Ethambutol tablets of 200 and 300 mg denominations were assayed by the standard non-aqueous titration method and a simpler colorimetric method. With the titrimetric method, assay values, appreciably higher than the stated content (117% or more), were obtained with the products of 4 companies, while all the values were within 6% of the stated content by the colorimetric method. Rifampicin and pyrazinamide interfered with the estimation of ethambutol by both methods; isoniazid, however, caused an overestimation with the titrimetric method only.

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A two-season diet assessment was done on 1957 urban and 758 rural subjects as part of air pollution, health survey. Only 46% rural and 48-55% urban subjects showed adequate calorie intake daily. Protein intake was low (below 30 gm. daily) in 46% rural and 11-19% urban subjects. Rural diets were quantitatively and qualitatively poorer. A major factor in poor nutrition was family income. In children of 0-4 age group, 57% rural and 21-37% urban subjects had inadequate calorie intake. The proportions in older subjects were lower. Detailed food consumption values from Bombay and villages around have been reported. Particularly poor intake of vegetables and pulses were revealed. There was significantly in higher prevalence of all respiratory complaints with lower caloric nutrition in residents from highly polluted area (P<0.05). This relation was also evident in the residents of 'low' area for multiple lower respiratory symptoms (P<0.05). Nutrition and income may have significant role in enhancing respiratory morbidity in relation pollution.

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From 3 year study on 4129 original survey subjects 2183 subjects were reassessed at 6th phase. The air pollutant profile was basically similar over 3 years but for 'urban medium' area where these declined a little. In 1960 regularly followed subjects, prevalence of dyspnoea, continued to be lowest; 4.3% in 'urban low' area, 8.3% in 'urban medium', 6.5% in 'urban high' and high (12.6%) in rural areas. The prevalences for chronic cough were 5.6%, 12.1 %, 11.6% and 15.8% respectively. The defaulting groups included more females from rural area, more from lower income families, more from those staying over 10 years in the locality, more smokers, more sedentary workers in nondusty occupations, more staying in temporary small housing, more of symptomatically abnormal urban and normal rural subjects. The prevalence of active tuberculosis was 0.2 to 0.4 percent in these 4 communities. In respective 4 communities, 7.5, 11.0, 6.3 and 2.4 percent were regularly taking medications. Generally in all areas abnormal chest symptoms were more frequent at ages above 45 years (29.3%), as against 14.1 % at age 10 to 19 years in 'urban high' group: P<0.05). In 'urban medium' and rural areas, those below 10 years also suffered oftener from frequent colds and cough. In 'urban medium' area, females had common colds oftener but in all urban areas males had cough and multiple symptoms oftener; in rural area females had oftener frequent colds and dyspnoea. All types of tobacco smoking was associated with significantly greater frequency of symptoms (as also in ex-smokers). While the smokers had more cough and dyspnoea, they had fewer common colds (r : 0.12 for 3 urban and 0.23 for rural subjects). Those working in dusty and manual jobs were more symptomatic (37% in 'urban high' 39% in 'urban medium' and 42% in rural communities as opposed to 17, 24 and 29 percent in respective 3 communities for sedentary nondusty workers); (P<0.01 for 'high' and rural 'areas). There was a weak relation with income, housing, fuel and no relation with sanitation. Those residing less than 5 years in a locality showed greater abnormalities in 'urban high' and rural areas (P<0.1). The 'urban high' female subjects showed lower function initially and 'urban low' children showed higher functions particularly in males below 10 years of age. At older ages, declines in 3 urban areas were larger (e.g. 87 to 176 ml in males and 45 to 205 ml in females of 'urban high' subjects). The rural subjects generally preserved functions better. All urban subjects showed expiratory obstruction (indicated by lower FEV1/FVC% values) oftener, particularly in 'high' area. The rate of increase in FVC or FEV1 in males (10-19 years age) was higher in 'urban low' area. Even normal urban adults showed a greater yearly decline in lung function than rural subjects. There was a strong correlation between SO2, SPM, NO2 and chest symptoms and a much weaker one with age, occupation, smoking and housing. Thus air pollution seems to be a major contributor to chest morbidity in Bombay.

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Causes of death from 1971-79 were categorised into cardiovascular, infectious, respiratory, tuberculous and cancer deaths. These were standardised for age and sex distribution of central Bombay and compared for trends in 4 zones of Bombay city. The city's growth has been more rapid in eastern suburbs over this period. The deaths due to infectious disease were declining and cancer deaths were increasing slowly. The deaths due to gastrointestinal causes remained stable; but death rates for cardio-respiratory causes were high and increasing over the period. The respiratory deaths were highest in Central Bombay which is most polluted. Standardised death rates for gastritis, diarrhoea etc. were declining in South Bombay, constant in the Central Bombay and increasing in other zones (provided with an inadequate drainage system). Deaths due to cardiovascular causes showed a decline in south Bombay and an increase in the central Bombay and western suburbs. The cause may be air pollution due to industry and vehicle congestion. Respiratory deaths were higher in the central Bombay and eastern suburbs where industrial pollution levels were high. The respiratory deaths in the eastern suburbs recently have declined a little with the pollution levels. Cancer deaths showed a relation to Benzopyrene levels measured. Thus in this analysis, patterns of death (particularly cardio-respiratory and cancer) were related to types of air pollution.

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Ninety-one Patients of gram-negative infections of lung were encountered in 423 bronchoscopies. This report presents an analysis of 29 patients of pseudomonas infections encountered in this series. Most of the patients have one or more predisposing factors and 22 had associated lung disease in the form of carcinoma, fibrosis, emphysema and bronchiectasis. Radiologically, the disease presented with diffuse lower lobe bronchopneumonia in 12 and lobar infiltrates were seen in five. Mixed lobular and lobar infiltrates were seen in 12. Lower lobes were frequently involved. Radiological regression was seen in only seven and radiological progression or death occurred in 12; in the remaining 10 disease was stationary.

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Two middle class communities in Central Bombay (622 and 808 subjects) were studied for 6 months in 1930-81. Between 88-91 percent were studied clinically, 83% assessed for nutritional status and daily health diaries were maintained by 89-94 percent subjects. From vegetable and fruit samples (94) collected from one wholesale and two retail markets, exuberant growths of various organisms like Klebsiella, E. Coli, Pseudomonas, Staphylococci and B. Subtilis were isolated; Fungi, Enterobacteria, Proteus were less commonly seen and Clostridia and Vibrio Cholera were isolated once. Of 32 water samples from households in the community situated next to the wholesale market, 17 grew numerous pathogens. From 35 samples from the households in second community, 18 grew mainly Coliforms. By I.C.M.R. criteria, 37 were of unsatisfactory standard. These results suggest contamination of food supply possibly due to unhygienic handling and of water supply due to intermixture with sanitary effluent. The air pollutant monitoring revealed the levels of SO2 40 to 59 µg/M3, NO2 33 to 46µg/M3 and S.P.M. 217 to 297 µg/M3. The community in Dadar revealed 18.3% having frequent colds, 38.6% chronic cough, 10.0% breathlessness, 11.2% frequent abdominal pains and 9.4% irregular bowel movements. The respective prevalences for Matunga community were 15.9%, 34.1 %, 8.3%, 8.0% and 18.2%. Usually the older groups suffered from cough and breathlessness while colds were commoner at younger ages. As a check, from 13 patients with acute diarrhoea stool samples along with 10 samples of vegetables consumed, were studied for bacterial cultures; in 8 out of 10 cases bacterial isolates were same in both samples. Only 44% of Dadar and 24.7% of Matunga residents had an adequate intake of food calories; the proportions for proteins were 51.6 and 36.3 percent respectively. There were greater health morbidities (particularly colds) with poorer caloric consumption but for protein intake there were no differences. There was a greater prevalence of abnormalities in subjects with higher income perhaps due to the fact that they might be consuming more vegetables and fruit. Thus the health abnormalities in these two communities were similar to those for areas with higher levels of air pollution in Bombay.

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In 1981-82, 258 patients seen regularly for a long time in chest clinic were analysed for correlation of lung function with pO2 and pCO2. There was preponderance of older males, 85.7% had both cough and dyspnoea. The females were fewer and had milder grades of exertional dyspnoea. Of these 31.8% developed cor pulmonale over the follow-up. Radiologically over inflation, evidence of pulmonary hypertension or cardiac enlargement were commoner with cor pulmonale. Those with more severe dyspnoea had greater expiratory obstruction, but bronchoreversibility was similar in all grades of dyspnoea. The former showed significantly lower pO2, particularly when cor pulmonale also coexisted. The relationship between pO2 and FEV1 was linear while that between pCO2 and FEV1 was curvilinear. Of this group, an attempt to trace 85 patients was made; 9 (10%) had died, and 26(31%) could not be reached. Those assessed more regularly had a history of milder smoking. The defaulting group had a shorter history, less frequent paroxysmal and milder exertional dyspnoea, and had a slower progress. Those coming more regularly were controlled better. Those with higher initial FEV1 values showed a significant decline, while those with lower values did not show a decline. The defaulting groups showed larger declines. There were more fluctuating functional changes in the regular group, particularly females. The declines in FVC or FEV1/FVC% values were less obvious. Thus more regular treatment was taken by frequently disabled patients which appeared to keep them in better clinical and functional status over long periods.

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A cross-sectional study of 3 urban residential and slum communities from areas with high, medium and low air pollution (5213, 9235 and 4700 subjects) along with a rural control community situated 30 km. Southwest of Bombay (3124 subjects) in 1980-81 was carried out. There were significant differences for SO2 and NO2 between 4 localities, as also for age, sex, occupation, housing and income among these communities; slums had much poorer surroundings. The prevalence of tobacco smoking in males of 4 localities was 15.8% (rural), 16.7 to 17.6% (residential urban) and 24.4 to 30.7% (urban slums) respectively. A history of diarrhoea was more frequent in all urban communities (particularly the high: 12.6%) as compared to the rural group (5.6%: P < 0.05). Breathlessness was seen in 10.0% in the 'urban high' area and 3.0 to 3.8% in other communities except slum subjects of the 'urban medium' area (22.4%)' chronic dry cough was seen oftener in the 'urban medium' area (29.5% residential and 34.9% slum subjects); productive cough (for 3 months or more) was seen in 2.7% (low), 3.8% (medium) and 5.8% (high) of the urban residential communities and 3.4% rural subjects. The slum subjects from two more polluted areas showed a higher prevalence. All the slum subjects (particularly from the 'urban medium' area), had a greater history of frequent colds. The prevalence of raised blood pressure was higher in more polluted (particularly the urban high) areas and slums had a lower prevalence. The urban high community also showed a greater evidence of obstruction on lung function.

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A study in 173 cardiac patients, 30 normal subjects and 1178 community subjects residing at a busy road junction was carried out. Of the last group, in 780, and, in all subjects from the first two groups, COHb levels were measured on venous blood. All subjects underwent a clinical assessment. Tobacco smoking was an important factor for COHb levels in normals and in cardiac patients. There was no relation between COHb and various abnormalities in ischemic heart patients but COHb levels were higher on the first day. In the community study, COHb levels reflected the factors of traffic density, its slowing at a junction, and effect of smoking. In females, the factor of cooking fuel seemed to act additively. The health morbidity varied from 52.5 to 62.4 percent (chronic cough), from 13.3 to 19.3 percent (dyspnoea) and from 23.4 to 32.9 percent (frequent colds) in 4 zones; other prevalences were chest pain (7.8%), irritability (2.7%), headache (23.8%) and diarrhoea (11.8%). While these were slightly oftener at older ages, there was no clear relationship to the COHb levels measured. At the prevailing high levels of other pollutants (SO2, NO2, SPM) In the area, CO pollution does not seem to show detectable additional health morbidity.

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From a prospective survey on 4129 subjects in 3 urban (high, medium and low according to SO2 levels) areas and a rural community showed an initial prevalence of dyspnoea as 8.0, 5.9, 3.2 and 5.5 percent in the respective areas. For chronic cough the figures were 5.4, 3.0, 1.4 and 3.3 percent and for intermittent cough 15.6, 5.8, 0.4 and 3.7 percent respectively. Those having frequent colds (8+ per year) were 10.8, 19.9, 10.9 and 10.4 percent in these 4 areas. The initial prevalences for chronic bronchitis were 4.5, 4.5, 2.3 and 5.0 percent and cardiac diseases were 6.8, 4.3 8.2 and 2.7 percent respectively. For lung function, (MEFR and PEF 0.25-0.75) the 'urban low' area showed higher values; it showed a lower decline. Over 3 years, (between 1978-80) 53-60% of urban and 44% of rural subjects were reassessed. During this period, the rural area shows slightly higher morbidities and the 'urban low' area lowest rates. The 'urban medium' subjects showed higher frequency of frequent colds and intermittent cough. There were lower prevalences, for cough and dyspnoea only, in the 'urban low' and rural communities where there was larger greenery. There was significant relationship of NO2 with frequent colds, of cough with NO2 and SPM, and chronic cough and dyspnoea to all 3 pollutants. There was also suggestion of lower lung functions in normal subjects due to chronic effects of raised air pollutant levels. These trends need to be confirmed by further analysis.

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As part of 3 year study of health morbidity in relation to air pollution around Bombay, of 4129 subjects 2232 were chosen to record daily health diary. By end of third year 1338 subjects kept it regularly; major causes for lapses were change of residence and noncooperation. There were no significant difference in the trends of each area over 3 years except in the 'urban medium' area where with a decline in the pollution, the morbidity decreased. Generally, the 'urban high' area showed the highest SO2 and S.P.M. levels. The levels of NO2 were highest in 1978 but in later 2 years these were similar to the 'urban medium' area. The latter site had lower SO2 but similar S.P.M. levels. The 'urban low' area showed low SO2, moderate NO2 and high S.P.M. levels. The rural area had only high S.P.M levels. The prevalences for common colds were highest in the 'urban medium' area around 30-55 percent; those for cough were 15-45% and dyspnoea 2-7 percent. The respective values for the 'urban high' area were, 15-35% (colds), 8-19% (cough) and 1-8% (dyspnoea). The values for the 'urban low' area were 5-20% (colds), 4-19% (cough) and up to 3% (dyspnoea). The prevalences for the rural subjects were very low. Generally the worst month was August, then September, May and June. The prevalences for common colds were worst in monsoon months. All the urban areas had high prevalences for diarrhoea. The trends revealed a significantly high morbidity around days with higher SO2 pollution in all urban - areas. The monthly trends revealed that the fluctuations in colds and cough corresponded broadly to S.P.M. levels in 1978, 1979 but to SO2 in 1980 (when S.P.M. levels were lower). There was no relationship with the duration of a particular symptom but to the intensity as reflected by need for medical treatment. It is concluded that in Bombay, the health morbidity fluctuates to a significant degree with air pollutant fluctuations.

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In a health survey 1776 subjects were followed regularly from 3 urban and a rural area for 2 winters and summers. Though there were significant age-sex differences, the prevalences of major and minor respiratory symptoms were only in significantly higher in winter. These differences were not so large as indicated by differences in weather parameters. The exsmokers behaved worse; for smokers alone winters were worse. The lack of correlation with seasons may be due to the fact that air pollutant levels are not following a seasonal pattern and health symptoms were fluctuating with SO2/SPM levels.

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Twenty-seven subjects with bronchial asthma were examined, their physical signs were noted, and spirometry was done. Physical signs were correlated with the FEV1 and their ranking was done in descending order. The number of physical signs were found to be related to the severity of airflow obstruction. A preliminary report on these 27 subjects is presented.

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In a study of bronchial responsiveness to aerosols of graded histamine doses (0.003 to 1.0 mg/ml) in 2 normal, 19 bronchial asthma and 10 COPD patients; it was seen that by FEV 20% criterion 6(32%) asthmatic 3(30%) COPD patients responded. By MEFR 0.25-0.75: 25% criterion 9(47%) asthmatic and 8(80%) COPD had responded to 1 mg concentration. The declines by FVC were similar but criteria of PEF or Raw were less helpful. While more asthmatic patients responded at lower doses of histamine, the differences were not significant. Thus asthmatic presentations in the city may be nonallergic in origin and cause may be similar to that in subjects with symptoms of chronic bronchitis.

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As a part of health survey in relation to air pollution, 16 smokers (11 from 'high' and 5 from 'low' zone) were studied with extensive serial lung functions, chest radiography and radioaerosol lung scanning. The clinical diagnosis were chronic bronchitis (COPD) in 9 subjects; but others (4 ‘High’ and 3 ‘Low’), were considered normal. The values of FVC, FEV1 were normal in most of these three groups, but FEV1/FVC% values were lower in subjects from 'high' zone. The functional declines were higher in normals of 'high' zone. Radioaerosol (ventilation) scans (with Technetium99) showed a normal picture in 2 COPD and 3 normal subjects; in 3 COPD and 1 normal subjects the abnormalities were definite. For perfusion scans, 2 COPD and 3 normal subjects showed a normal patterns while definite abnormalities were seen in 1 COPD and 1 normal subjects. Lung scans may pick up abnormalities in normal smokers at an early stage.

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A total of 125 workers from nitric acid plant were studied with clinical interrogation, lung function and chest radiographs. Those working for a longer period showed a greater frequency of dyspnoea and cough (P<0.05), also chest pain, giddiness and headache (P<0.01). In radiographs, basal scars and deposits seen in 51 percent; fibrosis was also more frequent with longer work exposure (P<0.02). Those with abnormalities in both, showed significantly lower FEV1 and expiratory flow rates. There were restrictive changes in lung function and in symptomatic subjects there was reduced oxygen exchange. But slightly higher methoemoglobin levels were unrelated to abnormalities. Some of these changes seem to be related to chronic exposure to Nitric acid fumes at work. These findings need confirmation by further work.

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