152 NOTES FROM INDIA. on behalf of the Lutheran Church and contains 450 beds. Its principal feature ih that it has seven floors, whilst in Berlin formerly single-floor buildings were preferred for hospitals. The wards do not contain more than six beds each, whereas in public hospitals the wards contain up to 30 beds. The patients will thus enjoy more privacy and quiet than those in hospitals with large wards. There are six operation rooms, a lying-in room, rooms for special treatment, a radiographic and hydrotherapeutic department, and a post-mortem room. A nurse’s training school is connected with the hospital. NOTES FROM INDIA. (FROM OUR OWN CORRESPONDENT.) THE POPULATION PROBLEM. IN the May number of the Indian Medical Gazette attention is drawn to the progressive increase in population which each succeeding census records. Since the British occupation it has grown by a hundred millions, and the first returns of the present census indicate relatively greater proportionate increase during the last decade, Bengal showing a gain of 7 per cent. Even at present the produce of the land cannot maintain the inhabitants in an efficient state of nutrition. Little arithmetic and less imagination are required to forecast the state of affairs a hundred years hence if this rate of increase continues unchecked. Overcrowding must become critical long before that, in spite of irrigation, improved methods of agriculture, and other alleviating agencies, unless some counter- vailing influences not at present in action can be brought to bear. Curiously enough, this reflection is prompted by the reiterated demand of the annual conference of research workers, for more active e measures of research, and prevention of disease. Already disease has been controlled to a considerable extent, the effects of famine much mitigated, and wars on any considerable scale in the country itself have been avoided for a long period. If all these factors persist or are intensified, what becomes of the balance between food-supply and population ? Delayed marriage and contraception are said to have e a restraining influence and certainly there is plenty of room for a change in the direction of later child- bearing. Birth control is only applicable to educated and intelligent sections of the community, but advanced Indian opinion is evidently trending that way, in some quarters. In Madras a " Neo- Malthusian League " has already been formed. INDIGENOUS DRUGS. Though they have not revealed much in the way of new specific remedies, the past few years’ investigations of native drugs have led to a considerable accumulation of knowledge of the medicinal plants which India produces. Lieut.-Col. Chopra, who has been responsible for much of the research work in Calcutta, says that about three- quarters of the vegetable drugs of the British and U.S. pharmacopoeias grow in India. The Himalayan valleys from Kashmir to Sikkim form the chief nurseries, but the Kumaon hills and Vindhya range in the north, and the Nilgiris in the south, also abound with medicinal plants and herbs, some of which grow wild, while others are cultivated. In many cases, where the actual official varieties do not exist, there are others belonging to allied species which possess similar properties, and are capable of being utilized as substitutes. They would, of course, have to be examined and standardised, and this work is already in progress. It is remarkable that the manufacture of drugs on scientific lines, and of surgical dressings, has hitherto been almost entirely neglected in India. With few exceptions, such as quinine and castor oil, nearly all the pharmaceutical and surgical requirements of the country are imported from Europe and America. Here is a very reasonable opening for swadeshi activities. THE ANTIQUITY OF SYPHILIS. There has recently been a tendency to try to ascribe the introduction of syphilis into India to evil coni- munications from the West. It is therefore instruc- tive to find Dr. Chenoy, in an article in the Antiseptic, identifying an unmistakable account of the disease in the ancient Hindu scriptures. The Ayurveda, lie ° says, contains several passages bearing on the subject. Infection is ascribed to the sexual act. There is a clear account of secondary symptoms, such as con. dylomata and mucous patches at the genital organs and mouth, and superficial ulcers in various situations, and the depression of the nose and perforations of the palate characteristic of tertiary lesions are also mentioned. The disease is spoken of as the shameful disease, and reference is made to round ulcers, prominent pustules, alterations of the nails, buboes, and alopecia, as well as stricture of the anus. The Ayurveda dates back to a period perhaps 1000 years B.c. Dr. Chenoy concludes that syphilis existed in India, and probably elsewhere, in prehistoric times, and is evidently one of the most ancient diseases of man. IIR. GANDHI AND FOREIGN MISSIONARIES. Alluding to recent reports in the press that he was hostile to foreign missions, and would like the missionaries to withdraw from India, Mr. Gandhi, writing in his paper Young India, now corrects and amplifies the statements attributed to him, as follows :- ’’ I hold that proselytising under the cloak of humani- tarian work is, to say the least, unhealthy. It is most certainly resented by the people here. Religion after all is a deeply personal matter, it touches the heart. Why should I change my religion because a doctor who professes Christianity as his religion has cured me of some disease, or why should the doctor expect or suggest such a change whilst I am under his influence ? Is not medical relief its own reward and satisfaction ? Or why should I whilst I am in a missionary educational institution have Christian teaching thrust upon me ? In my opinion these practices are not uplifting, and give rise to suspicion if not even secret hostility. " It does not appear that Mr. Gandhi has any special prejudice against Christianity as such. It is thought, in fact, that his ideas on religious subjects have been much influenced by the New Testament, as he undoubtedly has in social problems by the teaching of Ruskin. SOCIETY FOR RELIEF OF WIDOWS AND ORPHANS OF MEDICAL MEN.—A quarterly court of directors was held on July 8th, with Dr. W. Culver James, senior vice-president, in the chair. The death of an annuitant was reported, who had been in receipt of grants since 1920,and had received £787. Her late husband had paid in subscriptions about £52. Sums amounting to £2075 were voted for the half-yearly grants to the 52 widows and 7 orphans on the books of the society, and £123 was voted as special grants for six orphans, in order to enable them to continue their education after the age of 16, when the ordinary grants cease. Full particulars of the society and its benefits may be had from the secretary at 11, Chandos - street, Cavendish - square, W.1. An account will also be found in THE LANCET of April llth (p. 817).
Transcript
152 NOTES FROM INDIA.
on behalf of the Lutheran Church and contains 450beds. Its principal feature ih that it has seven floors,whilst in Berlin formerly single-floor buildings werepreferred for hospitals. The wards do not containmore than six beds each, whereas in public hospitalsthe wards contain up to 30 beds. The patientswill thus enjoy more privacy and quiet than thosein hospitals with large wards. There are six operationrooms, a lying-in room, rooms for special treatment,a radiographic and hydrotherapeutic department,and a post-mortem room. A nurse’s training schoolis connected with the hospital.
NOTES FROM INDIA.
(FROM OUR OWN CORRESPONDENT.)
THE POPULATION PROBLEM.
IN the May number of the Indian Medical Gazetteattention is drawn to the progressive increase in
population which each succeeding census records.Since the British occupation it has grown by a hundredmillions, and the first returns of the present censusindicate relatively greater proportionate increase
during the last decade, Bengal showing a gain of7 per cent. Even at present the produce of the landcannot maintain the inhabitants in an efficient stateof nutrition. Little arithmetic and less imaginationare required to forecast the state of affairs a hundredyears hence if this rate of increase continues unchecked.Overcrowding must become critical long before that,in spite of irrigation, improved methods of agriculture,and other alleviating agencies, unless some counter-vailing influences not at present in action can be
brought to bear. Curiously enough, this reflectionis prompted by the reiterated demand of the annualconference of research workers, for more active emeasures of research, and prevention of disease.Already disease has been controlled to a considerable extent, the effects of famine much mitigated, andwars on any considerable scale in the country itselfhave been avoided for a long period. If all thesefactors persist or are intensified, what becomesof the balance between food-supply and population ?Delayed marriage and contraception are said to have ea restraining influence and certainly there is plentyof room for a change in the direction of later child-bearing. Birth control is only applicable to educatedand intelligent sections of the community, butadvanced Indian opinion is evidently trending thatway, in some quarters. In Madras a " Neo-Malthusian League " has already been formed.
INDIGENOUS DRUGS.
Though they have not revealed much in the
way of new specific remedies, the past few years’investigations of native drugs have led to a
considerable accumulation of knowledge of themedicinal plants which India produces. Lieut.-Col.Chopra, who has been responsible for much ofthe research work in Calcutta, says that about three-quarters of the vegetable drugs of the British and U.S.pharmacopoeias grow in India. The Himalayanvalleys from Kashmir to Sikkim form the chiefnurseries, but the Kumaon hills and Vindhya range inthe north, and the Nilgiris in the south, also aboundwith medicinal plants and herbs, some of which
grow wild, while others are cultivated. In manycases, where the actual official varieties do not
exist, there are others belonging to allied species whichpossess similar properties, and are capable of being
utilized as substitutes. They would, of course, haveto be examined and standardised, and this work isalready in progress. It is remarkable that themanufacture of drugs on scientific lines, and ofsurgical dressings, has hitherto been almost entirelyneglected in India. With few exceptions, such as
quinine and castor oil, nearly all the pharmaceuticaland surgical requirements of the country are importedfrom Europe and America. Here is a very reasonableopening for swadeshi activities.
THE ANTIQUITY OF SYPHILIS.
There has recently been a tendency to try to ascribethe introduction of syphilis into India to evil coni-munications from the West. It is therefore instruc-tive to find Dr. Chenoy, in an article in the Antiseptic,identifying an unmistakable account of the diseasein the ancient Hindu scriptures. The Ayurveda, lie °
says, contains several passages bearing on the subject.Infection is ascribed to the sexual act. There is aclear account of secondary symptoms, such as con.dylomata and mucous patches at the genital organsand mouth, and superficial ulcers in various situations,and the depression of the nose and perforations ofthe palate characteristic of tertiary lesions are alsomentioned. The disease is spoken of as the shamefuldisease, and reference is made to round ulcers,prominent pustules, alterations of the nails, buboes,and alopecia, as well as stricture of the anus. The
Ayurveda dates back to a period perhaps 1000 yearsB.c. Dr. Chenoy concludes that syphilis existed inIndia, and probably elsewhere, in prehistoric times,and is evidently one of the most ancient diseases ofman.
IIR. GANDHI AND FOREIGN MISSIONARIES.
Alluding to recent reports in the press that he washostile to foreign missions, and would like themissionaries to withdraw from India, Mr. Gandhi,writing in his paper Young India, now corrects andamplifies the statements attributed to him, as
follows :-’’ I hold that proselytising under the cloak of humani-
tarian work is, to say the least, unhealthy. It is mostcertainly resented by the people here. Religion after allis a deeply personal matter, it touches the heart. Whyshould I change my religion because a doctor who professesChristianity as his religion has cured me of some disease, orwhy should the doctor expect or suggest such a changewhilst I am under his influence ? Is not medical relief itsown reward and satisfaction ? Or why should I whilst I amin a missionary educational institution have Christianteaching thrust upon me ? In my opinion these practices arenot uplifting, and give rise to suspicion if not even secrethostility. "
It does not appear that Mr. Gandhi has any specialprejudice against Christianity as such. It is thought,in fact, that his ideas on religious subjects have beenmuch influenced by the New Testament, as he
undoubtedly has in social problems by the teaching ofRuskin.
SOCIETY FOR RELIEF OF WIDOWS AND ORPHANS OFMEDICAL MEN.—A quarterly court of directors was held onJuly 8th, with Dr. W. Culver James, senior vice-president, inthe chair. The death of an annuitant was reported, whohad been in receipt of grants since 1920,and had received £787.Her late husband had paid in subscriptions about £52. Sumsamounting to £2075 were voted for the half-yearly grantsto the 52 widows and 7 orphans on the books of thesociety, and £123 was voted as special grants for six orphans,in order to enable them to continue their education after theage of 16, when the ordinary grants cease. Full particularsof the society and its benefits may be had from the secretaryat 11, Chandos - street, Cavendish - square, W.1. Anaccount will also be found in THE LANCET of April llth(p. 817).
153PANEL AND CONTRACT PRACTICE.
REVISION OF THE PHARMACOPŒIA.
RECOMMENDATIONS OF PHARMACY SUBCOMMITTEE.1
THE publication of their second report completes the work allocated to the Pharmacy Subcommittee. 1In issuing it the Pharmacopoeia Commission record ]
appreciation of the criticisms and suggestions madein connexion with the first report of the subcommittee, ’ ]and their hope that this report will also give rise to ’ comments, to which careful consideration will be given.The following examples show signs that the sub-committee appreciate suggestions and are willing toalter their tentative recommendations on adequategrounds.
Liniments, Ointments, and Plasters.—At an early stage oftheir work the subcommittee were informed that oliveoil of high grade would be described in the new Pharmacopoeia,and the suggestion was made that the use of a cheaper oilshould be permitted in making liniments, ointments, andplasters. The proposal, made in the first report of the sub-committee, that cottonseed oil should be used for thispurpose, has been adversely criticised, more particularly inrelation to liniment of camphor. The subcommittee now
make the suggestion that the Pharmacopoeia should recognise,in addition to the high-grade olive oil, an olive oil of lowerquality,which might be used in making the official liniments,ointments, and plasters. The case would be met by appendingto the monograph on olive oil a note to the following effect :-" Olive oil conforming to the above characters and tests,but possessing an acid value not exceeding 6-0, may beemployed in making the official liniments, ointments, andplasters for which olive oil is directed to be used."Eye Ointments.—The subcommittee have been asked to
devise formula’ for a number of eye ointments for inclusionin the new Pharmacopoeia under the name " Oculenta."They submit a description of a general process to be followedin making eye ointments, with a list of the suitable strengthsof various drugs commonly employed in this form.
1 General Medical Council. Pharmacopoeia Commission.Reports of Subcommittees No. 6. Published by authority of theGeneral Medical Council, 44, Hallam-street, London, W. 1931.Pp.24. 1s. 6d.
Hydrargyrum cum Creta.—The attention of the sub-committee was drawn to some experiments which showedthat mercury with chalk made according to the formula ofthe present Pharmacopoeia rapidly developed considerablequantities of soluble mercuric compounds on keeping. Ithas been found that mercury with chalk containing dextrosedevelops soluble mercuric compounds less quickly. If a largeproportion of dextrose is used the mercury is liable to separatewhen the mercury with chalk is made into a pill-mass. The
proposed formula is mercury 330 g., dextrose 100 g., chalk570 g., triturated together in a porcelain mortar until themixture acquires a uniform pale grey colour and metallicglobules cease to be visible when examined under a lensmagnifying four diameters.
Liquor Adrenalinœ Hydrochloridi.-The use of chloroformas a preservative in this solution has been criticised and thesubcommittee recommend that chlorbutol be substitutedfor it.
Liquor Sodce Chlorinatœ Chirurgicalis.-In dealing withDakin’s solution, the task before the subcommittee was todevise a formula for the preparation of a solution whichwould contain a standard proportion of available chlorineand would be free from excessive alkalinity. As the solutionundergoes decomposition on keeping and is often requiredat short notice, it was thought desirable to draw up theformula in such a way that the solution could be preparedextemporaneously from standard materials, and dispensedwithout analysis and adjustment. Chlorinated lime, whenstored under proper conditions, may be kept for a con-siderable period without decomposition. The formula givenwould enable the pharmacist to keep a supply of chlorinatedlime of known content of available chlorine, and todispense Dakin’s solution, as required, without furtheranalysis.
Syrupus Ferri Phosphatis cu»z Quinina et Strychnina.—Thesubcommittee have conducted a long series of experiments inthe endeavour to improve the keeping properties of thissyrup. The most satisfactory result, so far obtained, has been
secured by the replacing of part of the syrup by glycerin.
This report deals also with the preparation ofcollodion, extracts and liquid extracts (includingliver extracts), and infusions, injections, tinctures,suppositories, syrups, and other substances used inpharmacy.A report (No. 7) has also been issued by the sub-
committee on ampoule glass (price ls.).
PANEL AND CONTRACT PRACTICE
EXCESSIVE SICKNESS CLAIMS.
COMMENT on the growth of sickness and disablementclaims was made by Mr. A. S. Comyns Carr, K.C., inhis recent presidential address to the Association of
Approved Societies, reported in the National InsuranceGazette for July 4th. He pointed out that there waslittle evidence of a large increase of sickness amongthe population, which might explain the rise of claims.A factor which could not be left out of consideration,he said, was that the increase of facilities formedical examination had brought to light claims inrespect of complaints which some years ago wouldhave been, at any rate temporarily, overlooked,although they might in the long run result in seriousconsequences for want of early attention. He wasafraid, however, that there remained a considerablebody of evidence that there were a number of peoplewho put in claims which they would not have feltjustified in putting in some years ago. The corollary,he said, seems to be that there is a considerablebody of medical practitioners who are not so carefulwith regard to the certificates they give as they weresome years ago.
" Is it really true," continued Mr. Comyns Carr, " thatthere are medical practitioners who will grant certificates topeople not entitled to them, and, if so, how can it be pre-vented ? Is it a fact that medical practitioners are genuinelytaking a broader view of the degree of sickness which warrantea man or a woman staying away from work ? It may be quitetrue that by allowing claims at an earlier stage of illness youare, I do not say reducing the ultimate burden on the fund
but at all events tending to keep alive with a reasonable-chance of good health a number of people who otherwise-might be overwhelmed by sickness which is to some extentcurable or preventable. There is a good deal of suspicionthat there are a number of doctors who are prepared tocertify people who they know ought not to be certified andto certify people who they know ought to be back at work,if there is work to go back to, and who do it partly by allowingtheir hearts to get the better of their heads, and partly forfear that if they do not grant certificates the insured personsconcerned will transfer themselves to the panels of otherdoctors who will do it. In so far as there is anv foundationfor the latter suspicion, which is very widely held, it is veryimportant that steps should be taken to put a stop to it." Whether the best means is to limit much more strictlythan at present the right of an insured person to transferfrom one doctor to another, or whether there should be amuch closer supervision exercised, chiefly by the approvedsocieties, over the claims which come in from doctors whomthere is reason to suspect, with a view to the removal of-such individuals from the panel, I am not sure. I thinkthe latter method would be more effective than the former.There is much to be said against the restriction of the rightof transfer, but there is nothing to be said against the inflic-tion of severe penalties on medical men who, without reason-able excuse, certify people who should not be certified. This.applies also to regional medical officers."
INSURANCE PRACTITIONERS’ RECORDSIN SCOTLAND.
In an address to the Scottish Conference of
Friendly and Approved Societies. Mr. John Jeffrey,Secretary of the Department of Health for Scotland,said that recently the Department had been criticisedfor asking insurance practitioners to furnish certain
