41
These observations appear to show that there is a seasonal rise and fall
in the total number of infections in a given area and a corresponding seasonal
increase or decrease in the intensity of the infections met with ; and they also
support the view that there is a direct relation between the presence of high
or low endemic indices and the occurrence of malarial infections of high or
low intensity.
90. Relation of parasites to splenic enlargement.—The question has been
occasionally raised as to the relative enlargement of the spleen produced by the
different species of the malaria parasite. During the enquiry this point was
examined into in the case of 176 persons possessed of very large spleens
extending to the umbilicus or below it.
Of these—
70 showed no parasites.
41
,,
malignant tertian parasites.
58
„
benign tertian parasites.
7 „
quartan parasites.
Among the 41 cases infected with malignant tertian malaria only 7
showed the presence of crescents. Among a total of 121 crescent infections 75
showed enlargement of the spleen and 38 no palpable enlargement. Among
1,654 persons with enlarged spleen whose blood was examined for malarial
parasites in 862 or 52.1 per cent. no parasites were detected ; and among a largo
number of persons without palpable spleen whose blood was examined micros-
copically 54.5 showed the presence of malaria organisms.
Section 3.
91. MALARIA AS A CAUSE OF DEATH IN BOMBAY.— Unfortu-
nately little or nothing can be learned until quite recent times of the
effect produced by malaria on the health of the general population of
Bombay, and even now it is not possible to make more than a very rough
estimate of the total morbidity and mortality occurring in the City from
this cause. At the beginning of the 19th century the average annual mortality
in the City ranged from 4,000 to 8,000 rising to 26,000 in 1804 in consequence
of famine in the Konkan. The most common causes of death were stated to be
fever and liver complaint, but it is doubtful if much of this was due to malaria,
as in 1825 Seely stated that "the salubriety of Bombay caused it to be
"resorted to by invalids from other Presidencies and the interior."
But on occasion fever has claimed a large toll of human life, as for example
between 1863 and 1866, when scarcity in the rural districts and commercial
activity in the City led to a great immigration of labourers. It is quite possible
that malaria may have played some part in increasing mortality at this time,
for a number of reclamation works were commenced during this period, and
there are reasons for supposing that the Back Bay Reclamation especially led to
an increase of malaria in the parts of the City adjoining it.
In 1877 when the City was filled with famine-stricken people from the
Deccan, Gujarat and Rájputána, fever caused a heavy mortality ; but this
fever was chiefly relapsing fever, a fact shewn by Vandyke Carter, who reported
on it at the time. From 1878 to 1901 the annual deaths from fever ranged
from 5,000 to 9,000, but only a small proportion was due to malaria, and as
has already been remarked, when a new system of death registration was
instituted in 1902 and enquiry into the cause of death was made by trained
medical officers, the recorded fever mortality dropped immediately to 4,518
in 1902 and 2,333 in 1903.
92. Total Fever Mortality.—For the purpose of the present investigation
the record of deaths from fever is of some importance. Unfortunately as is
well known the term " fever " commonly used in India denotes no definite
disease but relates to many different condition!?.
B 136—11