lathyrism geography ind megaw et gupta 1927 par miles

7/29/2019 Lathyrism Geography IND Megaw Et Gupta 1927 Par Miles

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/ - ( , - x .Just, '-'l DISTRIBUTION OF INDIAN DISEASES:

Original Articles.

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THE GEOGRAPHICAL DISTRIBUTIONOf SOME OF THE DISEASES OF INDIA.f v 'By J . W. D. MEGAW, c.i.E.,* U E U T . - C O I . . , I . M . S . .

Director, Calcutta School of Tropical Medicine,an d

J. C. GUPTA. M.n..Re listrar, Carwicliael Hospital fo r Tropical Diseases,Calcutta.

THIS note deals with information suppliedb> 240 civil surgeons, each of whom has repliedto a series of ques tions contained in a ques-tionnaire issued by us.There has been a good deal of delay in pro-ducing this report because a small minority ofthe civil surgeons failed to co-operate, and evennow there are certain districts from which noreplies have been received.On the whole a very satisfactory response wasrmde to the request lor iniormation, and ourthinks are due to the civil surgeons and theheads of the medical departments of the Pro-vinces and Indian States who have taken so muchtrouble in helping with the survey.

The objec ts of the surv ev were to collecttogether in a concise form what is known of thegeographical distribution of the more importantdiseases of India and to call attention to the needfor a more accurate survey.The present survey, being based on the clinical observations of p rac tit ione rs, cann ot claim tov am great degree of accuracy, for although thecnil surgeon is usually a medical man of excep-, tional ability and experience, he seldom has the

advantages of laboratory aids for his diagnosis.In the case of som e disease s, inform ation from. the man on the spot is quite reliable when the\ disease can be recognised by clinical observations,' for example, lathyrism, plague, goitre, black-' water fever, catarac t, stone, guinea-worm , etc.r Other diseases will be recognised by some doctorsand overlooked by others; such are aortic dis-ease, general paralysis of the insane, yaws, etc.There are some diseases in which there is nocriterion by which a diagnosis can be made; theremay be a shar p difference of opinion as to whether, a cise of fever should be called dengue or sand-{ flv fever, or whether a case should be called epi-demic dropsy or beriberi .In spite of these and other sources of error, it1 l ikely that the reports which are analysed in

the maps and tables can be relied on as beingapproxim ately accurate. Wh ere there is goodreason to believe that the information is mis-leading', a note of caution is expressed in the text.Malaria has been excluded from the survey asthis disease has been thoroughly dealt with by theMalarial Bureau under Colonel Christophers anda detailed map of the incidence of malaria hasbeen issued recently,* Ho okw orm disease alsois not included, as this disease cannot lend itselfto a survey of this kind, and Dr. Chandler hasmade a broad survey of its distribution on lineswhich are far more likely to yield accurate results.Most of the replies were received in the years1923-1924. but some have been received as late as1926. In some, cases the maps have been revisedin the light of information which is believed tobe mo re acc urate than that supplied in theanswers to our questions, but on the whole thema ps an d tables represent, the. imp ression s a ndpersonal knowledge of the medical officers on thespot.S Y N O P S I S O F T H E R E P L I E S OF CIVIL SURGEONS.T Y P H O I D F E V K K .

This disease appears to be common all overIn dia . Rep lies were received from 209 civilsurgeons. The summary of these is :(a ) In

Common inRareUnknown

Total number ofdistricts

Adults.. 121 districts

7117

. 209

(/>) In Children.125 districts

6816

209The senior author's personal impression, basedon a fairly large expe rience , is that typhoid feveris far more common in children than in adultsin India. Th er e is reason to believe that in manyplaces in India, nearly every child gets typhoid

fever before re aching the age of 12 yea rs. Th ecomparative infrequency of the disease in adultsis probablv due to the immunity which persistsfrom attacks occurring in childhood. Theseattack s are seldom recognised, as the diseasetends to be mild in young children and a medicalman is seldom consulted.T Y P H U S F E V E R .

The only positive reports of the occurrence ofthis disease were the following:1. BengalThe only report was fromDa rjee ling where the civil surgeon states " Ibelieve there were several cases in 1921."2. Burm a 50 cases were reported fromBhamo from insanitary and crowded villages in


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MAP OF IND IAJHOrrmS DISIRI&OTIONOF OSTEOMALACM-


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MAP o? INDIASHOWING-DISTR IBUTION Of ENDEMIC GOITKE.

MAP OF IND IASHOWI.K WIKltOIW 0' hulu-ilS.


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306 THE INDIAN MEDICAL GAZETTE. [JUNE, 1927ENDEMIC GOITRE.The map shows the distribution of this dis-

ease. It is most common in the districts whichlie immediately south of the Himalayas and inthe hilly regions of Assam and Burma. Th edistribution suggests that the agency whichcauses the disease is carried down by the streamsarising in the Himalayas and other mountainsand is spread by the water which overflowsfrom these rivers in the rainy season.The distribution favours an agency of a chemi-cal nature rather than a bacterial infection.The geographical distribution, which appears toremain constant over long periods of time, isnot such as would be expected if the diseasewere due to intestinal infection'

OsTEOMALACIA.The information which has been obtained isshown in the map. The disease is fairly com-mon in many parts of Bombay, the Punjab, 1 theUnited Provinces and the Central Provinces; itappears to be very rare in Bengal, M adra s,Burma, and Bihar and Orissa.

RICKETS.This disease is much more cosmopolitan thanosteomalacia; its distribution is shown by thefollowing table.

CommonRareUnknown

tC

9

410

I

Ct ] C

0 i 32 ! 4

I4 I 4

O

317

dras.

6?

4

73

10

ijah.

1

6

i

10->i

, U 732

O

412448

It will be seen that the disease is more com-mon in Bombay, the Central Prov inces andMadras than in the other provinces. Bengal,"Assam, and the Punjab appear to be relativelyfree from the disease.SCURVY.

The only provinces in which this is at allcommon are Bombay and the United Provinces.The summary of the replies is shown in tabulariorm in the next column.

C o m m o n RareUnknown..

1

tr.

155

O

110

2

D479

n:

37

n)i

" O

479

LATHYR IS M.The map shows the remarkable distribution of \this disease.Except for Jhelum in the iPunjab, Meerut,'^|Shahjahanpur and Unad in the United Pro-"vinces, the disease occurs only in a belt whichruns across the C entral Provinces, the east of ,it is known to the medical officers of the di -*tricts. The positive reports can be accepted^without question, but in many of the districts in 'which the disease is reported to be rare or even,unknown the information is known to be in-saccurate. For example in the 24 Pargan as tdisease is reported to be unkn own , whereas jlarge number of indigenous cases have beenseen by us in Calcutta. i]Our knowledge of the distribution of filarial:disease in India is exceedingly meagre.It w as hoped that useful information would lpbe obtained from the replies to the question, f" W hat p ercentage of the prison ers in the jailshow elephantiasis of the limbs or scrotum?"Replies were received from 19 civil surgeon


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310 TH E IN D IA N M ED IC A L G A ZETTI [JUNE, 1927hand that inany of the mild and earlv cases arcoverlooked, so that any estimate which is basedon 'such figures as these must be regarded ajguess Work, but they are probably as near thetruth as any existing figures and they wouldindicate thai: there are from a half ' to onemillion lepers in India and Burma.

Disscininatcd sclerosis.This disease isreporte d from the .following plac es:(1) Bengalnil.(2) Assamnil.(3) BurmaTharrawady, Mandalay andTyangya.(4) B. & O.Saran.(5) MadrasGodavari, S. K anara andAnantpur.(6) U . P.S itapur, Lrrcknow, Benares, Par -tabgarh, Meerut, Ferrakabad, Cawnpur, Allaha-bad and Agra.(7) Punjab Karnal, Rohtak, Gurgaon,Amritsar, Jhelum, Shahpur and Ferozepur.(S) C. IP.Cambay, Sur at. and Sovantbati.The medical officers who report that they haveseen cases state that Hindu and Muhammedanmales have been affected. No cases were report-ed in females, but it must be remembered that adisease of this kind would be unlikely to come tothe notice of the civil surgeons if it occurred ina female.

EXOPHTHALMIC GOITRE.The distribution of the disease seems to bi t a" chance one." Young adult females are said tobe most commonly affected. Ou t of 35 repo rt-ing civil surgeons young males are mentioned by

only 2 civil surgeons, the remainder all reporthaving seen the disease in females.Acute Anterior poliomyelitis.This is onlyreported from Benares, Shahranpur, Furrakabad,' Allahabad, Mirzapur, Bunda and Agr a. Thedisease is by no means so rare as these recordswould sugg est. A good many cases have beenseen by the senior author in Calcutta.SPRUE IN INDIANS.

To the question " Have you seen any cases ofsprue among Indians?" only 10 civil surgeonsreported that they had seen such cases. Thesewere the civil surgeons of Gorakhpur, Furraka-bad, Ludhiana, Dera-Ismail Khan, Ahmedabed,Broach, Surat, Sovantbati, Sholapur and Ivolaba.The disease obviously is rare in Indians as com-pared with Europeans.HYDATID CYST.

Cases of hydatid cyst have been seen by 42 civilsurg eon s; of these 22 specify that the diseaseoccurred in the liver, the others do not specifythe organ of the body which was affected.

1 he disease ap pears to be w idely but sparsely !distributed all over India as is seen from th e!table. -- i

Reported asobserved.Reported asn o t o b -

served.

alboCJ

2

7

in.

in9

6

2 ,

11

4

oca

11

LU PU S VU LG A RIS.This disease is reported from 166 di tncts,jjbut only 4 civil surgeons report cases in whichjthe diagnosis was established by laboratory!examination.The disease would appear to be uncommon injmost parts of India, except the Punjab and h

United Provin ces. Fro m personal experience,'one is satisfied tha t the disease is even le ~common than would be suggested by the table;Almost all the cases which the senior author haseen in which the clinical diagno sis of lupvulgaris was made, turned out to be seborrhceic|dermatitis or other disease.

Report e da s ob -served.Not repor-ted.

boa6

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lathyrism geography ind megaw et gupta 1927 par miles

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