NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
48
of the mound and partly on the flat ground. Unlike the central area these suburbs,
mostly formed of mud-built huts occupied by Chamars and other low castes, are
densely populated.
The greater part of the population of Palwal therefore live in a zone not above
300 yards wide lying round the foot of and on the slope of the conspicuous but
partially deserted central mound.
Mortality.
The curve of mortality at Palwal is shown in Chart 3. It is noticeable as
rising even higher in November than in October, the same notched summit being
seen as occurred in the curve of Amritsar. The great majority of deaths were
recorded in the crowded quarters already referred to, but information was too
scanty to enable a detailed survey to be made.
According to age the deaths were as follows:—
Stillborn .
.
.
.
.
.
.
.
.
.
.
33
Children under five years .
.
.
.
.
.
.
. 590
Other ages .
.
.
.
.
.
. .
.
.
. 468
Reaction to Epidemic Conditions.
Like Amritsar, Palwal had already suffered several times from severe epi-
demics of malaria. The most serious of such visitations occurred in 1878. There
was also a very high death rate in the following year when the district was affected
by the great 1879 epidemic.
Spleen Rate and Parasite Rate.
Taken collectively the spleen rate among children examined gave the follow-
ing percentages:—
4
15
49
19
12
88%
147
Taking only the outskirts, the rate was higher and the increase in the size of
the organ very marked. The rate for the quarter Chamarwara was as follows:—
13
20
50
13
3
97%
30
Among adults the spleen rate was:—
7
13
7
19
54
46%
55
In a small area in the extreme centre there seemed a slight reduction in the
spleen rate, but it was difficult to get sufficient children in this almost deserted
portion to get reliable results. The examination of 16 children gave
—
0
19
31
12
38
62%
16
Palwal was therefore affected throughout by malaria of high intensity. If a
central protected zone existed it was small and contained but few people. Malaria
in the peripheral portions of the town was in places extremely intense.
49
An examination of the blood of children for parasites gave—
Infections over
100.
Infections over
20.
Infections over
5.
Infection under
5.
Negative. Percentage
infected.
Number
examined.
1
7
14
8
6
83
36
The species found being as follows :—
Simple tertian.
Malignant tertian.
Crescents.
Quartan.
24
4
4
0
Breeding Places of Anopheles.
In 1908, when Palwal was surrounded by standing water, there must have
existed around it a continuous ring of breeding places, and as the water subsided
many acres of land covered with shallow pools, eminently suited to the breeding
of anopheles (vide Amritsar), must have been formed.
A good idea of the conditions during the rains was obtained as the result of a
fall of several inches at the time of my visit, though at this time the season was
too early to expect to find larvæ in open pools. At the north end of the town
cultivated fields, then covered with an almost continuous sheet of water, extended
up to and even among the houses. On the west were acres of waste land covered
with innumerable pools and collections of water lying upon the impervious soil.
On the east were large sheets of permanent water and low water-logged fields.
Within the town breeding places were much less numerous and in the central
area on the mound no pools were found to retain water for more than a very
brief period.
At the time of my visit anopheles were not numerous, but a number of M.
culicifacies were caught in different parts of the town. The size of Palwal was
apparently insufficient to offer any obstacle to the spread of the epidemic. Like
Amritsar it appeared to have been chiefly influenced from its surroundings.
(iv) Bhera.
Bhera is a town of 18,680 inhabitants situated on low lying land near the
Jhelum river in a tract which suffered very severely in the epidemic. ( Vide Map
10.) It was visited in July 1909. Like Palwal it was surrounded by floods in
1908, so that it is stated a boat could have gone round the city. At the time of
my visit there was much water lying about the town and the subsoil water was
very close to the surface, in some parts less than six feet.
The town is more straggling than Palwal and there are large areas of waste
land within its boundaries.
50
The curve of mortality is given in Chart III. The first distinct rise in the
number of deaths occurred in the last week of September, the onset of the epidemic
at Bhera being therefore almost exactly synchronous with its appearance at
Amritsar.
The mortality was remarkable for the enormous proportion of infants, the
number of deaths at different ages being—
Stillborn 22
Over 5 and under 10 years
. 51
„ 10 „ 20 „
. 24
Under 1 year 260
„ 20 „ 30 „
. 18
„ 2 years 130
„ 30 „ 40 „
. 14
„ 3 „ 61
„ 40 „ 50 „
. 9
„ 4 „ 40
„ 5 0 „ 6 0 „
. 24
„ 5 „ 12
Over 60 .
.
.
.
. 94
Children under five years 503
Other ages .
. 234
Past History.
Bhera is interesting from the fact that the town suffered severely from
epidemic malaria in 1903, not because of excessive rain but following, it is stated,
upon the flooding of the surroundings by the Jhelum river. It has suffered in some
other epidemic years but never apparently so severely as in 1908.
Spleen rate and Parasite rate.
The spleen rate was taken in eleven places, being collectively—
9
13
47
23
16
84%
113
The centrally situated portions were examined to ascertain what amount of
reduction in the spleen rate, if any, occurred in among dense blocks of houses ;
but as 21 children gave a spleen rate as follows any definite reduction is doubtful :—
0
4
52
19
24
76%
21
In adults the rate was 36 per cent.
In any case such an area would have had but a theoretical interest as the pro-
tection must have been very slight and the area so small as to make it difficult to
get more than the number of children quoted.
The parasite rate in July was as follows :—
Infection over
100.
Infection over
20.
Infections over
5.
Infections under
5.
Negative.
Percentage
infected.
Number
examined.
0
0
6
8
26
37%
40
The parasites were, in the slides examined, without exception the simple
tertian species.
51
Breeding Places of Anopheles.
Anopheles were breeding freely in weedy pools just outside the city and in
one or two small puddles within the city boundary. It is impossible to say what
the conditions as regards breeding places during the rains might have been.
(v) Miani.
Miani is a town of only 7,220 inhabitants, situated near Bhera, but so situated
that a portion of the town lies on slightly higher ground which forms the bank of
the riverain at this spot.
Though the southern part of the town was on comparatively dry ground the
northern portion lay on water-logged ground with much standing water about and
the subsoil water level of from 5 to 6 feet from the surface.
The mortality rose in the last week of September and reached a figure of 403
per mille in the second week in October. The spleen rate was
—
5
19
35
20
21
7 9 %
56
No part of the town was found unaffected.
(vi) Gujrat.
Gujrat, with a population of 19,048, is built on a very high mound surrounded
by low flat cultivated land. Unlike Palwal the portion on the summit of the
mound is thickly populated.
The mortality first reached 100 per mille on the last week in September and
attained to a rate of 247 per mille on the second week of October, but this high
rate was maintained for a short time only.
The spleen rate on the margins of the city was
—
0
5
24
21
49
51%
37
In the central portions it was even lower—
.7
. 7
15
21
62
38%
130
H 2
52
CHAPTER VII.
Conditions in Rural Areas.
I.—VILLAGES OF THE AMRITSAR AND GHERINDA THANAS.
Though the figures are high the returns for the district of Amritsar do not
indicate such high mortality as occurred in the city. For the district as a whole
the increase in mortality above normal was about five times the non-epidemic
average.
Taking the figures for the separate thanas the mortality is seen not to have
been uniform.
Normal
rate.
Deaths,
October 1908.
Epidemic
figure.
West.
Amritsar .
.
.
.
.
.
.
.
.
.
165
1,613
9.7
Gherinda .
.
.
.
.
.
.
.
.
.
173
1,341
7.7
North.
Jandiala .
.
.
.
.
.
.
.
.
.
194
947
4 . 8
Wazir Buttal
.
.
.
.
.
.
.
.
.
159
515
3.6
Kuthna Nangal .
.
.
.
.
.
.
.
.
215
1,152
5.3
East.
Ajnala
.
.
.
.
.
.
.
.
.
.
207
1,150
5.5
Lopoki
.
.
.
.
.
.
.
.
.
.
156
761
4.8
Randas
.
.
.
.
.
.
.
.
.
.
109
452
4.0
South.
Tarn Taran
.
.
.
.
.
.
.
.
.
233
1,348
5.7
Sirhali
.
.
.
.
.
.
.
.
.
.
192
744
3.8
Vairowal .
.
.
.
.
.
.
.
.
.
122
452
3.5
The two most seriously affected thanas lie around and to the south-west of
the city of Amritsar.
The result of mapping the two thanas of Amritsar and Gherinda according
to the epidemic figures of individual villages is shown in Map 8. It will be seen
53
that roughly speaking, though there are areas which by this method appear to
have been less affected than others, the distribution of high mortality is very
general. Too implicit reliance on the figures may lead us astray, but there seem to
be islands of comparatively unaffected villages and areas of specially intense
activity.
Conditions found at Villages visited.
Atari.—Atari is a large village with a recorded population of 3,216. It forms
a compact block of buildings, the centre being occupied by large more or less
ruinous palaces.
In October 1908 only 35 deaths are recorded, so that the mortality does not
seem to have been very high (130 per mille), thus corresponding with its low
epidemic figure of 5.
In March 1909 the spleen and parasite rates were as follows :—
S p l e e n r a t e .
5
1 4
4 4
17
19
81%
41
Parasite rate.
Infections over
100.
Infections over
20.
Infections over
5.
Infections under
5.
Negative. Percentage
infected.
Number
examined.
0
2
7
3
22
35%
3 4
The parasites found being—
Simple tertian
. .
.
.
.
.
.
.
.
. 11
Crescents .
.
.
.
.
.
.
.
.
.
. 1
Though many excavations lay around this village, it does not seem to have
suffered very severely in the epidemic.
Dande. —Dande is a small village having a recorded population of 505.
The recorded deaths in October 1908 were 9, about 200 per mille. The spleen
rate in March 1909 was
—
0
4
45
32
19
81%
22
Rangahr and Raniki. —These villages lie close together. They have a re-
corded population of 783 and 781, respectively. The deaths recorded in October
1908 were in both cases 13 (rates of about 200 per mille). The spleen rate in
March 1909 was—
12
12
38
31
6
94%
16
0
25
42
25
8
92%
12
54
Kahangahr.—This was a large village. It was markedly different in character
to the others, being surrounded closely on all sides by cultivated land and trees.
It also gave the impression of being more prosperous.
The recorded deaths in October 1908 were only 5.
The spleen rate in March 1909 was
—
3
3
45
42
6
94%
31
Mahawa and villages in the neighbourhood. —It will be seen from the map
that these were all very severely affected. It is to be regretted that none or them
were examined. But it is worth mentioning that the country in this direction
was seen to be lower than around Atari. Collections of water were very conspi-
cuous features, and at Mahawa there was a jheel. Mahawa showed an epidemic
figure of 18 and a calculated mortality of 460. per mille.
Gumtala and villages in the neighbourhood. —In the Amritsar thana it will be
noticed that judging from the recorded mortality there is a comparatively
unaffected tract to the north-west corner, surrounding one village with a higher
rate. This arrangement of mortality corresponds very closely with the physical
features. Gumtala lies in a gentle depression of the kind we have several times
referred to. Close to it is a drained jheel, and the main drain of this part of the
country passes through this area. The subsoil water in April 1910 was 5 feet
from the surface. The mortality during October 1908 was 241 per mille (epidemic
figure 12).
The villages Kambo, Kairabad, etc., are situated on a distinct though scarcely
visible rise in the land, and the depth of the subsoil water in Kairabad in April
was 10 feet.
We can therefore trace a distinct connection between the intensity of epidemic
conditions and the low lying situation of the village. Yet this difference in situa-
tion is one at the most of a few feet.
II.—VILLAGES AROUND PALWAL.
The tract in which Palwal and Hodal are situated and which continued to the
south includes Muttra and Agra Districts (which it will be remembered were the
worst affected of any districts in the United Provinces) lies between the Jumna
river and the high land of Alwar.
It is a level alluvial plain with but few facilities for drainage and liable to
floods.
Ferozepore Jhir and Nuh are situated very curiously in a shut in valley more
55
than usually apt to be flooded and waterlogged. It will be noticed from figures
given that all the thanas suffered very heavily.
Normal.
Figures
October
1908.
Epidemic
figure.
Northern tract .
.
.
.
.
.
Gurgaon .
170
1,220
7.1
Faraknagar .
72
781
10.8
Jatusana .
105
837
8.0
Compact high ground .
.
.
.
.
Rewari .
148
997
6.7
Sohna .
52
419
8.0
Faurn .
75
687
9.1
Along foot of Alwar nills
.
.
.
.
Nuh .
122
1,404
11.5
Ferozepore .
131
2,346
17.9
Alluvial plain of Jumna .
.
.
.
.
Palwal .
142
1,357
9.5
Hodal .
112
1,083
9.6
Hosiapur .
83
681
8.2
Punahana .
127
1,324
10.4
Hattin .
134
1,281
9.5
Reaction of the Tract to Epidemic Conditions.
The normal average of deaths in the Gurgaon district is about 1,500. In the
month of October this usually is raised, showing that the district is consistently
malarious. But between the years 1880 and 1907, excluding 1904 in which year
the figures were raised by deaths from plague, the usual October rate of about 2,000
—3,000 deaths has only been three times much exceeded, namely in 1879, 1900 and
1901, deaths numbering in these years 2,967, 4,245 and 3,549, respectively. For
a period of about 27 years therefore this tract has suffered very moderately from
epidemic malaria, and indeed the highest epidemic figure reached by any thana has
been 4 (Palwal and Punahana in 1879 and Nuh in 1901).
But in 1879 the deaths numbered 14,179 as against 15,740 in 1908. Consider-
ing the probability of registration being less accurate at this time, it is probable that
epidemic conditions in 1879 were as severe or even more severe than they were in
56
1908. The behaviour of some of the thanas at this time contrasted with their
reaction in 1908 shows as follows:—
Normal.
October
1908.
October
1879.
Gurgaon .
.
.
.
.
.
.
.
. .
170
1,220
1,179
Palwal
.
.
.
.
.
.
.
.
. .
142
1,357
1,274
Jatusana .
.
.
.
.
.
.
.
. .
105
837
812
Taori .
.
.
.
.
.
.
. .
. .
75
687
594
Punahana .
.
.
.
.
.
.
.
. .
127
1,324
737
Nuh .
.
.
.
.
.
.
. .
. .
122
1,404
915
Ferozepore .
.
.
.
.
.
. .
. .
131
2,346
883
Rewari
.
.
.
.
.
.
.
.
. .
148
997
1,877
It is interesting to see that Rewari, the healthiest of the thanas in 1908, is here
one of the most severely affected, Nuh and Ferozepore in 1879 being only moder-
ately affected.
Conditions in the Villages examined.
Janoali.—This was a large village about five miles from Palwal. At the time
of my visit in April it was still surrounded by water, to avoid which it had to be
approached by a devious route. The subsoil water on the margin of the village
was between two and three feet from the surface.
The spleen rate was
—
7
28
47
17
0
100%
42
Dhatir.—This village was chosen as being situated on sandy soil. It is a large
village (population of 2,200) on a mound, and though visited the day after rain no
water had accumulated anywhere within the village. Around the village there
were but few excavations, the soil evidently not being suitable for building.
The spleen rate was
—
1
10
39
21
27
73%
92
The parasite rate was—
Infection over
100.
Infection
over 20.
Infection
over 5.
Infection
under 5. Negative. Percentage
infected.
Number
examined.
0
2
6
3
25
30%
36
All the parasites found were the simple tertian variety.
Pirthala. —A large village on sandy soil. The spleen rate was 75 per cent.
57
III.—VILLAGES OF THE BHERA, MIANI AND JAURIAN THANAS. ( Vide MAP IV.)
The thanas of Bhera, Jaurian, Miani, Pind Dadan Khan, Jalalpur and Lilleh
occupy the broad oval valley of the Jhelum above Shahpur. The chief physical
features of this riverain and the relation of this tract to the higher lands which sur-
round it will be clear from the map. (Map I.)
Above Miani high land approaches close to the river, and a little higher up near
Rasul, hills come close together forcing the river through a narrow gap. Above
this the Jhelum has again a wide valley in which lie the thanas of Jhelum, Dura,
Sohawa, Domeli and Dummon.
Mortality.
In 1908 the figures for the different thanas in the Jhelum riverain below Rasul
were as follows :—
Normal.
October
1908.
Epidemic
figure.
Jalalpur . . . . . .
. .
. .
55
826
9
Pind Dadan Khan
.
. . . . . . .
43
791
19
L i l l e h
. . . .
. .
. . . .
.
4 7
593
13
South Bank.
Miani . . .
.
. .
. . . .
.
60
538
8.9
Bhera . . . . .
.
. . . .
.
39
707
18.1
Jaurian . . . . .
. . . .
89 629
7
It is very interesting to observe that epidemic conditions of like severity
occurred in the Jhelum valley above the restriction at Rasul, the figures for the
thanas in this situation being—
Sohawa .
.
.
.
.
.
.
. 28
185
6.9
Domeli
.
.
.
.
.
.
.
. 56
517
8
Dura
.
.
.
.
.
.
.
. 64
468
7
Jhelum
.
.
.
.
.
.
.
. 85
826
9
Dhumman .
.
.
.
.
.
.
. 69
630
9
58
Mapped out in detail the Bhera and Miani thanas appear as shown in Map 10.
The villages in the Bhera thana are remarkable for the uniform high
mortality. They very rarely show an epidemic figure below 10 or a rate per mille
during October less than 250. As a rule the rate is from 300—400 per mille, and
in some it is even higher. Wazidi, with an epidemic figure of 41, gave a calculated
mortality during October of 651, Kohlian with an epidemic figure of 41, a
death rate of 439. The map shows clearly that the highest rates are in villages
lying close along the river margin. As the edge of the riverain is reached at
Hathiwind the rates become reduced ( vide Map 10). This effect is even more
pronounced in the Miani thana.
Reaction of the Tract to Epidemic Conditions.
In 1892 the tract was even more sharply visited than in 1908, the numbers of
deaths in the different thanas in October 1892 as compared with those in
October 1908 being as follows :—
Normal. October 1908.
O c t o b e r 1 8 9 2 .
Jalalpur .
. .
.
.
.
.
.
.
.
55
826
693
Pind Dadan Khan
.
.
.
.
.
.
. .
43
791
369
Lilleh
.
.
.
.
.
.
.
.
.
.
47
593
823
Miani
.
.
.
.
.
.
.
.
.
.
60
538
143
Bhera
.
.
.
.
.
.
.
.
.
.
39
707
295
Jaurian .
.
.
.
.
.
.
.
.
.
89
629
423
Sohowa .
.
.
.
.
.
.
.
.
.
28
185
286
Domeli
.
.
.
.
.
.
.
.
.
.
66
517
684
Dura
.
.
.
.
.
.
.
.
.
.
64
468
606
Jhelum
.
.
.
.
.
.
.
.
.
.
85
826
1,053
Dhumman .
.
.
.
.
.
.
.
.
.
69
630
402
It is interesting to note that Bhera, on this occasion, was not the worst affected
thana, the centre of the epidemic being further up the riverain.
Conditions in the Villages visited.
The following villages were visited in August 1909.
Alipur. —Alipur is a large village situated a little further inland than Bhera
from the river. It had an epidemic figure in October 1908 of 30 and a recorded
59
death rate of 377 per mille. There were excavations about the village, but there
were no special features to differentiate it from many other villages less severely
affected. The subsoil water was 10 feet from the surface (July 1909). The
spleen rate was
—
2
0
54
38
6
94%
50
Jamat and Ranga. —Two villages lying one on either side of an inundation canal
and within a mile or so of the river. They were surrounded by fields and the usual
excavations. There was nothing exceptional in the conditions at this time. The
subsoil water was 8 feet from the surface. The two villages combined had in
October 1908 an epidemic figure of 20 and a recorded death-rate of 461 per mille.
The spleen rate of Jamat was 81 per cent. and of Ranga 87 per cent. The two
combined gave—
5
11
45
26
12
88 %
53
Dhal. —Dhal was a large village, with an epidemic figure in October 1908 of 18
and a calculated rate of 332 per mille. It was comparatively speaking on high
ground. The subsoil water was 9½ feet from the surface. The spleen rate was
—
0
26
48
11
15
85 %
27
Kohlian. —Kohlian in October 1908 had an epidemic figure of 41 and a cal-
culated rate of 439 per mille. It lay nearer the river than any other village
examined with the exception of Jamat Ranja. The appearance of the ground
was as though water might lodge freely and it was largely uncultivated. The
subsoil water was 7 feet from the surface. The spleen rate was
—
0
8
68
12
12
88 %
25
Hafizabad. —Hafizabad was a large village, a mile or two from the river. It
gave in October an epidemic figure of 18 and a calculated rate of 382 per mille.
The subsoil water was 8 feet from the surface. The spleen rate was
—
5
26
47
16
5
95 %
19
Khan Mahomad Wala. —This was a large but squalid village situated some
miles inland. But the subsoil water level was high (5 feet) and in its neighbour-
hood were large areas inundated by a neglected inundation nullah. The epidemic
figure for October 1908 was 17, but the calculated rate was only 161 per mille.
The spleen rate was
—
0
23
56
26
3
97 %
30
Taken collectively adults in the above villages gave a spleen rate of
—
2
7
5
12
74
26 %
41
Hathiwind. —This village was specially chosen for a visit as it lay on the edge
of the higher country in the adjoining thana of Bhalwal. Though evidently
I 2
60
under different conditions to the other villages, there was a good deal of water
lying in excavations near by. The subsoil water was 12 feet from the surface.
The spleen rate was—
0
0
52
21
27
73%
23
Villages of the Gujrat Thana.
The Gujrat district may be looked upon as partly submontane where it lies
below the hills of Naoshera and partly Doab where it lies between the Jhelum and
Chenab rivers. The former tract consisting of the thanas of Karian, Karianwala,
Jalalpur and Gujrat is crossed by numerous torrents passing from the hills to fall
into the Chenab river. The latter comprising the thanas of Lala Musa, Dinga,
Kutheila Sheikan, etc., is of a different character, being for the most part
higher land and less heavily watered. The thana of Aurungabad lies geographic
-ally in the upper portion of the Jhelum valley, separated from Gujrat by some
low hills. It is the submontane portion which has suffered so severely from the
epidemic and the worst affected of the thanas was that of Gujrat. ( Vide Map I.)
Of all the thanas that of Gujrat is most cut up by streams falling into the
Chenab. At the time of my visit rain had swollen many of these, and it was
possible to see how when so swollen they were liable to break their banks and
inundate large areas.
Mortality.
Mapped out in epidemic figures for the villages an arrangement very like that
seen in the Amritsar district is evident. But in this case the contrast between
tracts in which the villages have been severely affected and those less affected is
greater. To the north-west will be seen a considerable number of villages with
low rates ; this portion of the thana adjoins that of Dinga in which the epidemic
figure was in October only 5.9. The country here is also of higher character
than elsewhere. Forming a sort of continuation of this high land eastwards is an
area occupied by a single village Nairowali with a figure of only 2. To the south,
and especially in the south-west corner, the villages on the other hand all show
without exception very high rates indeed. Groups of villages showing especially
high mortality are also seen at " a " and " b. "
Reaction of the Tract to Epidemic Conditions.
Gujrat has been affected by severe epidemic conditions on several occasions.
In 1900 the deaths in October were 3,883 or nearly three times the normal
rate ; in 1892 they numbered 8,351 and in 1890, 15,744 or half as many again as
they did in October 1908.