NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
140
out that the vast majority of the most dangerous wells in the City are so situated
that sun-light cannot penetrate to them ; and except in the case of the Parsis,
the view appears to be based rather upon some vague idea that air and day-
light will purfiy water, than on any strict religious grounds. It is a common
experience to find that Indian servants employed in large residential flats in
the City, which usually have many closed cisterns upon their terrace roofs,
persist in opening the lids of the cisterns, in order that the sun may gain access
to the water.
400. As regards the suggestion that the filling in of tanks and wells
may cause a rise in the level of the subsoil water, or that the covering of wells
may interfere with their ventilation, it may be pointed out that—
(1) The filling in of all the tanks and wells on the island would not affect
the subsoil water level to any appreciable extent. The amount of water
present in the wells and tanks represents only a fractional proportion of that
present in the soil; and the water level of wells or tanks is usually much below
the level of the subsoil water. The average rainfall in Bombay is close upon
72 inches or nearly 8 feet of rain per annum which is equivalent to a. fall of
37.5 gallons of water upon every square foot of the surface of the land. Much,
of this enormous volume of water drains away into the sea, but a considerable
amount which would otherwise drain away goes into the wells and tanks and
raises their water level considerably; and the existence of these open wells and
tanks helps to maintain the subsoil water at a higher level than it would
otherwise reach.
(2) As regards the supposed necessity for ventilating well?, it may be
pointed out that the fact that a well is quite open and uncovered does not
necessarily ensure its ventilation. The only way to ventilate many wells is by
drawing out a considerable volume of water from them, and a well entirely
covered may be better ventilated, if water is being continually pumped cut
from it, than a well the mouth of which is quite open. Other things being
equal the water from a well that is entirely covered will be cleaner and much
purer than that from an open well, especially one in the midst of a populous
city, exposed to dust and all sorts of contamination. At the present time
very few of the wells in Bombay supply water that is fit for potable use ; and
the covering of the majority of these wells would be a great sanitary improve-
ment even apart from the question of malaria prevention.
143
24,000 pills were distributed among the crew of their vessels leaving Bombay
after July. The results appear to have been very satisfactory, as very few
cases of malaria occurred among those in receipt of the pills, although the
previous year on boat after boat from 83 to 100 of the crew had bean attacked.
412. The sale of Quinine in palatable form,.— During 1910 a small
experiment was carried out in order to determine the possibility of popularizing
quinine by putting it up in a palatable form in small quantities and placing it
on sale at tea shops and with small vendors to whom a discount or commission
was allowed. For this purpose a number of 5-grain sugar-coated tablets of
quinine were obtained, packed in glass tubes, each containing 12 tablets. All
the tubes were labelled in English and in one of the vernaculars, some in Gujaráti,
some in Maráthi and others in Urdu. Directions in English and one or other of
the vernaculars were enclosed. The experimental price was fixed at annas 2 ½ per
tube and a commission of ½ an anna per tube was allowed to each vendor. Those
who agreed to sell were supplied with a large placard printed in the vernacular
announcing the fact that sugar-coated quinine tablets, for the treatment of
malaria fever and spleen, were on sale there; they were given 12 or more
tubes of tablets, and on a subsequent visit they paid for any they might have
sold at the rate of Us. 1-8 per dozen.
413. The experiment was only carried out at the end of 1910 and altogether
28 vendors were engaged. The following table gives particulars of the class
of seller, the locality and the number of tubes disposed of :—
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Class of seller.
Irani tea shop
Do.
Hindu tea shop
Irani tea shop
Do.
Ghándi
Iráni tea shop
Do.
Do.
Mahomedan tea shop
Hindu tea shop
Irani tea shop
...
...
Hindu tea shop
Irani tea shop
Do.
Mahomedan tea shop
Irani tea shop
Grocer
Ghándi
Do.
Irani
Iráni tea shop
Do.
Hindu tea shop
Muccadum
Ghándi
Do.
Medical man
Sold in office to different individuals ...
Locality.
South Fort
Do.
Do.
North Fort
Do.
Mint Road
Do.
Frere Road
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Dhobi Taláo
Do.
Do.
Do.
Do.
Esplanade Road
Do.
Do.
Improvement Trust chawls
Carnac Bridge
Parel
Dádar
Total ...
No. of
tubes.
24
24
12
7
28
31
20
24
31
48
151
84
76
6
12
61
19
2
96
12
17
28
12
3
83
132
12
193*
44
1,292
414. It will be seen from this table that a total of 1,243 tubes was sold
by 28 vendors in less than six months, an average of 4-1.5 tubes per vendor.
Each tube contained twelve 5-grain tablets or 60 grains of quinine, and the
total amount sold was equivalent to nearly 180 ounces of the drug. On the
average therefore each of the 28 vendors sold over 6 ounces of quinine salt.
It would be reasonable to assume that they would sail at least an average of
146
a day for 3 or 4 days is sufficient to check the paroxysms, and that the majority
of relapses may be prevented by continuing with a small daily dose of quinine
(about 5 grains) for a month or more.
429. Young children and even infants appear to bear quinine pro-
portionately much better than adults. A child of 5 years of age can easily
bear a dose of 5 grains of quinine repeated twice a day, and it is doubtful if
much less than a 2-grain dose is of any value in the treatment of infantile
malaria. Infants of under a year can bear the latter amount of quinine easily
and children of two or three years old, if suffering from chronic malaria and
enlarged spleen, often improve under a daily dose of 5 grains, increased to
10 when they get fever.
430. Finally, as regards the form the preparation should take, it may be
pointed out that although quinine solution is undoubtedly the best way in
which to administer quinine to individual cases, sugar-coated tablets are
so easily taken even by small children that they offer a very great advantage
when dealing with malaria-infected populations. From the point of view of
the prevention of malaria it is of more importance that, the many thousands of
mild cases should obtain a form of treatment which they will accept readily
and which will be of real service to them, than that, they should be discouraged
from making use of a remedy, by insistence upon certain ideal conditions as
regards its form and dose, which are only of great importance in serious cases
of the disease.
147
CHAPTER VII.
SOME REASONS WHICH MAKE IT IMPERATIVE THAT
THE CITY OF BOMBAY SHOULD UNDERTAKE THE
ERADICATION OF MALARIA.
431. Now-a-days the existence of a preventible disease in an important
city cannot be ignored and it has become the custom in large towns in the
tropics to carry out certain measures of anti-malarial sanitation as a matter
of routine. It is generally considered that such measures should be propor-
tionate to the prevalence and intensity of the disease, and that when malaria
is comparatively mild there is little need for drastic methods and heavy
expenditure, but if epidemics occur greater efforts must be made and increased
expenditure incurred.
432. Approaching the question of malaria prevention in Bombay from
this standpoint, it might be argued that, because malaria is endemic in Bombay,
it is necessary that measures for the prevention of the disease should be adopted.
It might be urged also that because the deaths from malaria numbered many
hundreds, the cases of disease many thousands and the money loss occasioned
to the City amounted to twelve or more lakhs of rupees per annum, it was
reasonable to spend a considerable sum in an endeavour to reduce these figures.
433. But there is a more important reason for adopting adequate
measures for the prevention of malaria in Bombay than considerations
such as these; and the possibility, not only of diminishing the amount of
malaria in the island, but of totally eradicating the local sources of infection
from the City, makes it imperative that adequate measures for attaining this
end should be adopted without delay.
434. If evidence is wanted in support of this statement it is only necessary
to point to the areas in the centre and north of the island, which are at present
almost free from malaria. A., B. and C. Wards are probably 80 times as malarious
as Mahim, Worli and Sion, but there is no valid reason why the former area
should not be rendered as free of malaria as the latter; and it should be possible
to accomplish this in a very short time, and with the expenditure of a com-
paratively small amount of money.
435. Many people are already familiar with the records of the anti-malaria
work that has been accomplished at Panama, Ismailia, Havana and other
places, but a repetition of some of the figures supplied by the officers responsible
for the work may be of interest.
436. Hongkong.—The anti-malarial measures adopted in Hongkong appear
to have been only partial ones. Dr. Clark, the Medical Officer of Health for
Hongkong, gives the following figures regarding the admissions to hospitals
from malaria and the mortality from this cause. The improvement recorded
is ascribed to the anti-malaria measures that have been adopted in the City.
Admissions to Hospitals.
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
Year.
Government Civil
Hospital.
516
450
344
475
679
787
349
347
221
266
Tung Wah Hospital.
No record.
1,021
865
780
1,220
1,294
752
568
433
419
148
The admission of malaria among the Police.
Year.
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
Total average
number of
Police.
631
630
630
770
929
920
919
921
993
1,018
Total admission
of Malaria.
203
160
121
639
390
407
176
167
107
127
Ratio per 1,000.
301
254
192
310
419
442
191
181
107
124
Deaths from malaria in Hongkong.
Year-
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
Deaths in the City.
290
302
280
218
242
281
189
152
90
87
Total in Colony.
533
554
530
546
555
574
425
300
301
287
Dr. Clark states regarding these figures—
" The rapid fall in the number of deaths from malaria within the
"city during the second quinquennium is most gratifying, for it is
" naturally here that most of the anti-mosquito work has been carried
" out
"
437. Rio de Janeiro.—Mr. M. R. Pestana-, the author of " Comment on
assainit un pays," gives the following figures as the recorded mortality from
malaria at Bio de Janeiro, before the commencement of the anti-mosquito
work there :—
1900
1901
1902
1,019
932
1,217
deaths from malaria.
Anti-mosquito measures were commenced in 1903 and the recorded mortality
has steadily diminished since that year.
1903
1904
1905
1906
1907
772
433
,295
266
239
deaths from malaria.
The author adds that owing to the fact that the city possesses many large and
modern hospitals which are greatly resorted to by patients from the interior,
many of the deaths from malaria shown as occurring in Rio de Janeiro are of
cases that did not contract their infection in the city.
438. Havana.—In. the " Sanidad y Beneficencia " Dr. J. Le Roy y Cassa
gives the following figures which show the mortality from malaria before and
after the anti-mosquito measures commenced by Gorgas early in 1901, and
continued since then.
149
Years.
1S96
1897
1898
1899
1900
1901
1902
1903
1904
3905
1906
1907
1908
1909
Total
mortality.
11,762
18,135
21,252
8,153
6,102
5.720
5,832
5,465
5,583
5,832
6,144
6.708
5,994
5,988
Malaria
mortality.
450
811
1,907
909
325
151
77
51
44
32
26
23
19
6
Co-efficient
of malaria
mortality.
1.95
3.46
8.00
3.76
1.30
0.55
029
0'19
0.16
011
0.08
0.08
0.06
0.01
439. Ismailia.—The following table gives the record of cases of malaria
at Ismailia since 1877 as given by Dr. Pressat. Malaria has disappeared since
the introduction of anti-malaria sanitation :—
Years.
1877
1878
1879
1880
1881
1882
1883
1884
1885
1886
1S87
1888
1889
1890
1891
1892
Cases.
800
400
500
400
450
480
550
900
2,000
2,300
1,800
1,400
1,450
1,900
2,590
2,050
Year«.
1893
1894
1895
1896
1897
1898
1899
1900
1901
1902 *
1903
1904
1905
1906
1907
1908
Cases.
1,750
1,000
1,350
1.150
2,089
1,545
1,545
2,284
1,990
1,551
214
90
37
No fresh cases.
No fresh cases.
No malaria contract-
ed in Ismailia.
* Anti-malaria work was began in 1902.
440. Panama.—Since the commencement of work at Panama there has
been an extraordinary reduction both in the total amount of sickness and
mortality, and that recorded from malaria. Gorgas describing the present
conditions, says :
" Our death-rate for the total population on the Zone has fallen from
" a maximum of 67.72 per 1,000 in July 1906 to 21.52 in December 1909.
«The rate for 1905 was 49.94; 1906—48.37 ; 1907—33.63 ; 1908—24.83 ;
"1909—18.19 (per thousand). The death-rate among employees from
" disease has fallen from a maximum of 62.15 in July 1906 to 1013 in
" December 1909."
Referring specially to the results of the special work against malaria
Gorgas says :
" It has reduced the deaths from malaria in the total population from
"a maximum of 16.21 per 1,000 in July 1906 to 2.58 per 1,000 in
"December 1909. Among employees it has reduced the deaths from
"malaria from a maximum of 11.59 per 1,000 in November 1906 to 1.23
" per 1,000 in December 1909. The admission rate among employees has
" fallen from a maximum of 1,263 per 1,000 in July 1906 to 191 per
"1,000 in December 1909. The admission rate per thousand among
" employees has been as follows :—1914—125 ;—1905—514; 1906—821;
" 1907—424 ; 1908—282 ; 1909—215."
B 136—38
15.1
1.
2.
3.
4.
5.
6,
Size
Population
...
Municipal income .
Malarious area ...
Breeding places of
malaria-carrying
anophelines.
Limits of danger-
ous area.
Miau Mir.
Cantonment area 8 square miles ,
16,000
Rs. 60,000
Whole inhabited portion of Can-
tonment.
Natural in character. Chiefly
pools of rain water in and around
Cantonment. Number unknown
and probably almost unlimited
at certain times of the year.
Pools may occur not only in the
Cantonment but in the dangerous
zone of flat land around it, which
extends for miles.
E. H. Ross has shown that even
at Ismailia, which is surrounded
by desert, a few mosquitoes enter
the town from small breeding
places a mile away, near a part
of the fresh water canal. If
this is the case at Ismailia, what
must be the condition at Miau
Mir which, in the rainy season,
is surrounded with breeding
places ?
To prevent malaria at Mian Mir
it would probably be necessary
to control an area as large as
the whole of Bombay Island.
Bombay.
Total area of Island 22 square
miles.
977,288.
Rs. 1,20,00,000.
Less than half the Island.
About 2,000. Almost all arti-
ficial in character. Chiefly
wells, masonry tanks, iron cis-
terns and a few pools and
minor collections of water.
The vast majority of the pools
that exist are harmless from
the point of view of malaria.
There is no dangerous zone
around the City. The sea
surrounds it on three sides,
and malaria is negligible in
the north of the Island. In
the north of the Island also
very few breeding places
harbour
malaria carrying
anophelines.
To free Bombay from the greater
part of the malaria present
there, it is only necessary to
control an area of about 10
square miles.
This comparison shows that conditions are much more favourable to successful
anopheline reduction in Bombay than at Mian Mir.
156
measures will be required for sometime, and the Special Officer appointed should
devote a large part of his time during the next two years to perfecting the
measuies of mosquito destruction now being carried out in that area.
470. As regards the use of quinine, it has already been pointed out that,
it must lake a subordinate place in Bombay. But it should not be entirely
neglected on that account. The data obtained during the investigation shew,
not only that quinine is readily welcomed by the people when supplied in a
palatable form, but that many of them will gladly purchase sugar-coated
tablets if they know where to obtain them in small quantities at a reasonable
price ; and shop-keepers and others readily become vendors of sugar-coated
tablets if they are allowed a sufficient profit upon them.
471. The popularization of quinine is a matter that can best be furthered
by the authorities, and the supply of suitable packets of the drug made up in a
palatable form, such as that supplied by the Italian Government, would be a
boon likely to be greatly appreciated. There is reason to suppose that the success
of such a measure would largely depend upon the palatability of the preparation,
and on this account sugar-coated tablets are to be greatly recommended.
472. As regards the gratuitous distribution of quinine, it may be pointed
out that this is a measure eminently suited to philanthropic agencies. It may
be suggested that the wealthier members among the different communities of
Bombay should be asked to organize for the supply of gratuitous quiniue treat-
ment to the poorer people in the more malarious parts of the City. In this
way sickness will be lessened and the larger work of malaria prevention be
somewhat lightened.
473. Finally it may be urged that the measures that have been suggested
should be given close consideration. It is often claimed that not only is
Bombay the wealthiest City of India, but she is the largest as regards popu-
lation and the most advanced as regards education and the general enlightment
of her citizens. She possesses local self-government, and an up-to-date munici-
pal administration, and her resources per head of the population are far larger
than those of any other municipality in India The problem of malaria pre-
vention in the City is far more easy, as far as natural difficulties are concerned,
than that to be faced in many other places ; not only can malaria be reduced,
but it can be absolutely eradicated from the greater part of Bombay ; and
the expenditure required is not only well within the means of the City, but would
amount to less than a tenth part of the loss occasioned each year by the disease.
158
APPENDIX II.
Note upon Black-water Fever in Bombay.
Occasionally cases of Black-water fever are admitted to hospitals in Bombay ; but in
the majority of instances the patients do not appear to have belonged to the City. During
the investigation however, two fatal cases of what appears to have been undoubted
Black-water fever were reported. In neither case was the disease returned as Hæmo-
globinuria. Unfortunately neither of the cases was seen, but a few particulars were
obtained from the medical men who attended. One case occurred in the Frere Road and
the other in the North Fort, both of which areas are intensely malarious. Both oases were
children, one a Jewish boy aged 7 and the other a Parsi child. The Jewish boy had two
attacks, a second one only a month after the 1st. He had suffered from fever and had a
large spleen. During an attack of fever and after treatment with quinine he was suddenly
attacked with persistent bilious vomiting, had a rigor and passed reddish-black urine.
Next day he was seen to be intensely anaemic and jaundiced. He rallied rapidly but a
month later fever again occurred and during treatment with quinine a sudden return of the
former symptoms took place. This time he did not rally, but sank with symptoms of
heart failure. In the other case there was a similar history, but the patient died of
suppression of urine during the attack. In another fatal case of the disease which occurred
in hospital in 1910, all that could be learned was the fact that the patient was a European,
and had previously lived in Burma. No particulars could be obtained as to the length of
his stay in Bombay or his place of residence, A definite history of • Black-water fever was
obtained from a European who lived at one time not far from Bombay in a small village
reputed to be very malarious. These facts are recorded, as they have a definite bearing
upon the relationship of Black water fever to exposure to frequent infections by malaria.
APPENDIX III.
TABLE I.
CLIMATIC DATA FOE BOMBAY (COLABA).
Temperature (in degrees Fahrenheit)-
January
..
February
...
March
April
May
June
July
August
September
...
October
November
...
December
Year ...
Means
derived
from
24 hourly
observa-
tions
1847—
3905.
73-9
75-0
78-8
82-3
81-7
83-2
81-0
80-2
80-2
81-2
791
76-1
79-6
Mean
departure
of the
lueiDS.
1-25
1-25
095
0-97
0-84
0-83
0-68
0-60
074
0-86
1-14
1-01
0-64
Í
Means for observation hours
1873—1905.
6 A.M.
69-4
70-0
74'3
78-3
81-5
81-2
79-8
78-8
78-0
77-5
74-6
71-5
76-2
2 P.M.
79-8
80-1
83-1
86-2
8S-2
85-7
82-6
82-2
82-8
85-7
84-9
823
83-6
10 P.M.
72-8
73-6
77-4-
80-7
S3-0
82-3
80-4
79-6
79-4
79-9
77-5
74-5
78-4
Diurnal range
of temperature
1873—1905.
Periodic.
10-0
101
8-3
7-9
70
4-5
2-9
34
4-7
8-1
10-2
10-8
7-4
JNon-
periodic.
14-4
14-0
12-1
10-8
9-6
8-0
6-8
7-0
8-0 Í
11-0 !
13-4 '
14-4 j
l
10-8
Mean monthly and
annual extremes
¡
1873—1805.
Maximum.
83-1
86-8
88-7
90-1
90 9
90-7
86-6
85-]
85-9
90-5
899
87-2
92-4
Minimum.
63-5
61-1
69-6
74-6
78-2
75-5
75-3
75-1
74-5
74-0
70'3
66 8
62-3 j
I
Mean
monthly
and
annual
range
1873—
1905.
19-6
22-7
19-1
15-5
12-7
15'2
11-2
10-0
11-4
16-5 ,
19-6 j
20-4
30-1
Absolute extremes (1S47—1905).
Monthly means.
Maximum.
77-3
77-7
81-8
85-0-
87-G
85 4
S3-1
S21
81-9
83-4
81-5
7S'3
S7-6
Minimum.
71-1
701
75']
78-5
82-7
81-0
793
78-7
78-9
79 5
75-9
72-8
70-1
Tally means.
Maximum.
79-7
82-1
85-2
87-6
89-5
S9'4
86-3
84-3
84-8
86-5
85-5
82-0
89-5
Minimum.
650
62-2
fi8-9
74-6
77-1
75-6
75-5
75-6
73-4
74'8
71-2
64-9
02-2
Individual
hours.
Maximum,
91-0
96-2
100-2
97*4
96-5
96-4
92-4
89-6
94-0
95-7
96-5
94-0
100-2
Minimum.
55-2
533
63-9
6S-5
74-1
72-5
71-9
71-9
70 5
70-5
62-7
57-2
53-3
Mean
diurnal
variability
of tem-
perature
1887—
1896.
0-88
0-84
0-74
0-65
0-42
0-96
0-84
0"76
0-77
0-76
0-74.
0-79
0-76
CO