NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
44
Unfortunately these records are quite unreliable, and though the deaths
returned as occurring in F. and G. wards, in which there is little or no malaria, may
be near the truth, those returned from A., B. and C. wards are far below the actual,
particularly since 1906. In 1908 it is probable that the actual deaths from malaria
in A. ward alone exceeded the total number returned as occurring in the whole
City. Of the 77 deaths from malaria recorded from this ward in 1908, 30 occurred
in North Fort and 35 in Esplanade, but there are strong grounds for believing
that the mortality from malaria in October alone in these two sections was
considerably more than this. Of the 133 deaths from malaria recorded from
B ward, 53 were reported from Dongri and only 27 from Mándvi. Dongri is a
section in which there is comparatively little malaria but Mándvi was very
seriously affected, and there is reason to suppose the mortality from malaria was
very high there in 1908.
97. Deaths at Seasons indicating Malarial mortality.—Owing to the
fact that the population of Bombay fluctuates both from year to year
and from season to season, it is difficult to estimate by indirect means the
probable number of deaths from malaria in any year ; but there are two well
recognized facts relating to the mortality produced by this disease which may
assist us in gaining some idea of the deaths produced by it in Bombay. Malaria
as is well known is a seasonal disease, and numerous observations shew that it
usually attains its maximum intensity, as indicated by the co-incident mortality,
in October or November, in other words immediately after the rainy season ;
and it takes the largest toll of human life from among young chidren under the
age of 5 years.
98. If we take the case of Esplanade section which has suffered severely
from malaria recently we find the total mortality recorded each month for the
past few years to be as follows :—
January
February
March
April
May
June
July
August
September
October
November
December
Total ...
1st half year
2nd „
1903.
41
47
54
46
30
19
21
23
27
29
30
42
409
237
172
1904.
55
56
62
49
44
32
27
40
40
29
25
45
503
298
205
1905.
58
71
73
45
49
38
19
38
32
24
31
44
522
334
188
1906.
37
45
77
124
60
37
37
46
32
24
56
60
| 635
380
255
1907.
i
29
53
72
67
22
35
32
44
51
67
63
621
288
323
1908.
61
81
87
81
71
44
35
48
54
98
66
75
801
425
376
1909.
61
71
87
83
46
42
30
40
61
48
55
55
679
390
289
It will be noticed that the mortality in October 1908 exceeded that of any
other month in the year and was nearly four times the mean of the October
mortality in the years 1904-1906.
Taking October and November mortalities together we get the following
totals :—
1903.
59
1904.
53
1905.
55
1906.
80
1907.
110
1908.
164
1909.
103
As it is well known that malaria in India almost always reaches its maxi-
mum in October and November, and as Esplanade section has been and still is
severely affected by malaria, it may be assumed that in October and November
1908 the disease occasioned about 100 deaths more than the normal.
45
The total deaths from malaria since 1904 in Esplanade section recorded
in the Health reports are as follows : —
Total ...
Deaths from malaria in
October and November...
1904.
1
1905.
8
...
1906.
6
2
1907.
9
4
1908.
53
17
1909.
31
11
99. Por the North Port which is also severely affected by malaria the
monthly mortality figures are as follows :—
January
February
March
April
May
June
July
August
September
October
November
December
Total ...
1st half year
...
2nd »
1903.
179
189
191
204
125
91
75
76
60
65
67
81
1,403
979
424
1904.
115
141
138
115
72
70
52
78
91
77
72
76
1,097
651
446
1905.
125
197
186
140
151
96
72
70
76
78
73
89
1,348
895
453
1906.
109
127
185
173
137
86
80
95
96
96
102
92
1,378
817
561
1907.
101
120
126
101
70
59
66
111
100
91
96
84
1,125
577
548
19Ü8.
77
95
123
128
118
96
64
74
79
103
93
96
1,144
635
509
1909.
90
86
134
119
93
64
59
73
71
80
74
90
1,033
586
447
As in the Esplanade so in the North Port the October mortality in 1908
shewed a considerable rise above the normal. There are grounds for supposing
that the North Port has been more or less malarious for many years, but it is
probable that a much larger proportion of the poorer inhabitants living there
obtain treatment when sick, than is the case in the Esplanade section; and if this
is the case it would materially lessen the rise of mortality in October.
The October and November mortality in the North Port since 1903 has
been as follows :—
1903.
132
1904.
149
1905.
145
1906.
198
1907.
187
1908.
196
1909.
154
It is probable that the increase of nearly 50 deaths a year at this period
since 1905 has been due to malaria, occurring chiefly among the untreated
portion of the population.
The deaths from malaria in the North Port recorded in the Health reports
for the past six years are as follows :—
Total ...
October and November
1904.
12
5
1905.
21
3
1903.
17
6
1907.
17
5
1908.
80
12
1909.
29
6
B 136—12
46
100. The monthly mortality figures for Mándvi section which has also
suffered considerably from malaria in recent years are as follows :—
January
February
March
April
May
June
July
August
September
October
November
December
Total ...
1st half year
2nd „
1903.
255
239
350
323
196
131
134
139
150
131
126
142
2,346
1,524
822
1904.
185
227
271
233
163
125
144
148
185
164
161
163
2,169
1,204
965
1905.
240
319
300
288
281
143
93
116
106
110
106
152
2,254
1,571
683
1906.
169
206
306
388
278
151
147
144
141
131
114
131
2,306
1,498
808
1907.
137
160
220
174
114
105
110
120
135
152
114
120
1,661
910
751
190S.
103
100
168
172
139
115
92
122
129
178
121
127
1,566
815
769
1909.
100
116
183
148
99
72
66
89
98
125
86
127
1,309
718
591
As in Esplanade and North Fort sections so in Mándvi there was a con-
siderable rise in mortality in October 1908, the highest mortality of the year
occurring in this month ; and there is no doubt that the figure would have been
much higher but for the fact that several thousand people were displaced from
the malarious area owing to demolition of house property in 1903.
The totals of the joint October and November mortalities for the past seven
years in Mándvi are as follows :—
1903.
257
1904.
325
1905.
216
1906.
245
1907.
266
1908.
299
1909.
211
There appears to have been a gradual increase of mortality at this season
each year from. 1905, and it is probable that this increase represents in part the
effect that malaria has had upon this section in recent years.
The mortality from malaria in Mándvi recorded in the Health reports
is as follows :—
Total ...
October and November
1904.
28
4
1905.
35
12
1906.
35
0
1907.
3
1
1908.
27
18
1909.
4
3
Of the 35 deaths reported in 1906, 29 occurred between January and June
and only 6 between July and December.
It is probable that the deaths actually due to malaria in 1908 were nearer
150 than the 27 recorded and it is certain there were many more deaths from
this cause in 1007 and 1909 than 3 and 4, the totals given above.
101. Owing to the displacement in recent years of very large numbers of
the people residing in Dhobi Taláo, Market and other sections of the City no
conclusions can be drawn from the monthly mortality returns for these areas,
and reference to them is therefore omitted.
102. Deaths among children indicating Malarial mortality.—It is now
generally recognized that malaria produces a greater mortality among young
children under 5 years and aged people than among adults between these
ages. Reference to the following table, which gives particulars of the deaths
at different age periods, etc., during 1907, 1908 and 1909, shows that during
1908, a year in which malaria was epidemic in certain parts of Bombay, there
47
was a considerable rise in the deaths among young children below five
years of age :—
Ages.
Under 1
1-5
5—10
10—15
15-20
20—30
30—40
40-50
50—60
Over 60
Unspecified
Total ...
Popula-
tion at
Census,
1906.
13,027
56,748
70,009
85,762
101,559
282,817
195,284
99,143
43,872
26,574
3,327
977,622
Total deaths at different
age periods.
1907.
8,276
3,670
1,352
1,883
3,275
7,26S
4,605
2,883
2,456
3,005
9
38,637
1908.
9,077
4,173
l,40S
1,69S
3,152
6,476
4,128
2,574
2,471
3,080
10
3S,27l
1909
S,030
2,972
1,201
1,573
2,833
6,329
4,050
2,664
2,334
2,874
12
34,878
Death-rate par 1,000 at
different age periods.
1907.
635.29
64.67
19.31
22.01
31.26
25.69
23.58
29.07
56.36
11308
2.7
39.56
1908.
696.78
75.53
20.11
1979
31.03
22.89
21.13
25.96
56.71
114.32
3.0
39.13
1909.
616.41
52.37
17.25
18.34
27.89
22.37
20.73
26.87
53.56
108.15
3.6
35.66
Percentage of deaths at
age periods to total deaths.
1907.
21.39
9.48
349
4.38
8.46
18.78
11.90
7.45
6.34
7.76
.02
100.0
1908.
23.71
10.90
3.67
4-42
8-23
13-92
10-96
6-72
6 «45
7-93
•02
100-0
1903.
23-02
8*52
346
4-51
S-12
18-14
irei
7-63
6-69
S'24
•03
100-0
Had the population of the City possessed an age distribution similar to
that of the Presidency, this increased mortality among young children would
bave reached a total of more than 2,500 deaths.
103. The deaths among young children under 1 year and under 5 years of
age in the different wards of ths City since 1902 has been as follows :—
i
A. Ward.
Under 1 year
1-5 »
Total ...
JB. Ward.
Under 1 year
...
1-5 „
Total ...
C. Ward.
Under 1 year
1—5 ,,
Total ...
D. Ward.
Under 1 year
1—5 „
Total ...
JE". Ward.
Under 1 year
1-5 ,
Total ...
F. Ward.
Under 1 year
i-s „
Total ...
G. Ward.
Undnr 1 year
...
...
1 5 „
...
Total .
1902.
¡
461
1S2
643
2,159
819
2,973
1,985
753
2,73S
761
357
1,118
2,700
1,085
3,785
740
297
1,037
770
397
1,163
1903.
415
214
629
1.866
771
2,637
1,813
916
2,729
734
365
1,099
2,457
1,127
3,584
719
3- ; 6
3.045
712
368
1,080
1901.
425
144
569
1,839
696
2,535
1,764
696
2,450
730
2S9
1,019
2,619
902
3,521
702
237
999
840
309
1,149
1905.
547
202
749
2,118
904
3,022
1,998
832
2,830
S66
332
1,198
3,195
1,441
4,63G
894
3G9
1.2G3
1,043
459
1,502
1906.
535
246
7S1
2,014
871
2,885
1,861
814
2,675
916
397
1,103
3,433
1,749
5,182
1,118
60 c J
1,727
1,227
627
1,851
1907.
i
458
191
039
1,546
6S8
2,234
1,569
726
2,295
721
389
1,110
2,433
1,077
3,510
78G
327
1,113
863
381
1,244
3908.
615
225
840
1,556
770
2,326
1,580
739
2 319
769
327
1.096
2,097
1,237
3,934
S55
3Ô3
1,338
1,004
483
1,487
1909.
410
157
567
1,277
530
1,807
1,547
567
2,814
699
276
974
2,399
827
3,226
S14
270
1,084
884
346
1,230
48
Unfortunately the fluctuation of the population from year to year influences
these figures very greatly, and in the last few years the population in certain areas,
notably in B., C. and D. Wards, has been greatly reduced owing to the demolition
of many insanitary localities. Probably 40,000 people have been displaced in this
way quite recently. But A. Ward has not been greatly influenced in this way,
and the increased mortality among children in that ward in 1908 is undoubtedly
due to the influence of malaria. It is probable that at least 300 young children
under the age of 5 fell victims to malaria in A. Ward during that year.
104. Examination of figures for smaller areas than wards brings out the
following facts :—
Mortality of Young Children.
Middle Colaba.
Under 1 year
1-5 „
Total
Fort, North.
Under 1 year
1-5 „
Total ...
Esplanade.
Under 1 year
1-5 „
Total ...
1902.
112
44
156
2G5
112
377
5S
18
76
1903
107
57
164
?21
110
331
68
38
106
1901.
129
38
167
210
73
283
74
23
1905.
153
41
194
28(5
12J
407
83
31
114
1906.
157
83
240
263
116
379
82
40
123
1907.
100
50
150
235
97
332
88
36
124
1908.
112
31
143
333
118
451
139
64
203
1909.
124
35
159
168
88
256
96
25
121
It will be seen from the above table that in 1905 and 1906 there was a
great increase of child mortality in Colaba. This increase appears to have been
associated with the increased prevalence of "fever" in Colaba in those years, an
increase shewn also by the rise in the number of cases treated at the local dis-
pensary. Esplanade and North Fort shew a greatly increased child mortality in
1908 and there is no doubt that this was the result of the severe malaria
prevalent in that year.
It is no use giving figures for other malarious sections such as Mándvi.,
Dhobi Taláo and Market, as very large displacements of population have occurred
in all these areas which render the figures fallacious.
105. Effect of malaria upon births, etc.—It is well known that malaria
exerts considerable influence in reducing the births and increasing the
number of still-births and miscarriages that occur in a community. Un-
fortunately the registration of births is not supposed to be accurate in
Bombay, and the shifting character of the population largely affects the
number recorded as occurring in different localities from year to year. But
it may be pointed out that in A. Ward which is very malarious, and where there
appears to have been little change in the population in recent years, the total
number of births has steadily fallen, as the following figures shew :—
A. Ward total births.
1902.
1,107
1903.
1,020
1904.
1,265
1905.
1,270
1906.
1,240
1907.
1,222
1908.
1,087
1909.
1,077
It may be remarked also, that as a whole, the births m portions of the City
known to be malarious have either remained stationery or shew a slight
decrease in recent years. During 1908 the ratio of still to live-births increased
in the malarious areas as may be seen by the following figures :—
Ratio of still-births to 1,000 live-births,
A. Ward
B. Ward
1906.
91
109
1907.
101
98
1908.
119
136
1909.
108
107
49
In particular there was a great increase in still-births in Esplanade section.
Ratio of still-births to 1,000 live-births in Esplanade.
1904.
106
1905.
176
1906.
175
1907.
158
1908.
218
1909.
188
Esplanade section was the area most severely affected by malaria in 1908
and the above figures are important in view of this fact.
106. Before leaving the question of malaria and its effects in reducing
births, increasing still-births and miscarriages and diminishing the natural increase
of population, it may be pointed out that the birth-rate among Pársis, who as a
race shew more evidence of chronic malaria than any other community in
Bombay, has been exceedingly low for many years. The Pársi birth-rate has
only once reached 30 per 1,000 in 1888 ; for long periods their total births have
only exceeded the deaths by a small number, the maximum excess of births over
deaths having only once approached 6 per 1,000 ; and for a number of years the
deaths have exceeded the births.
A large proportion of the total Pársi population live in the North Fort and
Dhobi Taláo, which are two of the most malarious sections of the City; many
Pársi families reside in houses which contain open wells infested with the
malaria-carrying anopheles Neocellia stephensi and many of them suffer from
chronic malaria ; and in view of these facts the lack of increase in the Pársi
population of Bombay is most significant.
Section 4.
107. MALARIA AS A CAUSE OF SICKNESS IN BOMBAY.—The
earliest records of sickness in Bombay do not suggest that malaria was
a very serious cause of morbidity 150 years ago. Judging by the hospital
returns for January 1774, quoted in another paragraph, only about 10 per cent.
of the total cases under treatment were admitted to hospital for "fever." But
at a later period the disease became more common, as may be seen by a table
quoted in Davidson's Diseases of Warm Climates in 1893. This table which
gives the mean number of admissions for intermittent, remittent and continued
fever per 1,000 of strength among British troops at different stations in India
for a series of years is as follows :—
Admissions.
Intermittent
Remittent and continued fever.
Lahore.
1406.0
48.7
Pesha-
war.
1119.3
717.8
Bombay.
917.3
94.5
Saugor.
703.1
169.3
Meerut.
674.5
126.7
Agra.
278.0
181.0
Luck-
now.
122.1
168.2
Port
William.
117.2
166.5
Madras.
39.7
116.6
Unfortunately the years to which these figures refer are not given, so that
it is impossible to learn the period to which the table relates.
108. The admissions for ague and intermittent fever among British and
Native troops stationed in Bombay since 1896 have been as follows :—
British Troops.
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1905
1007
1908
1909
Years.
Average annual
strength.
1,212
1,128
1,200
1,266
1,164
1,240
1,322
1,333
1,296
1,268
1,122
1,056
1,152
1,055
Total admission
for ague.
107
268
168
227
173
241
154
205
142
233
256
240
392
304
Ratio per 1,000
of strength
admitted
for ague.
88.3
237.6
140.0
179.3
148.6
194.4
116.5
153.8
109.6
183.8
228.2
227.3
340.3
288.2
B 136—13
50
Native Troops,
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
Years.
...
...
...
Average annual
strength.
1,255
1,383
1,213
1,232
1,234
1,264
1,167
1,801
1,005
720
554
586
648
711
Total admission
for ague.
257
249
303
271
318
522
329
391
323
271
261
232
330
235
Ratio per 1,000
of strength
admitted
for ague.
204.8
180.0
249.8
220.0
257.7
4130
281.9
300.5
321.4
376.4
4711
395.9
509.3
330.5
It will be seen from these figures that malaria has not produced a very
great amount of sickness among British troops in Bombay City. And although
there was a considerable rise in the admission rate between 1907-1909, the
increase cannot be attributed to local causes entirely, as during this period a
regiment that had been stationed in Lahore Cantonment (Mian Mir) was drafted
to Bombay. The situation of the Bombay Cantonment (Colaba) for British
troops is an excellent one, and there is little evidence to shew that malaria is
contracted in that locality, which appears to be wonderfully free from sources
of infection.
The admission rate for "intermittent fever" among Native troops in Bombay
is much higher than that among British troops. This is probably due mainly
to the fact that the barracks of the Native troops are situated in parts of the
City which have been shewn to be malarious. The Native Infantry Lines at
Paitan Road are within the area that has been influenced by the new dock-
works and the larger barrack at Marine Lines adjoins Dhobi Taláo section, which
is seriously affected by malaria on account of the number of open house wells
infested with Neocellia stephensi which are present there. It will be seen that,
in spite of good housing and regular treatment, the Native troops suffered from
malaria in 1908 in the proportion of over 500 per 1,000 of strength.
109. The following table gives the total admissions for supposed malaria
in a number of medical institutions in Bombay for a series of past years :—
1890
1891
1892
1893
1894
1895
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
Year.
...
...
...
...
...
...
...
...
...
...
...
...
...
.. .
...
...
...
...
...
...
...
...
...
Number of Hospi-
tals and
Dispensaries.
7
10
11
11
11
11
11
11
11
11
10
17
29
29
22
21
21
21
20
21
Number of admissions.
96,697
109,372
112,959
106,316
119,911
108,947
79,411
71,742
83,019
100,459
90,580
153,486
209,013
207,654
372,492
381,030
369,799
337,613
341.684
358,765
Number of malaria
cases.
9,911
13,264
13,723
13,174
13,424
13,597
8,417
4,345
6,170
9,811
10,190
23,597
34,217
38.148
48,539
46,461
51,181
55,364
63,938
54,839
Percentage.
10.2
121
12.1
12.4
11.2
12.5
10.5
6.05
7.4
97
11.2
15.3
16.3
18.3
13.03
12.2
13.8
16.4
18.7
15.3
51
From this table it would appear that in recent years only about 50,000
cases of supposed malaria have been admitted annually to dispensaries and
hospitals in Bombay and this number represents only from 12 to 18 per cent.
of the total cases treated. But these figures give no true indication of the
total amount of sickness produced by the malaria in the City.
110. If we examine the returns from the Police Hospital since 1901 we
get the following figures :—
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
Year.
...
...
...
Average
Total admissions
for sickness.
1.885
1,886
1,670
1,803
1,938
1,901
1,919
2,502
2,488
2,204
2,196
Admission for
fever.
1,095
953
815
897
1,034
890
913
1,626
1,455
1,157
1,083
Percentage.
58.0
50.5
48.8
49.1
52.3
46.8
47.5
64.9
58.4
50.2
49.3
It will be seen from this table that nearly 50 per cent. of the total
admissions from among about 2,000 police stationed in all parts of Bombay
are due to febrile disease. I)r. Powell's observations in 1901-1903 shewed
the presence of malarial parasite in 75 per cent. of all cases, so that it is probable
that the average admission rate for malaria among the police in Bombay is not
less than 376 per 1,000 per annum.
111. In 1908 of the total admissions for "fever" among the police, the
following percentages came from the different wards in the City :—
A. Ward
B.
C.
D.
E.
F.
G.
42.1 per cent.
29.5
10.2
6.0
6.4
3.3
2.1
Over 80 per cent. of the cases of malaria were drawn from A., B. and C.
Wards, rather more than 12 per cent. from D. and E. Wards, and only 5.4 per
per cent. from F. and G. Wards. These figures support in a remarkable way
the conclusions regarding the distribution of malaria on the island of Bombay
arrived at as a result of the spleen census and blood examination.
112. From the following table which gives more detailed particulars of the
admissions of fever at a number of dispensaries in the City, it will be seen that
the percentage of admissions recorded in various institutions in different parts of
the City during a series of years have ranged as low as 1.5 per cent. and as high
as 64.9 per cent.
53
admissions. A similar change is seen in the figures for No. 4 District dispensary
where a sudden fall from 20.7 per cent. and 16.1 per cent. to 7.9 per cent. is
recorded in 1908, the fever admissions rising to 26.5 in 1909. From some of the
dispensaries two sets of figures have been obtained, one showing a fairly high
percentage of fever admissions and the other a lower one and it has been found
impossible to ascertain which is the correct one. Some confusion appears to have
been caused by the attempt to notify cases of "supposed malaria" separately
in some institutions and to include them among general admissions for "fever"
in others. In the case of the Railway dispensaries it is quite obvious that the
introduction of some change in the method of recording all admissions in 1904 has
been responsible both for the enormous increase of patients treated and the great
fall in the proportion of fever cases. In the appendix, tables are given showing
the monthly admissions to a number of the dispensaries mentioned above.
113. It may be remarked that one of the arguments originally put forward
in support of the establishment of Municipal Free Dispensaries was the suggestion
that they would gire valuable indications of the presence of epidemic and
other diseases in the City. There is little question that the dispensaries
might easily serve as indicators of the prevalence of sickness ; and if their
sick returns were carefully systematized and in the case of fever admissions
a correction factor was established by the careful examination of some
hundreds of blood specimens from each dispensary, much valuable informa-
tion would be gained from year to year, which among other things would
be of great service in estimating the effects of anti-malarial measures.
114. During the course of the special investigation 1,001 blood specimens
obtained from fever cases admitted to a few of the hospitals and dispensaries of
the City were examined microscopically, and the results obtained are recorded
in the following table :—
Cases of fever from different localities in the City.
Ward.
Ward A. ...
B.
C.
D. ...
E. ...
F. and G.
Total ...
Number
examined.
33S
155
134
60
290
24
1,001
Number
infected.
180
G3
39
23
83
10
398
Percentage
infected.
53.2
40.6
29.1
38.3
28.6
41.6
39.7
It must be remembered that the percentage of infection found in these
cases by an examination of 150 microscopic field represents only about two-
thirds of the actual which would probably be as follows :—
Ward A. ...
B.
o. ...
D.
E. ...
F.
and G.
Total ...
79.8
60.9
43.6
57.4
43.2
62.4
59.5
per cent. infected.
»
Prom these figures we are justified in assuming that malarial parasites
are present in from 43 to 80 per cent. of the cases of fever diagnosed as
malaria in Bombay.
But there are considerable differences to be observed in the proportion of
infected cases obtained from different parts of the island, and this fact
emphasizes the necessity for making similar observations in connexion with
each dispensary, so that the figures obtained may be used as correction factors
for testing the statistics of admissions.
B 136—14