NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
34
It will be seen from this table that the greatest amount of infection is
present in the Wards which showed a comparatively high spleen index among
young children. But there is not quite a direct correspondence, for the parasite
index of 0. Ward is higher than that of B. Ward, whereas B. Ward showed
a higher spleen index than 0. Ward. This is no doubt chiefly due to the fact
that blood films were obtained at different times of the year, but it is possible
that other causes are partly responsible for the difference. Malaria in B. Ward
has been mainly due to diffusion of anopheles from the New Dock area and this
would only occur during the rains and for a short time afterwards. In C. Ward
malaria is spread by anopheles which can breed uninterruptedly throughout the
year in open wells. In Wards D., E., F. and G. the parasite index is very low.
80. As has been stated previously, in Bombay there is generally little
variation in the number of infections met with in adults and children. This is
shown by a comparison of the following table : —
Malaria parasite index.
(Street infection among adults.)
Ward.
Ward A. ...
„ B. ...
„ C. ...
„ D. ...
„ E. ...
•••
„ F. and G.
Total ...
Number
examined.
948
297
271
121
279
68
1,984
Number
infected.
324
41
59
10
10
4
448
Percentage
infected.
34.1
13.8
21.7
8.2
3.5
5.8
22.5
The parasite index among young children is as follows :—
Malaria parasite index.
(Street infection among children.)
Ward.
Ward A. ...
„ B. ...
„ C. ...
„ D. ...
„ E. ...
„ F. and G.
Total ...
Number
examined.
1,733
182
388
233
599
234
3,369
Number
infected.
609
24
134
9
23
7
806
Percentage
infected.
34.8
13.1
34 5
3.8
3.8
2.9
23.6
81. The figures of the parasite indices of smaller areas than wards are
as follows : —
Sectional Table of blood examinations for Parasite Index.
Ward and Section.
Upper Colaba
Middle and Lower
A
Ward
Colaba.
South Fort
| North Port
Esplanade
Mandvi
B Ward
Chakla
Umarkhadi
Dongri
Time of year,
June and July
May, August and Oct. ...
July
May, June, July and Dec.
All times of the year ...
May and July
May
December
June
Number
examined.
28
223
71
459
1,900
155
85
161
72
Number
infected.
1
44
16
160
712
29
9
21
6
Percentage
infected.
3.6
19.7
22.5
34.9
37.5
18.7
10.6
13.0
8.3
35
Ward and Section.
C. Ward...*
D. Ward...Ê
. Ward...<
F. Ward...-
G-. Ward...-
r Market
Dhobi Talao
Fanaswadi
Bhuleshwar
Khara Talaô
Kunibarwada
iChetwadi
Girgaum
Cliowpati
Walkeshwar
Mabalaximi
.••
fByculla
Tardeo
Kamatipura
1st Naipada
2nd do.
Mazagaon
Tarwadi
fParel
< Sivri
CSion
f Mahim
LWorli
Time of year.
Jume and September ...
April, October and Dec. .
October
July and December
November
October and November .
November
June and November
July and November
September
December
August
August
May
)
j-oeptember
...
May
May
June and July
June
...
June
July
July
Total ..
Number
examined.
102
306
58
97
96
4-8
31
103
58
58
104
361
187
60
54
151
65
65
47
113
54
23
5,395
Number
infected.
29
125
15
12
12
4
1
8
8
1
1
8
5
1
2
16
1
4
" 5
2
...
1,267
Percentage
infected.
28*4
40'8
25-9
12-4
12-5
8-3
3-2
7-8
12-9
1-7
1-0
2-2
2-7
1-7
3-7
10-6
1-5
6-2
0-0
4-4
3-7
o-o
23-4
The result of the microscopical examination of these films confirms the con-
clusion regarding the general distribution and incidence of malarial infection
in Bombay, arrived at by the spleen census. Thus wherever the spleen census
indicates the presence of a large amount of malaria, as in north Port,
Esplanade, Mandvi, Market and Dhobi Talao, the parasite index both among
adults and children is relatively high, and wherever the spleen index is low,
the parasite index is found to be low also. Bat although there is a general
correspondence between the two sets of observations it is not quite an exact
one. Thus both spleen index and parasite index nearly approach one another
when they are high, but the spleen index falls more rapidly than the
parasite index ; and a parasite index of 10 per cent. or 12 per cent. may be found
in an area where the spleen index is as low as 5 per cent. It is of course
possible that this may in part be due to an unconscious selection of cases for
blood examination. It has been noticed that the person who has been ill or
is feeling unwell, especially in the case of adults, is often more willing to
offer himself for blood examination than the person who is feeling quite
fit. But in the case of young children, who are tempted to submit to having
their fingers pricked, by the offer of a reward, this selection factor is not of
great importance.
82. Numerical estimation of parasites.—At the outset it was decided to
attempt a rough numerical estimate of the parasites present in infected
specimens and as a routine plan 150 microscopic fields were examined in each
film, a l-12th oil immersion objective and a No. 1 eye piece being usad. A
field of this size contains on the average about 200 red blood corpuscles and
thus about 30,000 red blood corpuscles were examined from each case. To test
the value of this method, in one batch of 61 slides, the examination of each
film not found infected in 150 fields was extended to a maximum of 600
fields or approximately 100,000 to 120,000 red blood corpuscles.
36
The following table gives the results obtained in this test examination :—
No.
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
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
Microscopic
fields examined:
600
600
600
600
600
600
600
300
300
600
150
600
150
600
600
600
150
600
600
200
600
150
600
600
600
600
100
600
600
150
600
600
600
300
300
100
150
600
600
600
600
300
100
300
600
150
150
600
100
600
600
300
600
600
600
600
600
150
100
600
600
Result.
Nil.
Nil.
Nil.
Nil.
One quartan gamete in field 187.
Nil.
Nil.
One crescent in field 117.
One benign tertian gamete in field 231.
One benign tertian ring in each of fields Nos. 232
and 289.
Nil.
One benign tertian ring and one gamete.
Nil.
One maliguant tertian ring.
Nil.
Nil.
Nil.
Four corpuscles infected with malignant tertian
rings, one containing four separate riugs.
Nil.
Nil.
Nil.
Nil.
One benign tertian half grown ring.
Nil.
Nil.
Nil.
Mil.
25 benign tertian, large piginented rings.
Nil.
Nil.
One benign tertian piginented ring and one
gamete.
Nil.
Nil.
Nil.
2 malignant tertian rings, one each in fields 261
and 286.
One benign tertian gamete in field '219.
12 benign tertian rings.
One benign tertian gamete.
Nil.
Nil.
Nil.
Nil.
One crescent in field 244.
20 malignant tertian rings.
One benign tertian gamete in field 271.
Nil.
One malignant tertain ring.
One benign tertian ring.
Nil.
20 quartan rings, large.
Nil.
Nil.
One crescent in field 283.
Nil.
Nil.
Nil.
Nil.
Nil.
One malignant tertian ring.
124 benign tertian parsites, rings sprolating,
bodies and gametes.
Nil.
Nil.
37
All the films referred to above were taken from children resident in the
same locality. Among them some had only recently come to Bombay, others
had just returned from a visit to their country but the majority had been
resident over a year.
Those mentioned below had not been long in residence.
No.
"
55
"
"
"
"
35
19
24
26
29
39
50
51
52
... 3
... 2
... 1
... 8
... 2
... 1
... 2
... 3
days from country.
55
"
"
month ,,
„
days
„
months ,,
„
month ,,
,,
months ,,
„
days
„
„
It will be seen from the table that 22 or 36 per cent. out of the total
of 61 children showed malarial parasites in their blood. But if only 150 micros-
copic fields had been examined, seven infections. Nos. 5, 9, 34, 42, 44 and 52
would have been overlooked and the infection index would have stood at
15 out of 61 or 24.5 per cent., a difference of 11.5 per cent. Only one among
the eight children arrived from their country showed a scanty infection.
If these eight are deducted from the total examined, the resulting parasite
indices at 150 and 600 fields examined would have been 28.3 per cent. and
39.6 per cent. respectively.
From these observations it may be assumed that an examination
extending over 150 microscopic fields only reveals about two-thirds of the
infections shown by an examination prolonged for four times this period and
it follows that a parasite index obtained by the former method must be raised
at least 50 per cent. in order to show a near approximation to the actual
rate of infection.
None of the eight children recently arrived from their country showed
palpable enlargement of the spleen, but of the remaining 53, 15 showed splenic
enlargement ; and of the latter, 9 had parasites in their blood.
83. Relative Intensity of Infections.—The varying intensity of different
infections is well shown in the following table which gives an analysis of
1.052 separate cases in which malarial parasites were found on examination
of the blood :—
Number of parasites in 150
microscopic fields.
1
2
3
4
5
6
7
S
9
10
10-15
15-50
20—30
30—50
50—100
over 100
Number of cases.
234
160
101
67
46
51
14
17
31
14
66
38
74
46
31
62
Percentage of
total examined.
22.24
15. 2
9.6
6.3
4. 3
4. 8
1. 3
1. 6
2. 9
1. 3
6. 2
3. 6
7. 0
4. 3
2. 9
5. 8
84. A comparison of the infections met with in the various wards, from the
point of view of number of parasites per infected person, reveals the fact that
the average number of parasites present varies in different localities, but shows
a more or less direct relation with the parasite index.
B 136—10
38
Average number of parasites per infected person.
Ward A.
„ B. ...
„ C. ...
„ D. ...
„ B
„
F. and G.
21.9 in 150 miscroscopic fields.
16.3
18.9
6.4
9.4
2.1
The above table shows that not only is there a very much larger proportion
of people in A., B. and C. Wards infected with malaria than in D., E., E. and G.
Wards, but the character of the infections differs enormously also. On the
average the infections in the first area (A., B. and 0. Wards) are nearly four and
a half times as heavy as those in the second (D., E , E. and G. Wards). It
follows therefore that the total number of malarial parasites present in a given
number of infected persons in A., B. and 0. Wards is far in excess of that present
in D., E., E. and G. Wards and the comparison of the mean parasite indices of
the two areas 31.1 per cent. and 4.1 per cent. does not. afford a direct measure
of the relative amount of malaria in each area. If we divide the parasite index
of A., B. and C. Wards taken together, with the parasite index of D., E., F. and
G. Wards taken together we obtain the following result :—
Thus 7.5 to 1 may be said to represent the relative frequency with which
malarial infections are met with in the two areas under discussion. Bat we
are not justified in saying that the first area (A., B. and 0. Wards) is only 7.5
times more malarious than the rest of the island. The infections met with in
those wards are on the average 4.3 times as heavy as those met with in D., E.,
E. and G. Wards and 7.5 X 4.3=32.25 represents a nearer approximation to the
truth.
Broadly speaking we may say therefore that the south of Bombay Island
is about thirty times as malarious as the north.
85. The following table gives further details of the percentage of heavy
and scanty malarial in lections met with in different parts of the City :—
Number of parasites per infection
(150 microscopic fields).
1—4
5—10
10-50
50—100
100 and over
Percentage of malarial infections in each ward, showing given
number of parasites.
A.
40.3
12.5
25.9
6.7
14.1
B.
57.5
16.4
17.8
1.3
4.1
c.
61.8
13.0
17.5
1.5
6.1
D.
80.0
6.6
13.3
0.0
0.0
E.
69.4
16.6
13 8
0.0
0.0
F. and G.
92.8
71
0.0
0.0
0.0
When we remember that, an examination of 150 microscropic fields or
30,000 corpuscles reveals only two-thirds of the infections shown by a more
extended examination of at least 100,000 corpuscles, it will be seen" that, the
vast majority of malarial infectious are but very scanty ones. Ross has
estimated that at least one parasite among 103,000 "corpuscles is probably the
minimum required to produce an attack of fever ; but there are strong grounds
for supposing that in ordinary cases many more than this may be supported for
a considerable time without causing noticeable symptoms. The majority of the
cases of infection recorded in the above table showed no fever, a very large
proportion had no palpable enlargement of the spleen, and it was the rule for
them to deny the suggestion of being ill.
86. Species of Tarasite present in Bombay.—Three species of malaria
parasite are now generally recognized and each of them is present in Bombay.
The proportion of each species met with during the enquiry was as follows :—
39
Among 1,36S cases of infection examined—
621 or 461 per cent. were malignant tertian.
589 or 43*0 „ „
3 , benign tertian.
148 or 10*8 „ „
„ quartan.
Powell during the examination of. a large number of malarial bloods in
Bombay in 1901-1903 found—
1,382 benign tertian infections or 52*9 per cent.
1,186 malignant
„
„
or 45*4
„
41 quartan infections
or 1'5
„
A comparison of these figures indicates that there has been an increase of
quartan malaria in recent years. Among 357 cases in which sexual forms of
the malaria parasite were observed during the recent enquiry—
14-2 or 39*7 per cent. were benign tertian.
1?1 or 33*6 „ „ ,j crescent malignant tertian.
94 or 26 "3 were quartan.
These figures indicate that a still further increase of quartan malaria may
occur in the future.
87. Seasonal Infection.—A series of observations conducted in one of the
most malarious localities throws some new light on the course of the seasonal
incidence of malaria. Blood specimens were collected at intervals from two
large chawls A and B, both containing many hundreds of people.
The observations upon chawl A are as follows :—
Infection indices in chawl A showing seasonal incidence and intensity.
Serial
number.
1
2
3
4
5
6
7
8
9
10
Date of observation.
ïOtli June 1909
29th September 1909
)4tk December 1909
13th April 2910
i 9th „
11th June
„
lltli July
„
' 22nd August „
4th October „
...
.\.
Oth December „
i
Blood
specimens
examined.
171
100*
165*
55
50
61
70
52
54
60
Number
infected.
92
34
48
11
12
15
22
20
¿8
16
Percentage
infected.
53 8
34-0
29-1
20-0
24-0
24-5
31-4
88-5
51-9
267
Average
number of
parasites per
150 fields.
35-0
30-4
8-2
2-8
2-8
210
13 1
•12-9
13-8
8-7
This table refers to blood from both children and adults.
The children taken by themselves gave the following series of indices :—
Serial
number.
1
2
3
4
5
<s
7
8
9
10
Month.
Juue
September
December
April
June
July
August
October
December
Number
examined.
107
69*
104*
51
29
55
68
44
42
50
Number
infected.
59
20
34
Î0
5
14
21
19
22
12
Percentage
infected.
55-1
29-0
32-7
19-6
17-2
25-4
30-9
43-2
52-4
24-0
Chawl B although situated very near chawl A did not show as high
an infection index and the infections mofc with were much more scanty than
those in chawl A.
* Many residents receiving quinine.
40
Infection indices in chawl B showing seasonal incidence and intensity.
Serial
number.
1
2
3
4
5
6
7
8
Date of observation.
23rd June
190J
2nd August
„
9 th Noy ember „
7th May
19]0
11th June
„
11th July
„
t
...
30th August
„
t
5th October
„
t
Number
examined.
150
95*
103*
75
51
42
50
64
Number
infected.
60
20
45
16
8
8
12
20
Percentago
infected.
40-0
31-6
43-6
21-3
15-7
190
24-0
312
Average
number of
parasites per
150 fields.
15-9
17-4
4-4
4-0
7*1
2-7
5-8
6-4
* Many residents receiving quinine.
+ Observations made by a different observer.
88. Chawl A was composed of lines of single storied huts built of
corrugated iron and provided with roomy open verandahs in which many of the
people used to sleep. An inspector visited this chawl daily and it was kept in
a very clean and orderly condition. Chawl B was composed of three two-storied
blocks of back to back tenements, dark, filthy and overcrowded. These tenements
were provided with a very narrow landing or verandah which the tenants
mostly shut in with matting. The windows also were all stopped up with
paper and rags. It appears probable that anopheles mosquitoes obtained access
to chawl A with much greater ease than to chawl B on account of the open site
of the former chawl and the fact that windows and verandahs were not allowed
to be closed in as in chawl B. A considerable portion of the inmates of both
these chawls were in receipt of quinine treatment from the middle of August to
December 1909. During 1910 they got no treatment.
89. The ten different occasions upon which bloods were examined from
A chawl showed a varying percentage of light and heavy infection.
Serial
number.
1
2
3
4
5
6
7
S
9
10
1
2
S
5
6
7
S
June
September
December
April
June
July
August
October
December
January
August
November
May
June
July
August
October
Month.
A Chawl.
1909 ...
...
...
1910 ...
a
...
•••
i)
• • •
.. >
)}
•••
...
j)
«•»
...
j)
• • •
...
>>
'••
...
B Chawl.
1909 ...
})
•••
...
jj
• • •
• • »
1910 ...
j,
«...
»..
i)
•••
>}
•••
>>
•••
••
Percentage
of infections
showing under
10 parasites
in 150 micros-
copic fields.
54-6
67-7
83-3
100-0
83-3
62-5
81-8
45-0
Ô4-2
68-9
70-0
63 5
97-7
93-7
75-0
*100-0
*75-0
*90-0
Percentage
of infections
showing over
100 parasites
in 150 micros-
copic fields.
10-3
11-7
...
' Ö-2
4-5
10-0
3 5
...
5-0
6-6
...
* Observations made by a different observer.
42
The annual mortality recorded under the head of "Fever" in Bombay
during the past thirty years is as follows :—
1879
1S80
1881
1882
1883
188*
1885
1886
1887
1888
1889
1890
1891
1892
1893
1894
8,445
7,513
6,437
6,4*3
5,903
6,830
6,648
5,820
5,612
6,642
7,266
6,489
6,837
7,751
5,884
6,458
1895
1S96
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
6,404
8,776
6,951
4,114
5,063
7,928
7,9 SI
4,518*
2,500
2,530
2,878
4,882
3,633
3,403
2,800
2,793
93. The total deaths recorded under the heading of tc fever " among
different race during the past ten years are as follows :—
Hindus
Mussulmans
Parsis
Jews
Native Christians
Europeans
Eurasians
Others
1900.
6,045
1,423
156
25
...
14
1901.
6,484
1,025
146
53
169
32
7
5
*1902.
3,299
160
19
160
54
15
4
1903.
1,560
443
147
12
127
30
7
7
1Î5O4.
1,573
522
150
5
136
19
6
6
1905.
2,010
E>74
121
S
us 30
10
2
1900.
3,735
783
152
18
329
IS
41
6
1907.
2,604
690
131
18
1J0
29
11
10
190S.
2,351
(5S1
144
11
160
39
12
5
1909.
1,874
57S
119
7
165
32
16
2
* À new method of Begistration was introduced during this year.
Among the Parsi, Eurasian and European communities cases of illness
with, few exceptions are probably treated by qualified medical men, and the
returns made by them will undoubtedly be more accurate than the gaessed-at
diagnosis relied upon in the vast majority of other cases.
94. The deaths from fever recorded as occurring in the different wards of
the City for a number of years past bas been as follows :—
De aths from fever in different wards.
Wards.
A.
B.
C.
D.
E.
F.
G.
Harbour-, Docks, Bailways
and Homeless
Total ...
1900.
315
1,628
1,306
641
2,633
766
634
5
7,928
1901.
264
T,fiS9
1,298
604
2,720
833
496
11
7,921
1902.
231
730
890
370
1,342
437
501
11
4,518
1903.
181-
647
470
21S
535
113
JÖ6
10
2,333
ISO!.
145
063
410
226
726
127
HI
8
2,416
1905.
195
5S7
646
219
965
160
163
13
2,878
1906.
i
283
S17
814
371
1,864
314
3S7
32
4,883
1907.
283
623
096
282
1,190
278
238
37
3,633
190S.
399
034
56-3
271
973
292
236
36
3,-103
1909.
370
424
444
217
854
259
1 182
50
2,800
95. The following table gives the recorded mortality from different kinds
of fever during the past ten years :—
Simple continued Fever
Enteric IVver
Ague
Remittent Fever
Iielapsing Fever
Malaria
Total ...
1900.
45
60
545
7,278
...
7,P2S
1901.
113
62
580
7,266
7,921
1302.
99
89
483
3,817
4.518
1903.
45
| 2,288
167
2,500
1904.
55
2,361
114
2,530
1903.
60
2,311
240
267
2,S78
1900.
134
3,S14
744
190
4,882
3907.
116
2,951
417
149
3,633
190S.
Ill
2,706
255
331
3,403
1909.
02
2,322
93
293
3,800
1910.
93
2,346
61
293
2,793
43
A consideration of the figures shows that it is hopeless to attempt to draw any
conclusion from them regarding the prevalence of malaria in different years.
The nomenclature used is also responsible for considerable confusion of ideas
as may he seen by a remark in the Chapter on "Health " in the recent
Gazetteer of Bombay City (Vol. III, p. 173) where it is stated that—
" Tarwadi and Byculla have a very low death-rate from Malaria, hut
"are notorious for the prevalence of Ague and Remittent fever* which are
"due possibly to the fact that these areas are not properly drained and
"contain many cesspools."
96. Recorded mortality from Malaria.—In 1903 the deaths from ague
and remittent fever, which had previously been shewn separately in the
mortality returns for the City, were pooled and in 1904 a special table
for malaria, as distinct from ague and remittent fever, was published in
the Annual Health Report. Since then a similar table has appeared
each year, and ague and remittent fever have been shewn separately
in Health returns as "fevers other than malaria." The following figures
have been extracted from the special tables for " malaria ":—
Mortality from Malaria by months, quarters and years, as recorded in
the Health Reports of Bombay.
January
February
March
1st quarter ...
April
May
June
2nd quarter
July
August
September
3rd quarter ...
October
November
December
4th quarter ...
Total of year
1904.
26
21
26
79
20
17
22
59
19
20
24
63
23
24
69
270
1905.
27
30
18
63
17
15
25
57
16
11
29
56
34
24
23
81
257
1906.
14
23
17
54
13
19
16
41
35
7
S
30
14
22
19
55
180
1907.
13
12
18
43
9
9
11
26
7
7
8
22
20
23
15
58
149
190S.
|
17
16
22
55
20
15
9
44
20
17
14
51
81
60
30
171
331
1909.
20
25
29
74
14
32
16
42
9
24
28
61
37
50
29
116
293
1910.
18
21
25
64
13
17
12
42
33
23
24
80
37
41
29
107
293
Mortality from Malaria by Wards.
Ward A.
„ B.
„ C.
„ D.
„ E.
., F.
„ G.
Harbour, etc.
1904.
16
125
37
13
59
16
1
8
1905.
35
95
74
11
47
3
1
1
1906.
29
71
40
11
24
7
6
2
1907.
33
35
33
17
19
5
7
...
3908.
77
133
41
38
35
5
6
6
1909.
72
71
45
20
51
11
6
17
** The italics are mine.—C. A. B