NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
38
To the north-east are large weedy tanks in which N. fuliginosus breeds in
immense numbers during the months of March and April. Similar sheets occur on
the west of the city, and one such source of N. fuliginosus is situated to the south
-east near Gurba Singh. The sheet of water to the south and west of the city and
many of those on the north and west are unsuitable for breeding and no larvæ
are found in them. M. culicifacies is found breeding in the subsoil water drain
and in a drain to the south of Khazana, but I have never found this species very
numerous at Amritsar. N. stephensi breeds especially in April and May in pools
around the city especially to the eastern side. During the rains the temporary
breeding places are exceedingly numerous as will be evident from the number
marked on the map south of Khazana, the only area in which these have been
shown.
Breeding places on the outskirts of the city. —Within or close to the city boundary
permanent breeding places are much less numerous than one might suppose.
Pools acting as breeding places and lasting some time were found upon waste
ground and in gardens in Jalewalyan and on a piece of waste ground near Khazana.
N. fuliginosus also occurs freely in some small tanks in Jalewalyan. This species
was also found breeding in the Municipal gardens and in a drain on the eastern
border of the city. Speaking generally breeding within the city boundary only
assumes importance during and after the rains.
The most important of such breeding places are
: —
(1) Flooded fields.
(2) Shallow roadside pools, pools in compounds, etc.
( 3 ) S m a l l p o o l s f o r m e d w i t h i n t h e a r e a o f h o u s e s w h e r e b u i l d i n g o p e r a t i o n s
are in progress or where a house has fallen clown, etc.; these are all
of a very temporary nature.
Breeding places within the city. —In the dry weather it would not be too much to
say that breeding places do not exist within the city proper. Unlike Delhi I
have not succeeded in finding any wells except one or two upon the extreme out-
skirts harbouring the larvæ of N. stephensi.
The large tanks of which there are several in the city have been examined
several times with no result, and it is interesting to find the healthiest portions of
Amritsar in regard to malaria are to be found in their immediate neighbourhood.
During the rains breeding places are formed in considerable numbers in the
outer portions of the city; but they decrease in numbers rapidly as one passes
citywards. ( Vide Map III.)
Distribution of Adult Anopheles.
During 1909, observations were more or less confined to Khazana and
Mahan Singh.
39
In March an examination of the area showed a few N. fuliginosus and even less
numerous N. stephensi on the extreme outskirts only. In May a catch was made
of N. fuliginosus, N. stephensi and M. culicifacies on the outskirts of the area, but
up to June adults were restricted to a narrow fringe of houses on the outskirts
of the city. At the end of June after several showers of rain adult specimens of
N. fuliginosus, N. stephensi and M. culicifacies were found considerably further in,
and as a result of careful search the limit of adults was at this time ascertained
to be that shown on the map labelled "end of July." At this time two adult
specimens only of M. rossi were caught.
Towards the end of August search showed that adults, mainly those of M.
rossi, were to be caught all over the area in which search had formally been negative,
and that the line of adult anopheles was now that labelled "end of August." This
line at which adults ceased to be caught even after long search was very carefully
followed. In the dense block of buildings north of Khazana it was not above 100
yards from the city wall; but passing southwards it extended up to the borders of
the island of high buildings already alluded to as K. Khai and was traced some
distance beyond this to the east. Thus in a month the whole of the south-west
corner to a distance of a quarter of a mile had become infiltrated by adult
anopheles.
At this time such pools as were found on the borders of Khazana swarmed with
larvæ, but in the centre of the area many pools, even very suitable ones, dried up
without becoming breeding places, showing that the great extension of M. rossi
noted had taken place with little or no help from pools within the area.
Observations in July upon Mahan Singh showed the presence of adult
anopheles throughout the whole area; but with the exception of one or two small
pools in a large compound on the boundary no breeding places were found.
In March and April 1910, and later in June, observations were made with
a view to ascertaining the distribution of adults of the species N. fuliginosus
which is found at this time in very large numbers breeding in the weedy tanks
outside the city to the north and west. Though at the time intra-mural breeding
places were confined to a very few spots chiefly in Jalewalyan, adult N. fuliginosus
were caught everywhere within the outer zone of the city.
At Mahan Singh they were found as far as the town hall, or in other words
to the margin of the central area in this part. In the northern portion of
Jalewalyan they were found up to K. Drail on the edge of the central area, and in
the southern portion of the same area as far as the buildings at the back of the
Golden Temple.
In all these areas it was just possible that breeding places existed though
careful search had failed to reveal any of sufficient importance to account for the
numbers of adults. But in Ghumarian the_conditions were peculiar and quite
40
preclude any chance of these insects (here as elsewhere found as far in as the border
of the central zone) having been produced locally. Ghumarian is an area closely
covered with houses. The only open spaces are the market square, a factory,
a garden used as a weavers' compound and some small yards in which buffaloes
are kept. Systematic search through the whole area failed to bring to light any
source of anopheles.
Immediately outside the city at this part however there is a very extensive
sheet of water in which, as it was overgrown with weeds, N. fuliginosus and C. pul
-cherrima were breeding in large numbers.
By searching the houses, sheds, etc., on the outskirts numerous anopheles,
mainly N. fuliginosus but also other species, were caught. A sample batch gave
as regards N. fuliginosus
—
N. fuliginosus .
.
.
Males
.
.
.
.
.
. 8
Females. .
.
.
.
32
After passing inwards from the city margin for a distance of about 150 yards,
a line was encountered such as had been noted at Khazana in which adults ceased
to be caught in shops, houses, etc. But it was found that past this line adults
were still to be caught in a stable or cowhouse or to a less extent over wells that
were covered with a roof. By searching in situations of this kind anopheles were
found to extend to a distance of half a mile into the city. They ceased to be
found almost exactly at the line already marked out by the spleen rate. 1
Passing beyond the region of cowsheds search was negative, but after passing
through a portion of the central area anopheles were again found, but in smaller
numbers, in cattle sheds of Katra Killabangian.
In all such places males were noticeably absent, only one male being caught
" beyond bounds," so to speak, in the whole period of observation. A represent
- a t i v e c a t c h m a d e i n a s i n g l e c o w s h e d g a v e —
N. fuliginosus .
.
.
Males .
.
.
.
0
Females
53
Further proof that these adults were not produced locally in obscure breeding
places which had evaded observation, is to be found in the fact that the insects
were of large size showing that they had bred under suitable conditions, which
could not be the case had they come from wells, pots, etc., even N. stephensi in
such a case occurring as very small specimens.
The condition of the ovaries is also peculiar, the ovarian index being of the
second type, vide page 88, or that characteristic of communities of anopheles
1 It is perhaps desirable to state that though wells harboured adult fuliginosus no larvæ could ever be
found in such situations.
41
remote from breeding places or existing after these have disappeared. As these
conditions lasted unaltered over a month there could be no question of any
abnormal or merely temporary condition, it being evident that anopheles found
their way somehow in large numbers into the city.
Taking the observations as a whole the distribution of adult anopheles (N.
fuliginosus) followed with remarkable fidelity the 75 per cent. isosplenic line.
Areas in which the Conditions were peculiar.
Kucha Ramanand. — A l l u s i o n h a s b e e n m a d e t o a p l a c e i n t h e n o r t h - e a s t
corner of the city where the zone of high spleen rate passes inwards in the form of
a bay. In a similar case in the south-east there is an extension inwards of low
buildings which satisfactorily accounts for this feature; but in the present case
the extension of the high spleen rate inwards has taken place in spite of the fact
that the buildings here are quite high.
A study of returns showed that this condition was also associated with a high
mortality during the epidemic. Carefully going over the ground I found that,
completely hidden away in the centre of blocks of buildings, there were two small
areas of waste ground. Whether these were the cause or not of the conditions, it
is impossible to say with certainty. A very much larger area of waste ground
lying in Division 6, in which anopheles were actually found breeding freely during
the rains of 1909, showed no such effect. Kucha Drail, immediately adjoining
Dacha Ramanand but exposed to the outer zone, suffered an even heavier mortality,
and it seems possible, from the conformation of the city here, that at this point
there occurred a veritable anopheles "drive," directing anopheles on to this point.
Kucha Muja Singh. —In the midst of an area with low mortality was an
alley very notable for the number of deaths which occurred during the epidemic.
This gully was situated in an area for which the spleen rate was found at several
places to be 0. Visiting it the spleen rate was found to be 50 per cent. No
explanation of this can be offered and time did not allow of further investigation
of the conditions.
Kucha Jamuan.—A somewhat similar condition was found in the south of
the city in a gully lying in among high houses but in the neighbourhood of the
"bay" referred to. This gully was brought to notice on account of the number
of deaths, and on visiting it the spleen rate was found to be 30 per cent. Exami-
nation showed no apparent reason for this gully being attacked; but the condi-
tions, on account of want of time, could not be fully investigated.
Katra Kanhayan.—This quarter lies well within the city and during the rains
of 1909 showed no breeding places. It suffered, however, severely in the
epidemic, and in February the percentage of children having parasites in their
Ey
42
blood was very high. As was frequently observed in centrally situated areas
invaded by the epidemic this rate exceeded the spleen rate.
Division 11.—This Division occupies roughly an area of 1 / 1 6
o f a s q u a r e
mile, or about 40 acres. It is exposed to infiltration of anopheles only on the
one side, namely, that facing the open ground on which lies Fort Govindgahr.
It carries a population of 16,748 living in rather large well built brick houses,
which are so densely packed that the narrow tortuous streets passing through
them will scarcely admit of a vehicle being driven through them. Like Division
10 which resembles it in character it exhibited little change in September but
succumbed eventually to epidemic malaria, showing a death rate of 342 per
mille in October and 250 per mille in November.
Loghahr, Moti Ram and Bag Singh, which lie to the outside of this Division,
showed in October epidemic figures of 7.5, 7.8 and 7.3, respectively. Chowrasta
Atara and Chauk Pasian lie further in and showed epidemic figures in October of
4.7 and 31, respectively.
In the conditions at Amritsar one is irresistibly reminded of the older theories
of malaria. The effect is exactly as though a sea of "miasm" had rolled in upon
the city swamping all the lower portions of the town and penetrating after a time
even among the high buildings of the central zone. The island of K. Khai, almost
but not quite submerged as it were in the flood, is a very striking example of
this effect.
(ii) Delhi,
Delhi has a population of 206,534 and is the largest city in the Punjab. It
is situated on the banks of the Jumna, but separated from the actual river in most
parts by a low marshy piece of riverain land known as the Bela. (Vide Map 7.)
Like Amritsar, Delhi is a walled city though the walls include areas of open land
surrounding the Fort and Cantonment. The actual city which occupies about
half the space within the walls is very compact.
Mortality.
The intra-mural portion of Delhi is divided into 11 wards, and these being
arranged very suitably for our purpose, and separate records kept, the
elaborate methods which it was necessary to use for the study of mortality in
Amritsar have not been necessary.
43
Ward I, for the most part composed of bungalows and office, lies facing
north and in part directly overlooks the bed of the Jumna. The rest of the
city is almost cut off from this aspect by the broad belt of railway which passes
through the north end of Delhi.
Ward II, immediately south of the railway, is largely occupied by public
gardens. The remaining wards are composed of dense native city. Along the
eastern margin are Wards IV, V, XI and X. Wards IV and V are very densely
crowded city. Ward XI corresponds in character rather more to the outlying
zone in Amritsar.
In the centre of the city are Wards VI and IX.
Along the eastern margin passing from north to south are the Wards III,
VII and VIII.
The mortality of the different wards during the epidemic in rates per mille
per annum and the periods at which invasion took place are given in the accom-
panying table :—
Septem-
ber. October Novem-
ber.
Decem-
ber.
Highest
weekly
rate.
Facing Jumna .
. Ward I .
178
262
125
104
305
1st week September.
Public Gardens .
. Ward II
93
147
117
88
155 3rd „ „
Eastern border of city .
Ward IV
108
236
175
165
245
4th „ „
Ward V
106
193
151
78
210 4th „ „
Ward X
..
. .
. .
. .
255
3rd „ „
Ward XI
. . ..
..
..
2 4 5 2nd „ „
Central .
. .
Ward VI
78
122
88
46
160 4 t h „ „
Ward IX
84
163
111
. .
200 4th „ „
Western border .
.
Ward III
99
151
91
57
170 2nd „ „
Ward VII
72
115
89
70
120
4th „ „
Ward VIII
84
162
111
79
175 4th „ „
It will be seen that the ward most seriously affected was Ward I. In the
case of this ward, which as we have said overlooks the bed of the Jumna,
mortality rose above a hundred per mille in the 1st week in September, a date
antecedent to that of the onset in any other part of the city.
G 2
44
The next most seriously affected wards were Wards IV, V, XI and X which
lie along the eastern border. In Ward XI which is most exposed to infiltration
and nearest the bed of the Jumna the mortality first rose above 100 per mille in the
2nd week of September. In Ward X, which adjoins Ward XI on the inner side,
the invasion occurred in the 3rd week in September. In Wards IV and V the
first marked increase in mortality occurred only on the 4th week of September.
Ward II, which contains extensive gardens with many opportunities for the for-
mation of breeding places, was not very severely affected and the epidemic was
rather late in making its appearance felt (3rd week, September).
The mortality in the western border of the city was if anything less than that
in the central wards. The least affected ward was Ward VII.
In spite of the first invasion occurring at slightly different times in the
different wards the epidemic reached its greatest development almost simultane-
ously throughout the city.
Behaviour of Delhi to Former Epidemics.
In 1906 the mortality in the different wards was as follows, the figures being
approximate only as they have been compiled from a curve :—
August.
September
October.
November.
December.
Ward I
.
.
.
.
.
49
168
222
146
111
Ward IV
.
.
.
.
.
71
134
172
184
9 1
Ward XI
.
.
.
.
.
77
154
229
164
74
Ward X
.
.
.
.
.
91
84
160
161
8 0
Ward V
.
.
.
.
.
63
72
85
76
55
Ward VI
.
.
.
.
.
48
71
96
95
64
Ward VII .
.
.
.
.
65
75
96
121
64
Ward VIII .
.
.
.
.
59
74
94
111
68
It will be seen that as in 1908 the most affected ward was Ward I. The next
most affected was Ward XI ; Wards IV and X also showed a marked epidemic
mortality.
In Wards VI, VII and VIII the mortality curve showed the merest
indication of an epidemic rise.
45
In 1903 the mortality was as follows:—
August.
September.
October.
November. December.
Ward I
.
.
.
.
.
28
57
87
127
105
Ward XI
.
.
.
.
.
41
70
117
78
70
Ward V
.
.
.
.
.
44
49
75
71
58
Ward VI
.
.
.
.
.
49
62
71
65
65
Ward VII .
.
.
.
.
41
56
64
53
50
The affected wards have therefore reacted very consistently to epidemic
conditions.
Distribution of Enlarged Spleen.
Delhi was visited in April 1909. The conditions in regard to spleen rate
were then as follows :— 1
Ward XI
.
.
.
.
.
4 17 62
7 10 90% 57
Ward X .
.
.
.
.
. ..
15 25 30 30 60% 45
Wards IV and V
.
. .
. ..
14 41 17 26 74% 67
Ward VI
.
.
.
.
. ..
.. 35 25 40 60% 40
Ward VII
.
.
.
.
.
.. .. 28 20 52 48% 50
Ward IX
.
.
.
.
. ..
4 15 21 60 40% 75
The spleen rate therefore gave almost an exact indication of the degree to
which the different wards were affected by mortality.
In Ward XI two observations gave 86 per cent. and 70 per cent. on the out-
skirts and central portions, respectively. In a low quarter near the Jumma Musjid
spleen rate at two places was 100 per cent. ; immediately to the west of this area
in Ward IX, in rather dense city, the rate was much lower, being only 20 per cent.
Further on in a different class of house it was again high, being nearly 50 per cent.
In Ward IV observations at two places showed 100 per cent. and in Ward V
high rates were also obtained.
In Ward VI, in an area of very densely packed houses, the spleen rate was
low (17 per cent.) ; it was high (89 per cent.) in a part close by where there were
stables, woodsheds, etc. In Ward VII it was very high in the neighbourhood of
one of the gates, but low in six other areas tested.
Breeding Places of Anopheles.
In pools in the bed of the Jumna and in swampy parts of the Bela anopheles
were found breeding in large numbers. They were specially numerous in small
1T h e s i x t hc o l u mn g i v e s t o t a l p e r c e n t a g e s .V i d eC h a p t e r I I I .
46
pools made in the sand by the side of the river, in pools left by the river, and in
a creek. Such breeding places however were a mile or more from the city proper
(vide Map 7).
A comparatively small number of larvæ were found in a ravine near the
south-east corner of the city ; but over the wide area surrounding the city away
from the river it was extremely difficult on two occasions to find any breeding
places at all. To the north of the city breeding places occurred in drains, and
other situations.
Within the city there is a canal passing through the northern portion and
pools are not infrequently found in connection with irrigation of the gardens.
Standing water was also seen in connection with a horse trough and in a few
other situations. On the whole there were within the walls exceedingly few breed-
ing places of the ordinary kind (vide however "wells"), certainly nothing to account
for the malaria of the whole city.
In Ward XI a number of large disused wells were found to be swarming with
larvæ of N. stephensi, but in the ordinary small wells of the city I did not succeed
in finding larvæ. There are one or two large compounds but no breeding places
in them at the time of my visits. In Ward IV no local breeding places of an ordi-
nary description were found. Want of time and the character of the houses pre-
vented any thorough examination of wells, but those examined were negative.
Distribution of Adult Anopheles.
Examination of houses, sheds, etc., in Ward XI yielded a small number of
anopheles including M. culicifacies, N. stephensi and N. fuliginosus. In the
centre of Ward IV anopheles were found fairly abundantly and catches have on
several occasions been made in this situation. Had the condition of malaria been
due entirely or mainly to wells we should have expected to find only N. stephensi.
An actual catch however of which a record has been kept was—
N. fuliginosus .
.
.
.
.
.
.
.
.
.
.
6
M. culicifacies .
.
.
.
.
.
.
.
.
.
. 12
N. stephensi .
.
.
.
.
.
.
.
.
.
.
3
P. rossi .
.
.
.
.
.
.
.
.
.
.
. 4
Enough has been said to show that as in Amritsar there is a close connection
between the mortality, the spleen rate and anopheles distribution. But it must
be evident that the malaria of Delhi is a complicated question requiring more
time than I have had at my disposal to investigate adequately.
The brief sketch given will, however, help us later on in arriving at a know-
ledge of the nature of the epidemic we are considering. That the same wards
were affected in a proportionate degree in other epidemic years and that the
47
distribution of the spleen rate corresponds to that of the epidemic conditions is
noteworthy.
(iii) Palwal.
So far we have considered two of the cities of the Punjab. The towns that
follow are such as may be called small towns of the Punjab. The conditions in
regard to them are important since collectively their population numbered in 1901
over a million and it was among them that the worst effects of the epidemic were
recorded.
At Palwal the recorded mortality in October reached 420 per mille, this rate
being exceeded only by that at Bhera and Hodal. This town was therefore visited
as soon after the epidemic as possible (April).
The town had a population in 1901 of 12,830. It is situated in the Gurgaon
District, south of Delhi, in a tract which suffered severely during the epidemic, and
the physical features of which will be discussed in the chapter on rural malaria.
The town itself is built upon a high mound which is entirely artificial; being
the result of centuries of accumulation. The country around the town, however, is
flat and possesses no natural drainage, the nearest nullah being several miles from
the city. Moreover this flat land is excavated in all directions and the soil is very
impervious. After rain its suitability for the breeding of anopheles could scarcely
be excelled.
The condition of water-logging at the time of my visit was very pronounced,
the subsoil water at places being within two or three feet of the surface. Large
excavations were also full of water and naturally suggested themselves as causes
of the malarial epidemic, though it is doubtful from their nature if they could have
played any considerable part in this respect. During the rains of 1908 the sur
-rounding low land was so flooded that the town could only be approached through
water, whilst donkey and cattle owners were much distressed for want of fodder.
Like most Punjab towns Palwal is extremely compact. The streets are paved
throughout and descend steeply to the various gates. By reason of the slope of
the mound, drainage within the city is excellent, and it might seem at first sight
very curious that it should have been affected, as it was in 1908, by malaria.
The central part of the town, composed for the most part of brick buildings,
is situated on the summit of the mound. It is sparsely populated, many of the
large houses being unoccupied; and some areas are apparently almost if not
quite deserted. Around this central part, especially to the north and west, are
qualid suburbs, if we may dignify them by this name, partly situated. on the slope