*s alimentary canal bacteria live unharmed, until they arc discharged in tJie c'xcrement or regvrgiiatcd in small drops which are called “vomit spots.” The fly infects food in two ways, i.r., mcchanicatly and vitally, e.g., the fly sits on ty^ihoid or cholera infected stools. It then flics to a glass of milk. It infects milk in two ways 1. Mechanically, by having filth washed off its legs. 2. Vitally by vomiting and dcfaccalir^ in milk : Experi- ments have shown that the flies infected with typhoid and anthrax germs can remain infected for weeks and there is some evidence to show that the typhoid germs swallowed by a maggot born in typhoid inTcctcd stools may persist in adult fly. Flies have a limited range of flight, i they are generally moving in a circle of about J mile of radius In India they can be carried to long distances by human beings, animals and other means of merchandise. They are not long lived. Under favour- able natural conditions their maximum life is probablv 60 days. They arc subjected to a natural disease, which kills them in large numbers in autumn. T^c increase in number of fl'cs is definitely associated with the climatic conditions of temperature ?76 HYGIENE AND PUBLIC HEnLTH and humidvty prevailing during the summer months, i e , June and July These climatic conditions favour the rapid mulcipb* canon, of flics Diseases spread bjiJ!us — ^They are responsible for convey- ing many diseases as cholera, infamfle diarrhoea, dysentery, liphoidfevCr, parasitic avorim, tuberculosis, oriental sore, 1 iu the direct agency of second host, as in ftlaria The common animal parasites that eflect human beings are as follows —Helminths — They arc tnploblastic worms consist- ing of epiblast, hypohUst and mesoblast They may be considered under three classes itz > nematodes, cestodes and trematodes I Nematodes or Round worms —They have slender bodies and liavc no segments oi appciidaecs They have welt developed alimentary canal, with mouth at one end and anus at the other end They are bisexual The males, are smaller than- the females The following are some of the important parasitic worms found in man — 1 . ASi,arit lumirtmdes —It resem- INSECl'S A^D TARASirES 281 b!es the common carthwonn being cylindrical and pointed at both ends, of pinkish grey colour, with glistening surfjcc when alive The adult female measures about 12' — 14' and the male about 3' to 10' with its posterior extremity curved anteriorly The fcmdlc lays enormous number of eggs, tbatlia\c resistant shell, outside which there js often a clear irregular albuminous- sheath The egg is non infective until a larva has developed This maturation takes a few necks while it is laying in the sod Mature eggs containing embryos arc ingested via contamina ted food, vegetables and fingcix Whenswallc wtd, these eggs find their way in the duodenum, where the shell dissolves ind the embryo emerges, perforates the mucous membrane of the intestine enters lymphatics and veins and reaches right side of heart and from there passes on to the lungs by blood stream It ‘hen penetrates the lungalvcoh, mtgra es up the trachea down th'* esophagus to reach tntestmes and becomes an adult to lay eggs They may be sometimes found matted in the intestines thu» causing intestinal obstruction 282 HYOIENE AND PUBLIC HEALTH Prevention — It depends upon — 1 Satisfactory disposal of nightsoil 2 Vegetables eaten raw should be washed under running svater preferablj with water containing potassium permanganate Use boded tvater for drinking 3 Treatment of all infected persons 4 Attendance to personal hygiene 2 Oxyuris vermiculans or Thread worms — They arc found mainly m cliildren The female is J' to i* long and the male usually half of its size Thej develop from ova in about 3 weeks time LiJteyeU — The eggs are swallowed and larvae hatch out m duodenum They pass down to caecum where they develop into adult norms and attach themselves to the mucosa of caecum and large gut The female soon migrates outside the intestinal canal through the anus and deposits her eggs on the perineal skm Tlie c„g$ remain attached to the skm in the grooves, aiound the anus, in the perineal hair and clothes of the host These eggs become infective to man within 12—36 hours of deposition and contain tadpole like larvae The host may be reinfected by contamination of fingers as a result of scratching and other members of the family m manywajs These worms crawl out of anus and give rise to much local irritation and often lead tomany difTercnt types of sympioros tg, enuresis, cough resilcssncss convulsions slecpless- Dtas, disorders of appetite etc They may cnict \hc vagma in females and cause vulvovaginitis, pruritus and Icucorrhoea Prevent on — To prevent auto nfeetion the nails should be cut short and kept clean and washed thoroughly after dcfaecation and before meals If possible child should wear gloves at night He should sleep alone There should be f cquent changmgof bed linen, underclothes, pyjamas and towels The anus should be smeared with dilute amroomated mercury ointment every night before going to bed The infected children should be isolated till cured 3 Tnchinella spiralis — It is a v \iparous and is commonly known as tnchim It passes its eni re life cycle m man rat or pig Tlic male is 1 5 mm long and 0 04 mm broad whereas the female is from 3 to 4 mm long md 0 06 mm broad Their habitat is the small intestine The parasite dificrs from others in passing its enure life cycle m each host The normal common host of incbmclla spiralis IS the p g which gets mfeaed by eat- ing rats or directly from mfected offtl and the larvae arc embed ded in the muscles rNSEC3S AND PARASITES 283 When the tnehmous meat u eaten by man or bv another animal, the capsules are dissolved, the larvae are set free in the small intestines and in about 2 days they grow into full mature worms The adult worm lies m the duodenum and jejunum The female parasite produces more ilian 500 young embryos at a tune which pierce the bowels and arc earned by circula- tion to active voluntary muscles* In about 7 to 9 days the larvae get encysted m the muscles Th-y miy remim in this form toe 8 monihs, after which they calcify and the larvae finally die Triclimiasis in man is a serious disease and is chancterised by fever, preceded by diarrhoea Soon there miy be severe pain and aching in muscles wi h oedema and cachexia When there IS excessive worm infection there may be infiammation of the intestines with severe and fata! haemorrhages The blood usually shows an increase of costnophiles even up to 70% P/eo arc prevalent m certain partsofTndia They arc long threadlike wonns the male is under 2* and the female about 3* tn lengUi Both sexes hve together, often coiled about each other m lymph cliannch The parasite has a fine sheath, m which it moves backward anti forward They complete their life cycle through parasitism in two sets of hosts I e , man and mosquito atUx fahgaa The culcx mosquito sucks the blood of an infected person ■during the niglit The embryos exhibit nocturnal periodicity 1 e , during the night they enter the peripheral circulation during the day they remain m lungs and larger arteries If the individual changes his habit and sleeps during the day, the embryos eventuiUy appear in the pcrepheral vessels only during tiic daytime The embryos or microfilariae enter the stomach and soon migrate into the thoracic muscles, of the 264 HYGIENE AM> PUBLIC HEALril mosquitoes where they pass tlirough senes of dc\cIopm6nts lasting for 10 — 14 days There is no muUiphcatiou of micro- niariae Thev finally migrate to the proboscis of mosquito When tins mosquito bites a healthy person, the infective larvae find their w'ay at or near the site of the puncture in skin and eventually reach the large lymphatic trunks where they slowly grow into maturity (m about a year of so) The female parturates and the embryos are earned via lymphatic trunks into ihoincic dua and from there into the general circulation of blood rjeeti — The most common effect is periodical attacks of lymphangitis with fever, elephantiasis and chyitina Once clephan'nsis is developed, no filariae are found in the blood, because all the embry os get locked up in the lymphatics Preeent on — One must protect one self from the bite of culcx mosquito by slecpinit under mosquito net Anti mosquito measures should be taken Patient should be segregated and treated 5 Draennculas fFilaria; mcdinensmorGatnea tvorm — In India this IS largely prevalent in Bomb w and Madras Presi- dencies, Mysore, Rajasthan etc The male, which is U inches long, has not been found m man A fullt grown female worm is from 16 to 48 inches long and about 1/17 inch in diameter The worm IS round, smooth and of milkv white colour It is threadlike and nearly the whole of the worm is occupied by uterus stuffed with embryos Roughly speaking there are about 3 million embryos per worm Ihc worm is chttfiy found burrowed m the subcutaneous tissues of the leg and seme- tunes of the back At the sue of choice the worm secretes an irritant substance, which gives rise to a blister It breaks the uterus of the worm prolapses in contact with water and dtsclia rges a milky looking fluid, containing myriads of embryos These larvae pass into water and arc taken up by the minute Fig 61— Fomttio Cp nen worm (Half 1 fe b zo) cyelops, vvi*hm which they undergo larval development in about five weeks’ time A healthy person gets infection by drinking the water containing the infected cyelops, the gastric juice kills the JNSECTS A1»D PAHAStTLS •Cyclops and sets free the larvae >vhich burrow and find their way into the subcutaneous tissues It takes about a year for the worms to mature Prtvenhon — 1 Do not allow any one to enter a w ell or a tank 2 Scram the uater through a musbn cloth or bod it before drinking 3 Disinfect die well water with potassium permanganate or calcium oxide (1 drachm to a gillon) Lime is also found to be very cffeciivc for killing Cyclops 4 Barbel fish (barbus puckeili) destroys Cyclops and laivae of guinea worms so they may be introduced in wells and tanks 5 Step wells should be converted mto draw wells so that physical contact with water by infected persons is completely chminated Step wells should be totally abondoned 6 Ancylestomnm duodenale or Hook worm -—The infection is common m Europe Egypt and India There arc two distinct varieties — 1 Ane^losloma duodti ale 2 J^ecator emericanus Nccator americanus is comparatively shorter and Aiore slender than ancylostomi duodcnale A typical hookworm is almost cylindrical the male 6 to 10 m m ind the female 0 to 10 m m long Its body is thread like with 1 conical shaped head and a large oval mouth fitted svitU four claws or ho{ k like iccih on the ventral sid* of the buccal cavity and two knob like teeth on the dorsal side b> which worm fixes Itself to mucous membr-mc of the mttsUncs An infected person passes a very large number of ova m the faeces winch have been estimated sometimes to be over 4 000 000 and when they happen to be Hid on moist earth further develop ment takes place and in about 5 d'xys time larvae moving actively m ihcir sheaths nre seen crawling up the bhdes of grass They cm hvc m this sti^^c for months svlien moisture and shade arc present, but arc rapidly kUlcd by drying The lar%ac passes through two moults before becoming nfcclivc So temperature, rainfall humid ty and condition of soil are impor tant factors to inlluence the spread of infection This is the mfectn c stage, when the Hrvnc enter human beings through hair follicles sweat glamis or intcroscop t fault in epidermis It causes dermatitis which is known as ground itch, ground sore or toe Itch After reaching the subcutaneous tissues they enter the lymphatics or veins and arc earned into the heart and fiom 286 irYOrCNE A^D PDBLIC HLALTH Fig of Anoylostomosi daodeackle (he heart into lungs and bronchial tubes from here they are swallowed IC swallowed they reach the stomach, lose their protecting sheath, pass into the intestines and develop into the adult worm in about 4 weeks, they then attach themselves to the mucous m'mbranc of the intestines, duodenum and jejunum and cause haemorrhage which gives rise to anacinn It may cause debility, pulTiness of face, abdominal pain, flatulence, const p<»kior., alternate diarrhoea and constipation, oedema of legs, palpitation etc Thus anaemia becomes apparent pallor of the whole body, especially of conjunctiva and tongue becomes marked The tongue Rcnerally looks like a sheet of whuc blotting paper, which n is rarely seen m any other condition except bleeding piles Moreover, the disease is more common in ftmalcs than m males because females usually choose segregated places well protected fiom view and go to the same spot ev cry day and thus they are brought into contact, with bcavdy infested sod again and again Men on the o'hcr hand use random convenient places and thus escape heavily infeccecl INSECTS AND PARASITES 287 localities During their journey in the bod^, these moult twice, Arhich are in addition to two moultings outside General ejfects on communily — 1 Loss of efficienc) of manpower among labourers 2 Lotfrer resistance of affected persons 3 Retardation of physical and mental development of children, thus delaying puberty 4 Sterility, abortion, an impaired Jactation in women Prevenlton of hook worm wftciton — 1 Faecal contamination of soil, water and vegetables which arc eaten raw, should be prevented 2 Faeces should be properly disposed of by installation of sanitary t)pes ol latrines In villages bore hole or dugwcll latrines should be provided 3 The infected persons and healthy carriers should be treated after isolating them t e , the source of infection should be isolated 4 Water supply should be protected from getting contaminated 5 Personal protection of individuals by use of boots, shoes, etc They should not go bare footed Personal hygiene should be attended to 6 Propaganda —The public should be educated regard ing the prevention of disease through hand bills posters, leau'cs, films, slides etc ’ Treatment —Now a days olden methods of treatment by thymol, eucaUpus mixture etc , have been replaced by carbon tetrachloride and recently by tctrachlorcthylene Carbon tetrachloride has to be prescribed cautiously since it has caused toxic manifestations and even death m many occasions Tctra* chlorcthylcne on the other hand can be safely given even to the children without any fear of toxic effect II Gestodes, Flat worms or Tape worms — The com- mon forms of tape worms arc — 1 Taenia solium 2 Taenia saginata 3 Dibothnacephalus latur 4 ^menoUpjs nana or d\/arf tapeworm 5 Taema echinococcus granulosus They are found in intestines They pass through two differ- ent phases m two different liosts The worm, consists of a minute head, a neck and rmvof segments The worms are devoid of any digestive organs They are Jong, flat and tape like worms and arc found m the intestines They are generally segmcmcdl 288 HYGIENE AND PUBLIC HEALTH and arc white or yellow m colour devoid of any mouth or all meniary canal The worm consists of a minute head called ‘ Scolex the whole bori> or the Slrobtla and the individual segments as ‘ Proglottides The ienglh vanes It may be as long as 4 metres or as small as 4 centimetre They pass through two distinct pliases in two different hos $ known as definitive and intermediate hosts Man is a definitive host for the taenia sagmata and diboihnocephalus latus inter mediate host for taenia echinococcus granulosa and both defin • tive and intermediate hosts for taenia solium and hymcnolcpsis nana Lift, history — The proglottides (npe segments containing uterus) are dislodged from the parent worm and passed out with the faeces when ific ova are set free and which retain their V taliiy for some time The ova at this stage arc eaten by some animal which is capable of acting as an intcnncdiary host i e , pig m case of taenia solium and cattle in case of taenia sagmata and fish in case of dibothriocephalus latus etc TJiey continue their deve* lopmem till the shell is dissolved m the intestines and the cm br\o with SIX hooklcts is set free These hooklets enable the embroys to penetrate the mtestinrs tothe solid tissue like museles of the host where they develop into cysticerctis stage (which is known as cysticercus celluiosac mease of pig) which remains passive in the flesh until it is eaten by man which acts as a dcfnitive host ' In the siomacli of the man the capsule is dts solved by the gastric juice and the scolex or head is set free wh ch finds us way in the intestines The head, b> means of its hooks IS fixed to the intestinal wall and develops into a fully grown tape worm wi hm eight weeks It then begins to pass proglottides charged with ova in faeces, which are ready to commence a new cycle 1 Taeua solium — ^Thc worm is 10 ft long or more consisting of 700 t iircsijmcnts Tlie 1 cad is of the sire of a pin and is piovidcd wuii lour wirkcrs The intermediate host IS both p f ai d the man 1 he egg must be swallowed by the pig 7 he egg shell is digested and the embryo is set free By the lymphatic system it reaches the muscles (tongue, neck shoulder and diaphragm), brain, eye «c and by losing its hook lets develops into a bladder like larva (cys iccriis) These cysts arc usaJJy of the sjic of a pea Pj^sjoeat jnfixJed m tins sway IS known as “measly pork* Man is infected by taking uch insufliciently cooked meat, generally in sausages Man is also hablc to become injected 'iccidcntally with the cysticercus stage by swallowing eggs from his own mfeettve faeces INSECTS AM> PARASITES 289 2 Taenia sagluata or taema mediocan* 1 ita —Us length IS 3-4 metres or ft or mve Head and p oglouiJcs arc similar to those of caenta aoltum The m erm d a e host is cow It forms cysticercui m the bovine fl sh anJ this is kn iwn as^b-cf measles VVnen the animtl is kilte I fo food th“ cysts should be discovered during msp ction otherwise if the b^ef is undercooked, the evsts will develop m the intestines of the persortf who cat it and produ e new up* worms Sjrr^ptoms — Usually infec ed personsecs segm“nts in a stool These may be ind ^cstion colic and cither anorexia or voracious or perverted appetite and nerve symptoms may somctim"s occur r ^ T M on C- S iimtota* D bliA 290 mOIENE AKD PUBLIC HEALTH 3 Dlbothnoceplislaa Jatns — It is a large ribbon like tape worm 3 to 4 metres or 25-30 ft long The cysticercus inhabits some species of fish The symptoms produced are not always se%crc In some cases the blood produces the symptoms of pernicious anaemia The eggs when discharged in the faeces of man dcvelope in water into larvae and taken by a fish in water 4 Hymenolepis nana or dwarf tape worm — It is 5-45 mm long and is very slender Laeh proglottides contains 80-180 eggs which are set free in the intestines It undergoes complete development from the egg to the adult stage without any mtennednry host, the larval parasite enters the intestinal wall where it becomes cysticercoid Later on it moves into the intestines where It attaches Itself to the mucous membrane and develops It occurs in hundreds and sometimes even in thousands and may cause symptoms of diarrhoea, cpileptiforra convulsions, headache etc on account of absorption of toxins produced in the system by the parasites frtwntion —It consists of the following measures — 1 Cure of the alTected person 2 Disposal of the human excreta in such a way that cattle, pigs or fish cannot have access to it 3 Thorough inspection of Ineat and pork in the slaughter houses by the veterinary surgeon 4 Thorough cooking of meat and fish 5 Thorough smotung or sailing of meat which is eaten raw and avoidance of taking raw meat 5 Taenia cchmococcas — It is 4 mm or }' to 2* long and has 3 or 4 segments onl} Its heads resembles taenia sobuim The adult worm is found in the intestines of a dog or a wou which are definitive hosts and has its cyst stage in man The ova are discharged by the dog in its faeces, which are mgested by the intcrmcdiarv host, pig, sheep oxen, horse or man The shell is dissolved m the stomach of the intermediary host and embryo is liberated which on piercing the intestinal wall, encysts as a hydatid cyst chiefly in the liver This hydatid cyst attains a great swe and forms within itself secondary cysts called daughter cysts The liquid m the cyst docs not coagulate on boiling Under the microscope, characteristic head or de* tached booklets can be seen This disease is common m some countries where men live in close association with dogs and taaf then be infected directly by dogs Pfeeenhon — (a) The stray dogs should be destroyed (b) Avoid tne close association between dog and man INSECTS AND PARASITES 291 and contaminating the hands with the faeces of dogs, (c) Strict personal hygiene should be observed. in Tresnatodes orFlohes : — ^Thc common ones which infect human beings are I. Distomutn or Fasciola hepaticnm (liver flnkeB) It effects sheep causing a disease known as “liver rot”. It is 20 to 30 mm. long and 8 to 13 mm- broad— heart shaped. The fertilised egg, when ejqielled from the bile duct into the sheep’s intestine is passed out with faeces and becomes miraci- dium which if it encounters a fresh snail, enters its body where it is transformed into a tadpolc*Iike “Ccrcaria”. It passes out of the snail, sheds its tail and leaving the water moves up a grass blade where it encysts- When this grass is eaten by a sheep, the young fluke is set free in the intestines. It then finds its way to the bile duct, attaches itself to the duct wall and attains maturity. Very rarely man may become infected through drinking infected water. 2. Schiseosoma or blood flnkes ; — ^Threc species of these worms are known to occur in man. They are : — (a) Schistosoma or bilharzia haematobium (urinary bladder). (6) Schistosoma roansoni. The adults live in the veins of messenteries. The symptoms produced are dysenteric and m peculiar form of cirrhosis of liver. It is followed by a condition known as intestinal schistosomiasis. (e) Schistosoma japonicum. It / gives rise to oedema and / ascites dysenteric symptoms, fj ^ emaciation and in later stages f fj cirrhosis of liver. The adult \ j j lives in the veins of the small [ /ffl intestines. \ O Sebistosoma or DUbarzia faaeina> tobinni : \'vC The male long; the female J*. They are generally lodged in the veins ofintes- ^ lines, bladder, ureter or kidney. They give rise to a chronic disease characterised by cystitis, haematuria and other symptoms due to blockage of the urinary passages producing a papillomatous growth. They are common in Africa and Palestine. An (mala aod famala) 292 mrCIEVE AND rpBLIO HEALTH > ciidemic centre has recently been discovered in Katnagin m Ifcmbay dis^ict The males are narrow, flat and leaf like worms and look cylindrical from the folding in the side of ihc skin, foimmgthe gynaccophoric canaUvhcrc ihc female is partially cndosrd The eggs afe o\al or spmdlc shaped ivrth a stout spme at the posterior end These are foiced through the walls of the vessel and eventually appear m the bladder or rectum and escape either through urine or the faeces as the case may be They find their way into water, develop into a ciliated embrvo or miracidium which becomes attached to Its intermediate host p»e fresh 'nater molluscs and develops into a cercaria form They infect man through the skin They enter the veins where they i^radually develop They are able to pass through and therefore any one bathing or even putting an arm in water infected by these organisms may easilv get needed Presenlion — Asoid drinkirg or bathing in schistosoma Infected rivers or tanks Boil tiatcr or strain' through a muslin cloth to remove 'vater snails -Copper sulphate solution m the strength of I in S millioii parts if used will kill the snails Treat all the infecetd persons adequately Prevent pollution of water wah human faeces and urine Tr/atment — Administration of antimony compounds is useful iQ the uuiial stages of the disease CHAPTER ‘XV preventable diseas^ In the olden times the word disease used to denote 'lack of case* but gradually it has come m the modern world to m^an some dcGmtc disorder or ailment in the human system vtz , body- or mind or even both. Thus we speak of diseases aflectmg the body as a whole or any particular pan or system of the body, With lhc advance of civilization more and more dtseases arc coming into light and are being investigated and -classified. Only a few important iisell ii to the stomach wall of anophelmemosquito ard grows ihcrr, whcic a cyst IS fottiicd around ir It is called coejjl This tnci cases m (he size and is packed with merozoiirs. T he oocyst rup urcs, discharging the s^oioitts into the body cavit> of the insects and ultimately they find their way mto the salivary glands of mosquito from where they arc transferred to a healthy person It takes 36 hours after the feeding on blood of an mfected person, for the zygote 10 develop in the stomach wall of the mosquito Ihe Sporozoues reach die salivary glands on the lOth andl2ihday Ihe whole dcvcioptneni in the mosquito takes about 12 days and it is infective from the i2th day onward and remains infective for the rest of its life lacnbatioo period —It is from 14 to 18 days It is the period ficm the bite of infected mosquitoes to the development of symptoms Impenaat Factor* —The following are the most imponnat factors which are interrelated and are concerned in the spread of the dis -»e — , (i/ Sourcf ej ivfnivm ' — Ccncrally children or mdividtals with gamelocyies m their pcrepharal blood, serve as reservoirs {lO Anop}ilme factor —The ftmalc anopheline transmits the infection under natural conditions from the reservoir to healthy persona and serves as a vector There arc breedir.g places for this type of anopheline The disease depends upon their relative abundance, their feeding and resting behaviouri and their individual suitability as a host (.»■) Omahe cortdtitons — Certain trinperaiurcs and presence of humidity is necessary lor the transmission of disease. The optimum conditions are a mean temperature of 20— SCHI With a mean relative humidity of 63% or more ^Vhen the relattre humidity is high the mosquitoes arc more active and feed more voraaously A high relative humidity also lengthens the lifcof the mosquito for the eomplct-* development of malarul parasite in It (ir) Preieau of ttucipltbU tnAnJuals —The pr«ence of susceptible persons such as labourers, troops etc , « also kxwwn as the factor of non immune immigration .UALARIA 297 {o) Eco^mic coudilions : — Insuffi:ient food, overcrowding and raminc coudftions have a great bearing 6n the incrdencc of malaria^" (pi) • Irrigation iias affected the prevalence of malaria con- lidcrably. 'Leakage from canals or water logging of the soil of water pockets along the tributaries, due to improper maintenance (ead to tncrcasc'in ttie incidence ofmiUria. {pu} Alalaria and rice euttivation : — The land is to be flooded with Water in rainy seasons for nee cultivation which leads to an •Increase of its incidence. (piii) Manmade malaria : — Burrow-pits along roads and railway lines, tanks, water troughs, etc., provided fay man serve *s breeding places for mosquitoes. Symptoms : — After an incubation period which averages 10 ^ays, the'atwck begins with mtlaise, chilliness and severe rigor, which shows three well-marked stages : — li The cold stage The patient feels cold, listless, with headache, nausea and vomiting. He soon shivers and the teeth chatter inspitc of abundance of bed clothes and hot water bottles. The skin temperature is sub. normal although the rectal temperature rises rapidly. 2. The hot stage i-' After one or two hours the p«ica begins to feel hot and the headache intensifies. The pulie is full and rapid. Cutaneous vessels dilate. Stupor, delirium and high fever may develop. J. The sweating r/ager—Thc skin being dry and hot rapidly becomes moist and there is a lot of persptra- ' tion. The temperature falls to normal rapidly and the patient feels comparatively well. It show characteristic periodicity depending upon the ^ parti- cular parasite which is the cause of it. Anaemia and enlargement of spleen and liver arc aftcrcfFects of the disease. Seasonal Incidence of Malaria Its maximum prevalciice »8 from August" to November. Race : —Negroes arc partially immune but no race is known ^ he completely immune. Sex Males and females are equally susceptible. Immsaity in malaria : -TTiere Is no natural immunity. T^tre is generally a partial immunity as a result of rcpcamd tweaions and re-infections occurrii^ over a long period. 29G ItYOIENE AKD rCBLlC HEALTH / ca!lfd gavulocyfes in ihe red cells. They are incapable of 'further dcveJupincm unless they are taken by a female anopheles mos* quiio. In the stomach of the mosqmto the male and the female loinis escape fiom the red blood corspuscles and are known as f am«{ of the lusects and ultimately they find their way into the salivary glands of mosqutio from where they are transferred to a healthy person. It takes 36 hours after the feeding on blood of an infected person, for the zygote to develop m the stomach wall of the mosquito. The hporoioites reach the sabvary glands on the 10th and 12th day. ‘I he whole development in the mosquito takes about 12 days and it it infective from the 12iij day onward and remains infective for the rest of its life. Incobatlea period It is from 14 to 18 days. It is the period ficm the bite of infected mosquitoes to the development of sjmptonu. Isapcnant Factor* The foUotving are the most importast factors which are interrelated and are concerned m the spread of the dis' »e (i; 5<7urf/ oj p^Jiction t — Generally children or individuals with gametocyies in their pcrepberal blood, serve as reicrroin. (ii) Anopkeline Jactot : — ^The ftmalc anophelinc traosmits the infection under natural conditions from the reservoir to healthy persons and serves as a vector. There arc breeding places for this type of anopheline. TTie disease depends upon their relative abundance, their feeding and resting bebaviourt and their individual suitability at a host. (.70 Clvnalu conditions Certain trmperaturcs and presence of humidity is necesjary for the transmission of disease. The optimum conditions arc a mean temperature of 20— S0K3 with a mean rclai ive humidity of 63% or’morc. When the relative hinnidity is high the mosquitoes are more active and feed ^re voradously. A high relative humidity also Imgthms the Ufe of the mosquito for the complete deveTofaiicnt of malarial parasite la it. ■“ (ip^ Tresenct of suse/ptd)U indicidaab * — ^The presence of susceptible persons such as labourers, troops etc., is also known as the factor of non«iiiuaune inunigration. UALVRU 297 j[o) Ecojiomic coaiiliam — Insuffi icnt fi>od, overcrowding and Kuninc 'conditions have a great bearing On the incidence of malaria (w) Irrigation has affected the prevalence of malana con- siderably Leakage from canals or water logging of the soil of water pockets along the tributaries due to improper mamtenance lead to increase in the incidence of mitaria (pu) Malana and rue cultioatton —The land is to be flooded with water m ram> seasons for ncc cultivation which leads to an Increase of its incidence (piii) Manmade malaria — ^Burrow pits along roads and railway lines, tanks, water troughs, etc , provided bjf man serve *3 breeding places for mosquitoes Symptoms —-After an incubation per od which averages 10 ■days, the attack begins with milatse, chilliness and severe ngor, which aho^v5 three well marked stages — 1 The cold jtage —The patient feels cold, listless, with headache, nausea and vomiting He soon shivers and the teeth chatter mspite of abundance of b»d cloth's and hot water bottles The skin temperature is sub- normal although the rectal temperature rises rapidly 2 The hoi stage —After one or two hours the pstien begins to feel hot and the headache intensifles The puhe 13 full and rapid Cutaneous vessels dilate Stupor, delirium and high fever may develop S The sweating stage —The skin being dry and hot rapidly becomes moist and there is a lot of perspira- tion The temperature falls to normal rapidly and the patient feels comparatively well It shows characteristic periodicity depending upon the parti- cular parasite wh ch is the cause of it Anaemia and enlargement of spleen and liver arc aftereffects of the disease Seasonal Incidence of Malana — Its prevalence M from August to November Race —Negroes arc pirtially immune but no race is known ery malarious place this index may be from 5 to 10 % Forecasting of malaria — ^Thw depends upon the follow- ing factors - (a) ^tudi of hieteorological eondiUons —The amount of rainfall during monsoon months extending over several years (5) Ctonm c eondiljOTi of the rcsidtms of tiie locality (r) spleen rate of the community m different localities i* ascertained every year Malaria Survey —It is rcallv a detailed social, sanitary and economic survey rather than exclusive malarial one Before taking 'inti-milana measures. It IS essential to do a preliminary survey v%hich consists of — (a) Study of the lerriiory, levels, slopes, meteorological conditions, sod and subsoil, the people and their mode ol life, existing drainage and an esumatc of the Malaria > 29d* cost of new drainage and also of the relation between the re. quirements of sanitation and agriculture. (i) Mortality and morbidity statistics and malaria index in different localities, examination of spleen and blood of the inha- bitants. Determine the species of malaria parasite. (f) Discovery and registration of breeding places of adult mosquitoes, the species and their seasonal distribution Investi- gation of their habits and their role in the production of malaria. (d) Provision of a contour map of different places or dis- tricts showing marshes, canals, ravines and nature of vegetation, etc., is necessarv. Information be obtained from the local gazet- teer, the census and sannarv reports It is also advisable to take photographs of breeding places of mosquitoes After the prelimtnarji survejr, proceed to ^-(r) Collect staltslicnl in/ormalion Prom "hospitals, dispensaries and schools, etc , Re- cords of past surveys or years should be gone through. {uj Aseeriain the spUen tndex In India different areas arc classified according to spleen rate (in) Prepare blood films of available children for ascertain- ing parasilie or endemic tndex (iv) Prepare a detailed spot map showing all the known human carriers in the area ■ (r) Examine sample catches of all local anopheles. Find out the percentage of each anophclinc’speeies present, its chief breeding grounds and the time of year when most prevalent. Investigate the type of anopheles mosquitoes and ihcir breeding- places as to when and where they breed. Next start the dissec- tion of mosquitoes caught m different areas and record the per- centage iiifei ted with the following' — - («) Oocyst in midgut. (i) Sporozoites in the salivary glands of mosquitoes. (pi) Correlate the information so obtained, so as to depict a clear picture of the amount, distiibulion and character of the disease especially, the manner m which U arises and spreads in the locality. It can thus be found out (a) Whether malaria is old standing or recent in origin. (A) What species of anopheles carriers arc present with oocysts or sporozoite percentage. (c) Reasons for sudden cp*dem c outbreak. Formulation of preventive measores This will depend i^pon the conditions revealed by the results of the survey and 300 HYGIENE AMD PUBLIC HEALTH m 11 be very largely detemaned by the financial resources available It IS of great \ alue ^Ca balance sheet is made out shovfmg on one side the estimated sum lost amtually from mslaria by interference svith labiur^ loss o*" wages and ejcpenditurc on (rea ment of sick and on the other the amount which is pro- posed to be spent on preventive measures Business Firms such as controlling tea and rubber estates or engineering works arc quick TO see the force of such an argument bur it must be ad Dinted that it is often diihcuh to persuade local authorities to spend money on antimalana measures even when it is pointed out that such expenditure will be a sound financial invesimcnt, in the long run All the available statistical inTonnatioo regarding the pre- valence of disease should be collected Methods of Prevention smd Control — They can be discussed under the following headings —I To do away with the eonduions which render possible the breeding of mosquitoes 11 Destroy mosquitoes at some period of life, i r , dunng adult and iarta stage in Prevent the mosquitoes from bitmg the mtn IV Attack the parasite as u arculates m the blood of man f e , adoption of and parasitic measures I. To d« away with conditions which render possiUe the breeding of mosqoltoc* — (<} To provide the drainage of the country on a large scale so as to dram properly the swamps and lakes They should be narrow, and deep rather than broad and shallow Sometimes subsoil drams are provided They are more ciTcctive in dealing with lull streams Their upkeep cost IS high (tt) To provide drainage ou a small scale around the town so as to prevent ram welter collecting m the pools and m the compounds of houses Try to fill all the depressions and small pools where water may collect (utl To keep clean, straight and free from weeds the edges of canals and small water courses This makes the water run quickly and by rcmo\ mg the weeds from the banks there re- mains no shelter or hiding place for the larvae (iff) To avoid having burrowptts along the roads railway hoes, tanks and pools where water can stagnate (s) To properly maimam jmgation cliannels and cxetciie proper control on the supply of canai water so that water is not supplied m excess of she actual requtremenu of the locality Concerned SOI n To destroy mosqnltoes »t some period of life •» (0 Destn^tion of mnqitito lime or AiUltroil m^irures — They aie as ibllowi “—(a) Afttarul^kerosine oil, diestC or fuel oil, etc , u sprayed on the suriace of water with a knapsack sprayer once a week or by soaking gunny bags, lum-j of tov'i' or cotton waste in It and throwing them into water (2 ozs or one chattick of kerosene oil for SO aq ft) It aspiyxtates th“Iarvac, as they cannot breathe Vcgelauoa in water should be remivcd to render it fully cflccUve (6) Paris grttn or Arrtoarsenae of cohpsr —It is mixed with bJO parts of fine road dust, slaked, Ume soapstone, saw dust etc and blown by a mschinc or mumilly It is very toxic to anopheltne larvae b It It do's not kill culictne and steg-Jrn/a larvae It is elTcciive even m presence of dense vcgciatiun It does not kill fish or spoil water fiir domestic purposes ^ to 11b. of pans green is uied p’r acre (c) DDT {Diehloro dipkenfl^truhloroeOis’ie'i is an elUcient larvmde It is effvCUve even m very small quintities and thus there is a great saving if it is jsed for the purpose It is used as 5 to 10% oily solution by spraying or 10 ^ if used as a dust. (d) Laroiculil Jifh —These eat larvae of mosquitoes There are many species ot sm ill fi>h in India Gmiusuj ajjiiis or top water minnows, etc , «ire used They muhiply rap dly and feed voiaciQuily on larvae and paptc Thev arc surface feeders and so especially effective agiinti anop teles larvae (/) Gammexane W D P — ^To control mosquito breeding in wet crops like paddy fields, where use ol malanol is contra* indicated on account of Its charring elf^cis on plants, garmiex* anehas been found useful and economcal For stigiaiing water in such fields two ounces of gam nex me W D P mKed in a gallon of water is used at the rate of 15 gallons of the sui* pension per acr* It wiU destroy mosquito larvae bat has no cITuci on eggs and pupae. (/) Oifervasnee of Dry Dsy In can^omt-nts, one dav in a week IS fixed when all cisterns, cess pus, stores of wat^f, g larras, etc , arc emptied and kcp. dry for some ume and iheo relillcd. In ihii way, if there IS any breeding in these waters, it is dcs* troyed bimilar 'Dry Days’ should be observed m the rest of malarial places m the country. (lO Dettru iton of aUlt m»tni/e'» •— (0 DDT. or Dichforo DiphinyUruhloronhat* a rcsidaal insecticide, is large- ly used n these days, in the form of emulsion or oily sol itton*. for spraying After the evaporaum of the solvent, m n ice '•ryi. tab of insecticide rcmam''on the surface of the walls. Wnen* 302 IlYGIEI^E A^D P0DLIC HEALTH the mosquitoes rest on the wall, for 10 20 minutes, they absorb -tome of the DDT through their legs and feet and get them* selves poisoned and die Generally emulsion of 5% strength is sprayed at such a rate that it will be sufficient to give protec tion for one mosquito breeding season Dosage is 1 00 to 200 mgm per sqtiarc foot It is used in the following forms — {a) D D T Aromax — DDT Techrucal 110 lbs Aromax 36 gallons Soap Lux flakes Q lbs Water 32 lbs 110 lbs ofD D T IS placed m a 45 gallons capacity barrel with an open top Its lumps are thorcughly broken About 4 gallons of aromax is then added to D D T and thoroughly macerated to make a paste which is constantly stirred Soap and water solution is prepared sqiarately m a container Th« IS added to the D D T , aromax solution and mixed properl) The resultant mixture forms 25% DDT concentrate and H diluted m the ratio of I in 10 with water to obtain 2 5% DDT emulsion It is sprayed with a stirrup pump or a knapsack sprayer, on the walls (i) d% DDT Ktreune ctl sohilion — DDT Technical 8 Ors Kerosene oil (grade 3) one gallon Add the required quantity into a contiiner and stir thoroughly to make a soluuonol 5% DDT kerosene oil solution (c) Gitgy s {50 % D DT xcaUr wettaHe powder) susperuun Geigy’s malaria spray poivder 8 Ozs Water 1 gallon. Make a pane of the Gcigy’s powder with a small amount of •water and then atlil more water to obtain the suspension of requisite consistenry P_yTt{fiTum D D T kmienc mwtust crjlU — Pyrclhrum extract liquid 4% 3 Ozs DDT technical 1 Or Kerosene oil 1 Gallon. arALARZA 303 Dissolve D.D.T. in kerosene oil and then add pyrcthmin ext, liquid. Spray it with a flit pump. (e) D.D.T. in aerosols The aerosol bomb contains 0.4% of pyrethrins, 3% D.D.T.^ 5% cyclohexanone, 5% sesame or some other oil in Freon. Its pressure forces the combination into the room. It is widely used against mosquitoes and other insects. (2) GammMOTf or benzene hexachloride or B.H.C. * — It is effective against mosquitoes as a residual spray, but its lasting properties arc not quite so good. Gammexane P520 contains 50% B.H.G. and is soluble m water forming a suspension. Gammexane P 520 (water dispersible powder) 12 Ozs. Water 1 Gallon With a small amount of water, make a pastcof gammexane and then add the balance of water to make milky suspension. It is sprayed by a pressure sprayer. (3) D/eWrin This insecticide is newer than D.D.T. and B H.C. Like D.D.T. and unlike B.H.C. whole weight of dicldrin in a 'fomtulation is insecticidally active. It is said to be more effective against flies and mosquitoes than the other insecticides. Four ounces of dicldrin 50% water weltablc powder is used in a gallon of water for surface spraying of 2000 sq. ft. to get the nonnal dose of 25 mg. per sq. ft. (4) Traps of various types are available in the market. The mosquitoes are caught in the traps and subsequently killed. (5) Cutting downof jungles and other useless vegetation, where the mosquitoes conceal during the day time, is of great value in a campaign launched against adult mosquitoes. (G) Bats, birds, lizards and dragon flies are natural enemies of mosquitoes but they themselves are a nuisance. (7) In olden days, different substances in the form of odours, fumes and gases were used but their use is now discarded since the discovery of D.D.T. Burning of katol sticks will also kill mosquitoes. « (8) Swatters consisting of a piece of wire gauze fixed to a wooden handle are effective and children may be taught to use them. nL Protectiott against the bite of mosquitoes :—l. Screen^ ing of buildings Rendering the house mosquito-proof by providing non-corrosive wire-netting to the doors and windows of the rooms, which can be done by rich persons only. 304 mG^E^E AVD t*DBLIC UCAITn 2 Mosquiio net —One should sleep under a mosquito net, vihich IS a most valuable prevetsUve measure The net should he of 25 hole mesh Ii should be hung inside the poles and tucked ptopctly with care under the mattress every night 3 ^Usquilo proof elotkes —Suitable clothings, boots, veils, g oves, tie , arc used to prevent bite of mosquitoes 4 Repetlents cr culutfitSti —Smearing various oils, omlm'nts on sarious exposed parts of the body repel the mosquitoes by the nnelleg Dimethylphthalatc citroncUa oil, eucalyptus oil sandal s^ood oil etc whieh if applied to the skm remains cffccuve as a repellent for several hours A common fomula is — Kerosene oil one part Cocoanut oil tuo parts Citronclla oil one part Carbolic acid one % Some patent fluids eg mosquitol, etc, are available in the market far the same purpose 5 Fans electric or ordinary are the best means of dnving away mosquitoes IV Aoti parasitic tneasures The ant malaria drugs «re used for two pu poses 1 Prophylactic 2 Curative I Prophylactic —There is no drug at present, which can be relied upon to pi even malana mfcaion, but the symptoms of the disease can be suppressed for some period The drugs act by killing the parasites that liave reached the stage, at which they can cause lever The drugs used arc — (a) Qoiaine prophylaxis —It is used in tiie following ways — (i) 10-15 grams daily should be given on two successive days m a week It is better that it may be taken m the evening so that it circulates at night in the blood when the anophclincs arc most active and inject sporozoites Quinine acts powerfully in alkaline substrata So a dose of sodium bicarhonati* or any oilier alkali should be given by mouili before qumme admimstra* tion In case of bcnigns, tertian (P vivax) tnlection, quininelias no effect (») 5 7 grains of quimne should be given daily as a propnylactic (i) Mepacnae —{!) Many people prefer mepacrine to quioiue It iv given m doses uf 0 2 gramme twice a week* 1° HALABIA 305 American army 0. 1 gramme of it is given daily with evening meal for six days in a week. (li) Suppression frealmeni or blanket treatment : — This is done with a view to reduce the ocxurrencc of clinical attacks of malaria. This is done before entry into a milarial area or during transra'ssjon season under special circumstances. It does not prevent infection. This consists in administration of two tablets of mepaerme daily after taking meals and thereafter its use is continued by taking one tablet daily. The person should be under medical supervision and the treatment is to be conti- nued for 28 days after withdrawal to a non-malarial locality or termination of a transmission season. (e) Falndiine t— (*) A biweekly dose of 0 1 gramme or 0.3 gra of it once a week is recommended for the inhabitants of the malarious area. For non-immuncs, 0 1 gm. of paludnue daily is recommended. It renders the crescents in human blood non-mfective to mosquitoes, hence roan ceases to be carrier of malaria mfectioa. 2. Curative J—(c) For acute single attack of mslaria : — Vivax mala^ria, malariae malaria and uncomplicated falc.parum malaria respond to any one of the following courses of trcamient. All act as schiaonticidal drugs:— 1. Quinine It is still the best specific, particularly quinine hydrochlor. Quinine sulphate is cheaper than other forms of quinine and so it is commonly used. There arc three methods of administration of quinme which are as follows : — ((i) Oral Quinine sulphate as acid mixture and quinine bihydrochlor as tablets ; 10 grams twice or thrice a day are given until temperature is normal for 24 hours • followed by 10 grains daily for 7 days. With a week’s interval between each such course, the liver should be kept normal with calomal and salts. Iron and arsenic should be prescribed during convalescence. (6) Intravenous injections 10 grains quinine bihydrochlor in 10 cc. of normal saline should be slowly injected when serious symptoms develop and may be repeated twice or thrice daily. (c) Intramuscular injections 10 grains of quinine bi- hydrochlor in 3 cc. of sterile saline arc mjected slowly and deeply into muscles of the buttock. 2. Atebrlae or mepacrlne Initial loading dose of 0 2 gm. if given three times daily for one day is essential, then 0 I gram of it is given three times a day for 4 days. But it has the disadvantage that it causes yellow colouration of skin, gastro- intestinal disturbances and mental psychosis. It is however, West Indies, South and Central Amcrjci It is endem c m West Africa and in latent form is found in pt-iccs called 'Silent Areas ’ Yellow rever” occurs in America due to infection from* monkeys, tvhich act as earners Etiology — It IS an ultramicroscopic filterable tirus wh ch can pass through a Bcrkefcld filter According to Noguchr the causative factor of the disease was a spirochac*c called leptoipira i teradex but ha view could not be substan latcd Mode of spread —The discxsc is spread through the bites offcTnaleaedrftfCiy^/i (Stegom>u fasciata) mo'quiio wiiliui first three days of illness Hence the importance of earl> diagnosis and of preventing of patient from being bitten bv Tnoscpiuoea especially during this period The mosquitoes are not inlcetive for 12 oays after the bi'e, but after ihtt period they remans infective throughout their life These mosquitoes bite lioih during day as tveU as night Incubation period — G days Fatality rate — It vanes from 5 to 50% or e\cnupu>fiO%» Immunity — Its recovery from one attack gives lifelong immunity Preventive znearares — 1 Immediate notification 2 Isolation of the ease and the patient must be screened from the bite of mosquitoes for the first 4 to 5 days of illness 3 hUasuTts againxX mosqmlott — ^They a-c — (a) Attack on tbcir breeding pHccs {b) AniilaTval Tneasures (r) Antiadult mosquito r'casures (cidcd accordu g to the schedule No person may land m India by aircraft either a- a passenger or a member of crew during the nine days following his departure from or landing in a •similar region to the above mentioned, elsewhere than in antiamaryl aerodrome, un'ess ne has been protected by vaecina- ition which IS considered cfGcatiuus or by a previous attack of the •disease Treatment — 1 General febrile trcamicnt At the onset €ivc a smart purge, phcnacilin be given for backache 2 Barley •Water and Dextrose, orange drinks should be taken freely, wi'h Soda Bicarb gr 180 daily to keep urine alkaline 3 Dextrose -5% m 10 ozs of normal saline may also be given intravenously DENOUE Dengue fever has a sudden onset with malaise skin rash. Intense Irontal headache, severe pains m the bones and joints Temperature falls on about the fourth day and a slow convales- •cence begins It is due to a filterable virus present in patient’s blood The d sense is spread by the Aeifet The virus IS acq.*u-cd by the mosquito by tnking blood from a patient dur- ing the first 40 hours on the disease It becomes infective in 12 •days, after biting nnd remains lifelong carrier of the vinis~ Prevention —The method of prevention which depends 310 irSOlTNE ASD PUBLIC HEALTH upon control of Aides Aeg}pit are same as used against yellow fever SAN’DFL\ ITVETl This IS a 3 da>s fever, accompanied uith headache pyrexia, sharp articular and muscuKr p-uns and occas omJIy, rash The incubation period is 3 4 days The disease is caused b> a filter able \irus \ Inch is present in the peripheral blood of the piticnl only during the first day of the illness The vector is PhUbolo mus Papatoni t\hich must bite a pati-nt of sandfly fever svilhin first 36 hours It becomes mfcctivc after 6 ta C days ^ml icimms infective for more than a week. Preventive measures — ^They arc — 1 Isolation of the sick 2 Control of breeding of sandflies and their acstruction. 3 Prevention of biting olsindflirs, by anointing the skm with- cilronel a oil etc Treatment —is symptomatic The patient should be m bed and salicylates given for rcUef of pam HFLAPSINO rEVEtlS They are of two kinds— (i) Louse relapsing fever (li) TicV relapsing or Tick fever I LOLSy HELAWINO FETEK Definition —It is an acute infect out disease cl anctcrisetl by an attack of h gh fever of sudden onset listing foe 2 5 days' terminating in a crisis followed after an ipyrexnl p*riod of 2 14 nays and by a senes of relapses cich being m Ider in chancier than those preceding it It has got a typical temperature cliirt Etiology — Tlic infection is due to a sp rillum now callcff spirochacta rerurrentis or carteri (in Ind i) which ire gcncnlly found in peripheral blood during the attack of the fever but are absent m apyrcxial stage Frcdisposingfactors —They arc o\ cr-crowdmg andlnsa" mtiry cond tions of life Spread of discise is greatly enhanced when persons sleep closely huddled together, using commoa beddings md cots etc Infestation may directly occur through clothes and use of common combs Mode of spread -It is not communicable from man to man It IS earned from fl e sick to the hcaUh> by blood sucking insects 1 1 , body iiec and possTily bugs W hen a lovuc bites an Kiftcied person it swallows the spirocl actes, winch at first dis appear, 1 ut a week liter wll be found m large numoers in ihr body fluid of the louse When tius mfected louse bites another LOUSE RELAPSING FEVER 311 healthy person, he feels irritation and scratches with finger nails the place where the louse has bitten and in doing so crushes the louse incidentally and infection is thus transmitted through the skm The spirochactes enter the body through the abrasions caused by scratching Thus the uotc worthy point that the louse Itself docs not inject the spirochactes into the human skm as IS somet raes wrongly supposed Both sexes hue and convey the infection Incubation period i^ from 5 to 10 days Mortality —1010 50% Seasonal prevalence —The disease is most prevalent m cold season and early part of hot weather In famine and war this disease generally spreads and so it is sometimes called Famine Fc\ cr Class of people affected — In ruial area, poor classes arc generally affected while in towms it has so far been confined to sweepers, shoe makers, coolies, etc So the disease is mainlv due to poverty ?nd uncleanlmcss Preventive measures —These arc as follows — (,0 Early diagnosis and notification of the disease (ill Isolation of the patient in a*' isolation hospital or at home (ni) Destruction of lice -Disinfestation of the clothing, bed- dirg, cots, etc , of the patients and contacts by o- 10% DDT powocr (mixed with talcum powder) Tins should be freelv rubbed m head and dusted lo clothings, beddings, cots etc , by means of a dust gun TheuseofDDT for this purpose has proved most cfiicatious The persons engaged in control opera- tioi s and those titlending on sick persons wear louse proof cloth- ing dusted with DDT powder When DDT powder is used for elimination of head lice no oil should be used on the hair because it is extremely dangerous to use D D T in kerosene oil o- any other greasy ointment, since in that case it is absorbed rapidly through the skin with liarmful effects In head bee, 3 applications of D D T at weekly intervals should be made Before the discovery of D D T the following measures were carried out — (i) In war, Serbian barrel was much used for dis- infestation and disinfection of clothes It undoubtedly LiUed lice but failed to destroy nits so double process was used i e , killing bcc bv steim and nits by ironing Sometimes the clothes began to emit bad smell There was also difticuhy in transport- ing Serbian barrel from place to place, as it is heavy (ti) Boiling clothes m solution of soap and crude potassium hydrate or Sajji for half an hour m an empty kerosene od tin* particularly in villages 312 HYOIEVE AKD PUBIO HEALTH Other methods or destruction of Itce ire — (r) Hand picking and combii g the head 'V’th a tnoderaiely heated comb through the fiair or one dipped m vinegar Where possible cut short or shave the hair of the head (ti) Hand picking of the lice from the infected clothing and turn ng the r inside seams and Ibid* outwards Do not crush lice in between the 6r>ger nails but kill them by drotvrung in Water or putting in fire (in') Exposure of clothes to sun with frequent turning and dusting wfh a suck (la) Valueless clothes should be burnt and others disinfect cd Heavy clothes as quilts etc should be put m ilie sun and then u’oned in. between the seams and folds (b) Cols should also be treated w th bo hng water followed by soaking with phenyl and exposing them to sun throughout the day (w; Por'klbngbce bugs etc m infected rooms — Eum ga- llon with cresol is sometimes done (cti) Pcdicuhcides —1 NCI powder — Naphthalene 96 parts Creosote 2 parte Iodoform 2 parts 2 An emulsion » Kerosene oil "j Mustard oil > equal parti Soap J Camphor little of it (fill) Great attention should be paid to the regular change of underwear* («) Improvement of living conditions with precision for frequent bathing and washing of clothes (x) Specific treatment — PemciUin G m adequate doses Arseme therapy is also v«dely used A single intravenous injection of04 G Neoars phenamine for an adult and 0 1 G for a child usually prevcnis relapses 2 TICK HELAPSma FEVKIt It IS caused by sptrocfuieta duUonx which is transmitted by various species of ticks bom infected persons to healthy ones It IS noi communicable from man to man The disease is non existeut in India but Is found n Kashmir and North Wcsicm paru of Pakistan It is vnde-spread throughout trop cal Africa Tlie disease is difficult to control on account of difficulty lo EPIDEMXC TYrnCJS 313 •destroying all the ticks particularly those hiding m the burrows of rodents As a preventive measure one should avoid the bite of the ticks by not goi ig m the houses or places infected with ticks DDT or gaimne'^ane powder should be freely dusted on tlic floors and other liidmg places of the licks If n tick is noticed attached to the skin it should be promptly removed by applying a drop of kerosene or turpentme oil to us body •nrnus rrvuits Tour types of fevers are generally grouped together and •called the typhus fevers, which are as lollows — • (i) Louse i/phus also called Epidemic Typhus or Exani- ihcm-tiic Typhus (ii") Flea typhus or murine typhus (ii) Tick typhus or tick borne with several varieties like lick bite fever, rocky mountain spotted fever etc (la) MUe typhus or mite borne typhus EPIDrMlC TYPntS (Spotted fever, jail camp o ship fever ) Symptoms —Onset is sudden with headache, vomiting, ihigh temperauire and delirium The eyt s become pink and ‘W'licry A charactens ic rash appears auoiit tlie fifth day firstly in the UNilia, on the loins, abdomen and back tvhich frequently heconics petechial The disease terminates by crisis or rapid lysis In fatal cases death occurs on the 14th day Mode of spread — The infective agent is RtckelUia Prowa- -Zekt vlncli arc oval filter passer organisms A pcdiculus humanus (rarely pcdiculus capiiu«) bites m infected pe son, with febrile disease and takes instrmstc period of 10 diys before it becomes infective for another human being It excretes a-icketisn in us faeces and usually defecates at the time of feeding Man is infected by rubbing faeces or crushed lice into the uound made by the bite or superficial abrasion of the skin. Diagnosis — / tVcif Fcfix Reaction is mrnerf out ft s aggfutmation of Bacillus Proteus X 19 by the patient’s blood scrum It is of diagnostic value at 1 litre of I in 100 upwards 2 Positive diaro reaction of the urine of the patients Season - — It is mainly a disease of temperate climates and -occurs m winter Tatality —On an at crage it is 15% to 30% m children and •aip to 60% in grown ups 314 inOlENP AND PDBUO HEALTH Prevalence — It occurs m most colde areas of the ssorld where appreciable group of the people Ji\c under unhygienic conditions and are lousy It is mostly found Ji Punjab N \V Frontier Province Pakistm and Kashmir particularly at the end ol ismter Preventive measures — 1 Isotilicaiion 2 Isolation — Palimi should be stripped of all clothings bcloTC being admitted to the isolation hospital and should receiv e a baili and hat c nil body hair sha\ cd He should be ihorouglily' dusted with 5% DDT powder 3 Delousmg of patient and debusing or destruction by fire of his clothings 4 Disinfes’aiion of the infested house — By fumigation with hydiocyamc acid gas if u is not possible to dis infest tlie iiouse uitli sulphur dioxide or DDT emulsion 5 Clothing —These are disinfested and disinfected with steam, DDT ponder te 5 to 10% DDT with Frcncli chalk or talcum powder, IS spray ed or dusted m clothing 6 prophylactic vaccine —U is prepared from licc and used for the protection of workers 7 Medical and nursing attendants should wear louse* proof suits and vigorous inspection for presence of lice should be carried out 0 Improicment of living conditions with provision for frequent bathing and washing of clothes Treatment -The patient is isolated m bed, debused by DDT powder, the head closely clipped and disinfected and axilhry and pubic hair removed 1 rcaiment is lymptomiiic by sedatnes and cardiac stimulants Newer antibiotics as chio romjcciin, aureomyceim and terramyem have given good results riAOUF Definition —plague is an acute infectious disease charac* tensed by iiigh fever, iiinammation of lymphatic gfatu/s Joimmg buboes and sometimes by pneumoma or septicaemia The onset IS sudden The pnuent is obviously scscrcly toxic with rapid iirrgular pulse, maikcd lieadache, tremor, resllcssncss, unitc*»dy gait, menul confusion prosliauon, delirium, coma etc PLAGUE 315 Cause — ^The specific cause of the disease js Pasteurclla pestis or bacillus pesus It w present m large numbers m the buboes of all cases of bubonic plague, in spuium, of pneumonic cases and blood of septicaemic cases It is also present in the spleen, intestines, lungs, kidneys, liver, other Msccra, and in blood in small numbers Incubation period —3 5 days, shorter m Pneumonic plague Varieties of plague — 1 Bubonic plague — It is most common The lymph glands draining the site of original inoculation are enlarged which develop on about 3rd day The buboes arc tendej and the surroundjng tissue is swol- len from oedema Suppuration is common Bacilli are obtained by puncture of glands 2 Pneumonic plague —It js conveyed by droplet infec- tion and not by nt Ilea Sputum contains large num- ber of bacillus pcstis The constitutional derange- ment is out of all proportion to any physical signs m the chest Delirium is common The case moriaUty IS 98 to 100 per cent 3 Scptjcacmic phgue —It is proved by blood smear or blood culture It is invariably fatal Mortality —In untreated Bubonic Plague 25 to 50% , Primary scpticacmic and pneumonic plague are usually fatal. Modern therapy has materially reduced the fatality Epidemiology —There arc two groups — (а) Urban or domestic form occurring in densely populat- ed localities It spreads along trade routes and is transmitted fi om rats (б) Selvatic or rural plague —It is characterised by spo- radic cases scattered over extensive country area through cpizoonc infection of a number of animals Seasonal R*cvalence — It shows a vvcll/m'i’-k seasonal pre- valence Iis intensity being ai Its lowest ebb in July, gradually mcrcasmg till it reaches its zenith m March anti declining during next four monllis High saturation defi"iencics, accompanied by high temperature, causes reduction m the incidence ofpitguc Role or the part played by rats — PJaguc is really an epizootic in rats and to a less extent in other animals like guinea pigs, but under certain circumsuuccs U attacks human beings Thcic arc two varieties of raw — 1 Black domestic rat or Raitut RaUus is a comparatively :316 HVOIE.VE AKD PUBLIC HEALTH small aoimal Its tail is longer than the body It has a small pomtcd head, a smooth coal and large cars It lives m close association with man and does not migrate to an> distance It is most susceptible lo plague 2 Brown rat or Ratius ^otOfgtcus or Mm Dteumsmts^i a Asild rat and is comparatively large It stall is shorter than the body It lives in sewers and drains The rat plague is dissemuiated primarily by the brown seiver raf, to blick domrstic rat or ratUi raUus The epizootic among O’ats is followed after about a fortnight by the outbreak of human plague Hole of fleas in plague — Yersin was first to discover that dlcas play n great part m trammssion of plague The Indian plague commission earned out several etpenments in 1901 and 1902 These dearly proved that if fleas \vcrc excluded, the healthy rats will not contract plague even if kept m contact v\ith infected rats If tlic fleas are introduced during the ex- periment, the plague at once b'gins to spread from rat to rM So these pro% c conclusively thit the most important agents in development and perpetuation of epidemic arc the rat fleas Hea Index t— This is the number of ^c^s found on a rodent. The average flea index is 5 5 Iheflea index is hic;hest during later part of winter and lowest id the monsoon months Mode of spread —It is primarily a disease of rats Tlie house rat or railuj rattui gets infection from sewer rat or mji ifixw* jMRHj during epizootic season As the disease breaks out m nts, healthy raw run away leaving the infected ones O dinanly the rat fleas do not attack human bemgs, but rats begin to die, the fleas for vrant of ihcir nataral host begin to feed on min and infest him cither by regurgitating the plague bacilli which are iil their stomach and oesoph.igus or bv excreting wiUi the faeces and thus infecting man through scratching or through bite, wound, or a minute existing abrasion of the skm If regularly fed on blood, the rat flea may remain mfecled for about three weeks In hot, dry climates, the Q-a sooo dies The epizootic in rats IS a precursor to the outbreak of human plague The bacilli find tlicir way to the nearest glands where they arc held up The glands get inflamed and swollen and form a bubo m groins, oxdla, etc pneumonic plague spreads from man to man directly through the inhalation of throat sccietions from the paiicnl and the fomrtes It IS very highly infectious Rat fleas play no part m spread of this infection which is fortunately rare IfU happens to puncture a vein instead of skm, the bscilU ^rc introduced into the blood and septicacmic plague results PLAGUE 317 Extension of plague epidemic —It follows trade routes, spreads from house to house, street to street, village to village and from one province to another depending upon the em gration of infected rats, but mostly rat fleas spread by incidentally getting earned in the beddings to far off places These Q*asarr imported on the body or m the beddings of the p-ople These fleas start the disease first in rats and ^en in men and m tnis way the roll goes on Blocked flea — Xenopsylitt Cheopu ingests the infected blood on biting The proventriculus of the flea gets blocked with mass of bacillus peslis growing on the ingested blood This Bea is called blocked flea It cannot fill the mideut with blood and therefore it is in a starved condition When it makes efforts to suck more blood it causes injection of bacilli into the skin of the host Partially blocked flea — When the Dta is feeding, it not only draws blood fiom the uound made b> the mouth pirts but also draws forward the con ents of mid gut, the regurgitated blood from the mia gut mixing with the blood m the oesophagus may then readily infect wound with plague bacilli It is a serious danger to the community It lives longer as u is able to ingest small quantities of blood ns compared to a completelv blocked flen Prcventioa and Control —The preventive measures are 'ts follows — 1 Pfotijkaluin —Prompt notification be enforced of the incidence of plague cases as well as of the abnormal mor- tality among rats 2 Isolation of the person suffering from plague into an infectious diseases’ liospital, ifpra^'iicablc or in any segregated room of a house particularly m case of pncumoaic plague 3 Evacuation oj the infected premises — As soon as the disease is recognised, the inmates of infected houses arc re- moved to sc^cgalion camps ana huts Tins step should be ^ taken when there is abnormal rat monality in a house Subse- quent arrangements be made for the disinfection of the house and destruction of rats and fleas 4 I^rophylaclie anUplague tnoadahon — Haflkme's Anti- plaguc Vaceme — Dose is 2 cc generally when given m a single dose, or 1 cc followed by another 1 cc after a week There is severe local and general reaction It confers immunity for 6 — 8 months Prophylactic Inoculation with avirulcnt living plague bacillus by de Vogel and Otten xs much favoured m Java and Madagascar 6 Campaign agninst rats — (a) The construction of rat proof houses —The gram stores and gram markets should be 318 hygifm avd puduc kealtr 8itua*ed away from the residential area and should n'ver be utilised for the purpose of human habitatio'' The houses and grain stores should be rai free fn the houses no water or food be exposed where rats can h'we access, so thcywill run away for want of food (b) Rat destruction — The public should be educated that the rats are tbcir greatest enemies and they should be desuoyed at all cost It IS objectionable with certain communities such as Jams The methods employed areas follows (i; poisoiious liaili — Baits consist of an tnnert base to which is added some poison. The common bases used arc nita, bread mash, sugar meal etc The most common poison used is barium carbonate It IS cheap, tasteless and safe to handle 1 Ib of barium carbonate and 2 lbs of atta or flour arc thoroughly mixed with water and made into a fairly firm mass Divide the niiss into 2400 round baits of unilorm s ze so that each sliouhl weigh 9 grams and conum appioximaicly 3 grams of barium carbo- nate iVhilc preparing these it is very important to avoid imparting tlum any extraneous taste and odour such as from dirty hands and utensils, for rats have highly dev eloped and dchcatc sense of taste and smell These ire placed 20 to 40 m each house m plac-s only accessible to rats behind boxes and beneath cornbins so that danger of their being taiten by domestic animals and children is eliminated A single bailing IS all ilut is required and baiting over successive days has no advantage Prebuting lias proved to produce far better and constant results tiian Uirm poisoning The method is to lay unpoisoncd prebait* on tlic first and thud da) and similar baits containing poison on the fifth day The one great disadvantage of this method is that these operations are sometimes followed by an oflensivc smell in some of tt c houses due to decomposition of dead rats in places from where t*'ey cannnt be temoved This can be usualh prevented by closing the rat holes with mud to entomb them The other common poisons used for this purpose arc stry chnme, white arsenic, phosphorus, tme phosphid'* and red squill Recently highly cfrcctivc rhodcniicides as sodium fluoro- acetate (1080) and dicoumariac ^Warfnn) have come into the msrkct Trained pcrsomiel should be engaged to distribute them (ij) Bjf Fumisahta — This is a very efiectiv e method It should be carried out by a trained squad All openings of the burrows except one should be closed The noarle of the pump IS introduced into the burrow and fumigation is done Como- qurmly all the rats along With Iheir flets arc killed Cyanogas ' A” dust or cymag is blovm by Cyanogas apparatus which i» PX-iOUE 319 ■very commonly used and js very effective The other gases which are used me carbon monoxide, carbon dioxide, sulphur dioxide, etc \n ided fumigant should be toxic to rats jrJ fleas It should have a great penetrative power and must be non combustible and non explosive It should be easily available in the mai fi-l and should preferably be fairly cheap (iii) By trapping — There is a great advantage of Xilling rats by trapping over baiting m that it can be cm i^’d 'iiit as a more ■or less pci-maneni measure It is relatively exjic wiv •* and rc- •quircs go » 1 supervision To be effective it should bt, carried out coniiniiouslv with sufficient energy lo ensure that more rats are removed than replenished by brt-cding The traps are placed in adjoining houses for 20 to30da>sand then removed to the next block Trapped rats are transferred every day to the col- lecting cage, which is taken to the disposal station where the xats are drowned immersing the whole cige m a tub contain- ing water and phenyl or other suitable disinfectant or pulicidc. Traps should be cleansed with boiling water and smeared with sweet oil oacc a week to keep clean and am act the rats and prevent thetr rusting Attention must be paid in var>ing the baits Stale and useless vegetables and fru ts are good Onions, nee, chaptliei, meat and melons are excellent baits C Destruction or extermination of rat fleas — Tins is \ mo»t important measure adopted m these days for ‘lie prevention of plague DDT or g?mraexnnc art the chief rcsid lal insecticides used tor ifie d<*stniciion of rat fleas 7 he floors ire dusted with 10% DDT powder and the walls are sprayed wath 5% DDT emulsion in kerosene oil Similarly gammexanc dust 8 ozs for every 100 sq ft may be used Since fleas aje four d m cracks and crevices, so that floors and walls upto 4 ft should be spe- cially attended to The standard kerosene oil and soap emulsion or Dyrethrum extract in kerosene oil in the ratio of 1 in 20 may be used as a spray Naphihalere may be sprinkled on floor Cresol fumiga- tion in bubonic plague and foimaldehyde gas fumigation m pneumonic plague are also carried out Inchthirg and bedd/ng, the Reas are killed by means of •exposing them t > sun’s rays It has experimentally been shown that a temp ratuic of I16®r for 45 minutes will kill fleas in •clothings and quilts For practical purposes, clothes should be subjected to a temperature of I20^r for at least one hour: — (1) The piece of ground selected for exposure should be flat and hard, preferably wath a layer of sand and should be free from grass, leaves, stones, etc, which might afford shelter to fleas (2) The clothes should be thmiy spread in a smgle layer 320 HYOrLVE AND PUBLIO ID XLTH and thick clothings should be turned over once or twice 3 Exposure to full sunshine during the hottest part of the day should be continued for one liour 7 Du n/tctim of room with DDT or gammexane emulsion should be done m bubonic plague Spraying with pcsirmc or kerosene oil or napihaltnc and crcsol fumigations arc also earned out In pncuinonic plague, fumigation isith formaldehyde should be done S PfTsanal Proteettm of field workers against liras by weekly dusnng of cir thing with insect cidc ponder Daily apph cation of insect repellcms IS a valuable adjunct In presence of pneumonic or suspected pneumon c plarue physicians nurses and attendants must be protected by complete overalls ploves, and hoods equipped with face ma^ls of three tail^-d buadage with a pad of cotton wool This face mask should be burnt after each exposure to infect on 9 Education should be imparted to lay public by means of lectures, hand bills fi ms and slides to show how inf cuon occurs and to teach ihem how to guard against ruts and fle,.s 10 MoTt'tmt Qjwhrt — (I) All non iniccied ships com ng from foreign ports should poisess a six monihly certificate of deratisation If they do not possess a cerlilicale to the effect they will be inspected and if rats are found, they wdl be fumi gated ^2) Any ship coming from forci^ ports which within preced ing GO davs, touched a foreign port m which human or rat plague has been notified, will be treated as rat infested ship It must get derntisa ion certificaie The ship will be kept far awny from the quay ard gangway removed until the needful lias been done Treatment — Streptomycin is the drug of choice for the treatment of all forms ot plague It should be administered in- tramuscularly in the following doses 5 gm every 3 or 4 hours ts given until the temperature hccom's mrmil, thereafter I gm of the medicine is given daily in divided doses until a to al of J5 0 gms has been given In severe cas'*5, auremycetin, terramyan or cliloromyccun should be used in addition to strcpcomycm Sulphadiazme and sulfamerazme are also recommended for use IQ large outbreaks of the disease Surgical trealment ^ —Hot wet applications may hasten locahsdUon. Incision should be avoided (ill frank fluctuation occurs ENTERIC FEVERS 321 ETTERIC rPVERS Lntenc Fevers include typlw d and paratyphoids Th^ for- mer is caused by Bacillus tjphosus and the latter by Bacillus paratyphoid A B or C These arc acute infectious and highly communicable fevers of long duration f und all ovei the world affecting middle age group mi e in miles, than m females and have got an incubation period of 10-14 days Symptoms —Onset is instdeous The patient complains of severe Ironial headache and backache Siuw fever starts which gocson rismg by about one degree every day Tongue is dry and coated Pulse is s'ow m compans »n to tcmperaiurc If not treated it sinks into typhoid state The diagnosis is confirmed by — (1) Blood culture (2) Widal rc iction Typhoid and paratyphoid bacilli are found m blood during first two weeks and m unne and faeces of ihe patient after two weeks and also in faeces and urine of the earners Bacilli remain alive in faeces and watci for a consideiablc period, when not exposed to sunlight, I ut do not multip y m them They multipfv in milk They are uestroyed by heat at 60®C They arckilled by-phcnyl 2 5% Th-y may live for many weeks in ice In the upper layers of the soil it retains its vitality for a long tune ‘ Mode of spread —The d sease is chicfiy spread bv the discharges from the bowel and uniic through the medium of water, milk, articles of food and drink and also through the agencies of lies, fomites and dust Tiphoid carriers *re one of the unportant causes o'* spread of the disease, of which the faecal carriers are more common than the urinary ones Carriers arc more common arrong persons over 40 > ears of age^ etpcoally fcanalcs The infection enters through mouth and reac*'cs intestines where the oiganisius attack the lymphoid foil cles (Payer’s patches) and enter the systematic circulation and so the I icilh are found m it in the first week Later on the bacilli are dis charged m the faeces and urine The inrcc*ion may be direct or indirect The firmer is due to laci" of observance of proper prcciutions in handling patients and Ihcir discharges Tne Utter is through contamiiuied art cles offood and dnnk as in uater milk, vcgenblrs, oyster shellfish etc j Soil pUys an importanr part m the spread of the disease Age — It IS common between the age of 5 and 35 but un- common under 5 years S22 mCIFNE AND rOBLIC HEALTIC Seasonal Prevalence — It is prevalent through out the j ear, common m waim vvcaincr and maximum m July to October Occupations —The classes of people who are more cxpoied to mfectu It I r , doctors nu m >uth in doses of one gram every Six hourly for 2 to 3 days until the tempera- ture comes down and ilien 230 mgm is given eight hourly for 8-4 weeks Complications are dangerous and should be prop-rly treated A starch and opium enemt mxy be req i red for d t rh>*a or for haemorrhage Laparotomy is essential in the event of perfora- tion. CHOLERA Cholcri IS an.acutc mfeciious disease, caused by specific in- fection of al mcnlary canal characterised by sudden onset of severe w atery diarrhoea, vnmiung cram-as m legs_grc3t thirst and sjqip rcssion of unne The stools arc like nee water It IS endemic in East Pakistan, the delta of Ganges and some other parts bl' intlia Epidcm c extensions take place from time to time The infection is imported from these centres by ^1 or road, by means of persons suffering from it and by e arner s, t nlcctcd artic les etc Season — It occurs in late s umme r and autumn and gene- rally dies away with the app-arance of cold weather Warmth an d moi sture are important predisposi ng fa ctors for the preva^ Icn^ofl3ic disease Etiology —It is caused by a Imng germ called choler a tibuo . whicli is found m the stools and vomits of the patient It IS active, mobile, coma shaped and gram negative organism. It grows in an alkaline medium at a temperature of 30®C to 40®G. It dies at 35‘C in 15 minutes In fresh water u cannot survive 824 ITYGrENB AND PUBLIC HEALTH Ion? It grow-s outstde the body in soil polluted ^^^th organic matter, sewaire milit and other articles of food and drinl. In- sects, particularly the house flv plays an important part m dis- gemmat m of this disease TTtc germs of this disease can liv« for a fortnight m a R\ Mode of upread —1 By mouth —When polluted water, infected milk or food are taken 2 From person to pcison — Carelessness of persons attend ing on the cholera patient by not wash ng their bands propctly, and thus infecting the food or annk or themseUes 3 Fomttes —From clothes and linen soiled with disdiargei of infected peisons 4 Indirectly —Through flies which carry infection both mechanically and vitallv 5 Cholera carnets — Tliese are not a significant factor i» spread of infection locnbation period —This is very short, ranging from a few hours to 1 or 2 days but occasionally prolonged upio 10 days Immamty —One attack confers a mild grade of immunity which appears to aflbrd some protection for several years The esacuations of a cholen case are most infectious during the height of t! « disease In the epiUrmic period tlte propor- tion »f deaths to the attack is greatest dunrg the per otl of maximum intensity of the ep dem c When it b gms to subs da, the recovery rate may considerably exceed the number of deaths Preventive meaaares — They arc as follous — 1 ^tjfiea/ien — The case should be notified prcmptly etc* if It IS a douinful one 2 Isolation of case m an isolition ho'piial or at home The coniects should be segregated and treated 3 Local mra ures — («) All dejecta should be received la a basm m which there should be placed quicklime at the lioltom It should be buried or burnt away at a great distance f om th« town (4) Lime should be sprinkled on the floor of the room » winch the patient is being treated (f) Amifly measures should be taken Fly papers be placed in the room (rf) D smfertion of soiled hnen should be done before it « sent for washing (r) Some suitable disinfectant be kept at the door for svaih ing hands after attending and nunmg the patient CHOLERA 325* (/) Protection of articles of food and drink from flies and dust. 5 Fs. are dangerous “Fingers, Food, Files, Faeces and Fomites”. (g) All latrines, privies drains etc., should be cleaned with a disinfectant lotion oi sprinkled with lone or bleaching powder. 4. Anticholcra or essential oil mixture : — This is used both for preventive and curative purposes. Its foimula is :■ — R/ Spirit Aethcris 30 mins. Oil of Cloves Oil of Juniper t 5 mins, each Oil ofCajuput j Acid Sulphuric aromatic J5 mins. Dose; — I drachm m an ounce of water taken every halfan iiour. Total daily average dose is 8 to 10 drachms for curative purposes For treatment of contacts for the first five days till immunity is acquired after anticholcra inocula- tion, one drachm of the mixture is given m water once or twice daily. ^ 5. (at An Initial dose of 0.5 c.c. and a subsequent dose of 1 c.c. of antichdlera vaccine should be injected after an interval of one week or 1 c. c of the vaccine may be injected straighiawav m a single dose mmsss inocula- lion. It contains 6Q0Q m.ll io n vilrio choler a per c.c. It confers Inmmnhy for s« months In the case ot epidemics a booster of I c._c. should be givcjj every six months. Many countuerr"equire travellers from an cndtmic cholera area to possess an inter- national cholera vaccmaiiort certificate for entry, which is’”vaHd fronFfi days after injection for 6 months. There is a mild local and general reaction. (b) DiUtascint \ — One pill of vegetable bile salts is taken empty stomach, follmved by one tablet of vaccine consisting of 60 billions of dead bacteria, after 15 minutes. This is repeated for 3 days. Immunity lasts for a year. 6. Duin/rch'oa t^Both concurrent and terminal disinfection should be cairied out. Beddings and clothings should be disin- fected by steam. If this cannot be done effectively, burning is the most important measure after getting the permission of the owner. If they arc of value, expose lo the sun for several hours, and turn them over and over again, so that the rays of the sun may penetrate from all sides. Utensils of the patient should be boiled. Disinfect charpoy or iron bed, as the case may be. Mattresses should be disinfected by steam. 7. Suriltsaiion ef water supplies : — Provision of properly filtered u'ater supply has been m itself suflldent in scamping S26 maiENE Ain> public iteilth out fl olcra jn Europe It has also reduced the jnc dence of this disease in Irdi On incidence of infect on immediate disinfrctu n of supplies which arc exposed to risk of pollution ts earned out hy c rollowinq methods (atuil»nces pred sposc to the attack of the disease and acid media is hostile to Uic growth of germs (g) Butter should be made from boiled milk and should n t be puicbased from the bazaar CHOU- RA 327 (A) People should avoid indigestion They should be temperate in their habits and modcriie and regular jn tbcir mcnls On occurrence of diarrhoea in any individual the medical advice should be immcdiaicl; sought for (i) Takp hot drinks and hot meals Weak tea Icmonjuice, curd or butter milk may be taken with advantage 1 1 , Aniicholera propaganda by means of lectures, films and slides should be carried out 12 Special Measures m Melas and Pairs — Besides adop^ mg the aforesaid measures the following prccauiions^should also be taken — (а) Protection of watcrsupply (б) Special accommodation and kitchen arrangements {c) Special bathing places {d} Proper disposal of nighisoil («) Tree inoculation, atleast, one week before the arrival of pilgrims TreaCmenC —I Patient should be kept warm m bed 2 He should drink glucose water m «ma!I quantity frequentlv ffe may be given small pieces of ice to suck, to quench thirst 3 Sulphasucctdine or Sulphaguanidine 4 tablets with Kaolin one drachm and tiro taWrts wub KaoJm one drachm four hourly till vomiting and diarrhoea subsides Sometimes the following powdtr has also been tried with good results — Sodium Bicarb grs 5 Calomel grs J Caffine grs 2 Mft pulvc one dose This can be given every two hourly till purging and \omiimg stop and then given 6 hourly 4 Permanganate Pills 2 grams each enteric coated givco every J of an hour
nicr bacAlus) svl^ch grows ^iehy ir t he t bmat, larynx and other ponions nfthe'upper res mratorv nassan es. It is found in the secretions of mouthy nose and throat and in shreds of cfDcous membrane. Occasionally it forms membranes on the eycsj^^ajid vagina and rarefy jnjnQtcted woimdj. The bacillus is killed by direct exposure to sunlight and heat. It IS comparatively a lurdy microKirganism. Seventy of the condition depends upon '—•()) Amount o^thc mcmbra.nc (2) ( olour of ihc mcm^nc. fS) Ajnounjjjf adehni* (4) Amount Of nasal dUebarge'and presence "oT Kae» morrhage. Geographical distribotioB*— It is a widely spread infection and IS mjre prevalent m temperate reg^ns. It is more urban than rural. Age •— Although no age »s extmptcd from its attack yet it IS common m children between the ages o f 3-3 year s. Ssasoaal prevalence —The epidemic commences with the begitm.ng of the cold season and its maximum intensity reaches in Movember a nd D gcod^cr. It is common m hills during rain s Predisposing caoses ; — They towere d vitality due to ove rcrowding i nsan tary surrou ndings, vorcthroat, nasal cattarh, harynguis and unhea ltliy conditions of moiTni and thro al. ' Incnbatioa period : — ft is short and usually varies fro m 3_ t o 4 days but it msy be as short atjone d ay o r_cy£n only 6 hours. Mode of spread : — The most common way is by personal crmmumcation, chiefly through the carrier s, whether sick or healthy Nasal earners nr^mor c dangep on* than throat can lers. In majority o cases, the disease is spriuid b y dfo plct tiolm ion, t he bacilli being cxpcifcd fmm the mou th antl’n^e by cougfiing, sn^zi rig. spitting, speaking oirTcming. Il may be indirectly transmJucd through i nfected articl es such as ha^dkcrclytfs, toys, slate p encils, etc. DIPHTHERIA 32S It IS conveyed m some cases by taking contamirmtcd__nulk and other articles or food Itis traccalJTe to diphtheritic sores on the teats of the c ow, nr esiunaBIy7nI«ted by a mlE er e arner romites may also spread infection Cross infection in hospitals is common I nfection can spread over patient's own body , thus a child may Infect his finger by picking his nose, or hii eyes by wiping his eyes after picking his nose D phthcria convalescent should not be allowed to m ix freely with healt hy person s, unle ss at least two or three successiv e Swa bs tak en from the th roat and nose p r ove to be negative. The course of the illness can be described best under 3 headings ( 1 ) Stage o£toxaemia (2) Stage of c ardiovascu lar failure (3) Stage of paralysis Immnntty — One attack of diphtheria is not known to con fer jm*n inity ktek Test — Tt is the test by which the presence of diphtheria amt bodies m the body ofa person are detected The test consists of giving the intradermti mjec ion into skin of the forearm of 1/50 of a m n mum lethal doic for a guinea pig, of diphtheria toxin diluted to 0 2 c c A control test is made on the other forearm with s mdar amiunt of toxin whicli has been previously heated to 75*C to destroy the toxin A posit ve reaction is shown by the appearance of a circumscribed area of redness within 24 to 48 hours and indicates that the person is 4usccp ible to d phth-rta A negative reaction is shown by the absence of rcaciim in either arm and indicates that the person 18 immune to d phthena Pseudo retclion Persons who are sensitive to these proteins, will, irrespective of the presence or absence of anti- toxm m their sera show on tx>ll» forearms a red flush within 24 hours which fades away completely wjthm 4 days Preventive measnxes — They arc as follows — 1 Jiotifualion 2 I solgUort — The patient should be isolated either m th e hwpi tsT a \ bomc.j T r'a room 3 of the bouse is earned out by spraying o f 1 % solutioiuji-iormalin . *l he beddings anH the clothings are dis infected with stca^ All slates m y-s etc ^ ho uj dJiC-boilcd for ^ hgur T he secretion trom The mouth and throat shou ld be received on ~a' pi ece of cloth and sub scque mly btiint aWa y Dunng convalescence, mouth should be was hed some anti- septic louon Antisep pr- Tnub i contain ing sulphapvfidine are worth givini^ a trial in cahTheli. tmiru iiffitiaa — The new infant it usually msusc« ptlblfc.proh ably , ow^ng to anti toxin deri ved froin the maternal blood Immums-ition should not be done in child ren under one year of age From I year to 5 years of ^e Ac child is^vcry^'cept^yc and attacks are very often fa^ ‘They nec3Tnunimisatioii _ ‘ (ecks interval (2) Toxoid an titfixm floccules (TAT ) — 3 doses of 1 cj e ach at an interval of 2 lo~5 werks x f e~ ^dm m istfred mtramu s tcylarly itpiovoltes si g iit reaction and i s suitable for adults , (3) Punfied toxoid aluminium phosphate prec putted t yp TAPI has been ifUrodoced recently It is less liable lo cause foca l reacti on than APT It is given m 2 doses ofQS ^c~ each at an int erval of 4 weeks by intr amuscular ifijcctio nt »j Before giving these injections Maloney’s test should be carried out to ascertain hvpcrsrnsitivct*if8s to formal toxoicT in sstAi-trox. 331 (rf) Schtck negative (— ), sw^b negative (— ) (Harmless and immune ) (ff) Schick negative (—), sw-ib positive (+), bacilli avini- lent (Harmless but susceptible) (f) Schick negative (— ), swab positive (4-), bacilli virulent (Dangerous carriers Isolate from the onset) Treatment —1 Put the pat ent to bed, in absolute res^ owing to the danger of heart failure 2 Serotherapy has reduced the mortality The minimal doses advocated are — Units in Thousands Age of the Pciunt mdd moderate severe *verj severs Children under 5 years ofage 3-5 5~I0 I0~20 15—30 Above 15 years and aduhs 5-10 JO-15 20-40 30-60 It should be given intramuscularly Concentrated serum contains 2,000 to 2 500 units per c c If dis“asc has been pre valent over 48 hours, double doses are needed Seoim shoud be warmed upto body temperniure Repeal aficr 12 hours, if there is no improvement One lac unit of pemcilhn in no tnal Saline to be injected 3 hourly for 2—3 days Intravenous glu cose IS also needed 3 Give fluid diet till the throat is clear 4 Tracheotomy or laryngeal intubation may be required for laryngeal obstruction SMALL POX OR VARIOLA It is an acute infectious disease characterised by sudden onset, with fever, chills, headache, backache pn siraiion con- tinuing for 3 or 4 days The temperature then falls A skin eruption appears which passes through the successive stages of tnaculc, pjpulc, vesicle, pustule, foims crusts and Cnally scabs, which fall olT at about the end of third week ending m pitting or scar formation Tlic crup ion is usually syam meal and is more profuse and general, more profuse on prjm nonces, extensor surfaces and surfaces exposed to irritation It is most abundant and earliest on face, next on forearms, W'risis and hands and Csvounng the limbs especially distally more than the trunks It IS more abundant on shoulders and chest, tlian on loins or abdo- men, It IS most communicable in early stages of the disease Forms of Smallpox — Itoccurs in two foims —1, Typi csd or severe t) I e called Varula Major — This occu« rn India and IS of a classical type 332 irrotEsr Ajf» PUDLtc heaitu 2 Mtld or ra tnr knowa ai Alaihvn or Varmla Mvi*r and occurs in South America, and USA, etc Variola mtjor occurs m three types*— (<>) Hwnmhngu Smalipix • —There arc two types of hicm'irrhtgic sraiHpox which arc very mzlij^ant (i) Purpuric (black snullpox), with very scanty ns?i Hirmorrhages occur in the akin, internal organs and mucous m-mbrancs (»{) Vanola H lemarrhagica Piistulosa —In this ease haemorrhages occur after th“ devHopm nt of rash svhich may not reach pustular stage hfortaluy is 8 )% (b) GrnJIuffit Smallpox — In this t\pc lesions join logethcr or merge and touch at the edges It »s usually fatal Mortality » 50% ’ (f) Afodijied or DisereU fjrpet -The rash is scanty and dis Crete Tlic pmdromil symotomi are m irked Th* Iciions arc short The m'Mlificaiton may be due to vaccination m childhood XforialUy is 10 15% In enrtra distinction to those of chicken pox, the skm lesions, >n smallpox have a hard sliottv teel the vesicles are muhilo* culac, lough and difiicuU to break all lesions tend to be at the stage of development and the distribution orsmillpox lesions is peripheral The greater concentration is seen on the face fore* ntms wrists p ilms, lower legs feet in* lud ng th^ soles The ei tensor surfaces of eictrcmitirs arc freq i“nily mare heavily involv- ed than the flexor areas They are relatively sparse on the elicit, abdomen and upper pin of thighs Canse — It is caused by a filterable virus which is identica- with that of Vaccinia U is present m the secretions of mouth and nose at an early stage and later on II IS present m skm erup tions also The disease is very infectious and contagious It attacks people of all ages but is fatal, particularly m young children Mode of Spread — Tlic mlcction spreads directly from case to case The disease IS spread by secretions of tmutli and nose of Uic patient which contatiu infection, and alto from pus of the skin eruptions and by dned scales which arc inlialed by a healthy person Actual method of transmission ts not yet prov cd, but It IS presum-d to be aerial This is well knovm that smallpox can artifi'-ially be induced by scabs In England it lias been seen that the infection actuilly spreads more from the smallpox hospital to the nearest liouses than to the farthest places Incubation period IS 9 to ]5 days, and on ao average it u 14 days SITALLFOX 33S Period of Infectivity or ComznanicablUty —It begins with the appearance of rash and lasts till the desquamation of all ermts has taken place Ordinarily this period is thought to be between 5 to C weeks Immunity One attack confers immunity, or it is attained through successful vicci nation Prevention — The following preventive measures should be adopted during the outbreak of smallpox — 1 J^ol fuaiion — Sometimes tlie cases are concealed Infor- mation ngaidmg the ii cidence should be obtained through con servancy d< par meat m addition to other means of notification 2 Isolation — The patient should be isolated into a smallpox hospital or an isolation hospital or in home 3 Concurrent Dtsm/tction — Ornl and nasal discharges should be dt posited m a paper hag or other suitnble container and burnt All articles concerned wiili ilie patient should be sterilized i VaectnaUon —Is the only weapon to root out smallpox All contacts of snuillpox cases should be vaccinated Vaccination and revacctnation should be vigorously earned out from house to house Vaccmatiun is done between the age of 3 6 months and rcvaccination after 4 5 years of primary vaccination Every man must get revacemauon at an interval of C 8 years 6 Cm e>/ ConpuUmni —Tio person sufTcrsng from small- pox should be allowed to go out and mix freely wuh other per- sons till every scab or scale has disappeared and there is no sore left on the body The com alescem should be given a bath with soap and water and his clothes should be changed by dis- infected ones It IS not uncommon to sec children recovered from smallpox in convalescent stage wuh scabs, on their body, playing about in streets They are a real source of danger and can cause the spread of the infect on C All heads of dcpariroenis, principals, headmasters, hcad- mislresses, managers of factories, etc , should be informed as to the prevalent c of «mallpox in a particular locality and carrying out of the immediate vaccination is the only prophylactic mea- sure knotvn for an cfiective safeguard against the disease They should be further advised not to allow clerks, students, factory workers etc , in ^hosc houses casrs of smallpox have occurred, to attend to thrir N>ork till tlie patient is completely cured and house adequately disinfected 7 Cart of Dead Body — All persons who have died of smallpox should bfWraiipcd in a diecr soaked in 4% solution of foimabn and should be cremated or Imncd without any delay 334 inoiEVE AVD rtrcLic itPALni S Diii’ifftiton of ihe House —The mrccted house should be thoroughly dis nfcricd with (bmialdchyde or sulphur diotidc The ualls should be Jime wished AH articles of clothi ig, bedding, etc , should be exposed lo sunshine dunng the houcst part of the day The local municipjl commitices should end eavour lo provide themselves with a steam disinfector and the public should be encouraged lo get their articles disinfected thcrcfiom 0 Fdtuatioa of ihe lay puihe should be done by handbills, posters pamphlets public tcciurcs, GIms, slides, etc They should know how to protect themselves against smallpox Treatment —There is no specific trcatmiit Thisismimly sytnptomttic Recently sulphonam dcs (4 to 6 grams daily) or peniciiliii 30 000 units every 3 or 4 hours intramuscularly is continued for a week The mouth and skin require frequent sponging with 1 in 4,0QQ permanganate lotion and dusting with Bine talcum powder Ihe eyes are washed svuti l>onc fotion and bone ointment ii applied to lids Diet IS restricted to milk, glucose and fruit juice A saline Diaphoretic mixture and plenty ofiluid are also of value ^ACC1NATI0N It was introduced by Sir Edward jenner m J7ft8 Before the introduction of \accmatton, it was customary to inoculate persons svjih variolous matter obtained fn«n a mild case of ‘msllpo’t, called inoculation against smallpox It was not a saiisficiory amngtmcnt but was very dangerous as tn many cases the persons got an aitice of smallpox and it developed in the form of an epidemic This practice is however now pro* hibited by law l^cectttation js the introduction of the virus of cowpox or vaccinia into the skin of liuman beings in order to prevent smallpox The disease, thus produced, is a very mdd alTatr, showing phenomena of vacemaiion This mild disease is elTfc* (ive to save the individual from Uic drcadlul disease ir, small* pox Vaccination is the only and in fact the surest method of prevention of smallpox It can be absolutely stamped out by systematic vaccmation and revaccinauon in a country. After Its introduction the following mnhods were employed (a) Arm U arm nulW:— Children were vaccinated with he lymph obtained from other children This method Was objectionable as the child was troubled SM \L1.F0X 333 every time when som* other person was to be vaccinat- ed through this m*diod So this was given up (i) Calf to arm mtVtod —The vaccine was grown on a call and th- child was directly vtccmatcJ from jt T/ns m-thod was widely foUnwed m the Punjsb for sometime It was subsrqucnily given up, as a large number of calves were used and there wts no super- vision or control over the vaccinators regarding the cleanliness at the time of taking lymph from the calves Method of Vaccination —Healthy persons should be vacci- nated Children sufT-ring from fever, bowltroublc, skm troubles as impetigo or ecztma, should not be vaccinated Do not t accinaic in a home where there is a case of erysipelas It IS done on the outer side of the arm near the insertion of deltoid muscle or m fiont of the forearm, 2 inches below the bend of the elbow Care should be taken to protect the vesicles Sometimes when vacctnauon marks are not desired on the arm or fore-arm pirttcularly m females, calves of tlie legs arc selected for the purpose of vaccination SUnluation of ike Part of the Body to be vaceinoted is done by soap and water and then dried Absolute alcohol is applied and rhe area is allowed to dry up Generally no antiseptic is applied, but if applied, it is thoroughly washed with clear water to remove all traces of the omiseptic and the place allowed to dry up prior to vaccination Siatltsaiton of Inslruments —Vaccination needle, lancet or, rotary lancet and probe are used for vaccinating purposes They are sterilised by passme tlirough flame They must be cooled before use otherwise they will kill the virus conta ned in the lymph They can be sterilised by wiping with absolute alcohol or rectified spint before use Methods — These are as follows —(e) Purtclure Melked — It IS like tatooing A few superficial punctures arc made through a drop of vaceme with a sterile needle wiihm an area not more than I inch in diameter The needle ts kept parallel to the skin This gives little chance of contamination (i) Imsion Method —This used to be the only method recommended m Germany for sometime A single linear inci- sion, not more Than ^ inch long through the epidermis is made -hrough a drop of lymph or before the lymph is applied Tht vaccine is gently rubbed over the scratch (c) Scanfeatton Method —In this method scarification or cross scratching is done The objection to this method is that It produces a relatively large abraded surface which is soon 53G inaiEVE AND PUBLIC HTALTir covered by a dry hard crust of serum and blood through which the pniption cannot pierce The vesicles foim a ring around the fcarilird area leaving a centra! irritated wound inviung infec tion This method is forbidden m Germany (■i) Bj Riliy Lin et —The stcrilued rotary lancet u placed gently over the part and u given one rotation with suffi ciemp esswe but without drawing blood Vaccine is applied and rubbed in («) A/ulnple Pressure Mtthnd — It is the best of all the methods because It causes less dtscomroil, is completely painless, mtoivcs ram mum trauma and is less likelv to be associated With set ere local reactions or septic complications The object ofthc \acctnaiion is to imiodure the vaccinia virus into the deeper layers of the epidermis, where mullipltcaiion takes place more easily In this method a small drop of vaccine is placed on the skin a flat sided or triangular needle eg a hagedorn of a large size in good condition which should be sharp and sterile, a held parallel or tangentiallj to the arm One side of the needle IS p essed ft m y and rapidly into the drop about thirty tunes in 10 seconds The needle is not driven into the skin, but by the action of needle the lymph IS driven into deeper epidcr- mnl layers The excess of vaceme lymph should be gcntlv wiped offtlis arm Namber oflasertlons —The number of insertions are three in case of pr msry and two m case of revaccination Tiiey should be I finches apart so as to prevent them frora joining together Phettomenn of Primary Vaccinatloa —There may be mllammitory reaction tt, reddening and itching during the pciiod of incubation itf for three days On the third day papule appears which is superficial, round, hard and red in colour wtueh becomes slightly elevated on 4lh day when one or more small papules appear After the fifh day, it vesiculate*, becomes multilocular, mablicatcd, and is surrounded by an mflamimtory red margin, called the Areola The vesicle has a doughy or tense feeling and docs not fluctuate It is charnctenstic on the 7th day On the 8ih dvv, n becom's flaitcncd, larger and the umbhcation or the dcprcssitm practically disappears On the 9ih day, it is Qattcned and less full and beertfnes pustular It IS then greyish, tense, lorulalcd and full of lymph It develops to Its maximum Size on the i2th day During tlui period, slight eonsiuuuonal symptoms such as headache, malane, SMALLPOX , 337 fever swelling and tenderness of regional lymph glands, rcstless- tfiess and itching are observed A brown crust or scab forms on the surface on the 14th day ■svhich dries up and falls about on the 2lst day The scar is first red and finally becomes white and depressed and marked 'With little pits Age for Vaccination — It must be done in infancy iVhcrt tile child IS three months old and m no case later than six ■months Infints may be vaccinated as early as one w cck of age "but are less responsive to stimulation at the time If there is any reason to suspect that child may devcloji €nialtpo\ or there is an epidemic of smallpox inT the locality, -vaccination should be performed atonce ' Ifprunary saccmalion is successfully done immunity for ■smallpox will last for five or six years Rcvaccination should be done at the time when tht child enters school at the age 6T "S or 6 >ears ancT igain at the age of ten to twelve yeari 5ind it the age ofiurnty years Vaccination after Cxposare to Smallpox —K person who has bcenm contact with a case of smallpox and who gets vaccinat •cd at once usuiUy escapes the disease or m the event of an attack -of the d scase It IS very much modified The feason is that the incubation period of vaccinia is shorter » r , 0 days and that of emallpox is longer i < , 12 days so the vaccinia v)rus has four more days to net Successful vaccination may therefore be per- formed at any time during the incubation period of smallpox Reactions of Primary Vaccination — If phenomena of vaccination is observed m at least one out of two insertions, the result is successful If the result is unsuccessful. Vaccination -should be repeated again at the end of a month If again.it is •unsuccessful It may be repealed for the third time at an interval ■of three months until successful If the result is unsuccessful even at the third time, the conclusion is that the cluld has got natural immunity against the disease f If there is no phenomena of vaccination or absence of a take; after primary vaccination m newly bom child, It may be due to one of the following caus-s and that cause should be investigated,— (f) Technique of vaccination may be ivrong (ii) Vaccine may not be effective or potent (iiA The child may have natural immunity (id) The child might have wiped out the vaccine by drop- ping the sleeve over the arm before it was dry ^e) Application of vacanc to the cleansed skin, before it IS dry 338 3lT0IJa,E AM» lUBUC HEALTH (pi) The applicalton ofa baniiagc or a shield Reactions after Revacaaauon —There arc three tjpes of reactions — (а) Reaction of Immunity or Immediate Reaction — \ papule appears on tJic first daj It does not develop m o a vesicle and npjdly subsides This shoivs that the person Ins got unmutiUy (б) Ateelercltd or latemaid j?rlaclic purposes, and u ippears to be of much use 8 Virus inoculation has also been tried in America with good results 9 Prophylaxis on general hygienic lines, consists in rait* mg (he standards of housing and nutrition TreatTneut —The patient must bt kept in btd and aympio* matic treatment be given for bronchitis, laryngitis or conjiincu* vitis Regular nursing toilet of the mouth, lips and eyes is com* forting and preventive of secondary infection Sulpliadiazine 0 3 G three times a day for a child of 5 > ears should be given foe 5 days U is circcuvc in prevenung -complications MintPS (INtECTIOUS PAROTITIS) Mumps in an acute infectious discise of sudden onset, clur- actensed by fever general malaise and by cnlarg nicnl and tenderness of one or more salivary glands usually ol thepirotid It lifts the ear and gives the face a whimsical appearance It it first unilateral, passing later on to the odier side Irismus is well marked ind pain may be fell at the angle of the jaw before stvelhtig appears and mouth cannot be opened properly Cause — It is trmsed by a filter passer virus which is present m saliva, blood and cerebrospinal uuid For its spread a dote contact IS necessary ACUTE P0I.10MYia.ITIS f 343 Incnbadon period : — It is from 17 to 26 days. Age -The infection is mainly of childhood and adolescence, Infectivity rate It is high. Complications: — ^Thcy are orchitis in males, mastitis and oophoritis m small proportion in femates. It may cause dcaihess tn rare cases. Prevention : — The following measures should be adopted 1. The patient must be isolated until swelling of sahvary glands is subsided. Treatment is begun with a purge. Mouth washes may be used and hot fomentation or Icthyol Belladonna paint is applied to the swollen parotids. All patients near puberty should be kept in bed for 10 days. In adolescents, 10 c c. of convales- cent serum be given to check the complications. Sulphon^ides be given for preventing secondary complications, 2. All utensils should be boiled. 3. Movements of ilie contacts may not be restricted. Treatment It is symptomatic. In orchitis surgical relief of pressure lias been of much use. The use of steroids has also shoum some success. ACUTE POLIOMYELITIS Acme poViomye\itis or infam'de paralysis is one of main crippling diseases of childhood. It is an acute infectious and wmmunicablc disease affecting the central nervous system and infrequently resulting in pariysis. It attacks children of all ages. Cause : — It is a hlterpasser virus, which is found in naso- pHaryaigeal secretion, faeces and urine of patient and carriers. The carriers play an important part in the spread of the disease. Faccalcarriers arc more dangerous than the nasopharyngeal ones. The c.'iusatwe agent invariably involves the nervous sys- tem, especially nerve cells of spinal cord and medulla oblongata. The seriousness of disease and its after effects depend upon the extent of damage that liie virus docs to Uie nerve cells. If they' arc only slightly damaged, complete recovery is possible. But if a nerve centre is completely destroyed by llic virjis infection, tlicn tlic -muscles controlled by it are permanently paralysed since the nerve cells once dead cannot grow again. It may be con- veyed through water or milk. Hot dry weather tends to foster epidemics. , Incubation period : — It is usually 7 to 14 days but some- times it may be only 3 days. 344 maiENE Am> public jilalth Symptoms — It shovrt two stages —1 slu^e — TJjc attack of poliomyelitis begins wih high fever, coryzT, head- ache, chilliness, pam all o\er the body and occasional!) epis- taxis Children arc droirty but the adults arc restless It is followed by irritability and njjidiiy of neck Cerebrospinal lluid reniains clear m this stage 2 Pdraljflu stage —After the first stage there is recovery for 2 3 days and then second stage follows with its characteris- tic implication of group of muscles Ihc 'spinal sign" of this stage IS the pain produced, ashen the attempt is made to bend die spine forward The paralysis is of a ilaccid type, shows great variation m degree and range The lanb sceins to he loose and flake like Foot drop, irritability to raise the ann md straighten the leg, facial parilysis and squinting of eyes arr the result of this disease II muscles of larynx and pharynx are involved, it proves fatal Glass of people —It attacks all classes of people some- times well to-do persons are a/Tecied In England mostly piblic ^ools were affected viith this disease Mortabty —It ranges between 10 and 20% Fifty per cent of those, who escape dcaili, are crippled m vinous nay rand sequelae include permanent muscular paralysis, atrophy of limbs and deformity of joints Prevention and control —The lollowing measures should be adopted —1 Notification of the ease to the Iteahli authorities 2 Isolate the patient Give him romplclc rest m bed and ireit the symptoms ts they arise Mechanical rcspirttor or "Iron lung *, js required when the paralysis nttneks the muscles of the chest 3 Since polio virus Ins been found m the liowcl wnstr products md m sesvige, md scrmirntte disposal of nighisoil pirti- ciitiriy of paiients suffering from this disensr is dangerous 1 here must he provided therefore an adi-quatc arim^cm-nl for proper disposal of urine and ficces 4 All sources of water supply should hr protected D ir ng the outbreak of epidemics swiinmng batls should be chiori Tinted 5 O'crcrowding of children in schools, playgrounds and ancmas should be atoided C Soft ftnihs should be washed tn weak pemnnganaie solu--^ tiou and niilt should be pasteurised CEREBRoapiKAL FEVER 345 7 Antifl) measures m wellequtppcd orthopaedic clinics should be adopted 8 PohomylitJS vaceme discovered by Jonas Salk is a preparation of formalin killed virus combimng antigens of I, 2 and 3 and is said to be cflcciivc m preventing paralytic polio— mjlitis inabout 75% ofpersonsXNho were vaccuiated The vaccine u administered in 3 injections of 1 c c each , the first Uvo being about 4 5 weeks apart and die third about 6 7 weeks apart or even later Convalescent sera for prophylactic and curative pur- poses have been tried but the results have so far been incon- clusive 9 All suspected earners should be treated with potassium permanganate gargles and 4 tablets of sulphadiazmc daily 10 For residual paralysis, ambulatory treatment, massage and muscle reeducation witliouc iafigue are the proper measures dimng the stationary stage, which begins s6me 2 years after the acute attack Deformities may require to be corrected by the use of plaster, forcible stretcl ing tenotom> or similar surgical procedures Treatment — It is symptomatic Use of sulphonamides have been found of service in prevention and treatment of respiratory and aural comphcitions Treatment by 'vay of fomentation and massage, which must be given for a long duration of time, help temporarily, weakened muscles to grow strong and useful again CEUTBROSPINAL FEVER It IS 1 specific infectious disease chanctensed by a sudden rigor fever, severe headache and symptoms of memngitis that IS rigidity of neck or retriction of head herangt sign is pre- sent and pulse is slow Paueni becomes apathetic Etiology — The disease is caused by the orj^an sm Di^ loeoccus me? mgtltdis v traeellularis now commonly knowm as Nttssma MentngtUdis or meningococcat and is founj m the ccrcl rospmal fluid of patients and mso-pharj ns of carriers of the disease Incubation penod — zs 2 10 da}S Mode of spread — ^Thc disease is sprend b> healthy carriers rather than the cases Cases ire doubted as source of infection Ttiey are mildly infectious during the course of disease The person attending the patient often becomes a earner He rarely contracts the disease Infection takes place by aerial or droplet infection The predisposing cause is the saturation of the air With water vapours Under conditions of great humidity the nasopliaryngeal mucosa becomes more spongy and permeable Camera play a most important pan in this diseisc An cpi— 346 UYGIEVE AVD PUBLIC JITALTB dcmic of cerebrospinal fe\ er is heralded by an excessive incmse in the number of earners AduHs act as carriers and cluldrcn suffer from the disease Incidence — It is mostly prevalent m children and >oung aduUs No age is exempted from its attack Seasonal prevalence — Tltc highest prevalence of the disease is from iebruary to Apiil It is common in jails barncks, schools, army, etc CompUcations —racial or other paralysis, blindness or deafness Mortality —It is high Itmiybe from20to75“o nmong infected Prevention —1 Isolation of cases and contacts should be segregated for 3 iveeki 2 Efforts should be made to prevtm ovcrcroiiding Fresh air and sunlight should be provided 3 Artiseplic girglcs should be used Spraying of throat or oUiw local treatment should be tried 4 Suabs of nasopharjnx of all theconticis should be bdC- teriologicall) examined and comnet carriers should be treated tilth stilpl tdiazmc Sulpliadnzine is also used to reduce momlit) from tJie disetse 5 Prophylactic \ acetnes m 3 doses have been prepared and tried tvitli some success Treatment —Penicillin si ould be injected in the doses of 30 000 units every 3 hours until 7 or 8 millions units have beru given Alternatively sulphathiozolc or Sulpliadiazmc should be gncnin dally doses accord ng to the age Dehydration be pre- verted b> giving fluid b> mouth or by injecting norma! silinc Till COVtvtON COLD A cold in head or Rhnilis or Cjr/ia is an acute highly commiinictble disrisc charactcnzcd by catirrlial inlUmmntion of mucous membrane of nose, piranasal sinuses phxr>fi-x Jarnjx, trachea bronchi etc It is roost common of ah diseases for there arc very friv people viho esexpe having from one to three colds a year and each cold lasts on nn average 2 to 5 days If the cold 1 $ neglected, ilinxy lead to serious compHcations of upper respiratory tmet Although one may not be actually m bed dunng this time his work tlecrcnscs in eflicienc y The greatest econom c loss out of all sicimess may be attributed to the common cold In schools, the most frequent reason for dais absences is colds THE CO&IUO^ COLD 343 Causes - Colds are caused, by a filterable \irus Any indi- ■sidual no matter how healthy he may be, if he comes into contact, '\vith some one having cold, may contract it However, there arc factors which make one more susceptible such as dry overheat- ed rooms sudden changes in temperature drafts, improper food, -obstructions of the nose fatigue exposure to cold and wet , m fact my condition which produces lowered viiahtv One may have symptoms resembling a cold fiom the inhalation of dust or chemicals or one may have a non mfecitous allergic rhinitis Mode of transmiBsion —It occurs by direct contact or by droplet infection or through fom tes Ptriod of communicability ranges ftom 24 hours before onset to 7 d;*)S after onset Symptoms —A cold manifesis itself by the mucous mem- brane of ^e nose becoming swollen the secretions copious and the eyes watery The nose beet incs obstructed and this m turn produces a temporiry loss m smell and nsic Sometimes fever and aching in the back and limbs becomcouistanding s>mpionis Treatment —There is no specific ther-ipy lo cure common cold so far Most colds lun a regular course, although early treatment will usually shorten the attack Rest is pertiaps the greatest Ihctor in their trea mem The hot bath which is often highly recommended should be used cautiously If one perspires freely after a hot drink and hot bath, he is likely to become chilled as hts clothes dry up and his cold may become worse The diet should consist of foods easily digested, such as fruits especially the ettrus fruiis green vcgenbics tggs, butter and milk If the cold does not improtc quickly after simple treat- ment, a physician should be consulted One should watch closely for a skm eruption as a scrmtng cold might be one of the other communicable diseases such as scarlet fever or measles Ovenvork and late hours svhilc recovering from a cold may cause a relapse, which is usually more severe than the initial infection A reinfection may take place by using the same handker- chief or cleansing tissue too long Hands and handkerchiefs should be washed frequently avhilc one has a cold or paper hand- kerchiefs can be used avitli little expense and subsequently burnt Coldvaccmcs are of limited value and have not proved especially c/Hcacious either m preaeniion or cure of colds, but in some cases they prose to be of temporary value The indiscri- minate use of aniibiotics nasal drops and of solutions to be sniffed up the nose should be guarded against, as they prove injurious 348 IiyGIEVE AND rUCLIC IlFALTH Bicnvmg the nose hard, no matter, whclber jt is on one or both sides, while one has a cold may cause ear infection or sinusnis If one has frequent colds, even though they arc not severe a ph)sicjan should be consulted Anuhistimine drugs have come into use in colds caused by an allergy The virus of common cold or rhinitis may extend into the throat and result in tonsillitis pharyngitis or laryTigitis, or into the bronchi causing bronchitis or into the lungs i»ncn pneumonia may result Colds are regarded too often as trivial 'Ihcreforc any one careless, when having a cold lacks a proper sense of social rcsponsibihiv ProbabK the best medicine for avoiding the cold is to gargle the throat wiiJi common sth m vv'nrm water Prevention — The prevention of colds means iJie prev ention of the spread of llic secretion frum the mouth and nose of m dividual who have colds Lvery im> drop of secretion from the nose and mouth of the individual who has cold is filled with germs and is contagious It sccim to he more contagious ui early stagts of Uie disease nnd one should carefully protect others at this time Isolation of the individual during the first one or tavo^ days of icuic rhinitis will often help to prev ent its spread Keep* ing up one 1 resistance through out door exercise wholesome food plenty of rest and proper vcnlilaljon is important in pre- vention of cold Chilling die body by too little heat or too litilr clothing lowers the resistance to colds remperature moisture and circulation of air in houses are imjioriant factors m the prevention of colds Cold drafts should be avoided Glycol spray should be used on floor* walls and heddme in the barn lor airbirne d scases Hie spray appears In reduce their spread It is an acute lughiv communisablc febnle^ hsrgve d inc- terised I y ftarr he ida li e~ch Ils n, pain in 1 mLs and ibc bick and frequ^tlv 1 \ mllainnialion nl tl c icsp raiory and gastro-micstiiial tr ici anti vwnitmg It assumes pandrm c form after certain in ervals and spreads over all pans of tl Vworld eg « fiuenra of ISIO Etiology It 18 a filler bleviruvrf which tJ ere ire three stmrs A B £. C Lniil last ipricnic //l^rr latilvi v*as beheved to he us cause Oivc view wthu ioriWur n only a complicating agent like £ifeptQcoccu s I acmoly ticus, pneumo- coccus, etc. Incubation period »— U varies from I to 4 days INFJ UENZA 349 Mode of spread — The virus ts present in the nasal discha r- , gcs and the s putum The infection usually spreads from one person to anouier (IirecUy 1 1 , minute particles of sputum contain the virus and may be present in fcmittes aUo It is highly con- tagious and occurs in all seasons and attacks all ages Nearly e&ery body is susceptible to it This disease is most infectious during Its first 3 days Carriers probably play a part in its spread Tatigue, overcrowding illventilation, exposure to dusty and chilly atmosphere are import mt predisposing causes Railways, cmcmas, etc , also play a great part m the s,yread of the disease Immunity — It dors not confer immunity and subsequent attacks are comparatively more severe Prevention — Isolation of cases be rigorously enforced Cinemas, theatres, e c , sUo^d be closed as there is a nsk of getting chill, on suddenly gcumg out of these congested places Overcrowding of c\ery soit should be avoided Wellvcntilated rooms and avoidance of draught should be encouraged Chilling ■of body should be prevented by wearing warm clothes Hyg ienic livin g, taking of good nourishing diet, and avoid* ance of overwork are die mam precautions to be observed irx the evrnt of outbreak rf the disease Aniis^ptic throa^gargle should be done and a bit of cinn amom be kept m the mouth Moreover, sneezing, spilling amTcouglimg m public places should be avoided CloscwovenmusJm of about 40 mesh an inch or gauze facemask should be used while attending a patient The clothes, beddings, handkerchiefs and the room used by the patient should be thoroughly disinfected Secretions from nose and throat of tlic patient should be received in a spittoon containing some disinfectant As there is a risk of conveying infection by hands, so they should be immediately washed after their coming in contact vvith the patient Prophylactic mceinahon — I Attempts have been made to prevent or modify the disease by injections of living attenuated Virus but the results are inconclusive 2 Vaccination by formalised inrus also gives encouraging results 3 Passive imrminily is produced by giving an injection of convalescent scrum Cdtuaiton of the public regarding the mode of healthy living and prevention of catching and spreading infection by pamphlets, posters, handbills etc , is very essential Treatment o-There is no specific treatment for influenza 350 inoiLNE ilND PUBLIC HFAlTil «cep( general supporlue measures for upper respiratory infection wfloonsocoucn on rcRTussn Pertussis is an acme respiratory infect on, caused b> Haetl lus pcridtsisor Unnophitdi /frfciMtr imolvirg the trachea and bronchi and chatacfcriscd by an imtnl catarrh with insidious onset and irritating cough t vstmg for a few days to several week', merging into a stage ilicchicl feature of wn ch is a scries of set ere parox ysmal cough in t hidi the f ce becomes suffused, the loncue protrudes, the sail! a IS blood stained and finally \omitmg taxes place Isicnbation period and Period of CommunirabUlty — The incubation period IS often about 7 d lys the limit is 21 days The neriod of danger of the spread of disease, extends from 7 days after exposure, to ilircc weeks after onset of typeal paroxj m Mode of spread —It is most mfcctirms before it is diagno- sed « « inthecirly caiarrhaV stages and tlie infection spreads directly from person to perso i by droplet infection It is probable that inhalation of reccrtly infected dust from cisthes or bedding may be an imporunt factor The mam source of mfccuori is nasopharjngeal, laryngeal and broncl lal disrharges Age —Whooping cough occurs in all ages, but is preeminently a disease of young children flic case mortiliiy m the fi st year of life IS about 10% Of the total deaths about 00% occur under the age of 5 years Sex —It IS rather commoner in females, though case fatality ‘ IS the same for both sexes Seasonal Incideace i— It vanes but death rate is h ghest in Lter part of winter and spring 1 1 , during March and April Complications — They are epistaxis and subconj inctival and ot icr haemorrhages, convulsions, hernia, broacliitis and bron- chopneumonia and ulcer of frenulum linguae in children Sequelae --Cardiac dilatation and m some cases tuberrulosis Treatment — It is syanptimiaiic Paregoric may be given for cough and belladoi na is helpful as an anuspasmodic Sul- phcmamidcs are said to red lec the risk of fatal term naiioa Opm air treatment is an imporlani adjawat Hyp t in nun* rabbit serum strep omyem and oliicr amboics have been tried and liavc proved useful Control — ^The theorv that every child must liave v% hooping cough duriru, one stage tr tie cdier if his life is uy rrcct \\ hooping cough like udicr iiifixtious coinptaiius can be avoided, TUBERCULOSIS 351 5f due precautions arc taken at the right time The first andl the most important item m prevention of the spread of the disease is early diagnosis, m the individual patient and his isolation He should be excluded from the school for a period of 6 weeks Several pertussis vaccines arc available for prophylaxis Four doses ofsauer vaccine are recommended to be given between the ages of SIX months and two >tars and a b''ostmg dose may be given at the end of second year A period of one week sKould lapse between each of the first three doses and a month between the third and the last dose A temporary immunity may be conferred on young cluldren, who are exposed to immediate risk , by administrating an injec- tion of convalescent serum TUBERCULOSIS It is caused by tubercle bactUus, which was first discovered by Robert Koch in 1882 It belongs to genus Mjcobactcrium It 18 a very hardy micro organism and can live in dry state for six months When exposed to direct sunlight it is killed after eight hours It is also destroyed by boiling for 10 minutes All waim blooded animals seem to be susceptible lo this disease This is prevalent both in tropical as well as temperate climates and is more prevalent in large overcrowded cities and towns AU domes- ticated animals may suffer from tuberculosis Cows and bufia- Iocs in India do not suffer fr»,m tuberculosis to the same extent as in Lngland as they live in open air and sunshine during most part of the year Goats are immune to this disease Symptoms in Pulmonary Tuberculosis — ^The onset may be insidious or acute A common mode of onset is an acute transient febrile illness accompanied by respiratory cattarh and miHise The most outstanding of these early manifestations arc haemoptysis and pleurisy The characteristic symptoms are — ■ 1 Excessive fatigue — ^Patient is exhausted in ordinary daily svOrk 2 Loss of svcight 3 Failure of appetite 4 Amcnorrhoca in females 5 Slight rise of temperature m the evening 6 Husky cough 7. Hight sweating . B Slight palpitation 9 Rapid pulse 352 inCIF\E AVD PUDIIC HEALTH Later symptoms — Tlic toxiejnn is sho^^n by suinqinqr of temperature The bod\ is >\'astcd, the checks arc flusfied, the c>cs bright and sunken nnd the lips are dry The fingers may be clubbed The nreath has peculiar odour , the sputum is copi- ous ind pucnilcni There is often an unnatural sense of wcl- heing and hopefulness of reco\er\ B“8idcs the retraction of the upper part of the thoracic wall and displacement of mediasti- num, immobility o\cr tht diseased areas of the lung will he noted Over c^tensn e infiltration air entry and movements arc often restricted and rales and rhonchi ire heard Consolidation IS chiractcriscd hy impiircd resonance Modes of infection — They ire — ! Infection by mlnlation of droplets expelled b% tuberculir piiiaus, tlwough caughmg, sneering, yiwnuig and loud speaking, iipto a distance of 3 feet is called droplet nfeclion 2 Inhihng fine dust containing tubercle bicilli derived fiom dried sputum ind other infecccd discltirgcs Uirown on floor, walls furtiiture, clothes, etc , vs Inch disintegrate into fine atomised particles 3 Infection miy occur by handling sputum or other dis- cluirges of tuberculir pautm and therefrom contamin.iung irliclcs of food ind drink 4 Through the ingestion of articles of food ind drmk con- timinatcd with tubercle banlli 5 By direct contact by inoculation into skm of mucout membrane , kissing or using common glisses or tumblers, cups, pipes, etc 6 Children somciimcs gel the infection by taking milk in- fected with tubercle biciUi i e , milk derived from n tubercubr cow 7 A child at bitth even from tubercular parents ts not tuberculous It is by contact with contagious cises thit child ren begin to get infection from a few months after birth Hcre- ditiry transmission of tuberculosis docs not occur 0 riics play an important pin in the trinsmiision of dis- ease by mcchinically mfecimg articles of food and drink Infection depends on several factors, such as (i) The iintlcnce of the tubercle bicdh introduced in the liod) (li) Dose or the number of bacilli introduced (ui) Frequency of infections (ir) Path of infection, whether Uirough susceptible tissues or not (r) Tlic sensitiveness of the individual fUnLRCUl OSIS 353 Control or Prevention of Tabercnlosis — ^ General mea- sures — 1 Attend to the general sanitation Live in open air and sunshine 2 Proper construction of streets and buildings The streets should be wide There should be plenty of free space between and behind the houses There should be no back to back house construction There should be ample open spaces, gardens and parks in or near all the congested localities Unhealthy congested areas or slums should be demolished Improvement schemes should be launched 3 Regulation of unhealthy trades and proper precautions should be taken to prevent inhalation of dust 4 Supervision of articles of food and dunk should be stiict Veterinary surgeons should be employed to inspect meat and also the animals meant for slaughter- ing They should nlso inspect m Ich cattle m dair^- farms and milk lo the dairies 5 Improvement in the standa*-d of healthy living b> tak- ing nourishing food and living m better houses etc Purdah system descrvi's to be condemned 6 Education of people through propaganda by leaflets, magic lantern slides lectures, films and film strips The public, espcciilly the phthisical patients, should be forbidden to spit everywhere Spittoons should be provided m factories, ofllccs and otlier public places B Specific measures — I Compulsory notiBcation — ^Thic measure should be enforced The patients of this disease are seldom noiificd by medical practitioners There is a tendency to conceal the incidence of this disease, so that it may not serve as a sligma to the rest of the family 2 Separation of babies after birth from tuocrciiloiis parents 3 A complete Antitubetculosis Orgamsition — It consists- of — (a) Tubercitlosu dispensary or clmte sjstem — Its functions arc — ^«) To examine and diagnose cases of tuberculosis (») To aavise patients regarding the treatment and supei- vision of treatment of all persons suffering from tuberculosis (ni) To examine and trace out the contacts through tuber- culosis nurses or health visitors m houses and schools and detect the incidence of tuberculosis at an early stage (ic) To arrange for after-cair of persons discharged from, institutions and offer them suitable v\agc earning 254 nYOIE^TE AXD rCBLIO HEALTH vocations, and to sfutc them in tuberculosis colonies or industrial settlernenis To serve as an infonnsiioo bureau and propaganda cenirc regarding the incidence of this disease and its pretention. iim I r^. IIBSD n BBHUI KSSBaSB^n EZSQlDSS ■■■■1 1 Q||2|RHH|QQ ■BSShIDSB SfrTl Q Tig. M L*7»ui orTul/«n*ui<^<* Cvnlrai TtTBERCrULOSIS 355 (pi) To serve os a curative centre. Building This should consist of a waiting hall, doctor’s room, a few examination rooms, a pathological laboratory. X-ray department, a health visitor’s bureau, a record room and a small dispensary. 1. Medical Officer ; — The doctor should have specialised training in tuberculosis. TTiere should be one doctor for every 200 deaths from tuberculosis per annum. 2. Tuberculosis nurse or a lady health visitor. 3. Clinical and laboratory stalT. Site i — Ti should be centrally located and easily accessible, provision of one dispensary for every 150,000 to 200,000 of population 1$ necessary. (A) Hospital and Sanilorium Hospitals are meant for advanced cases and sauiwria for early cases, where they arc trained to take care of themselves and after discharge safeguard themselves against the reactivation of the disease. The site at a higher level, away from any possible nuisance is usually selected fora sanitorlum to promote the health psychology and physiology of the patients. Bat'hospitals can be located any where. Sanitorium should be situated at a place with less rainfaU protected from the sun and the wind. There should be maximum sunshine and adequate water supply available. The soil should be dry and porous with capacious land round about, planted pre- ferably with pine trees. It should not be situated on very high hills. In India, saniioria are also being built on plains to reduce the cost of maintenance. _ (c) DomicUtsny Irtalment : — It lias never been possible to hosipitahse all cases present in the community at a given time, owing to the small numberof beds ax'ailable in tuberculosis insii- tutions. So domiciliary treatment must be resoned to m majority of cases. Patients with limited involvcmcm, ^ncom^o^able homes, uherc there are no children, and able to take hygienic precautions, snay be allowed to remain at home. In home treatment and care of patients and their families, the health visitor and the care committee play an important p.art. Open air shelters, where the patients can be kepi during the day should be tried. (if) Village SeVlcmmls or Tubertttlods Oitonles' are arranged near the samtorium or tuberculosis dispensary so that proper supervision may be carried out. In such colonics, chief industries are ....t,,.!...-.. 15 1> ITYOIEVE AND PUBLIC UEVLTH facturc of fibres, pnntmg, friming, basket and mat making etc. Here the patients spend moat of their inne m the open air for diversional or occupational lhcrap> Arrangement is also nude to emplo) c\ tuberculosis patterns to rmble them lotiVcpnn ^g^m in social md economic hfc of the communit> (r) Tlicrc should be close cooperation between tuberculosis clinics, medical prartitioners and medical ofiirers m charge of tirious liospitnls (/) Creation of Cere and Afict care Cemnitlees to work in connection SMtb tuberculosis dispensaries hospitals sanitoni and \illage settlements of coloiucs ig) li C G Xactmahon or Prephyledtc Immu/iisalion — Btutllus ealtntKe gturin is a living boMOC stram of tubercle bacinu*; which has been rendered aiirulrni and is used for the preparation oftacemefor immumsauon Tethmqur — tf is earned out in two stages — 1 Tubtmlu or M6n\onx tesi —Ills done to find out whether am particular person had an) previous tubtrculous infeciton or not'^SiifTicicnl allon —The intcelion is iijadr intradcr mall) into the skm of the arm just below the slifuldcr on itsualh the left side Ciiough r}waimty is injeried so as to make v wheal Omni in diameter No general reaction such as fcvpi or pim follows nor 15 there an> intetnipvjon in one * normal work A “local reactieii ’ occurs us lall) 3 or 1 Viccks after the vaccination at the sue of itijeciian which consists u' tliC formaiion of a small nodule and m some case* i small ulcer may follow which lieaU itself Icav mg a tinj scar It ma> be mcntioiieij here that if a chihl-HS vaccinated it birth theft IS no uc«l of) tifarming the Monioiix test \ accuu lion Jiouc^er rr^pe^^e^} suhsequrntl) at ibou^ 10 anil 15 vears after perf rmmg momoviv. test rttparaU'^n nj TVirrm/m md tiCG \oy a W.H.O. expert, who periodically inspects the laboratory. Precautions to be carried out in BCG vaccination technique are I. All strict aseptic precautions in handling the material, syringes, etc. 2. Both the tuberculin and vaccine arc to be kept at a low temperature in an ice box or a refrigerator. 3. Fresh tuberculin and vaccine are to be used. Weekly supply is to be received from Guindy, Madras. The stock of vaccine must be consumed within a %\eek and tuberculin within a fortnight after which their potency gets deteriorated. 4. Separate syringes arc to be used for tuberculin test and BCG vaccination. It may be noted that BGG vaccination is carried out in persons upto 20 years of age. (A) Provision should be made by health authorities for thorough disinfection of houses where deaths from tuberculosis liave occurred as well as for the disinfection of the other articles of the room. (i) Individual measures .—1. The patient should not spit anyt\nere. He should spit in a sputum cup containing some dis- infectant. When he is going about he should spit m his hand Tcerchief which may be boiled afterwards. 2. When coughing, he should keep the liandkcrchief before his mouth. 3. If he is married, he should live singly and, if not, he is advised not to marry. (j) Conlacls : — 1. Contacts should visit the lubeiculosis cin one gram in 2 c c of double distilled water intramuscularly daily for 2J months >Vaich for early signs of deafness, m which case the admimstratioii should be discominued PAS (Paro aromosilicyhc acid) by mouth, three tablets of 5 grs each, sue limes n day must be given simaltaneously with streptomyxm. It may up>ct digestion It should be given for 3 months INH (Isonicotmic acid hydroztdc) called Isoniazid 100 mg twice 1 day is guen bv mouth (,alciuro, Vitamin A and D (Adexolin, Halibut oil, Cod liver oQ) should be given 3 Symptomatic treatment such as Serolm, Llixif Neogadine or Codiene for cough, inhalations etc should be given 4 Surgical treatment combined vvjth antibiotics is the modem practice Aniflcial Pneumothorat and collapse of the lung IS done in suitable cases Thorocoplasiy is done for more extensive cases Adhesions may require division fiCRl BLRl It IS a disease caused by the dcficicna of vitamin Bi or thnminc m diet, which is said to neutralise certain poisonous lubstaiwfs which are produced during metabolism of carbohy- drates Tlic amount of thiammc needed vanes directly waih the amount of carbohydrate metabolised, so that too much c vrbohy* dcate and too little tluammc plays a part m cau'ing Eeri Bert Occorreoce » — It occurs among nec rating races, due to pro- longed eating of polished rice The outer layer of nec contains ami-Bcn Ben Vitamin, which is absent m polished ncc Types of Beri Beri — I. tWj mild ben ten — Wealencss and numbness of legs with diminished knee jcrls, polyneuritis eic 2 Chrome dry ben beri — ^Tltc nbov e symptoms t,ct more pronounced There may be foot drop, wrist drop and tJie patient is bedndden 3 UVt or dropsual type — Appearance of oedema is a special fcaiure along wath »ymptoms like dry beri ben 4 AeuUcardat btn izri — -DdatalJon of heart or failure of heart during an attack of wet ben ben 5 Jnfanlile ben ben t— It occurs tn infants of mothers sulTcring from ben bers HAUIES 359 Prevention; — It disappears if the use of polished or over milled rice is abandoned and whole ncc substituted. The nee should be either home-pounded or of the parboiled milled type. ^^^lolemeal bread may be used. Taking of canned foods should be avoided. Diets containing thiamine should be given or ade- quate doses of thiamine be given intravenously. Such substances- like tnarmitc or yeast extract or ground nuts rich in antmcuritic vitaiam should be freely given. RABIE3 Rabies is an acute infectious disease communicated from a rabid animal to a susceptible animal ii«ually through a uound produced by biting nr fven beking of a rabid anunal on an abraded surface. It js a virus disease and the infection is local- ised in the nrrvnus systo)ic aetd If necessary, tliewomTd should be ciilirgcd The ncid should be applied v.nh a glass rod, care being taken tint pocket* and recesses do not escape If ’cid is not available penmngan st e ery staJs p ure nit ric aad Sliver nutate or iodine may be used 2 J'ojIeuPT' prophjlatic irealmetU — \flcr the wound t* cautemed the question of giving pastcur s ireilment is const dered The physician IS guided by the litllouing facts — (n) The dog u dead and tl u considered f > be robtd — All f«r mild be placed if the microscopical test is negative (c) Tht dog hat run au.af after biting —In case of unprovoked fitnck one should assume that the dog is rabid and the patient should get treatment (<0 The dog IS alwe —The dog should not be killed If il eriod ofll days - treilmcnt (m D addition to local (i) Severe ex po«'rc (mul J^pJe , or face, |»«d or neck bites) (a) Hcalthv Healthy Hyper immune Scrum irarnc- diaicly , no va- ccine as Jong as animal re- mains noitaal 1 Healthy Climcal signsof rab es or pro- ven rab d 1 Hypenmaiime scrum immedi- ately , start va- ccine at first sign of rabies 1 1 CO Signjstig. I gcstneofrabies (li) Rabid, es- caped killed or uriknou-n Any bite by wild animal ! HcalUiy Hyperimmune serum immedi- ately, follotved by '■aecine , vaccine may be stopped if ani- mal IS normal on 5lh day afier tsposurc Hyper immune Scrum immedi ately, followed by vaccine Uic scrum may be civen n.^ *n '* "** “* » may DC given Dose 05 cc per kym of body writht RABIES 363 ' In Kasauli, sheep are used. They are injected and killed. The brain is removed, 80% brain emulsion is prepared and incu- bated. It is reduced to 5%. After sterility test, it is filled into 10, 5 and 2 c.c. ampoules. Dose of anlirabic vncctne I. For licks and scratches on intact skin and mucous membrane :~-2 c.c. daily for 7 days. 2. For licks on wounds and deep scratches 5 c.c. daily for 14 days. 3, For licks and scratches on head, face, neck and bites, ^over the body drawins* blood : — 10 cc. daily for 14 days for adults, 5 c.c. daily for 14 days for children. The vaccine is injected into loose subcutaneous tissues of abdomen. Tincture iodine is used to atcrjJjse skin. DlagnOiU of rabies in dogs 1 — ^Thc course of the disease may be divided into 3 stages Prcmontlary stage .‘--There js a change in disposition of the animal. It is easily excued. 8, Stage of exettemtPt : — It is restless and may become furious and even show signs of delirium It rushes about attack- ing every object and dogs, biting and inoculaimg men and animals. It runs straight. 3* Stage of paralysis It soon sets in, first starting in the hind limbs and then becom*ng general. The course of the disease is always rapid If alt these stages are noticed, then it is a case of funout rabies. If the first two stages are transient or absent then it is a dumb or paralytic rabies, peath occurs in 2 to 3 days Presence of negri bodies m the brain of a rabid dog is the most important evidence so whole of the head packed in ICC should be sent to the- laboratory for examination, Control of rabies in dogs : — It consists of: — 1. Destruction of all ownerless, stray dogs : — The fjHowing methods are used : — f»j Use of lethal chambers. («) Injection of magnesium sulphate solution in spinalcord of the dog (ill) Shooting (u») 3 grs. strychnine tablet wrapped in a small quantity of halua. This is an mhutaan tvay of killing dogs and should be discouraged. 2. Registration and licensing of all pel dogs in a municipa- lity or district board. 3. Muzilingand restraint of dogs during control campaign. Quarantine of all imported dogs. 364 ITiGIEVE 4\P rUMLIC HEALTH 4 Compultorjf noUjuahon of all cases of rabies 5 p7p/>A;r/flr J»f jreoJmnif of i>et dogs >vnh ant inbic vaceme 6 / of the public regarding rabies and its pte* vcntion and Jitmching ofpubhcnj campaigns Anthrax is a d sease caused by Uacillu^ 4nlhtactt II is pnmirily an epizootic of 'inimals cspctiallyof sheep and cattle tmt transmissible to man It is usually caught ftom uorking % ith infected mimals or 'inimal products Human anthrax occurs in the follnuini, three forms — (a) \fals»ont I ustule — Itoccurs due to conlaininaiion of a cut or wound with anthrax tnicro- ori,anisni Thu is common among butchers fanners md \etcnnary surgeons and those employed in dealing witli "Ool hair bnstlcs and hides The d sease lias also been contracted through infected s(ia\ mg brushes \sh eh liave notb“ arelv spreads from man to man. Its incubation period is about 14 days. Prevention : — ^The following measures should be adopted: — • 1. Diagnose the disease in animals. The infected animals should be isolated and treated oi slaughtered, to stamp Out the disease. 2. Boiling or pasteurisation of all milk especially goats- milk, before use. It should not be taken rav\'. 366 UYGIFyE AST) rCCLlC HEALTH FOOT AVI> MOOTS DISEASE It js an acute and hgWy communicable disease of clovett* ■footed animat* and is chiractcnsed by an eruption of vesictes ■on the mucous membrane of the mouth and on the skin between the tors and above the hoofs, some tunc on udders or other parts of Uie bod) It IS n virus disease and i* trinsmitted to man through the ingestion of ra'w milk and imlk products derived from atumals sufTcrmg from foot and mouth disease and rarely may become infected dirough contact uith affected parts by milking, slaugh* tenng, and looking after tlie animals The disease is xmld u> -man and is rarely fatal Prevention —This ii ns follows — 1 In countries where the ■disease does not exist, all unported cattle mutt be kept m qua> xanune 2 Suppression of the disease m animals by isolation, slaughtering and disinfection 3 Individual protection should be carried out by distnfcfr tion and pasteurisation of milk aLvNOPRS Glanders IS a wid* spread commsmcable disease of horses, mules asses and other animals Cattle arc immune It is caused by Baeillui mtlUt which ts itomsporc bearing It is readily communicable to man and is characterised by the occurrence either in nasal mucous membrane or the skin of the mflamma- lory nodule* >»hich break doom forming tjlccis The momhiy i* about 50% It occurs both as nn acute and m chronic forms Prevention — It is done by cradicalion of the disease in animals Tins u carried out bj early diagnosis by the tnallcia and scrolog cal test*, isolation, slaughlenng and disinfecuon The personal prophylaxis of glanders m man depends upon edu- ciiiion and care of those who have to handle horses Rubber gloves may be used ovhen handling mfcctcd horses I Brnosv It IS a chronic comraun cable disease, characterised by Ics’oni of the skin and by involvement of percpheral nerves ivith conse* quent anaesthesia, muscle ucakness and paralysis and trophic changes m sVm, muscles and bones Leprosy is caused by n^hacienum Irprae and avas dii* covered by a Norwcigian (eprologist named Atmsur Ilanicn la purulent discharges fiom nose, ukefs, cir. The disease develops slowly and after a Jong exposure Clulrdcnnrc more suscepuble •than adults LBPROST 3C7 Varieties — There are two vancties — 1 Kearal or anae> thehc — It IS benign and resistant The peripheral nerves are aiTcctcd The patient lives comparatively longer 2 J{odutaror lubereular — The patient lives from 8 to 10 years on an average Signs of leprosy — 1st stage — TUcre is an appearance of a small patch on the skin. It has less sensation than the surround ing skm There is a thickenmg of the ulnar nerve and feeling of tingling sensation when nerves arc pressed The patient is seldom infectious 2nd stage — Skm of the face becomes thick and wrinkled, •ears are sivollen and the skin of the whole body IS thickened and covered with nodules The nodules affect the nose and throat which consequtmly discharge a fluid containing Icpia bacilli This stage is infectious and lepra baciUt are passea even in sinnc and faeces 3rd stage -“•In this stage there are very few lepra bacilli and the patient IS much less dangerous Patient develops defor- m ties of hands and feet The fingers and toes become bent, ulcerated or drop and disappear altogether The patient is some* times unable to shut his eyelids There may be foot drop This ts the most painful and loathsome stage of the disease and it is tliiltcult to do anything at this stage Leprous or Upra reacUon — Tnis is observed during treatment and IS specially marked m second stage When it occurs the cry much worse The leprois re- action may continue for 10 — 14 days Some paiicnis appear to have improved following a rcaciion while oiheis may get worse. There may be one reaction after another for many months Methods of spread — ^TTicy are — 1 Aerial — Coughing and sneezing by the infected person , 2 Tom tes —Clothing, liandkcrchicfs etc , used by infected persons 3 From person to person —Prolonged exposure or close contact IS necessary before mfection takes place 4 Ind rcct — Flics mav carry baalh from ulcers and dis- charges B»d bugs have been found to harl our the bacilli and arc capable of transmitting the disease m an mals Leprosy cases can be divided into Icpromatous and non- lepromatoui ones from control point of view, Lepromatous cases arc infeaious Prevention • —1 Compulsory notification 368 mtUM- \NDPlJlI1l 2 Isolation and stgrc^aiion of infectious cases m their otvn liomes, hospitals and institutions Theinstituiionl arc —(a) l^rosana — ^Ihcy arc for the ible IxKlicd non-crippled and controlled leprosy ciscs where lhe> can earn their htelihood b\ agriculture or poultry farmiog etc S b) llospit-tls — he) nre for ti eating ojien infectious cases c) Leperhomes ond ostiums — rhe\ arc meant for crippled patients 3 The beddings and cooking utensils of the patients should he kept ipirt and lJie\ should he soaked m a divnfrctant solution t Lepers should not l»c iHcnxcd to go m Uie streets, to keep shops or hTndle food oi winder about in the countr> as beggars, padiirs or mendicants Their dischirgcs clolbc* and dressings should be dcstTO)cd or thoroughly disinfected, 5 Indiscrimmate ilcos gumg to Icpars IS wasteful ind must he atnided ns tt attracts lepars to hm Cities religious places, fairs etc , ind so cncounges the spread of infcciion f> Thc> should be treated with newer sulphont groups nr with chaulmogfi oil h>dn >car|»ate of sodium and morxhtiiie of vsrituro If \CHOMl Inichotiu t* « Contagious follicular conjunctiMlts wilh cliaractenstic Sigo j,fanulations It is gencmllj preceded h> someothcr abnormal c>ecrmditionlollowing the iciite state of granulation there is a chrome state of cicatrisation as a result «r which the lids ma) become deformed The disease is serious because it mat lend to scarrmi, of the eye tissues and crentual blindness It IS caused b) a sirus Uiat imadrs tbe mucous nieinbnnr covering the surface of tht c'cball and the lining of the lids The disease ma) be spread b> personal contact or tlirr>Uc,h the handling of towels haiidkcrcliicli and other hnen which has •Ijcen lutidlrd by a person swlTcring from the disrisc Tlie spread of trachoma js fiaoured b) jnaltuunticm over crowding and inadequate perw nal cleanliness Good results are now reported to follow the atlministralion of sulphanilimidc both orsllv and as a tituraied solution applied lathe lesion DcforuiU) of the eyelids require Inrgcal treat mem Atlcution should l>e paid to personal luKiene t ) VFftt ai Dl't TJir) fccnrnlly include sjphihs ginorrloea and cluncroid or soft sore and granuloma ingumalc (vnirrruml which are all VENEREAL D18LASBS 369 imp-It is an acute infectious disease clianctensed by inflammation of the urethra painful micturition punilent discliargc and a Iiabtlit> to certain comphcitions such is ophthal mia endorard us nnd arthritis It is caused by neisseria gonocKtvs discovered first bv Neisser in 1079 whicli is a gram negative dipio toecu* U IS contracted by sexual miercourse In majority of casts it may be caused indirectly by infected toMels bed clothes etc Incubation period —-It is 3 days to 3 weeks Ateragels wtth n one week Symptom* —The) are enlarged painful Ijmph ghnds pus from UTCtlia painful meturujon and difficulty mMalking If not treated it leads to a chronic stage Among Its sequelae in males arc urethral stnetures and m frmales steril t> In nciv bom babies ophthalmia neonatorum is caused dunn^ the passage of baby through the tagmal canal of mother suffering from gonorrl oea It may lead to bl ndnets Treatment —Procime penicillin 400 000 umts n giten dii ly for 4 da> s m acute cases iiid surgical interference is done In chrome cases 1 Sulphadiazinc — 1 5 gm four times a day for 5 days 2 Alkaline mixture as nlkacitron 3 Nonirritniing blind diet 4 In chronic urethral stricture Sounding may be helpful Soft chancre — 7f t< /ocafised and may ?ica7 spontmeouil^ but I'acr ne of efuerry 6e them Borehole Jatrmes or dugwcUUtrmes are very useful and arc iliercfore especially 'a'dTocate'3 Trench latrines arc quite useful and inexpensive duZdnsfi shouW not be allowed to ease themselves anf*- tvhcrc and everywhere m the house Disposal of dry refuse is very important This consists of refuse from stables, cowdung, food wastes, dust etc This is used b> the sillagers as a manure m their fields Proper manure pits shoutd be provided at a suitable distance from their residential houses The refuse should^^c covered with earth so that the flies may not breed m them wmch should then be removed to the fields in due course of time Incineration of the refuse is also su^ested, particularly when It IS mixed with nightsoi! as its disposal becomes more sanitary when subjected to mcineration. The removal of waste water, ram water and other liquid wastes IS generally effected through surface drains Tnsy should be made pucca With a propw gradient and should be cleaned periodically Arrangemems should be made for utihsirg ihis water for irrigation purposes over agricultural land 5 '^Disposal of dead bodies — Suitable separate places should be fixed for the disposal of dead bcxiics of men and am- 376 InGIE^P AVD rUBLTO HEALTH malj, where they may no be a tour'T of ciunince to the tetidctvti ol that village 6 Measures against preventable diseases —Arrange* menu should be made lor p oviditigpiophylactic as uell as cura tive meastr s against preventable diseases There should be treatment c< nir s or dispensancs provided m vil) ges, in the rniio ol one for esc y 2)003 pcfso 8 If ih it is not possible or f t is a small village, ihrn a iraveUing d spe isary under the chaige uf a qual fied tntd cai olTictr will srrvc as V usMul puiposc in giving medical relief and p ophylactic inocilation dum g cpiditnics to the vitligeis Vrangvmcnts should be made for aiumdaria and mitcmity child welfare woik Tfavellu g diipcnsarict maj also serve useful pu pose itidiiutbulmg drugs ct^, to the poor in the vilhges in ihe ease of emergency At lensi trained dais should be available in viH ges \ illage wrmcn sho ild be emoiiniel to settle m rural areas -firr training If p «s blc a lid> heal h visitor should be tmploied for a grojp of villiges to look afief tnaiemii) and child welfare vork Nystcmaiic vaccinaton and rev*arciiiation arrangements should exist for the prevention of Smtllp X in filhges 7* Proper supervisioa ofartlcles of food Bad drink — Part uUriy the tun- ol ojtbrealt of cpi lem c* the villagers shou d protect their food uufT* from d isi and die* Nf Ik should be liotled Villagers should be advised to take Ixnled vsatir daring epidemi s The uatcr of tat ks and wells should be sierdis-d by n»ans oJ blrtdnngpovidir \VA»hfrmen should not be allowed to wash din> nnd intccied clothes in the tank or we^ water used for dnnkirg putposcs CHAPTER XVII SALTATION AT FAIRS FESTIVALS Many a time fairs and other festivals have been a source of •outbreak of epidemic diseases, cliirfly cholera So it is very •essential that arrangem'^nts should be mide for their successful ■control b'*fofehand For carrying on these m asurcs some person •or persons should he mide responsible for the organisation of the fair There should be appo nt^d also a m-dical officer of health ■with executive powers who should b' put in charge of the sanitary arrnngan-nis Adequate funds will be needed by hon to make himscll efT ctive For cfR lent control of epdemes durn^ these fairs the ifollow ng p*) nts should b“ attended to — 1 '■rlanning of the arrangements — ^The organisers of the fur along with the medi- cal olff'cr of iiealih and other m mbers of tht advisory committee should chalk out n plan ‘^t i$ for thim to sec that the ground *s cleared of all vegetat ons levelled and dimarcnted into dtflt- rent blocks with well planned roads The layout plan should 'be fixed, at n prominent place for the information of the public III fact long b fore the opening of the mela the pigrms should be advised through posters and neivspaper advertisements of their obligations vis a vis the arrangements made Accommodation —This is to be provided to the orgam- sers pol ce, health and medical authorities m die first instance For the pilgrims residential blocks along with sanitary conve- rnicnccs should be arranged/-'^T’hc land selected should have natural drainage and sho ild be well shaded and watered If there are any depressions cesspits or pools they should be filled 'ip The mam road approaching the mela ground should be tmetalled or otherwise made smooth and firm '•'3 Medical and sanitary arrangements — The fair should be under the charge of a medical ollicer of health and the whole area should be divided into blocks placed under the charge of sanitary inspectors ^Moreover, accommodation should be pro- vided lor infectious diseases’ cases where patients should be ircmoved on stretchers Adequate quantity of disinfectants should be provided Temporary fospitals and dispensaries, with quab- tfied doctors, should be arranged for the treatment of sick persons ''d.'-'^ater supply — EfHciciit arrangement forthe supply of whol some water should be made from any one or more of the ^following sources — 376 n-yOIENF AVD PUBLIC UEAITH mals, where they may no be a source oF nuisance to the i-endems oJ that village 6 Meaimres agausst preventable diseases —Arrange* ments should be made tor p oviding prophylactic as well as cura tive meastr s against preventable diseases There shou'd be treaimcnt erntr s or dispensaries provided m v lU'-ges, m ihe rnt o ol one for ere y 20 OOO perso s If thn is not possible or f t is a small village, ihrii a travelliug duyicnsary under the chaigc of a qual Ged med cal offtcer will s lame moc dalion durn g epiihinics to thcvilligcts ArrangiTnenta should b** Tnade for ant m 1 iria and •maternity child welfare woih Travelling dispensaries may also serve useful pu pose m dtsiiibutmg drugs ct , to lEie poor m tlie vilhges m the case of emergency At least named rlais should he avuifahle in viU ges Village wfmen shodd be encOura|eJ to settle in rural areas md infected clothes m the tank or well water used ibr diinkirg purposes CHAPTER XVII SAWTATION ATJ^AmS AND FES'nVAI-S Many a time fairs and other feaijvals have been a source of •outbreak of epidemic diseases, chiefly cholera So it is very •essential that arrangements should be midc for their successful control b-forehand For carrying on these m-asurcs some person or persons should he mtde responsible for the organisation of the fair There should be appoint^ also a medicnl olTiccr of health "With executive powers who should b** put in charge of the sanitary arrang-nn*Tits Adequate funds will be needed by hm to make himself effective For cfTi lent control of cpidcmcs dun^ these fairs the ifollowing points should b- attended to — 1 ‘■'rlannmg of the arrangements —The organisers of the fair along with the medi- cal officer of health and other m mbers of the advisory committee should chalk out a plan ‘•^t IS for th vided for infectious diseases’ cases where patients should be iremoved on stretchers Adequate quantity of disinfectants should "be provided Temporary hospitals and dispensaries, with quali» 'fled doctors, should be arranged for the treatment of sick persons *• 4.'''Water supply — Efficient arrangement forthe supply of v/hol'somesvater should be made from any one or more of the tfollowing sources — 378 nvaiEVE ANX» PUBLIC HEALTH ^ (a) Filtered and chlonnated %vatcr f om a^vatcr worLs^ which IS very safe '^b) Deep tube u ells ^c) Wells ( the healtli department People accept a programme or service only when they are convince of its utility and do not find it at great variance with their culture and tradition In order to use the educational approach, thtrrfoTc, we need lo be conversant with the sciences that take note of cluinges in soaal attitude and cultural patterns -in a community In other words tlic social sciences pro\ ide the ^baats for the principles tmderljmg health education programmes HEALTH EDT7CATI0H 381 } What is health^edncation ? The question need to be answered in two different aspects i e., as a science taught in the school of public health and at a service provided by a health department: — (a) A* a science taught in schtol of public heailh : — t^Healih education means an understanding ol the svays people leam and accept newer ways to live a healthier life. Tne subject also deals with problems of miss comnunication, rnedia used for communication and the choice of media used in different Situation. ^ (6) yii a service provided by a health d'pzrlmtnt : —Health education by itself has no spuciuhzed programme but forms an important and integral pun of any public health prograramc,. conservancy, environmental sanitation, nutrition, maternal and child care etc., so as to improve the efficacy of the service. The work done m a section ol health education I* more than educa* Uon as the work of a health educatton is not coifined to provid- ing only knowledge or infurmation on various aspects of health to an individual or a community. A liealth education programme has to create consciousness m the community about the Prevailing health pioblems. The communuy organiaaiion should lead to utilization of the existing resources m the com* munity for solving the health problems. The m'ltt diflicult task that follows a community health p ogramm? is the maintenance of the initial force in respect to mdividu ils so as lo change in- dividual behaviour that will lead to better health for the indivi- dual and the family. As a muter of fact, the tvork does not stop there, as an assessment of the work m terms of the obj'ec- tives is another important part and so is also the follow up. It h not essential that health education should perform all these functions and services. As mentioned before, such a method and approach to work should form the basis of every field worker fn the health dcpirtment. If we apply the principles of health education to the work performed by a sanitary inspector in development programmes we will see that unknowingly, he has followed the educational approach so as to achieve the success in his developmental programmes, e g. before initiating work on construction of drains and pjvcm'mt of streets, he must have ctsde the ptopie conscious ofthe pro&icm and aiVoofthc re- sources by way of funds available to help them in overcoming the existing p'oblcmr. B-it how much did he make the indivi- dual conscious of his responsibility as a m ’mb cr of the society in the upkeep of the new cons ruction and how much has the new construction helped an mdividuil to change his habits? The answer to these rwo q’lestions wilt indicate the uUimne success of any programme. An average fieW-Hurker m'g'it miss to take stock of the activities if lie is unable to answer the above mentloa* 382 II1GIENE AND PUBLIC HEALTH cd questions He is also likely to Jniss because he has not been trained in the educational methods and techniques The section of hcaltli education therefore aims to provide — (a) ll'ilh rthlton to health department —(i) Necessary aid in planning and implementation of the educational aspeas of depart mental programme (n) To establish values and standards belbre launching a programme, so as to measure the success of various programmes (b) WUt Ttlahan to the eammamtj — (i) Help to the commumty to recognize and define its health problems (ii) Help to the community to discover resource^ available for soKmg those problems (iii; Understanding that maintenance of the health of 3 community is a socnl rcsponsibil ty requiring participation of all members of the community The ultimate goal of the section of health education should be to help m the establishment of a community which understands and practises sound health principles Underlying Principles to Health Education —ns has already been stated the study of social and cultural patterns that aids an individual to leam and a« form an important part of the educational approach In the field of public health education as distinguished from school health we are concerned with the ways by means of which adults leim and act Though still more research is needed to understand the ho\vs and whys of learning yet sufficient work has been done to indicate the factors concerned in the learning process Briefly stated the following facts ind calc the accepted prmaplcs — All individuals ire capable of learning throughout their lives 2 In advancing age the capauty for learning is not chang ed Substantially but the desire to leam is alTccted due to lack of interest 3 Ml individuals when exposed to a learning experience will not leam the sime way, as their own outlook which covers the bati. ground experience will influence the learning siiuiuon eg any one if told about the eflicicy of antivenum serum against snake-bitc miy not believe the fact if he comes fmm a family that believes in clianling of ‘Mantns’ for removing the cfTcct of With the advent of independence, a Ministry ofHealth has been established m the centre The Ministry is ditecilj responsible for the health of the centrally administered areas 1 he states are autonomous m respect of Medical Relief and Public Health The centre, however advises and keep'< in close touch with them m their endeavours to build up the health of the people, commuted to their charge The Health Minister ts an elected m“mber from the public He has a secretary and under secretaries m his ministry The Central Ministry of Health comprises of the mnm Mimsirv and the Directorate General of H alth Sen, ices which functions as an attached ORl'c The CentTal TDircctoralc ts under the charge of Director General of Heath Services who is assisted by Deputy and Assisunt Directors General and advisors who deal With difTcrent branches State Health System of Administration —The portfolio of health is under an elected minister He is assisted by a secre- tary to the Government There is a Director of Health services who IS m administrative officer and IS meharge of medical cdu* canon, med cal and Public Health administration He has n D'puty Director off leallh (medical) Deputy Director of Health (Public health) and assmant Directors incharge of various sec- tions The Deptiiv Director of Health (medical) controls the curative side through the civil surgeons under whom arc hos- / pitals and dispensaries m the districts the Deputy Director oT Health (Public Health) controls the preventive Side through the D strict and Muniapal m-*d cal officers of health Du ing the Ustfav years there has been rapid expansion in both the cura- tive and preventive sides Public Health Insurance schemes are PITBLIC HEALTH ADMIXISTHATION 387 being gradually introduced so that in a few years medical aid ■Will be available to every individual on a payment of a small monthlv premium. The directorate deals with the minister through the secretary of the depariment. The Director Health Services or his deputies and assistants can inspect all murud- palities, district boards, factories and medical institutions etc. Due to the Act of 1919 the district boards and municipalities Were entrusted with very high powers and could carry out any work, with the approval of Government regarding financial matters. The Health Department functions under the following heads : — State Health Department. Health and medical organisation for municipalities of urban areas, <5* Health and medical organisation for district board fo’r niraTarca^. The functions of the state department arc, to control epide- mic diseases and to organise preventive and curative works. It supervises these works in an advisory manner. But when such advice Is Ignored by a local bodv without any reason the govern- ment does take suitable action against it. The Bhore Committee Report .\n all India Health Survey Committee consisting of 25 member^ under the chairman- ship of Sir Joseph Bhore published an exhaustive report known as the Bhore Committee Report on 25ih December, 1945. The committee recommended a total expenditure of about lOOC^crorcs of rupees during the first ten years in^onncction with lh?"cstabhshm“nt and maintenance of a health service in India. It suggested a long term programme extending from 30 to 40 years and a short term programme to be implemented within 10 years. Long /erm programmt : — For this purpose a distriej health organmtioi^is to beset up. with an arbitrary TOpulaiioh of 3 millions Iifa district and so it U also called “3 million plan.” The details are f. The Priroap^ Urut : — It will be serving popjl.ation of 10-12 thousands and will haye six medical bfll-crs, six public healt^niifscs'and a 75 beddcd_ hospital," with the fc- rjuired nursing “sTalT. It will provide both prevrntive and curative health service. The public health nurses will visit homes jhd deal with~ the health of school cluldrcn and the welfare of mothers and children. *-'2: The Secondary Unit A number of primary units (about 15-25) will constif'tc it and so hrger staff will be employed. There will be an administrative officer who will he responsible for Supervision and coordination of the work in the whole area. 388 maiEXE AND TVIiLlC HEALTH There ^vill be whole time heads of different dg^artments of medicine, surgery, maternity, tuberculosis and pathology and two senior public hemth nurses and two senior sanitary inspectors 3 The District Health Unit — A number of secondary units about 3 to 5) together will form the District Health Unit Its organisation will be thus on a laigc scale with a provisionfor 2,500 beds Short term programme — ^This is meint for supplementing the existing health services m the states To start with, there will be 5 primary units m a distnct and each unit shall scrvc40,000 population, with a 30 bedded hospital A secondary unit will be established in each district at its headquarter and provide Jughcr type of medical services ^Medical Census — A medical census was taken in India in 1951 to ascertain the number of persons engaged in medical and health services The results arc as follows — Registered medical practitioners 91,930 Vaids and HaUms etc 9C, 917 Compounders 30,407 Nurses 31,517 Midwives 23,930 Vaccinators 5,026 Denusts 3,283 Miscellaneous 72,970 ''Medical and Health Education —Medical colleges were first opened m Madras and Calcutta in 1 035 and recognised by die Royal College of Surgeons m 1845 Since Uien there has been a special provision for military medical students for the Indian Medical Department At present there arc 42 medical colleges m India On the recommendation of the Inicr-university Board an “All India Council of Post graduates Medical Education”, was set up Recently an all India Institute of Medical Sciences has been Kt up at Delhi which would be one of its kind m South Asia For the post-graduate training m Public Health subjects, an Ul India Institute of Hygiene and Pubbe Health is m existence tt Calcutta Diploma in Pubbe Health is also imparted by Bombay Umvcrsity In the majority of states, healtli schools citist for the training iflady health visitors and arrangements Iiavc been made for ttnuimg of sanitary inspectors, nurses, compounders etc J Problem of Public Health In India s — ^Thc PJanmng Com cnission has staled that, tacideoce of sickness, the cxiitcnce -of disability, the death rate, the expectation of hfe at various ages md the relation of the active population to Uic total determine rOBLIC HEALTH ADMINISTKATION 389 the qualitative and quantitative use that can be made of the available man power.** It has been estimated that nearly 75,000,000 persons su/Ter from malaria in any normal year and it takes a heavy toll of at least 750,000 lives. It has been estimated that about 2} million active cases of tuberculosis exist annually and that ^ million deaths take place each year from this cause alone. The common infectious diseases biz., cholera, smalhpox and plague are also responsible for a large amount of mortality. Moreover, malnutrition and under-nutrition reduce the vitality and power of resistance of an appreciable section of tlie population. Widespread adulteration of foodstuffs is doing, insidious harm to the health of people. Water supply is totally inadequate. sx* Control of Major Diseases : — In 1937, a movement was started against tuberculosis which was assummg an alarming pro- portion every year. It is estimated that nearly 15 Lakhs ofpeo- f ie suffer from this disease and 5 Lakhs die of it annually. The arge scale measures are taken by the Government in introdudng the^B.C.G. vaccination in controlling tuberculosis. It is being carried out dh a mass scale since April 1951. Three training and demonstration centres for the oontrol and prevention of the tuber- culosis have been opened at Delhi, Patna and T rivandru m which Impart training to the medicarTtudents, postgraduates etc. T.B. seals’ sale campaign is being regularly organised by the Tuber- culosis Association of India since 1950-1951.'^ - ‘7- A National Malaria Control Scheme was launched m 1953 ns a part of the rive Year Plan. It provides for tbe establishment of 136 Field Malaria Control Units to give protection to 136 million people out of 200 million people residing in the malarious areas. It lias been estimated that there are over one million leprosy cases in India. “The mission to lepers” is the greatest voluntry organisation for anti-leprosy work. It was started m 1875 a nd has 93 mstitutioils alHIiated to it. ^ In India it is estimated that over two lakhs of people die of cancer annually, “The Tata Memorial Hospital of Bombay” ami “Chitranjan Hospital of Calcutta” arc the only two institutions for the treatment of cancer in India. B C.G. Vaccine Laboratory at the K.E.M. Hospital, Gumdy (Madras), the Central Drugs Laboratory Calcutta, the Central Research Institute KasatiU and Serological Laboratory Calcutta provide facilities for research. Defectives LfTorts arc being made for the improvement of the lot of defectives in India such as crippled, blind, deaf, dumb and mentally defectives. It has been estimated that today the 39Q nYoiEM. ANP ruBLio Bt.\r.Tn number ofblmd persons m India totals about 1 000,000 and deaf persons numjcr 600 000 Ticrcwa ‘training centre’ Ibr the blind at D hra Dun to impart vocational training There arc U} all about 50 institutions tur the blind m India The institutions for the deaf number 43 Family Planning —Lim tation of population is recognis'd as an u gent continuing and universal necessity Growth of ptav pic m numbers seems to out strip pfoduciion The p'oblcm is as old as the earliest Egyptian Papyrus and as netv as the seve- ral recent solumeson world utdc spreading tip of population increase Tne h'tter ra thod of !un tanon of births is birth control Tnts his another advantage that it msmtains ihe health of mother and children by prop'r spacing of children The pub- lic should be educated and convinced to adopt a policy ofhm ted procreation Indeed in the matter of conception control, the main urgency is for cfTcctivc sunpl city and the search for this kind of a remedy should appear m all tvorld programmes of sciences and culture v' •^Ams and mtthadt of toneeption tontrol —(1) Pregnancy to occur as often as u IS feasible to bear and rear a cluld "tth health, happiness and usefulness to jprogeny, parenu and com- munity i ertile couples should be given council regarding addi tional pregnancies (2) Premarital examination to ascertain or develop mental and physical fitness for marriage and child beaimg (3) Sexual intercourse to be adjusted in frcqu eneVn dura- tion and response to mutual satisfaction and well Being of the partners (4) Conception to be controlled with these requisites m mcw, by one or more of the foUovnng methods primarily one in tlic ^^lfc s care A For each occasion — (I) Deforc coitus the woman places a protective barrier in the vagina, such as cervix cover, pessary , or avatchspring diaphragm tampon jelly or suppository (2) The man wears a cos er oc sheath on the penis or lacking the aoo\ c (3) The man with draws after the woman’s orgasm and before his ejaculation i e coitus intcrruptus or rarely coitus rescr- aaius (4) Sclfdiagnosts of ‘ Safe period" or “Kjthm period and restrict on there to (o) The douche is rcbtisely undependable PUBrjC DEALTir ADMIVlSTRVnON 391 B For prolonged protection she means as sperm immunity or ovulation control irradiation hormones or heat to the testicles, only if the research can p ove that their use is safe and effective C For permanent protection when necessary stcr lisation without unsex ng by surgical closure of spermatic ducts of males or oviducts of females, in ofli e or m hospital or for the moper able near the menopause by irradiation D To fosler desirable fertility and plAn each pregnancy , infertile cou des to b- systematically studied a^d treated To d scover ra-thods utterly simple and cheap for the poor and ignorant and the peasantry of over populated countries Extensive basic research 1 The planning commission gave importance to the family plan nuts «v India vn \o rnawnam proper bal tnee between tn creasing population and limited resources of tiie country A provision of rupees 65 lacs was made m the first five year plan for —1 Educating fhc people about family planning 2 Train- ing health jiersonnel and 3 Finding cheap dependable and harmless methods of birth control Three pilot scliemes , two m Delhi and one in Mysore were started to asses< the value of “rythmic** or ‘safe period method In the s-cond five year plan* a provision of rupees four crores was made for this purpose and it was proposed to start 300 urban and 200 rural climes Fandly Planning Association of India - — It was founded -in Bombay m July 1949 Its aims and objects are — (1) To impress upon the public the necessity for family planning and to give guidance on reliable methods of achieving it (2) To work for the establishment of centres where married couples can get advise on — (a) spacing of the birth of children (b) the use of scientific contra ceptive methods (c) treatment of childless couples desiring to establish n family (d) marriage problems (3) To endeavour wherever fcasible, to supply the neccs» sary contnccpiive apphanc s to married couples of low and middle income groups at as low a Cost as possible (4) To collect information *ind statistics relating to family planning (5) To foster and develop cont c s with orgamsations engaged m i similar type of work in the India and abroad 392 mOlENE AMj public JIEALTll Aclmluj — (1) It IS developing fhc **Kalumb Sudhar Kendra** to become alround health and welfare centre where parents can rcccuc help and guidance (a) to space or limit their families (and also to be treated for infertility m order to start a family jf possible) where that IS what a couple deuces (b) to rcceuc medical and psychological guidance for sex or other tnantal difficulties ^c) to learn how best to care for their children and themselves m order to insure health and Htness For this purpose a Well Baby and Well Mother tlmic is shortly to be started at the Kendra (2) It IS airang ng short training courses for qualified medical perwnnci on the various aspects and techniques of family planning (3) It IS helping to establish family planning clinics m van ons pans of India (4) I IS mtetuifymg »u educative drive by talks, film shows, posters pamphlets etc , giving information on family planning loan ever wider public Hospital Social Service —It is defined m England as follows 1 Service to the patients as a part of hospital ireaunent 2 Service as a conreetmg link between the hospital and the public in the treatment of the mduidual pitient and the general health programme of the area covered 3 It senes to create better understanding through inter* pretation of the hospital to the public and public to the hospital strengthenmg the s^ork of both, by bnnging about better results 4 It serves to assist m rescarcli by studying groups of cases an mg general!}, etc PUBLIC HEALTH ADMINISTRATION 393 In Western countries, the course prescribed is that she must /have had four years training in a college and obtained a 'Taachclor’s degree plus experience of two additional years in an •accredited programme of study in the medical aspect of social •work. It includes a year’s field work under supervision. Smillie says, “The medical social worker was introduced first into the outpatient clinic services, and then added to the hospital stafTasapart of the medical team. It is not her sphere to •diagnose disease nor to administer therapy. She is trained to understand and to help the patient, solve personal and family problems. She is also trained to observe and interpret the relationship of social and economic conditions to disease, and to recognize the particular social problens that are produced by illness.” For the health worker Social Medicine means 1. A study •pf social efiects of disease, especially the cficcts of disease on the ■family unit. 2. Individual health education and advising people about the medical aspects of their problems, etc. 3. The provision of a variety of Social Services to rcllere •domestic stress and to support curative medical services. ^ 4. A research method used to identify social circumstances •which favour a high incidence of disease “The medical social worker has now established henclf as an invaluable person in the overall comprehensive plans for care '•of the sick. She aids also in the prevention of recurrence of illness, and is of great assistance in promotion of individual’s and family’s health and stability. Her mam concern is the social situation of the patient. She studies his family relation- ships, his whole economic status, and bis home and work environ- ment, and makes an estimate of the manner m which these factors nmy relate to his illness. With those facts at hand, she may aid in making plans for carrying out of his treatment and for his subsequent rehabilitation of all of those factors tliat impinge on his life, and that may be affected by his illness, are reviewed, as well as the influences of his home environment 'tliat may have an clTect upon his recovery, arc ^evlc^ved. Medical social workers conduct their activities in the hospital, lin the clinic, and in the home. They help the physician to under- stand the particular situations and problems of the patient, and •also help the patient to meet and solve those situations wliicli to diim at off times, may seem hopelessly insurmountable. The social worker accomplishes her results on the basis of 'individual case studies. Each person and each situation must be 394 mClENT AVD PUBLIC ITFALfll handled in accordance with h« particular needs. The most important tools that the medical soaal workers use arc — 1 Material relief, m whic*' actual funds xnay be pros ided to tide the patieniovenn emergency or until the patient may be aided in securing material assi all people for the highest le%el of health Preambit of the eonsltlutton of fi' li 0 -^he health of all people IS fumlimental to the attainment of peace and security and IS dependent upon the follesi CO operation of mdividuals and protection of health IS of value to all*^ Unequal development in different countries in the promotion of the health and control of diseases cspixially commun cable <1 scascs, IS a common danger Health development of the child is of basic importance, the ability to live harmon ously in i changing total environment H essential to such development Problems to be given to priority arc mahria lubcrculosri venereal discasci maternal and child health nutntioiual and environmental sanitation ‘World Health Organisation is or|,a niscd to furiush med cal laalities to member nations to collect the vvoricl vvise statistics, to serve as a central clcanni, house for a rapid exchange of epidemiological mfonnation, to cndicale epidemic and endenue diseases to encourage and conduct sacnfi fc research to disseminate medical information and to assist m the medical development of an mfirmerl public opinion on “matter s ofheaUh It IS also amcemed with the standardisation PUBLIC HEALTH ADMINISThAlION 397 of drugs, biological, preparations, diagnosis procedures andl Mmenclaturc wjth respect of disease and causes of death. *>^r administrative purposes the world has been divided into 6 regions : — (I) South East Asian countries India, Ceylon, Nepal, Burma, Thailand, Indonesia and Afghanistan with Nctv Delhi as their head quarters. (2) America, \ (3) Europe, f4) Eastern Mcditerranian Muslim countries including* 'Pakistan. (5) Western Pacific countries. (6) Africa. ^ • Finances of World Health Organisation TJicy arc provided through the voluntary contribution by various member countries. They contribute according to their ability to pay but get aid according to their requirements. Thus m 1954, India contributed 12 lakhs of rupees and got aid worth Rs. 24 lakhs. Projects for which aid is given must be for the country as a whole and they must be accomplished by the State Government concerned even when the aid is withdratvn after three years. Aid is given in the fonn, of expert personnel and equipment. World Health Day On xhclth Altai 1940, the constitution of the World Health Organization officially came into force. Each anniversary is now observed as World Health Day and is used by National local authorities to interest people in health needs and to stimulate their co-operation in health action. ^'United Nations Inte rpational CSiildrens* Emergency Fund i.e., UNICEF -It is also a specialised .ngcncy of United. Nations Organisation like World Hc.nlth Organisation. It^vas started in 194G, after the Second World War, to benefit the- motlicr and children of various countries involved in that war. Since 1950 however the Fund is applicable to all under-developed countries. Hence, now the words international and emergency have been dropped from the name of tlic organization. It is now ’called United Nations Children Fund but abbreviatson m vogue is still UNICEF, Like World Health Organisation it has 80 (eighty^ member countries. It gives aid to all nations without discrimination of race, colour, polit’cal belief etc. Russian and other communist coimtrics arc also its members. For administrative purposes the whole world is divided into four regions, viz. (1) Asia with Bangkok as its headquarters (2) America (3) United Kingdom and Africa and (4) Europe, Eastern mediterranean countries and France. ^98 inCICNE A^P PUBLIC HEALTH Aid IS Given only for those projeas vluch arc to prevent disease and to promote health of ihe mothers and child en Up 40 19o4 about 80 million children of the svorld have derived benefit from this fund, in some form or the other Vanous projtcfs aided by £t,V/C£F in India are --^ome of the projects and schtmeson puLI c hcalih w! icli have been initiated in India recently, after liaving received aid in the fomi of person ncl and matcrnl from the UNICEF arc the well known BCG Campaign, venereil diseases control programme, yaws control programme in hilly tracts of Madh>a I’radesh, Hydenbnd, Andhra, installation of a pcmcillm factory near Poona, and a DDT factory near Delhi, a dairy plant at Bomba>, opening of maternity and child health and nursing training centres at Calcutta, a Pcdiatnc centre at Madias, provision for dried skmwn- ed milk to needy cliJdrcn, nuising bags, etc for lady health visitors, midwis es and other equipment required for maternal and child health centres, etc First FiVe Year Plan — ^Aficr independence m 19-17, our national Covemment realised that nation’s health is perhaps the most potent single factor in detc mining the character and cxietn of its development and progress and ai y cfTort on improving the national health and expenditure of money in respect thereof, was an investment which yielded immediaie and steady return in jneretsed productive capacity Hrnce in 1950, the First National Five Year j’ian vvas drafted and Us mam aim was to fight against disease, unhealthy environmen's and malnuint on. The Five Year Plan earmarked Rs 99 55 crorcs for medical and public health schemes The Central Government p oposed to spend Rs 17 07 crorcs from this nmount mostlv on the propos* ed AH India Medical InstiUirc and National Malaria Control Programme The following statement shows the distribution of this -amount in lakhs of rupees — Medical Public health Total Central Government SGa 23 1,222 20 1 7fi7 43 Part A ‘?iaics 3 394 30 2 9jG00 C 300 30 Part B States 5fi0 70 657 40 1,238 10 Jimmu and Kashmir 4Q00 82 20 J2a 20 Pan C States 222 50 220 00 450 50 4,003 73 5,14a 80 9,9Bf 53 PUBLIC health administration 39gt In the fir*t Fwc Year Plan a sum of Rs 2,069 crotcs was spent which was distributed as under — Agricultural commurnty development 17 5% Irrigation and power 27% Transport and Communication Social services (including medical 24% and health services) 16 6% Industry 8 4% Rehabiliiation of refugees 4% Miscellaneous 2 5% Among the social services arc included medical and health •services, education, housing, backward classes, etc Out of Its 340 crores a sum of Rs 100 crorcs (99 55 crores) was ■cprrAarted for medical and health schemes The order of preference given to various health programmes Was as follows — ' 1 Provision of safe water supply and disposal of excreta 2i Control of mass diseases Such as malaria, tuberculosis, 'Venereal d seases, cancer and m*n al diseases 3 Preven tve health care of the rural population through health units and mobile units 4 H*a1th services for mothers and children 5 Health education and training 6 Self sufTiciencv m drugs and equipment 7. Family planning and population This plan sva« crmplctcd bv the 30th March, 195G The country made progress m c\cry respect The chief achievements Were —Health and medical piovisions become coniparaiivcly’ belter The country vas on ns svay to become self sufficient m, food and various other productne ccmmodiiics Moreover, mighty irriga'ional and indusuial wo ks dams etc uere on their Way to completion There was every reason to believe that the country would fare far better m the Second Five Year Plan as compared to th- First r»ve Year Plan Second Five Year Plan — ^Thc aims and objects of this plan were to increase per capta income and narional income as a whole by 23%, rap d industrialisation speciall) heavy industries and the increased agricultural pioductivity and cmplnjmcnt Supemston — There is a isational Devchpmcit Council for general supervision consisting of members of the Planning Commission the Mini try ol the Un on Government and the Chief Ministers of the states The council his a standing com- mittee of 14 members consisting of the members of the pianiimg commission, the Chief Minuter of Bombay, Madras, Uttar 400 llYGIENK AND FUBLIO HEALTH Pradesh West Bcnsil, Punjab, Travincor Cochinc, My'sorcr Hyderabad and Rajasthan. Ftnances —A huge sum of R$ 7,100 crorcs {cjc Rs 4,800 crorcs for public sector and Rs 2,300 crorcs for the private- sector) were provided, to unplcmcnt the vanous schemes and prograinincs as per details given below — 1 Heavy industries and transport 48% 2 Irrigation and power 18% 3 AgncuUure and community projects 12% 4 Social services 20% Government of India had to incur an expenditure of Rs 950 crorcs on the above seaors, out of which a sum oF Rs 220 crores was proposed to be utilized {or the cxtetision and betterment of medical and public healtli services only This amount was to be sp'‘nt on its \arious branches in the following order of pnonties —(1) Health centres (2) Training of medical and health personnel (3> Control of mass diseases (4) Im provement ot environmental sanitation and family plannmg Details of comparative study of the Tint and Second Five Year Plans and the state ot affairs prevailing before the unple- mentation of these schemes are well reCccted m the following tabular data ~ Items Before 1931 First Five Year Second Five Year Plao 1951— SG Plan 1956-^1 Total outlay Outlay for medical Rs 2069 crorcs Rs 7 100 crores and hcahh service.. — 100 „ .. 270 „ Hospitals 8 600 10 000 , „ 12 600 „ Hospiul beds 1,13,000 1 25 000 „ , 1,55 600 ,. Health Units ^ ^ 723 „ „ 3,000 Medical Colleges 30 •10 „ 4G „ Dental Colleges 0 , 10 „ Doctors 59 000 70 000 „ 80,000 „ Nunes 17,000 22 000 „ 31,000 „ Midvvivcs 18 000 26 000 „ 32,000 Health visitors 600 COO „ 2,500 Nurse dais 4 000 6 000 „ 41,500 „ Samtarv Inspectors 3,500 4 000 „ 7, COO „ (Rs 27 crorcs) 200 units 1 200 million [ population Malaria (Rs 17 crores) IG2 units 1 162 million 1 population Pdana Control Units 13 Control Units 65 PtTBLIO HEALTH ADMIMSTRATION 40) Survey Units 22 Survey Units 22 166 clinics fEntire popu- 15,000 beds, 21 j lation to be million children covered were given BCG Vaccination and 63 millto I children were tuberculin tested Rs 1 crorc — 35 centres 135 centres — 2100 centres and 4 Regional Pedia- tric centres Rs 651 lacs Rs 5 crorcs, 300 (This amount urban clinics, 2000 was not meant rural clinics For for comracep- use of contracep- tives) tives, Rs 22 crores Rs 25 crorcs for rural, Rs 26 urban «anitatJon crores urban for by Central Gov- water supply ernment Rs 10 crores to assist urban water supply impiove- mcm schemes, Rs 27 and 23 crores to be pro- vided by the state Govts for improvement of rurul and urban water supply schemes respect- ively THIRD FIVE TEAR PL-tH A Provision of Rs 342 crores has been made m the Third Plan for health ^and fairily planning programmes as against Ra HO crorcs and Rs 225 crorcs m the First and Second Plans respectively The Plan lays increased emphasis on preventive public healih services As m the Second Plan, specific programmes have been drawn up for improvement of cnvironmcrial sanita- tion, specially rural and urban watcrsupply, control o( communic- Tuberculosis Venereal Diseases Leprosy Maternity and Child Health Family Planning iinvironmemal Sanitation 402 HYOlEKi: AAT) PUBLIC HEALTH able djsciscs, organization of institutional faalitles for providing health services and for training of medical and health personnel High priority has also been accorded to family planning for which Rs 50 crores have been earmarked The report records substamul progress in vanous health programmes There Ins been a marked decline m the incidence in malaria Considerable progress has also been made in con- trolling other communicable diseases like iilana, tuberculosis and venereal diseases The number of hospitals and dispensaries has increased from 8,600 ui 1950-51 to 12,600 in 19C0-51 and of beds from llSQOOto 185,600 About 6W schetnes of urban water supply and drainage emailing at a total cost of Rs 112 crores ha%c citlicr been completed or in progress According to the report, there Jias been a steady improtc- ment in the hcaltli of the population This is indicated b> the following table Bu^ rates, death rates and expectation of life— lMl-61, Period birth death rate life at birtli rate rate male female male female 1011-51 39 9 27 4 190.0 175 0 32 45 31 66 1951-56 41 7 23 9 161 4 146? 37 76 37 49 1956-Cl 40 7 21 G 142 3 127 9 41 68 42 06 The broad aim in the Third Plan will be to remove the shortages and deficiencies that ha%e hampered the implcmcnta* uon of various heihh programmes during the Second Plan A major objecti\e is to make atailabic supply of good dnnking water in most vilhges m the country by the tnd of the Third Plan. Institutional ficihties arr lo be expanded so that medical and health services reach progressively a larger number of people, specially, jn riiril areas WJiilc profp’oinme for the eradication ofmalanawill be completed, effort will be made lo cndicaie other communicable diseases Drainage programme mil also be undertaken on a large scale m the urban areas The number of hospitals and Dispensaries is to be increased to 14,600 from 12,000 by the end of the Plan period, doctors from 70 000 to 01 000, nurses from 27,000 to 15,000, primary health units from 2,800 to 5,000, medical colleges from 57 to 75, annual admissions in these colleges from 5,800 to B,000 and maternity and child uclfarc centres from 1,500, to 10,000 Surveys arc bring undertaken to ascertain the present stale of rural water supply A provision of Rs G7 crores lias been made This includes Ks 35 crores for the vilhgcand water supply programme, about Rs 16 crores under the Plans of the States under healtli, Rs 12 to Rs. 13 crores under the community PUBLIC HEALTH APMINISTRATION 403 development programme and about Rs. 3 to 4 crores under the programme for the welfare of backward classes. A sum of Rs. 89 crores has been provided for urban water supply and drainage schemes. The urgency and importance of providing drainage and sewerage and arranging for safe disposal of sewage in torvns and cities also need greater attention. These facilities are at present lagging behind the water supply facilities and it is, therefore, necessary that the schemes of drainage arc considered simultaneously with those for water supply and arc carried out under a co-ordinated programme. A total expenditure of Rs. 23 crores was incurred on the control of communicable diseases >n the First and Rs. 64 crores in the Second Plan. The Third Plan entails a total outlay of Rs. 70 crores for this purpose. Work on the control of these diseases will be undertaken on a much larger scale. The BCG vaccination campaign will be immsified to cover another 100 million persons. The number of TB clinics will be increased from 220 to 420. About 3,500 more beds for tuberculosis patients will be added bringing the total number to 30,000 by 1966, The Plan provides Rs. 3.5 crores for the expansion of facilities for post-graduate education This programme has a very high priority and is to be completed m the early years of the Plan. To improve the condition of service for nurses and to attract larger numbers of women to this profession it is proposed that in each State there should be a special nursing service and a nurse superintendent should advise and assist the Directcrof Health Services. Special emphasis has been laid on imparting health educa- tion. It is estimated that the number of children in schools will increase by 20 million at the end of die third Plan. As the incidence of sickness and d'sease among these cliildren due to maltreatment and other preventive causes is extremely high, cartain measures have been suggested to prevent it. These include clear drinking water and sanitary facilities in schools, arrangements for medical inspection, and instruction of teachers in health education. In view of the importance of school midday mc.nls, specially for the poor children, this programme, it is suggested, should be extended progressively. The Plan also envisages a large increase in the production of the drugs in the country and replacement of imported drugs and raw materials by indigenous manufacturers. It calls for special tlTons to prevent tlic production of spurious drugs and food adulteration. It su^csts that co-opertive consumer stores should be built up, specially, in towns, as a means of 404 toraiFVL WD PUBLIC HEALTH assunng the supply of pure food stuff* There is also increased emphasis on encouraging the indigenous system of medicine The programme for family planning provides for (a) cduca non and motivation for family plann ng (b) provision of services (c) training (dj supplies (c) communication and motivation research (f) demographic research and (g) medical and biological research It involves a total outlay of Rs 50 crores family planning semces have to be made available much more V idel> than at present According to tentative programmes dravTi up for the Third Plan that number of famil} planning clinics is likely to increase from about 18)0 to 8 200 About C 100 clinics may be in rural areas and 2 100 in the urban areas D strib It on of simple contraceptives and general advice should be entrusted in a much larger measure to the voluntary organiza tions to piratned cal personnel and to dais' specially trained in fomily planning uork It IS further stated that a large scale of fam 1> programme has to b^ supported necessarily indigenous niatufactureofeon tracepcives Detailed plans for ihcproducuon of these I olli by the Government and p tvate firms should be drau-n up as a matter of high priority Over the past five years facilities for sterilization operation have b'en extended in several States and about 12.^000 opera tions have been carried out It ts v suatizd that during the third plan fsc lutes for stenhzaton will be extended m district hosp Uls subditis onal hosp tals and to such primary health centres as have the necessary fic I tics for siirg cal work With the help of mobile units these fac Iitics can be extended The report says that bes dcs the focilUtcs which are undoul>* tediv needed in any large scale effort to limit families there should be the greatest emphas s on moral and psychological dements on restraint and on such social pol cics as education ofavomen opening up of new employment opportun tes for them and raising the age of marriage In add tion to advice on b rth control the fam ly planning programme should include sex and family education w^adonal Malana Control Programme — Malaria has been recognised as by far the biggest and most important health problem m India It v is csi mated tliat nl out ItO xndl on people suffer from tl is disease every year of m lorn about a mill on d c Apart from this 1 gh incidence of disease malana 11 also responsibJc for untold s ckness and sufferings The econom c loss to the nat on due to malaria is incalculable and taiisi run into hundreds of crores of rupees every year PUBLIC HEALTH ADMIMSTBATIOV 405 According to the information collected from Directorates of Health Services of various States m 1932, the total population requiring protection from Malana m this country was estimated to^c 200 million The Health Survey and Development Committc recom- mended m 1946, the creation of an organisation at the head- quarter of each State and establishment of a number of malaria control units, each under Medical Officer, especially trained m antimalana work for operating in the affected areas in differcat parts of the State. 'during the Tirst Five Year Plan, Planning Commission ra- vicwcd the question of malaria control on a country svidc basis and recommended that this disease being a Pjbltc t^allh Enerry No 1 should be given lop priori^ and should be earned out through a central organisation m co operation with States ^ v^o implement this recommendation, a comprehensive pro- gramme oi malaria control m India was drafted in consultation tviih representatives of International Organisation interested there-m and some of States* Ami malana Organisations and thu brought into its wake National Malana Control Programmtr^hii programme was examined as a “project** by the Planning Cthe state was made for this vital scheme The Malaria insmme of India coordinated the whole programme and distnbu cd supplies It was also responsible for rescaich and trainmg staff in methods of malaria control '-'•during the First Five Year plan, 162 malana control units Were set up to do ami malaria work The progranunc consists of residual DDT spraying of insecticides m houses and treatment 406 irYOIEVE AI»D PUBLIC IIE\LTII of patients tv lift anti malana drugs in. malirious areas One unit 1 $ cxpc«cd to protect one miHioa population fc^NaHonal Malana JEradication Programme — According to the vaoous resolutions passed by the World Health Assemblies cmphasBing the need for total eradication of malaria, the Govcmnjcnt of India embarked ona nation Vride eradication campaign in April ISaS This was a landmark m the historj of public health administration in India and is the most gigantic health project ever Hunched by any country in the world In tius huge project the United States International Cooperation \dministration and the World Health Organization are also collaborating ‘Malaria Eradication , accord ng to the Sixth Report of the Expert Committee on Malaria which met at Athens in June 1950 tmder tile auspices of the WHO means the ending of transnns- '< on of malaria and the elimination of the resertoir of infective cases in a campaign limited in time and carried to such a d<*grcc of perfection that, when ii cotnes to an end there is no resumption of transmission that differs from malaria control in tnanyavays W hcreas malaria control aims to bnng the disease doivn to a preialence tfiat « IS no more a major public health problem, malaria eradication aims at the total eradication of malana parasite It has been shown that it is possible to achieve malaru eradication PL \KV1VC AKD onCtVIZATIOV In order to achieve the desired standards ofcrncicnc), the activities of Malaria Eradication should be looked upon ns an urgent measure outside the regular routine of health depanments Proper planning and perfret organization is Uie stne qua non of any malana eradication scheme Malana eradication aetiailies should have the support of legislation There should he a continued assurance of aiailabi* ht> of funds and budget The budgetary requirements of the campaign arc well IV thin the fnanctal means of the countries concerned Proper training of personnel and hgh standards of efficiency and caliber on the part of all employees is a mint m any programme Malarn Eradication programmes have four pliasci 1 Preparalorj) — Thismcludes an initial suncy planning and prclmimary organization The primary piirpo'c o'" this surrey is to dehratt the malarious area of the country, if this f ai not liccn already done Training of stalTshould also be carried out during this phase Aotmally thu lasts a y car 2 AltacL — \s soon as the preparatory pliase has ended theatiack pliasc starts This means a complete coverage of PUBLIC HFALTH ADMINISTRATION 407 the whole area until the cessation of malaria transmission and emptying the parasite reservoir The assessment and evaluation of attack phase are measured m terms of what remams to be done rather than what has been accomplished Normally this phase may last fortJircc years 3 Consolidation — This begins when the attack pliase has come to an end During this phase, all residual pockets of transmission should be investigated and eradicated This phase IS also termed the sur\ eillance Active case finding and adminis- tration of anti-malarials form the chief method of eradicating the residual foci of malaria transmission Normally this phase continues till three years of active surveillance 4 Almnltnanct — ^The phase of maintenance begins when the activities of consolidation or surveillance have come to an end Before this phase begins all the criteria of eradication must have been met Within the Ministry of Health, and the Directorate of Health Services, a full time Dircaorofthe National Malaria Eradication Programme directs and coordinates the Programme At the state level, the activities are conducted tvith the direction and supervision of State Maianologists withm the State Ministries of Health and the Directorates of Health Services At present there are 390 units m the country, each of which covers a population of one million Umt is the lowest functional group withm the programme Each imit consists of Malana OlTicer 1 Assistant unit ofRcer (Non medical m-charge of spraying logistics) 1 Senior Malaria Inspectors 4 Malaria Inspectors 4 Technicians 2 Accountant 1 Store keeper 1 Upper division clerk 1 Mechanic 1 Motor drivers 5 Motor cleaners 5 Peons •' 4 Chowkidar 1 Sweeper 1 Superior field workers for 12 months 4 Tield workers for 12 months 10 Endemic Units Endemic Units in Plains in difficult areas Superior Field Workers for 5 months 32 44 Field Workers for 5 months 170 230 408 inCIENl. AND PUBLIC lIEALTn Hypoendcmic Unit* Supenor field ^vf)rkcrs Tor 2} to 3 aonthi 32 Field workers for 2) to 3 months 170 SnrveillaiJce team per nnit — Impeciors 25 Surveillance \v'orkcrs 100 In addition to above s x inter state (regional) organizations each covering tv\o or three States, liate been organized to give technical direction The amount of DDT p-r round of spray per unit has been increased from 35 5 tons of 73% wettable powder to 45 tons depending on the arcs and requ remenu Besides the normal quota of four trucks and one jeep 300 trucks were to be pmctired as a reinforcement to be nllotted to those units operat ng under the control programme Each unit waste be provided wth tsvo mcroscopcs, as ''cJl as 60 000 slides and anu malanals Each unit is suppl ed uath 30 Hand compression «prayer» and CO SiiiTup pumps Thelsaiional Expenditure amhonred for anti malaria work m India m 1959 was m the region of 20 million US dollars Tlic tiialana expci dituie budgn as ccirpartd to the total hrabh bud get m 1930 was 19 5% Estimated cost for the Tlnrd Five \ear i’lan pcuod is Rs 58 37 crorcs 38 un ts m add tmn to 162 already set up underth** First Plan would be needed d irmg the Second I «vc Year Plan to extend protection to 200 m llion p**opIe who arc exposed to risk One malana control unit cons sts of tbe following s aff — Medical Officer “^en or Malar a Insprclors Malaria Inspector* Score keeper Aero in ant Clerk Van Cleaners Van Driven \lethau c Teons I 4 4 1 I I 5 5 J 4 I-UBLIC HEALTH ADMIKISTRATION 409 Waldunan . . 1 Supcnor Field Workers (regular) . . 4 Field Workers (regular) , . 10 Superior Fir Id Workers (5 months) . . 20 Field Workers (5 months) .. 110 The following transport and equipment is provided to each tumi Trucks . . 4 Jeep car , . 1 Hand compression sprayers . . 30 Stirrup Pumps . . 60 F^ch unit IS supplied %vith 53.3 tons of 75% wcttable powder and anti-malaria urugs annually. Besides above, each state has been supplied with two micros- copes. Some of States liavr been supplied with station wagons. The cost per unit to a State Government is estimated to be Rs. 1,32,000/-. Nine such anti-malaria uniis are functioning tn Punjab state. The State Malaria Organisation varies^ from state to state but general pattern IS showTi diagramatically in a chart State Malaria OrgasusatioD State Government. (Department of Health) Director of Health Services Drpufy Director of Malarhhgy (Stole Mahrioiogist) I District Medical OITiccr of Health I I Malaria Officer. lie Unit. I I Eaccuijvc. Administrative. 1 Mechanic { 1 1 1 •Senior-Malaria i 1 { Accountant. Store- Clerk Inspectors. keeper. Malaria Inspectors. 1 I i \ i Superior Field Drivers. • Cleaners. Field svorkers. workers. 410 mGIE\E A\D rUBLIC lUEALTH ■^Tnbercolosis s^em«5 wcltided -under the Second Five Year Plan — '^Inlroiuclion ■— II xvas estimated thnt m Indn there ivfTc about 25 lAkhs of paiicois suffering from active tuberculosis and about 5 JaUis die every )car due to tuberculosis According to West em standards to deal mth such a situation uc would require 500,000 hospitals beds and about 4 OOO Tuberculosis clinics Exutingfacttiliex — ^Thcrc arc at present m Indn 139 uk paticnt institutions including sanatoria and hospitals Thctottl number of beds at present available for tuberculosis p-vticnts in the count!-) is about 29 138 The number of clinics is 170 There are about 130BCG vaccination teams with over 150 doctors and 750 technicians The number of people \vl o have been tuhcrciilm tested IS 75 millions 16 millions have been given BCG Vaccination ^ v-yreeJirf Fim Fear P/a I — The following items were included’ in the Second Five Year Plan 1 BCG Vaccination 2 Estabhslunent of clinics and domiciliary service 3 Establishment of trainine and demonstration centres A Provision of beds for isolation and treatment 5 Facilities for after care ''C Resenreh ^ 1 BCG lacciiatton ->]tvvas planned to tuberculin test and vaccinate all the susceptible population estimated at about 170 millions bj 19GI 2 Cltnie and Domtcthaij Servie< — The mam functions oF a clinic IS diagnosis, advice and follow up In Indio- ovving to the paucity of beds for tuberculosis patients clinics have been given a wider function eg to under take a certain amount of treatment pirticulirly treats ment in the patients homes fir domiahar) service) "I he ultimate vim V -as to have one clinic for ever) 100 000 population It was planned to establish 300 more clinics during the Second Five \ ear Plan 3 Tramng and Demrslralto i Centres — Some of llie larger clinics were planned to be centres for training different categories of personnel such as doctors nurses Itevhh Visitors and techmciaiu and also for demonstration of clmic service of proper standard 1-otir such centres were already walking and it was planned to add 10 more centres d iringtbe Second Five k car PJm 4 Hospital Beds — 10000 beds were to I c oddecl during thr 2n(I Iiveycarllan These beds v ere to be provided PUBLIC EEALra ADMIEISTBATION 411* in crowded localities especially for isolation of infectious patients living in unhygiemc homes. 5. Aftet’core and Rehahilitiition The need for after-care- colonics and rehabilitation centres for ex-tuberculosis patients was fully recognised. At that time only 5 such centres were existent The 2nd Five li’ear Plan provided for the establishment of 8 more work centres, mainly in association %vith the larger clinics, where patients, ex- patients and their faimhes «ould be taught handicrafts, some of which can be carried out by them as cottage industries. C. Researth : — A Chemotherapy Research Centre tvas start- ed in Madras. The research was being carried out by I. C.M.R. on behalf of Government of India with the active cooperation of W.H.O. and Britain Medical Research Council The mam object of this investiga- tion is to find out the efficacy in tuberculosis, with the- new antibacterial drugs. National Smallpox Eradication programme t-^The Central Ministry of Health has proposed to embark on a nation- wide basis the National Smallpox Eradication programme durmg the 3rd 5 Year plan. The proposal has been accepted by the Planning Commission, One of the preparatory steps In this direction has been the starting of pilot projects in the states during the year 1960-61. * The Central Expert Commisson on Smallpox has recommen-- ded that the entire Smallpox Eradication programme should be completed within a period of 3 years from the date of its incep- tion; the programme being carried out in two phases, the first phase being devoted primanly to planning and obtaining necessary equipment etc., and second phase to the actual work of vaccination. The 1st phase of the programme envisages interalia the provision of additional facilities at the existing vaccine producing Institutes of the country for the augmentation of vaccine lymph supplies, Jn vietv of the National importance of Smallpox Eradication project and wlh a view to attaining the targets in respect of production of vaccine l>'mph, the Govt, df India has decided to give cent percent central assistance to the states. The scheme is essentially centrally sponsored and the expenditure Is . to be received by the state Govemments in the form of subsidy. There arc at piesent 13 vaccine Institutes in 11 States of the country providing all the smallpox vaccine used in India. The present capacity of \accinc production of all these Irutitutes is about 75 million doses annually. ' 4! HTGIEVE AKD PUBITC UEVLTII Approximate!/ 250 million additional doses of %accine Ivmph will he needed for the National Smallpox Endicatjoa programme which eimsagts vaccination of entire popviKtion of tlie country csiimatcd at 430 million in 19G! Government of India has procured 2o0 million doses of freeze dried vacane, front, Russia instead of manufactunng « in llie country 1 he whole scheme has beennorlicd out and is under the acute cons deration of the Government of India The Scheme has been thus finalised and commenced from 196162 onuards and the entire progr.mjnic Mill be concluded with in a spell of 3 years v/* ^ costMtJvrry di^tlopment pitoJECTS '^Background and ongui — India has adop ed the idea of a « elf ire State It is tty ng lo carry out its principles in prac- tice The idea of a Viclifare state must be very old but us conception of vselfare as the ptonaiy object of tiie state is new There IS colossal poverty m our country Our per capita income is only Us 273 per jear Besides there is the ternfe population pressure Vbout 10 COO more mouths to be fed are being added every day m Ind a Our country is rural as 8“^ per cent of the population lives in the villages There are 51 lac of villages w th a popuiat on 01294 million and the principal aim of the Vvclfare state IS todral w th poverty Th“ rJational Govemmem therefore, rightly thought of the development of Villages / When the First Five Year Phn (from Apnl I9al to March 193G) was started ii included the Community Dcvcloiv mcnl Project for rcvitalisai on ofvilhges The term Commu nil) I’lojeci IS American but the plan is rot Amercan The development prrigrjmme IS 100 percent Ind an It is a real rural development pre gramme he mam purposr is to cl miaa 1c triple encm) o'" tic vllaccr it povert) ignorance and disease It is tl c project of the people for the people *' The si ect anchor of ll c v.1 nlc programme u self help Tlie success of the p ogranime mil 1 c affected bv h w in kIi the villagers have been excited The creation o leadersh p amona the Village people for solving tbcir own problems IS the am of the project Details sf K Project — An area fiir inleni vc tori In all f elds IS selected Kach p i> cct ctve s ^bo it 3(0 v 11 grs wnb an Tiea of aboi i CCO rjuarc m Ics and ”1 popuHt on of al out 2 lacs Each project consists of tlrcc blocks Each block has 100 villages and a pupulat on of alxml 70C00 Ladi block is PtniLlC HEALTH ADMINISTHATION 413 again divided into several sub*blocl.s. Each sub-block has 5 to 10,villagei, under the charge of a Gram-Sewak or Village-level Wo rker. This is the lovest unit of the block. Each project was to cost 65 lacs of rupees, over a period of 3J years in the First Five Year plan. This is a comprehensive and multi-purposes scheme. The expenditure is incurred under the foHouing heads : — 1. Agriculture. 2. Animal Husbandry and Veterinary Services 3. Fishery. 4. Irrigation. 5. Communications. 6. Co-operative Societies. 7. Cottage Industry. 8. Education. 9. Social Education. 10. Medical Relief. 11. Public Health. Major emphasis is laid on agricultural development and other productive measures to improve economic status of the people and improve (he mode ot hfc of the people. Organisation and Operation Central Administration planning Commission. I Commumly Project Administration. Administrator Community Project Administration. Project Administration in the States Set Up- I State Development Commissioner. Deputy Development Commisioncr. I Disti. Development OfTiccr I Dlstt. Development Committee Project Executive Officer. I Project Advisory Comnuliec Ali mCItVE 4M) PUBLIC HFALTfl Assistant Project Executive OIBcer In charge of Blocks I Extention ChitfSocuICo-opnk V«tem CoUsk^ Officer ^uckltaa ttr** Dary IndUi* Agreuliunl Orsanner Doctor loc* Secondary Pntn*f> Health HeaUh Social Organuei Unit Uutt I Health 1 I ! Village Level Vfoekets Village Committee j Village Clubs I Cram Sewaks and Gram Sevikas Village Welfare Bodies [ The Key man of the whole set up — Village Level Worker or iGram Sesvak, •^lllealth Prograrame —There is & provision of one Primary Health Centre in etch block This health centre is the focus^ ftomvthich health ncuvities radiate into the intenor areas Emphasis is laid on preventive m'*asurcs along with the provision for treatment facilities Each such health centre has a dispen* sary and an indoor ward of six beds A maternity ond child welfare centre u attached to this centre The services provided are — 1 Medical Relief 2 Maternal and Child Health Wore '' I Environmental Sanitation 4 Health Education ^ School Health Work StJjf of ihe Vnrtary IltcUh Ctrtrt —It consists following — 1 Doctors 2 Compounders 3 Smitar> Inspectors 4 Health Visitors 5 Mtdwives C Trained Dais 7 Cook 0 Sweeper 2 (one for mobile timt) 2 2 2 4 6 of the The viholc staff will work as a team The health work mainl> concentrates on preventive measures rather than on .^eurativ c measures The midmvcs and dais are to live in selected PUBLIC HEALTH ADMINISTKATION 415 places close to the people. The mobile doctor will open sub- centres in the different parts of the block and will keep open village medicine chests with the gram-sewaks. '^Secondary Health Centre : — ^Therc will be one for each project at the project headquarters, with a hospital of 40 beds. It is also the supervising centre for the block primary health centres. Staff of Secondary Health Centre : — It consists of the following : — 1. Administrative Medical Officer. 1 with public health qualification 2. Assistant Public Health Engineer. 1 3. Malaria Inspector. I 4. Senior Health Visitor. 1 5. Medical Officers (Men), 2 6. Lady Doctors. 2 7. Laboratoiy Technician. 1 8. Clerk. I 9. Stpnotypist. I 10. Compounders. 2 11. Cocks 2 12. Sweepers. 4 13. Nurses. 4 14. Anti malana staff. 6 On second October 1952, fifty-five such community Develop- ment Projects started functioning. National Extension Service Blocks : — ^\Vhcn the rural public Saw the success of these community projects, there was a great demand for such projects. In 1954, National Extension Service Blocks were created as the resources \Ncre limited for the increase of the wealth of the country by improving agriculture and allied productive activities. The blocks have now become a permanent feature of the development programme of our coun- tr,v. Tbrn^ircjs nfjthisjnovcmcni are the same as that of Community Development Programme. Staff of each block is as follows : — 1. Block Development Officer. 1 2. Extension Officers. — 3 Agriculture. Animal Husbandry. Co-operative & Fanchayats. 415 Iliori VE AVD PUBLIC HEALTH 3 Soaal Education Organism 2 (I male and 1 fem^r) 4 Overseer svith Public health bias 1 5 Village Level Workers jO Fmances — In the first Five Year Plan, 700 blocks under Community De\clopm'nt Project a id 1200 Naiinnal Extension Blocks were provided wuh a budget pros ision of 101 crores B> the Second Five Year Plan (1961), it is proposed to cover the enure rural areas of India It needs 5,000 such National Extension Blocks for this purpose CHAPTER XX SOCIAL MEDICINE Social Medicine is the latest comer m the field of medicine and IS still in tlie early p nses of its evolution Its boundaries dilHcult to fix, so as yet, propci and suitable definition has not been fiamcd Gladston Says “It has carried and noiv carries difTereftt meanings to difiVrent persons To some it means social pathology, the art and science of studying disease in the social group or the community xtfuh the same techniques, which medicii e has hiiliei to utilised in the study of disease m the individual To some, social medicine means an extension or public health, to cmbiacc social factors of communal health, such as housing, recreation, school, lurchcons and mental hygiene There is a small and energetic group which sponsors the idea that social medicine is to be achieved m conjunction which xnedi cine and social sciences There is still a smaller group that looks upon medicine as the embodiment ol 1 new o’d pnilosopty bear* mg on man’s position m and relation witlv ivorld about him This group considers the mod ficaiion of medical education, m accordance with the fundamentals of esseniidl ecological philoso* phy, a fundamental pre requisite to the realization ol social medicine For the proper understanding of this science, It will be better to know the ocfinitions which arc given by d fTerent authors to the ^ terms such as Preventive Medicine, Public Health, Social Medicine and Hygiene In 1920 Professor Winslow described “Public Health -vs the science and the art of preventing disease piolonging life and promoting physical and menial hcalih and cfliciency through organised conimuniiy clTirts, for the sanitation of ihe cnviron- mems the control of community in'eclions the education of the individual m principles of personal hxgitne, the organisation of medical and nursing serMces for the eiily dmgnosis and preven- tive treatment of diseases and the development of the social machi lery uhich mil ensure to etery mdi^duil m the ronimumiy a standard of living adequate for the mamicmncc of licalih ’ In 1032 M r Bo'd said * Preventive Medicine mav be defined as the branch of applied biology \yli cli sc( ks m reduce or eradicate disease by removing or altering the responsible ciiologi- 418 lnOIt^E AND PCDLIC HEAL'CH cal factors Included ^Mthm its scope are two subjects which ore •often confused witlnn its , these arc Jiygicne and salutation res- jicctively H>Bienc IS the proper care of the body, to permit the normal functioning of the \anous organs and tissues, while saniW ation is the proper cleaiUmess of the environments ” Prof Warren says * Preventive Medians consists of two distmet pliascs, the protection of the health of the individual and yrotection of the health of the community ” Lea\ell and Clark m lOoS m ihar text book of Preventive ■Medicme say ' This subject is broader than merely the preven- tion of disease Medicine must also be concerned with promoting health and with the prevention of total disability, by rehabilitation of those damaged by the disease process The term "preventive an-diane" is widely used and generally accepted and wc propose to employ it here in a sense sufBctenily broad to include both health promotion and rehabilitation Much confusion has nnsen between the terms * preventive medicine” and ‘ public health" Attempts to difTcrentiate these terms by definitions ■alone are likely to confuse further, than enlighten It is better to consider first on the one hand, how a public health officer practises preventive mediune and how on the other, the private practitioner applies it Both are practising preventive medicine as we propose to use the term, but their points of view and ■emphasis ddTer in many respects " They further add "Tbe preventive medione is the saenre and art of preventing disease, prolonging life and promoting physical and mental health and efilaency This definition applies to preventive medicine as practised by cither tlie private practitioner, dealing with bis individual patients or the public health officer with aggregations •of individuals m his community Public Health may then be •considered a sort of division of prcvoitire medicine, the part of which requires organised community effort or action. Dr Gladstone says * Prevent ve medicine is divisible into two depariments-Communal preventive mcdianc and personal preventive medicine The former ii largely the province of the sanitary engineer, the chemist the epidemiologist and public health officer Personal preventive medicine t$ primarily a function of the private practiiioner, dealing with mdividuvl patient Communal preventive medicmc (Public Health) is highly developed and has a record replete with accomplishments " Wilson G Smillic in 1952, m bis book on Preventive Medicine and Public Health says *‘I have made a distincuoa between preventive med anc which I consider as a function of the individual in promotion of personal and family, health, and public health as a community function The autnor may be accused of SOCIAL MEDICIKB 419 halr-spUltlng, soplustry, since there is an orerlapping of these functions, with no clear^ut distinction between them. But I ■brieve that the distinction is a valid and -useful one, and that it will be found to be most practical in organising the instruction of the students and in planning teaching programme \vith depart- ments of clinical medicine Public health encompasses those activities that are tmdertaken for the prevention of disease and the promotion of health which arc primarily, a community res- ponsibility. These activities may be carried on by an official department of public health, by voluntary health promotion agencies by department of education, by slate or country medical societies or other community agencies The physician should be thoroughly familiar with the need for these activities. He should participate in them, but they are not his direct responsibility Preventive Medicine encompasses those activities, that arc the direct responsibility of the individual in the prevention of disease and in protection and promotion of the health of himself and his family. Who is responsible for the proper conception and execution of these activities? Th^ fall, for the most part upon the ihmily health advisor. Usually this person is the, private physician, who aids and guides all members of the family in all matters pertaining to individual health protection Preventive medicine, then represents individual responsibility for activities that are carried out, for the family as the unit. Public Health represents a community responsibility nhich is carried out for community beneGt. In the first instance the family is the unit for consideration. As per report of loterdepartincnt Committee on Medical Schools in Gteat Britain, the term Social Mcdiane includes the more restricted, though vrry important, subject of disease prevention. It also signifies a particular conception of medicine, a conception that regards the promotion of health as a primary duty of the doctor, that pays heed to man’s social environment and heredity as they effect health and that recognizes that personal problems of health and sichness may have communal as ^vcU as individual aspects,” According to Fred Grundy the term Social Medicine has no settled meaning but it essentially signifies three important facts 1. That most of the diseases have a Social origin or can conveniently be regaidcd aS due in part to social causes. 2. That disease has social consequences and often requires social services as well as medical care services in any complete therapeutic programme he., social remedies arc often needed as a part of therapy. 5. That social services arc often needed along side medical care services in order that sick persons may use the 420 HIGIDM: AJIDTtJBUC HEALTH latter ^flcctivel) e g provisions for the care of young ‘ chJdten, while wiih a toxaemn or olhci condition is admittbd to hospital for ireaimcnt As 1 subject of study, the term Social Medicine composed the following — (0 Tlie Agencies of Social Therapeutics (u) \n nspcct of epidemiology concerned particularly with research L> tnCems of surveys and statistical invcsliga* tions into the Social and genetic factors which afreet hralili and the incidence of disease ( 111 ) The reciprocal relations existing between medicine and Soaety (iv) Social psychology and Social Psychiatry started the first department of that name m I9 fields (soaal vs clinical medicme) as whole-sale versus retail Social Medicme is public health maturing ’’ PCcmge, ps>cho!og>, economics, ph>sical and social nnihropology including biology as well as ioaal ■medicine Tne existing Preventive Mtdicinc and Public Health should be reorientated in such a waj so as to create, through the right type of health educanon of public, nblc to participate in the fullest human a\cll bcirg Healih is not merely absence of -disease, but t is a state of complete physical, mental and social well being Med cal care can never be limited to organic impainnem, physical illness or handicap, but has to 1 c combined asith the trcatnfnt of social factors that influence the effectiveness of medical care and contribute to the degree and duration of dis- ability Increasii g consideration of the environmental and emo- itonal influences upon illness has been noted in lecent years The environmental influences may be physical or social As Social Med cine depend s ji pon environment, which is •completeiy~different in difft.rent countries and which is still in infancy in India, research is of utmost importance m the depart mtht^f SohUl medicine for which specialised staff will be needed Grant ( m 1949 ) has stressed the relative importance of medical and non m*dtcai measures m th* praciicc of Social medi- cine It depends apart from medical care programme^ on the following norvmedical meosures -(1) Social welfare with Jiarticular reference io family allowance training of tlie disabled maternity benefit and home helps (2) Housing policy based on population needs rather than icntalvilics (i) A nauonal food policy (4) Provision for mental social ind physic il recreation through community centres and educational measures for the •development of health consciousness Sir Arthur says : “Social Medicine, as it is termed, is not a new thing It is in integral part of preventive medicine What needs to be more fully reilized, both b> medical profession and by the public, IS the wide conception of preventive medicine The Xurposcofihis science and ait is application of knowledge to the prevention of disease ” Sir Parquhar Buzzard considered * Social Medicine as the union of runcdial and Preventive medicine He recognised that "there were some, indeed many dialog cal factors of disetsc and ■disability which neither Chnicnl Medicine nor Public Health embraced, in their rc-prctive sphere of knowledge and which are their discovery or c^poslllon required new techniques and new instruments” Hewas the lirst to advocate the creation of auto- nomous dipanment of Social Medicine He believed that the time had come when Preventive medicine should possess like remedial medicines certain centres of research stafied by men 426 mOILVE A^O PUBLIC HEALTa and ^vomcn giving their wholeUme to the solution of number of problans, many ot which at present moment seem to be nobody’s business ‘They should be closely associated with the university medical schools on the one hand and the hospitals or groups of hospitals on the other, the former providing for research and the latter the access and key to material " In Social Medicine, one has to "enlarge the field of vision" and to broaden ‘etiological study " prof Hobson professed to "regard Social Mcdicmc as a philo- sophy which should permeate all branches of medicine, for its implications cannot be divorced from any branch of medical learning It is a branch of mediane also which provides a connecting link with the wider humanities He considers Social Medicine as the study of man within his environment lo give him life and to give it more abundantly " Galdston says "Social Medicine is frequently confused with socialised medicine, yet the nvo are worlds apart Socialised mi^icme envisages the perpetuation of current medical thought jind practice, while Social Mcdicmc their radical reform In me current situation, they are antagonistic and not similitudes Socialised medicines are modes m the application ofmedicmes. these are organisational sclicmes for the distribution of medical services They have been cultivated under the cornpellmg im- pulsions of social, rather than economic potential and ideological changes in society But Social medicine is pronaTiW a derivative of the progress of medicine itself It repretems a maturation of medicine, the attainment of a neu high point. It is not easy to draw a line of disuncuon between Preventive and ^lal Medi- cine According to Fred Grundy, the enlargement of preventive mcdicme by the introduction of personal hygiene and health education and promolive services lias gone lomc tvay in miking Social Medicine as synonymous But, however it can be said that Pret cntivc medicme is primarily concerned with the immediate physical causes of disease, whereas Social Medicuic attends mainly to Uie circumstances whicli favour the incidene of disease "Hitherto the medical students’ ittcntion has been directed almost entirely to tlic diagnosis ind ireatmcni of disease and mainly of estiblished disease rather than of early utid slight departures from health whicli if ignored or neglected may lead to establishment of disease ‘ The majority of physicians and surgeons have curiously little concern uitii etiology of disease— the first essential for pre- vention At present neither the opportunity nor yet the appro- priate type of iraming or assistance requisite for the study of SOOlAIi MEDICINE 427 etiology or prevention of disease arc available. Their material) is mainly selected for four factors, the gravity, the difBcuUy or rarity of their cases or their suitability othenvtse for admission- to a hospital. Some of the most common diseases, the less lethal iseases and the beginning of the disease are even considered as providing poor teaching material. Health and sickness in the population and their possible correlations with signiiicant and measurable social or occupational influences arc outside their province. **We arc still as a profession thinking more about curing than preventing, more about medical care and us huge costs than about the economics which could be afTected by attacking the basic causes of disease.” Social Medicine in England.—Thc agitation of Social Medi- cine was first initiated in England about a century back. Eater on in America it was called Socialised Mcdicme and in Germany as jovial medizine, took initiative in soaal medicine ? What- ever may be the reasons, it vvas derived from the social necessity rather than inspiration of certain ingenious men. About a century ago, there came sanitation movement m England’ In reaction to social and ecological bye-products of industrial revolution. The misery of lower classes, the degrading slums of manufacturing towns and cities, the pitiless exploitation of women and children, the Ignorance, squalor, disease, corruption that resulted from and were witness to the social, economic and cultural dislocations incidental to change from agrarian crafl economic to one of the capitalist maclime production, stirred many people to awareness that human life, labour, power, and the other important elements m national wealth, were being squandered in the persuit of selfish and immediate profits. There was naturally a general protest against it. Sanitation movement was a part of this protest. It was dircUcd to the betterment of physical environmental, hygienic conditions under which people lived and worked. The State Government also came to know of its responsibilities for the health and care of people. Several social reforms as accident prevention, compensation to injured workers, limitation of working hours etc. were consequently made. But sanitation movement lost its w.ay to bacteriolog>’, when bacteriologist told the world that diseases would be eradicated from the world Mithin a short time. In the .advent of modem medicine in the later half of last century, medical practice grew tremendously and dazzled the scientific and lay worlds- But certain events and experiences quickened the embryonic move- ment of Social Medicine.” Sir Wilson Jameson gave a discourse 428 II\Giri,E-/<5fD PUBI-IC OTALTH on ^^a^ and advanccmenl of Social Mcdicme ^fcdical Research and enquiries made by the Royal Commission ol Physical 1 nm- mg (Scotland 1903) the interdeparim rual conimitict. on phjsical dttcriontioii JOO’i and a dtpaitmental commiltte onmtdical inspection and feeding of children niicndmg public elementary schools m England in i90j created a profound impression on the hearts and minds of the public, and p^ved the way for the birth of Social Medicine m England Social Medicine had feeble growth during next decade Ihen came the First Great World Wir ol 1914— 10, m which entire population, ric military nd civil was involved in wide strains and sircsscj Many, so far imperceptible deficienacs cropped up Great improv cmem was mademall walks ofJife Various branches of service showed rapid progress the advance- ment of which was however hampered on account of econonijc depression, uncmplojmem, eveimounting threats of various other post war problems Various individual and collective remedial schemes were drawn up b) ingenious men the result vvas rather socialised medicine in the form of Britain National Iltalih Schemas instead of Social Medicine Man> other schemes for the improvement of public health services were initiated (or child ren, nyjthws, infants, and tr eatment of venereal distase s,~fubejtxulot» and in'^tTs inal hy giene B>~enJoFcing^AT7TETonal Hosptial 8>st(in,‘’ Govcromem provided public medical service for people which they were incapable of providing for themselves individually But strictly speaking this vvas again not Social Medicine The movement of Social Medicine is essentially a dcrivitive of Second \\orld War S ocialised medicine brine a bad med o ne was replaced bv_Soaa l MVdicinc According to Ryle ‘Social Med cine* I5 concerned with scientific diaplmcs and improvements of prcventiv c and rtmcdiaJ practices based thereon and not on iroliiical planning ’ Tlinc are two points of views viz humanuanan starts with the individual as a member of commuiuty and finds the duty of Social Med cine to serve h m directly as such It tells the doaors that the patient IS not collection of phenomenon of morbid anatomy but a human being with a place in society^ The other view is 'Cieniific, tf study of group by stiustica) methods VMthout particular rrfcicncc to individual eases and dctcttninai on of social ct oJogy and repercussions of disca'cas mass phcnrm»non Training in Socia} Medicmem Mrdieal Educaiipn — Ryltwtn^e, “In teaching of our siudrms incur r»staitl es inouricccnmin- dations of policy, we have need both Ibr *v nt w idfil_, m n d a new Tcalrm We can no longer rcmim conitni wiiiv manv of tluTold cdTvcni ons of our text books and exam nation which have SOCIAL MEDICINE 429 changed but little m form and manner m a generation, although they have multiplied both m ihwr imposition and number VVe no longer believe that medical trutlis are only chicHy to be discovered under the microscope by means of the test tube and ammal csperiracnt or by clinical examinations and mcreasingly pothological studies at the bed side Psychological and soviological Studies ha\c an important part to play ] ven so, It IS not yet appreciated, how intimately disease and social circumstances aie interrelated The whole natural history of the disease, m human commumties as well as m individuals is npe for the fuller and more exhau tive study ” In all medical colleges in India, a department of social and preventive medicine should be established under the charge of a whole time professor, who should be assisted by an assistant professor, and a lucdical officer of health who is in charge of a fully organised rural health centre In this centre there wll be a health educator, a public health nurse or a lady health visitor, sanitary inspectors, assistant surgeons and a public health engineer In addition to the provision of laboratories m basic subjects m medical colleges and the dm cal section of the teaching hospitals, laboratories should be provided with controlled urban (200 000 population) and rural (500,000 population) communty fields for the investigation and the teaching of Social Medicine The essential features for integrating Social Medicine m medical education are the theoretical, praaical and the social aspects, With the end that the atm of instruction should be (a; to industrial and social factors and accompanying problems which disrupt the normal functioning (b) to tram the students m the j practice of social investigation to enable hon to use the appropriate social technique m the planning for therapy or aflcr- care based on the realities of each pitient’s social as well ds "medical needs (c) To bring into contact the students, with various public and private welfare and social agencies together with remedial organisations so that he may learn how these are ‘ prepared to co operate with the medical p aciiUoncr or doctor in the care of the pitient ( The British Medical Assocntion n their report of the Medi- cal Gurriculm Committee, “The training of a doctor 1918” has recommended a teaching programme winch is suitable in medical school groups The first group of subjects will serve os an introduction to the slucly of Socal Medicine, to the concept of Preventive medicine and to the emo lonol aspects of the diseases ' In the second group of subjects the trnching will coincide, as nearly as possible w th the oppropriitcchniciltrarhing and the instmciions will be given dur ng th** s'coid clmicnl y^ir The tcaclung of Preventive and Social Medicine should spread 430 mroiENn and public hhalth ■throughout the 5 years of under graduitcs’ medical studies. Their details should be as foUows The number of lioursmay be ■vaned according to the discretion of the professor who is head of the department — Introduction to Preventive and Social Medione I Year 5 Hours 2 Medical Statistics I „ 3 ,, 3 Health and Nutrition (a) Food and Nutrition, Dietetics (bj Malnutrition and Deficiency diseases II M 8 4 Physiological Hygiene, Air, light, sunshine II .. 5 5 Fnvironmenial Hygiene Ill »» 25 6 Epidemiology and Communicable diseases tyi- M 35 7 Industrial Hygiene IV „ 5 8 ^{aternal and Child health V ,> 5 *» 9 School Hygiene V „ 5 If 10 Health Education V „ 4 II 11. Mental Hygiene V n 2 11 12 Public Health Adauiustration V „ 2 13 Social Medicine V M 6 II Tlie recommendations of (he committees and conferences iield, to rcfoimaiion in the teaching of Preventive Medicine are —1 The contents of the medical curriculum should bear a direct relationship to the needs of the country 2 The teaming of the "basic” doctor should include, as an inseparable component, education in community and preventive aspects of medicine 3 Tlie practice of utilizing the services of part time teachers from local Iwdies, to teach the subject is not satis- factory A full time department of Social and Preventive Medicine with adequte staff should be established m medical colleges 4 The teaching of Social and Preventive Mcdianc should be spread during prcchmcal, chiucal and internship periods 5 Preventive Medianc should permeate the whole of medical education There is no subject ol ihc medical curriculum in which the t'*aching of some a»pcct of Soaal and Prevcmive •medicine cannot be suitably incorporated and there arc many specific situations in which the teachmg needs to be integrated with other departments 6 The emphasis dunng the prechnical period should be on the normal growth and physical and mental development, SOCIAL MEPICINE 431 adaptation of man to his enviromnent*physicaI, social and liiological and maintenance of normal health. In this period the student should be taught the concept of health and nor- mality, the medical aspect of human ecology, biostatistics and the structure and functioning of the society (social anatomy and ■social physiology) in which they have to work. The student -should be orientated in fundamentals of psychology, social anthropology, sociology, medical economics, historic evolution of medicine and demography. 7, To create a preventive and promotive attitude, students should be inculcated with the importance of preventive and social aspects of medicine. Preventive methods, applicable both ■at individual and community level, should be an important part •of the teaching of medical students. 8. Clinical conferences may be held during the precllnical period, in which cases selected to illustrate social origins of disease and multiple causation may he presented once a month in co-operation with other departments. The conference should be essentially of a “preclinical type, i.e. mainly concerned with the diagnosis of the circumstances and the condition of the patient rather than with his disease. In the final analysis the chain of infection or causation showing points where this cham could have been broken and the disease prevented has to be brought out to stimulate the thinking of the students in tenns of maintenance of normal health, social causes operatmg in disease and need for early prevention, detection and treatment. 9. The student during his training should act as family adviser of one or two assigned families with a mother and a Rowing child and a chronic case. He will thus receive, through prolonged association with the family an intimate understanding ■of the relation of health and disease to the total family, and appreciation of the importance of maintaining optimum health. He will also learn to assume responsibility for creating and raain- -taining support with the family so that he develops the baiic concept of a “social physician protecting the people and guiding them to a healthier and happier life." 10. It is very important that students come. in. <»ntactvrith the living conditions of the people, so that Uicy may know them and their importance in the causation and spread of disease. As -over 82 per cent of the people live m villages, it is desirable that students should spend about 33 per cent of the total training period in the subject of social and preventive medicine on field studies in a rural health centre, preferably situated in a com- munity project. This will promote in sludehts a communlly out- look, will enable them to mterpret health and disease in relation 432 H'iOlENC AND PUCI IC llLALTn to socnl background of the life of the people anti will help them to understand rural health nerds i he student should also be able to understand that unpeovem-m m cormiunity health ts mainly due not to t\hal »s done when people arc ill, but to the face lliai they do not becom* ill when the uivironmcnt in which th y live IS healthy The necessity of the department of so lal and preventive medicine having a rural health centre for invcAigation and teachm^j is an tln^jOus to the p ovivton of laboratories and hospital beds ior ifachin _3 ol other discipl ncs Preven ts RsMinet tn the OJtJi>ors and Indoors of Trachtns Hispilals — They arc under an oilier ol the department of the preventive and so lal m“dicmc of the college, g-ncrally the assis- tant professor who is detained specially to the hospital to super- vise the cases and the students All patients coming fiom the controlled urban area are issued record forms of a sp-cial colour, m ord*r that the sluJents and hosp tal staff are aware of th“ residence of patients The registrar notilies the nam'*s of all such cases immediately to the oOi er mcharge of that department The reports of the rctuUs of any preventive measures taken are sent for anri included m the patients hospital record The out patient depanmems of large hospitals probably oiter most favourable envtronm nt for teaching preventive m*d cine The mam pre requisiies lor tffcctive teaching in out patient depart- ment are —I A group of influential clinical lea-hcrs represent mg all departmenis 2 racilitics for diagnosis and treatment 3 A close reiatioaship b*tw“cn out patient department and the social agencies in the community 4 A close and constam correlation of teaching programmes of several elm cal depanmems 5 A p ovis on so that each student maybe able to attend the same p iticms over a nlai vtly long p nod of tone If th" pat ent IS adrnitlcd indoar the staff member gives a prclmnary genrral plan of mvcstigition The m-d i al clerk, after completing hs chnral d agnosis routines and if iht. case corn's und-r on* of the prrv ous d sgned diseases go”s to the patents horn to dcl*im nc the s »c o ccoaom c or 5 p*c fic micio b o’ogical and emalional facto s or conll els caus ng the disease and to prescrib* the preventive measures that m ly be md cated in each mstanre Ihs the siud“nl adds to his rcc< rdi of the case Then onward rounds the studenis pres*nt iMo a-pccts of diagnosis as to tlic clinical condtuonand second as to the soc al SOCIAL M£DIGINL 433 etiological factors together with m each instance, the indicated therapeutic on preventive recommendation Diagnosis and treatment are then commented upon consecutively by the cliiu* cian and the professor oi social medicine or Jus as:>istant Teaching activities include weekly seminars m which the problem* of individual paticnis are d scussed The seminar is conducted by the staff officer incharge ot the students’ investiga- tions, professor of bociaJ Medicine, professor of psychiatry, medical soci tl worker and 4 to 6 students and m some cases upto 14 students The report oj the case is presented by the student who investigated it Each faculty member discusses the aiiua- tion fiom his own point of view and questions the student with regard to the various aspects of the case The attending student participates in the discussions The student is expected to follow up his patient and later to file a supplementary report In cases of death and autopsy the case is presented at the routine chnico pathological conierence, where diagnosis, etiology and prevention are discussed jointly by the pathologist, climctao and professor of Social Medicine Some contact with village life m India has been urged since early years A technique to a-complish this purpose which is used abroad and recently initiated m India is described below — Medical undergraduates arc assigned one or more families as medical advisors and in the later years as family doctors The student visits his family regularly 2— 4 times per month over a period of three years, which may cover the 2nd 3rd and 4th years of his studies Thus the student mamtams contact with the normal and abnormal members of the family requiring hospital or dispensary care Record keeping of his observation is an essen- tial part of this scheme This family doctor plan is supervised by senior staff and such case studies provided material for group discussion Modifications of this teaching devise are numerous and the number of family assigned and the freqacncics of con tact may certainly vary On the whole it can be said that in general this activity has proved an imercstmg and enlightcnmg mechanism In addition to fa nily assignments, it lias been advocated that students pariicipaic m rural medical and health care prog- rammes for selected comtnunuics In other wo ds a community practiccfield i$ recognised as an essential part of the ficilittcs and responsibilities of deparunent of preventive and social medicine Parncipitton m heaUti surveys, disp nsary care and efforts to meet social needs of a given community constitute togcihcr an important part of a stndent’s field experience To follow up. 434 mOIPNE AND PUBLIC HLALTII selected hospinl rases to the home uill emphasise for him the prcvcrtiv e aspects of disease The fam ly mvestigatio t of cases of tuberculosis, typhoid orfilanasis, for example, wiU if ade- ■quatclv planned and supervised bring out the social and environ- mental faao'S of disease in question This arrangem"nt will also bring a student m contact \snth various public and private welfare and social societies and orga- nisations Hr sii?/ learn how and to «ftat cacfcnf, they are pre- pared to co-operatc With the physician m the case oJ a patient He util also Icam hoav financial and other helps arc arranged and can be arranged by \anous commun ly organisations Health Centre — Factors like pre\ cn tion oriH ncss and the promotion of health- logically demand a centre i n which the family doctor, the pr event iyrjii'‘^hh sgrsire<, and_the agencies for socio-m^dical c are can all be gr o uped together Tbe concept ofth s health centre was first pUred before the public eye by the Dawson of Penn report in carlv twenties It is the only natural vehicle for making Social Medicine available to people !t pro- vides under one roof a focal po nt for community health activi- lies which accept the responsibility for the conduct of the six njmi- mum basic Health services, via , 1 Control of cotTjnumcablc disea'es 2 Environmental Saintaiian v-c' 3 Public Health Laboratory Service 4 MaiPinity and Ctdd Health Hygiene ^ 5 Rrgiitrat on tabulation and analysis of births, deaths anil notifiable d seascs ^ 6 Public Health Educaiian Its activities nre both preventive and curative and the patients Will scarcely realise where preventive m d cine ends and the curative begins Emphasis has to be laid on the study of the patient as a %>hole, and stress needs to be given on stu Jy o man 111 disease instead of the discas* in man. The palirul has lO be treated as a whole and not in $egm*nts The puieit needs to be lol owed into life, instead of on the autop>y table Such a centre is usually und*T the charge of a health ofTi cr who IS trained in the techn qur of this new aparoach to Sctcial Medicine It places m the Jield not only an individual piysician but also a team consisting of public health nurse, mdwives saniiarj inspectors, health educator laboratory staff etc Tins centre may also be visited bv a parttim* dental surgeon as well as a vetennanan for meat imp ction In b g cities however it is asiumrd that the health ermre Will accotrmorJatc four u> eight gtmci al practUK n^rj, scrvii g a population of 10,000 to 20 000 and covertLg an area of one mile m diameter SOCIAL MEDICINE 435 To such a centre an effort is made to secure the periodic attendance of not only the sick, but of all persons in the area. The Centre provides medical care fijr ambulatory cases. A periodic medical examination is earned out, as a check-up of the community. It provides personal and community preventive service. In rural ureas feu m.ttcmity beds and a labour room are provided for materniiy cases and emergenc es nnvironmerjial and working conditions arc ascertained by interrogation as well as by home visiting and asseisment of health or ill hcalih is made in terms of individual, environmental and social pathology. It also serves as a ceniic for health education and recreation centre on family basis. Public and voluntary agencies work side by side to provide direct services to ir dividual and families. Financial and other aids arc ananged by commumiy organisations. Definition and Historical Evolntion of Society : — The phrase Social Medicine includes two uordi. ; social pcrtaimng to society and medicine. Society stands for (a) Jorw which means fellow or comrade and (b) •feridar which stands for a group or a community of men. Man is a socius m a socieias— an individual comrade in the group of community. Individual has two lines of growth (d) developmental and (b) social Development begins in the womb of the mother-prenatal. Then there is the natal stage and finally postnatal The post- natal stage is generally divided into (|i)mcDnataI or infant stdge between one month and one year ; (u) pre-'chool stage, 2 to 5 years, (ui)^chool stage, 5 to 15 years ; (iv) Adolescent stage, 15 to 17 years j (v) adult stage, and \vi) soaal stage when the individual is an accepted member of a small or large unit of families. The smallest unit is a village or a town. Then a zail, a thana, a tehsil, a district, a state, a nation and finally the world. An individual who but century ago had a primitive status, in the primitive society of tribal era is now rerfconed not merely a member of a family but a member of the world. The problem of the individual is accepted to be the problem of the vvorld. Consequently there has arisen necessity for World organi^.itions. like the United Nations Orgnnisations and their Special Organi- sations like World Health Organisation, Food and ^agricultural Organisition. International Labour Organisation etc. National, State and Local Organisations — to extend gincraliscd and spc- riahicd sm ices to the indstidual — •'Jhrs'* service? were created by upgrading the position of tlie individual, on local, state, national and world level. 430 mramiTE and public health Resutli from recogmitcn and tvoluUon tn the value of tndwidaal and xts lelation to a large community —The relation ship IS physical, phys o ogical and social— thcandividual reacts to the society and the society reacts on the individual Both are complementary to each other The mayor functions of a soaol life defined by an American author are as follo^v3 — 1 Education 2 Protection of life, property n d natural resources 3 product on of goods and scr\iccs disiributioii of re- turns of production 4 Consumption of goods and services 5 Communication and transportation 6 Recreational use of leisure 7 repression of aesthetic impulses 0 Expression of religious impulses 9 Integration of the individual (development of balanced citizenship and service to society) 10 Expression of freedom (poluical education) 11 Exprcssionofknowlcdgc and adaptation to invention “In the pcrspeclwc every man should have the opportunity to obtain — 1 Physiologically adequate food for proper grotvth and maintenance of sound health 2 Shelter which includes a hous^, furniture clothing and sanitary environment 3 The opportunity for developing positive health and phys cal fitness 4 An education suited to his abilities and adapted to his requirements of national and world ciuzenship along With Ciciluies for fostciwvg a spirit oC explajiauoa and adaptations to inventions and the chance to develop his Ic sure and m retirement to extent wh ch the wcaUh produc ng capacity ofhis country for the time being can offer Th s course visualises full «Qciai production full social dis- tribution and full Social utilization for the progressive develop- ment of individual and society Historical Xvolutloa of Physician and medicine — ^The profession of medicine implies service of mankind S nee the dawn ofc vdisat on, medicu c is a profession for relief ofdiscases but the relief was bnsed on the conception of the cause ofdiseascs, prevail ng social customs and economic structure of tl e soaety To begin u th at the dawn of humanity, disease and disability were atiribiited to supernatural causes such as the wratli of the gods and possession of by demons So the treatment SOCIAL MEDICINE 437 was directed to the appeasemcRtor the God, like sacrifice oflfcr- ings, worship etc. .Therefore in pnmUive society the physician was the medicine man, priest and migictan in one person. This person was a mediator between world of man and the avorld of spirits and gods. In the Rig Veda (2000 B.C.), references liave been made to such physicians. In the later period i c., in the period of Yajurveda (1000 B.C.) or in the tunc of Ebers Papyrus (1600 B C ), there was a splitting up of this complex pcisonaliiy and the priest, physician and the magician became separate persons, but the temple medicine also persisted and even now m our present day civilisa- tion it tends to exist. Simultaneously and at later stages, the disease was thought to be due to sins, disobedience to natural and religious laws, crimes or vices and accordingly the cure prescribed was the atonement or appeasement of the gods bv sacred wash, or holy- bath, almsgiving, fasting, etc The priest who practised religion carried out this function for a long tune. At a later stage csp-cially in India and Greece the cause of disease was attributed to a natural process the result of the action and reaction between the body forces or humours and the environment. Thereafter, scientific medicine started and developed with observation, dcscnpiion, inferences, cxpertmeius and recorded facts in the hands of Agnivesa, Charka and Suiruta in India, Hippocrates, Aristotle, Galen m the West Avicenna Rhazes in Persia. Unfortunately in India, medicine stagnated after Charka and Susruta. Later on Madhava came into the picture. From 800 A D. onward many works on the subject were written by \'agbhtta Chakrapani Bhabamisra and Sarangadhara. They are merely commentaries and claborar'ons on the previou'* tvorks of Charka and Susruta. Further progress and development of medicine was confined to the Ctliphate empire and the West. In the last two centuries the progress has been so spectacular in the ^Vcst that we arc now in a position to prevent many of the diseases and their ravages and increase the life span of man, although due to foreign rule in India not much progress was made in tJie indigenous system of medicine. The earliest priest physicians of Rig-Vcdic age were held in great esteem. The early Greek physicians, the Asclcpiads, ancestors of Hippocrates considered themselves descendants of Asclcpios the hero of health. They \vere laymen but they had learnt the art of healing. They needed to practise their craft by moving from place to place, like similar roving healers in our country in the same period specially the Buddhist monks. 438 maiES'E A2n) pubuc health The same practice even exists today as \sc find svandering^ medic«inis as tvell as mobile d spensarics and uniti, m many states In Greece these healers had their shops and they also used to go from place to pUec They used to charge ftc, so their position m soaety s\as not ver) high, but they svere better respected than other artisans In India and Persia during the same period, the physician was held m high esteem, but the surgeon did not command much respect In Rome the healers were slaves at first and high price was paid for them About the 2fd Century BC Greek physi lans began to migrate to Rome as they were considered superior and moic efiictent Some of them were engaged in the army Surgery started as dealing with the extraction of foreign bodies by the barbers knox^n as Shalyashastra It did not command much respect in the beginning, but later it occup cd an important posiuon m medicine and uas called the moilur of surgery In India m early days, Dlianwantn learnt the art from Indra , remcamated m fi^naras and nught Susruta Surgery In India and in many other countries, the institution of king s physicnn w*is ss old as kingship itself His tent wts next to king s in the battlefield In many countries, he had to certify the king s food before the king xxould cat it Dur ng the Orahmanic period, the physician was respected but there xxcre already Kuvaidyas or Kuhakas (from which the modem term quack is derived), was increased m number , Charak describes txvo kinds of physicians the true and the false During the Sarahita period the status of tlic physician went Ncrv low Food ofTcrcU by a therapeutist an ungrateful person etc., should not be accepted ’ (Manusimhita) It became a mere craft descending frobi father to son There was a general decay m the cultural and scientific progress It went on deteriorating till about the time ol Charak At the time of Charak and Sasruta the social position of the physician was fairly high He wis much respected While this was going on in India m Cilipliatc empire medicine grew and developed in the West and the pjiysician held an important place in the court, society and church In India owing to the foreign inv'asions and domination no progress was made in the advancement of mcdianc The physician was not held in the same social position as m oUier coun»ncs nor was he given onv opportunity or facility to improve his knowledge, to do research in his science or for the betterment of the public On the contrary the Western countries SOCIAL MECrCIND 43J> have done a lot in this direction and liavc gitcn a Jead to the world. Rcmcneralion of the physician — ^In the earl) days the physician was paid accoidji g to the sutcc*s of the ireaiment, citi er in cauri si ells or i.ird In «lic code ol Hcmmurabi (2f0 BCj, a physician’s tariff is seen, in winch ihe .mount is chaigfd according to the position of the p»tient 7 hereafter the itmuncratioii Was paid to the physician accoidmg to the result of the treatment This was i oi con«ideicd stti factory as m many cases in'pitc of the bisi < ff Tls, the di'ease piovcd fatal Thn caficr he was paid accoidirg lo his ifforts, the sysitm which IS more or Ie«s present m these days Even m Rig Vedic limes the medicine was practsed as a means oflivelihood. In Charak’s (200 B C ) period medicine was assuming a social character Charak laid dow-n a principle that the physician must ti eat free the poor, the helpless and the Brahmin it was for such patients as vvere poor, could not pay for their trcaiment, lost their earning power through illness, etc , that a number of chaiitable iiismuiions wereopened m the middle ages At that time the medicine was practiced rot only lor gam alone, r or was It always iVec It was practised for arquiiing religious merit as well as for the sake of monetary gam At that lime the practice of accepting rc\vards or gifts by the physician after rccotery ttom illness and after child birth had also uaned Ifihere was any disagreement, regarding fee, b'Uveen the physician and the patient, the matter x'as referred to “x committee of experts, according to the ruling given by KauUlya’s Arthasastra During the end of the last century, due to industrialisation, the needy pfpulation increased iremcndouily Morro\er the Tned cal aid h.-d beet me very expensive, due to costly drugs and injections commg into the market This difficulty was surmounted through the advent of , due to changed circumstances newer codes of ethics Were promulgated for the regulation of medical practice, regarding advertising, under-bidding, fee tplatiiig, taking paiiciiis away from a fellow practitioner etc Later on the \VorJd Health Organisntion drew up a code of medical ethics and m oath for the medical profession Society has ilways tried to protect itself from the abuse of phys Clan’s power by establishing st ndards of medical behaviour Ihcse htie ihcir origin in three different spheres ptt — 1 Individual conscience of the phys Clan who should re- frim fiom things which he cotsiders wrong 2. The Govcrrmeni which protects the IcgTl claims of the pliysirians as well IS the the Society against abuses of medical piofession guarding pciicnts' secrets and mal mg the physician liable for damage due to negligence 3 Ihcniedcal profession who sees that its members m^intiui iht dignity and tradiUo’'$ of the profession Fegistration of Pliystcians —In verv early days pliysiCi- ans were not Jieei scsc-in could enter to profession after olnaitimg the king s pemussion In Rome the numbti ol physicians was fixed Antomu* I’lUS lixed, that not more tinn 5—7 phys enns be allowed to practise in a cut Hie number depended upon the size of the city They were also re“64 5 1 65—74 22 75— 1 0 The above tabic shows that population of juveniles is 'crv high and the population of people nho hve beyond middle age u very lo>¥ Table HI — Showng coropir son m the proportion of popubuons \ ui those in some other countries of iJ e world Countries Percentage of total populat on 0 — ! \rs l~-4 yrs 5 — 14jrs 55 &. ibovc Indn 33 13 5 38 3 83 Europe 20 9 5 26 0 173 Gcimany 1 5 70 23 5 19 I U K 1 5 86 22 5 21 I Prance 1 6 7 1 21 5 21 4 USA _ 10 8 27 I 16 9 Africa South and Central 29 13 7 13 1 85 America 3 J 116 40 1 74 _ SOCIAL aiEDICIJJC 443- India has young population when compared with other Western countries which have aging populat.on. So there is predominence of environmental problems and infectious diseases arid tuberculosis. There is lack of capital and insufilcicncy of skilled workers. In Western countries in aging population, there arc opposite characteristics i.e., importance of degenerative diseases and medical care. There is political and ideological conservatism. Marilal Stalus Pallem • — In India an ouistanding feature of the marital paltern is the large number of child marriages which continue ricsplie the Child M.irnagc Restraint Act According to 1951 census, there are 2,833,000 married males t),l 10,000 married females ; 66,000 widowers and 134,000 w.dows between the ages of 5 to 14. '^'^irtb and Death rates and Infant mortality rates Year. Birth Rate Death Rate I.M R. 1931 35 0 23 0 179 1941 32 1 21 9 J58 1946 28 9 10 7 136 1951 24.9 14 4 124 ■ According to the constitution of India there are only 14 languages recognised m India but there are 845 languages, co-dialects including 63 non-lncJian languages J/alional Income and per capita Income : — National Income for India fot 1951-52 was Rs. 9990 crorcs and per capita income was Rs. 274.5 in that year. }yoTkins PoTct ; — Out of 35.93 crorcs only 14 32 ciores make up the uoriing force, of which JO 37 crorcs or 72 4% of the total working force was agricultural and the rest arc engaged m other professions like commerce, banking, manufaaunng, hand trades etc. •’ Principal Crops : — India js an agricultural country and the principal crops grown are rice, wheat, jowar, bajra, gram, goundnut, cotton, fodder crops etc. Patlern of Rural Economy : — There arc on ^an average 5 21 persons in a rural house. Of these 28.1% are earners, J6.C% earning dependents, and 55 3% non-canung dependents. Annual Consumer’s Expenditure —Annual Consumers Expendi- ture is Rs. 220 per person in 1949-50. Family Budget : — ^Thc National Income Committee has work- ed out the following family budget : — Food. 66. 3% Clothing. 9. 7% M44 HYOIEVB ANP FOBLIC HEALTH Education 0 7% Rs 1 6 Health 1 27% Rs 2 8 Fuel and light 3 25% Ceremonial 7 21% Other amenities Rest Average annual expenditure on clothing m rural area » Rs 21 per person It is 31 4% m West India and 13>5% in East India Average annual expenditure on foot sscar is Rs 5 39 highest in North West India and Rs 0 56 lowest in South India The Annual Expindilure on Medtctnes and Medical Services pet Person It is highest in Lasi It dia being Rs 3 97 and lowest in North India winch is Rs 1 42 fhldmsx --16 3% of ail house holds in rural areas have holdings oi 10 acres, or abo\e, 5 3% had 25 acres Average holdings in India is only 5 acres, in Bombay 10 7, in Punjab 10 m Uttar Pradesh 6 in Bengal 4 5, m hladras 4 and lo Hyderabad 12 acres Road and Ttajpe —India’s road system is insufTicient far her needs On an average, there are 6 7 miles ol all weather Toads per hundred iquarc m les of a country The development of communication is one of the major items of India’s Five Year Plans and Rs 100 crores is allotted for the purpose Physiology of Society —In case of an individual the ph>siologicaI functions arc digestion, circulation, respiration, assimilation, excretion, gro'vih and reproduction In case of society simiWr phenomena are observed They are dealt one by one as follows — (a) Digestion, which may be equiialenl to food production and food dotribution It will depend further on available land resources, stage of indusiriahsation, balance between ogriculturc and industry and on fdCililtcs of transport, marketing, stocking and distribution (b) In society the function of respiration will depend upon the type oflumg It is poor in India There IS overcrowding m houses Ihty are ill ventilated and are not giving proper protection against harmful cflects of nature like sum, ram, siorm, atmospheric pollution etc (c) Assimilation in society will mean the methods of consumption of food, the knotvlcdgc of food, and educational level for the utilisation of food SOCIAL MEDICINE 445 (d) Excretion in society will depend upon excreta dis- posal, sewage disposal, disposal of house-hold refuse, . disposal of kitchen waste, insect control, disposal of industrial waste etc. (e) Growth of society in India will depend upon birth rate, factors playing on the average expectation of life, environmental like water supply, proper food supply etc., purchasing capacity of the society, internal security and protection against external . dangers, form of Government, pattern of society may be individualistic, fdtsltsuc and socialistic etc. (/) Reproduction of society : — A progressive and dynamic society can reproduce its kind, pattern, civilisation- tradition. There are some of the principles which lead a nation or society to reproduce its kind by inflicting its nationality on other nations, by war or by foreign domination etc. Some of the following tables will give an idea of our /■ society . — Table I (A.C. XJkil Science and Health of India, Journal of Asiatic Society Vol. XX 1954, No. 193) Birth rates Guatemala 48 7 Mexico 45 7 Federation of Malaya 42 0 Ceylon 40.3 Putorico 38 5 South West Africa 35 8 Israel 32 9 ChUc 32.4 Peru 30 3 Yugoslavia 30.2 Japan 28.4 Canada 26.6 Union of South Africa 25.7 India 24,8 Portugal 24 2 Finland 24.0 U.S.A. 23.4 Australia 23 3 Lebanon 23 0 Ncthcrland 22.7 Ireland 21.0* 446 HYGINE AM> PUBLIC HEALTH France 20 4 Spam 19 9 Italy 19 e Moiway 186 Denmark 18 1 Belgium 165 Sweden 16 4 Table n (India 1955 Page 10) Population grouth since 1691 m India • — Census Year Population lU million 1891 236 1901 236 1911 230 1921 249 1931 276 19-11 313 1931 356 During 30 >cars, since 1921, there has been an increase of 1 1 crorcs m population The pattern of grownh subsequent to 1921, shotts that the growth population \^as repeatedly checked by famine and pestilence Cultivation kept pace with the grovith of pfipuldiiou before 1921 After J92J, however, it has been lagging far behind the population Table QI (India 1933 Page 13) Urban and Rural population Percentage of total Population Year Roral Urban 1921 08 7 11.2 1931 07 9 12 I 1941 06 1 13 9 1951 82 7 17 3 Table rV — Expectation of life at birth Tountnes Estim itrd for the Period tjip-ctxlion ot Iile at bi Male Female India 1931—41 32 09 31 37 Mexico 1910 37 72 39 79 Canada 1947 65 10 69 05 Pifunia 1941-^3 50 54 53 46 United States J93— 48 67 8 71 7 Sueden 1941—45 67 06 69 71 United Kingdom 19j0 665 71 2 SOCIAL iOBDICINE 447 From the tables it can be seen that the average expectation of hf« m India is the lowest and unlike ether countries, the expe- ctation for females is less than that of males Public Health IS a '*purd>asable commodity” and a modem public health piogit-mmc will depend upon the capacity of the communiiy to earn and pay Ihe follow iig table of income and expenditure per capita will give some idea regarding the same Tabic V Area tn Popula* Propor- Annual per Annual per- capita expen- capita diture on the Countries sq miles tion tion den- income basis of reve- siiy per m nue acccord- sq miles rupees mg to budget 1952—53 United Kmdom 94,279 50.033 OCO 541 I 1069 1272 India 121,700 342,114.000 382 4 65 12 0 USA — - — 1371 — Table VI — (A C Ukill Science and Health of India Journal ol Asiatic Society 1954 V«1 XX) Revenue Exptndi- ture under some items m U K and Biitish India 1938 39 Items Lnglaiid &. Scotland British India Defence 27 3% 34 0% Police K-r.. 8 0% Jails 0 1% 1 3% Education 18 2% 8 4% Medical and Public Health 22 7% 3 4% Agriculture and \ eicr naty 15% 17% Social Palbology — Pathology is departure from the normal function or diifunciion In an individual this condition leads to subnet mal or abnormal functioning of the physical and physio- logical functions In society and community, this condition leads similarly to subnoiroal or abnormal functioning of the society or community It rcdi ces the asset rondiiions and adds to liabilities Liability societies are either stagnant, unprogrrssive ommus societies Asset soactics arc dynamic, progressive and plus societies ' 44b hyoine pcbic heath Some conditions of society at large arc as follows — 1 Comparative tnfanl mortality rate of dtferenl eountne for the jear 1V50 Chile 153 2 France 47 4 India 127 2 Canada 40 7 Phillippines 101 7 Switzerland 31 1 Portugal 04 1 Denmaik 30 7 Cr) Ion 81 8 USA 29 2 Spam 69 4 Australia Sweden 24 5 20 5 '•'2 Dxpeaatwn of life at bnth of different countries Male Female Year India 32 09 31 37 1941 Canada 65 18 69 05 1947 USA 61 60 65 89 1939—41 U K 66 5 71 2 19o0 ^ Infant mortal ly conditions indicate the morbidity conditions jn infants Phenomena like infant mortality and expectation of life are the index of the fitness of environmental, ^aal, imtitu-' tioaaX and cultural needs ofn soacty 5 Comparalioe crude death rate of difaenl e«in/ri«s — Mexico 164 Japan 11 0 India 164 Switzerland 10 1 Chile 15 7 Sweden 98 Ceylon 12 0 Australia 96 France 12 6 Canada 90 UK 11 7 Nonvay 89 i Deaths at specific age groups, shoan as percentage of total deaths at all ages {Dhore Committee Vot IV Page S) — British India Under 1 year 1 5 years 10-5 years Total undtt 10 years 193o 39 England and 24 3 18 7 5 5 485 Wales 19J3 66 2 1 I 1 100 5 Maternal mortality {Phore Committee Vol tV page 2) About 200 000 %»oman die m India every year from causes associncd wuh pregnancy and child bearing and some 4 millions suffer from varying degree ol disability and discomiprt as a result of tlic same causes SOCIAL MEDIOIKE 419 6. Maternal mortalily in im^jrtaat eou tiries s — Iiidta U.K. U.S A. 20(19^5) 0.6o{1951) 0.9 (19iy) 7. At jTtalily figures from chief diseases in Indian Union. lu rate pjr 100,000 population. 1948 1950 1918 1950 Cholera 67 2f Fevers 1 14 1080* Plague 9 2 Drseutery and Diarr.ioea 69 84* Small pox 17 11 Kespt. Diseases 135 *Figmes I5J* for I9 j7. Infant mortality rate, average expectation of life, the ciude death rate anj specific death rau5, arc the indices which show what IS being d me in the held of paalic hc.tiin and social weU fare in a couniry. Fro n ihc study of above tables, it will be clear that the progresjive and advanced country s liave done much to accomplish in reducing die various moitality /igures to the mmimjni. In progrestive countries the cxp.'c.ailoit ul life for females is also higher than for males. Dut in India the posi> tion IS dilferent. Tiie reversed ptenoiiisna in wim; i is due to c luses associated with cuild beaiiiig. Deaths nm')iig tnfams and children under 10 vears of age show, that nearly half the total number of deaths are among children of 10 years of age and of this, half take place in 1st y«arol life. 5. Population percentage bp age groups Age India U.S.A. Germany England Sweden 0-15 39.8 23 I 21.7 21.8 20.8 5-50 50.6 54.6 5o5 . 53 6 55 0 50 & over 9.6 20.3 26.1 24.2 24 2 It will appear ihat the population of old people is much higher in the West, than in India but old people in the West arc looked after by tlie State and aie not a liability on an individual. Some social securities provided at State level, take care of Uicrn. India’s population is a growing p ipulatiun and not aguig population as we hncl in the case ol "West, ‘hence it has the important weakness of a growing (lopalatioa t I ck ot able bodird persons, lack oi monetary return, scicniiUc return^ unstable govcmmcnis etc. Morbidity : — Mortality rates give some idea of health p'‘ob1cm> in a coinmanity but incidence of morbidity is a bi.ucr and signihcani measure of health Oi ill health in a comniun.iy and its relationship with economic 'status, with liousiug aud 450 mCIESE AND PDBUO HEALTII other environmental conditions with ovcrcroMding with the amount and kinds of mcdicat care Besides, there is a relation ship between th** morbidity and mortality rates In India 200 000 mothers die iroro causes associated with pregnancy and child birth whereas some 4 million mothers suff r from var>ing degrees of disabil ty and discomfort 2 mil! on people die from Afalaria every year and 100 million suff r f om It Similarly 500000 die from tuberculosis and 2 5 million sulTcr from it But morbidity report ng is less efllcicnt than mortality reporting Many persons consult quacks hakims and vaids, who do not keep a careiul record of iJicir cbiniele Besides ihere arc people who do not consult anybody and leave ihcir sickness to the mercies o*' nature So one has to glean up figures largely from surveys conducted in ddferent countries of the world ^s regards the incidence of disease, malaria has const tuted €1%, measles 10% diarrhoea and dysentery 38%, other fevers 1% t)phoio fever, influenza and pneumonia 0 6% of total sick* ness 4 4% population hid hookw*oriii inr<*ction and 3 7% round worm, Haemoglobin deficitncy seems widely prevalent The morbidity rate is found the highest m infancy and quite high in lower agv. group It can be said with some certainty that India is the largest reservoir of infection for cholera, smallpox and plague Their morbidity and mortality vary from year to year In addition) there are endemic diseases hie leprosy, Glariasis guincavvorm and hookworm Preventable diseases impose a heavy burden m ihe loss of productive powers due to non fatal but disabling iKncSs as well as expend ture on med cal and institut oml care In the United States of All erica tuberculosis costs SiO million dollars for med cal earn and other services Sinton esiimaicd that malaria m India involved on economic loss of 80 million pounds a year Both in urban and run! area (he health conditions are very low The causes of low level of health in India arc — (a) Lack of provision for an environment conducive to hcalthfuMiving such a Unhygienic houses overcrowd ing low standard of samtitinn primitive metl ods of c llrciion rimoval ood disposal of refuse, cacrcia, unsafe water supplies, breeding of flies and mosquitoes etc (b) Lack of adequate nutnton Food consumed is in- sufTicient from qualitative and quantitative points of BOCIAL UEDICINE 451 vjcw In about 30% of families, it is deficient m calories and energy tequ rem nts The diet is ill- balanccd and deficient m vitamins, fats and protems of high biological value (c) l.ack of availability of health protection to all mem- bers of the communiiy irrcspeciivc of their ability to pay for it This will be clear from the following table of the strength of qualified he'ilih pcisonncl m Indian Union in 19a0 (A C Ukil s Journal) — Total Ratio of population Doctors 59 317 1 6019 Nurses 10,000 1 33 700 Health Visitors 600 1 595 000 Midwives 12,000 1 29 750 Pharmaejsts 73 1 4 760 000 Dentists 3 407 1 104 704 Comparison tn provision of seroices and qualified personnel Populat on served bj> A bed A doctor A nurse A midwife 1 British India 4,000 2 If 10 years pro- 6 300 43 000 60 000 gramme Bhore cozunuice is implemented 971 2 000 500 4 COO 3 UiiUed Kingdom I4I 1 000 300 628 The number of doctors employed m public health duties is 1,206 of whom 317 possess public health qualification A little over 50% of 300 d 8ti lets in India employ a medical ofiicer of health, the rest arc still unprovided for The total number of sanitary inspectors emplo>cd is 3000 One health visitor for 400 000 population a midwife for 60 000 cannot even touch the fringe of the probhm ol health The shortage of personnel combined with insuBiciem number ofhoT tab dispensaries the quality of services rendered, the shortage of food low literacy, lack of proper health education facihties, unh>gicnic surround- ings unfavourable conditions for wo k and rest substandard and low standard of life, lack of legal implementation all contribute towards chronic asthenic morbidity m India India stands at the present moment from public health point of view behind United Kingdom ly 100 years, USA by 7a years and Russia before ihe revolution Diagnosis —Diagnosis precedes treatment, is equally true both for clinical as well as Social Medicine, for there is a definite analogy between the study of diseases m the individual and 452 niGIEVE AXD rUJJLiC HEALTH diseases or itl health m the group or community The clinician IS as much interested in the mJividuat as the soaal medicine man in population group The efficiency of diagnosis in chiiica ] xnedicinc is due to availability ol standardised instruments like stethoscope ophlhalmoscop* etc , but tlicrc is no such specified instrument in social medicine though there haTC been specialised methods of exam ning the group or community These specified methods arc mcluded in the teim 'survey* Types of survey — ^There are livo types of surveys i e general and special The gtntTal nirvty — It is earned out by means of a schedule or schedules v-ith or without addenda tvorked out for these schedules The general hcalih survey reveals the influence of social env ronmcnial, economic educational and culluni factors and others on the incidence of human disease and disability Consequently it seeks and promotes measures other than those usually employed in the practice of rcm-dial medicine against such forces which interfere with the full development and mam tenance of man’s mental and physical capacity Spetiel survey —It provides only Imted information about the socul factors and other factors involved m any specific disease or disab iity m relation to social conditions with lamiiy groups or cummunity Specific surveys have been extensively used for the study of disease and disability associated with occupation But logically a general survey precedes a special health survey, so that the clTcct of multiple factors on a specific pioblem ts crystalised Cfwmi »rp^ IS generally conducted vnh the follow- ing objectives — 1 To obtain an integrated p ct ire of the health conditions of the population and of some of die factors likely to influence the state of the ccmmunity hcalih 2 To fnd out the mam health problems of the community and to delrimme if possible ilicir lelatae importance thus hclpM sng In the fnitnation of a progressive and baLrccd public 1 ealib policy for better lieallh protection 3 To serve as the base for assessing the extent of progress that mighi be arliirved as a result of specific health measures, by carrying out periodical survey ofspecul types 4 To eollcrt material and to obtain a deeper appreciation of the health problems for pu poses of irarhmg 5 To evolve a complete scheme of general health survey for use in dinVreni parts of ibe country with lucli modifications as local conditions may warrant SOCIAL MEDICINE 463 The General Scheme of invesdg^ation is as follows 1. To dicp a theoretically sound sample of population. 2. To investigate all individuals included in the sample, wth regard to tbcir biological and social characteristics, amliro- ponutne measurements, state of health and disabilities at the time ol investigation and during the past 12 months, suppoited by rapid chnical and hthoraiory examination, with special refeicnce to nutritional assessment, 3. To reinforce the genera! investigation of individuals with special investigations Jor married women, infants, pre-school children, school children and pregnant women, 4. To inve’itigaie thoroughly the cases of such people for arriving at a diagnosis and general investigations of the circum- stances in which the cases ol notifiable diseases arise. 5. To classify f-miUcs with regard to socio-economic and biological characteristics. 6. To assess the sanitary conditions of houses. 7. To visit villages for pu p»scs of study of environmental conditions and special otgantsaiiuii wnh particular reJerence to schools, hospitals, other coipuraie activuies. 8. To take in’o account the woik of voluntary organisations working in the area, thcir constitution, official status their range of activities, thces Slate Insurance Act to provide b‘'ncfits i enploytes m case of sick- ness, maternity and cmplo)mem injury and d sablcmcnt This act IS the first of us kind in the whole of South East Asia It was amended in 19jl to meet the objections of employees m Delhi and Kanpur on the grounds of increased cost of produc- tion, Scope —The act at present applies to all perennial factories using power and employing 20 or more peisoiis It covers labourers employed directly und indirectly and also clerical staff It does not apply to persons %vhosc total remuneration exceeds Rs 400/- a month There is a provision m the Act to extend the benefits to other classes ot labour, sucli as aguculiural, coiomcrcial etc Administration — scheme is administered by Employees’ State Insurance Coxporatioit^onsistmg of the following — (a) Labour Minister Government of India, Chairman. (i) Health Minister Govemmciitoflndia, Vici Chaiman, (c) Not more than five persons nominated by Cmtral Government of whom at least 3 shall be ofiicials of Central Government (d) One person representing each of the part A and part B States m which ihe act is in force, to be nominated by the State Governments concerned, (e) One person nom nated by Central Government to reprcsi nt part C S-ates (/) Five persons nominated by Central Goveirmcnt representing employees. is) Two persons nominated by Central Government re* presenting the medical profession (A) Two elected by the Parliament. 4S6 mOIENE AXD PUBLIC irE\LTU Two orthcsc 13 mcmbrrs foroi a standing committee for gencjal idmir istraiiou lucniy eight mcmbcis coiismute a medical brnciit council to advise the coiporation on medtea) brntfits ^ The executive head of the corporation is the Director General, w ho funi tions through a net work of rrg onal and local ofiiccrs There arc Regional Advisory Boards, which includes representatives of cmplojcis employers and Suite Govcinmcnis Source of income — The income of the rmplQ>ers’ State Insurance comes fioin ih cr sources — 1 Cuntributio is from em- ployers at the rate 'peciHed b> the act and the luhs fiLmed at vainustimci Iivansfou — ISnPtoRs 1 2o nP per week and voiks out to b* from 2 to 2 o% of thier wagts rmployces with average d Illy wage of 1 s than a rupee arc not required to pay anything but thrir rmplovrrs are not exrmp ed 1 he contribu tion is pi>rtblc by employers only m implemented areas 2 Unlike contribution fom employ res which is payable only in imphm niid aira, the iniploKis comnbution is payable throughout the coumiy irnspio >e of the f ci whtthcr tie ton ccin IS coveted or not In the original act this comr bmion tvai on a graded scale like that of employees’ contnbulion, but roughly double of the laitrr In the amended act oDOol* this is lepiated by what is called “Special comnbution ’’ 1 his is appli- cable only til 1 1 such time, as the s«i is implm ented in iht wiiole country At pr sent it 'imounts to 5% • f the total wage bill, in unimpiftnentid areas and Il% m implemented areas The dif- ferrt cc of i% IS due to the fact tlat the resi’onaibihly of the employcis >is legards Uorkmm* Compensation Act is taken over by the rorpoTation vn m plvTOcnVed ase%s This cowtrvbwvwiw « liable to be increased as tlic scheme is imphmcnted in more areas subjr ct to a maximum of 5% 3 The Cemrnl Governme«»t has contributed 2/3 of the con of administration of the scheme for the first 5 years The State Governments’ contribution, which was l/3rd uplo June, 19a1, has been revised to } of the cost of medical benefits provided to the insured persons n rhcir rr»p ciive areas with tfilcl from July 1954. I here IS a provision fur the coiporatK n to receive loans from the Central Goveinment or any individual itc The latest available figures s’ ovv that over Ra 2 crorcs have been received ascQnwibutvin.ovcs Rs 17t lakhs beiv.g fiotn. employcis and Rs 39 lakhs fr« m cmplovecs A'^Benefit* — ^The following types of benefits -vre envisaged for the einpli>yecs insured in ^clones — Benejit — Th 3 IS a Cash nllcnvancc pivnblc u» workers during absence from work caused by sickness and ccrtiiied by the cotporadoa doctors SOCIAL MEDICINE 457 Thcmaiimmn bcntfit payable is for 56 days m a I"'; ^ sjaestionofeatcndiinrtnispenod for sufferer from lubctculoiis and other long-te.mdseases.s under conuderat.on 1 he rate or benefit is rbughly half the dailv wages. No benifit ts payable 'for the first two da) s of a spell of sickness. 2 . This is also a to an ‘nsured woman employee f a period of 12 ucc r mot more than 6 weeks ran p ncced luc expected date of confine- ment. It is also roughly half the salary. iJrarJil .—Disablement may -or permanent, partial ot total due to ‘mploymmt injaiy In ease of temporary disablement t.vctedii.g 7 days lie svi 1 be paid from' die firsi day f.ic am lUii, of benel, fo [^er. anaiient disiblement is decided un tiie recommtiidaiions ol a medical board. Baufi employee “ -employmeii. injary, the b.ncfit for life ccriian cases agtd parents will also get a ce • •of certain period, in form of pension. -i-,. B.-Sledical Benefit :-This provides -medical irealmtm with reasonable skill at a dnlien- •obsletries..-00 workers on his panel I his worker has a free clioicr ofa doctor in this system A panel doctor gets Rs 6 oO np m Bombiy and Calcutta for insuied worker per year and R$ 6/ elsewhere in India This includes attention in clinic, home visits if required, dressings, rout nc mixtures powders, pilUi and common mjecuons, but costly medicines cun be had from cenam app ored chemists on his recommendation The worker gets specialist skill and in> vctugatiotvs at diagnotuc ccnwcs opened by State Governments at the Suic luispiijjs on tecommciidations fiom the p >ncl doctor Here 1 vcstigutioiis like cxaminulion of blood, sputum, urine, stools, X ravs are earned out If a patient is to be referred to a hcispiial the Slate Goveniment Ivts made arratigrinent with ccriaiD sutc or prnutdy run iiospiul for their admission The usual preventive inoculations arc to be given by the insurance med Cdl ofliccr or p inel doctor 1 hus tlicrc arc two svstems on trial i r Suic Seivicc Svstcro and Panel System In pmel sys- tem, the wotker caw choose his doctor md can change him after a year or earlier if he changes his residence It is a tompetitivc scheme and hence the doctor IS always more alert and has to think of the social side of the pitien The worker, if sausGed With tlic doctor, can take his tainiiy lo him In the service system, the doctor will attendonly ihcworkcr For his Ltmiiv, the workrr liasto ppimeh anoihcr doctor A panel doctor w II get piivaic p acticc iiom the worker’s family and Uius physician patient or physician family relationship SOCIAL MEDICINE 459 could be preserved But m service system there is advantage of conirolling geographical distnbution, better overall control by the State, though the doctors arc apt to get inerhanisrd lose their independent and pmmpt action and take little interest in- mcdical rcseaich The worker dots not have a free choice and may have to go to more than one doctor m course of a single illness A state service doctor is liable to get a transfer and the patient doctor relationship carirot subsist On the whole the advantages of the panel system arc more than the State service s) stem \/^EHABlLITATION Definition — It^may be defined as any sei vice mccssary to render a duablctTpcf ao i linp engage j5 ~ a rnnuner itive o^up^ ion l7i practice'u is a seivicc ol vocatio- nal adjustment a programme of vot^tional counselling, tiaming and placement with supplementary services It is a service for creating and recreating eimi ig capiciiy for all types ofphyu^ly handicanp'*d pertons through vocational ndjust- ment not only helps produttion but u also make a the work- er happier m that he is not~denend« rtt 6d oTFiers," For his living and has thc“sat«8faction of remaining a useful member of society In rehabilitation the cooperation of the individual at all stages IS essenual v/ Evolation —The ancient and the medical attitude towards the handicapped was one of cruelty neglect, contempt and later pity vhich was satisfied bv alms giving In too many minds, even today, the word Itandirapped disabled or crippled excites sympathy and persons wlio arc the victims of the^e defects, cither congenital or acquired arc looked down upon as sub- standard people, separate and distinct from normal population Modem medical, surgical science and modern nd to \acat onal adjustment have changed this picture Physical restoration or improvement is now rhe rule rather than the exception Voca- tional preparations for other jobs is accepted as a feasible and ■successful method of making the disabled efficient, self support- ing and self respcctmg citizens Principles - The underlined principles of vocationol reha- ■abiltiation arc iiased on — , (a) The dimocratic concept of the way of living demands, equity of opportunity for all cmzcns including the physically handicapped (i) The sccicly expects the support of each citizen m proportion to his capaaty Vocational rehabilitation 1 oITrjs 10 the handicapped person and opportunity for employment and at the same ume, makes possible his duccomribuiioti to the society. H\GIEVE AKD PUBtlO nCALTH >4G0 (c) Dcpenrnrc has aho%«7i lliai most disabled persons can v.oik elHciciiiIy, ifprq>arcd for jobs campjtible with their physical condiiioas A man with a big ambition can do anything at bench itni a noimal nun of equal skill can do A man with in arm amputation may still be I C( mpct*-nt sales-man, draftsm-jn, artist or a lawyer \ deaf man is hand crpprd only in commu nicaijon ni d t oi unskilled w«h the use of lus hands Thus a disabled person has far more lOcational assets thin are lost through his impiirment ( (g) Vocation'll rehabilitation is economically sound iHflw to orgsuse rehabilitaucn service 1 Disabled persons ire lociied Uirough an organised case fmding piogrammc ind elTered ichabilitation senice, if um niploy ed or under t mploy ed 2 An eipcrt dnenosis is made of their employment needi and of their physicnl, mental and «>caiiuml resoutces S Corrective siirgrrv or therapeutic treiiment may be provided or secured, if necessary for employment 4 Prosilietic devices (1 mb«, hearing iid etc) may be provided or secured, if necessary for i mploy ment. 5 Expert counselling or guidance assists them to decide upon a suitable tmployraent objective 6 A plan is prrpirrd ouilimng the strps or services ticed ed lo enable ihc disibicd person to secure suitable employment 7 Training carefully planned and supervised, >* provided to those, who need such preparation for tmplojmciiis. 8 Munienancc during training may be provided m case of need 9 Oiher necessary services, incident to the solution ^ personal or family problems a«c provided or secured SOCIAL MbDIClLE 4C1 10 The culmmaung factor and an essential step in every CdSe IS entry mto suitable rtmuncrutive emplovanent Such placeitient is followed up lo determine its lasting success or to provide any needed adjustment HebabUitation Programme in Various Countries I. UsiTKp Statfs Of Amfhio* — Ooodvvill Industries Boston — It IS an industrial organisation and not a chafiublc institution It gives training lo the disibltd and then employs them in various bra/ichcs of iheir industry It is run on non profit, scIf-sufTncnt lines The Goodwill Ind isiries collect discarded maternls from beiween I to 2 imlhon American hom''s, provide employment to J6 000 disabled persons and give them wages of nearly 8 million dollars a year 2 Nouwav —League for Cripples runs four hom“s where cripples receive vocational training 3. EnousHu —-Disabled Persons Co operation Ltd A private enterprise to organise factories, where disabled persons may work under siiehered cond t ons, has been established HebaViUtation as a Socio Economic Field —Its vast economic poicnuahtics are just beginning to be appreciated tnd an ideal field for medical social workers Any unt al invesixn'nt for retaining, adjust ng and preparing a disabled person mil give a very good ecouom c retuin both to the md viduai and the community , over and above the removal of society stigma and social JiabiJuy REFEBENCES 1. A note on ^‘Definition” by R K Anderson of the Rock Feller Foundation 2 “The meaning of Social Medicine” by Lago Gladston MD 3 Dutta-Mcdicine and Social Welfare 4 Lecture notes of D' K- G Patnaic, MBBS, DPH, M P H , Dr PH John Hopkm’s A«;soc»ate Professor ofSoctal Medicine, AH India Insmuie of Med cal Sciences New Delhi, on Public Health Adm mstration 5. A treatise oti Hygiene and Pubhc Health by B N. Ghosh 6 Fundamentals of Personal Hvgienc bv Krueger. 7 Preventive Medicine aod Public Healtb by Wdsoa, G Smiihc. CHAPTER XXr VITAL STATISTICS Bv Dr Jacjjt Sivoir m.b b s (Hovs) d r n,, (MEIML13t) B a (STATISnCS), P.II.S. There arc three known methods of gaming scientific kno>v- lledge intuitive, cxp'nmfint il and stitis The power of correct intuition IS very rare and IS found o ily m very few gifted indtvi* duals to any marked extent The cxp*rimcntal m*thod requires strictly controlled conditions. %%hich are very diffi ult, it not impovsiblc to achieve m human beings The only way open to a m'dical man to increase his knowledge is field studies infiucnced by multiphnty of causes, and to analyse the findings so as to determine the exact mHaence of each cause or condition. This is the statistical method -^he science of Statistics has been defined as a study of the methoJs applied m colic ung, analysing and interpreting quaiititatwc data m a department pr^nquiry Statistics arc figures arranged m such a manner as tolirmg out any significance ivhich they may possess VlTAt. STATISTICS '^ital statistics arc stiustics relating to the life hi«toiy of communities oi nations They include the events of origin, continuation and lermmation of theJives of pcople/^Ravmoiid Pearl has defined it as the spcaal branch of Biometry which concerns itself with the data and laws of human mortality, natality, morbidity and demography In recent years, the term "Vital Statistics’’ has been used to denote facts, systematically collected and compiled in iiumen* calfuim, relating to or derived from records of vital events, namely live births, deaths, Ibetil deaths, marriages, divorces and the like laiPORTANCE Vital statistical data truly constitute the bookkeeping records of any nation When somebody com“s to you for a medical check up, you take his temperature, count his pulse beats measure his blood pressure, count the proportion of various blood cells and look tor the presence of specific diseases But what about a comm imtv ? It alssnecdta periodic check up Is It a heilthv community or has it som; d isca^M ? What diseases*’ The period iccbcck up ot community health depends mostly upon recording cominuoiisly and completely, ail vital events in each individual household And there are vital tstatistics vTlicy give us comple c information about the life VITAL STATISTICS 4C3 history of a community which can be obtained in no other way. They furn ish the means of comparmg tne life_history„ol_a ^roup or nation witlTtliat ' of, ot hers a nd of~tfie present with the _pasl. The vital statfsttes j^cscnt_ a* picture olTinre^tate-of adjustment of thejx>mmunity to environments. They help us to plan the policies and programmes ol public health and to ■assess tht results of such programmes. SOURCES There arc thl£e^03«CtU-gf_yital_sta tistics n am ely census, registr ation a nd su rvey Census is an actual count of thTe popula- tion at a particular moment Registration is recording an event as and when it happens. Survey is a specially carried out collection of all data and its detailed analysis. CELSD8 'Census is a count of the whole population at a particular moment, theoretically instantaneous Jt indicafes a cross-section ■of the population at that particular moment. In practice, it is taken during one particular day. The first census was taken m Sweden m 1749. In India, the first census was taken between 1867 and 1872 and was repeated in 1881. Subsequently it is being done at an interval often years. The last census was taken on 1st March, 19ol. 'Despite precautions, many errors occ ur m the census. 5oine of the p^ojjIc are missed, others are counted iwicc.*^ Crrors in j:he_rccorded Jigcjirc most frequently met with In India, a good majority ol people do not know their exact age, others do not give ihcir exact ages because of indifTei cnce. ESTIMATID POPULATION FOR ANY INTERCNKSAL YEAR. It is estimated by the following methods ; — 1. Natural increase method Est mated popuIation=ceasus Population plus (births— deaths) plus (Immigrants— emigrants). "^2. Arithmetical progression method: Jt_is ^ assumed that the ropulation^mcreascs in__aruhnictical progression, .that is by the same number, every year. Example : Let the population of a town is J931 bc« 142,427. 4G4 maiENE AND PDBUC HEALTn Let iis population in I9JI beaiI3l,237 Increase m icn yeafs=» 142427 — 331,217=1 1,190 Annual increase in popuUtioi = li, 190/10=1, 119 population in 1960 i c 9 years after the last census-* 142,427 plus 9x1, liy*l52,4JB ^ '3 Gcomctiical progression method It is assumcdjtliat the population mcrcuscs lu gcomcutcal progres sion i e , the raiioui population ol any year lu inttof tiie previous year is the Some Ehujnple 2 Let the population of a town in 19ol bc= 142,427 Let us populations in 1911 be=*13l 237 It the dill udi rate ol growili be r, 12 log raalog 142 427 — log 131.237»o 153o924=3 I lbUou3=U UiS5i61 log r»O,00u3o5iG Log of the estimated population m 1960 te 9 years aAer the Isi ccusus=5 ljJaJ24 plus 9 (U iX)3aj36)=3 18o374U population m 1960=153,312 4 The inhabited house m"thod. This method is of particular use m towts, where the house tax is in torce The total number of homes in the towt is oo amed ^from the tax registers Thisnumrertt m titiphetl by the average n im jer of ttihdbiiaius per h luie as as^'crumeJ in the prev ous census An addtion of one p rson is midc f>r every uninhabited house Tins accounts tor beggars, sadhus aad other paacment dwellers nroisTRAriON It IS the recording of an event as and when u happens In a number of Western countries rcguiratum of all viut events le births deaths xn»ny diseases, and even marriages and divorces IS ccmoulsory Inourcouairy the vital registrit on ii done for births and deaths only T i« is also very uniaiisfictory especially in the rural areas Inc system of registration of liirihs and deaths was 6rn introduced in India in 1863 Generally speakit g a registrar or sub registrar s appointed for keeping ihc records of births and deailis m a particular It c.ility In the rural areas he is usually th*‘ police ofTi er inchargc of thelhana or Pol/ce Statsun In towns, the Health Officer or Sanitary Inspector is usually the registrar The period witlun which births and deaths shoald be bought to the not cc of this olficer dilft-rs at d irwreni places, voryti g from twenty four hours to two weeks VITAL STATISTICS 465 In registering births the following particulars are usuallf •noted — ] Date of Hrth 2 Name (if any) of the child, 3 Sex, 4 Name of father and grand father, 5 Occupation, 6 Address, 7 Name of reporter, 8 Date of reporting, 9 Name of dai or attendant at the delivery, if any, 10 Name of motlier, 11 Age of mother, 12 Parity of mother The following particulars are usually noted in registering deaths — 1 Date of death, 2 Name of the deceased 3 Name of the father or husband Cm case of marrietS tvoman} 4 Sex, 5 Occupation, 6 Age of the deceased, 7 Address, 8 Cause of death 9 Duration of last illness, 10 Name of reporter, 11 Date of reporting In tiic rural areas of most of the States of India, the chaukidar is the primary agency responsible for the recording of the buths and deaths His illiteracy and ignorance b esides his per occupation with other” duties (wlucti he considcTs more impomnt) are well known He is expected to record all births and deaths occurring in his beat (someumes three or four 466 HYGIENE AND PUBLIC HEALTH Villages) in his books and to rqiort them fortnightly to ilic neir* est police station ^Vhat actually happens is that he catches hold of any conveniently available scrat-htcrate person just before going to the police station and gets entered m his registers particulars of all births and deaths, he can remember at the moment He [does not worry about inaccuracies He just wants some entries to be made The primary reports of vital events are recorded by the registrar, as above described, who passses on the data to the District Health Officer or the Civil Surgeon through the Superintendent of Police or the District Magistrate The district figures are then passed on to the Director of Health Services of the State, who periodically publishes them. The all India figures arc published, Statewisc, by ihc Registrar General The mam defects of the vital records of India as main- tained by this method are omissions lack of uniformity in com- pilation, inaccuracies with respect to the cause of death anSDICtL CLflTIFlCATION OP CAUSE OF DEATH The correct recording of Viial Stausiics is of the greatest importance if our countfv is to prosper and progress is wcllknown no enterprise, business ai,riculture industry or my such undertaking can succeed unless we keep full accounts of Its income and cxpendiiurc When we are dealing vMih the much nioie impornnl enterprise of human life to keep an account of hen and where people come, and hou, when, and nhy they go awa> is of supreme importance Of greatest importance m this connection i$ the cause of death, so that stqis may be taken to prevent u incccssarv /oss With this object m mind it is desirable that all deaths cspcriaUv iliosc occurring m all the towns and m all villages where dispensaries ire situated should be recorded on the International Form of Medical Ceriificanon of Cause of Death This form was first devised by the Si’clh Decennial fnter- national Revision Conference, meeting m Pans in 1948 It calls for statements on the morbid condition, directly leading to it the underlying cause of death, and cofitnhiitorj condi- tions In order to obtain correct factual data U is essential that you should ffcalisc what is required of you in using this form This form (Figure 1) pl-«ccs upon the Medical Officer the responsibility of mdicatu^ the exact course of events leiding to death 46S HYOIEVE AND PDBUC HEATH TTic following directions should be kept in mind while filhngr m this certificate — (i) Name of deceased To he given in full Do not use initials If deceased is an infant, not yet named at lime or death, ivrite “Son of" (S/o) or “Daughter of’ (D/o), followed by names of mother and lather ^ii) Date of birth please trj to ascertain this in the largest possible number of deaths It is of great importance from botli the legal and statistical point of view fill) Age This should be stated whether or not the da e of birtn has been gn en If deceased is more than one j car old give- age in years last birthday (completed number of years) If under 1 year give age in months and days If tinder 2Htours gitcago m hours and minutes (iv) Cause of dea'h This part of the form should always be completed by the attending physician pcrsomiUv The certificate of death is divided into it o pans I and 11 Part I IS again divided mto three pans lines (a) (b) and (c) If a single morbid condition completely cjcpi tins i)jc death ilun this will be wntten on line (a) of Part I and nothing more need be writientn the rest of Pirt I or in Part II lor example, small pox lobar pneumonia cardiac betihen are sufTicicnl c luscs uf death and usualh nothing more is needed Often, howeter, a number of morbid conditions w ill I ate been present at death and the doctor must tlicn complete ihe- certificaic in the proper manner so tl at the correct undcrl) mg' cause will be tabulated Pirst enter in Part I (a) the immediate causes of death This docs not mean ihc mode of dv ng eg heart failure respiratory failure etc Ihcs** terms should ot appear on the certificate at all since tl ev me modes of dying and iiot causes of death Next consider wheiher ilie immed ate cause IS a complication or delayed result of some other cause If so enter the antecedent cause in Parti line (b) S permit the isolation ol the factor responsible for t particular result It IS necessary therefore that this control group be similar to the group under study in all respects except the object of study Rates and Ratios —Ratio is a relationship bct%sccnu«> members. Rate is a particular tjpe of ratio It is a rclalionslnp between the number of times a specific kind of c\cni occurs and the number oT exposures to the risk of its occurrence Birth Rates — Crude birth rate It is number of live births m a spcci f^d t m e in *i spccifed_papuIatioii usually m a year per thousand population Crude annual birth rate Iso oflive births m a >earx 1000 Mid year Population Annual crude birlli rate based on weekly and monthly 1)111113 IS calculated as follows Crude annual birth r^te ^ No of births m a week x 52 x 1000 Mid year population No of birtlis m a montiix I2x 1000 “ Mid year Population Age Limited Birth Rate — Allhogh the crude birth rites will show the general trend overt me and tlic tpproximiie levels of natality among different geotrrapl ic areas a rate based on die population w I ich more closcl) corresponds to ihc group “exposed to risk is moic memingful for certain purposes especially for intemaiional or inter irei compirisons The numerator of the refined rate would remain the same as the crude mte but the denominator would be 1 mitcd to the age sex group of die popidatien able to coniributr to the birth rate^ The formula for such a rite known as the age limited hve- birilisratc’ is given below m terms of the female population — Number of live births which occurred Annual age lirat amongl the popuhtion of a given ted live birth geographic arct during a given year rate (also known X 1 000 as a * fertility’ Mid year feinnic population of ages rate} 10 to -49 in the guen geographic area during the same > ear Foetal Deaths — Tl c fgurci of foctil deaths should neither^ be included in the births nor deaths m the oFicial records Tlicy should be compiled scparatel) and compared to- live births Foetal Death is death prior to the complete expulsion or extmcuon from its mother of a product of conception irrespective- VITAL <5TATIbTIC5 471 of the duration of pregtiaacy the death is indicated by the fact that after such scparaiion the foctvs (}ocs not breathe or show* any other evidence of lift* such as betting of the heart, pulsation of the umbilical co d or definite movement of volun tary muscles ^_^Stillbirth — It IS defined d^s^non'jmousuithlatc foetal death, that IS, of twenty eight competed \%ctks of gestation or over Death Rate — It is calculiced m thesime uay as crcTde birth rate that is numbei of deaths m a specified popula tion m a specified time Crude death rate No of total denths m a year x 1000 Mid j car population ^ Annual etude death rate based on iveekly or monthly deaths IS calculated ns follows — - Crude annual death rate No of de aths m a iv cck 52 X 1 000 Mid year Populat on No of dead s in a month x 12 X 1000 ** Mid year Populaiion Specific Death Rate — Mortality due to a specific cause or alfiongst a selected group of persons specified according to age, sex, occupation etc , is called the specific death rate Specific dath rate No of deaths in a specified classs of popuation m one years X 100 0 No of persons exposed to the risk ol dying in a specified class of population '■’■'Age specific death rate — No of persona dying in one year in the age group eg of 10 15 yearsxlOW . The total No of persons m that age group fcg"" 10-15 years) Age Specific death rales are comparatively higher at the extremes of life Sex specific death rate is usually higher for males m all developed countnes but m under developed coun- tries like India, it is higher for females m the reproductive ngc group The healdncst period ofhfc in India is between the ages of 10 and 25 Specified death rates may also be calculated for dilTereijt occupations In order to calculate it, the number of deaths occurring among those engaged m a particular occupation and the total nurober of persons so engaged must be known 47: mCIENi: AND PUBLIC niLVLTH Occupation deatB rate — > Isiiinbcr of deaths occurring in a year among those I engaged in a particular trade or occnp ationx 1000 ** Total No of persons so eng iged ’ Generally speaking mortality n h ghcr among industrial ■workers pirlicularly those engaged mjuie textile paper and iron mills mines at d them cal factories Standardised Death Rate — In comparing the mortality condilions of a number of places or mortality conditions in the same place at diffc ent periods of time the respective crude death rates cannot be used because sucli rates ore often affected considerably by the ige and sex consmiition of the population concerned The fact that the crude dnth rate of one place is h ghcT than of another pKcc is m itself no ctidcivcc of ^^or5e mortality conditions in the former place Any population con taming many persons round about the ages of 10 to 23 nlicn the death rate is at its minimum must hate a lower total (crude) death rate tlian that of a population cor taming mmy infants or old people at itluch points of life the death me is rclitivcly high, even though the age specifc death rates for nearly all nges m the former population may be h gher than those in the latter. Again comparison of death rates may ilso be affreted by the sex propor- tions of the populations considered, for at most ages md from most causes fenules generally s ilTer a lower mortality rate thin males except dunne the child bearing age It therefore follows that crude denth rates should be correc- ted to allow for differences in the age and sex distribution of the popuhtion This may be done by the use of what are called standardised rates that is by theoretically equating the age and sex compositions of the different populations ^IhfaDt Mortality — It denotes the deaths of inf inis (below one year of life) la a community It is the best known mcaiufc of the effectiveness of public health measures m any eommiin ly Infant Mortality Rate Number of deaths diinng the year of children under one year x 1000 ”■ No of (ive births during the year Other things being equal mfant mortality rate is higher among male than female children as male ch hiren are more deli calc and comparatively more difticult to rear than the female onc^ ^ Neonatal Mortality — It denotes the mortal ty of lAfanW within four weeks of tlicir birth Neonatal mortniily rate No of deallis during the year of mfanis under 2(1 days xWO ^ No of live births VITAL STATISTICS 473 '''■'"’^Maternal Mortality —It denotes the mortality of mothers “who die during" pregnancy, child birth or as a result thereof "Maternal mortality rale No of maternal deaths m a > ear m pregnancy, childbirth or as a resul t thereo f x 1000 No of total btrilis m the > ear Perinatal Mortality — ^Because there is rcasion to believe that some deaths during the first week of life are inadvertently or deliberately registered and counted as late foetal deaths, and because the problems under!) mg late foetal mortality are frequently related to those causing mortality during the first few weeks of life, some investigators have suggested combining data foobtamonc rate which could measuic the risk of dving during the period near parturition, also known as the “perinatal” period •O^Morliidity Statistics —The registnuon of diseases is m- complete, even m highly developed counincs In India and other underdeveloped countries, where even the registration of births (%nd deaths is inadequate and incomplete, almost no statistics of diseases are available They miy, however, be obtained by a s pecial surv ey, that is recording all the cases of a particular disease occutring m a particular area and a particular period of time The findings may, then be described in terms of the incidence of/prevalence of the disease m that particular locality Frequency of il'nesscs commencing during a yea r from a porticuJar cause x 1000 Total mid jear population No of Cases suffering from a par- ticular disease at a particular in- stance of time X JOOD _ Incidence Rate= Point Pravalence Rate Case Fatality Rate population at that particular time No, of deaths among cases of the disease for which rate is to be calculated X 1000 No of cases of the disease or persons suffering from that disease Mean Duration of Life or Expectation of Life at Birth It is the average number of years which persons of a given locality, group or community live, assuming that they die ac- •cording to a given table of probabilities of fife, i e., according to a life tablei 474 n\aiESE AVD PtTDUC I1E\LTH life Table —It represents generation of individuals passing ihrougfi I fc to extinction The table furnishes the mean duration of life or the expectat on of life at birth and also the avcraj,c length of time a person of any age may be expected to- bve STAllSTICt-L LtlHENCr Statistical evidence of the health of a community is furnisli- ed by the follot\ang — h^Crude death rate 2 j Infant mortal t> rate 3 Maternal ftfortaljty Rate 4* Expectation of life at birth 5 Perinatal niortaht> rate Vital Statistics of India and Puryab The population of India (1961 census) is 436 424 429 Tlie populauon of reorganised Punjab (1961 census} t» 202 98,151 The density of populaton m India (1961) is 384 per sq mile The birth rate of India (f9a6) is 30 70 per 1000 The birih rate of Punjab (1950) is 40 4 per 1000 The deal*’ rate of India (I9a6) is 13 41 per 1000 Ihe death rate of Punjab (I9a8) is 15 0 per 1000 The infant mortality rate of India (195S) is IIG per lOOO Uve birilis The infant mortalitj rale of Punjab (19591 « 97 12 per lOOO h\e births The still birth rate of Punjab (1958) is 9 So per 1,000,000 The maternal mortaIit> rate of Punjab (19 j8) js I 21 per 1000 live birilis The spccifc death rates ofsome of the most important caus cs of death m Punjab (!9 j 8) arc Cholera Small pox Fevers D>sentery and diarrhoeas Respiratory diseases Injuries Other causes 0 OOOj per 1000 0 02 per 1000 9 94 per 1000 0 45 per 1000 2 15 per 1000 0 19 per lOOOr 2 20 per lOOO VITAL STATISTICS 47i TABULATION Human mind cannot easily grasp the significance of a large volume of statistical data Glassification of the information and setting out It in a tabular form provides one of the means of achieving this purpose The process of tabulation consists in ar- ranging in such a ^vay that like is associated uith like and facts vvluch relate to different characteristics arc arranged in mutually exclusive categories A good table throw* into relief the important featmes of the data, economizes space and provides a convenient method by which various combinations may be easily read, compai'ed and interpreted A table must have a suitable title which should be clear and precise Explanatoi> notes and definitions should ac- company the table when ever necessary Table must be num- bered and also referred In a frequency table, all the observations are classified ac- cording to suitableclass-rntcrvals and the number of observations having values m each of the mtcnals is given against each inter- val (see table I) Table 1 Frequenc) distribution of the weights of a group of new horn infants m Ferozeporc (1958) Class interval Less than 1500 gms Frequency 23 Class interval 2400—2499 gms Frequency 1483 1500—1599 „ 117 2500— 2o99 „ 1243 1600-1699 „ 358 2600 2699 „ 1137 1700—1799 „ 432 2700-2799 „ 839 1800—1899 „ 631 2800—2899 „ 743 1900-1999 „ 783 2900—2999 „ 542 2000—2099 „ 820 3000-3099 „ 231 2100-2199 „ 1024 3100—3199 „ 120 220J— 2299 „ 1256 3200—3299 „ 58 2300—2399 , 1361 — Total 13221 When observations arc made on two attributes for each in- dividual the data can be classified according to both the attribut- es simultaneously fsec table 2) m order to depict the nature and degree of association between them Table 2 Relationship between nature of food and Nutri- tional sta tus in a group of stu dents of Simla (1959) NUTRITIONAL STATUS Good Bad Total Vegetarians , 53 78 IJI Non-vcgetarians ^ 123 114 237 Total. 176 192 368 47C HYGIENE AND POBLIC HEALTH ^Vhen abscrvaUons on two mcasurcible charactcnstJcs (con- tinuous variables) arc made on tbe same slI of individuals, the data can be thrown out m a tabular form as in table 3, m order to know the nature and degree of the correlation existing bclufen the characteristics Table 3 — Bivariate frequency table shotvmg the infant and maternal mortality rates, per lOOO live binlu for 48 dificrcnt towns of the Punjab 19 dU Infant Milenul Mortality Rates lor 1000 live births Total Mortality ■ . ■ ■■ Rates 0 0 023 026-0 50 0 50.10 1 0.1 50 1 50-2 0 2 0-3 0 50 to 7o 3 2 1 — — — . « 6 7G to 85 4 9 5 1 I — =20 86 to yS — 3 I 3 — 2=9 goto 100 — 1 2 5 2 — «10 100 to lOo — — — — 1 =» 1 105 to 100 — — I — — — = I ll0iot2Q — — — 1 — — » 1 fo'td 7 ii 10 10 5 “1 From the design of the above table it it clear that if the Ovo characters are positively correlated, then cells along the leidtng diagonal (upper left hand corner to lower right hand comer) will have more frequencies and if the Correlation u ncgitive the cells alonir the to her diagonal will have more frequencies Diagrammatic Representation — Tlie presentation of statistical maternl in grah'c form is n device fur cmphasieing salient point which ma) be lost in the mass of figures m a table* To quote the words of R A Tislier "Ditgrams prove nothing "but bring out standing features readily to the eye The> are therefore no substitute for such critical tests as ma> be applied to the data bm -irc valuable in suggesting such tests, and in ex- phining the conclusions founded upon them *’ The roost fre- quently used dnpiams are of four types, those which arc made for the purpose of comparison of things or events, those used to represent trends or changes with respect to time , those used to -distribution , and those lor ficilit-iting computatio*' In order to compare frequencies of things which very con- tinuously wc mate use of Instogniins, frequency polygons ogives etc For things which very discontinuously wc use bir dia- grams and in order to depict percentage composition, we make use of pic dngr'vms In tnakwig a histogram wc use the horizontal axis for representing class intcrvxls and the v^ ticil axis for thc-frcquencies so tint frequencies are represented by rectangles of proportionate areas By joining the nud points VITAL STATISTICS 477 of the tops of successive rectangles we ob*ain the frequency- polygon Ogive IS the sort of curve which would be got if 1000 men taten at random were arranged jn a rosv in order of their heights be^irming with the shortest at one end and ending with tallest at the other and a smooth line touching the heads of each man be drawn In bar diagrams, bars of equal width with length proportional to the magnitude of the frequency of the groups represented are drawn without the sides of adjacent bers touching each other In a pie diagram a circle is divided into different sectors, the angles of which arc proportional to ihe per- centages The commonest graph to nepict the trend of events m time is a line dngram with time plotted on the horizontal axis and frequency or magnitude of the event in question on the vertical axis In order to study the rate of change of any character, jt will be more advantageous to use stmi-loganihmic ruling in which the horizontal axis is ruled in the ordinary or antlunctic scale but the vertical axis is graduated according to the logarith- mic scale This kind of chart is called ratio cnart and if points plotted on this chart fall nearly along a straight line u means that titc statistical magnitude it represents is clianging at a uniform rate In a spot map the locality of occurrence of an e\ ent is indi- cated by a properly located dot on the map This kind of map is useful m epidemiological work In shaded maps d ITercnt types of shad ng or colouring of areas arc used to bring out sta- tistical facts In a nomogram complicated relationships among more than two variables arc represented diagrammatically and complex equations arc rendered easy for numerical solution AVEJtACES The most common measure of the average of series of measurements is the Arithm etic Mean which is obta»ned by add- ing all the observ atibiis and dividing the sum bv the number of obsenations An aJtcmative measure kneivn as Ote sn js got by arranging all _ob$ervations in ascendmg j)iL descendmg order of magnitude and piling om _thc_middle Another mclliod of expressing an average is to pick nut_the nbvcrvation or me asurem ent which occurs most fre^ cfftly and is known_as Mode ^ ” Consider the following distribution of the number of guinea pigs in 12 litters , 1, 3, 2, 2, 5, 1, 2, 3, 3, 2 4, 2 The arithmetic mean of the sizes of this group of 12 litters is got by adding all the litter sizes and dividing by 12 which is 30 divided by 12 47Q inaiEVE AND rODLlC ilCALTa 'Or equal to 2 5 guinea pegs If the Jitter sizes arc arranged according to magnitude, we obtain the order 1, !, 2, 2, 2 2 2 3, 3,3 4, 5 Hence the middle, ttvo observations are each cquil to 2 Hence, the median size of litter is qual to two guinea pigs The mode of the distribution » also equal to 2 because it has the mastimum frequency, viz 5 I he median posjesscs some advantages over the arithmetic mean If it is desired to get the median height of a group of children lhe> may be lined up in order of height and the middle child picked out without taking the actual hicasurrments of all the other children Another ad\antagc is that it is tiot alTccted by the extreme members of the group is m the ease of the iritlraetic mean Consider for excmplc the deaths from cholera m a toiMi for eleven years 0 3, 10 11, 14 14 432 2 6 5 0 The arithmetic mean of th'^c 1! observations is 15 deitlis whicfi hirdly gives tlic noimal experience of the town But the median figure of G deiihs is i better index of the normal cxpcri cnee of cholera deaths because it is not so much iJTectcd Iiy the extreme figure of 432 deaths of an epidemic year ^^hen a d stribution is tery unsymmetriciJ and number of absceauotu IS large the mode gives n \cry satisfactory measure of the avenge Cot sider two sets of values giving the weights m lbs of two groups of boys viz 3G, 40, 2^*, aC 81, 120 and 17 and 52 5 1 58 51 50, 35 and 5G Both these two groups have the same anihinctic mean value of 51 lbs But it is dear th*it the two sets of observatons have wide d (Terences with rej^ard to the varniionof the observations among thcmseivcs riirrc are various measures to describe llic \arntonofi set of measuremems The simplest is the Rangs which is the difference between the largest objcr\“it on and llic smallest observation An improvement on Ran'Te is the Interquartile Range which is the difTercncc bcivvccn tlie upper quartilc and the lower quartile The upper quartdc iS tlic value \vh eh have three fj irtfjs ofihe obscrvitiois belrwitand one fsurth abov c and the lower quartil has one fourth ofihe observations below It and three (btirfh* above it The standard measure of variations is knovvrn as Standard Deviation It is obtained as (bllows the dificrenee “of^c-iSi observation from the arithmciic mean is obtained, the dilT-rcnces arc squared and ad led flic sum if divided by the number of observmions the square root of this quotient is the standard deviation The unit of study of public health workers is the community as a vvhoJr We arc jmrrcsted m the whole populuion as a group and not in the individuals m their imlividual capaaiy VITAL STATISTICS 479 As such, wc have to study the characteristics of the communi- ty in order to define our problems and to assess our results It IS not always practicable to meet every individual m the •community for the purpose Even if it were possible to do it js not n ortli the effort and expenditure involved Wema) study a part of the comm.u'>it> and if tlic selection of the part has been properly done, we may, with a reasonable decree of correct- ness, assume that our results are applicable to the whole of the community This process of the selection of a part to represent the whole is called sampling The part so selected is known as a “SAMPLE’ Sampling process consists m the selection of a part of an aggregate (called populit on or universe to represent the whole or aggregate Sampling examples are provided by a handful of ^rain taken from a sack or a piece of cloth cut off a roll A Saimplc is a part of population and a sample is said to be a random one, if every individual m the pjpulation has in equal probability of being included m the sample The object of sampling is to obtain the nearest estimate to tlie values m the population for the labour expended In •other words, the purpose of sampling procedure is to secure a sample which subject to limitations of size will leproduce the characteristics of the population, especially of immediate interest, as closeU as possible CHAPTER MENTAL HYGIENE (ByDb ViD^ASAOAnMEp!CAi.Si.piiT Pb Mestal Hospital Ask ) Mental H>gicneconipn*es the iciivuies and techniques which promote and mamnin mental health which is the capacity m an mdividual to form Innnontous relations with others and to parti- cipate m Or to contribute constructively to changes iti his social and phystc.d environment It implies also an ability to achieve a harmonious and balanced satHfiction on his poicntiallj confiictmg instinctive drives and a personality which have developed in a way wh cii enables these drives to find harmon ous etprcsi on m the fall realiaation of his potentialities Mental Health is mflucnced b> both biological and social factors It is not a static condition but IS subject to v-inations and llucttittions of degree It may be studied under the following heads — • 1 Mental disorders 2 Prevention of mental dtsordeis 3 Prevention of mental health (a) Persona! and (J) Pulhc 4 Adm nisirativc aspects of mental health services I •nPES 01- MENTAL DlbOItDrrS (<*) Organic Nervous diseases 1 1 those following upon in fccuoiis toxic degenerative traumatic vascular nutri- tional metabolic and cnHorcrinc disorders and mllam mations new growths evsts etc oTbram (6) Functional nervous disorders or emotional dis- orders — (i) Psyclosis or insan ties — Schizophrenia, minic de- pressive psychosis involutional depress on and paranoia (u) Neuros s or Psychoneurosis — Hysteria anxiety neurosis and obsessive compulsive neurosis includii g I Iiobias (r) Psychosomatic disorders, such as cases of hyperten 5 on gisiTiC uJeyr hndaches diabetes eczemas u U- carns allergic cond iions progen ta! disorders, (frequency of micturition impotence, frigidity etc ) (d) Mental Deficiencies (Amentias), whicli include cases of * any land of degree of arrested or incomplete devclopnicni of the nund exist ng before the age of 18 years sufBcicnt to prevent the ii dividual from mating SIENTAL HYCTENL 481 an independent adaptation of life and to render him in need of external care ” They are classified into 3 grades — (t) Idiots — Who are unable to guard themselves against oi dinary physical dangers (ti) Imbeciles — They arc able to do simple routine jobs but unable to lead ludcpcndent existence (m) Feeble muidcd — Thev can only do simple routine jobs mdcpendmily but cannot benefit from education m ordinary schools (e) Psychopathic pcrsonalitfcs — They are emotionally unstable and impulsively aggiessue from an early age, and give evidence of being unable to learn from experi- ence and have no constdcralioii for o hers (/) Cerebral dysrhythmias (idiopathic and secondary ) — slioivn as vittous forms of epilepsies and epileptic insanities (g) Behaviour disorders of children such as truancy fiom school, rebelliousness and juvenile delinquency Causation of mental illness — ^Three factors, namely constitutional, psysical and phychological are attributable as causes of mental diseases The trinity is closely inter woven in the production of a given psychiatric state ihough the part of each varies m each individual, but it cannot be objectively clearly separated Tilt constitution of an individual is based on heredity and gets modified by the environmental factors of nounshm"ni intra- uterine Jifi? (influenced possthh by ike ememonai state of the mother) and by the social climate, dietetic and other environ- mental factors of extra utciinc lift The constitutional peculiarities (which however, be accu- rately measured or predicted) arc responsible for the predispo- sition to mental illness wh Ic physical and psychological factors constitute the prccipiiaimg causes Pliysical factors have been bnefly referred to against organic mental illness (vide sup’-a), but they will not account for the in- dividual or personal dificrcnces m the mental symptoms, uhich are dricrmmtd by the individual s psychological biography Pi^chologvcl fuel ts — ^Psycho-analysis has revealed three strata of mmd (i) the central core, the irf or the biological mind, common to all living beings manifcucd in the need lor physical and emotional security («) the or the intellectual understanding of self and the environment and one’s own formu- lation of ambiiions standards and ideal called the egoistic d n es and fill) Xlie super ego or conscience, which enshrines the do's 482 HYGIENE AND lUBLIC HE\LT1I •ind dotit’s of society con\ejed \ cry caHv m life through pircnts and subsequently through teachers, booJes and other sources of information Conflicts between id and ego, or beiweai cither of these and the supcr»ejjo, which occur at every step of our lives, produce a painful emotional state of ncrvious mental tension, vvhich gets modifled by certain inherent unconscious mental mechanisms called defence icaciions of ego, vviili the result that it Cither gets eased off, or failing that, it provokes certain second- ary cficcts in the mind (and through nervous pathways’ m the body), leading to a variable degree of physical ill health, and disturbance of intellectual ejnevtney, emotional balance and of harmonious relations With others II ritmENTiON or mental DisonoFits Unlike many preventable physical diseases, described m other parts of ilus book, nearly 76% of mental jlincsscs m Europe and over 90% m the Punjab (according to my own cKp-riencc of outpatients and inpatients at the Punjab Nfenlal Hospital, Amritsar), have no specific physical or psychological aetiological fiCtors for their causation and epidemiology, (conditions that determine the frequencies of the diseases) with the lesuUthat distinct tcchiuques of immediate prevcniion of functional mental illness are not available An emotional disorder depends partly on constitution and partly on environmental influences particularly of the early age-period So far as the latter are concerned, the real prevention vvould come, from a whole-life policy, beginning from infancy in rnoBtoTiov of mental health (a) Personal — Personal mental hygiene deals with matters pertaining to the mental health of the individuals and their children, for whose proper bringir^ up they arc responsible The principles whicJ* should guide m in teaching the subject to iieoplc arc given below — For Adolescents and Adalts — i Lo^ ThnelJ — 'Love Thyself means, tint one should /cel happy as one is feeing gratc- lul to nature for not hating been made worse, nor tnv 7 uig better people, since no two things are alike n nature Diminution of the fund of self love leads to feelings of trderiorily winch arc the banc of a young person’s b/c, as thev lead to nervousness, lack of self confidence and drooping of spints 2 Adapts lOH ttiPi enrinrtmnt erJ uitA one^t/lf — Adaptation With self, refers to casing off of intrapsychc conflicts rclatir^ to $cx and rigid egoistic standards, as they are not easily resolved and precipitate mental illness Ifarmony vvith cntiron- merit means harmonious social relations vvhtch give usthevery much needed emotional security aiENrAL mOiENE 'tss 3 Concede freedom of thought and action to others within the framework of harmonious social relationship — This principle is the instrument for achievement of social harmony, and inculcates in us, respect for the feelings and nghts of others 4 Active interest in games and in physical exercise — Its advantages are — (a) Maintenance of bodily heat and toic of voluntary and involuntary muscles {b") Casing of nervous tension, as per the dictum of Sherrington, one of the greatest neurophysiologists of the present times, , “Nervous tension is eased most by muscular exercise, least by thought and by speech in between ” (c) The struggle for existence is waged with brawn, under the guidance of brain (d) Teaches team spirit and hcahhy competition (,«) Inculcates the habit of vigorous work, and fair play (/) Tncndly competmo i and even chances of victory and defeat mellow down our emotional reactions to successes and failures m life (g) It gives us the joy of achievement and enhances self confidence (A) Physical stamina cultivated in games enables us to pursue mental work with rigour 6 Acceptance of want, hardship and pain as essential stimuli of life —Mighty forces of nature can do a lot of harm »© man and he IS bound to force want, hardship and pain not infrequently Afati must accept those as essential elements of life and stimuli to vigorous iciton Without obstacles, life would be insipid and, therefore, we mast meet them courageously, accepting what we cannot change Religion, which is essentially faith m the presence of Fatherly Almighty God is but a simpler form of visualizing the mighty forces of nature ^ncntioncd above As this 13 thi“ accepted sentiment of nil mankind, it can be made use of, for personal mental health and umvcrsal peace G Subordinate emotions to intelligence, enriched by active association with others — In our daily life we do not foster deeper insight into our actions, with the result that, m many of our acici’tCics, «tr aev irayrc cenatamaf etar limitations as human beings, wr arc bound to make mistakes in life but a certain d^ree of introspection is essential, to under- stand our ictions and to plan their betterment m future situations Wc have to unders'and that with our limitations as human beings. We arc bound to make mistakes, asm the time honoured adage “To err, is human”, and that wc have to Icaru from our mistakes and not to brood or weep over them All types of experience adds to our learning 484 inOlEKE AND PUBUC HEALTH From ihc point of vic>\ of e\oluUonaI Jiistory, anxiei) Avhich IS based on memory and imagination is an advance on cr fear, as It enables us to anticipate danger, pam mj ir> sadness 'tnd other uncomfortable events fir abend of the nctiia! hnjpentngs The response to anxictv should be plannmg to get over thf* expected diiliculty, rnihcr than rumination xshicli Nsould result m exaggernted or morbid nnxicty Active association Nvith others enables better mfirmition and consequent Nvider perspective Such persons arc more likely to keep m step \nth reality nnd their chances of liarboiirmg phanla sics day dreams nnd speculative suspicions, as octur m schizo- phrema would be elimmxicd 7 De itifemed on sex — Almost the enure humnn culture over the ages has clamped a taboo on sex nnd the rclig on tint alloHS I utiationof corjuc'al relationship with so much fm f re pomp and show, decries sexual pleasure cchementiv Most youngmenin India (as nsscssed from my contacts with Punjab students nnd others) trudge through their adoIf«cem c under a henvy load of sex fears relieved only when they find tliem selves lobe potent sexually after marriage nnd on learning of pregnnncy in their vsives It ts nothing but a myth to believe tliat erotic fentastes m a young person are indicauve of mental derangement cr ihnt they nre stnful \oungmcn should be given correct inf i-maiion about the physiologv of seminni fluid anti technique of coitus and of the elTccts of night discharges and of mnvtuibation to disabuse their minds of supposed serious consequences of imagm ed scxuil and other d seases resulting from them Rules of mental hygiene for infants and children — These rules nre similar to tliosc described al ove nnd do i ot need very detnifed cxpfaiialion / Accept tke ehiCd and foie fiim — The Uiought of a chiick being not needed or not desired (bera ise it Ins not the desired gender or is an ui wanted additu n to tl e already large fam ly or IS d sahlcd physK ally or mentally \ tmy make us utter unsavoury words or be harsh to the child Ln\ mg the cluld mrani feeling liappv w th him w ihfjut any reservation The child being an abst lately dependent organism needs nburd int love for his healthy etnotioml drvrlojmeit Cl iltlrcn suckled by u ihappy mothers often suffer from jrd grs- ti )ii disturbed sleqi and fretjumt crying vsliile a Iivetl child personally altrrdcd tobvus mitherdoea not develop those and tin Icsinblr habits such as tliuiub suck ing shyness aid fiddmess f r food Likewise the older eh Id is saved fiom sufh bad habiis as stealing sexual perv erstons and rebellious rondict 2 Respect the child as a persan — Respect consists in apprccia tton of certain qualities in another individual The child needs MENTAL HYGIENE 485 to be appreciated foi its natural cflbrts for self-development by its innocent inquisitivenessj motor activity and for its profound attach- ment to the parents Our failure to do so hampers the child’s balanced emotional development and may produce feelings of inferiority m him 3 Do nol dissuade a child from misconduct by a show of iemper nor frown at kis mistakes — ^Tlie child develops the same emotional pattern, as the people with whom he is closely associa- ted A rigid and guilt-Iadcn attitude towards a child’s errors would be followed by the development of a rigid, obsessional character, m which a person is never happy with himself, It is a mistake to think, that strict and harsh \igilancc of the child against making mistakes or doing bad acts, would develop into a lofty character Such a child develops a mixed attitude of love and hatred for the parents and those m authority and is apt to get badly shaken with self hatred on having done a •mistake The children of carpm?, nagging parents, cither become rebellious or timid or get short of imtiauve and self- confidence 4 Do not expect from the child a standard of behaviour higher than that reasonable for his age —This kind ol approach would lead parents to with-hold their full a'^ceptance and lot e for the child, and when it leads to expre sion ol disappointment With the child, tt produces in him feelings of anxiety, inferiority, <3epression, sulkiness and at times disgust 5 Answer a child's question intelhgently, giving short eonertU ■answer within his intelligence A human child is naturally inquisi- tive and parents must answer its questions precisely Further, t\e should encourage motor self expression, by letting him do things, as iie likes, guiding him, here and there Curbing this inquisiticeness would lessen his initiative, self-confidence and interest in outside things and may make him miroveit 6 Let there be the same code of conduct for the }oung and the old — A child gets perplexed when, he is itsked not to do a thing vhich the grownups arc doing I have known a child of three, questioning his parents for doing the same action, which he had not been allowed to do T A'ever threaten or premise anything that jok cannot or do not intend to carry out — A threat is a fear of possible harm from a certain actum It sliould be gently told to the child but Without exaggeration, lest It should geneiatc severe anxietv 111 him Threats of a policemai , ghosts oi devils which are far from reality, create misunderstandings about a highly valued servant of society and the fear of the unknoivn, respectively "When fither is held out as a punishing person the cliiid elevciops fear of authority and if deprived of a good deal of 485 IlYOirsE AVD PUBLIO HEVLTII tmo lotnl seairitv m hfc The threat of punishment should! be gently gnen, \viUioutb«ng influenced by aiit,fr and \ indie tiMHiess The child should never be put to sham in presence of his brothers sisters or friends Punisiunent can be gi-aded first %wthdra\%Bl of certain prts ilegcs m the family such as going oullbr shopping or attending an entertainment then ith hold ing pocket money or sweets and finally a slap or two Parents will be considered as untruthful or undcjicndable if promises made by them to children are not kept Repetition of such experience will distort a child s s rets of ihevsorld of grown ups S liculcaU joicat tnler sts — 1 rom the young age of G-9 months the child should be given opportunities of associating withitspeers sharing sweets toys and the lot c of mother with them By persomi! example parents give practical element iry lessons in sclfdcmal and social service and prevent the c inker of jealousy taking root m the \o itio rhticl 9 Eremragt self expresston —The child expresses itself firstihrou^h movements and later through speech Giving of max mum freedom of movements ami speecli impererp ibly guided mto purposive citannels of play, conversation and answers to their qucstio is, s the best training m self express on, which cntbles the child to achieve maximum realisation of its potemtalities This guidance by parems, m tlic role of friends ard mentors must continue when th** cliild starts atttndii^ school 10 Bnngfn^upof the wcd to grow and blossom III (b) P iblic iicalth programme —1 he following extmas Irom the World ffcaflh Organfsaiion Technical Report No 31, gives an admirable introtl iction to the description of activities and techmq les which promote and maintain mental health of the community * Until a great bod) of tcchncal knowledge luitablr to the training and capacities of tile worker concerned has been devc- •MrKTAL HYGIENE 487 Iop'*d, the mental hygiene contnbiition which the public health worker can make m his day to day uork may be broadly des- cribed as the appreciation of human problems m a human way, jfi appreciation for sshich existing s>stem of medical education do not usually provide sudicient preparation *' “Even when there is no formal programme Tor mental hygiene it is implicit m a very wide range of jiublic health activities It IS always implicit it those times, hen in the course of his duties, a health worker has a personal relationship -with a patient or another member of the staff In interviews and in giving council, the mental hygiene influence of the health svorkcr IS direct m reducing aiocicty, giving reassurance and m providing the conditions through which the ii dividual can find for himself the solution of h s emotional and sorjal problems “ “To summarise, the essentials for an effective mental health programme ire —(a) The worker should manifest m his own talk general behaviour the principles of mental hy gicne (b) He should study and evaluate the prevailing attitudes and practices of the community and then adopt his teachings for pro- •ducing a gndual change in them {Mental hygiene programme tn maternity service —The maternity services provided in the ante natal clinics and through the home visits of the lady health visitors have hitherto been in terms of general hygiene nutrition, medical care and pelvic ineasurcracnis However, it needs to be realised that pregnanev 18 a great emoiional experience ‘The attitude towards the prospective child (wanted or unwanted), the minor and major •discomforts and liazards of pregnancy and parturition the satis- d’attiow of fnlfitmewt of Iwt biological sole as a woman, and of 4iddcd prestige in the family, the anticipation of a charge in respect to her, daily routine and in relation to her husband and to others who come into close personal contact with her and the facts of her jiersonal information on the subject, economic factors and cultural patterns will determine, if this experience would be 1 rich and bappv one or one full of unxiety, misgiving ^nd fears “ The responsibility of doctor or nurse towards tlie pregnant ttojidiers a, as. below — I Imparting of ujfoaujiijnn. about gestation and labour, at a very slow pace, in the discussion group meetings in the antenatal clinic This will also dispel anxieties winch arise from, ignorance or m s information 2 To encourage the prospective mother and father to -speak out their anxieties and fears bom or traditional beliefs, -and to listen to them with understanding and tolerance, with a view to help them to work out the solution of their emotional probler^i. 4Q8 IIVaiFKC AND VVBLiC HEALTH Menial health eij infant and preschool child — ^Thc followtng- pracnccs m the Iiandlmt; of infants arc to be guarded ngatnsi because these damage the devefopmg personality bj generating innrdinait anxtci> at this tender age — 1 Boulr f( tdm-’ 2 Ripid feeding and sleeping schedules 3 Impcrsoinl Inndhng of the bodv 4 IfitoVrant and pretmture toilet training 5 Restriction of infantile movements 6 Breast feeding must not he continued after the age of one >cnr, and vtcaning must be gradual and not suridrn 7 Inf xnts and children must nc\er sleep on the same Cot as their mothers, sisters or grannies 8 Giving extra auemum and indulgmce to one child, as compared to the others, particularly the one immtdjaicl/ next to him 9 The child should oc cncoungcd to take active interest m play and exjircss himself ireejy in speech It must never be ordered about too mticli, nor brought up m relatively rigid discipline and code of mor'ilitv, 'is it Would not allow taking a lenient view of ns inistnkcs and siiortcomings, m later life 10 Clnlclfcn between the ages of C months to 30 months must never be separiud from their moilicrs, as it leads to emotmrul depression, m which the child be- comes riuiet, withdrawn and riiher dull There is cvidcnci, that children separated at this age-p-nid fiom /ovvng mothers dcvelc^ into an isexn}, fiiycho- pa'hic pcrsonnlincs, unless thev develop bonds of w irm affection >' ith foster mothers Menl-il health of srAoof going child — N*cxt to liomc, the school IS the place wli^Tc the child spends most of his time md It should, therefore, be like a Iwjnie, w here principles of mcmal health discussed in the preceding sections ire translated into praaice by the teachers , who arc parent subs tlutcs there The object of teachers shoiJd not merely be imparting instructions m arts and science f>r gaining certain vocational skills, b it to promote fuller devciopm-nt of ihr potmtnbtici of the child as well, for a welladjmcd and ha|»{iicr life, which can only be done 111 an a moipiirrr of picastm soci»l relationship of the pupils with the teichert and the pupjb thems Jvrs The bchaviobr of the teacher towards the school children and hii mrihuds of tcadimg would not only mad fy the pcrsonaluy , of the cliild, but also influence him (the child) immensely m MENTAL ItYOIENE 489 formiTjg a^personal idcoJogfor a styleof life. Teaching through play, for the* ‘kindergaitcn and primary school and through manual ^ W6rlc' in the middle school allows tlie children to develop' heen" interest in education and make full use of their innate cndo^s'inc'm. Sex tnformatiort : — ^The scic.icc of mental diseases teaches that a large' proportion of emotional disorders are caused by fears and guilt associated with sex ideas, interests and functions. From the point of view, of mental hygiene, it is, therefore important that information on sex be introduced m the school curriculum as a nature-study subject beginning with study of common plants, flowers and birds, Ibrciattofi of fruits, repro- duction in common insects, pets and domrstic animals, and finally in the Jiigh classses, general ph\ siology of human-being Including reproduction. Tlie information, thus gained, wll be shorn of guilt, shame and curiosity associated with sex to an intense degree in the adolescent and adult mind, and to a milder degree in the average married man and woman, at present time. Backward children in /cAce/s : -Grossly backward children need to be given education In special schools, where emphasis is laid more on manual work than on formal education. Such children, apart from being a dragon other students of the class, will very likely, develop strong inferiority feelings, even if they arc not chided by the teachers or tested by their classfellows. Separating the mentally backward children from the average is therefore, an important part of Mental Hygiene programme otherwise such children either become problem children or get emotionally disturbed. Delinquency in children : — Anti-social conduct in children is due to the following causes : — 1. Improper home environments, due to unstable, alcoholic or mentally deficient parents. 2. Want of playing fields, wheic the chfldern give express- ion to thnr innate psychic energy of aggression and learn ways of fair play 3. Harsh treatment meted out at school for poor scliool- work. 4. Falling into the company of gangs of antisocial adolc- ■scents, which is more likely to occur, when there is no happiness in the home. 5. Influence of bad ciacina pictures. Avoidance of these causative factors, and concentration on Jiealthy development of the personality of the child, as explained earlier, would constitute remedies for stamping out of delin- quency. 490 nTOIFVC AM> PDBUC IIEALTIt Menial health problems e^f adoletunls {14 If 20 jears old jottShs) — Adolescence is a period of chingc in the sphere of physical Tncntal and social de\e!opmcm of the child, and is therefore, exposed to stresses some of ivhich are listed below — 1 The growing child who has been progressively learning more and more, feels greater confidence m his own 'ibihlies with consequent cra\ mg for more iiidrpcmlciice, which may be resist ed to varying degrees by parents with consequent sulkiness, nagativtsm, and major or minor defiance The adolescent finds fault with the ideology and conductor the pTCnts nnd doubts their ability to guide Turn 2 Tlic onset of puberty with the appearance of menstrua lion in girls and of night emission in boy s, brings about a varying degree of fear m their rrunds as they are ignorant of them 3 Awakening of sexual interests ideas, activity and phantasy is usually associated i ith guilt feelings because of tlie strict social and religious taboo on sex kor the same xearons the biological mterert in numbers of the opposite sex weighs equally heatily on their minds 4 The ability to cam money after leaving school is hkelr to jnflate their immature ego and add to conflicts with parents and with authority Tlie adolescent needs to be giten guidance in these difficul ties tl rough infomiaiton on sex ethics and social tcKtiousluos jn school and through oilier channels of information detailed subsequently n ADMIMSTIt\TI\F ASPECT OFMENPlt JfP VlUr BUtVJCi ^ The Spirit of work mall human endeavours, pure so in Mental Health services, sliould be the cultivation of good inter- persona! relations amongst fellow ivorkcrs or fellow inenibcw of the staff of the orgamsation avliicli is l>ound to l^e reflected in their tolerance and understanding of those whom (hey serve The treatment using of the Menial Health Services is as important as the preventive side and should be ndeq lately provided for as in general medicine It needs to have the jollow- ing separate departments -~l Mental Hospital nccommodat on for the treatment of fresh Cases, at the rote of at least one 1 ed per 2 000 of the population located in small units of hiindred beds m difrcrcni parts of the Stale Admission to these JiospnaU should be open as in a general hospital unlike the presot sy«cm of getting order of admission from the District- Magistrate 2. Homes for tncurahle insancs, advanced mci ft! defeimt patients and fur advanced qstlqilicj hav ing bed ac^onimodnlion ■at the rate of one betl f r 500 of the population AtlrtiWoh to IIENTAL HYGIENE 4.91 licse institutions and decision about the liability for maintenance charges would have to be made by the la\v*courtj as in these days. 3. Out patient psychiatric clinics, associated with all Mental Hospitals and widi the District Hcad«quarters General Hospitals. 4. Child Guidance clinics at every District Head-quarters for the early treatment of behaviour-disorders of children. 5. Hostels for delinquent children, separately for different age groups, associated with a regular clinic for the treatment of delinquency. 6. Spedal schools for back-ward children. The Mental Hygiene wing of the Mental Health Services has to be very broad based, as is evident frgm the preceding pages. It may be summarised as follows:— “1. Lady Health Visitors, Midtvivcs, Nurses uind doctors of the ante-natal clinic, give mental health 'guidance to pregnant and recently delivered women. 2. The lady health vtshor, the school teacher, the school medical officer and the general practitioner, direct bchaviour- problem-children to the child-guidance cimic. 3. Thesdiool psychologist studies problems of backward- ness in studies and behaviour problems, in which he gives preliminary guidancci and refers the unimproved cases to the child-guidance clinics. He also gives vocational guidance to the scholars. 4. The school teacher who has a very gre.nt influence in the building up of the personality of the child needs to be psychologi- cally orientated, sotliathis teaching and, general behaviohr is guided by psychological principles. 5. Youth guidance clinics for the adolescents. 6. Marriage Counselling Bureaus, staffed by psychologists and social workers, for the guidance of man icd people. 7. Psychiatncally-orientated medical practitioner, has a very vital role to play in the Mental Health Services, by early diagnosis of illness and aberrations in behaviour, caused by -psydiirfiogfUi’* iw.'cons, -an^i kjy yntipct p^iysicaTly ill and the convalescent patients, to prevent over-lay of psycho, genic illness. 8. Social clubs : — ^The psychiatrist and other staff of the psychiatric outpatient clinic, in association with local teachers professors and the gentry can start scp.irate social clubs for youngmen and young-women, preferably in scliool and coIJeRc buildings where apart from playing, games, debates. discossioM and lectures can be arranged for the benefit of the younir people. Parents can be invited to these clubs and discussioni 492 mCIEM. AND PODLIC JITALin Jicld with them on the problems of >oung children an adolescent^ 9 The public hcnUli service stnlT, vvlio come into clos contact V ith the public have an important role to plaj m prp pagation of mental healtli and they need to be as well Iramra i/ If, as schooHcacbert and ancillary medical staff - 10 HenUh Education of the public through nctvspapers^ radios and the cinema screens Thcscnior olUcers of tlie Mettfll Health Service, S'lho hav» built a good ttame and reputation can contact the ncwspapci editors in their area and arrange to publish simple infortnauvc articles on the bringing up of children and management of tht behaviour problems, on the prevention and treatment of mental illnesses and other allied subjects They might answer some of tht enquiries of the readers of the paper, m its columns Likt. wise they niay arrange talks on die radio on the common mcnia)! health problems and connected subjects In this uay, they ihafli have made the public mental hvgicnc conscious Subsequcntltl the Cinema ston uriterj would certainly tile up the menia| health problem theme for their pictures I Films and film strips on mental hygiene subjects, preparecl m certain tdtanced countries, can be obtained through the courtesy of their Embassies, for exlubiting to selected audiences’ Books and periodicals on Mental Hygiene, suitable /or layj readers, can be got introduced m schools, colleges and public libraries and information about the same got published in BtagsziBfS and nctvspaptrs index Absolute humldttyi Abyssinian tube wells, Acid carbolic, j' Hydrocyanic. Acquired immunity, ^ ISaXluW process, > Active immunity. Acute poliomyelitis. AtoilrSty Disinfectant test, Adsorbents Aedes Aegypti, Aerated water taotones amount required, borne epidemics, composition, conditioning diseases due to. examination of, heating, jt-.nfpr. hot dry air as disinfec- tant, humidity of, impurities, sewer, soil. Alcohol Alluvial soil, g Al«»« , ,i'n'‘cy;Smmum 150 320 «oni iratlve aspect of mwital health sen-ices behaviour disorders caption of mental' Illness, tlcfinltlon, delinquency m children, disorders, mental health problems, neurosis, ’’sr . PWt,„pa,Mc per., on,. psychosis, roles of mental 481 481 430 489 480 490 4S0- 483 482 hygiene, sox education sex Information special school? social club?, Mercurial barometer IJITblercnry per cUorldi poisonini:. 18. Mercuric iodide 190 Mefeoroloai- ’ 172 Milk composition of condensed, derived, designations, diseases due to cir«ts of heat on epidemic graded, humanised, pasteurisation preservation ’ stcnlbatlon. ««» *“PCral Salts 2S0 Ministry of ITfalth, 341 141 141 142 141 145 22 451 467 431 480 481 218 489 491 491 171 25S 220 258 171 147 147 149 155 155 150 148 151 155 154 148 >48 145 11 '. ■ 38rt Minimum IhermomeOT desk, Maternal ““Sde ol mulunul parasite “?meSn unalnst, TepeUent®, traps, varieties, Mumps. Mustard oU &1 Extension service nroaranvtn® _ ^„ra\ dislniectanis. Eradl- f rate, . "’“Marion proe'f®® NMural “SSSSn o< «amr ventilation. sr„&»’ Nemam^as, ■NesneW's Sight sail bucMta. carts. removal 01, ■well Notldontlon. Huts, ^ 236 1 „ Outviard OT S^oSafu. M6 269 OoKmete, 291i Oocyst, aS4 ^ 233 «t«m'ta'>'=«. 3S PaSslt.0 mdett. 2,9 303 animal 321 raStyp>'“'' * WrboH®! rate, 301 ^’«|SSuSSmhBr-land«‘er 31 Patron's 265 15« ^STulus capdas. 265 2.0^'“=-- I 400 |S"l f ... fe*” ■"■' S 1 Z rdritprcad, 39 prevciltiom 294 30 Plasmodium rrentl- 30 Plenum sy=«” ° lal 29 plumljlsnii 169 pjjjs desk. Kn latlon 00 181 Plus dcslt. a, 13 ’■“'““"age removal 241 - — 3 sewage i^u —1 Pneumoconiosis. 1^9 ponds, 102 224 10 occupational ponons, O'toludlne test, outlets. Pneuutvv— ISSiuoo esllmatlon 0.. weeffic, - 195 22i post-natal. 220 Pos^’^^'^Vrinal cncepliall^s. 36 post ' 19 irpfeSmVnlo. Polsonmi' Leprosy Lice Liver flukes Louwes ventilators . M Made soil Maf-got. Mom spring Maize Malaria control «*njgs used in dcveiopnientaj cycles cllologj of forecast incidence of index man made Prerenllon of symptoms sarvej Jfalarlol Malta fever Margarine i^rWmo quarinllnt “•-JPIeiual morfallly Matom.iy a„a chM Welfare scope MekinT?? “^^ometcr Meai^ 'cntllator. Meat character of diseases due to Inspection of tinned Mechanical filter Medical benefits, Medical census and health education. bj. %I ™ ,, norkcr IS «4 "‘’“.‘’'h'’""'"' 474 2D1 58 152 274 18 137 293 300 304 . ' ‘vfc'cne adm tratl\e aspect of menial hcallh sm,tvs beh„lo„. dKordem " caiwalion ot menial illness deflnitlon delinquency m children disorders mental health problems, neurosis ■’■'SS"”'— w P^ycliomaljc disorders PsychoncurosS * P^tnopalh.c P-tjehosJs «iJos of mental hjglenc «ex education sex Information ®P«lal whooJs. social clubs bnrometer {£ljjf^ry per chloride Polsonint 18. Mercuric iodide 190 5Ielcoroloev 172 Milk ®® composition of condensed, derived designations, dlseisea due to eflVxlfi of heat on epidemic eroded humanised Pasteurisation, preservation 'terlllsation. *on salts 330 Mlnistiy of Ifealth. 294 294 298 293 298 297 300 297 298 301 |51 8C> 150 321 341 141 141 142 lit 145 392 179 431 431 439 480 490 4S0 432 482 430 480 461 489 484 213 489 491 49] 17) 258 2^0 253 171 147 451 467 143 155 154 150 143 151 155 154 143 HP 14 113 35rt Wlalmum thermometer Minus desk. Morbidity rate, Mortality rate infantile Matenja] 1 Mosquito, cycle of malarial parasite destruction, diseases earned by life cycle, protection agalns*. repellent*?, traps. Varieties, Mumps Mustard oil K Kails Kationat Extension Service Blocks National Malaria Control programme National Smallpox Eradi- cation programme Natural disinfectants, Inunimlty, purification of water ventilation, Necator Amcricanua, Neonatal mortality rale. Nematodes, Nesftelds tatUcts Night soil buckets, carts, removal of, disposal of, Non-fermented drinks Norton's abyssJnlan tube well Notification. Nats. O occupational poisons, Offenslse trades, Ollgodimanilc action, Otoludinc test. 372 Outward quarantine, IBl Oxygen in air, 473 Oxyurls vermicularls, 472 Ozone, 473 Ozonisation, 263 OoLmete. Oocyst, 294 20i 271 272 303 JOl 303 270 342 160 238 13 55 285 422 280 39 79 79 79 79 150 241 140 Pandemic, Paraform tablefs, Parasitic index, I^rasltes animal. Paratyphoid fevers, Parboiled nee, Paris green Pasteur-chambor-land filler Paterson's filter, Pediculus capitas, corporis Pcrchlorlde of mercury. Percolating sewage filter, Perflation Period of mfectivity. Permanent hardness, Personal hygiene, Permutii process Pbttcn ko/Ter’s test, Phene], Phosphorus poisoning Physical disinfectants Pit latrine. Plague, and rat, mode of spread^ prevention, Plasmodium, Plenum system of venti- lation Plumbism, Plus desk, Pneumatic system of sewage removal Pneumoconiosis Ponds Population estimation of. Specific, Post natal. Posture Post vaccinal enccphatlUs, Potassium permanganate Prenatal clinic. 236 97 282 48 35 296 296 233 251 293 279 321 136 301 37 22 255 265 256 108 55 234 28 195 30 5 259 225 251 75 314 315 316 317 294 60 30 181 102 224 10 4C3 192 212 33t 259 190 Prcswatlon of mujc _ of meat “toiosplieric. on health ^vale Ijolatlon Privy, acqua oonstructjon of. Prolccllie foods Proteins animii meat vegetable Public Heclih latrine ' 314 70 71 72 71 464 460 310 174 47 Quarantine domestic international. Innard maritime outward scholastic Quartan malaria Quinine In malaria n Hables Racial Immunity Rain rauge water Rapid fillers. Rat. destruction fiea, Pumlgatlon poUon protection from. 14J » P^ugne, f disposal of ™ domptaj Of. S n of i? IfeEtaratlon “ Rehabllllatlon. ‘3 ncIapsloE fescr CO buraldlly, CT nraplratlon. I?4 I!.cc.‘*“^'» 114 Rldeal walicp^ »,«..(» ■ 136 «»n,dEcopcmn""'“'P‘ “S 114 Rlngttorm 142 Rivers 372 267 Poou and tubers „? Round worm 386 Rom 380 3« Bural SambiiJon 202 c fever IS Saturated steam Scavenging Ml Schick test, ^Bctrs.'u'idTnr’’""' ™ cimics ^ 180 ;f® Scurvy 186 ynj ®^ats and desks. Separate systeni of '■emoial ,o? g Serhlan'bll'rrcl ^ 1 ” ao 7 Seunge 183 3?l ''>iatmem iS l;' dtS:S'„r”™- jg 3>a See?™' of ]” 318 jjjp 02 'Isanslnc Of. jj} disadvantages of, flushing of, inspection of, ventilation of, Sheringham’s valve, Siderosis, Silicosis, Siphon trap. Siphonlc-closet. cix’s thermometer, ISihtenns ol animal, IlMplnE Sleeplessness, Sludge activated, disposal. Small pox itnmutiUy. prevention o‘i vaccination o'. Smoke nuisance, n.ed.cnl evolution 0 msur- “’’S'ceto^dl. SSSS^ij SS#- ^tlnrnm Mattti. reliahlltotlom registration remuneration . . 441 102 Social anatomy, p_„,and 427 101 Social medicine in Englana 101 soidal security, , ,01 .rmnlng In medi Sheringham's valves, 294 soft sore, 29 58 Softening of water, 224 Soil. 163 224 air. 163 97 bacteria 161 90 classification. 179 composition, jg5 220 dampness of. jg 3 202 diseases from jg2 279 made 161 203 retentive, 162 109 water. 93 '33“ "““s-rr'radmt.on t«®a; 337 138 734 coya bean 338 77* ipecies immumty, 277 speciOc death rata, jj8 188 splenic Index, 333 114 Sporadic, 295 417 sporogony, 298 S^rozoite index, 16 3 springs. 18 456 variellon ot. 19 yield of, 384 349 .g health system, ^gg statistical index, 251 43® Steam, 351 455 SmUu® Si saturated, 252 3 superheated, ^.jl Stm hlrths, 0 454 Btrearos. «|^”"-SLi.a--^'^tlva 7« water, 262 176 18 4 WB^*. 1 Sulpbur-dioxide. 459 lunshine recover. ^ surface springs. 440 syphilis. uiauon, 1?“ ®,na Sh, Tabulation, * ^'ala echlnococcM JJaaia aaglnat,^™’ Taewa solium. TanJc ieptic. Settling, «Pe worms Tea. Teeth. ./"'“'’Sir'"-- V Vmporaiy hardness •leianus kata, maximum h^olmum. six’s «ar radiation, or 'aeuuai terrestrial ThlrJa* “““ "'T Siai Tear plan t^ad worm, ?wu“'*,°““'eclor T.ekrelapsmg.,a„r, janed meat aod ash 5btaTtfb°^”'"T’ ’ Trades dusty. Traps, fly gully, grease, tnlrrceptlng, Siphon, _ varlet^c^ Trematodes Trench fe%Vr Trenching ground •' laying of '"‘aagement. m 3^,be „X 3M S;", 'ofluenoe I s?o'?,‘"''»» or- » 20Tuh^®”°"'* f®? after care. 350 pru. rd ,^^’'“‘tTe,er, MI M Tmlius /ever MI 51 3M 172 U 172 W^a-Molet rajs uJS”'”' ■•n 173 UK/Ci"'”" ™‘''. 174 35 130 II 397 401 Y |?| ''aeclnollon, ,,, age of, 334 2fi« ‘^«’P»C8tions Of ff® ProtecUon ^ 33S 2S ^ Phenomeni 335 7I s, "actions, 336 3M *nanufacture 338 Valve closet.. 338 331 vcgeiabjes, 89 loods 157 JZ green, 131 fvSK'oS‘-»*. iS |« SSS,'" ■ 5“ I SLr- Tetem. g 15 Wei S r? external. 38 internal, 32 xi natural, 55 Weather cock or wealher of sewers, 101 vane 175 outlets for, 68 Well Abyssinian, 13 plenum or propulsion artesian. 13 system ol GO cleansing of. 15 Vacuum or extraction cone of filtration, 13 system. 81 deep, 13 Village sanitation. 374 examination of. 16 Vital capacity. C4 privy. 71 index quality of well water. 15 layer 21 quantity of water m. 14 statistics, 462 shallow, 12 Vitamins, 116 sources of pollution. IT ciassineatlon, 116 tube. IT varieties of, 12 W yield of, 17 Wash down closet, 92 Wet and dry bulb. 174 wnsh'OUt closet, 90 Hygrometer, 174 Washlnglon-lyon’s disin- Whisky, 158 fector. 253 Whooping Cough, 349 water. at-tion on load, chemical analysis, chlorination of. collection ot sample, distillation ol, examination, nitration ot, ground, hardness of, katadyn, action on metals. Impurities of, purification of, rain, requirements, sea softening of, TOurces o/, sterlhsation, suhsoli. surface, tanks upland surface. Water-borne diseases, ‘Water closet. 30 Wool sorters’ disease, 224 42 World health organisation, 399 32 Worm guinea, 284 39 hook, 285 33 round, 280 39 tape, 287 Am thread, 282 22 Wuchererla, 223 X 38 ^ 30 Xenopsylla, 317 2G XerophtalmJa, 117 ro ■' fever, 308 ^ YieW of spring, 19 ^ of well, 17 32 Z 12 9 Zeolite. 30 10 Zero desk, 181 11 Ztac, ?1 31 Zygote, 295 88 Zyklons, 262