PREVENTION AND CONTROL OF CHOLERA

INTRODUCTION

Cholera is an acute dehydrating diarrhea along with rice watery or colourless  stool as a consequence of vibrio cholera or vibrio El Tor stains. Mortality is more in vibrio cholera and morbidity and  carrier state is more in El Tor. It was spread over vast areas of world in the past and the most important epidemic centre in the world was Bengal in India from where the pandemics had, and also important centers are central India and south Tamilnadu and Uttarpradesh and deltas of main rivers in India, so that India was known as home of cholera. There are also endemic areas in China Yangtse valley and in Burma and Philippines. It increases with the onset of monsoon and decreases rapidly after monsoon. Places of pilgrimage are the main epidemic centers for its dispersion all over the countries. Pandemics and epidemics follow the routes of travel.

Cholera EL Tor stain

A research worker in 1905 on the shores of Red sea isolated peculiar strains of from the bodies of pilgrims of from mecca, who had shown no signs and symptoms of cholera, but shown in laboratory just reacted like vibrio cholera bacillus except that it produced a haemolysin. Because the pilgrims had not really seen died of cholera. Thus it was thought that vibrio E Tor was not a disease producing bacteria till it was proved and established in Celebes causing a severe disease exactly like cholera. The infection remained and confined for a long time to small areas of the island of Celebes till 1961 and it attacked many countries in pacific region and in south east Asia from where cholera had disappeared, encroaching upon the traditional areas of classified cholera. During 1955 El Tor cholera spread in many countries and epidemics broke out in India, Nepal, Pakistan,etc, and question raised whether the cholera El Tor is a variation of classical cholera or is a different disease from practical point of view been settled in 1962 by WHO research group on cholera. The illness caused by the El Tor vibrio is indistinguishable from that caused by the vibrio classical cholera. It is, therefore, now regarded necessarily identical with classical cholera and must be treated as such and international health regulations also redefined cholera to include cholera El Tor. Man is the reservoir of infection. 

Source of infection

Cases suffering from cholera and polluting water, food, etc, are the immediate source of infection. Route and mode of transmission are infection by vibrio cholera by ingestion and most common vehicle of infection being water.Organism of cholera can survive in water with saline and organic contents for a long time. Mild cases cholera defecating daily on the river bank or near collection of water, like ponds, for few days can start an explosive out break of cholera amongst those who drink this water. Vegetables and fruits washed or watered with polluted water may also carry the illness if eaten raw. If milk is diluted with polluted water can spread the disease and also flies may infect food in the presence of a cholera case close by. Mineral water is also a vehicle when it is made by unpurified water. Food contamination by polluted water, cooks and other food handlers serve as a vehicle of infection. Incubation period is less than 5 days and may be little as 12 hours. A case of cholera is ineffective during the incubation period, the course of disease and about 7 days there after.

Prevention and control

Protected water supply purified, protected, chlorinated and proper disposal of night soil and sewage. Safe and protected milk supply, protected wholesome food, and washed green raw vegetables and fruits like watermelon and absence of flies and healthy habits of eating, drinking and defecating and personal hygiene. A prohibition of employment of workers who may be carriers to handle food are the principal preventive measures. Regular preventive inoculation campaign in endemic areas of cholera. It confers protection for 3 to 6 months after which re inoculation is required. All the cholera vaccines manufactured in India contain El Tor component. International Health regulations by WHO are important to prevent the international spread of cholera which has become very easy because of the increase of speed of  modern travel. Under the regulations people coming from areas where cholera persists, must be vaccinated and are carefully screened. Preventive measures are taken on arrival from suspected areas by ships, aircraft, trans and road vehicles. A better standard of living, personal cleanliness, clean water supply, better health services permitting rapid hospitalization of cholera cases, better food hygiene and health habits are the important factors in the control of and research in cholera is to be hoped that the long standing epidemicity in India will disappear and spread of cholera El Tor will be prevented.

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BODY EXERCISE, FATIGUE AND RECOVERY

INTRODUCTION

 EXERCISE

The  body requires normal strain. Physical inactivity leads to obesity, low muscular laxity, low katabolism, low cardiac tolerance and a low threshold for physical and emotional stress. Physical activity is a stimulant to the growth of children and adolescents and promotes and increases mental relaxation in adults. It increases resistance against heart disease, respiratory infections, etc, prevents obesity and physical and mental dullness. Excise should not be so excessive as to cause extreme fatigue as like all stimuli, it becomes a stress making factor if it is excessive. It should be sufficient to produce pleasant weariness demanding relaxation. Stage of relaxation recovery must follow exertion causing.  Relaxation and sleep are necessary for recovery of the body from fatigue eliminating biochemical products and psychological  effects of mental and physical exertion. Sleep should be sound with out any artificial aids like pills of tranquilizers, seductives. A sound sleep is make sure by freedom from ill health, good feeding and enough mental and physical exercises and comfortable from thermal environments, freedom from pests like bedbugs, mosquitoes, rats and sand flies and so on, and also comfortable garments, bed, bedding and bed linen and free from noise.

USE OF LEISURE

Recreation for persons to get interest in healthy out door and indoor activities and games, recreational outings, visits to places of historical, cultural and religious interests and hobbies like painting, music, handicraft, photography and other past time re creative engagements for using leisure in healthy endeavor to attain produces a healthy attitude of life, inhibits temptation to indulge in unhealthy activities, aimless loitering quarrelsome behavior and provides relaxation. All facilities may be provided and men to be induced to take full advantages. Ethical, religious and moral teaching keeps the mind of people geared to healthy thought and action which provides a strong inhibiting factor in unhealthy pursuits like promiscuity and alcoholism or heavy smoking habits. A high physical standard is achieved by regular exercise. Drinking and smoking should be avoided.

PERSONAL PROTECTIVE MEASURES AGAINST DISEASES.

Active preventive measures against diseases may be non-specific and are to be build highly resistant positive health against ill health like use of mosquito net against insect borne diseases like malaria, filaria and and protection of eyes with dark glasses and use of proper cloths in winter and summer to avoid adverse effects climate such as heat stroke, cold injuries like frost bite,etc. immunization is a single most protective measures against some specific diseases. Observation of personal protective measures should become a part of our behavior pattern. There are direct or indirect measures which protect against physical injuries, mental break down and such other non-preventable diseases. For example maintenance of vehicles, good training, precautions to to avoid accidents, physical and mental fitness are some of the some of the non specific measures.

MODIFICATION IN MODE OF LIFE

Modification becomes essential under certain conditions. Life in extremely hot surroundings like desert require a high water and an adequate salt intake. similarly life in high altitude needs sufficient caloric food intake to meet effects of cold and hypoxia. Adequate protection by proper use of extra clothing is necessary in cold at an high altitude. Use of dark glasses is necessary to protect from snow blindness at high altitude areas. Protective clothing must be used to take care of insect vectors, leeches and snake bites. similarly living in different terrains wants good habits of living in harmony with the surroundings. Regarding personal hygiene men should should get facilities each day for washing and changing inner clothes and socks. At the same time dangers of bathing and washing in revers and lakes which are polluted with sewage to be remembered.

CARE OF THE FEET AND PREVENTION OF SORE FEET

All men are to wash their feet minimum twice a day, normally in tepid water if available. After this they should be steeped in cold water for ten minutes. Soaking them in a solution of salt water is useful to harden very soft feet. It is useful to wear a pair of thin nylon or cotton socks. Changing into chapels at the end of the day work is great value.Those with a tendency to sore feet should dust with foot powder each day. Feet must be kept clean always.

PREVENTION OF NON-COMMUNICABLE DISEASES

Introduction

Diseases are mainly divided in two groups namely, communicable and non communicable groups. The communicable diseases showed the greatest decline in the country some diseases like tuberculosis,  poliomyelitis,etc. while some others have shown an increased incidence. Non-communicable diseases and injuries are similar to the communicable diseases and shown a trend of increasing accidental injuries and non communicable diseases, there fore, primary, secondary and tertiary prevention is applicable to non-communicable diseases as in the case of communicable diseases group. A few of the such examples of diseases  shows below. These diseases chosen due to their trend is rising in population or may be expected to rise in the near future more and more. The following examples are stress diseases, mental illnesses, hypertension, heart diseases, stroke, cancer, peptic ulcer, goitre and  allergic disorders and accidental injuries, etc. 

Stress diseases

In this sense stress is a link of certain chain of reactions which makes the process of development of final resistance to the strains. Resistance produced may be specific or general. In the biological consideration of stress these reactions produce the general acclimatization and specific adaptation syndromes. These syndromes are in reality the normal mechanisms of the development of resistance and not the symptom complex. The symptoms do not manifest themselves if the process of production of resistance is smoothly. The general adaptation mechanism is produced when the general defensive process of the body are excited. Biological stress is caused by pathogenic organisms and physical stress is caused by physical factors like heat, cold, burn, injury and psychological stress is produced by an adverse situation, emotional or social challenge, proximity of an aggressive or over showing personality. A group of diseases presently considered to be produced or influenced by such strain and stress of life are called stress diseases. Individual with resistance against stress may be recognized  in their childhood and their inherit resistance boosted up by providing proper environments. Mental illness, hypertension, heart diseases, cancer, peptic ulcer, goitre, etc and its prevention are written in  my previous blogs. please see.

Allergic disorders

The meaning of the word allergy is altered reactivity, just a maladaptation syndrome which is making its appearance of morbidity in all over the world. Some of the manifestations of stress termed as psychosomatic such as skin rashes and upper respiratory bronco-spasms can not be distinguished from the ones with allergic reasons(aetiology). Stress or psychosomatic aetiology plays some role precipitating allergic manifestations. Allergy is another type of detest reaction of hypersensitivity to the antigen produced by antigen-antibody coalition which shows during the process of development of immunity against it. Allergy may exist not only for against a foreign protein but also to physical factors like cold, heat, and biological factors like certain plants or chemicals like, sulpha, by getting conjugated with serum protein and acting as antigens. The tissue response to antigen is brought about by an inter-action of antigen and antibody.

Accidental injuries

Accidental injuries make the second major cause for sickness. The first is being the respiratory group diseases.These injuries vary to a great extent in degree of severity and may be only out patient treatment or may be serious requiring prolonged hospitalization may knock out the individuals from work from a considerable time and some individual should require restorative and rehabilitative treatments after curative treatments in the cases of severe burns and rail and road transport accidents and fire works explosive  accidents  in religious functions of temples, masjids, churches where lot of persons are gathered. Major injuries are simple fractures, compound fractures and complicated fractures, and also head injuries and chest injuries and perforated abdomen and deep lacerated wounds of soft tissue parts. Minor injuries are  abrasions, contusions, sprains. small incised and lacerated wounds.In a majority of motor transport accidents the driver is at fault. Over speeding, negligence and carelessness are the factors. The road may be narrow and with sharp bends specially in hilly areas or it may be slippery with slushy. Industrial injuries caused by electricity and fire, suicidal injuries including hanging and drowning,  poor maintenance of machinery and equipment and explosion, etc.

Preventive measures for accidental injuries

Most of the accidental injuries are preventable if attention is paid for for health promotion. All should  be given about health education on promotion of health of injuries on the various causes of injuries and its prevention. Physical fitness of persons by balanced diet, good living conditions, and proper medical and health care to workers including periodical medical check ups, and providing healthy work environments, specially to industrial workers. Proper anti fire precautions and removing all types of stresses and guarding of dangerous machines. Supervision of workers and investigation of all injuries and good house keeping. Disability limitation and rehabilitation : Early treatment by physiotherapy will prevent disability in many cases of injuries. Early treatment will prevent prevent prolonged hospitalization. Rehabilitation of all injured patients important in making them useful members of the society and also to help them gain confidence in making them their livelihood. There should be medical, psychological, social and vocational rehabilitation.

preventive measures for allergy

In the case of allergy a careful search for the agent which is a person is sensitized, required by a skin tests and advise to avoid them to save man power and man-day wastage.In all cases precautions to combat allergy if it rises must be taken. Desensitization by giving gradually increasing doses can be carried out if the allergy is proved. Any food stuff  like vegetable or some sort of fruit is seems to be allergy after consume it is better to avoid it. Many persons are allergic to chocolate biscuits and ice creams and there by increasing bronco spasms and running nose and suffering from asthmatic complaints after taking some food stuff. It is always better to prevent than cure by taking some anti-allergic medicines. some persons are allergic to cold and in winter season those will increase with allergic manifestations e.g. asthma.etc.

Prevention and control for stroke and heart attack

The artery which supply blood to cardiac muscles is blocked then the person gets heart attack, similarly the artery which supply blood to brain is blocked, will get stroke which is also known as cerebro vascular accident(cva). The block takes place in right or left common carotid artery or in both which supplies blood to head and also to brain by its branches.If the cerebrum in right side is affected, left side of the body is paralised, same way if the left side of cerebrum is affected , the right side of the body is similarly affected. A by stander if he knows the signs of stroke he can save the life of patient by asking to speak a simple sentence, or tell to rise his hands or try to make smile. If he can not to do any one of these he will be taken to a hospital with in 3 hrs where a neurologist is available, then his life may be saved. Heart attack some times will not show pain in chest in the diabetic cases, but other symptoms like feeling of vomiting(nausea) excessive sweating, pain chin and radiation of pain to left hand. Normally heart attack begins at the early hrs of morning from 5 to 10 am while the heart is taking rest in the early morning hrs. Drinking one glass water before going to bed prevents stroke and heart attack. It can be prevented by dehydration by drinking water, says cardiologist. Take aspirin tablets before going to bed by  the advise of your health  provider, dose, and time he may tell you. The 65% people may get attack at night in the early hrs of sleep may not get up, but may wake you up with pain from your sound sleep,then you must call your neighbor or close relative nearby him and wait by the arrival of doctor or make the patient lie down in a stretcher and take him to hospital,do not make him to walk or move  till the pain subsides after giving injection to relieve pain by doctor.

 

INSPECTION OF FOOD ITEMS AND PREVENTION OF FOOD ADULTRATION

INTRODUCTION

Food is a substance when taken inside, meets 3 requirements of body, such as it is essential for energy production, replacing of the worn-out tissues and promotion of tissue growth. Mainly its either by themselves or in a combination with others in the body having among their functions which are regulating these 3 processes. For the purpose to appreciate of influence food on health and the factors which effect food requirements, it is necessary to know the chemical compositions of foods and their metabolism in man. This knowledge is for assessing the food requirements of  in the practical theory, the clinical effects of diets varying stands and their rectification is possible only if the basic facts are estimated justly. The common constituents of food necessary for human nutrition are proteins, fats and carbohydrates which yield energy and carry tissue growth and repairs. Energy is required for maintaining body temperature and main actions of organs and for mechanical work. Vitamins are organic compounds required in small quantities for normal growth and maintenance of a healthy life. Vitamins are mostly available in fresh milk, meat, eggs, vegetables and fruits. 

Inspection of food stuffs.

The prevention of food adulteration act, 1954 is to control quality of food stuffs kept for sale to the public. The inspection of food items offered for sale is necessary to ensure that they are of an adequate nutritive value,will not cause food borne diseases. Composite laboratories are available for special tests and analysis. Food inspectors and regional vigilance food inspectors are appointed  in municipal corporations and panchayaths by state governments. The service of food inspection officers are enlisted to work with food laboratories to ensure the quality of food and if any adulteration is found in tests the seller will be prosecuted and if found guilty then punished with fine and imprisonment. Adulteration of food at storage and selling of adulterated food to public are offense as per food adulteration act,1954.

Inspection principles

Sampling of the products requiring inspection is the first important procedure. Samples should be adequate in quantity. For example if tinned milk is being examined it may be essential to sort the consignments into different brands. In the analysis of sample obtained the factors should be noted are the appearance, taste, physical condition, smell of the commodity in relation to its normal characteristics and its keeping qualities. For the food items in bottles, in cartons. bottles and cans,etc, the internal and external condition of the container, expiry date of warranty period and name of manufacture are to be considered.

Disposal of food stuffs after examinations.

Food may be considered fit for issue with out conditions, fit for issue with in a limited period, or unfit for issue. The only difference between atta and flour, these two wheat products are, in the the point of view of inspections, is that atta contains more pericarp or bran and of the germ of the wheat berry. So it is a grayish colour as compared with refined flour. Fresh flour or atta smells good and having a uniform and has a band taste devoid of sharpness. Prolonged storage normally results deterioration or from adverse storage conditions.The main causes for rejection are poor baking quality, infestation of larvae by common during monsoon, mould infection may occur in moist condition, and etc. Ordinary bread is made of white flour and must be well risen and aerated and free from large cavities and with a elastic peace of bread. It can be consumed after 24 hours after baking, and the main defects in bread are heaviness and sourness and soddenness. All these may be due to bad storage and bad baking. Biscuits are made of flour, sugar, salt, hydrogenated oil, water , milk and bicarbonate of ammonia. On examination it should be noted appearance, colour, odour, hardness, palatability and presence or absence of insects. The main defects are rancidity, softness and presence of moulds. The main principles of inspecting fresh milk supplies is to find out visible dirt and adulteration and assess nutritive value and keeping quality and ascertain efficiency of pasteurization. The specific gravity of milk is1.029 to 1.033. But adulterated milk by water with will show below normal, but still can show normal by adding sugar or corn- flour. This can be detected by laboratory tests.

Appearance of rice and degree of milling, insect infestation, mouldiness should be  noted while inspecting rice.And milk products and hydrogenated oil, tinned fruits and jam, sugar, dals and beans and peas, condiments, tea, salt, tinned meat and fish and etc are to be inspected  periodically in shops and in hotels where food is served and samples also to be taken and sent for laboratory tests to find out adulteration in food stuffs displayed for selling to public.

pm kutty

INFLUENCE OF CLIMATE ON HUMAN HEALTH AND WELL-BEING

INTRODUCTION

The beneficial effects on the health and well-being and progress of mankind is from the adaptation. Even after acclimatization the physical, physiological, psychological and functional abilities of human being are maximum with in a certain range of atmosphere and climatic conditions. Climate decides the energy level of man in a given environment. In a tropical climate to counter act the difficulty of in heat loss. Man has adopted a lower rate of heat production. The main capacity of young healthy adults living near the equator is only a little more than half of the vital capacity in similar individuals living in a temperate climate. Sub tropical and temperate climate are more suited to the fullest efficiency of man as moderate variations maintain the vigour of developmental progression.

THE METEOROLOGY

This is recently developed branch of science which studies the effects of climate living organisms. the branch of biology which deals with the inter-relation ship of organisms with their complete environs, inclusive of earth, water, atmosphere, radiation, plants and other living organisms is called ecology. The science concerned with atmosphere, weather, climate and inter relation between the components of atmosphere is called meteorology. Bio meteorology consists of the ecology of living things; plants animals and man. It joins biology, ecology, and meteorology in the study of system in which organisms and atmospheric component of the total environment interact. It has got 3 sub divisions namely, the plant, animal and the human bio meteorology. The favorable reactions maintain the internal normality and lead to adaptation and biological success of the organisms; unfavorable reactions lead to internal imbalance, non adaptation of living things and its biological defeat and disease process.

THE ADVERSE EFFECTS

Climate adversely effect on human health directly of its whimsical and extremes; indirectly by influencing mans metabolism or defensive mechanisms and remotely by modifying his complete environs. The direct adverse effects are caused when exposed to climatic extremes and if the homeostatic mechanisms fail, either due to severity or rapidity of or prolonged exposure or non-adaptability, or  due to physiological dysfunction. This conditions produce like heat stroke, cold injuries, heat exhaustion and high altitude hypoxia, etc. Incidence of infection and illness, functional deficiency or inefficiency due to them are commoner than due to the direct influences. The remote mode of causation of disease is by adversely changing the external environments so that it affects human physiology hurtfully. Thus prolonged shortage of water in areas with low rain fall may be associated with higher malnutrition. Meteorological changes also bring about the evolution and devolution of disease on the pathogenic organisms either by direct influence or indirectly through change in the socio-economic and cultural patterns of the community. There are three types of reactions occur in response to exposure to climatic extremes. The first type occurs when the homeostatic mechanisms inadequately meet the challenge of climatic vagaries and extremes in an inadequately acclimatized person and the second type happens when the homeostatic mechanisms are quite adequate but the external conditions are excessively severe or prolonged and the third type occurs when the homeostatic mechanisms completely surrender because of stretched beyond normal tolerable critical limits and the failure of general adaptation mechanisms and general collapse results.

A knowledge of the principles of bio meteorology is necessary for health staff from the point of view of promoting health, prevention of ill effects and prevention of and control of diseases and maintaining of high physical and mental efficiency.

EFFECTS OF POWERFUL SOLAR RADIATION

Solar radiation affects the health directly or indirectly. The direct effects occurs directly to eyes and skin. Various wave lengths of the component rays in the solar spectrum which penetrate the atmosphere cause biochemical, luminous and thermal effects rays are Ultra-violet and violet, Blue are biochemical rays. luminous rays are Green, Yellow, orange and heat rays are Red infra red. The combined effect of solar radiation is to provide radiant thermal energy to warm the skin and stimulate metabolism to produce a biochemical effect on the living organisms and plants. In temperate climates sunshine promotes a feeling of comfort, cheerfulness and physical well-being. Moderate exposure to sun rays is beneficial even during hot weather when it promotes adaptive mechanisms. Forty percent of the solar radiation is reflected away from the unclad skin reducing the thermal heat load to a great extent. And also clothing reduces the penetration of solar radiation. Very little of ultra-violet and longer infra-red rays are reflected from the skin surface, and there fore they are absorbed in the upper horny layer of skin. The infra red which penetrates beyond the epidermis causes heating in the dermis and the deeper layer which produce vitamin d and destroy micro organisms.

In the tropics so much sunshine is uncomfortable, irritating and enervating and dangerous to health. Constant exposure to the intense glare from the sun is irritating to the point of causing distress, head ache, mental irritation and exhaustion. There are heat effects but are the radiation effects may occur in the tropics, sub tropics and high altitude or even in the arctic zone. The long term effects of exposure to intense unfiltered sunshine as at high altitude or in tropical or sub tropical regions are ageing of skin with wrinkling and loss of elasticity and in the long run even the rodent ulcers and skin cancers. The rays at high altitude are unfiltered of its short ultra-violet portion and causing harmful effects. Similar effects are seen in those parts of the world where sun rays are mostly unfiltered due to paucity of terrestrial dust and water vapour. for example in Australia and Newzealand where rodent ulcers are common.

PROPHYLAXIS AND FIRST AID

Clothing removes a larger portion of the  ultra-violet rays. It should be based on the fact that skin pigmentation is increased by rays of wave lengths different from those which produce sun burn and dermatitis. Protective s should be the applications which filter out the shorter sun burn portion but allow longer pigment-forming portion of ultra-violet rays to pass through. Application of calamine lotion is the first measure for sun burn and solar dermatitis. The best preventive measures for eye is wearing of glasses as advised by ophthalmologist or by an authorized person. The symptoms are intense pain, photo phobia(fear of looking to light), etc. Coloured glasses and plastic filters can absorb most of the ultra violet components of actnic rays. In advising sun glasses all the three regions of the spectrum have to be considered. The best glasses are ordinarily green or rose smoke colour. Infra-red transmission through them is slight and also they completely filter out the harmful portion of ultra-violet spectrum and transmit fifteen to twenty percent of visible radiation.

PREVENTION OF DISEASES LIABLE TO BE IMPORTED BY AIRCRAFT

INTRODUCTION

Journeys by air from countries where the major ineffective diseases are present like cholera, yellow fever, plague and typhus, etc are endemic to non-infected countries are so soon that are normally transmitted with in the incubation period of these diseases. the administrative authority for the health control of air traffic is based on the international sanitary regulations by the world health assembly in 1951. 

RESPONSIBILITY OF THE COMMANDER OF THE AIRCRAFT

The commander of the aircraft should see that he is not carrying any passenger suffering from an infectious disease. He should see that the passengers and aircrew are fully protected by inoculation and vaccination against diseases that are prevalent in his own country and country of passenger en route and against which protection is available. He should ensure that similarly they are protected against diseases that are to be likely present in the country of destination, and in other countries through which the aircraft is routed. This is essential for the safety of air crew and passengers and also for complying with the convention of international aerial navigation. For this purpose the diseases considered to be ineffective are as mentioned above, and no animal or plant product likely to convey diseases and no living animal or plant should be carried across national boundaries with out special permission of from all concerned. this is very essential to prevent the spread of diseases such as hydrophobia(rabies) etc. to avoid importation and exportation of animals that might become pests.

IMPORTANCE OF PROPER AND TIMELY NOTIFICATION

The effectiveness of the international sanitary regulations depend primarily on the rapid exchange of notification. This is the responsibility of health administrative authority and world health organisation. The health administrations are bound to notify world health organisation(WHO) by means of telegram/signal with in 24 hours. that a local area become an infected local area. Similar information must be sent when evidence is found of yellow fever virus in an area where it was not found previously. First information by the health administration of local infected area must be supplemented by detailed information afterwards and then follow up reports. Deaths and quarantinable diseases must be reported to WHO by the health administration.

CONTROL OF SANITATION IN AERODROMES

The commander of aircraft arriving from abroad must notify any case of death other than accidental. Any case of death suspected quaratinable diseases that has occurred on board to the aerodrome officer by wireless message. On receiving such message the aerodrome officer must notify the medical officer concerned immediately. Infected planes which are coming from infected local areas or those with rodent dying abroad. On such infected aircraft on landing air crew and passengers must not be allowed to go out until the medical officer examines them and declares the plane and crew/passengers free from infection. If there is any case on board showing evidence of infection. must be hospitalized under proper supervision. For yellow fever cases a mosquito proofed ambulance must be used to avoid mosquito bite while transferring, sucking of infected blood with yellow fever virus by the aedes mosquitoes.Yellow fever virus is not imported to India so far.

CASES RELATING TO YELLOW FEVER 

 If an aeroplane shall be regarded as infected with yellow fever, and if it has a case of yellow fever on board, or if there has been on board a case of yellow fever and subsequent to the occurrence of that case, all measures of sanitation have not been taken to the satisfaction of the health officer before arriving in India or live mosquitoes are found on board. Aircraft and cargo shall be disinfected and all infected persons shall be disembarked and isolated to such periods as the health officer may consider necessary. All persons on board shall be medically examined before getting out or under such arrangements may be made by health officer to reduce to a minimum the risk of spread of infection. and any passenger or crew who disembarks and is not in possession of a valid certificate of vaccination against yellow fever shall be segregated until his certificate becomes valid or until a period of not more than 9 days reckoned from the date of last possible exposure to infection has elapsed, whichever occur first.

HYGIENE AND SANITATION IN FLIGHT

Water supply, food, emergency ration, disposal of wastes and ventilation problems of air craft are to be checked and proper action to be done before take off the aeroplane. Disinfection of aircraft is carried out as per the international regulations laid down. These are given in Govt, of India, Indian aircraft manual, 1964. Disinfection of aircraft when considered necessary can be carried out with formalin spray. For the purpose of 5% formalin solution with 5 ml of formalin to a liter of water should be used. The spraying can be done with a hand pump or stirrup pump. The size of  nozzle tip should be capable of producing a flat fan spray of a uniform pattern with a spray angle of 60 degree, and the size the nozzle should be 0.4 mm. All removable articles should be disinfected as usual.

HEAT STROKE AND HEAT EXAUSTION AND ITS PREVENTION AND FIRST AID TREATMENT

 HEAT STROKE AND HEAT EXHAUSTION

Introduction

The effects of heat are spread out in the subtropics in the hot season. But hey are less happened in the tropics than generally, expected mainly the heat stroke. The epicenters for effects of heat are the shores of the Persian gulf and the central and western plains of India like Punjab, Hariyana, etc. The incidence of effects of heat in India is commonest in an area drawn horizontally through Nagpur with its western limit marked by drawn vertically along the western border of Bengal Asansol, excluding the coastal areas. The great majority of cases occur in Punjab, but there is hardly a place in the plains of northern and central India. Most cases occur during the week or two prior to the on set of the south west monsoon and during the breaks of monsoons, when atmospheric temperature and humidity are very high. In the north and west dangerous period is in the end of the June or later. In central India it is in mid-June. While in the south and eastern India, May and early June are critical periods. But the cases occur at any time during the hot weather in any part of India. The incidence in Kerala in recent years with sun burns starts from March to May before onset of monsoon.

Primary environmental factors

High atmospheric temperature is the most main important primary cause. Final effect is determined by the period of exposure to the hot temperature to 43 degree centigrade in dry atmosphere. As the temperature increases high 46 degree or more in the presence of wind velocity of more than 32 km per hour the danger point approaches and the heat stroke may occur. Direct exposure to sun rays increases the body heat load further and may occur the attack. Constant exposure to the sun glare is irritating to the causing point of distress, head ache, mental irritability and exhaustion. High atmospheric humidity is an important factor as high atmospheric temperature in the causation of heat effects, since upon it depends the evaporating power of the atmosphere and hence the body heat loss. Air movement is the important atmospheric factor which decides the human thermal comfort.

Heat stroke.

Onset is sudden. This condition occurs a result of an excessive rise in the body temperature. When sweating and its evaporation are adequate the thermal loss maintain the the thermal balance of the body and continue to do so until the replenishment of water is maintained. The regulatory mechanism may fail if the conditions are adverse such as any deficiency of any water in the body or the internal requirement is excessive or the external conditions are unbearable under intense solar radiation, high temperature or  very hot winds. The heat load imposed upon the body by such severe conditions may be about 200 kilo-calories per sq.meter of the body surface per hour, which is equivalent to the metabolic out put of any Strenuous work. It occurs due to lack of sweating and beak down of heat regulating centre in the brain. Under all such conditions, when the heat regulating mechanism fails to keep body temperature below the critical level, high fever develops. There may be sign of lack of sweating, giddiness, feeling vomiting, exhaustion and frequency of difficult pass urine. The individual in good health may suddenly become unconscious and get rapid  rise in temperature above 40 degree Centigrade.The main causes are very high fever, stop sweating, head ache, restlessness,  thirsty, anxiety, dry tongue, and in later stage unconsciousness with circulatory failure. the face is congested or in bluish colour, eyes are suffused, and the skin is dry and burning. abnormal and loss of consciousness occur in about one third cases. Mental confusion is seen in two third cases. Mortality varies with the degree of high fever/pyrexia

Heat exhaustion.

This occurs commonly more than heatstroke. Onset is gradual and body temperature does not rise as high as in the case of heat stroke. Those are not so much due to excessive temperature, but are rather the result of water and salt shortage due to excessive sweating. The reasons are depletion of salts in the body due to more sweating, and very high humidity and lack of cooling body. Water necessity in the body in hot climate is higher than in cold climate or a temperate climate. If water intake also reduced its exertion is reduced, but normal water loss necessary to remove the toxic nitrogenous metabolites has to continue in concentrated  urine. Excessive sweating also reduces salt balance in the body. Normally 15 gm salts intake is adequate. Any salt consumed in excess over daily requirement is exerted in urine. If the intake is reduced or exertion in sweat is increased, salt is conserved by diminishing its excretion in the urine.

Water constitutes 70 percent of the body weight and maintenance of  the fluid  balance and its distribution in the 3 compartments is importance for the health of cells and tissues and its constant by the relative osmotic pressures.

Sign and symptoms of heat stroke

Temperature of body becomes above 104 degree F, dry skin, mental irritability, head ache, muscular cramps, fits, slow respiration and unconsciousness

The prevention of effects of heat.

The fluid intake must be enough to produce sweat and compensate for loss of water. Supply of cool water should be ensured. water consumption is likely to be inadequate and if it is not cool enough to quench thirst. Moderate work in hot climate may need upto 7 to 10 liters of water per day per and men for man on long time doing strenuous physical work even upto 15 liters a day may be needed.

Salt intake must compensate for its excessive loss in sweating. Rest and sleep should be adequate as the recovery must compensate for the activity. he best period for the best satisfactory and result restful sleep is during the coolest 3 to 4 hrs before dawn.

Bathing should be done every day. Improved shower  baths are also of great important and valuable. An active , healthy and clean skin is an important factor dissipation of heat through radiation and evaporation and convection.

Clothing should be normally light and loose and permeable to water vapour and air. Food must be wholesome and well cooked and must be consumed with good amount of fluid. Dining hall should be cool and comfortable as no one can be expected to take full meals under hot and humid conditions.

Living rooms must be well ventilated and cool. A large numbers of heat stroke cases occurs in congested and ill ventilated and crowded rooms and huts, etc. In an area if possible, fans made be available to workers in their tents and quarters and no one should be allowed to sleep out side.

Medical inspection should be regular and through to detect early symptoms of the heat effect or any other diseases which may aggravate the effects of heat. Cases detected early can be often placed in rest in a cool place.

Avoid working in sun when it is too hot from 1 p m to 3 pm(IST) and drink plenty of pure water and use umber la while walking in sun, also avoid tea,coffee and alcohol,etc. during extreme summer and take rest or avoid doing strenuous work during peak hours.

First aid and early treatment

Keep the patient in bed or on the floor and fan on to reduce temperature. Raise the foot end and keep wet cloths on the body to reduce temperature and give plenty of fluid diet. This is necessary to stop the progress of illness, avoid permanent neurological injury and save life. Temperature must be reduced rapidly by spraying cool water and fanning. Ice-cool water is not to be used. Give plenty of cool water to drink, not too much. The temperature is checked every 10 minutes when cooling is reduced when it comes to 39 degree centigrade, patient is to be removed to the heat stroke centre. Dehydration is treated by administration of fluids and electrolytes. Cases of pure water loss is treated with water only. In severe cases with considerable impairment of mental and physical capacity there may be a deficit of 5 to 10 liters. In salt deficiency, if there is any giddiness and fainting on standing, there may be an approximate deficit of 4liters isotonic saline and if urinary chlorides are absent and if there is any feeling of vomiting/anorexia, nausea and vomiting with systolic blood pressure above 90mm of mercury, there may be a deficit of 5 liters, and if systolic blood pressure is less than 90mm of mercury, there is an approximate deficit of 8 liters.