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CHAPTER IV.

Tuberculosis.

     Details of the extent to which tuberculosis is prevalent in India will
be found in the Public Health Commissioner's reports, but the extent
of the problem and the inadequacy of the efforts which have so far been
made to meet it necessitate a short reference.

     2. Unfortunately the available data are inadequate, and our chief
evidence regarding its widespread incidence comes from Dr. Lankester's
report in 1920; a note by General Megaw based upon reports collected
from medical officers and others throughout India; the figures collected
from limited surveys in different areas, and conclusions which have been
reached in the Public Health Commissioner's reports.

     3. Dr. Lankester, who carried out an inquiry into the causes, preval-
ence and possible measures for prevention of tuberculosis in India from
July 1914 to June 1916 observed in his report which was published in
1920:—

       "To sum up: the impression left upon the mind after careful
       inquiry, with comparison of such statistics as are available,
       is that many large areas in India, which 40 years ago were
       practically "virgin soil" to tuberculosis, have now become to
       a considerable extent infected; that phthisis has been for
       generations, probably centuries, a common disease of the
       larger cities, yet even in these there has been considerable
       actual increase during the last 40 years; that while in smaller
       towns and in the village districts it was formerly compara-
       tively rare or even absent, yet in these during a similar period
       the disease has made its appearance and spread widely. The
       increase has been most marked in connection with those
       centres which have shown the greatest commercial and
       educational development, and in the village districts which
       have been linked up with them by direct lines of communi-
       cation."

   4. Major-General Sir John Megaw in 1933 estimated that there were
probably two million cases of tuberculosis in India. His conclusions
were:—

       "Tuberculosis is evidently very widespread throughout the villages
       of India but is specially serious in Bengal, Madras, the Punjab
       and Bihar and Orissa. Pulmonary tuberculosis seems to be
       much more common than extra-pulmonary except in the
       United Provinces and Bombay. The low incidence in the
       Central Provinces is remarkable and is perhaps associated
       with the sparse distribution of the population and with defec-
       tive means of communication.

       "Tuberculosis is well known to be exceedingly prevalent in the
       cities and large towns but little is known as to its incidence
       in rural areas. The evidence of the dispensary doctors goes
       to show that the disease is very widely disseminated through-
       out India. From other sources of information it seems likely