ICMR BULLETIN VOL.7-No.-2-FEBRUARY-1977.pdf

Media

extracted text
Vol. 7 No. 2

326, V Main/ i Block
Korambngala
Bangalore-560034 "
India

DRUG ADDICTION
The phenomenon of drug abuse is not
recent.
Man has always used different subs­
tances to alter mood states.
The reasons
for usage of .drugs vary and
are highly
individual.
It is sufficient to note that
every society has recognised the need of its
members to escape reality or produce euphoria
and provided for a culturally acceptable drug
use/abuse.
However, consumption of a drug
alone, does not imply dependence.
The use of
culturally sanctioned drugs in a controlled
manner even if dependence producing is not
considered "abuse".
The problem of drug abuse has received
greater attention in recent times, not so much
due to the novelty or magnitude of the problem
itself, but more due to the changing trends in
. usage.
The age old culturally •circumscribed
barriers in drug usage are being thrown aside.

Asian countries, from Turkey to Thailand,
are the areas .traditionally growing opium.
India, is one of th.e World*s largest exporters
of raw opium for medical purposes. The growth,
cultivation and export of opium has been a
subject of international cooperation for a
long time, and all the previous agreements
have now been consolidated into the Single
Geneva Convention1, which now regulates inter­
national control measures, from growth to
sale, for all narcotics.
Also included among
narcotics in the Single Geneva Convention, is
cannabis which is not in fact, a narcotic but
a hallucinogen.
Since cannabis and opium are grown in the
Asian countries, there is considerable social
familiarity, regulation and controlled usage

February, 1977

AN OVERVIEW
of these substances, by the general popu­
lation.
In an effort to implement the Inter­
national agreement, most of the Asian coun­
tries moved to ban the growth and cultivation
of opium.

In the sixties, alongwith other social
changes in the environment. Western countries
experienced an increase of drug abuse, parti­
cularly in the younger generation.
The subs­
tances abused were cannabis, LSD (which at one
time was used therapeutically)
and other
hallucinogens as well as heroin. Since heroin
was manufactured from opium, the pressure on
Asian countries to ban cultivation was in­
creased and in most of these countries ban on
opium cultivation followed.
Simultaneously,
stricter police regulatory measures were en­
forced, to check illicit traffic.
Legislation in the concerned countries
ignored the problem of the socially integrated
drug abus er,
who suddenly found
himself
classified as an addict.
However, in the
absence of an effective administrative con­
trol, and poor health services, these measures
failed to control a basically socially integ­
rated behaviour.
Instead, a fertile ground
was created for illicit traffic in narcotics
and for introduction of more potent drugs like
heroin and morphine.
Surveys from most of
these countries show a high prevalence of
heroin abuse in the population, especially so
in students.

In India, the problem of drug addiction,
took quite a different shape, and presented
different dimensions. The Government of India
had a well defined policy controlling the

growth and cultivation of opium even prior to
the 1961 agreement,
almost dating back to
1895. Further, when in 1954, India controlled
opium consumption, unlike other Asian coun­
tries , it took to opium rationing rather than
total ban and hence provided for the addicts
and the social users in the general popu­
lation.
The period in which India undertook
this programme was also relatively calm and
heroin abuse on a vast scale had not yet
started, even in the West.
Also, wisely
enough, India did not simultaneously ban or
control cannabis, but allowed its abuse and
also relaxed the laws on alcohol consumption.

During these years, certain other factors
mainly geo-political in nature, helped India
escape the heroin epidemic which swept the
rest of South East Asia.
Geographically,
Indian borders were
relatively closed to
traffi c from other
Asian countries
e.g.
Afgariisthan, where large illicit cultivation
took place.
Politically, there was no large
scale presence of any foreign troops. However,
in recent times, the situation has altered to
some extent.
The border with other Asian
countries being open, and enforcement measures
in some tightening up, it is to be expected
that opium as well as heroin will begin
to
appear in India from over1and routes with in­
creasing frequency, initially for transhipment
to other countries, and later on for consump­
tion within the country.
Magnitude of the problem in India:

Indi an studies in the area of drug abuse
are few, though one of the earliest and most
exhaustive studies on drug dependence was con­
ducted on Cannabis by the Indian Hemp Commis­
sion2.
The available Indian studies can be
classified into four broad categories viz. (i)
studies which primarily deal with epidemiology
of mental illnesses, (ii) those which deal
specifically with
drug addiction
in the
general population, (iii) drug addiction in
the s tudent population and
(iv) clinical
studies which deal with adverse effects of
drug abuse.
Epidemiology of Mental Illnesses:

In a community survey of psychiatric
morbidity3, drug dependence was found in 2.27
per cent
of the population in Delhi-Agra
regions.
Further analysis of these cases of
drug dependence by drugs abused,showed alcohol
dependence in 59.4 per cent followed by bhang
in 17.5 per cent and poly drug addiction in
the rest.. Among socio-demographic correlates,

2

drug abuse was highest in semi-rural areas,
followed by rural and urban areas.
It was
more common in industrial areas. In the social
perception of drug abuse, alcohol was accepted
as a social evil, bkang accepted by some while
ganja smoking was stigmatised. Dependence was
seen mostly in males and there was caste and
community preferences in drug abuse.
In a
similar survey in Lucknow1*, a prevalence rate
of 18.55/1000 was found, with Muslims account­
ing for 41.54 per cent of alcohol abusers. In
a study of the rural population in Bengal5
addiction to alcohol and drugs was seen in 1.3
per cent of the population.
Other community
prevalence surveys6-9 have reported addictive
abuse of alcohol to vary between 0.2 and 4.8
per 1000 population.
Drug addiction in general peculation:

The second category of studies are those
which deal specifically with, drug addiction in
the general population.
The study team on
prohibition10 made an attempt to study drink­
ing patterns in India. It analysed the budgets
of 21,197 working class families collected by
the Labour Bureau of the Ministry of Labour
and Emplo^ent in 50 different centres, spread
over all the states of the country. It showed
that between 10-24 per cent of all working
class families were given to or reported
drinking. Considering the wet and dry areas of
the country together, 12 per cent of the fami­
lies reported drinking.
The percentage of
families drinking was lowest among factory
workers (9.6 per cent), higher amongst planta­
tion workers (14 per cent) and highest among
mine workers (23 per cent). These families, on
an average were observed to spend 9 per cent
of their earnings on alcohol.
The national
sample survey found that urban families spent
much more than the rural on alcohol and that
expenditure on drinking was above average in
^north-west India, and below average in west and
south India.
Among socio-demographic corre­
lates, the prohibition team felt that in­
creased consumption in urban areas was more a
trend towards pseudo-westernisation.
In a study of selected villages in Pun­
jab1 1 alcohol abuse was found in 74 per cent
of all adults above the age of 15 years.
The per capita .expenditure on
alcohol was
Rs.2000/- per annum.

A study of drug- abuse in villages of
Sangrur district of Punjab (unpublished data)
revealed an overall prevalence rate of 28.7
per cent (in population aged 10 years and
above). Tobacco abuse was the highest (40 per

cent of the population), followed by alcohol
(25.55 per cent),
opium
(18.9 per cent),
barbiturates (6.2 per cent) and cannabis (2.2
per cent). Majority of the opium abusers were
dependent on the drug.
It was seen mostly in
males.
Alcohol abuse started earlier in life
and preceeded the abuse of opiates. The drug
abuse was more prevalent in farm labour as
opposed to people with more sedentary pro­
fessions .
•
Drug addiction in students:

The third category of studies is restric­
ted to the student population.
In a study of
1,132 students in Calcutta University12 a pre­
valence of abuse of tobacco in 26 per cent and
amphetamines in 11.4 per cent was found.
A
survey conducted in selected
colleges of
Delhi13 showed a prevalence rate of 24.7 per
cent. Tobacco abuse was highest, followed by
alcohol, tranquillisers, amphetamines, opium
and barbiturates.
A similar study among
Bombay University students】" revealed a preva­
lence of 19.7 per cent.
The most commonly
abused substance was cannabis followed by
amphetamines, barbiturates,LSD, opium, heroin,
cocaine and morphine. A study from Chandigarh
(unpublished data) found a prevalence rate of
18.87 per cent among the students.
The most
commonly abused substance was amphetamines,
followed by mandrax,cannabis and barbiturates.
In an English medium boys * school in Delhi a
prevalence rate of 32.2 per cent was found15.
Tobacco abuse was highest followed by alcohol
and cannabis.
A study】6 in which 100 core drug abusers
were studied with regard to the drugs taken,
socio-economic background, pocket money, the
topics being studied and personality make up,
showed that more than 70 per cent belonged to
the higher economic strata, receiving pocket
money of Rs.150-200 per month and studied in
the Arts group. Most of them had certain per­
sonal and social problems which induced drug
abuse.
PanwaVLahs, dhobis and fri ends were
reported to be the main sources of drug
supply.
A pilot survey was conducted under the
aegis of the Council to determine the pattern
and prevalence of drug abuse in the students
of Delhi University.
The survey explored the
role of the twin variables of sex and attach­
ment of hostel in relation to drug abuse.
In
addition, it included i tems on socio-demographic correlates and incorporated person­
ality measurements.
The survey estimated
that the prevalence rate of drug abuse in both

men and women students was 32.7 per cent.
It
was significantly more in men (45.7 per cent)
as compared to women (18.3 per cent) and in
institutions with attached hostels. The inci­
dence of drug abuse, when alcohol and tobaccothe most commonly abused drugs-were excluded,
fell to 23.8 per cent in males and 10.5 per
cent in fema-les.
In males, the third most
commonly abused drug was cannabis while in
females it was analgesics.
The fourth most
commonly abused drugs in both was tranqui­
llisers .
In males, other drugs abused were
amphetamines, barbiturates, opiates, LSD and
cocaine, in that order.
In females, the
other drugs abused
were negligible.
No
exclusive opiate abusers were seen. The majo­
rity of the students abused drugs in a casual
experimental manner.
The total number of
addicts in this study identified on the basis
of craving response was 38 males and 4 fe­
males giving a prevalence rate of 8.4 per
cent. Excluding alcohol and tobacco, the pre­
valence rate worked out to 2.2 per cent. Among
the socio-demographic correlates singificant
associations were seen with nuclear family
structure, high parental income and education.
In addition, the drug users fell in the normal
introverted quadrant of E.P.I.
(Eysenck*s
Personality Inventory) which was in keeping
with the experimental nature of drug abuse.
This survey highlighted some of the methodo­
logical
issues
related to
questionnaire
studies in drug abuse.
Major ones amongst
these were problems concerned with over res­
ponders, false responders and under respon­
ders . Valuable information was gained regard­
ing the ideal size and presentation of the
questionnaire.
Clinical studies on adverse drug effects:

The fourth category of
studies have
originated from clinical set-ups and deal with
adverse effects of drug abuse.
Most of these
studies have explored the adverse effects of
cannabis as this is the culturally sanctioned
drug of abuse.
Dhunjibhoy17
reported that
following
cannabis intake, hemp psychosis resembling
acute or chronic mania, could occur.
In a
study of drug habits in normal and mentally
ill patients】％ it was observed that drug in­
dulgence was decidedly more in manic depres­
sive psychosis and schizophrenia than in any
other category and that the mentally ill
tended to abuse drugs indiscriminantly while
normal persons in the habit of drug abuse
exercised a specific choice. It was seen that
there was a higher prevalence of drug abuse

3

among psychotics as compared to psychoneuro­
tics .
Although the difference was not signi­
ficant the neurotics showed drug habit to a
lesser extent than the normals'.
A study from
Agra showed that of 368 consecutive admissions
to the mental hospital, 100 were habitual drug
users. Cannabis was found to be the commonest
drug abused, followed by alcohol. It was seen
that abusers were mostly younger in age and
started drug intake in early life usually be­
fore 30 years of age.
In another study】9
cannabis abuse was seen in 3.2 per cent of the
total of 39,001 patients admitted to a mental
hospital over a period of 10 years, while in
other studies20 it was found in 23.67 per cent
of 566 consecutive admissions.
Acute toxic
psychosis lasting for fewLhours or days, more
frequently with persons using potent cannabis
preparations has been reported21.
However,
three studies??-?' on heavy cannabis abusers
did not report any case of cannabis psychosis.
It is often said that the popular drugs
of abuse in the Indo-Pak sub-continent have
been cannabis and opium, especially in the
rural population.
However, recent reports
indicate that contrary to this belief, alcohol
is the most popular addictive substance abused
and has replaced cannabis and opium.
The
popularity of alcohol has been clearly brought
out by psychiatric morbidity studies as well
as surveys on the student population. Indeed,
from the studies in Punjab, it appears that
considerable benefits of the
ngreen-revo­
lution n are being diverted to alcohol consump­
tion.
The best guide to the problem of drug
addiction in terms of those who are confirmed
addicts are the psychiatric morbidity preva­
lence surveys.
These surveys have consis­
tently shown that the most common addiction is
that of alcohol and addiction to all other
drugs, especially opiates, is comparatively
insignificant if not absent. However, the use
of opiates and cannabis has been an acknow­
ledged facet of Indian life and as the Punjab
study shows, the percentage of population
abusing opiates is likely to be much higher
than the current official estimates.
This
brings us to the interesting question of
cultural tolerance of drug abuse. The percen­
tage of persons abusing opiates could be much
higher than the official estimates, and they
may also be 11 addicted" according to the medi­
cal criteria but it does not necessarily imply
that they are not socially integrated.
In
other Asian countries, such groups of persons
were prohibited from abusing opium and en­

4

forcement machinery was brought in with the
result that opiates were replaced by harder
synthetic drugs like heroin.

The studies conducted on student popula­
tions in India suggest the range of drug
abuse and do not essentially reflect the ex­
tent or magnitude of addiction.
The signi­
ficant trends which emerge are that (i) drug
abuse is mostly confined to licit drugs,
(ii) the manner of use is experimental and re­
creational, (iii) even if licit drugs are in­
cluded in the range of drug abuse, more than
50 per cent of boys and 82 per cent of girls
are totally abstinent; all this is in marked
contrast to the phenomena and the prevalence
and pattern of drug abuse in other countries.
Western as well as Asian, where there is wide­
spread heroin and related drug abuse.

There is some evidence to suggest that
psychotropic drugs are being leaked into illi­
cit channels.
The reasons for this could be
many.
Firstly, it is possible that these
drugs are being over-promoted and hence over­
prescribed by the medical fraternity; thus a
minor tranquilliser may be manufactured by two
or three competing firms, who tend to promote
their sales by increasing the range of indica­
tions for which it can be prescribed. A care­
ful scrutiny would show that the only effeGtive indication for the drug would be manifest
anxiety symptoms rather than inferred anxiety
as in psychosomatic illnesses.
The medical
profession also tends to prescribe these drugs
in a more blanket fashion.
Secondly, though
the sale of these substances is regulated
(legally) by prescription, they are not as
vigorously applied as for narcotics.
Since
India is a signatory to the International
Psychotropics Convention, this is an area
which would need careful and stricter regu­
lation.
Despite all these surveys there are still
certain lacunae in the information on drug
abuse in India.
There are, for example, a
large number of substances with the potential
of abuse, which are freely available.
The
volatile solvents, petrol,glue, paint thinners
etc. have not yet made their appearance on the
addictive scene, but can do so in
future.
Also, no longitudinal studies on the preva­
lence and pattern of drug abuse are available,
except perhaps from Delhi,and hence it is very
difficult to comment on changing trends, Very
few studies have dealt with the basic biologi­
cal research issues, and none has evaluated
treatment approaches.
There are no studies
available on the addictive potential of indi­

genous drugs.
The information relating to
drug abuse is scattered over too many disci­
plines and agencies without meaningful coordination or communication.
There is also a
need for the evolution of uniform methodo­
logies for data collection so that the results
are comparable not only across the country,
but also over a period of time.
In view of the importance and the growing
concern over the problem of drug addiction in
the country,
the National Drug Addiction
Committee was appointed by the Government of
India to go into the extent and incidence of
drug abuse with particular reference to the
student community.
The Committee has 11 mem­
bers derived from different fields such as
Education, Mental Health as well as from the
Drug Controller's Organisation and the Nar­
cotics Commission. The Committee has taken up
an in depth study of drug abuse among students
in many cities.
It is also attempting to
obtain information from Drugs Controllers from
different States of the country with regard to'
the enforcement of laws pertaining to this
problem.
The Committee has also contacted
psychiatrists from different parts of India in
order to obtain information on treatment and
rehabilitation of drug addicts/drug abusers.
In order to get first-hand information on the
problem of drug abuse the Committee has also
met and interviewed various categories
of
officials and individuals.
A questionnaire
has also been sent to the Vice-Chancellors of
various Universities in India seeking their
opinion on the problem of drug abuse in the
student community.

The Committee is expected to submit its
report to the Government of India this year.

References:
of

1.

Single Geneva Convention.
Narcotics, U.N. 1961.

2.

Report of the
Indian Hemp Commission
(1893-94). Simla, India, Government Cent­
ral Printing House, 1894 Vol.7, National
Archives, New Delhi, India.

Division

5.

Elnagar, M.N., Maitra, 0., and Rao, M.N.
Mental health in an Indian rural commu­
nity . Br. J. Psychzat. 118: 499, 1971.

6.

Verghese, A., Beig, A.,
Senseman, L.A.,
Sunder Rao, S.S. and Benjamen, V. A social
and psychiatric study of a representative
group of -families in Vellore town. Indian
J, Med. Hes. 61: 608, 1975.

7.

Nandi, D.N.,
Ajmani, S.,
Ganguli, H.,
Banerjee, G., Bora], G.C., Gliosh, A. and
Sarkar, S.
Psychiatric disorders in a
rural community in West Bengal - an epi­
demiological study.
Indian J. Psychzat.
17: 87, 1975.

8.

Surya, N.C., Datta, S.P., Gopal Krishan,
R., Sundaram, D. and Kutty, J.
Mental
morbidity in Pondicherry. Trans. AZZ India
Inst, Mental Health. 4: 50, 1964.

9.

Sethi, B.B. and Gupta, S.C.
An analysis
of 2000 private and hospital psychiatric
patients.
Indian J. Psychiat,
197,
1972.

10. Study Team on Prohibition-Report of the
Prohibition Enquiry Committee submitted to
the Planning Commission, Government of
India, 1964.
11. Deb, P.C. and Jindal, R.B.
Drinking in
rural areas - a study in selected villages
in Punjab. Monograph, Punjab Agricultural
University, Ludhiana, India, 1974.
12. Banerjee, R.N.
Prevalence of habit form­
ing drugs and smoking among college stu­
dents : A survey. Indian Med. J. 57:193,
1963.
13. Mohan, D. and Arora, A. Prevalence of drug
abuse in college students. J. Indian Afed.
Assoc, 66: 28, 1976.
14. Chitnis, S.
Drugs on the College Campus,
Tata School of Social Sciences, Bombay,
India, 1974.

3.

Dube, K.C.
Drug abuse in northern India:
Observations concerning Delhi-Agra region.
Bull. Narcotics. 24: 49, 1972.

15. Mohan, D., Thomas, M.G. and Prabhu, G.C.
Prevalence of drug abuse in high school
population.
Paper presented at Inter­
national Working Group Meeting on Alcohol
and Drug Dependence, Manila, 1975.

4.

Thackore, V.R. Mental illness in an urban
community. United Publishers, Allahabad,
India, 1973.

16. Delhi School of Social work - Students and
drugs.
Published by the Delhi University
Press, 1972.

5

17. Dhunjibhoy, J.E.
A brief resume of the
types of insanity commonly met with in
India with full discription of "Indian
hemp insanity" peculiar to the country.
Indian J. Mental Sd. 312: 254, 1930.

18. Dube, K.C. and Handa, S.K.
Drug use in
health and mental illness in an Indian
population.
Br. J. Psychiat. 118: 345,
1971.
19. Verma, L.P.
Cannabis Psychosis.
J. Psychiat. 14: 241, 1972.

Indian

20. Dube, K.C., Jain, S.C., Basu, A.K.
and
Kumar, N.
Pattern of the drug habit in
hospitalized psychiatric patients.
Bull.
Narcotics. 23: 1, 1975.

21. Chopra, G.S.

and

Smith, J.W.

Psychotic

reactions following cannabis use
Indians.
Arch. Gen. Psychzat.
1974.

in East
30: 24,

22. Aggarwal, A.K., Sethi, B.B. and
Gupta,
S.C.
Physical and cognitive effects of
chronic bhang (Cannabis) intake.
Indian
J. Psychizit. 17: 1, 1975.

23. Mendiratta, S.S. and Wig, N.N.
Psycho­
social effects of long term cannabis use
in India.
A study of 50 heavy users and
controls.
Drug and Alcohol Dependence.
1: 71, 1975.

24. Ray, R.
The association between chronic
cannabis use and
cognitive functions.
M.D.[Psych.) Thesis, All India Institute of
Medical Sciences, New DeIhi, 1976.

ABSTRACTS
Some Res earch Projects completed recently
A study of 方丸e fzbrznogen turnover in experi­
mental atherosoleroszs and ca^terloscTeroszs
and the possible effects 0f selective fibrino­
gen depletion in the
evolution of these
lesions

It has often been suggested that thrombo­
sis is an important initiating factor in the
causation of atherosclerosis.
A study was
undertaken to evaluate this concept by s tudying the behaviour of fibrinogen, the essential
substrate for thrombosis, and also the effect
of reduction of the quantity of the substrate
in rabbits rendered atherogenic by feeding
cholesterol.

Atherosclerosis
was produced
in two
groups of rabbits by feeding chol6sterol and
saturated fats for a period of 2 months and 5
months respectively.
In the latter group
cholesterol feeding was intermittent during
the last 3 months.
Isotopic labelling of fibrinogen with
125] was carried out using chloramine-T.
The
half life of labelled fibrinogen in the two
groups of cholesterol fed animals was 52.05
and 51.5 hours respectively, which was not
significantly different from the normal values
in this laboratory.
Selective

6

fibrinogen depletion was

pro­

duced in the two groups by injecting Arvin
(purified *protein derivative of the venon of
Malayan Pit Viper) twice daily.
The blood
fibrinogen was maintained around 100 mg per
cent for a period of 8 weeks.
The lipid pro­
file and haematological parameters (except the
blood fibrinogen levels) of these animals were
no different from those of the control animals
fed on a similar dietary schedule.
The gross
appearance of the aortae was also identical.
Histopathological studies did not reveal any
significant differences.
It
was concluded that
intravascular
thrombosis probably does not contribute signi- _
ficantly towards the evolution of athero- •
sclerosis when this was induced by feeding
cholesterol and saturated fats to rabbits.

R.P. Sapru
R.N. Chakravorti
Department of Medicine
Postgraduate Institute of
Medical Education and
Research
Chandigarh.
Publicaticn:

Moza, A.K., Kumar, M. and Sapru, R.P. Satis­
factory radioiodination of rabbit fibrinogen
using Chloramine-T.
J. Lab. Clin. Med, 87:
169, 1976.

c

，，k

4.
- 二Y
・- " -* -14— — —■

..,・

■

▼—
■ — ■■ ■

“..r—

— * 一 二）
— 一 —■— 一•

-一二工「
广 +，r ~

*

gation. The resistance transfer is determined
by an extrachromosoma1 genetic element (plas­
mid or episome) termed the R-Factor, which
consists of several ^-determinants•,each con­
ferring resistance to one antibiotic, and the
'resistance transfer factor1 (RTF) which en­
ables the transfer to take place.
Transferable
drug resistance is
now
recognised as the most important mechanism of
drug resistance in
Gram-negative bacilli,
particularly intestinal bacteria. Such resis­
tance is frequent among the commensal intesti­
nal flora.
When these resistant strains in­
fect the urinary tract or other sites, anti­
biotic therapy may not be effective.
A more
important problem is the spread of R-Factors
to
primary intestinal pathogens
such as
shigellae rendering them refractory to anti­
biotic therapy. Widespread outbreaks of baci­
llary dysentery caused by such drug-resistant
shigellae have been reported in recent years
from Central and South America and Bangladesh.
Localised outbreaks have occurred in India
also.
The most important danger of transferable drug resistance is its spread to
intestinal bacilli that cause invasive or
systemic disease.

While R-Factor
had been observed with
increasing frequency in salmonellae causing
food poisoning or gastroenteritis, it had not
spread to Salmonella typh心.
It was therefore
postulated that S. typhi was a poor acceptor
of R-Factor and hence may not become resis­
tant . However, in 1972, outbreaks of chloram­
phenicol-resistant typhoid fever occurred in
Mexico and Kerala. Similar outbreaks have
since been reported from many parts of South
East Asia.
At Calicut, S. typhi strains have been
monitored for drug resistance since 1968. Till
1971, no instance of multiple drug resistance
was encountered in S. typhi isolates, though
R-Factors conveying resistance to chloram­
phenicol (C), streptomycin (S), sulphonamide
(Su) and tetracycline (T) were common in
commensal intestinal bacilli as well as in
urinary pathogens.
It was also found that
resistant Escherichia coZW isolated locally
could transfer their resistance en bloc to
local isolates of S. typht by conjugation in
vitro. Tliis suggested the possibility of drug
resistant S. typhi strains emerging by similar
conjugation in the gut.

In May 1972, for the first time, a strain
of S. typhi resistant to chloramphenicol was
isolated from the blood of a typhoid patient

8

who had not responded to
chloramphenicol
therapy.
The resistance was of a high order
(chloramphenicol M.I.C. 500 mcg/ml as against
2-5 mcg with sensitive strains), to multiple
drugs, and transferable.
This marked the
beginning of an outbreak of chloramphenicolresistant typhoid fever in Calicut.
Of the
114 strains cTf S. typhi isolated subsequently
in the same year, 60 (52.6 per cent) were
resistant.
The resistant strain has become
endemic in this area and since 1972, a varying
proportion of strains isolated every year has
shown resistance. The incidence of resistant
strains was low in 1973-1975 (10 per cent to
14 per cent), but in 1976 there was an in­
crease, 39 per cent of the isolates being
resistant.

In vitro drug resistance has paralleled
clinical resistance.
Chloramphenicol
was
found ineffective in typhoid cases caused by
resistant strains.
Co-trimoxazole has been
very useful in such situations.

The resistance pattern has been uniform
throughout the last 5 years,
the R-Factor
mediating resistance to CSSuT and belonging to
the plasmid group Hj.
But now there has
occurred a change in the phage type of the
resistant strain. While all resistant strains
were of phage type DI N, biotype I till Decem­
ber 1974, they have since then become phage
type C5, biotype 11.
For nearly 5 years since its appearance,
drug resistant strains were confined to north
Kerala.
However in recent months, they are
being encountered in small numbers in other
parts of India also. This is an ominous sign.

Transferable drug resistance is very fre­
quent in Gram-negative bacilli causing urinary
infections.
R-Factors were found in drug
resistant urinary pathogens with the following
frequency: KlebszeZla - 73,4 per cent, E. coli
-48.3 per cent, *Paracolons1 - 72.7 per cent,
Proteus - 27.9 per cent, Ps. aeruginosa - 1.3
per cent.

R-Factors were also very common in the
commensal intestinal bacteria: Klebsiella 81.5 per cent,
coli - 68.0 per cent, •Para­
colons 1 - 62.5 per cent,
Proteus - 73.9 per
cent, Ps. aeruginosa - 12.5 per cent.
In order to assess the prevalence of RFactors in relation to the exposure to anti­
biotics, a comparative study was made, testing
for transferable drug resistance in the in­
testinal flora of three populations, viz.

children in rural, urban and hospital environ­
ments . Multiple drug resistant bacteria were
found in 66 per cent of rural, 88 per cent of
urban and 96 per cent of hospital samples.
A
greater difference was noticed in the fre­
quency of R-Factors in the three populations,
31.8 per cent in rural,
47.7 per cent in
urban and 85.3 per cent in hospital strains.
The frequency of R-Factors is directly
proportional to the extent of antibiotic use.
It is therefore important that antibiotics be
handled with restrain lest further spread of
R-Factors render them totally ineffective.
Hi^ilights of sane aspects of transferable
drug resistance in salmonellae in India

Dr； K.B. Sharma, Prof, of Microbiology,
Lady Hardinge Medical College, New Delhi also
highlighted some aspects of the work on trans­
ferable drug resistance in salmonella, being
conducted in his department.

The presence of multi-drug resistant RFactors in S・ typhz was reported for the first
time in India at Calicut in 1972.
The focus
has remained active and localised at Calicut
since then; the original strain of Vi l phage
type DjN was, however, replaced by another RFactor containing multi-drug resistant strain
of S. typhi belonging to Vi II phage type C5
towards the end of 1974, though the characters
of the R-Factor remained the same.
In- the year 1976, multi-drug resistant
R-Factor containing
S. typhi
were encoun­
tered at various centres viz. Trivandrum,
Bombay, Madurai and Emakulam.
Though single
strains were encountered at the other centres,
Emakulam experienced a prolonged outbreak
which started in May 1976, which has lasted up
to the present and 30 strains of Vi ll phage
type A have been received by the Centre at
Lady Hardinge Medical College. The characters
of R-Factors from
all these centres are
similar, though different phage types were en­
countered.

tance

R-Factors determining multi-drug resis­
were also encountered in other salmo­

nellae.
Since October 1975,
more than 200
strains of S. neuport were isolated from cases
of neonatal septicemia in Delhi, carrying a
high fatality rate.
These were mainly resis­
tant to ampicillin, chloramphenicol, kanainycin
and tetracycline.
The R-Factor of S. newport differed in several characters from those
of S. typ丸，and other salmonellae found else­
where.
In 1976 from Bombay, R-Factor carry­
ing strains of S. paratyphi B were isolated
from 2 cases (one of which was fatal), and one
strain of S. alachua from a fatal case of neo­
natal septicemia.
One strain of S. enteri岗成 s carrying R-Factor was isolated from
blood culture of a case of septicemia in Cali­
cut in October 1975. However, the characters
of
R-Factor of this
strain were
quite
different from those of S. 切ph, endemic in
Calicut.
Recently in November, 1976 two
strains of S. paratyphi- A were encountered in
Madras, which also carried R-Factors.

The increasing incidence of isolation of
R-Fattor
carrying intestinal pathogens is
certainly an ominous sign. Since there can be
an interspecies transfer to these plasmids,
the R-Factor usually gets transferred from a
commensal organism such as E. coZ, to the in­
testinal pathogens. The risk to man does not,
therefore, depend only on the transmission to
man of drug-resistant pathogens, but also on
that of drug-res is tant non-pathogenic intesti­
nal bacteria, which can be freely communicated
from animals to man.
Indiscriminate use of
antibiotics in man and animal husbandry leads
to the selection of such organisms.
The time has come to initiate a survei­
llance programme for transferable drug resis­
tance and to initiate a national antibiotic
policy with regard to antibiotic use in clini­
cal medicine,veterinary medicine and as growth
factors in animal husbandry. In this regard,
the medical and veterinary professions as well
as Pharmaceutical manufacturers bear a heavy
responsibility.
There has to be a co-opera­
tion between all the three and the Government
to reverse the change in ecology of pathogenic
enteric bacteria, which has resulted from an
indiscriminate use of antibiotics.

SUMMARY OF DR KAMALA MENON MEDICAL RESEARCH AWARD (1976) ORATION
Dr. Shanti Ghosh, Head, Department of
Pediatricsz Safdarjang Hospital^ New Delhi,
delivered
the
Dr. Kamala Mencn
Medical
Research Award (1976) Oration cn 'Problems of
low birth.weight babies1 at the Indian Council

of Medical Researdir
ruary r 1977.

New Delhi

on 18th Feb­

In India about 10 per cent of newborn
babies are underweight and there is a much

9

higher mortality and morbidity among them.
Perinatal mortality is directly related to low
birth weight and lower gestation. The reasons
for this lie in poor maternal nutrition and a
high infection rate -the result of poor living
conditions, lack of knowledge and low income.
A study of the」 pattern of intrauterine
growth of babies at the Safdarjang Hospital
showed that for the first 35 weeks, the curves
were the same as those of more affluent coun­
tries, but the growth rate becomes less after
that period. This evaluation was also carried
out among the high socio-economic group women
in a community study, and the same trend was
seen though to a lesser degree.

The rate of intrauterine growth influ­
enced morbidity and mortality at all ges­
tations, minimum problems being found in those
appropriate for gestation, the problems be­
coming progressively more both in babies with
retarded and enhanced growth rates. The major
causes of morbidity in small for date babies
were asphyxia,
pulmonary causes including
haemorrhage and hypoglycaemia, while in the
preterm babies it was due to intracranial
haemorrhage, asphyxia and birth trauma.
Mortality in these babies has been re­
duced considerably with the early diagnosis
and treatment of infection using gastric cyto­

ICMR

logy as criterion of infection and also by a
planned early discharge.
The study also
demonstrated that these simple devices could
be practiced even in small district hospitals
and Health Centres.
In another study, low birth weight babies
were studied longitudinally for their growth
and development from birth to six years.
It
was found that while their growth velocities
were almost similar, their growth curves did
not catch up v/ith those of normal babies. When
the preterm and small for date babies were
compared, the preterm babies showed a much
better catch up in growth and also showed the
same pattern as that of the normal babies.
Their development was within the normal range
even though there were rather more babies with
a lower I.Q. level. On the whole,there was no
developmental handicap.

Growth studies carried out in high socio­
economic group children, from birth to 16
years showed that the 50th centile of growth
curves for weight and height were close to the
25th centile of Harvard curves. Indian child­
ren showed the adolescence spurt 1-2 years
earlier than American children.
Children from lower socio-economic groups
showed considerable handicap in all parameters
of growth as compared to the higher socio­
economic group children.

NEWS

Dr. T.A. Lambo, Deputy Director General, WHO,
visited the Indian Council of Medical Research
■on 5th February, 1977,
where he addressed
senior scientists and the Directors of the
Permanent Institutes of the Council. Dr. Lambo
indicated that the WHO was interested in
promoting the philosophy of self reliance in
developing countries by improving the mecha­
nism of coordinated research into regional
problems. With this in view the WHO had esta­
blished Regional Advisory Committees on Medi­
cal
Research to
identify and
formulate
research proposals depending on the regional
problems and priorities. Dr. Lambo hoped that
the Indian Council of Medical Research would
play a major role in promoting intercountry
research programmes on regional problems.

Dr. C. Gopalan,
Director-General,
Indian
Council of Medical Research, chaired the meet­
ing of the WHO Study Group on Malaria at the
WHO Regional Office, New Delhi, between 9th
and 16th February, 1977.

The Scientific Advisory Board of the Indian
Council of Medical Research met in New Delhi
on 7th February, 1977.

Dr. M.S. Bamji, Assistant Director, National
Institute of Nutrition, Hyderabad,participated
in the meeting of the Steering Committee of

10

Dr. C. Gopalan delivered the Second Mellanby
lecture at the Central Drug Research Insti­
tute, Lucknow and the Dr. M.B. Lal Oration at
the K.G. Medical College, Lucknow,
on 17th
February, 1977.
Dr. M.K. Raina,
Research Officer,
Indian
Council of Medical Research, participated in
the UNESCO sponsored Tliird Asian Symposium on
Medicinal Plants and Spices held at Colombo,
between 6th and 12th. February, 1977.

the Task Force on Oral Hormonal Contracep­
tives, held at Geneva between 22nd and 28th
February, 1977.

Dr. M.S. Bamji. Assistant Director, National
Institute of Nutrition, Hyderabad and Dr. U.M.
Joshi, Senior Research Officer, Institute for

Research in Reproduction, Bombay, participated
in a WHO meeting on 'Effects of oral contra­
ception in the presence of deficiency and
disease states: Vitamin studies *, held at
Geneva between 28th February and 2nd March,
1977.

ICMR AIDED SYMPOSIA/SEMINARS/WORKSHOPS
A Symposium on 'Carcinoma breast and its
Comprehensive Approach1 was held in connection
with the 30th Annual Congress of Radiology at
Chandigarh, between 1st and 4th January, 1977.

An International Symposium on 'Venom and
Toxins * is being organised by the Haffkine
Institute, Bombay between 4th and 6th March,
1977.

A Symposium
on
Atherosclerosis * was
organised during the 3rd Annual Conference of
the Association of Biochemists of India at the
Medical College, Baroda, between 7th and 9th
.January, 1977.

A workshop on fNon-cirrhotic portal fib­
rosis 1 is being organised by the Department of
Pathology,
University College
Of Medical
Sciences, New Delhi, in February/March, 1977.

A symposium on *Nutrition and Functional
Performance1 was organised by the Nutrition
Society of India, at the National Institute of
Nutrition, Hyderabad on 28th January, 1977.

As part of the fifth All India Conference
of Physical Medicine and Rehabilitation, sym­
posia on various aspects of Rehabilitation
Medicine are being organised at the Medical
Rehabilitation Centre, Patna between 20th and
22nd March, 1977.

The Indian Council of Medical Research
National Workshop on 'Newer perspectives in
microbiological inves tigations of
strepto­
coccal infections and their sequelae*, is
being held at the
Lady Hardinge Medical
College, New Delhi between 21st and 26th Feb­
ruary, 1977.

A workshop and a symposium on 'Hospital
infections with special reference to Pseudo­
monas aeruginosa1 are being organised by the
Department of Microbiology, All India Insti­
tute of Medical Sciences, New Delhi between
23rd and 31st March, 1977.

COUNCIL'S TRAINING PROGRAMMES FOR 1977
^mod^iasis:

Leprosy:

At the Central Jalma Institute for
rosy, Agra.

Training course in Leprosy for
officers: (December, 1977).

At the School of Tropical Medicine, Cal­
cutta.
-

Lep­

"Technicians
biasis.

medical

Training

Reproductive Biology ：

in

Amoe-

Research in

Repro­

Cours e
.

Virology：

At
(1)

the Virus Research Centre, Poona.

Diploma course in Virology of
versity: (July, 1977).

(2) *Training Course for
period of one year.
(3)

At the Institute for
duction, Bombay.

Short-term course in
(June 13 to 26, 1977).

Poona Uni­

(1)

Course on Immunological Techniques: (Feb­
ruary, 1977).

for a

(2)

Course in Hormone Assays: (March, 1, 1977
to April 30, 1977).

Culture:

(3)

Course in Endocrinology and
Control: (September, 1977).

Technicians

Tissue

Fertility

11

(4)

Course on Human Cytogenetics: (September,
1977)・

(5)

Course in Reproductive Biology and Fertility Control: (November,1977 to February,
1978).

Training course in Clinical Pharmacology:
(January 15 to February 28, 1977).

Biostatistics:
At the National Institute of
Hyderabad.

Nutrition and Endocrinology:
At the National Institute of
Hyderabad.

(1)

(2)

Nutrition,

Annual Training course in Biostatistics
for Statisticians: (November, 1977).

Nutrition,

Laboratory Animal Technology:

Annual certificate course in 'Endocrino­
logical Techniques and their Application:
(August, 1977 to September, 1977).

Annual certificate course in Human Nutri­
tion for Teachers in Agricultural Univer­
sities: (August, 1977 to October, 1977).

(3)

M.Sc.
(Applied Nutrition) course: (June,
1977 to February, 1978).

(4)

Annual certificate course in Nutrition:
(December, 1977 to February, 1978)♦

(1)

At the Virus Research Centre, Poona.

Short-term course in Breeding and Mainte­
nance of
Laboratory Mouse
Colonies:
(March, 1977).
⑵

At the National Institute of
Hyderabad.

Nutrition,

Laboratory Animal Technicians Training
Course: (August, 1977 to September, 1977)

COURSES FOR TALENT SEARCH SCHEME FELLOWS:
Immunological Techniques:

Haematology:
At the
Bombay.
(1)

(2)

Blood

Group

Reference

Centre,

A certificate course in Blood Banking
Technology and Basic Haematology
for
medical officers:
(February 1, 1977 to
March 31, 1977) . •
Training course in Blood Banking Methodo­
logy for Technicians:
(May 2 to May 14,
1977)・

Occupational Health:
At the National Institute of Occupational
Health, Ahmedabad.
(1) "CMR/WHO training
Toxicology.

course in

Industrial

(2) *Refresher course in Occupational
for E.S.I. medical staff.

Health

At the Department of Biochemistry,
All
Indianinstitute of Medical Sciences, New
DeIhi:
(January 24, 1977 to February 5,
1977).

Clinical Ciemistiy and Instrumentaticn:
At the National Institute of Nutrition,
Hyderabad:
(February 28, 1977 to March
12, 1977).

Oell-Biology and Cyto-Genetics:
At
the Indian Institute
Bangalore:
(June 29, 1977
1977).

of
to

Science,
July 12,、，

*Haematological Techniques:
At the Department of Haematology, Post­
graduate Institute of Medical Education
and Research, Chandigarh.

Principles and Methods in Medical Statistics:
(3) *
Training course on Chemical Hazards in
Chemical Industry organised jointly by
the NIOH and the National Safety Council.

*Clinical Phannacology：

Clinical Pharmacology:
At the Department of Pharmacology,
G.S. Medical College, Bombay.
*Dates to be announced later.

12

At the Tuberculosis Chemotherapy Centre,
Madras.

Seth

At the Department of Pharmacology,
G.S. Medical College, Bombay.

Seth

SCIENTIFIC LECTURES TO BE HELD AT
INDIAN COUNCIL OF MEDICAL RESEARCH, NEW DELHI DURING
FEBRUARY AND MARCH, 1977
Date

Topic

Speaker

18.2.1977

Problem of Low Birth Weight Babies
(Dr. Kamala Menon Medical Research
Oration, 1976)

Dr. Shanti Ghosh, New Delhi.

4.3.1977

Breast milk and defence against infection

Dr. Vinodini Reddy,
Hyderabad.

18.3.1977

^cotic infections in India
(Dr. Y.S. Narayana Rao Oration, 1976)

Dr. L.N. Mohapatra.
New Delhi.

ICMR TECHNICAL REPORT SERIES
Price
Rs.
'Research in Medical Education (1970)
*
Research in Health Practices (1970)

4.00

3.

Acute Encephalopathy Syndrome in Children (1970)

4.00

4.

Technical Review on Pneumoconiosis in India (1970)

4.00

5.

Exfoliative Cytology(1971)

4.00

6.

Symposium on Nutrition and Heart Disease (1971)

4.00

7.

Developments in Industrial Psychology in India (1971)

4.00

8.

Study Group in Urolithiasis (1971)

4.00

9.

Proceedings of Seminar on Immunity and Immunoprophy 1 axis in Cholera (1971)

4.00

1.

$ 2.

10. Assessment of the National Filaria Control Programme (India, 1961-70)

4.00

(1971)

4.00

11. Diagnosis and Treatment of Pesticide Poisoning (1971)

4.00

12. Symposium on Clinical Evaluation of New Drugs (1972)

4.00

13. Techniques in Blood Group Serology (1972)

4.00

14. Laboratory Methods in Investigation of Thyroid Diseases (1972)

4.00

17. Proceedings of the First Annual Meeting of the Indian Academy of
Cytologists (1972)

4 00

18. Growth and Physical Development of Indian Infants and Children (1972)

4.00

、19 . Review of Work Done in Rural Water Supply in India (1972)

4.00

20. Genetics and our Health (1972)

4.00

21. All India Conference on Research in Reproduction and Fertility (J973)

4.00

22. A study of Morbidity Patterns and Standard of Medical Care in the Rural
Centres of West Bengal (1973)

4,00

23. Proceedings of the First All-India Workshop Conference on Stroke (1973)

4.00

24. Seminar on Infectious Hepatitis and Study Group on Australia Antigen (1973)

4.00

13

25. Atlas of Histopathology of Liver: Hepatitis and Cirrhosis (1974) '

-10.00

26. Studies on Pre-school Children (1974)

4.00

27. S.tudies on Weaning and Supplementary Foods (1974)

4.00

28. Medicinal Plants of India - Vol. I (1976)

30.00

Statement about ownership and other particulars of the ICMR Research
Information Bulletin as required under Rule 8 of the Registration of News­
papers (Central) Rules 1956.

Place of publication

.Indian Council of Medical Research
Ansari Nagar, New Delhi-110016.

Periodicity of publication

Monthly

Printer*s Name

Shri Prem Chand

Nationality

Indian

Address

Administrative Officer
Indian Council of Medical Research
Ansari Nagar, New Delhi-110016.

Publisher's Name
Nationality
Address

]
]
]

Same as above

Editor*s Name

Dr. G.V. Satyavati

Nationality

Indian

Address

Indian Council of Medical Research
Ansari Nagar, New Delhi-110016.

I, Prem Chand hereby declare that the particulars
true to the best of my knowledge and belief.

given

above are

Sd/- Prem Chand
Publisher

EDITORIAL BOARD

Chairman
Dr. C. Gopalan
Director-General

Editor
Dr. G.V. Satyavati

Members
Dr. S.V. Apte
Dr. Usha K. Luthra
Dr. V.N. Rao
Dr. A.D. Taskar
Dr. Sabita Tejuja

Printed and Published by Shri Prem Chand for the Indian Council of Medical
Research, New Delhi at the ICMR Offset Press, New Delhi.
R.N. 21813/71

Position: 2394 (9 views)