Sept., 1938] SOLARIA IN ANTI-TUBERCULOSIS WORK : JAYARAM & SHERIFF 557

Role OF SOLARIA IN ANTI-TUBER- CULOSIS WORK*'

By B. JAYARAM, m.b., b.s., t.d.d., l.r.c.p. & s.

Medical Officer, Krishnajammanni Tuberculosis

Sanatorium, Mysore and

A. K. SHERIFF, m.b., b.s., t.d.d.

infectious disease, much less tuberculosis,

jan be eradicated by therapeutic measures only. ^ tuberculosis the infection is universal and

0rbiditv, disability and mortality high. Pre-

dion is cheaper, easier and obviates the

?Uttering and loss of human lives that this

(llsease entails.

Choice of preventive methods F?r tuberculous infection to be transmitted,

Irolonged and intimate contact with an open

j^Se ^ necessary. Infection is not always fol-

th^GC* -ky disease, and if disease does appear

t]^re. *s usually a long latent period. During *s interval the body forces, as represented by

^e Word 'immunity', come into play and ecide the issue between silent infection and

amfest disease. The prevention of tuber-

he.^Sls' therefore, falls essentially under two

Prevent infection from taking place. ") After infection has taken place, prevent

it from becoming manifest disease. view of the fact that 75 to 100 per cent of

be are ' infected, the latter consideration

^comes the more immediate and practical issue, lle the former remains the ideal.

Value of home visiting in prevention of tuberculosis

kn^lr0u^h the systematic home visiting of all ?Wn tuberculosis cases, by a qualified nurse,

/all contacts are persuaueu iu uu tjxaiumeu uy a

qualified doctor. Work in Mysore shows that 14 per cent of contacts have signs of manifest tuberculosis in various stages; 15 per cent of these are children under 10 years of age, with

enlarged cervical or tracheal bronchial glands, and of these many have lung infection and some have tuberculous peritonitis. There are many more who give a positive intradermal tuberculin reaction only. Frank cases of tuberculosis are either segre-

gated in their homes and educated in the hygiene of prevention or admitted to some suitable insti- tution. Those that only show signs of infection by a positive tuberculin test and weakness, probably with palpable cervical glands, are

picked out and .r-rayed in order to decide whether active tuberculous disease is present. From the point of view of prevention it is this the largest group that really matters. If the resistance can be increased, there is a good chance of arresting the disease.

Sunlight as 'preventive of tuberculosis

This can be done by the judicious use of sun, air and physical exercise, which are the most efficient preventive factors. We are all familiar with the health-giving powers of the sun, and the remarks of a well-known authority in' res-

pect to its use as a preventive factor in tuber- culosis are of interest.

Graph showing the ultra-violet-ray content of the sunlight in units during the months of September and October 1937, as observed in the P. K. Sanatorium,

Mysore.

Average sunshine in hours in a day:?

10 10 9 9 10 8 8 7

Cloudy Cloudy Cloudy Cloudy

A. P. Cawadias says: 'Instead of endeavour- ing to prevent disease by acting on the external factors of disease, a work done by the public health authorities and a matter of hygiene in

general, we try to prevent disease by strengthen- ing the constitution of the individual. Sunlight has undeniably proved of the greatest value in strengthening of the constitution, and this should be applied preventively to children, especially to weak children \

Summary of a paper, condensed for want of space.

J I i L II III IV V VI VII VIII

558 THE INDIAN MEDICAL GAZETTE [Sept., 1938

The Mysore solarium

The Indian Red Cross Society, Mysore City, has set up a

' solarium ' which could aptly be termed a

'

day-preventorium to give practical application to the above knowledge. The solarium is an inexpensive building with a

wedge-shaped tiled roof, running north and

south, supported on wooden pillars, with a cement floor and open on all sides except for bamboo chicks which can be rolled up or let down to

any height to control the admission of the sun's rays. Pre-tuberculous children from infected homes are brought every morning and are given a graduated dose of sun-exposure under strict medical supervision. The smaller children take the sun bath lying down and others who can walk and play are given a loin cloth and a wash- able hat, and are encouraged to play in the

open. The point, however, must be stressed

that just as exhibition of a drug is regulated by the pharmacological dose and individual idio-

syncrasy, so heliotherapy has to be carried out in accordance with a strict technique and

dosage, not only to derive the maximum benefit, but to ward off undesirable incidents, which must follow if tuberculous individuals are indis-

criminately exposed to the sun's rays. Strict individualization and careful graduation are the fundamental principles of this treatment.

The morning sun is most potent therapeu- tically, particularly in our country, as later on in the day the heat is very exhausting. The insolation is begun on the legs and more and more of the body is exposed, increasing gradual- ly the duration of exposure provided no unto- ward result, either local or general, follows. On completion of treatment, each child is

given a bath and half a pint of milk, some

tomato juice and cod-liver oil. The clinical results so far achieved are very encouraging.

Action of sun's rays There is a certain amount of controversy as

to the exact amount of ultra-violet rays in the

sun in India. Experiments carried out

Mysore over a short period (September and October 1937) show that there is a fair amount of these rays available.

In explaining the good results that follow from the work in Mysore, we should not ignore the influence of rays other than ultra-violet and the effect of fresh air (serotherapy) which haS been proved to have a stimulating effect on

general metabolism. It is the sunlight as a

whole and the air bath which are more im~

portant. Sunlight is a mixture of three groups of eleC"

tro-magnetic radiations, viz, infra-red, the

luminous or coloured rays, and ultra-violet ray?* The infra-red have a hyperaemic and thermic effect, the luminous a psychological effect ana

the ultra-violet a biological effect in that thev

stimulate metabolic, endocrine, nervous alic

vegetative functions. The effect of sunlight 011

the human organism may be described as :

1. Direct or local.

This action is analgesic, germicidal, an

sclerosing, it helps to bring about a rapid heal' ing of any surgical tuberculous condition an"

is- valuable in various other non-tuberciiloi'6 conditions as well.

2. Indirect or remote.

This causes bronzing of the skin, and has a

general powerful stimulating effect on both the mind and body.

Conclusion

The Mysore plan of work is simple and cheap- The structure costs Rs. 300 and is large enoup1 for 12 children to be treated simultaneously^ If this plan is adopted all over India, we w*' come to possess a very effective weapon againS tuberculosis. However, in this important Vr?' phylactic effort, all depends on the indispensab16 co-operation of medical men, health authority3 and charitable organizations, and it is with t'1

object of interesting such persons and organic*1" tions that these few lines have been written.

Patients under treatment at the solarium. Patients under treatment at the solarium.