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THE GOVERNMENT OF INDIA’S SANITARYPOLICY.

(FROM A SPECIAL CORRESPONDENT.)

THE Government of India have issued an importantresolution on the subject of sanitary progress and develop-ment in India. The resolution lays down three broad

principles on which sanitary work must proceed in India. It

must rest on a knowledge of the people, their conditions oflife, their prejudices, social customs and habits, their

surroundings and financial means, and it must secure their

cooperation. It must recognise the diversity of local con-ditions in a country which includes numerous communities,castes, and creeds, which exhibits almost every variety ofclimate, temperature, humidity, and level of subsoil water.Its introduction must be preceded by preliminary localsurveys, inquiry, or experiment. The policy of the Govern-ment of India is to keep the control of research under itself,but to decentralise other branches of sanitation.

It then proceeds to consider the present state of our

knowledge with respect to all the principal diseases ofIndia, and also on such subjects as infantile mortality,vital statistics, urban sanitation, conservancy, water-supply,drainage, epidemic diseases, pilgrim centres and pilgrimages,the adulteration of food and drugs, adulteration of milk,town planning and relief of congested areas, and ruralsanitation. On each point it indicates the state of knowledgeso far reached and the broad lines of the policy whichshould be pursued in future. It concludes with the

expression of the opinion that the diffusion of sound educa-tion will remain a most potent and penetrating instrumentof sanitation among a population which still views it forthe most part with hostility or unconcern.

Investigations into the Ca2csation and Prevention of Disease.Research is slowly lifting the veil which hides the secrets

of disease and mortality and opening up fields of inquiryscarcely thought of a generation ago. In 1902 a

research institute was founded at Guindy, in Madras, namedthe King Institute after Lieutenant-Colonel King, C.LE.,in view of his devoted efforts in the cause ofsanitation in that presidency. The Central ResearchInstitute has been established at Kasauli. The PlagueResearch Laboratory at Parel has been extended andre-equipped, and is now the bacteriological laboratory forthe Bombay Presidency ; and a proposal is under considera-tion to attach to it a school of tropical medicine. Aresearch laboratory and school of tropical medicine are

under construction at Calcutta. Pasteur institutes existat Kasauli and Coonoor. A third is about to be establishedin Burma, and it is under discussion to establish others inAssam (where it will be combined with a research laboratory)and Bombay.

Besides the routine work connected with the bacterio-logical diagnosis of disease, antirabic treatment, themauufacture of various vaccines and sera, and generalresearch, these laboratories at different times have beencentres of many special investigations, notable amongstwhich are those on plague and enteric fever. It is hopedthat before long each province in India will have a laboratoryfully equipped for research. The foundation of the IndianResearch Fund Association in 1911 has marked an importantera in sanitary progress. The association has been activeand can already point to some achievement. Out of anincome of Rs.15 lakhs (100,000) received since its

incorporation and up to the end of 1913-14, an expenditureof over Rs.14 lakhs (93,333) has been sanctioned. In1911 Major S. P. James, I.M.S., was deputed to studyyellow fever in its endemic area and to draw up proposalsfor protecting India against the introduction of the disease.These proposals are still under consideration. In themeanwhile, stegomyia surveys have been carried out inCalcutta, Bombay, Madras, Karachi, Rangoon, and otherseaports. Antimalarial schemes based on preliminarysurveys have been carried out at a cost of Rs.6,02,000(S40,133). Investigations are at present in progress intothe problems connected with the prevalence of cholera, kala-azar, dysentery, leprosy, and goitre.

Malaria and Plague.The report states that the conditions and causes under-

lying the prevalence of malaria vary greatly in differentplaces, and no one antimalarial measure is suitable for all.Quinine both as a prophylactic and curative agent is of greatvalue to the individual. Its powers of saving life, alleviatingsickness, and destroying sources of infection cannot be over-estimated. There should be no relaxation of the efforts toeducate the people in the use of the drug, and its sale byshopkeepers in rural areas might well be encouraged. Theregular administration of quinine to children in schoolsduring the malarial season is a practical measure of easyapplication and of proved ability ; it is valuable alike for itsimmediate good effects on the health of the scholars and asa means of spreading knowledge of the use of quinine.The treatment of permanent collections of water is im-

portant whether it be effected by water tidiness, throughsloping of banks and clearing of weeds, or stocking with fishof proved ability as mosquito destroyers or by both methods.As regards plague, the chief conclusions that have been

reached so far may be summarised as follows. In India,where the pneumonic form of the disease is relatively rare,plague is essentially a disease of rats communicable toman and a few of the lower animals ; an epidemic amongstmen is directly dependent upon an epizootic amongrats. Plague spreads from rat to rat and from rat toman through the agency of the rat-flea. The plaguebacillus under natural conditions does not long retainits vitality outside the body of the rat, the rat-flea, orman. Plague has a definite seasonal prevalence, generallyconstant for any given place, but varying in different partsof India ; investigation shows that the plague season

coincides with the season of maximum prevalence of rat-fleas. Infection is carried from place to place only overshort distances by the spontaneous movement of rats ; inother cases infection is carried either (a) by the agencyof man or personal effects acting as a means of transportfor infected fleas ; or (b) by means of merchandise,which may contain rats as well as fleas. It is not yetestablished which of these two agencies is the more

important, but recent work, both in India and the Far East,has emphasised the importance of grain as a vehicle for thetransmission of infection.

In comparatively few places in India does plague infectionsurvive the adverse conditions of the non-epidemic season :such places are usually either (a) large towns, or (b) placeswhich have been infected late in the epidemic season. In

places which have suffered from repeated and severe

epidemics of plague the rats have become less susceptibleto plague than are the rats in places which have remainedplague-free or have suffered but slightly. These conclusions,says the resolution, have been arrived at after much carefuland painstaking research, and constitute a great advance onthe knowledge of plague which was available when in 1896it first appeared in Bombay. They point apparently to asimple solution of the plague problem-no rats, no plague.

Urban and Rural Sanitary Problems.The resolution then deals with other diseases, infantile

mortality, scavenging, and the adulteration of food. Whilemuch has been done to provide drainage and pure waterin large cities, there can be little hope of improving theirsanitary condition permanently until measures are taken torelieve congested areas and to provide broader streets andbuildings more open to sun and air. The constitution in1898 of the Improvement Trust in Bombay marked a notablestep in advance. By the end of 1912-13 the Bombay Trusthad incurred an expenditure of Rs.488 lakhs (Z3,253,333)towards schemes aggregating 802 lakhs (<&5,346,666). Broadroads have been driven through the heart of the city, slumareas have been abolished, and dwellings provided for theaccommodation of the poorer classes.The difficulties which surround rural sanitation in India

are well known and persistent. Contaminated sites, pollutedwater-supply, badly constructed and insanitary dwellings, andthe habits and prejudices of the people raise obstacles to

,

progress, which in most provinces are still well-nigh insuper-. able. The Government of India have informed local govern-I ments that they are at liberty to expend a portion of theI imperial grants for urban sanitation on rural sanitation, pro-. vided practical schemes for this purpose are forthcoming,

but they have postponed special imperial grants for this

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purpose until such schemes are more generally advanced.They fully appreciate the enormous importance of ruralsanitation in a country which is mainly agricultural. Past

experience and present conditions, however, indicate thatthe subject is still one for experiment on lines conceived toattract the cooperation of the people. Without their cordialhelp no sanitary staff could effectively deal with the villagesanitation of the 220,000,000 who inhabit rural areas inBritish India. The danger of employing low-paid and imper-fectly trained subordinates in a matter so closely affectingvillage life is now generally recognised and should never beout of mind.The resolution then points out the importance of education

and concludes : There is room for many workers in the

sanitary field. The Governor-General in Council appealswith confidence to all who are interested in the well-beingof India to join with him and the local governments in asustained endeavour to give effect to His Imperial Majesty’smost gracious wish that the homes of his Indian subjectsmay be brightened and their labour sweetened by the spreadof knowledge with all that follows in its train, a higherlevel of thought, of comfort, and of health.

Home and Foreign Notes.(FROM OUR OWN CORRESPONDENTS.)

MANCHESTER.A Visit of American Surgeons.

A PARTY of American surgeons visited Manchesteron July 8th. The visit was organised by the ’,American Gynaecological Society in order that ’

its members might have the best opportunity ofseeing the work which is being done in their owndepartments away from home. Most of the chiefcities and universities of the United States sentrepresentatives to Manchester, which is one of thefive cities in England and Wales on the definiteprogramme of the visitors. The Royal Infirmary,the St. Mary’s Hospital, and the Lying-in Hospitalwere visited. At the Royal Infirmary our visitorswere obviously much impressed by the arrangementand the very thorough equipment of the spaciousbuildings. The homeliness and comfort obtainedsimultaneously, and the decoration of the wardswith flowers appealed to them. Surprise was

expressed that, as usual, the public hospitals inthis country have no accommodation for privatepatients who might wish for more luxurioussurroundings. What, however, pleased the surgeonsmost was that they saw in the operating theatres ofthe institutions they visited ’’ swift, skilful, andexpert operating," and "sane, wise, direct, -carefulwork "-I quote their flattering words.

Increase of Medical Students at Manchester.The graduation ceremonial took place on July 4th.

From the annual reports issued by the Vice-Chancellor we find that in the Faculty of Medicineduring the session 1913-14 there were 305 studentsof medicine, 34 being women. In the Faculty ofMedicine 129 students were working in preparationfor the examinations of Manchester University;4 for the University of London; 6 for other uni-versities ; 3 were preparing for the Fellowship ofthe Royal Colleges of Surgeons of England; 2 forthe F.R.C.S. of Edinburgh; 2 for the L.S.A.;33 were preparing for the Conjoint Examination ofthe Royal College of Physicians and Surgeons ofEngland; 2 for the Diploma in PsychologicalMedicine; 3 for the Degree in Dentistry; 57for the Diploma in Dentistry of Manchester;13 for the Diploma in Dentistry of the RoyalCollege of Surgeons of England; 53 were working

in the following special departments-viz., pharma-ceutical, 3; public health, 46 (37 of these were

preparing for the Diploma in Public Health, 4 forthe Diploma in Veterinary State Medicine, 7 for thetuberculosis course, and 5 carrying out research) ;and 4 were taking special medical courses. Thenumber of beginners in medicine was considerablyabove that of previous years. The total number ofstudents during the academic year was 1654.

Successful Appeal for the Radi2cm Scheme.At one time it seemed that the Manchester radium

scheme might have to be either abandoned or post.poned until the necessary .f:25,OOO was obtained.The results of the initial appeal fell far short ofthe expectations of the committee. The address ofDr. Dawson Turner gave an enormons impetus tothe scheme ; the striking feature, however, is whathas been done largely through the enterprise of thenewspapers, more especially of those controlled byMessrs. Hulton and Co. All the arts, devices, andcarefully worded appeals that energetic journalistsknow well how to employ have been used withalmost magical and immediate results. For a longtime there was a standstill at .f:8000. A " RadiumDay " was instituted in Manchester and other towns;and appeals were made in all directions. As thecause was good, Manchester and the neighbouringtowns have responded most handsomely, and theworking men and women have contributed accord-ing to their means. In a little over a fortnight thetotal contributions have increased from JE8000 to;E18,450. The Joint Committee have appointed Mr.Hartley Lupton, of the Physical Laboratory of theUniversity, to be physicist in charge of the radiumdepartment about to be instituted in the Royal In-firmary, while Dr. Marsden, of the same laboratory,will be consulting physicist. The department willbe got ready under their direction, and it is hopedthat an initial supply of radium will be availablein October.

Poor-law Children and Ophthalmia.Owing to the prevalence of ophthalmia amongst

Poor-law children in Crumpsall, and also to the factthat there were more children at Crumpsall thanthere is accommodation for, the Manchester boardof guardians decided on July 8th to ask thesanction of the Local Government Board in respectof the purchase of a building at a cost of .S7250 tobe used for children suffering from ophthalmia.The situation ought to be relieved by the proposedfacilities for isolation of the affected children.

Lancashire and the Annual Factories Report.The annual report of the Chief Inspector of

Factories, which was issued on July 8th, containssome remarks which have a special interest forLancashire. The total number of persons employedin factories was 4,488,774 and in workshops638,335. Textile factories accounted for 18,323accidents and non-textile factories for 146,495. It isstated that from 25 to 40 per cent. of all industrialaccidents are preventable if all practical meansare taken. The establishment of safety committeesof men and officials is recommended. Action is

being taken in the cotton area in regard to thelifting of heavy weights. Cases are mentioned ofchildren lifting skips of cotton weighing 56lb., andof others of 13 to 16 years of age lifting up to82 lb. As to the removal of dust, it is stated thatthe cotton industry can claim one of the greatestsuccesses in regard to the removal of the dustfactor as a cause of many diseases. In regard