MEDICAL SERVICE VOL. 41 No. 6 JULY-1984
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- Title
- MEDICAL SERVICE VOL. 41 No. 6 JULY-1984
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pastoral ministry and natural family planning in a hospital • trained to o verprescribe ? <> hearing loss—silent epidemic in schools > tongues are for
tasting 0 legal education—9 J the. national security act 1980; your rights if
arrested • amoeba : companion or killer • ascaris : most popular worm
vol 41.
.
,
no 6
july 1984
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official house journal
of the catholic
medical
service
hospital association of India
"the love of Christ
urges us" 2 cor 5 :14
vol 41
editorial board
no 6
july 1984
contents
dr c m francis
dr ravi narayan
dr prem chandran john
dr daleep mukarji
mr augustin veliyath
fr george lobo sj
prof george Joseph
dr paul neelamkavil
1
editorial
2
2
pastoral ministry and natural family planning
in a hospital context
fr f v ferrier
3
fr edwin m j
3
people, pills and prescriptions-11
trained to over-prescribe ?
mira shiva
9
hearing loss—silent epidemic in schools
nelly reyes ledesma ma
13
tongues are for tasting
goldie down
15
legal education—9
the national security act 1980: your rights
if arrested
p d mathew
19
amoeba : companion or killer
bernardo sepulveda
29
ascaris : most popular worm
benjamin d cabrera
35
chai news and notes
39
4
editor
fr john vattamattom svd
5
• 6
cover design
p m isaac bangalore
7
8
published by the catholic
hospital association of india
c b c i centre, goldakkhana
new delhi-110001
printed at kalpana printing
house new delhi-110016
9
"Articles and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of india"
EDITORIAL
Health : beyond medicines
It is told of an incident in one of New York City's big hospitals. A
patient there called for a minister. The minister walked into the room and
realised that the man was a complete stranger. The patient told the
minister "I know you. I have heard you preach several times. I ask you
to come because I want you to get me out of this place". The minister
was puzzled. "You mean you are here against your will ?" "No", the
patient replied. "I am being given the medical care I need. I know that.
As a matter of fact I am a physician myself. But you are the only kind of a
doctor who can get me out of this place once and for all." "I am sorry",
the minister said, "I still don't understand". "I have got a stomach ulcer"
said the patient earnestly. "And do you know how I got it ? By hating!
By getting angry and hating 1 I want you to show me how to quit.
Because if you can teach me how to get some serenity, then, with the
treatment I am getting here, I will be all right".
The pastor was silent for a moment.
Bible on your table. Do you use it ?"
Then he said, "I see you have a
"Oh, I read it. But my trouble is that I don't know how to practice
what it teaches. You go ahead ! You show me how ! Read it to me.
Give me the works I"
The pastor agreed to this rather unusual request. He out-lined a
technique for the physician. He asked him to confess all his resentment
and hatreds and the wrongs he had done, then to ask for forgiveness.
"Don't just believe that God is going to forgive you sometime or other", he
added, "but that He already has done so, even while you ask".
The physician eventually got well. Gradually be understood the
importance of religion; he discovered the wisdom of not being self-centred.
Finally he was happier and healthier, than he had ever been.
There is no doubt that what we think and feel has a vital effect on our
health. There is a real connection between our state' of mind and the
state of our health. Our attitudes, our philosophy of life, our goals,
our ethical ideals, all these are big factors in our physical well-being.
It seems that a very high proportion of the illness is caused by fear, anger
and guilt. These three emotions are the three great enemies of health.
What is our attitude towards health care ? Are we treating the symptoms
or the persons? What emphasis do we put in the health care system in our
institutions? Are the medicine and high technology centred or person
centred? Many more questions like these will have to be asked and proper
answers found if we want to find meaning in our healing ministry and make
it relevent to today's situation particularly in our own country.
Pastoral Ministry and Natural Family Planning in a Hospital Context
— Rev. F.V. Ferrier
Early History
In the fall of I960,1 was studying Medical
Morals with the late Fr. Gerald Kelly S.J. I
proposed to present a study on the argument
against contraception. Fr. Kelly counseled me
not to spend energy in this. He judged there
was not much value in focusing on motives
for or against contraception. He argued that
people would accept the position only if they
accepted that there was a natural law and
the acceptance of the existence of God. He
was convinced that arguments do not bring
anyone to hold either a position based on
natural law or the acceptance of God's exis
tence; arguments only manifested the reason
ableness of both.
This connection comes back to me at this
time telling me how longstanding has been
my interest in Natural Family Planning, also
helping me understand how accurate Fr.
Kelly's insight was in the light of my own
experience.
My first experience in a hospital as a cha
plain was in November 1963 as part of my
final year of Jesuit studies. The way we
worked where I was stationed was only as
dispensers of the Church's sacraments. We
were not to counsel with patients or staff.
There is little similarity with that first experi
ence and my current ministry in a hospital.
During that first experience as a chaplain
I had no involvement with Natural Family
Planning directly.
After studies I spent fifteen years in the
Jesuit school in Houston, Texas, USA. My
main work was as Registrar. I still had op
July 1984
portunities to express my interest in caring
for persons. Outstanding among those op
portunities was becoming a presenting priest
with the Marriage Encounter Movement. This
brought me into close pastoral contact with
many families.
During this period Humanae Vitae was
published and immediately become a point
of intense controversy in Houston. My efforts
to uphold Paul Vi's teaching of the Church's
position was highlighted by two experiences.
One evening I was a guest in the home of
some Catholics who were publicaly very
verbal against the teaching of Humanae
Vitae. I was able to show that I understood
what they were saying. I was then able to
call them to enter into the Mystery of who
we are as the Church, for they were having a
deep conflict with authority.
The second evening was with Marriage
Encounter couples in an intense discussion
regarding sexuality and the Church's teaching.
The call there was to mature acceptance of
responsibility and to realization of their being
revered and respected by the Holy Father.
The focus was on Pope Paul's admonition not
to exclude those having difficulties from par
ticipating in the sacramental life of the
Church. As yet the Ovulation Method for
Natural Family Planning was not present.
From August 1979 until August 1982 I
was a chaplain in St. Mary's Hospital in Gal
veston. St. Mary's is a Catholic Hospital and
the oldest private hospital in Texas. It is
about 50 miles south east of Houston. During
this time I met Sr. Catherine Bernard and got
3
to learn from her the ovulation method of
natural family planning.
and gave them to appropriate persons, using
them as a teaching aid.
Shortly thereafter- Mrs. Harrigan came to
Galveston to assist Sister in presenting the
Ovulation Method for Natural Family Planning
to the staff from the Family Life Clinic that
is connected with the University of Texa's
Branch in Galveston.
I taught the philosophy and the method of
Natural Family Planning to a number of co
uples and individuals both in and out of St.
Mary's Hospital. Upon reflection I became
concerned about what I was doing teaching
the method. Was there sufficient follow up?
Was I focusing on my need and anxiety
rather than ministering in a sound manner ?
Of significance was the fact that the doc
tor that is now the head of St. Mary's Ob-Gyn
service attended that basic presentation.
Later the Education Department would
invite Sister to present the Billing's Method
to two groups in St. Mary's Hospital as part
of their inservice training. The presentations
were to a cross-section of the personnel,
then to the nursing personnel on the Ob-Gyn
service. At the time of the presentation to
the nurses I made an explicit effort to get
one or more nurses interested in becoming
teachers of the Ovulation Method. This latter
efforts is still progressing at the time of this
writing.
In addition to what has been listed above
in which I had some Part—Sister Catherine
used her talent and knowledge helping indi
viduals both in St. Mary's Hospital and
outside.
Also, Sister introduced me to a number of
persons who were interested in the Ovulation
Method of Natural Family Planning.
Once Sister was able to depart—in
February 1982—I saw myself as having an
opportunity to make her efforts continue and
bear fruit.
Personal Efforts
From and through Sister I had received
much literature on the Billings' Method. In
addition I personally purchased a number of
copies of ''The Ovulation Method 'of Natural
Family Planning" by John J. Billings, M.D.,
4
As I faced these questions I stopped my
efforts to teach the method and began to
work to get the Education Department more
actively involved.
The Education Department would have to
sponsor teaching the Ovulation Method of
Natural Family Planning if it was to have a
lasting value in St. Mary's Hospital and if it
was to be officially accepted by the hospital.
My hope was to have a NFP Clinic spon
sored by the Education Department.
To assist the Education Department I pur
chased three sets of slides for teaching pur
poses. I made a cassette tape explaining the
slides. I turned all of this over to them. They
would have the basic equipment for begining
a teaching program. They still needed to
have the freedom and the trained personnel.
After I made my reservation to attend the
Seminar in Houston a very significant thing
occured. The Catholic Hospital Association
of the United States sent an inquiry to St.
Mary's Hospital concerning what was being
done to make Natural Family Planning avail
able both to the patients and to the larger
community. Administration
directed the
questionnaire to Pastoral Care Coordinator
realized that the Education Department was
the appropriate group for answering this
inquiry; so the Pastoral Care Coordinator and
I answered the questions and then passed the
form onto the Education Department for their
Medical Service
concurence; then it was returned to Admini
stration. The answer given showed we were
sputtering to do something but were really
doing nothing that was of value—even
though we wanted to get going. At last I the
hospital officially accepted that it was res
ponsible to do something.
The arrival of the questionnaire charged
the complexion of my attending the seminar
in Houston. The hospital chose to send meto pay my transportation and tuition-as well
as one member of the Education Department.
No one was available from the Education
Department so I went alone.
During the seminar I finally got to meet
Dr. Hann Klaus whom Dr. Catherine Bernard
(Sr. Catherine) had mentioned so frequently.
Dr. Klaus held two additional workshop
that I attended: the first was to acquaint
priests with the Ovulation method of Natural
Family Planning as well as to introduce them
to some couples in the diocese who were
involved with NFP; the second workshop was
for hospital personnel.
I had the presentation for the hospital
personnel recorded and the recording sent to
St. Mary’s Hospital's Education Department.
In that presentation Dr. Klaus, made it very
clear that NFP belonged to the Education and
not in the Medicine services in the hospital
setting.
On returning I made all the procedings
available to the Education Department.
One very supportive experience was being
alerted by the Education Department regard
ing the "Natural Family Planning" television
tape recently acquired by the Nursing Educa
tion Department of the neighbouring Medical
School. The nurse in the Education Depart
ment and (‘reviewed this program with joy
and hope to eventually have it available to
show through St. Mary's television system. It
was worth obtaining by budgeting fund.
July 1984
My presence at St. Mary's Hospital was
quickly drawing to a close. I wanted to be
sure that 1 did all I could before leaving to
have a Natural Family Planning program
planted.
The Education Department was interested
in getting the backing support of the doctors
and nurses in the Ob-Gyn service. They also
wanted to get some personnel trained to
handle the one-to-one aspects and group
classes.
The head of the Ob-Gyn Department was
interested in establishing Natural Family
Planning in St. Mary's Hospital, but the com
munication between the groups seemed bog
ged down.
At this time St. Mary's Hospital was
changing administrators. I asked the sister
for insight into why the efforts to make
things move were so apparently unfruitful.
She suggested that I should go directly to
the doctor who was the head of Ob-Gyn.
Before doing this I contacted doctor in the
Sisters' Houston hospital who was one of the
main supports for NFP in the diocese. He
offered to consult with the doctor in St.
Mary's.
I met the doctor and shared my anxiety and
fustration as well as my aspirations and desire
to facilitate getting a Natural Family Planning
service going. I told him of my imminent
departure and how I wanted to do what I
could do before departure.
Once again before departing I met this
doctor and urged him to stay with his plan
to have the entire effort for teaching the
Ovulation Method dependent on getting a
couple as teachers but to let it get into the
Education Department. I also lent him books
of Dr. Billings and Mrs Wilson.
In August 1982 I moved from Galveston
to Houston. I continued to call on the
5
Education Department at St. Mary's Hospital
to see what was happening, to encourage
and to stimulate whenever possible.
I again talked with the doctor to find out
how it was progressing from his perspective
and to reclaim the books so that I could make
them available for others.
In November I made a trip to the Educa
tion Department to follow the progress. I
was able to help clarify that the project was
dependent on the Education Department
rather than on the doctor. Also I was of as
sistance in focussing on the practical neces
sities of having teaching space and funding.
I learned on that visit that the Education
Department has obtained the service of a
certified NFP teacher to train their personnel.
I also learned that they are working to coord
inate schedules with the teacher and the
doctor, so some necessary meetings can be
had finally establish a program.
As of this writing the doctor plans to
present the Ovulation Method to the Ob-Gyn
D epartment in his next inservices presenta
tion. Further, he personally was planning to
attend the programme Mrs. Harriggan had in
Corpus Christi, January 14-16, 1983, and
was getting the hospital to send members of
the Education Department as well.
The impression the Education Department
is giving me now is that this effort to open a
Natural Family Planning service in St. Mary's
Hospital is progressing much more rapidly
than co many similar projects.
Mary's Hospital for the Galveston area, I have
also been seeking to bring NFP into the
Corpus Christi Parish Community in Houstonthe parish in which I am presently residing.
There are regular announcements in the
Church's bulletin urging parishoners to call
for information; I then put them in contact
with a certified teaching couple.
Again, this is very slow. I think this slow
ness is due to to lack of desire or interest on
my part but to my limited ''know-how" in
proceding.
Gradually I'm seeking to bring the Ovula
tion Method of Natural Family Planning into
Hermann Hospital where I am presently a
student rather than a teacher. I have establi
shed contact with personnel in the Patient
Education areas, and I am learning what are
the practices and procedures within this hos
pital. As of this writing there is one of the
services that has some of my materials and is
showing some interest.
Reflections
As I reflect about this presentation there
has been a point that is repeatedly present
to me : share my own experience—that's the
unique gift I have to offer.
On the surface I have the experience of
fear that I am impotent in furthering Natural
Family Planning.
Looking back, however, I have a sense
that his effort is similar to trying to move a
sitting elephant. It is possible, but it is. not
easy for the untrained.
I react to my fear by wanting to blame
others. I want to blame my "Pill-popping"
culture. I want to blame the disinterested
and ignorant medical professionals. I want
to blame the sense of indifference and even
alienation some fellow Catholics have shown
since Humanae Vitae
In addition to this efforts to establish a
Natural Family Planning Center/Service in St.
These may have some blameworthiness,
but not for my sense of impotence.
6
Medical Service
I see my culture is contrary to Natural
Family Planning. If it were not, Sr. Catherine
would have set Galveston aglow through her
efforts. Further, my efforts from the vantage
point of hospital chaplain would have engered enthusiastic, positive responses. Seeking
to inspire and motivate others is painfully
slow.
To put this another way, it's not the idea
but the person-to-person relationship that
has made me very interested and committed
to NFP.
These reflections bring me back to what
Fr. Gerald Kelly had told me in 1960 : a posi
tion based on natural law is either self-evid
ently accepted or it is scarcely possible to
convince anyone of it.
Further, when I review my attitude —that
others ought to see NFP the way I do—I see
this compromises my love and respect for
others, I see I am seeking to have others be
the way I want them to be rather than accept
and love them the way they are.
I can and have used pastoral authority to
move people to respect Natural Family Plann
ing, but I cannot convince anyone of it's
merits from reason alone.
As I seek to get even more in touch with
my experience I see I have an assumption
and an attitude that affect me in my effort to
share NFP as a pastoral care person. My as
sumption is that anything so good as NFP
should automatically ignite enthusiasm in
who ever learns of it. "My attitude is that
"others should see things the way I do".
As I look at my assumption—that NFP
should automatically ignite enthusiasm in
whoever learns of it—I discover that this is
not really true in my own life. It really is not
NFP that has motivated me to do whatever I
see I am able to further it but rather my com
ing to know Fr. Kelly and Sr. Catherine and
their enthusiasm.
July 1.984
I conclude that my assumption that NFP
should automatically ignite enthusiasm is
possibly commendable but is very naive.
Admitting this is painful for me, I tend to
presume other persons who do not see things
my way are wrong. I see them as inexperi
enced and missing out on so much I It would
make me feel good and powerful to change
them and make them to be my way !
I have to change my attitude now, I have
to accept that my Pastoral Ministry in the
Hospital Contest calls me to slow—and occassionally discouraging—person-to-person
contacts with the educational personnel to
make the Ovulation Method of Natural Family
Planning available. This has to be my way
of caring for people by providing the blessing
of the Method for them.
Realizing and accepting this truth has been
and still is shocking but it is contact with
reality. This is the path I now use to bring
this gift to others.
7
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PEOPLE, PILLS AND PRESCRIPTIONS—II
Trained to over prescribe ?
—Mira Shiva
Health Needs and Medical Care
Today there is better understanding of
HEALTH as well as the recognition of the
implicit relationship of disease with UNMET
BASIC NEEDS OF FOOD, CLEAN AND
ADEQUATE DRINKING WATER, CLEAN
ENVIRONMENT. All that goes on in the
name of 'Medical Services' at constantly
increasing costs, is being increasingly ques
tioned by more and more people today.
tance of health education, in prevention of
disease. Unfortunately we found that much
of the health education 'given' in all good
faith does not necessarily result in changes
in 'attitudes or behaviour/ The subtle but
crucial difference between “giving of health
education1' and “being able to communicate,
be listened to, be 'heard' and understood"
was painfully realized only with experience
in the field.
For approximately 60-70% of Indians
below or around poverty line no amount of
medicines 'modern' or 'traditional' can deal
effectively with most of their health pro
blems having their roots directly or indirec
tly in poverty.
(The well off can afford adequate care
for themselves and don't really need us.)
We, the health personnel realize the limi
tations of our role even as ‘deliverers of cura
tive and medical care', we are unable to
help with, and ensure consistent supply of
adequate nutrition even after we have made
an accurate diagnosis of second or third
degree malnutrition with multiple vitamin
deficiencies. Even while we go on diagnosing
and dealing with serious and fatal diarrhoea,
(the childhood killer number 1,) we some
how cannot ensure adequate supply of clean
water.
On looking back we realize that we were
never trained to be "facilitators of health."
in the real sense of the word. Actually
some of us sincerely believed in the impoiJuly 1984
9
Realization of this, as well as realization
— The pressing health needs of the peo
ple who needed us most
— The limitation of our training which
does not equip us to deal with their
problems effectively
— The expected and traditionally accep
ted role of voluntary health institu
tions
— The obvious need for the changing
role of health institutions, towards
more relevant functioning, leaves
many of the more sensitive and
socially conscious health personnel
from service oriented health institu
tions facing a moral crisis and
dilema.
For the time being let us accept, that
voluntary health institutions (like others) are
geared only to "deliver medical care" and
they do so with commitment and sinceritly.
Medical care as it exists today is based
mainly on 'use of drugs', whether it's in a
big teaching hospital, health centre or even
in most community health programmes.
When accusations are made that health
personnel all over misuse drugs, and are
“pawns -in the hands of the drug industry”
and part of an exploitative medical industry
complex"— the allegations are very serious
and cannot be rejected without as analysing
them.
Principles of Rational Drug Use in our
medical education
It is a very well recognized (but an unfor
tunate) fact that our medical education has
not equipped us adequately to deal effecti
vely with the problems as they exist in the
field. Our teaching of pharmacology and
Therapeutics is from Ivory towers for Ivory
Towers. Principles of 'Rational therapeutics'
10
are not taught keeping in mind the conditions
under which the health personnel will have
to be functioning in the field i.e.
— With limitation of diagnostic facilities
and of supportive staff.
— With heavy workload and pressure
of time & diversity of function
— With financial constraints with ever
increasing deficits
— Shortages of drugs
— Little or no referral facilities or help
in consultation
— Long distances and Hopeless trans
port facilities involved, which make
revisits by patients for reports and
follow-up difficult
To deal effectively with all these cons
traints calls for constant innovativeness,
initiativeness, skills, concern and commit
ment. It is a fact that those ‘'undrained
brains" meeting all these challenges in the
field to the best of their ability are worthy of
deep respect
Unfortunately in many cases as the diffe
rent constraints increase, the situation dete
riorates in the absence of authentic need
biased drug information with no facilities
for meaningful ongoing medical education
to certain lacunae begin to occur—unwit
tingly. Our medical education never geared
us for dealing with these lacunae.
Inspite of the encylopedic knowledge of
pharmacology we acquired, we find oursel
ves totally foxed when confronted with
hundreds of unheard of drugs. We are
unable to critically evaluate, from amongst
the hundred of brands of the same product,
—the most rational product to stock our
pharmacies with and to prescribe.
Our entire medical education is based on
the use of generic named drugs and that too
Medical Service
mostly single ingredient drugs. The medical
journals also use non-proprietary generic
names and then we walk into the world of
Brand names—of which there are 30,000 in
India. Many health personnel don't see the
unreasonableness of the brand names—?///
confronted by a critically sick patient with
numerous prescription slips full of unfamiliar
brand names. The realization that most of
these are combination drugs with varying
contents of ingredients makes it all the more
complicated to figure out what was prescri
bed and actually consumed.
A PRESCRIPTION FORVOU
SNfclTE
OUT yOUR
PROBLEMS*
SUGGESTIONS etc
ON
DRUG ISSUES
Our education does not equip us with a
thorough understanding of:
— our country's health & drug policies
— our people's health needs and health
priorities
AMD
SEND
— the rationale behind generic drugs
over brand names
DRUG column
medical service
cbcj- centre
— the existing drug control mechanism
and its ineffectiveness
— concept of essential drug list and its
relevance for a developing country
like ours
— irrationality
drugs
of
most
combination
— the various hazardous drugs banned
in various countries which should not
be allowed to be manufactured, mar
keted and prescribed
— the half truths and biased drug infor
mation fed by the drug industry on
which the health personnel tend to
depend in the absence of EASY
ACCESS TO UNBIASED MEDICAL
DRUG INFORMATION.
According to the working group on Ratio
nal Drug Therapy of WHO, out of 17 ways
July 1984
WEAR GOLDAKKHANA
NEW DELHI-110001
in which doctors misuse drugs, the commo
nest is overuse. Over use of Drugs means :
— too large a quantity of drug
— for too long
— prescribing of an,unnecessary drug
— prescribing of many drugs adding no
additional benefit for the same pur
pose
Factors leading to overprescribing
1.
Inadequacy of time and facilities for
diagnosis.
2.
Lack of knowledge of drugs and
prescribing principles (over prescri
bing to avoid risk of underprescrib
ing)
11
3.
Pressures exerted by patients
4.
Heavy and often unethical practices,
marketing by drug companies and
distribution of samples.
5.
Desire to retain patients good will.
2.
Treatment by more than one doctor
often of more than 1 system of me
dicine.
3.
Self medication by patient.
4.
Stoping premature cessation of drug
is due to financial reason,, fear of
harmful
effects (most allopathic
drugs are considered hot), and be
cause of some unacceptable mild
side effect.
5.
Drug substitution at the chemists
6.
Illegible prescription
7.
Chemists own vested interest.
Another problem for Failure on part of
the patient in taking drugs properly i.e. right
drug given to the right patient with INADE
QUATE or NO appropriate drug information
may not be taken properly. Reasons be
ing
1.
Failure to understand and follow the
prescribers instructions which may
have been given too vaguely or not
at all.
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Medical Service
Hearing Loss—Silent Epidemic in Schools
Nelly Reyes Ledesma, M.A.
Many people suffer from hearing loss. The
universal estimate of the prevalence of hear
ing loss according to the National Institute of
Health in the United States is that one out
of fifteen person is affected.
Hearing loss is a problem that is least re
cognized in the Philippines as an ailment.
When it comes to hearing impairment we are
backward compared to some other countries
in Southeast Asia.
The deaf and hard of hearing themselves
are not willing to do much about their pro
blem. They don't even admit that they have
impaired hearing.
concealed in his eyeglasses—and his career
improved. He is now an assistant manager
of the bank.
There are indications that the hearing pro
blem in our country is getting worse every
year.
Loss of hearing is prevalent among the
elderly and because of modern science and
medicine people are living longer and deaf
ness among the aged is rising.
Preliminary investigations of hearing tests
using Elementary School children as subjects
conducted by the Bureau of Elementary
Education and the author of "Prevalence of
Hearing Loss in the Philippines from 1974
Up to the Present" have shown that 15% of
children have already been labelled mentally
retarded and placed in a school for the re
tarded because the real problem, loss of
hearing, had not been diagnosed.
What does progressive hearing loss mean?
It means that
1. You ask people to speak
up; 2. You turn up the TV and radio louder;
3. You find it difficult to follow conversation;
4. At partieis, you have to concentrate har
der on the face and lips of the speaker in
order to hear what they are saying; 5. You
Some of the common causes of hearing
begin to withdraw from social contacts, have
disorders are German measles, chronic ear
tendencies to become irritable and moody;
6. You make life difficult for those around infections, prolonged medication and noise
trend continues
James Macmahon, Ad
you; 7. You miss much of the fun of living.
ministrator of the New York League of the
Hard of Hearing says, "by the year 2000 we
The problem of hearing loss affects the
social life of an individual. Take the case of won't be able to hear one another without
using hearing aids.
a 32 year-old bank employee who had diffi
culty understand customers. One day the
Only a small percentage of the estimated
manager of the bank informed him that due
50 million Filipinos suffering from significant
to his auditory problems he might loss his
hearing loss can be helped by surgery. The
job. The employee went to an audiologist
majority must be given auditory rehabilitation
(hearing specialist) upon the recommenda
(hearing aids), speech-reading, auditory train
tion of an EENT doctor and found that his
hearing loss which he had for many years ing, sign language and total communication
or a combination of all these approaches.
could be corrected simply by acquiring a
Advances in miniaturization enable the manuhearing aid. He got one—a near invisible aid
July 1984
13
facturers of hearing aids to come up with
models that can be worn almost invisibly and
i nconspicuously.
Hearing experts advise that the average
person can protect his hearing or make up
for what he has lost by doing the following :
1. Have your hearing checked at least
once a year by an EENT doctor or an audio
logist.
2. Avoid exposure to loud noise. Use
earplugs or ear protectors if you will be ex
posed to loud sounds.
correction is possible. If not, the doctor will
refer you to see an audiologist who will
measure the extent of your hearing loss, as
well as the type and determine if it can be
corrected surgically or by using a hearing aid.
4. Contact a speech and hearing centre
which generally has an audiometerist on its
staff supervised by an EENT doctor or an
audiologist.
5. Don't try to hide a hearing loss. Admit
that the problem exists and do something
about it.
3. If you suspect that you have a hearing
loss go to an ear specialist to see if a medical
fromjg^
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Medical Service
Tongues are for Tasting
—Goldie Down
I SMILED as I watched our seven-month
old grandson's chubby hands carry the
wooden toy to his mouth. He lost his grip
and the toy tumbled out of reach. Never
mind. Tiny groping fingers closed around
a felt ball and lifted it mouthwards. Next it
was a plastic teething ring, then a bunchedup corner of the knitted rug on which he
sat, and finally he grabbed a nearby maga
zine and chewed the cover to a slobbery
pulp.
side—the superior and inferior longitudinal,
and the vertical and transverse muscles.
When these muscles contract they change
the length, breadth and width of the tongue;
they also enable us to "poke out" our
tougues and draw them inside the mouth
again.
Psychologists explain the primal urge
which forces babies to convey everything
they grasp up to their waiting mouths, but
I was not thinking of that as I watched his
little pink tongue explore the different sub
stances.
The tongue's surface is covered with
mucous membrane which contains many
nerve fibres that carry stimuli to the central
nervous system. This membrane also contains
a large number of epethelial cells, commonly
called tastebuds. These are gobletshaped
clusters of cells that open by a small pore to
the mouth cavity.
"I wonder how sensitive his tastebuds
are," I remarked to my daughter. "Do you
think he recognised the difference between
wood and wooy?"
"He certainly knows that differences in
food tastes," she replied. "He loves honey
on his cereal, but he actually shudders
when his orange juice is sour".
"Interesting, isn't it?" I nodded, and
settled back to think about tongues and
taste.
Variations
Every normal person has a tongue, but
not all tongues appear the same. Tongues
vary in size and shape as much as their
owners do. Basically the tongue is a mova
ble muscular organ anchored at the inner
end to the floor of the mouth. The muscles
which lie within the tongue are called the
intrinsic muscles. There are four on each
July 1984
Our tongues help us in speaking, and
assist with the chewing; swallowing and
tasting of food.
Glands underneath the tongue produce
some of the saliva that we need to moisten
dry food before swallowing it.
The Function of Tastebuds
The upper surface of the tongue does
not feel as smooth and slimy as the approxi
mately 3000 tiny bumps or papillae, which
dot its surface. Each papillae has receptors
(tastebuds) on it, and it is these receptors
that help us to recognise four basic tastes.
The tastebuds at the tip of the tongue are
sensitive to sweet things—which is why we
lick ice-cream; those toward the back of the
tongue taste the bitter things, while those
at the edges and sides of the tongue recog
nise the salty and sour things. The middle
part of the tongue appears to be insensitive
to any of these tastes.
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For a long time scientists tried to fit
every taste sensation into one of these four
categories, but they now realise that the
tastebuds sometimes work together—the
individual nerve fibres possess mixed sensiti
vity and respond to more than one basic
stimuli. For instance, acid plus salt or acid
plus salt plus sugar.
But the tastebuds don't identify any
flavour unless it is in solution. Dry foods
taken into the mouth must be dissolved by
saliva before the taste can be detected. Per
haps that is why foods like nuts have little
taste until they are well chewed and mixed
to plup with saliva. Conversely, if solution is
held in the mouth for any length of time it
tends to lose its flavour.
Taste-masking is common, when we try
to camouflage one taste (Usually an unplea
sant one) with another; such as adding
sugar to a lemon drink, or trying to disguise
castor oil with orange juice.
Touch Contributes to Taste
Touch sensations originating in the nose
and lips and though the entire mouth and
throat contribute greatly to our sense of
taste—the smoothness of whipped cream or
melted chocolate, the crispness of celery,
the brittleness of toffee, the sogginess of
bread in soup or the lumpiness of oatmeal
porridge.
The different, kinds of touch sensation
are based on either the physical or chemical
properties of the substance or a combination
of them. Touch and pressure receptors in
the tongue tell us the particle size, texture,
consistency and temperature of the heat of
pepper and mustard, or the cool sensation of
peppermint. Some foods like cucumber,
lettuce and boiled rice rely more on texture
than flavour to give them taste.
July 1984
Taste Thresholds
The threshold of taste is much higher
than that of smell. In other words you need
a great deal more of a substance to detect
it by taste than you do to detect it by smell.
Olfraction is estimated to be 10,000 times
more sensitive than taste. For instance
quinipe, which is very bitter, needs a solu
tion of only I molecule of quinine to 1
million molecules of water in order to be
tasted; sugar needs 1 molecule in 2,500
molecules of water, and salt in 1 in 1,500
molecules of water in order to be tasted.
Once the taste and smell threshold has
been established it requires at least a 20 per
cent increase before any noticeable difference
in taste is effected. If the flavour is weak in
the first place it may require as much as
100 percent increase in order to be discerni
ble. Remember this when adding salt, sugar
or any other seasoning to your food.
The average person has approximately
the same taste thresholds for salt and sugar,
but they vary for other tastes. Some people
are blind to certain taste sensations—which
probably detracts from their enjoyment of
food. Still others can detect the chemical
benzoate of soda as tasting sweet, others
think it bitter. To most people the same
chemical is entirely tasteless.
It is never safe to utilise the sense of
taste to detect a poison. Never say, "Oh, it
tastes all right," and then proceed to eat it.
A lot of poisonous substances have no taste,
some are even temptingly sweet. Keep this
in mind when tempted to try unrecognized
beans or mushrooms.
Animals' Tongues
The tongues of many animals appear pink
and pliable and not unlike the tongues of
homosapiens, but in others there are im
mense differences in structure and function.
17
Whales are enormous creatures, but be
cause they don't chew their food they have
no need of tastebuds, and those who should
know assure us that a whale has few, if any,
tastebuds.
On the other hand, a cow which chews
continually and apparently enjoy its food
again and again, has some 35,000 tastebuds,
ten times as many as a human being has.
Because we can only -taste things that
are soluble, animals , that live in water have
tastebuds all over their bodies. Fish can
even taste with their tail fins. (Full marks to
the scientist who discovered that.)
In mammals the tongue's mobility inside
the mouth creates a negative pressure which
enables the young to suckle.
In adult horses this negative pressure is
great enough to lift a column of water three
feet, so that a h6rse can easily drink from a
stream or trough without lifting its head to
swallow.
Tongue and Disease
When you are sick and the doctor asks
to see your tongue, it is because changes in
18
the tongue's appearance will often give a
clue to disturbances in other organs and
systems.
The normal tongue has an evenly colour
ed, finely granulated surface, and any
changes of colour, uneveness of surface or
degree of moisture can reflect a disorder
such as gastrointestinal disturbance.
However, don't panic if you wake one
morning with a furry tongue. A coated ton
gue actually provides no diagnostic clues,
because it can be caused by a wrong diet
(or a heavy meal of indigestible foods late
at night), by smoking and even by breathing
through the mouth.
Oral cancers are on the increase, princi
pally due to smoking, although defective
teeth and hot-spiced foods bear some of the
blame. If a tongue cancer is diagnosed
early enough it can safely be removed by
surgical treatment, possibly combined with
radiation.
Don't take any risks with this precious
organ of taste and speech. If you suspect
that anything is not as it should be consult
your doctor IMMEDIATELY.
Courtesy : HERALD OF HEALTH
Medical Service
LEGAL EDUCATION—9
The National Security Act 1980: Your Rights if Arrested
— P.D. Mathew
Deprivation of personal liberty
The constitution of India guarantees per
sonal liberty to every citizen, which is one
of the most cherished values of mankind.
Its exercise is essential for the self-fulfilment
and personality development of citizens.
Yet this Fundamental Right is not abso
lute. Under Art. 22, the State is empowe
red to enact laws for preventive detention
and to put reasonable restrictions on the
liberty of the citizens in order to safeguard
the security of the State and public interest.
At the same time the Constitution puts cer
tain restrictions on the power.of the legisla
ture to enact the laws for preventive deten
tion by providing Constitutional safeguards.
Despite these safeguards, there is always
the possibility of abuse of power by the
legislature and the executive. It is then the
responsibility of every citizen to safeguard
his Fundamental Right of personal liberty
and in case of encroachment by outside
forces, to seek redress through legal reme
dies provided by the Constitution.
The purpose of this' booklet is to enable
the public to understand the nature of the
clauses concerning preventive detention and
the provisions of the National Security Act
1980. It also highlights the duty of the
detaining authorities and the rights of the
detenu detained under the Act and the Con
stitutional remedies available to the detenu
in case of illegal detention.
Preventive Detention
What is the nature of preventive deten
tion ?
July 1984
Preventive detention is arrest of a per
son prior to committing an illegal act
and his detention without trial. The object
of preventive detention is to prevent the
individual from committing an illegal act.
The suspicion that a person will act in a
manner prejudicial to public order, the secutiry of the State or public interest is enough
to justify his detention. It is not necessary
for the State to establish actual breach of
public order etc.
What are the Constitutional safeguards
relating to preventive detention ?
Art. 22 of the Constitution approves
the enactment of preventive detention laws
to prevent anti-social and subversive ele
ments from destroying the development and
welfare of the Republic. At the same time
it provides certain safeguards against the
abuse of legislative power. The following
are some of the Constitutional requirements
to make the preventive detention laws valid.
* Preventive detention cannot be ordered
by the Executive without the authority
of a specific law.
* The detention of a person must be in
conformity with the procedure laid
down by a valid law i.e., a law which
the legislature has the competence to
enact.
* It is obligatory on the part of the State
to constitute an Advisory Board whose
opinion has to be sought in case of
detention beyond two months.
Ordinarily Parliament cannot enact a
law authorising detention beyond two
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months without the intervention of an
Advisory Board. But it may, by law,
prescribe the circumstances under
which, and the class or classes of
cases in which, a person may be detai
ned for more than two months without
obtaining the opinion of the Advisory
Board.
* No State can enact a law authorising
detention beyond the maximum period
prescribed by Parliament.
* Parliament has also power to prescribe
the procedure for the Advisory Board.
* Under Art. 22 (5) a detenu has a
right to obtain information as to the
ground of his detention and has also
the right to make a representation pro
testing against the order of preventive
detention.
* According to Art 21 of the Constitution
the procedure prescribed by the law
must be just and reasonable.
Court's Jurisdiction in case of detention.
1.
The Court can examine the validity
of the law itself on the ground of
competence of the legislature, viola
tion of Art. 22 or interference with
the jurisdiction of the Supreme Court
under Art. 32.
2.
When a law on preventive detention
is challenged in the court, it must
consider the true nature and charac
ter of the legislation and decide
whether the law is really on the
subject of preventive detention or
not.
3.
The Court may examine the grounds
specified in the order of detention
to see whether they are relevant to
the detention, e.g., acting against
the secutiry of India and maintenance
of public order etc., and set the
detenu free if there is no rational
justification for the detention.
4.
It may examine the bona fide of the
order and interfere if it is mala fide
e., if the law of preventive dete
i.
ntion is used for any purpose other
than that for which it is made.
When is an order mala fide ?
* An order of detention is mala fide :
if it is made for a purpose other than
that intended by the legislature e.g.,
to suppress the activities of a political
opponent;
* if the grounds on which the detention
is made is not proper or irrelevant;
* when it appears that the authority issu
ing the order did not examine the
grounds properly;
* where the Court has declared, the
detention of a person to be without
jurisdiction, and a subsequent order
of detention is issued on the same
grounds.
Effect of unreasonable delay
Since preventive detention is a serious
invasion of personal liberty, the Court would
scrutinise delay in the observance of the
procedure expected from the detaining
authority at each of the states involved and
where there is no satisfactory explanation
for such a delay it would strike down the
order of detention on the ground that the
order was made by the relevant authority
without applying his mind.
What is the
Board ?
scope
of
the
Advisory
The only function of the Advisory Board
is to report to the government whether a
July 1984
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detenu is liable to be detained for a period
exceeding two months. If the report states
that a person is liable to be detained then
alone the government is allowed to detain
the person beyond two months, provided
the detention is valid on its merits and does
not otherwise violate the provisions of the
Constitution.
Is reference to the Board obligatory ?
In view of Article 22 (4) there is no need
of any reference to the Advisory Board, if the
government does not continue the detention
beyond two months or if it releases the
detenu at any time earlier than two months,
upon consideration of the representation of
the detenu. >
But if no reference is made to the
Advisory Board any detention by the govern
ment becomes illegal on the expiry of two
months from the date of detention.
Has the detenu a right to representa
tion ?
Art. 22(5) of the Constitution gives a
detenu a Fundamental Right to make a repre
sentation to the government. But he has
no right to be heard by an independent tribu
nal. If the Court finds that the detenu is not
given the earliest possible opportunity to
make a representation to the government, it
can declare the order of detention invalid.
In order to make an effective representa
tion in time, the detenu is entitled to get all
the relevant documents on which the detain
ing authority has relied for the detention.
The right of detenu for consideration of
representation.
* This right is a Fundamental Right guara
nteed by Art. 22 (5) of the Constitu
tion.
22
* The government must consider the re
presentation with an unbiased mind.
* It is the obligation of the government
to consider the detenu's representa
tion independent of the consideration
of the case by the Advisory Board.
* The government must consider the
representation as soon as it is received.
* Where the government fails in its oblig
ation to make the initial consideration,
as soon as the representation is receiv
ed the order of detention becomes
invalid.
THE NATIONAL SECURITY ACT 1980
The National Security Act 1980 provides
for preventive detention of a person under
certain circumstances. The main objective
of the Act is to enpower the government to
detain persons acting in a manner prejudicial
to the defence or security of India, to the
country's relations with foreign powers or to
the maintenance of public order, supplies
and services.
Note
The Sections referred to in this part are
the sections of the National Security Act
1980.
Who has power to issue order of preven
tive detention under this Act ?
Only the Central and the State Govern
ments have the power to issue orders of
preventive detention. The State Government
by a written order can direct the District
Magistrate or Commissioner of Police to
exercise the powers of preventive detention
in their respective area of jurisdiction. (Sec
tion 3).
What are the grounds for which detention
can be ordered ? (Section 3(1) and (2)).
* For acting in a manner prejudicial to
the security and defence of India and
Medical Service
its friendly relations with other coun
tries.
* To regulate or restrict the movements
of a foreigner whose activities or move
ments may be considered prejudicial.
* For making arrangements for the expul
sion of a foreigner from India.
* For acting against the maintenance of
public order or supplies and services
essential to the community.
What is the procedure to be followed
when the order is made by the District
Magistrate or Police Commissioner ?
The District Magistrate or Police Commis
sioner who issues an order for the detention
of a person must report the fact to the State
Government together with the grounds all
other particulars related to the detention.
The above order cannot remain in force for
more than twelve days unless it is approved
in the meantime by the State Government
(Section 3 (3)) .
„ What is the duty of the State Government
when the order is' issued or approved by
it?
When the order of detention is issued or
approved by the State Government it must
within 7 days report the matter to the
Central Government together with the
grounds and other particulars on which the
order has been issued (Section 3 (5)).
How the order of detention executed ?
A detention order can be executed at any
place in India in the manner provided for
arrest under Code of Criminal Procedure
(Section 4).
What is the power to determine place
and conditions of detention ?
July 1984
The Central or the State Governments, by
general or specific orders can specify '
1.
the place of detention;
2.
the conditions of maintenance, disci
pline, and punishment for indiscip
line;
3.
the transfer of the detenu from one
place to another, or from one state
to another.
Note
* The removal of a detenu by one State
Government from one State to another
requires the prior conset of the Govern
ment of the other State to which the
detenu is transferred.
* According to Section 6 of National
Security Act an order of detention
cannot be declared invalid merely be
cause :
1,
the person to be detained remains
outside the territorial jurisdiction of
the government or of the officer issu
ing the order; or
2.
the place of detention is outside the
territorial jurisdiction of the said
government or officer.
What is the procedure to arrest abscond
ing persons ?
* If the Central or State Governments or
the District Magistrate or the Police
Commissioner reasonably suspect that
a person against whom an order of
detention has been issued, has abscon
ded or is concealing himself to evade
the execution of the order, the govern
ment or officer. By notification in the
Official Gazette, may order the person
to appear before the officer within a
specified period and at a specified
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place. If a person fails to comply with
such an order he can be punished with
imprisonment for a term which may
extend to one year or with fine or both.
This is a cognizable offence and the
police can arrest the person without
warrant.
* If a person proves his inability to
comply with the order or informs the
concered officer within the specified
period, of his whereabouts and the
reasons for his non-appearance, he will
not be punished.
* the Government or the officer may also
report in writing the fact of absconding
to the Metropolitan Magistrate or a
First Class Judicial Magistrate having
jurisdiction in the place where the
absconding person ordinarily resides.
* The Magistrate may publish a written
proclamation ordering him to appear
in the Court and declare him a proclai
med offender. If the warrant or proc
lamation fails then the Court may
attach his movable and immovable pro
perty (Section 7).
What is the right of a detenu to receive
the grounds of detention ?
When a person is detained, the authority
issuing the order ordinarily within 5 days and
in exceptional circumstances within 10 days
of the date of detention, must inform him of
the grounds on which the order has been
issued and must afford him the earliest pos
sible opportunity of making a representation
against the order to the appropriate Govern
ment. If the grounds of detention are com
municated to the detenu after 5 days from
the date of detention then the reasons for
the delay must be given to him in writing
(Section 8).
July 1984
Can organising peaceful processions and
demonstrations be a ground for detention
under the Act ?
The Supreme Court has repeatedly emph
asised that public order is not affected by
peaceful processions and demonstrations
and that even a breach of law and order does
not amount to a disturbance of public order.
In the opinion of the Court public order can
be said to be disturbed only by a large scale
community-wide disorder. This decision of
the Supreme Court makes it clear that persons
participating in peaceful processions and
demonstrations cannot be detained under
the laws of preventive detention.
Advisory Boards
The Centre and each State Government
must constitute one or more Advisory
Boards, in accordance with the recommenda
tions of the Chief Justice of the High Court
of the State (Section 9).
Constitution
Each Board shall consist of 3 persons
who are, or have been or are qualified to be
appointed as Judges of a High Court.
The Government must appoint one of the
members of the Board to be its Chairman.
He must be or have been a judge of the
High Court.
Reference to Advisory Boards
In every case of detention, the appropri
ate Government within 3 weeks period must
place before the Advisory Board, the grounds
on which the order has been issued, toge
ther with the representation made by the
detenu and the report of the officer who
issued the order.
25
Procedure of Advisory Board
The Advisory Board must first consider
the material placed before it. Then, if neces
sary, ask for further information from the
Government or any official concerned with
the detention or the detenu himself. If the
detenu desires to be heard by the Board,
after hearing him in person, the Board must
submit its report to the appropriate Govern
ment within 7 weeks, from the date of dete
ntion. The proceeding of the Board and its
report are confidential matters not to be dis
closed to the detenu or the public (Section
11):
Report of the Board
The Board must specify in the report its
opinion as to whether or not there is suffici
ent cause for the detention of the person
concerned. Majority decision of the mem
bers will be considered to be the opinion of
the Board. The final opinion regarding the
validity of the detention order must be com
municated to the detenu.
No lawyer is allowed to appear on behalf
of the detenu before the Board.
Action on the report of the Advisory
Board (Section 12)
1.
2.
If the Board is of the opinion that
there is sufficient cause for the dete
ntion, the appropriate Government
may confirm the detention order and
detain the person for a period not
exceeding one year.
If the Board finds that there is no
sufficient cause for detention of the
person, the appropriate Government
must revoke the detention order with
out delay and release the detenu
immediately.
Duty of the detaining authority to consi
der the representation by the detenu.
26
Independently of the reference to the
Advisory Board, the detaining authority must
consider the representation at the earliest
and come to its own conclusion before con
firming the detention order (See cases
(1979) 4 SCC 401 : 1980 SCC (Cri.) 4).
The detaining authority is competent to
consider and take a decision of the initial
representation made to it by or on be
half of the detenu. It is, however, open
to the detenu to make further representation
to the State or the Central Government (See
case 1979 SCC (Cri.) 1015).
Maximum period of detention
The maximum period for which a person
can be detained is 12 months from the date
of detention. The Government has power
to revoke or modify the detention order at
any earlier time (Section 13 & 14).
Issuing fresh detention order
The Government is empowered to issue
fresh detention order against the same per
son in any case where fresh facts have arisen
after the date of revocation or expiry (Sec
tion 14(2)).
Temporary release of persons detained
1-.
During the period of detention the
Government may direct the release
of the detenu for a specified period
with or without specific conditions
(Section 15).
2.
When granting him release the
Government may require him to make
a bond with or without sureties for
the due observance of the conditions
specified in the direction.
8.
The released person is expected to
surrender himself at the specified
time and place to the specified
Medical Service
authority at the expiry of the period
. of release or when the release-order
is cancelled.
4.
5.
If the released person fails to surren
der himself without sufficient cause,
he is liable to be punished with im
prisonment up to two years or with
fine, or with both.
If the released person fails to fulfil
any of the conditions imposed on him
the bond executed by him may be
forfeited and any person bound by
the bond would be liable to pay the
penalty.
Protection of action taken
faith
in good
This section bars a person from instituting
a suit or legal proceedings against the
Government or any officer for anything done
in good faith or intended to be done in
pursuance of this Act (Section 16).
Note
Though the National Security Act was
enacted only in 1980, the clauses on preven
tive detention have to be interpreted accor
ding to the Supreme Court Judgements
prior to that. In various judgements the
Supreme Court has laid down certain condi
tions for the validity of detention. The
reference to the cases is given in brackets.
What makes a Preventive Detention order
invalid or illegal ?
The following are some of the reasons
that can make the order of detention
invalid :
* Law providing for preventive detention
and the action taken underwit violate
Articles 19 and 22 of the Constitution
((1979) 4 SCC 370).
July 1984
♦ Consideration of extraneous material
by the detaining authority without
communication of the same to the
detenu.
* Detention of petitioner for a second
time on the same ground, on which
earlier detention was made ( (1973) 2
SCC 822).
♦ Detaining a person for forming associa
tion for ventilation of grievance in a
lawful manner and for making protest
in a peaceful manner (1975 SCC (Cri.)
160).
♦ The intention of the detaining autho
rity is mala fide.
* The Officer issuing the order of deten
tion has no authority to do the same.
* Relevant materials essential to the
formation of the subjective satisfaction
of the detaining authority is kept away
from him (1979 SCC (Cri.) 262).
* Copies of the documents, statements
and other materials relied upon in the
grounds of detention are not furnished
to the detenu along with the grounds
of detention during the prescribed
period ( (1980) 4 SCC 531 : (1980) 4
SCC 624; (1980) 4 SCC 499).
* Refusal to supply to the detenu copies
of material referred to and relied upon
in grounds of detention ( (1980) 4
SCC 624 : 1981 SCC (Cri) 86).
* Ground of detention is so vague that
the detenu cannot clearly understand
the allegation against him and he is
thereby prevented from making an
effective representation ( (1979) SCC
(Cri.) 999)
♦ The grounds of detention are irrelevant
or non-existant ( (1974) SCC (Cri.)
609).
27
* The order of detention is not properly
explained in the language of the detenu
who does hot understand English
( (-1970) 3 SCC 489 : 1971 SCC (Cri.)
95).
* Despite requests the detenu is not
given the earliest possible opportunity
to make an effective representation
• against the order of detention ( (1980)
4 SCC 531 : (1980) 4 SCC 525).
with the procedure established by law is on
the detaining authority, because of the clear
and explicit terms of Article 21 of the Cons
titution.
What is the attitude of the Supreme Court
in cases of Preventive Detention ?
In case of an application for a writ of
habeas corpus the practice being evolved
by the Supreme Court is not to follow strict
rules of pleading in view of the peculiar
CONSTITUTIONAL REMEDIES
socio-economic conditions prevailing in the
What are the constitutional remedies
country, where large masses of people are
available to a detenu in case of detention
poor, illiterate and ignorant and access to
under the Act ?
the Court is not easy on account of lack of
For the protection of his Fundamental
financial resources. It does not place undue
Rights, the detenu can move the High Court
emphasis on the question as to on whom
under Article 226 or Supreme Court under the burden of proof lies. Even a post card
Article 32 of the Constitution by means of a
written by a detenu from a jail has been
petition for issuing a writ of habeas corpussufficient to move the Court to examine the
He can also challenge any of the provisions
legality of detention.
of the Act on the ground that such a provi
The Supreme Court has shown great con
sion is in violation of his Fundamental
cern for personal liberty and refused to throw
Rights.
out a petition merely on the ground that it
does not disclose a prima facie case invalida
Duty of the Court
The judiciary is the custodian of the 1 ting the order of detention. Wherever a peti
tion for a writ of habeas corpus has come up
Fundamental Rights to life and liberty and
before the court it has almost invariably issued
has a duty to strike down a law if it does not
a rule calling upon the detaining authority to
provide for just and reasonable procedure
justify the detention. Once the rule is issued
for preventive detention.
it is the duty of the Court to satisfy itself
What is the nature of a writ of Habeas
that all the safeguards provided by the law
Corpus ?
have been scrupulously observed and the
This writ is an order or command from
citizen is not deprived of his personal liberty
the Supreme Court or the High Court calling
other than in accordance with the law. The
upon the person, who has detained another
Court has always regarded the personal
to produce the latter before the Court, in
liberty as the most precious possession of
order to let the Court know, on what ground
mankind and refused to tolerate illegal dete
he has been confined and to set him free if
ntion regardless of the social cost involved
there is no legal justification for the deten
in release of a possible renegade.
tion. The purpose of the writ is to test the
For further information in legal matters
legality or otherwise of detention and not to
contact:
punish the wrong-doer. If detention is not
legal, the detenu will be ordered to be relea
Director, Legal Aid
sed.
Indian Social Institute
Lodi Road, New Delhi 110 003
On whom is burden of proof ?
Tel : 622379, 624760
In habeas corpus cases, the burden of
Gram : INSOCIN
proving that detention was in accordance
Medical Service
28
Amoeba : Companion or Killer ?
The amoeba lives widely in peaceful coexistence with its human
hosts, but occasionally it turns into an aggressive pathogen.
Bernardo Sepulveda
Amoebiasis is the infection produced in
human beings by a histolytic, or tissue-dest
roying parasite, known scientifically as
Entamoeba histolytica. This amoeba usually
lives and reproduces in the large intestine,
and does not always cause disease. In most
cases, peaceful coexistence reigns between
the parasite and its host, or carrier. Occasion
ally, however, the amoeba penetrates deeper
into the body, damaging tissues and causing
amoebic disease, or invasive amoebiasis.
Only a few of the factors which change the
amoeba from an inoffensive parasite into an
aggressive pathogen are known. The impor
tant point is that not all those who harbour
E. histolytica in their intestines necessarily
suffer from amoebic disease, although they
may help to spread the infection among
other people.
Amoebiasis has certainly existed since
remote antiquity and many of the outbreaks
of dysentery recorded since the time of Hip
pocrates were probably of amoebic origin.
Clinical descriptions which make it possible
to identify amoebiasis with relative certainty
have been published since the 17th century,
but Fedor Aleksandrovich Losch actually
made the discovery of E. histolytica in 1875
in St. Petersburg, now Leningrad, in a patient
suffering from dysentery. A few years later
the amoeba was also shown to be present
in liver abscesses.
Poor people's disease
Amoebiasis can be found all over the
world, including the cold and even polar
July 1984
regions: epidemics of amoebic dysentery
have been recorded among Eskimos at the
North Pole. However, the frequency of inva
sive amoebiasis varies greatly from one
geographical area to another. In the less
developed countries, most of which are
located in the tropics and subtropics, the
proportion of patients with the invasive form
is much higher. This does not mean that a
tropical climate favours development of the
disease—in Mexico, for example, invasive
amoebiasis is more prevalent in the central
plateau, at an average height of 2000 feet
above sea level and in a temperate climate.
The fact is that in the tropics most of the
human population live under poorer economic
conditions, are less well educated and lack
adequate health facilities. It can be said,
therefore, that amoebiasis is not a tropical
disease, but one of poverty and ignorance.
Certain zones within the areas where
amoebiasis is prevalent are severely affected,
and have been given the picturesque and
expressive name "homelands of amoebiasis'*.
They include south-east Asia, east and west
Africa, Mexico, and the north-west part of
South America. The reasons for the concen
tration of the disease in these zones is not
known.
Of the disease-causing parasites, the
amoeba has one of the simplest life cycles.
It develops into only two forms: the active
trophozoite form, and the inactive cyst form.
The trophozote alone invadest issues,, causing
the disease. The cyst does not invade tissues,
but is the form which spreads amoebiasis.
29
In its active form, the amoeba is a uni
cellular eggshaped organism with an irregular
surface, about 30 microns in diameter and
very motile. The inactive cyst is smaller
and rounded, with a rigid-external wall which
protects the parasite when it leaves the
intestine, enabling it to live for several days.
More is now known about the ways in
which E. histolytica attacks the body. It first
adheres to the cells or tissues; next it kills
the cells, probably by means of toxic sub
stances; and subsequently it eats them
through "mouth" which open in the outer
surface, a process technically known as
phagocytosis.
In this way E. histolytica can penetrate
and invade the mucous membrane of the
large intestine, producing ulceration and
other damage in the intestinal wall; this is
the reason for its name. It can also spread
to the liver and other organs.
Amoebiasis is contacted mainly through
eating food and water contaminated with
the cysts of the parasite. The disease is
spread largely by food-handlers-itinerant
vendors, housewives and cook, who carry
the amoeba in their large intestine. If they
do not wash their hands after defecating,
the cysts remain in their fingers and are
transferred to the food they handle.
Flies and cockroaches which have been
in contact with human faeces deposited in
the open because there are no sanitary
facilities can also contaminate food. Vegeta
bles and fruits which are eaten raw, such as
lettuce and strawberries, can become con
taminated if they are irrigated with sewage
or manured with human excrement. Seafood,
particularly oysters and clams, becomes
contaminated when sewers drain into the sea.
Drinking water from springs, streams, wells
and reservoirs can became contaminated
with faecal matter and the same may happen
if drains discharge into river-water.
30
All these forms of contamination reveal
the very important role played by ignorance,
poverty and resultant social backwardness
in the transmission of amoebiasis.
When the amoeba invades the wall of
the large intestine, the most common clinical
symptom is dysentery, with mucus and
blood in the stools, colic pain and straining
at stool, Amoebic dysentery is usually a rather
mild disease; there is no fever or general
malaise and, with suitable treatment, the
symptoms disappear in a few days, some
times spontaneously. Other varieties of
dysentery, such as that caused by Shigella,
are usually more serious.
However, intestinal amoebiasis does
sometimes—luckily less frequently-take more
serious forms, such as colitis with extensive
and deep ulceration of the intestine, amoebic
appendicitis and amoeboma, a tumour-like
lesion which can be confused with cancer of
the colon. Mortality is high for ail of these.
•
The most frequent extra-intestinal compli
cation is amoebic abscess of the liver, which
causes a high fever, profuse sweating, intense
pain on the right side and enlargement of
the liver. One of the peculiarities of amoebi
asis is that liver abscess is three to four times
more frequent in men than in women. In
the absence of suitable treatment, the prog
nosis for this complication is very grave.
Other • uncommon
complications
of
amoebiasis are brain abscess, almost always
fatal, invasion of the male and female sex
organs, also sometimes confused with cancer,
and invasion of the skin, generally in regions
near to the anus.
Mention should be made of another
disease supposedly caused by E. histolytica
and termed chronic amoebic colitis. This
diagnosis is generally reached in the case
of patients with intestinal disorders such as
diarrhoea, constipation, flatulence, abdominal
Medical Service
pains and mucus in the faeces together with
E. histolytica cysts. The great majority of
these patients are suffering from the comp
laint known as "irritable colon", sometimes
also called spastic or nervous colitis, and are
at the same time carriers of the parasite. In
such cases the characteristic lesions of
amoebiasis are not present; the active tro
phozoite form of the- amoeba is not found
In the faeces; and specific treatment is in
effective. This condition is sometimes called
"false amoebiasis’*.
Until recently it was believed that disea
ses caused by parasites, unlike may viral or
bacterial infections, did not provoke an
immune reaction in the body which might
help defend the individual against the
disease. We now know that, at least in some
parasitic diseases and especially in amoebi
asis, such an immune defence reaction does
exist. It has been proved, in fact, that in the
case of amoebic abscess of the liver and in
other serious forms of amoebiasis relapses
are exceptional, even when cured patients
return to the same unfavourable conditions
which first exposed then to the disease. This
shows that the body can acquire immunity
of against a fresh infection the amoeba, and
on the basis of clinical observations we
believe that even the mild forms of amoebia
sis can confer a certain degree of immunity.
Moreover, it has been shown that the
great majority of amoebiasis patients have
antibodies against the amoeba in their blood
which are able to kill the parasite; these pro
bably* have a protective effect, acting perhaps
not so much against actute infection, but
rather preventing fresh attacks. Apart from
this type of immunity, termed humoral since
it is connected with the blood fluids, another
type has been demonstrated which depends
on various cells and is therefore called cellu
lar immunity.
Finally, it has proved possible to immunize
animals by injection of extracts of E. histo
July 1984
lytica. Immunized animals remain protected
against inoculation with virulent amoebas,
although similar inoculation causes serious
lesions in non-immunized animals. All this
points to the possibility of developing a safe
and effective vaccine.
Very effective drugs are now available
for treating amoebiasis, namely metronidazole
and its derivatives. If administered at the
proper time and in a suitable dosage, these
drugs can cure 90 per cent of amoebiasis
cases in a period of 5-10 days. They have
the advantage that they can be given by
mouth, are generally well tolerated, and they
should be regarded as the drugs of choice.
Also, a special feature of amoebic lesions is
that properly treated and cured they general
ly disappear without noticeable trace, leaving
the affected organs completely restored to
health.
The indications for surgical treatment of
amoebiasis are very precise. Especially in the
case of liver abscess, surgery should be
reserved for a few patients only.
As regards E. histolytica carriers, there is
some dispute about whether or not to treat
them, but the most reasonable veiw is that
they should undergo treatment, because of
the likelihood that they may spread the
disease.
Since the cysts of E. histolytica are the
only form by which amoebiasis is transmitted,
it would seem theoretically simple to prevent
the infection by destroying cysts. Undoub
tedly, if this could be achieved it would put
an end to amoebiasis all over the world, but
in practice it is not so easy.
The essential preventive measures are
social : they consist basically of improving
living conditions and educating the poorer
sections of the population in countries where
amoebiasis is prevalent. An additional
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advantage is that such measures would also
help to control other bacterial and parasitic
intestinal infections. Nevertheless, they call
for much time, money and effort to be
successful; in the meantime, advantage has
to be taken of whatever means are available
with current resources.
fn areas where there is any risk of
contracting amoebiasis, care should be taken
not to eat in establishments which fail to
conform to hygienic standards, and especi
ally never to consumefood or drinks sold by
itinerant vendors. Vegetables and fruit eaten
raw should be carefully washed under a jet
of running water. As regards varieties of
seafood which are consumed raw, it is safer
not to eat them in places where the sea is
probably polluted.
Cooks and assistant staff in restaurants,
housewives and all persons who handle food
should be taught that it. is essential always
to wash their hands after defecation. Flies
and also cockroaches should be unremitting
ly destroyed.
July 1984
Water chlorination does not kill amoebic
cysts, which also resist disinfectants with a
base of iodine, permanganate or silver salts.
Therefore, if there are any doubts ragarding
the purity of water, it should be boiled for 10
minutes before drinking.
Individual or mass administration of drugs
for the prevention of amoebiasis is not advi
sable, since in practice it is ineffective and
inconvenient.
Although personal prophylactic measu
res are straight forward, the best methods,
of nation-wide prevention and control remain
to be devised, used and evaluated. Control
programmes should probably not be specific
for amoebiasis but integrated into national
and international programmes for safe water,
sanitation and control of faeces* borne
disease.
At the World Health Organisation, both
the Parasitic Diseases Programme and the
Diarrhoeal Diseases Control Programme are
actively promoting research into E. histolytica
and are seeking the best strategies for diag
nosis, treatment, prevention and control of
amoebiasis.
Courtesy : WORLD HEALTH
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Ascaris: Most “Popular” Worm
Twenty adult ascaris will steal 2.8 grams of carbohydrate each
day from their host's small intestine. The world's most common
intestinah parasite, they thrive on careless hygiene.
Benjamin D. Cabrera
Ascaris—also known as the gaint intestin
al roundworm.—is so common the world over,
and so readily noticed when expelled, that if
it were to join a world "popularity" contest
for human parasites it would definitely be the
winner. It remains prevalent worldwide pro
bably because the female worm is extremely
prolific, the eggs deposited in soil are very
resistant to adverse environmental conditions,
and the method of infection is so simple,
directly related to existing sanitary condi
tions.
Ascariasis is a household and backyard
infection. Young children pollute the soil by
defecating where they please. As a result,
ascaris eggs in their faeces accumulate where
the children usually play, near dwellings, pro
viding a source of new infection for others or
of reinfection of the original host.
In some countries, human excreta are used
to fertilise vegetable gardens. Also heavy
rains, winds, insects, pigs and chickens all
play an important role by disseminating the
eggs in the soil. Ascaris spares no-one and
infects both children and adults for as long
as the eggs continue to be ingested through
food, water or direct contact.
In some rural areas in the Pilippines,
people regard the ascaris as part of a growing
child. They believe that for a child to deve
lop and grow normally it must have some
ascaris worms in the intestine. In most coun
tries, however, people strongly believe that
ascaris is neither beneficial nor a benign
infection.
July 1984
Ascariasis is caused by Ascaris lumbricoides. The adult male and female worms are
white or pinkish and inhabit the small intest
ine, where they stay unattached in the lumen
or channel and simply glide along the folds
of the intestinal mucosa. The adult female
is about 35 centimetres long with a straight
posterior end and the diameter of a lead
pencil, while the male is smaller with a curved
tail end. The female lays approximately
240,000 eggs per day, or about 65 million
during her reproductive lifetime of nine
months. A child harbouring
50 female
ascaris may contribute 12 million eggs per
day to the pollution of the soil. Once depo
sited, the eggs are very resistant to dessication and low temperature. Their shell isjquite
impermeable, so the embryo will develop in
5-10 per cent formalin, in one per cent so
dium hydroxide or in sea water.
Soil Contamination
The eggs laid by the females pass out in
the faeces at an early stage in their developme.nt. If the faeces are deposited in soil, the
eggs will develop further inside the eggshell
into infective larvae, in about two to four
weeks. These eggs may remain viable up to
two years or more in soil. Children or adults
in contact with contaminated soil may ingest
the infective eggs, particularly if they eat
without washing their hands. The eggs then
hatch in the small intestine, liberating tiny
larvae which burrow into the mucosal wall in
order to enter the blood circulation, passing
through the liver, the heart and ultimately to
35
the lungs within a period of one week. The
larvae subsequently penetrate the capillary
bed and go to the air sacs, the bronchial tree,
the trachea and finally the epiglottis. They
descend through the oesophagus and the
stomach, returning to the small intestine,
where they mature sexually. The total opera
tion, from ingestion of infective eggs to
maturity of the worm, lasts approximately
three months.
Ascaris is a prominent parasite in both
temperate and tropical countries, but it is
commoner in warm countries where sanitation
is poor or lax. Approximately 900 million of
the world's population are infected. Although
ascaris occurs at all ages, it is mostly found
among children—who are more frequently
exposed to contaminated soil than adults—
and slightly more often among males. Pre
valence rates vary greatly, even within the
same country. Examples of the.highest pre
valences reported recently include: Philip
pines 85-90 per cent, Malaysia 82 per cent,
Thailand 70 per cent, Indonesia 83 per cent,
Taiwan 50 per cent, Brazil 58 per cent, Colo
mbia 59 per cent, Costa Rica 40 per cent,
Nigeria 30 per cent, India 20 per cent. Re
public of Korea 58 per cent, Vietnam 45 per
cent, Islamic Republic of Iran 98 per cent,
Ethiopia 58 per cent. South Pacific countries
35 per cent.
Although about 85 per cent of ascaris in
fections may be symptomless, the presence
of a few worms can be as dangerous as har
bouring several. The most frequent com
plaints of people with ascariasis are vague
abdominal discomfort and colicky pains in the
upper abdomen. Early symptoms usually
depend upon the number of infective eggs
ingested, as well as the individual's sensitivity
to the infection. Lung inflammation may set
in a week after infection and last for about
three weeks accompanied by cough, difficulty
in breathing and fever secondary to larval
36
migration. Adult worms irritated by drugs or
by high fever may become entangled, which
causes mechanical intestinal obstruction. A
single or a few ascaris adults, because of
their "wanderlust", may migrate up the bile
ducts, causing infection and gallstone forma
tion around the eggs. They may also ascend
the pancreatic duct, causing fatal haemorrha
gic pancreatitis, or enter the liver, causing
multiple abscesses. Acute appendicitis due
to adult ascaris is not uncommon.
In addition to these problems, the adult
worms remove food materials from the host,
causing loss of appetite and faulty absorp
tion. In many developing countries where
prevalence and intensity of infection is high,
the effect on nutrition among already poorlynourished children should not be underesti
mated.
It has been found that 20 adult ascaris
can consume 2.8 grams of carbohydrates
daily. In the Philippines, about 20 million
Filipinos harbour approximately 20 adult as
caris each. Therefore the food loss caused
by ascaris per day could be the equivalent of
1,000 fifty-kilogramme sacks of rice.
Ideally, the most effective means of con
trolling ascariasis is a combination of personal
hygiene, proper disposal of human faeces,
health education and environmental sanita
tion, with potable water supply and mass
treatment. Most of these are easier said than
done, mainly because of poverty and socio
economic factors. Often, it is not possible to
apply all these factors simultaneously; but
mass treatment together with personal hyg
iene and proper use of toilets should be
sufficient. The objective of mass treatment
is not to eliminate the worms totally, but
rather to reduce the worm burden and the
frequency of transmission. Among children,
the benefits gained from control may be in
the form of a gained weight, fewer absences
from school, greater alertness and improve
Medical Service
ment in academic performance. Among
adults, work efficiency and less absenteeism
are the direct effects of deworming.
From our experience, we feel that periodic
mass treatment given three time a year at
four-month intervals for a period of three
years, using broad-spectrum anthelminthics
such as pyrantel pamoate, oxantel-pyrantel,
mebendazole, flubendazole or albendazole, is
the most effective method of control. Other
countries like Japan, Republic of Korea and
Taiwan treat the population only twice a year.
Recent ascariasis control work in the Philip
pines done for a period of three years reveal
ed that mass treatment of an entire com
munity did not differ much from selective
treatment of children alone in another com
munity, in its effet on the total prevalence of
these common intestinal worms.
The prevention and control of ascariasis
depend u pon establishment of certain barriers
to the spread of the disease through the
application of epidemiological knowledge. In
most tropical and developing countries, it is
not easy to obtain either the cooperation of
the people themselves or official backing.
The reasons for this may be low socio-econo
mic status, lack of education in personal
hygiene and environmental sanitation, ignor
ance and inertia among people about the way
ascariasis is spread and the measures requ
ired to prevent infection, and lack of interest
or concern on the part of officials.
National Successes
However, the successful eradication of
ascariasis in some countries or regions
(Japan, Republic of Korea, Israel) has taught
us that the control of ascaris is possible and
can be achieved with modest funds and effort
on the part of governments, communities and
infected individuals.
Courtesy : World Health
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Medical Service
CHAI
NEWS
NOTES
Oil Lamps : A Hazard
The life of a new born baby seems to be
safer in brighter homes than the homes were
oil lamp is used. Oil lamps are hazardous to
the new born babies. Official demographic
surveys show an infant mortality of 167 out
of 1,000 in village houses lit by oil lamps,
whereas it is around 132 where lighting is
by lantern and 90 by electricity. The same
is linked to the urban areas as well, where
infant death rate is 59—electricity, 114—oil
lamps and 92—lantern. Infant mortality rate
is on decline—from 204 per 1,000 in 1911
to 114 per 1,000 at present. Life expectancy
has doubled. These trends are being review
ed for the "Population Conference" to be
held in Mexico.
An interesting finding is that the fertility
level is the lowest among the Christian and
the highest among the Muslims. Another
reason for high infant mortality rate both in
the rural and urban areas is the source of
drinking water, where the population drink
water from the wells/pond tank/river.
The infant mortality rate would be
reduced from 114 per 1,000 to 60 and the
net reproduction rate to one per 1,000 by
2,000 AD.
Information, VHAI
Bonded Labour
Bonded labour system is the oldest in
Bihar and U.P. These findings were revealed
in an evaluation study on rehabilitation of
bonded labour, conducted by Planning Com
mission. The main aim of this study was to
identify, free and to rehabilitate the labourers.
July 1984
About 98 percent were bonded due to indeb
tedness and 2 percent were due to customary
of social obligations. The report adds, that
the State and district authorities failed in
providing allowances during the intervening
period of release and rehabilitation, thereby
exposing them to hunger and ralapse into
bondage. The rehabilitation schemes have
not been of much help to the labourers. The
study therefore, recommends to spend some
money on education of the children, on social
functions, medicial care, etc. The protection
of civil rights be enforced and encourage
voluntary organizations to undertake social
reforms. Identification job is still incomplete
in some states. It is suggested identification
be made during surveys for locating popula
tion below the poverty line.
Information, VHAI
Ineffective Polio Vaccines
Anti-polio vaccines given to children
under the immunization program are found
to be ineffective in a number of cases, this is
according, to Dr. P.K. Sethi, who runs a well
known rehabilitation center in Jaipur. An
inquiry into the working of this program
would reveal the facts. About six cases of
polio are registered daily in the centre. In
many cases the victims were found to have
been given anti polio vaccines. These
vaccines become ineffective because they
were not stored at the stipulated temperature
by the health department. It was noted that
in MP about 200 primary health centres did
not have the refrigeration facilities and in
certain places the refrigerators were out of
order. He stressed the need to manufacture
39
rehabilitation aids for the disabled locally.
He also said the traditional artisans and
village carpenters could be trained to make
artificial limbs.
Information: VHAI
Pesticides
International
Development
Research
Centre (IDRC) reports that about 10,000
people die of pesticide poisoning every year
in the Third World. About 7.5 lakh cases of
pesticide poisoning occur all over the world
annually resulting in about 14,000 deaths.
Out of this, roughtly 3.75 lakh cases occur
in the Third World. Pesticide poisoning is
becoming the most pervasive occupational
hazard in the Third World. Sri Lanka has an
average of 104.5 cases per 1,00,000 of
population—highest in the world. Health
risk increases rapidly with the production of
toxic chemicals—dyes, pesticides, detergents,
flavour essences, pharmaceuticals, preserva
tives, plastics, etc. which is handled by the
workers. The incidence is more in the deve
loping countries because it is the major im
porter of these toxic chemicals. In the Third
World figures do not include long-term
effects as cancer, sterility, birth-defects and
disability in general. This report referred only
to acute poisoning where death or sickness
occurs rapidly after exposure over a short
period.
Gonoshasthaya Kendra (GK)
PO Nayarhat; Via Dhamrai,
Dhaka, Bangladesh
Gonoshasthaya Kendra was the only or
ganised field hospital for freedom fighters
and refugees on the Eastern border of
Bangladesh during the war of Liberation in
1971. The core of the health program is the
work of village—based paramedics, local
people (most of the women) and promoting
the free health insurance scheme for the poor.
The agricultural extension program rural
credit facilities, the school and the narikendra
training centre were all initiated in GK to pro
mote rural development program in which the
poor organise and participate.
Gonoshasthaya Pharmaceuticals (GP)—is
to produce high quality drugs at reasonable
price and production of essential drugs as
listed by the WHO. The research, develop
ment and quality control department is
equipped with modern machinery and equip
ment. Facilities are therefore :
(1)
to carry out research on new drugs
and develop the conventional medi
cines.
(2)
water purification
distillation
(3)
air-conditioning and humidity control
unit
(4)
dissolution tester
(5)
Bio-availability test
Information, VHAI
Tuberculosis
de-mineralization
The Ministry of Health and Family Wel
fare has sanctioned Rs. 1050 lakhs for the
detection and cure of tuberculosis for
1984-85. During the current year the Center
will provide anti-TB drugs worth Rs. 902
lakhs to the TB clinics in various states.
They also train up workers on modern
technology. Some of the drugs produced by
GP are aspirin, paracetamol, diazepam,
metro-nidazole, antacid, ampicillin, (capsule
form and drysyrup), tetracycline and pencillin (dry syrup).
Information, VHAI
Information : VHAI
40
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Position: 2467 (8 views)