NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
27
mining the presence of anopheles. It is indeed only under very exceptiona
circumstances that a crowded community in the tropics is free from anopheles.
In the Nagpur district, ¼ of a mile was found by Stephens and Christophers*
to be readily traversed by anopheles in passing between their breeding-places
and villages. In this locality, however, the distance of half a mile appeared
to put a considerable check upon their presence. In Mian Mir, on the contrary,
anopheles appeared to traverse half a mile as readily as shorter distances.
The distance travelled in Mian Mir, however, was over a bare plain with little
or no obstruction to the passage of light or sound. We believe indeed that it was
largely on account of the extremely flat and open nature of the country around
Mian Mir that such long distances were traversed by anopheles. Further experi-
ments upon this point are, however, of the utmost importance.
III.—The spread of adult anopheles.†
During the course of the experiments it was found that anopheles breeding-
places formed very often a complete circle around the bazaar or other situation in
which the adults occurred. When, by means of the operations, the distance of
breeding-places was increased around the Royal Artillery bazaar, it was found that
anopheles did not all lay their eggs in the nearest pools but that they often flew
in directions necessitating much longer distances being traversed than was
necessary. The only explanation of this fact appeared to be that anopheles, when
searching for breeding-places, spread in all directions and continued flying until a
suitable breeding-place was found. Although at one time the pools at T were
available for breeding, swarms of larvæ appeared in the groups M, P, and K
(vide map).
Such a habit would explain the spread of adul tanopheles from areas where
breeding-places are abundant into such an area as that under consideration which
had been artificially rendered free from breeding-places. Every large source of
food-supply would indeed be an agent for disseminating adults in all directions.
Taking into consideration the number of such disseminating centres in and
around the area, i.e., bazaars, native lines and servants' quarters, it is not so very
surprising that the operations were ineffective in preventing the final occurrence
of adults in the area. From a variety of reasons we believe that an infiltration of
adults took place mainly in the following ways :
—
1. Spread from servants' quarters outside the area to neighbouring quarters
within the area and from these to others still more centrally situated.
2. Spread from the native cavalry lines, which were unfortunately only 1,000
yards distant.
* "An investigation into the factors which determine malarial endemicity." Reports to the Malaria
Committee of the Royal Society, 7th series.
† See also the first report of the anti-malarial operations, page 37.
E 2
28
3. By flight over the open plain surrounding the area on the south and east
aspects.
Showing infiltration of adult anopheles into an area. The large arrows indicate flight in search of
breeding-places ; the short arrows flight towards lights, sounds, etc., after eggs have been laid.
Reference has already been made to a portion of canal in which larvæ were
especially abundant. This lay between the Royal Artillery bazaar and the Native
Cavalry lines, but considerably nearer to the former. It appears probable that
in the radiating flight from the Cavalry lines a number of anopheles would reach
this canal, but having laid their eggs, would as readily fly to the Royal Artillery
bazaar as to the more distant Cavalry lines. Thus no amount of oiling of this
portion of the canal would prevent anopheles using it as a means of reaching the
Royal Artillery bazaar. (See the above diagram shewing the method of infiltra-
tion of adult anopheles into an area.)
That anopheles adults are constantly changing their feeding and resting
place is rendered very evident by the remarkably constant sporozoite rate in
M. culicifacies. It matters little in this respect from which house, shed or stables
this species is taken, since the percentage of infected individuals is much the
same in all places.
29
IV.—The time of pupation and hatching of mosquitoes in Mian
Mir.
Numerous observations on pools under natural conditions showed that
M. Rossii did not pupate before the twelfth day. The observations were made in
September when there was much hot sunshine and the nights were warm. No
difference in the rate of development was noted in the case of shallow or deep
pools, although the temperature of the water in the very shallow pools was very
high during the day, 96°
F. to 102° F. In the deeper pools the water was much
cooler, 90°
F. or less. Adult M. Rossii hatched out two days after pupation.
Fourteen days appeared therefore to be the minimal time in which adult
M. Rossii hatched in September. As this month appeared especially favourable
for the development of this species, it is probable that the above represents the
shortest time in which M. Rossii can develop.
Observations upon canals showed a very similar period for pupation of
M. culicifacies. The minimal time in which nymphæ appeared in a freshly
filled canal being thirteen days.
Considerable differences existed in the time of pupation and hatching of the
different genera of mosquitoes. Species of the genus Stegomyia hatched with
marvellous rapidity, pupating on the eighth day and hatching on the tenth. Of
all the genera Anopheles was the slowest in developing, taking three days longer
than Culex and four days longer than Stegomyia.
Table showing the time of pupation and hatching of some mosquitoes under
natural conditions in September.
Date.
Day after first
filling of pools
or pots.
Weather.
Pupation.
Hatching.
6th September 1903 .
1st
First shower after
15 days drought.
Hot sunshine.
Rain.
None.
None.
"
" .
2 n d
8th
"
" .
3rd
9th
"
" .
"
1 0 t h
"
"
.
5th
"
"
11th
"
"
.
6th
"
"
1 2 t h
" .
7th
Hot sunshine.
"
"
1 3 t h
"
" .
8th
"
"
Stegomyia.
"
14th
"
"
.
9 , t h
"
"
Culex.
"
15th
"
" .
10th
"
"
None.
Stegomyia.
1 6 t h
"
.
1 1 t h "
"
"
Culex.
17th
"
" .
12th
"
"
Anopheles.
Muci dus.
18t h
”
"
.
13th
"
"
None.
None.
1 9 t h
"
" .
14th
"
"
"
Anopheles.
20th
"
"
.
15th
"
"
"
None.
30
V.—Observations in regard to deposition of ova and their resist-
ance to desiccation.
Various observations have been made in regard to the resistance to desicca-
tion of ova of anopheles. Christophers and Stephens, as well as Nuttall, Cobbett,
and Strangeways-Pigg, found that ova allowed to dry upon blotting paper for a
few days did not give rise to larvæ on the addition of water. The former
observers also note that no larvæ appeared on the addition of water to earth taken
from the bottom of twenty-five small, dried, anopheles rock pools. Gray also got
negative results with earth taken from a dried-up pool. Liston * described the
hatching at once on the addition of water of ova which had remained several days
on mud not quite dry. I was able to confirm this observation of Liston's
with ova taken from the bottom of partially dried up pools in Mian Mir. Ova
could be detected in some cases even when the mud had been quite baked in the
sun. They did not, however, appear ever to be laid on mud in this condition, but
were laid readily on mud which, though cracked from drying, was still moist.
Ova were laid daily on mud so long as signs of moisture were present, but once
the whole pit had become thoroughly dry no further ova were deposited. In
many cases pits, even before becoming thoroughly dry, were overrun by ants,
and ova were never found under these circumstances.
Ova were searched for on mud of various degrees of dryness, and when
found were removed and placed carefully on water. The results are noted in
the following table :—
Character of mud.
Number of ova taken.
Number hatched in
1 5
minutes.
numbe r
eventually
hatched.
Quite soft . .
.
.
12
0
12
Cracked but moist..
10
2
8
Quite dry. .
.
.
.
25
5
1
Slab of soft mud with ova
dried 12 hours in sun.
A large number.
0 0
Ova of M. Rossii laid during the night of the 21st September 1903 and
placed in a small natural pool exposed to sunshine, became young larvæ on the
morning of the 24th. Other observations on ova also gave about this time (48
hours) for the hatching of the larvæ. Eggs laid upon mud, therefore, appear to
undergo development and to hatch out at once on the addition of water. From
this cause many larvæ must be present on the very first day of rain and the
hatching of the adults anticipated, by 48 hours.
* Liston, 1nd. Med. Gazette, Dec. 1901.
31
VI.—The effect of heavy rain upon anopheles larvæ.
On several occasions when pits containing anopheles larvæ were examined a
short time after rain, it was found that all the larvæ had disappeared. At the
same time larvæ were found 50 to 100 yards away in innumerable small puddles
left by the rain. Since these larvæ, from their large size, could not have developed
in situ, it was evident that they had been washed out of the larger pits and dis-
tributed over the ground. After one shower nineteen large pits were observed to
have been emptied of larvæ in this manner and the larvæ were found scattered
over the ground.
VII.—The effect of desiccation on anopheles larvæ.
When the above-mentioned puddles dried, it was easy to determine how long
larvæ resisted desiccation, by pouring some water on to the site of puddles of
varying degrees of dryness, and observing the results. In most cases larvæ
could be seen immovably fixed in the surface film of mud. These, however,
liberated themselves on the addition of water, even when they had been exposed
to the sun for some hours. When, however, the mud had so far dried as to lose
its glistening surface, the larvæ were destroyed.
32
PART V.
QUININE ADMINISTRATION.
IN addition to operations against mosquitoes, experiments were made in regard
to the efficacy of quinine administration to British troops, native troops
and the native children of the followers' lines. In all cases where adults were
concerned a dose of 15 grains of quinine was given on two consecutive days
weekly. In the case of native children proportionate doses were given. Conse-
cutive days were chosen, since, in the majority of cases, double infection with
the benign tertian parasite was found.
Quinine, when employed as a prophylactic against malaria, is usually distri-
buted to British troops through non-commissioned officers. It was our experi-
ence, however, that by such a method of administration a very small proportion
of the men really took any quinine. Unfortunately it was found impossible to get
a satisfactory method of administering quinine to large bodies of men. Even
when the men were mustered and a roll called, many were found absent on
various duties. On the whole, except in very special cases, administration of
quinine to large bodies of men was always more or less imperfect. It will be
necessary, in order to arrive at any conclusion as to the value of quinine
administration, to consider the experiments under three heads.
(a) Experiments limited to a small number of men where quinine was
administered with scientific accuracy.—One hundred men among the British
Infantry volunteered to take quinine regularly. A list was made of the
men's names and a mark placed for each dose of quinine taken in my
presence. Of the hundred men 95 had taken six doses of quinine up to
the 1st September. The results of this experiment were very marked. It
was very noticeable that after a man had taken four doses of quinine he did
not get malaria. Two doses of quinine was not apparently effective, since
several of the 100 men who had received two doses were admitted for ague.
Of those men who, after the first four doses, continued to take the drug
regularly, only two were admitted to hospital for malaria. In neither case,
however, were parasites found on examination. Among the remaining 353 men
there had been in the same period 71 admissions for malaria. In 50 per cent. of
these cases parasites were found by Captain Sewell, R.A.M.C. Between August
25th and September 15th the admissions from the men taking quinine were 21
per mille as against 201 per mille from those not taking quinine. From 29th
September the whole of the British Infantry were placed under strict quinine
treatment, and the smaller experiment ceased.
Black line = British Infantry (outside the area)
D o t t e d l i n e
= R o y a l A r t i l l e r y ( W i t h i n t h e , a r e a )
33
(b) Administration to large bodies of men under very strict conditions.— The
taking of quinine was made compulsory and a roll of each company was kept
on which was entered each dose of quinine taken. The men were paraded and
the administration of the quinine was carried out under the supervision of a
medical officer. The administration was on the whole very thorough, but it was
found impossible to be sure of men who were absent on various duties. These were
supposed to take quinine on returning to barracks, but it was of course impossible
to be certain that they did so. Compared with the results in the first experiment
the effect of quinine administration was disappointing. Coincident with the
institution of the quinine administration, there was, however, a distinct fall in the
admission rates ( see chart showing weekly admissions). The admissions in each
week from 1st July to the 10th November in the British Infantry and the
Royal Artillery were as follow. The asterisk indicates strict quinine adminis-
tration :—
Weeks .
1 2
3
4
5
6
7
8
9 1 0
1 1 12 13 14 15
1 6 17 1 8 19
Royal
Artillery .
0 0
0 0
0
1
1
2
0
2 2 4 12
7 26 26 24 36 31
British
Infantry .
0 1
0
3 2
5
7
1 0
41
1 1 19 26
*
29
*
24
*
1 8
*
5
*
14
*
1 0
*
16
The strength of the British Infantry was considerably greater than that of
the Royal Artillery, and on the whole a very distinct reduction in malaria
appeared to follow the administration of quinine upon these lines.
(c) Quinine administered without supervision or under regimentals supervi-
sion.—In every one of the experiments of this kind not the slightest effect was
evident. In the case of the native cavalry quinine was given under regimental
supervision to all but two squadrons. The admissions were greater among those
supposed to be taking quinine than among those not doing so. In this and
similar experiments it was found impossible to maintain adequate supervision
even when the administration was supervised by a regimental officer, and it is
extremely uncertain how many of the men really received quinine regularly.
We may say then that the experiments very clearly showed that the effect
of quinine administration to troops depended entirely upon the care and strictness
with which it was administered. In the experiment with a limited number of
men any man not taking quinine as intended was not included in the results,
and the action of quinine was most clearly demonstrated. In actual practice it
34
is almost certain that such a thorough giving of quinine would be found
extremely difficult. In the case of the experiment dealing with the British
Infantry the administration of quinine was made, it is believed, as thorough
as is possible except under very special circumstances, and here although
the results were not to be compared with those in the smaller experiment, a very
distinct reduction in malaria appeared to take place. As a routine practice, under
conditions existing at present, we do not believe quinine administered to troops
is of much value. Could, however, very much more stringent regulations be
brought to bear upon the carrying out of this measure, quinine appears to be a
most effective means of lowering the fever rate.
The Administration of Quinine to Native Children.
Attention has several times been called to certain native quarters situated
in the neighbourhood of the Royal Artillery barracks. Early in the operations it
was recommended that one of these (syce lines), within 150 yards of the barracks
and at a less distance from the hospital and prison, should be removed to a greater
distance. Another much larger source of infection existed in the regimental
bazaar which, at the time, was considered too large to remove. Since then,
however, the Government of India have taken steps to have this bazaar pulled
down and re-erected at a safe distance. In the case of the syce lines there were
certain objections to their removal, and since they formed a comparatively
small community, experiments were instituted by Captain James as to the possi
-bility of treating all the children with quinine. The results obtained by him were
satisfactory, and similar experiments with regard to this point were carried out
in the present year. In the early part of the season a generally low rate of in-
fection prevailed among the children in the area. Towards the end of September
a rapid rise in the endemic indices of the different bazaars was noticed. At this
time then it was thought that a good opportunity for the demonstration of the
value or otherwise of the administration of quinine to these children existed. No
difficulty was found in getting all the children in the lines to take the drug.
A list of all the children was obtained from the Cantonment authorities and a
gift of native sweets made to each child after taking the quinine. To my
surprise the children readily took large doses (5 to 10 grains) and did not com-
plain of any symptoms of cinchonism. The effect upon the spleen rate was very
distinct, as is shown in the following tables. During October the spleen rate in
these children was reduced from 67.8 per cent. to 54 per cent. In the Royal
Artillery bazaar, the children in which had not received quinine, the rate remained
high, viz., 64.5 per cent., as also in the hospital followers lines, viz., 6o per cent.
Looked at in detail the results were still more striking. A glance at the
accompanying tables will show that in nearly every case in which the spleen
35
was enlarged it was reduced in size by the treatment, whilst in many cases
enlargement of the organ was no longer perceptible.
Table showing the effect of one month's administration of quinine to native
children.
Children.
Spleen before taking quinine.
Spleen after taking quinine.
1
1 finger's breadth below costal margin Just palpable .
.
.
.
. Decrease.
2
4 fingers' „
.
.
.
. 2 fingers' breadth .
.
.
. Decrease.
3
Nil
Nil
4
Nil
Nil
5
Reaching to umbilicus
.
.
. Reaching to pubes .
.
.
. Increase.
6
3 fingers' breadth
.
.
.
.
Nil
Decrease.
7
Nil
Nil
8
Nil
Nil
9
Nil
Nil
1 0
Just palpable .
.
.
. Just palpable.
1 1
3 fingers' breadth
.
.
.
.
1 finger's breadth .
.
.
. Decrease.
12
3 „ „
.
. .
.
1 „ „
.
.
.
. Decrease.
13
2 „ „
.
.
.
.
Nil
Decrease.
14
1 finger's „
.
.
.
1 finger's breadth.
15
1 „ „
.
.
.
. 1
„ „
.
16
2 fingers' „
.
.
.
. 2 fingers' „
.
17
Nil
Nil
18
4 fingers' breadth .
.
.
. 1 finger's breadth .
.
.
. Decrease.
19
1 finger's „
.
.
.
Just palpable .
.
.
.
. Decrease.
20
1 „ „
.
.
.
Nil
Decrease.
21
Just palpable .
.
.
.
.
Nil
Decrease.
22
1 finger's breadth
.
.
.
.
Nil
Decrease.
23
3 fingers' „
.
.
.
. 2 fingers' breadth .
.
.
. Decrease.
24
Nil
Nil
25
3 fingers' breadth
.
.
.
. 2 fingers' breadth .
.
. Decrease.
26
3 „ „
.
.
.
2
„ „
.
.
.
. Decrease.
27
Nil
Nil
28
Nil
Nil
29
1 finger's breadth
.
.
.
. 1 finger's breadth.
3o
3 fingers' „
.
.
.
.
Nil
Decrease
31
Nil
2 fingers' breadth. .
.
.
. Increase.
32
Just palpable .
.
.
.
. Just palpable.
33
3 fingers' breadth
.
.
.
. 3 fingers' breadth.
34
Nil
1 finger's „
.
.
.
. Increase.
35
Just palpable .
.
.
.
.
1 „ „
.
.
.
. Increase
36
1 finger's breadth
.
.
.
.
Nil
Decrease.
37
Nil
Nil
36
PART VI.
GENERAL CONCLUSION.
T HE conclusions arrived at by myself are in close accordance with those
expressed by Captain James, I.M.S., in the first report. It has, however, in
many cases been possible to confirm and render these more certain. We may
tabulate what has been demonstrated in the Mian Mir operations as follows :—
1. The destruction of anopheles within an area by attacking their breeding-
places is extremely difficult. Although large numbers of pools were filled up
and drained, and millions of larvæ destroyed by oil, adult anopheles were still
abundant.
2. The mere obliteration of local breeding-places is useless. In Mian-Mir
almost complete absence of breeding was ensured to a distance of over half a
mile, but adults still appeared in large and in increasing numbers in the area.
3. A distinct effect was produced upon the malaria of troops and on the
endemic index of the bazaars. This was, however, only evident in the beginning
of the fever season, and could not be maintained.
4. The failure of the operations appeared to be due to the passage of adult
anopheles into the area from without. This went on steadily during October
when breeding-places were not present in the area, and it could not be prevented.
5. The value of quinine administration was found to depend entirely upon
the degree of supervision exercised. Experiments showed that where the men
really took quinine regularly the admission rate for fever was much reduced.
6. The operations further demonstrated the necessity of removing bazaars
and followers' lines to a distance. Experiments undertaken with the view to
rendering small collections of native followers innocuous by treating the children
with quinine were very successful. Where small native communities, especi-
ally servants' quarters cannot well be removed, the regular administration of
quinine to children is a prophylactic measure of great value.
It is significant that some effect upon malaria was produced by anti-
mosquito measures, but as regards Mian Mir it is evident that the operations
undertaken were unable to effectively control the incidence of malaria
among the troops. It is our opinion that, although the operations yielded
a great deal of information and showed what difficulties must be taken into
account, they were not those best adapted to the eventual reduction of malaria.
The latter we believe to be such gradually carried out sanitary reforms directed
against malaria as are indicated by careful investigation into the conditions
present in cantonments. At Mian Mir, for instance, there are several features
37
which can be unhesitatingly denounced as tending to foster malaria. These
cannot be removed at once, but their gradual removal is in most cases, we believe,
possible. In the experiments efforts were made to obtain immediate results, and
the permanent removal of widespread insanitary conditions was not attempted.
It is possible that the conditions in Mian Mir were more difficult of control
than in some other cantonments. We have, however, no certain knowledge
of the conditions in other cantonments, and until a detailed examination
and careful mapping of these has been carried out, it is impossible to say
how far measures directed against malaria based upon these lines are likely to be
successful. With regard to quinine administration we think the difficulty of
maintaining efficient administration will prevent this measure from being of much
use as a routine one. Moreover, it appears to us that gradual but permanent im-
provement in the health of stations by well-directed sanitary reforms, wherever
these can be carried out, will in the end yield the best return.
G. I. C. P. O. No. 2696 S. C.—28-4-1904—1,150.
No. 9.
(NEW SERIES.)
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
SECOND REPORT OF THE ANTI-MALARIAL OPERA-
TIONS AT MIAN MIR, 1901-1903.
BY
LIEUT. S. R. CHRISTOPHERS, M.B., I.M.S.
( On special duty. )
ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF INDIA
BY THE SANITARY COMMISSIONER WITH THE GOVERNMENT
OF INDIA, SIMLA.
CALCUTTA:
OFFICE OF THE SUPERINTENDENT OF GOVERNMENT FRINTING, INDIA.
1904.
Price As. 10 or 18.
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