MEDICAL AND PUBLIC HEALTH SERVICES

DISEASES COMMON TO THE DISTRICT

Communicable diseases such as malaria, tuberculosis, cholera, smallpox, plague, leprosy and guinea-worm were most common in the district of Sholapur.

The following account is reproduced from the old Gazetteer of Sholapur District published in 1884:—

" Of endemic diseases the chief is guinea-worm, which most frequently attacks the inhabitants of the hilly parts of Barsi and Karmala. The disease chiefly originates from the use of bad turbid water. Most of the wells especially in the Barsi sub-division have steps. Though regular bathing is not allowed in these wells, the people stand on the steps below the surface of the water whilst they bathe their limbs and clean their dirty vessels. In the water which thus becomes constantly more and more contaminated are generated hundreds of guinea-worms which attach themselves to the naked limbs of those standing on the steps and burrow under the skin. In most parts of the district at the end of rains from about October intermittent fever prevails for two or three months. The fever is caused chiefly by the sudden changes of temperature and the setting in of the easterly winds. It is not severe and is usually without splenic or other complications. Skin diseases, specially scabies and ringworm, prevail more or less throughout the district. Formerly an epidemic of cholera, nearly always broke out at Pandharpur during the annual fairs, especially at the chief fair in July, but of late, owing to better sanitary arrangements, though out-breaks of cholera have not been altogether prevented, the disease generally appears in a mild form. [Of the out-breaks in 1871-72 and 1872-73, in 1871-72 cholera broke twice. The first out-break lasted from the 27th of July to the 18th of August, during which forty-four persons were attacked and eighteen died; the second out-break was in March during which three persons were attacked and one died. In 1872-73 cholera prevailed largely and broke four times. The first out-break lasted from the 1st of April to the 25th of June, during which 71 persons were attacked and 20 died; the second lasted from the 17th to the end of July during which 49 persons were attacked and 25 died; the third lasted from the 8th to the end of August, during which four persons were attacked and all recovered; and the fourth lasted from the 8th to the 16th of November during which two persons were attacked and one died.] Small-pox, as a rule, does not prevail as an epidemic.'' Table No. 3 shows the number of deaths caused due to various diseases for the years from 1866 to 1970.

Guinea-worm: In 1851, 85 patients from seventeen villages suffering from guinea-worm were treated and 73 wells were disinfected. In 1956, guinea-worm infection prevailed in hundred villages of eleven talukas with a population of 1,27,966. Conversion of step-wells into draw-wells and regular disinfection of water-supplies with a heavy dose of T.C.L. was carried out. During 1961, twenty-four villages having a population of 41,371 reported 772 cases of guinea-worm infection. Four step-wells in the infected villages were converted into draw-wells and two new wells were constructed in Sholapur district.

Cholera: The main season for the out-break of cholera is the rainy season, but occasionally summer also, when there is scarcity of water. The infection takes place through rivers and other water-sources.

Record of the past two decades shows that the epidemic of cholera has been a regular feature in this district, especially those villages situated on river-banks in Sangola, Pandharpur, Akkalkot, South Sholapur, Mohol and Madha talukas and the places where the major fairs are held. Fresh water, after monsoon, often causes infection of an epidemic of this kind and it flares up in no time due to contacts.

In 1882 cholera appeared after the Pandharpur fair in July and continued throughout the district till the end of August. Out of sixty cases treated in the civil hospital, 25 proved fatal. At Sholapur and Barshi 81 and 65 cholera cases respectively were treated in the local dispensaries, out of which 36 and 20 cases respectively proved fatal. In Pandharpur in the same year there were 101 cases, out of which 57 proved fatal.

In the year 1935 in Sholapur district cholera appeared in all the ten registration circles and was reported from 271 villages and towns. There were 4,668 attacks and 2,120 deaths recorded due to cholera. The intensity was highest from July to November. The first case was reported on 3rd January 1935 from Patkul village in Madha taluka. In Sholapur town cholera broke out in May and continued till November with 166 attacks and 103 deaths. Pandharpur town had 90 attacks and 69 deaths in all, distributed over a period from February to November. Of these, 28 cases and 20 deaths were indigenous and the rest imported. The deaths recorded in the rural areas taluka-wise were Barshi. 453; Sholapur, 496 and Sangola, 420 whereas the death-rates were 3.96, 3.89, 4.63 respectively. In Pandharpur town the high death-rate recorded was 2.55.

In 1945 in the whole of the Sholapur district 4,621 cases and 3,293 deaths were reported from 294 villages in 17 registration circles. The infection was sporadic up to April and began to spread from May. The month of July recorded the largest number of deaths, viz., 1,251. Sholapur, Barshi, Malshiras and Madha talukas were the worst affected. The high death-rate recorded in the Vairag town was 5.55 whereas the same was 403 in the rural areas of the Sholapur district.

Details about cholera inoculations in the Sholapur district for 1961, 1962 and 1963 are given in the following statement:—

In the year 1961 prompt steps were taken to organize mass anti-cholera inoculation in the affected areas by the Public Health Department with a view to bring the epidemic under control. Anti-cholera preventive measures are taken every year in the district and the total number of persons inoculated in a population of 18,60,119 stands at about 7 lakhs.

Disinfection of water-supplies from rural as well as urban areas is undertaken by technical staff such as Sanitary Inspectors, Sanitary Sub-Inspectors, vaccinators, sanitary squads, etc.

Regular disinfection of water sources with bleaching powder is undertaken so that the villagers would not fall a prey to the disease. The staff of Public Health Department has so far disinfected 15,000 wells, Government as well as private, 4,000 springs from beds of nallas and rivers, thereby enabling the supply of potable water to the public and minimising the incidence of water-borne diseases. As per the compulsory rules prescribed by the Government, during the fairs, anti-cholera inoculations are carried on and necessary sanitary arrangements are maintained. The following statement shows the cholera inoculations for a few years:—

The following statement gives the taluka-wise statistics of cholera inoculations in Sholapur district for the year 1972:—

The following statement shows the number of in-door and out-door cholera patients treated:—

Small-pox: Next to cholera the leading epidemic is small-pox. A good measure of success has been achieved in the eradication of this disease. The National Small-pox Eradication Programme in this district was undertaken since the year 1910 through local agencies like District Local Board to bring this evil under control. There were 25 permanent vaccinators, out of whom eleven were Government employees, and 14 were District Local Board employees. Each vaccinator treated about 50,000 people. In rural areas, extensive efforts were undertaken to cover children and adult population by vaccination and re-vaccination.

The particulars about small-pox incidences in Sholapur district are given below:—

The above statement shows that in 1963 the average number of attacks per habitation was the highest. In 1961 the proportion of deaths resulting from the attacks was the highest, viz., 60 per cent whereas in the year 1963 the same was 20 per cent. The decrease was the result of the efficacy of the measures undertaken.

In the affected and threatened areas vaccination and re-vaccination campaign was intensified on a mass scale by appointing extra vaccinators. Measures such as propaganda in favour of vaccination and prompt notification, and explaining other preventive measures by means of magic lantern slides, leaflets, posters and talks were also carried out.

The following statement shows small-pox vaccinations and re-vaccinations performed in the district for the years 1961, 1962 and 1963:—

The above statistics show that the proportion of re-vaccination to total vaccination was significant in view of preventive measures undertaken.

There are 23 regular vaccinators, 78 N.S. E.P. vaccinators and four Sanitary Sub-Inspectors who carry out primary and re-vaccination in the district. In times of emergency, Sanitary Inspectors also perform vaccinations. During the year 1968-69 the vaccination staff performed 78,000 primary and 1,28,300 re-vaccinations.

Fevers: Fevers which belong to the endemic group of diseases account for more than fifty per cent of the total deaths. They are most common after the closure of the rainy season. They are almost always intermittent at the beginning and in ordinary cases remain intermittent throughout the attack for a longer or shorter period.

The number of deaths that occurred due to fevers for certain years are given below:—

Plague: Plague first broke out in the Sholapur district in December 1896 and was chiefly confined in the beginning to Sholapur town. The infection was probably brought from Bombay. The district suffered very severely from plague in 1902-03 and 1903-04.

The following statement shows the total mortality from plague from 1896-97 to 1915-16 for a few years:—

In the former Akkalkot State, the first case of plague occurred in 1897. The disease caused deaths of about 400 persons up to June 1900. The total attacks and deaths in the year 1905-06 were 590 and 437; in the year 1910-11, 122 and 89; in 1915-16, 1,656 and 1,155 and in 1919-20, 22 and 20.

Several factors in connection with the severity of this epidemic are noteworthy. It was found that late rains had caused a migration of field-rats which showed a greater plague infectivity than ordinary house-rats. The mortality of the epidemic was relatively greater amongst females than males and this may be ascribed to the fact that there were few inoculations of females.

In the year 1935 in Sholapur district 446 deaths were reported from twenty villages. The death-rate for urban areas was 0.50 during the year whereas in rural areas especially in the Barshi taluka it was 2.91 per thousand.

During the year 1945, 1,951 deaths were reported from 159 villages due to plague, the reason being that infection which was severe in the last quarter of 1944 was carried over. The disease, however, progressively declined in the first half of 1945 and recorded the lowest number of deaths during June, i.e., 3. From July there was recrudescence of the epidemic which reached its maximum during September. Among the talukas, Sholapur, Barshi, Madha and Karmala and among towns, Sholapur, Barshi, Vairag and Kurduwadi were badly affected. High death-rate, i.e., 2.23, was recorded in the rural areas of the district.

Special anti-plague measures were organized in the district in the areas which were severely affected. Anti-plague workers were appointed by the Sholapur District Local Board. They visited villages and carried out ratting operations and disinfection of infected houses. The operations consisted of mass inoculation, cyanide fumigation, rat baiting and trapping, disinfection with kerosene oil and soap emulsion for which special staff was appointed in affected areas. Mobile units were formed in the district for quick transport of medical staff and equipment from village to village.

In 1935, in Pandharpur and Sholapur towns, fumigation on a small scale was carried out and 60 and 222 houses respectively were treated. 38,259 inoculations were performed in Sholapur district during the same year.

During the last two decades, that is, approximately from 1955 onwards the district is completely free from the incidence of plague. No single case has been registered or detected. The disappearance of plague may be partly due to the natural waning of the disease but its total absence can to some extent be attributed to extensive D.D.T. operations undertaken primarily for malaria control and intensive and systematic anti-plague measures adopted by the plague organisation.

Malaria: Malaria control and anti-malaria measures could be regarded as the most beneficial and popular activity of the department. As a result of the D.D.T. spraying for the control of malaria the incidence of the disease has been reduced considerably. The activities were executed under the National Malaria Control Programme. The district was taken up in its entirety in 1956 for the spraying purpose. In 1956-57, ten villages in Pandharpur and Malshiras talukas were visited wherein 1,084 children were examined, out of whom four were found to be positive cases.

In pursuance with the nation-wide Malaria Eradication Programme, a unit was established at Pandharpur in 1959 which is assisted in its work by sub-units working at Barshi, Pandharpur, Sholapur and Kurduwadi. The increased incidence of malaria in Malshiras taluka of Kurduwadi sub-unit was noticed in August 1961 by surveillance, both active and passive. The number of malaria positive cases detected till the end of the year was 473. Immediately investigations were carried out to study the reasons for the increase in the incidence of malaria in the area. The investigations revealed that the high incidence was due to incomplete coverage of D.D.T. spraying. As two rounds of spraying had not successfully interrupted the transmission, major portion of Malshiras taluka was sprayed from 16th December 1962 and to get better coverage D.D.T. (Technical) was sprayed in that taluka. All the positive cases of which most were indigenous as revealed by the epidemiological investigations were radically treated.

In 1948 there were 313 deaths from malaria, of which 74 were reported from urban areas. In the next year death toll was 807 including 124 from urban areas of the district.

In 1961 the number of out-door and in-door patients treated was 7,330 and 53 respectively, as against 3,604 and 29 out-door and in-door patients treated in 1965. Only three deaths were reported in 1961 in the district due to malaria. In 1961-62 an additional third round of spraying was given to 29 villages in Malshiras taluka covering a population of 44,269. During the same period, in the Pandharpur unit, 64,248 fever cases were detected, out of which 58,947 were given presumptive treatment. The National Malaria Eradication Programme is being implemented in the district with Pandharpur as head-quarters. The district is divided into four sub-divisions. During 1972 there were 8,257 malaria cases in the district. It is proposed to continue the Malaria Eradication Scheme in the Fifth Plan for which a provision of Rs. 55.00 lakhs is made.

Tuberculosis: For the control of T. B. the B. C. G. vaccination scheme was launched in 1954 and was implemented in the first instance in three towns in the district, viz., Sholapur, Pandharpur and Barshi in 1955. Till 1959 the mobile units which worked under the scheme, carried out vaccination programme in all parts of the district. During 1960 mass vaccination programme was again carried out for the second time in Sholapur, Barshi and Pandharpur.

Government has provided facilities, free of cost, for the diagnosis and treatment of cases and fifty beds are reserved for T. B. patients at the General Hospital, Sholapur. Since the inception of the scheme till the end of the year 1957, 62,065 persons were given tuberculin test by private teams. Out of them, 35,916 were found to be positives, 11,679 negatives and 14,470 absents at the time of testing. The total number of persons vaccinated was 11,661.

The statistics of B. C. G. vaccination in the district for 1957, 1963 and 1964 is given below:—

* Since the commencement of the scheme up to 1957.

The following statement shows the classification of patients for a few years:—

Leprosy: Leprosy is a dangerous disease that causes deformation amongst the persons affected. Sholapur district has a number of leprosy cases due to its hot climate. The following statement gives the number of lepers per 1,00,000 persons for the years 1891, 1901, 1911, 1921 and 1931:—

The following statement gives statistics regarding deaths due to leprosy:—

In 1961 leprosy incidence was 18.02 per thousand in Sholapur district. The control measures for this disease are administered mainly through the out-patient treatment in all hospitals, dispensaries, primary health centres and special treatment centres. The voluntary organisations also undertake such out-patient treatment. One leprosy hospital was specially opened in the Sholapur city area under the supervision of the civil surgeon. Prior to 1942 such cases were admitted into the general hospital where necessary treatment was given. At present in the district there is one centre at Vairag, covering 41 villages. In 1961 the population under the project was 50,616. In 1960, 43,289 persons were examined. The number of cases detected in 1961 stood at 67 whereas 1,226 cases were under treatment. Besides there is one Government colony for lepers, viz., Kedgaon Leprosy Colony, Kedgaon, which provides for 125 beds. There is also one Voluntary Leprosy Hospital at Sholapur providing for 280 beds. In 1967-68, 600 cases were under treatment at the hospital.

The number of leprosy patients by the end of August 1973 was 12,220 in the district. There are 35 survey, education and treatment units in the district, of which two have been opened in the Fourth Plan. In the Fifth Plan it is proposed to open one more unit for treating the leprosy patients. A provision of Rs. 2.78 lakhs has been made for these units.

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