NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
SECOND REPORT OF THE ANTI-MALARIAL OPERATIONS
AT MIAN MIR, 1901-1903.
PART I.
SUMMARY OF THE OPERATIONS ANTECEDEN TO THOSE WITH WHICH
THIS REPORT DEALS.
THE operations at Mian Mir and the conditions under which they were carried
on have been described in previous reports,* but it will not be out of
place to briefly refer to their main features. The operations were intended to
demonstrate the reduction of malaria in a cantonment by measures based upon
recent knowledge of the ætiology of this disease, and as started by the Royal
Society's Commissioners, together with Captain James, I.M.S., were primarily
directed against mosquitoes. There were many reasons at the time why this
method of prevention should have first consideration. Not only did the
reduction of the number of anopheles appear to be the most complete and
satisfactory of all measures, but it was a method of malarial prophylaxis con-
cerning which nothing was as yet known of the ease or difficulty with which
it could be carried out. In the course of their researches in Africa, the
Commissioners had become doubtful of the practical value of operations
against mosquitoes in the moister regions of the world. But in the semi-
desert conditions prevalent in North India, and especially in the Punjab,
they saw what appeared to them to be the proper sphere for such operations.
A cantonment in the North-West of India which offered the best conditions
for the experiment was therefore sought for. But most cantonments which
appeared to be favourable for operations were comparatively healthy, whereas
those at which high admission rates for malarial fever were constantly recorded
were generally found to be unfavourable for operations. The more malarial
stations for troops in North-West India, as shown by the admission rates for
intermittent fever, are :—
Station.
Admissions per mille ; average for
years 1896-1900.
Delhi
. .
.
.
.
.
.
1,145.6
Ferozepore
. .
.
.
.
.
.
760.6
Mian Mir
.
.
.
.
.
.
,
663
Meerut
.
.
.
.
.
.
.
477.2
Fatehgarh
.
.
.
.
.
.
.
464.4
Amritsar
.
.
.
.
.
.
.
445.6
Fort Allahabad
.
.
. .
.
.
. 400
* Reports to the Malaria Committee of the Royal Society, by J. W. W. Stephens, M.D.,
S. R. Christophers, M.B., and Captain James, 8
th series. October 1902.
First Report of the Anti-Malarial Operations at Mian Mir, 1901-1903, by Capt. S. P. James,
I.M.S., Scientific Memoirs by Officers of the Sanitary and Medical Departments of the Government of India (new
series), No. 6.
2
It is important to note that, on examination, each of these stations was
found to possess some serious drawback to the carrying out of successful anti-
mosquito operations. Delhi Fort was found to be in close proximity to the
native town of Delhi as well as to an extensive tract of sand and water in the
bed of the Jumna. Ferozepore was found to have extensive waters not far
removed in the bed of the Sutlej River. Even in Mian Mir, which was eventually
chosen, it soon became evident that the presence of irrigation in this canton-
ment was a condition much more unfavourable to operations than had been
anticipated. But on the whole Mian Mir appeared to be best adapted to the
carrying on of the experiment, and the conditions seemed sufficiently favour-
able to allow of a marked success being achieved in the fight against malaria.
This cantonment, however, covered an area of about 12 square miles, and
only a portion was therefore chosen for the experiment. The selected area was,
to a large extent, isolated from the rest of the cantonment. It contained the
barracks of the Royal Artillery, a large and some small native bazaars,
officers' bungalows and their gardens, and was representative of most canton-
ments in North India. About three-quarters of the cantonment was left
untouched, and this part, being under the same physical conditions as the chosen
area, formed a valuable control in all operations.
The experiment was commenced in September 1901, but actual operations
were not undertaken until April 1902, since the first six months were devoted
to a thorough investigation into the conditions present. At the time when the
investigation was commenced, little was known as to the breeding-places of
anopheles. It was customary to discuss points of biology as relative to the
whole genus anopheles, and considerable discussion still took place as to the
presence of anopheles larvæ in this or that situation. The work of Stephens
and Christophers 1 and of Daniels 2 in Africa, James3 in India, Grassi4, Nuttall5,
and others in Europe had gradually made it evident that anopheles were not so
restricted in their breeding-places as was at first supposed. Immediately prior
to the experiments at Mian Mir, it had also been shown by Stephens, Christo-
phers, and James, that individual species of anopheles frequented particular
kinds of breeding-places, and that one or other species bred in almost every
possible kind of collection of water, even in foul water (A. Rossii) and in pots,
1
Stephens and Christophers. Reports to the Malaria Committee of the Royal Society, 1st, 6th and 7th
series.
2 Daniels. Reports to the Malaria Committee of the Royal Society, 3rd series.
3 James. Ind. Med. Gazette, Dec. 1899.
" Malaria in India." Scientific Memoirs by Officers of the Medical and Sanitary Departments
of the Government of India. New series, No. 2.
4 Grassi. Studi di uno zoologo sulla malaria. Secunda edizione,note-volmente accrescinta, October
1901.
5 Nuttall, Cobbett and Strangeways-Pigg. Journal of Hygiene. Vol. 1, No. 1.
3
earthenware vessels, etc. ( A. Stephensi) . In Mian Mir the irrigation channels
were found to be a prolific source of anopheles. La r v æ we r e f o u n d i n t h e
shelter of grass or fringing vegetation even in the more swiftly-flowing channels,
whilst they swarmed in many of the sluggish, weed-containing ones. The
interesting discovery was made that the larvæ in the canals were almost
entirely those of a single species, viz., A. culicifacies.P o o l s f o r m e d b y r a i n
were also found to swarm with larvæ, but these were, with rare exceptions, those
of A. Rossii. Earthenware vessels, fire pots, and other utensils, though not im-
portant sources of anopheles, were interesting as containing larvæ of A. Stephensi.
A few species, quite rare in comparison with the two species mentioned above,
viz., A. fuliginosus, A. nigerrimus, and A. pulcherrimus, bred in a few grassy
and weedy pools in the surrounding country. The two species A. culicifacies
and A. Rossii—the former breeding in the canals and the latter in rain-formed
pools—were of most importance in Mian Mir.
From the researches of the Commission in Bengal it had already appeared
that A. Rossii was a species whose presence did not appear to bear much relation
to the prevalence of malaria. A. culicifacies, on the other hand, resembled in its
adult, egg, and larva states, as well as in its habits ( i.e., the selection of running
water for breeding), a number of mosquitoes of which the African species
A. funestus is the type, which have been shown to be actively concerned in the
spread of malaria and to be associated with a high malarial endemicity. The
importance of these facts led us to dissect large numbers of each species both in
Mian Mir and in Ennur—a highly malarious village in the Madras Presidency.
The glands of 850 specimens of A. Rossii were examined without sporozoits
being found, whereas these bodies were detected in the glands of 18 out of 328
specimens of A. culicifacies. In Mian Mir it thus appeared that A. culicifacies
was the species mainly concerned in the transmission of malaria, and that the
canals required the first consideration.
Experiments had appeared to show that the presence of larvæ in the canals
was largely dependent upon a sheltering fringe of vegetation, and that removal of
this greatly diminished their numbers. The first operations, therefore, which it
was decided to undertake were:—
(1) A thorough cleaning of all irrigation water-courses within the area and
within a distance of half a mile beyond its limits.
(2) The conversion of one canal which passed close to each of the three
barracks, the quarters for families, the hospital and prison, into a brick channel.
The conditions during the rains were at this time imperfectly known. It
was evident, however, that a large number of pools must be formed. It was also
probable from several considerations that these pools were the main breeding-
places of A Rossii. Though the pools appeared to be of less importance than
B 2
4
the canals, it was nevertheless decided to undertake vigorous operations against
them, and to add to the above :
—
(3) The filling-up of as many as possible of the pits which abounded in the
area, and during the rains the pouring of kerosine oil on all breeding-places which
could not be permanently done away with.
A very important feature in the area was the presence of certain bazaars. An
examination of the children in these revealed a very high degree of infection, and
infected anopheles were caught in the houses in large numbers. A large bazaar—
the Royal Artillery bazaar—was situated within 400 yards, and no less than three
smaller native communities within 150, 400 and 400 yards, respectively, of the
barracks. It was, therefore, recommended that—
(4) One of the syce lines situated at a distance of only 150 yards from the
barracks should be moved to a greater distance. The parasite rate in the chil-
dren of these lines was then 56 per cent.
Operations were actually commenced in April 1902 and continued by
Captain James, I.M.S., for a period of over a year. Fifty coolies were at first em-
ployed to clean the sides of the canals which were much overgrown with vege-
tation. When all the canals in the area had been cleaned, a smaller number
of men were kept permanently at work on them, removing fallen leaves
and other débris, and plastering the sides with mud. As a result of these opera-
tions the canals in the area were converted into clean channels of water with
little or no shelter at the edges for larvæ. Captain James notes that up to the
beginning of June the cleaning appeared to be a very effective measure,
and that larvæ. were less numerous in the cleaned canals than in others. Later
in the season, however, the efficiency of the operations was not so marked.
In the initial experiments it was evident that sufficient attention had not been
given to the more sluggish water-courses in which, in spite of the thorough clean-
ing of the banks, larvæ became abundant. . The brick-lined canal, which, it is fair
to state, was one of the most sluggish in the area, also contained many larvæ
during the later months of the year. The general result of the cleaning opera-
tions went to show that where the flow of water was sluggish, cleaning of the
edges of the water-courses, though hostile to larva development, did not prevent
the breeding of anopheles. In channels, especially the main rajbahas, where the
flow of water was considerable, cleaning of the banks was most effective, and
larvæ were rarely seen in cleaned channels of this nature.
In addition to the cleaning operations, Captain James tried the effect of
shutting off the water and drying the watercourses, also of oiling the canals
with kerosine oil, and the latter course he found most practicable.
During the rains, in addition to the work on the canals, a great deal had to
be done in connection with rain-formed waters. The operations were of great
5
interest since they gave some idea as to how far the conditions at this time
could be influenced. The rainy season in Mian Mir is very short and the
rainfall not great. Nevertheless, as Captain James points out, the ground
is very impervious, so that rain water readily collects in shallow pits or even upon
the flat ground. He notes the following as the main additional breeding-places
in the rains :—
1 . S h a l l o w a n d e x t e n s i v e s h e e t s o f w a t e r .
2. Surface drains in which water lies after rain.
3. Rain-filled pits.
The shallow sheets of water shrink very rapidly, but residual pools are left
which had to be drained, baled out, or treated with oil. Water in surface drains
was similarly treated. The most difficult of all the breeding-places to control
at this time were the rain-filled pits. Some idea of the number of these may
be gathered from the fact that Captain James records 137 as present within the
area after a fall of rain of two hours' duration. Of pits of this nature 250 were
filled with earth before October 1902 and many more were systematically oiled
during the rains.
In addition to the work on the canals and rain-filled pits, the most care-
ful examination of the whole area for breeding-places, and their destruction
when found, was carried out. Pools in connection with Persian wheels—the
apparatus for raising water from the canals—were found a fruitful source of
anopheles and were periodically oiled. Collections of waste water and many
other miscellaneous sources of anopheles were systematically destroyed.
Such were, in the main, the anti-culicidal operations carried out by Captain
James from April 1902 to the end of the fever season in that year. It would
seem strange if they had not an effect upon the number of adult anopheles in
the area. Yet the results were by no means as great as might reasonably
have been expected. Anopheles were evidently still quite abundant in the
bazaars, and regarding A. Rossii Captain James could note no difference in the
numbers as compared with the previous year. With regard to A. culicifaciesh e
notes that they were present, but in diminished numbers, so that the treatment
of the canals had appeared to be more effective than that of the rain-formed
waters.
On the whole we have the somewhat startling fact that in spite of most
energetic operations having been carried out continuously for many months, in
which the whole of the canals had been cleaned, 250 pits filled with earth, and
large numbers of other breeding-places destroyed by oil, the reduction in adult
anopheles was at the most very slight.
With regard to the effect of the operations upon the malaria of troops, it
6
was unfortunate for the outcome of the experiments that the year 1902 was an
exceptionally healthy one for all troops in the Punjab. Though a very small
number of admissions for malaria occurred among the Royal Artillery, an equally
small number occurred among the British Infantry, who lived in a portion of the
cantonment where no operations had been carried on. Moreover, Captain James
notes that during the Delhi manœuvres many changes took place among the
men of the Royal Artillery, and concludes that where so many factors affected
the statistics it was impossible to obtain results of value from their consideration.
On the endemic indices of the bazaars, however, Captain James notes a distinct
effect as following upon the operations. In his figures for the indices of the differ-
ent months a most marked reduction is seen in August and September. In a
later portion of the present report a similar result is noted for 1903, and it appears
certain that the low figures for these two months were the direct outcome of the
operations, since in neither case was there anything like the same small rate in the
control bazaar or in the same bazaars in the previous year. In October 1902
the amount of malaria, however, had increased to such an extent in the children
of the Royal Artillery bazaar as to nearly equal that in the control bazaar. On
the whole Captain James concludes that the fever season had been delayed and
shortened in the bazaar as a result of the operations.
We can then summarise the main results of the first year's work as follows :—
1.Cleaning of the banks in itself did not prevent the breeding of a n o p h e l e s
in the water-courses, and in addition oiling with kerosine oil was found necessary.
2. The breeding-places of A. Rossii were extremely abundant during the
rains. The breeding-places within the area were, however, almost entirely
destroyed by filling up or oiling.
3. Adult A. culicifacies were to some extent diminished, but in the case of
A. Rossii no reduction was noticeable.
4. The fever season in the bazaar was delayed and shortened. In the case
of the troops no deductions could be made on account of changes among the
men at the time of the Delhi manœuvres.
Although the value of several other means of prophylaxis was investigated
by Captain James, I shall here draw attention only to an attempt during the cold
season of 1902-03 to destroy anopheles over a wide area. It was found by him
that in the cold weather both adults and larvæ of A. culicifacies became extremely
scanty. He also found that no new batches of eggs were deposited during this
time, and that when the larvæ which seemed to be hibernating were destroyed in
any pools, no new ones appeared. As adults were not to be found by the most
exhaustive search, he concluded that this species hibernated in the larval form,
and he hoped, by the destruction of the hibernating larvæ over a wide area, to
cause a diminution in the numbers of anopheles in the on-coming warm season.
7
The operations were, however, without effect, and in May 1903 anopheles were as
abundant as ever.
The results of the operations directed against anopheles, in spite of the
thoroughness with which they were carried out, cannot be regarded as very
encouraging, and Captain James, in his concluding remarks, is distinctly of opinion
that as far as the first year was concerned the operations were very far from
being an unqualified success.
T HE operations dealt with in the present report were carried on from July 1903,
and included the rains from the 15th of July to the 11th of September, and
the fever season from August to November. They afforded the opportunity of a
second estimation of the value of the operations.
On the whole the operations were similar to those in the previous year. But
as the canals had been cleaned and a large number of pits filled, it was possible
to still further extend the area of the operations against rain-formed breeding-
places, and this was done to a distance of nearly three-quarters of a mile in every
direction. At the same time the greatest care was taken that no breeding-places
were left nearer at hand, and the various sections of the area were carefully gone
over at short intervals. The whole area of the operations extended over about
four square miles, and is shown in the map which accompanies this report.
The physical conditions of Mian Mir, and especially the conditions in relation
to malaria in this cantonment, have been sufficiently described in Part I, and it
will not necessary to do more than describe the operations as they were carried
out in the present year. These operations may be very conveniently divided
i n t o —
1. Those connected with the irrigation water-courses.
2.Those dealing with a variety of sources of anopheles of small extent, such
as stone reservoirs, waste water, and other casual collections of water.
3.Those directed against the rain-formed pools.
Except in cases of emergency, coolies employed on the canals were kept on
this work, since they had learnt exactly what was required of them. With regard
to the second series, very little coolie labour was required, since breeding-places of
this kind were not difficult to destroy once they were detected. A fresh gang of
about 30 coolies was engaged for work during the rains only.
I.—Operations upon the water-courses.
The sides of the canals in July were very smooth from the constant " plas-
tering" and larvæ were rare even in the more sluggish channels. Larvæ, however,
were not abundant in untreated canals at this time. In August, larvæ began
to be abundant in the canals, especially in a long canal near the large Royal
Artillery bazaar, not very far from the extensive lines of the Native Cavalry.
As at this time the cleaning of the sides seemed to be quite ineffective in stop-
-ping the increase in the number of larvæ, "oiling" was resorted to. In the
OPERATIONS FROM JULY TO NOVEMBER 1903.
PART II.
8
9
present year the whole of the canals in the immediate area and to a distance of
half a mile, or a little less in some cases, were oiled, and the process repeated at
first every week and later at intervals of 12 days. The latter time was determined
by experiment (see time of development of larvæ in Mian Mir, page 23), and was
the time taken for larvæ to become full grown but not to pupate. After the
institution of this regular oiling nymphœ were caught with the greatest rarity in
the channels so treated.
As it was found necessary to employ "oiling" even after cleaning of the
banks, it was important to determine whether kerosene might not be employed
directly upon uncleaned canals. Experiments, however, showed that the presence
of vegetation in water very greatly interfered with the destruction of larvæ by oil,
and in some cases abundant larvæ were found after oiling such waters, in the
cases of both canals and pools. Fringing vegetation, as it occurs in most of the
untreated canals in Mian Mir, was found to render effective oiling impracticable.
Ordinary cheap kerosene oil was used and was spread by means of a watering
pot. The cost of effective oiling was found to be, in channels 1½ yards in width,
about Rs. 4 to the mile. As the total length of canal oiled was roughly 4 miles,
and as some of the channels were rather wider than the above, the monthly cost
of oiling was about Rs. 30 to Rs. 40.
Experiments with emulsion of kerosene oil. —As the spreading of kerosene
oil seemed to be the only satisfactory way of treating the canals, it became
important to reduce as far as possible the cost of the process, and to see if
similar results could be obtained with a smaller quantity of oil by modifying the
method of application. It was found that kerosene oil readily emulsified when
shaken with soap solution. It was also found that oil so emulsified spread
much more uniformly upon water and required no mechanical agitation to dis-
- t r i b u t e i t . I n e x p e r i m e n t s i n t h e l a b o r a t o r y o n p u r e w a t e r c o n t a i n i n g l a r v æ
(anopheles) the following results were obtained:—
After 15 minutes.
Af t e r 1 h o u r .
1 c. c. pure oil per 100 sq. c. water
All dead.
.5 c. c. ,, ,, ,, ,, ,, ,,
Many living.
S o m e s t i l l l i v i n g .
.25 c. c. ,, ,, ,, ,, ,, ,,
No marked effect.
A few dead only.
.125 c. c. „ ,, „ ,, ,, ,,
No effect.
No effect.
1 c. c. oil in emulsion per 100 sq. c. water
All dead.
.5 c. c. „ „ ,, ,, ,, ,, ,,
All dead.
.25 c. c. „ „ ,, ,, ,,
No marked effect.
About half larvæ dead.
.125 c.c. „ „ ,, ,, ,,
No effect.
No effect.