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CHAPTER IV.
133. THE COST OF MALARIA IN BOMBAY.—It is always difficult
to estimate the cost of a disease to a community, even when there are exact
figures to go upon, because there are so many different factors to take into
account. In cases of death there is the loss occasioned to relations, cost of
burial, funeral ceremonies and expenses which are incurred in connexion with
it ; and there is also the loss of possibly useful lives to the community,
representing capital of unknown amount. But when we come to estimate the
loss occasioned by malaria, death is a small matter compared with sickness.
Boss states that probably one-third of the total population of malarious countries
require medical treatment on account of malaria every year and that probably
from one-fourth to one-half of the total attendance at hospitals and dispensaries
are due to this cause.
134. But in India the number of cases of malaria attending hospitals is no
criterion of the total number of sick, and in a city like Bombay, where there are
probably not less than 700 qualified medical men, a host of unqualified practi-
tioners and many hundreds of chemists and druggists of all sorts, only a propor-
tion of the total sick among the population attend hospitals and dispensaries.
There are many people among the working classes also who do not think of seek-
ing treatment until after they have suffered from repeated attacks of fever ; and
it is probable therefore that only a small proportion of the eases of mild "inter-
mittent " malaria receive treatment of any kind. During the past ten years
the supposed cases of malaria treated at certain of the hospitals and dispensaries
in the City appear to have varied from about 15 to 18 per cent. of the cases
treated. The total number of cases of all kinds receiving treatment is between
3,00,000 or 4,00,000, giving an admission rate for sickness on the whole popula-
tion of nearly 400 per 1,000 per annum. But if we take the Police Hospital we
find that the rate of admission per strength for all diseases is more than 1,000
per 1,000 of strength and of these admissions nearly 50 per cent. are cases of
fever. During the years 1901-1903 the diagnosis of these fever cases, based
upon a careful examination of the blood conducted by an expert, showed that
75 per cent. were due to malaria.
It is certain that there is at least as much sickness among the general
population as among the police and probably a far greater amount ; but if we
estimate the rate to be the same we should have about 1,000,000 cases of sickness
in Bombay each year. Of these cases half or about 500,000 will be cases of
febrile disease, and of these "fever" oases 75 per cent. may be assumed to be
malarial in nature. That is to say, on a very low estimate there are probably
375,000 cases of malaria in the City every year.
135. As about 60 per cent. of the population of Bombay are workers we
may estimate that about 225,000 cases of malaria would occur among them and
would result on the average in the loss of about a week of work in each
case. Taking the average earnings of workers as at Us. 20 a month (which
is a low estimate) this would mean a loss of about Us. 5 per case, either in wages
to the worker or loss of work to the employer, and the total loss would be
equivalent to Us. 11,25,000. If we estimate a loss also of Re. 1 on every case
of malaria occurring among nob-workers, this would amount to another 1,60,000
of rupees, making a grand total of Rs. 12,85,000 per annum. In 1908 the
loss was probably more than double this or nearly Rs. 30,00,000.
136. Or we may arrive at a figure in another way.
To take the Police, again, among whom the average admissions for
"fever" are nearly 540 per 1,000 of strength per annum. The pay of the
subordinate police including the cost of their free quarters may be put down at
Rs. 15 per month or about 8 annas per day. Allowing one week off duty for
each case of fever, which is a low estimate, about 1,100 weeks of duty are lost
from this cause each year, or nearly exactly 1 per cent. This loss, estimated on