NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
61
The behaviour of the different thanas in these years was as follows:—
Deaths in
October
1908.
Epidemic
figure
1908.
Deaths in
October
1892.
Epidemic
figure
1892.
Deaths in
October
1908.
Epidemic
figure
1890.
EASTERN GUJRAT.
Karian .
.
.
. 123
1,008
8
556
5
753
6
Karianwala
.
.
. 161
1,474
9
1,070
6
2,312
14
Jalalpur .
.
.
. 102
884
10
1,372
5
4,498
16
Gujrat .
.
.
. 180
2,000
JHELUM VALLEY.
Aurungabad .
.
. 103
807
8
685
7
659
6
WESTERN GUJRAT.
Lala Musa
.
.
. 205
1,575
7
927
4
1,527
7
Dinga
.
.
.
. 135
800
6
645
5
1,278
9
Parinwala
.
.
. 176
1,066
6
1,365
8
2,413
13
Kutherla Sheikan
.
. 121
564
4
881
7
658
5
Kadriabad
.
.
. 41
169
4
352
9
215
5
Though the effects in the different thanas vary, it is clear that there is a
general tendency for certain of them to be consistently more affected than others.
It is interesting to note that Dinga and Parianwala, though comparatively
mildly affected in 1908, were nevertheless severely affected in 1890 when epidemic
conditions were still more intense over this area than in 1908.
Conditions in the Villages visited.
Nairowali. —This village which as noted above had an epidemic figure of only
2 is situated on a piece of gently swelling ground. The river bed marked on the
map to the east was no longer recognisable except as a tract of low partially
flooded land. The channel to the west of the village on the contrary was in
active flood but ran not in a depression but along high land part of which at
a distance of two miles or more formed the gentle rise upon which Nairowali
stood. Around the village were a number of excavations and a number of
anopheles larvæ were found, but one could see even with the unaided eye that the
ground sloped away in most direction from the village and the villagers stated
that they were not subject to floods. The spleen rate was
—
0
0
8
17
74
26%
35
62
Shadiwal. —This was a very large village situated on a nullah subjected to
flooding. The epidemic figure in October 1908 was 25. But the spleen rate was
low—
0
0
21
21
58
42%
38
Darawala and Tricha. —The first named village having the extraordinary
epidemic figure of 70 and being surrounded by other villages with very high
rates an effort was made to visit it. But the flooded condition of the country
prevented my getting further than Tricha. Even this village, since it lay across
a deep sheet of water, was not actually entered.
Kuthala. —This village lies near the Chenab river and showed an epidemic
figure of 27. A nullah in the neighbourhood was stated to flood the village.
All round the village the land was low and swampy looking. The subsoil water
was 3 feet from the surface. The spleen rate was
—
5
10
40
20
25
75%
40
Gurali and Gurala. —These two villages showed epidemic figures in October
1908 of 46 and 21, respectively. They were situated in broad low-lying plains
that gave one the impression of having been the bed of a large river. The land
was low-lying to an exceptional degree and the subsoil water was very near the
surface. The spleen rate at Gurali was
—
3
27
39
21
9
91%
33
Nurpur near Gujrat. —This is a small village not marked on the map. It
lay in the line of one of the nullahs which pass round Gujrat city. The spleen
rate was—
0
25
31
6
38
62%
16
Nurpur. —This village had an epidemic figure of 54. It was found to lie in
the course of a nullah which became flooded by the Jehangir river. Another
village in the neighbourhood was found to be situated on an old bed of the same
river and to be liable to floods when this river received more than a certain,
amount of water. The spleen rate in both villages was high but has not been
recorded. The focus of epidemic conditions at " b " seemed to be in relation to
floods from the abovementioned river.
Shandiwal and Mand. —Mand ( c) lay on comparatively low-lying ground ob-
viously liable to be flooded by the river. Shandiwal and other villages forming
the focus as " a " at the time of my visit were surrounded by water which I was
informed was the result of flooding by a nullah to the north.
Harianwala. —The epidemic figure for October was 5. The spleen, rate was—
0
0
13
26
61
39%
31
In Gujrat the association between severe epidemic conditions and flooding
was peculiarly marked.
63
CHAPTER VIII.
Conditions in Non-Epidemic Areas and in Epidemic Areas in Non-
Epidemic Times.
I.—VILLAGES OF THE SHAHPUR THANA. (Vide MAP 10.)
The conditions in the Jhelum riverain north of the point near Kushab and
Shahpur where the river turns abruptly to the south has been referred to.
Followed southwards beyond the thana of Jaurian the riverain is still traceable
through the thana of Shahpur and that of Sahiwal.
Shahpur is almost entirely riverain land, but on the border furthest from the
river there is an abrupt change to Doab land which in this situation is very
abruptly marked off and exhibits characters that are almost those of a desert.
To the south of the thana the desert, like conditions approach close to the river
and inundation canals which have been a constant feature of the riverain from
Bhera downwards cease at this point and give place to canals of the high irriga-
tion system. Nevertheless the riverain is still clearly marked in certain maps
through out Sahiwal.
In accordance with a general law in riverains there is a tendency for the lowest
land not actually occupied by the river to be close under the opposite bank. In
Shahpur thana this arrangement was shown very clearly, for whilst the river ran to
the west of the thana the most water-logged land was that lying close along the
desert margin in the neighbourhood of the villages Saidaspur and Wegowal on the
eastern margin (vide Map 10).
Mortality.
The result of mapping the villages by means of epidemic figures is shown in
Map 10. The most noticeable features are the group of villages with very high
figures which adjoin the thana of Jaurian to the north and the extremely low fig-
ures shown. in the villages to the south as Sahiwal is approached. As the thana of
Sahiwal as a whole showed an epidemic figure of only 2 it is probable that most of
its villages were similarly unaffected. Two other features are also seen, namely, an
isolated area of high epidemic conditions due to the villages Wegowal and Sardar-
pur and a similar area on the banks of the Jhelum due to the single village of
Kandan.
Conditions in the Villages visited.
Shahpur.—Shahpur though a town possesses a population of only 5,855 and
in reality is little more than a largo village. It is situated on flat alluvial land
about two miles from the river. At the time of my visit (August) it was in
64
comparison with places further up the riverain conspicuously free from standing
water. The subsoil water was at a depth of 12 feet. In the centre of the city
owing to the accumulation of soil on the site the depth was 28 feet. In October
1908 the death rate was only 52 per mille and the highest weekly rate to which it
rose was 177 per mille. It was therefore much less affected than any other town
we have yet considered. The spleen rate was
—
0
5
16
27
51
49 %
37
Akilshaw.—This was a large village near Shahpur. There were innumerable
excavations both within and outside the village, but very little standing water.
The subsoil water was 15 feet from the surface. The epidemic figure was only 3.
The spleen rate was
—
0
2
47
16
34
66 %
36
Nathuwal. —This village lies in the neighbourhood of the river but on compara-
tively high land. The subsoil water was 11 feet from the surface. The epidemic
figure for October 1908 was 1. The spleen rate was
—
0
0
32
8
6 0
40 %
25
Kandan.—This village was situated on low-lying ground close to the river
Jhelum by which it had been flooded in 1908. The epidemic figure for October
1908 was 30, and as in October the deaths numbered 30 whilst the population of the
village at a liberal estimate was not above 1,000, the death rate must have been at
least at a rate of 300 per mille. In the case of Nathuwal, distant one or two miles
but on slightly higher land and distinctly a larger village, the deaths in October
numbered only 5. In the neighbouring large village of Tankiwal (epidemic figure
1) with a recorded population of 1,355, the deaths numbered only 7 or about 60 per
mille. There can be no doubt therefore that the village Kandan suffered from
severe epidemic conditions, though its neighbours on very slightly higher ground
did not. The conditions call to mind very strongly the little epidemic areas which
in 1908 and 1892 are seen along the course of the large rivers in the western tracts
of the Punjab. Very few children could be obtained, but those examined showed
spleen rate as below—
0
0
29
23
47
53 %
17
Among 10 adults only one had enlarged spleen. The subsoil water in the
village was 8 feet from the surface.
Wegowal and Sardarpur.—The situation of these villages have been referred
to. Approaching them from Shahpur the country was noticeably more water-
logged, and in the neighbourhood of Wegowal the subsoil water was at a depth of
only 4 feet. The villagers informed us that the water which lay about was the
result of flooding from an inundation canal. The spleen rate was—
0
31
26
10
32
68 %
19
65
Dharima.—Though this village is in the Sargoda thana it will be convenient to
describe it here. At Wegowal we have noted that the subsoil water was only four
feet from the surface. Two miles further east the Bar country is reached and water
is at a depth of 20 feet from the surface. At Dh arima a little further on, it is at an
even greater depth. The village is a straggly one on irregular ground which is
dry and arid looking in the extreme. The epidemic figure of the village was 4 and
the spleen rate
—
3
6
18
21
51
49 %
33
II—VILLAGES OF THE BHALWAL AND KOT MOMON THANAS.
The Bhalwal thana lies immediately to the south of the thana of Bhera, the line
of junction of the two corresponding to the edge of the riverain. Whilst Bhera is
almost all riverain land, Bhalwal lies within what is called the Bar.
To the south lies the thana of Kot Momon which is wholly Bar country, the sub-
soil water being everywhere at a depth of 40 feet or more, and the country evidently
only saved from being a desert by irrigation. To the east of Kot Momon lies the
thana of Miani Gondal the high land of which is continued into the thana of
Kutheila Sheikan in the Gujrat district. South of Kot Momon is Midh which
lies largely in the Chenab riverain.
Mortality.
In October 1908 the different thanas showed a recorded mortality as
follows :—
Normal.
October
1908.
Epidemic
figure.
Bhalwal .
.
.
.
.
.
.
.
.
.
40
205
5.1
Kot Momon
.
.
.
.
.
.
.
.
.
40
94
2.3
Miani Gondal. .
.
.
.
.
.
.
.
.
51
93
1 . 8
Kutheila Sheikan
.
.
.
.
.
.
.
.
121
564
4.6
Midh
.
.
.
.
.
.
.
.
.
.
73
289
3.9
In the case of Bhalwal the village epidemic figures are high along the Bhera
border but low elsewhere. In Kot Momon the figure is frequently unity or low,
though one village Kot Raya is exceptional in having a figure of 20. In the latter
thana we seem for the first time to have succeeded in getting an area not influenced
by the epidemic.
K
66
Reaction of the area to Epidemic Conditions.
As a rule the thanas mentioned show very little, if any, increase of the normal
average in October. But in 1903 the rates for Bhalwal, Kot Momon and Miani
Gondal were doubled, whilst in Midh the deaths were slightly higher than in
1908. A distinct, though slight, increase is also noticeable in 1892, in 1900 and in
1901.
Conditions in the Villages Visited.
Bhalwal.—This village had an epidemic figure in October of 1. The subsoil
water was at a depth of about 40 feet. The spleen rate was—
0
0
23
6
71
29 %
17
Dera Ali Tragger. —This village was a hamlet of Nabusha Bulu which is shown
on the map lying against the Bhera thana. The land was beginning to fall towards
the Jhelum but was still high, and the subsoil water was about 25 feet from the
surface. The epidemic figure was 9. The spleen rate was
—
0
0
25
42
33
67 %
12
Luliani.—This was a large village in the thana of Kot Momon with an epi-
demic figure of 2. It was surrounded by flat land with but few excavations, and
the aspect of the country was very dry. The subsoil water was at a great depth.
The spleen rate was
—
0
0
0
21
79
21 %
19
Kot Momon.—This was another large village lying in the heart of the Bar
country. The country was very dry, but many excavations were present around
the village. The epidemic figure was 1. The spleen rate was
—
0
0
0
0
14
0%
14
Kot Raya.—This village, which it will be remembered showed an epidemic
figure of 20, was unfortunately not visited, though it was afterwards found to be
situated close to a part of the road where a leaking canal had flooded a consider-
able tract and near some sheets of water in which anopheles larvæ were seen
in enormous numbers.
III.—VILLAGES OF THE SARGHODA THANA. ( Vide MAP IV.)
This thana occupies a large portion of the Shahpur Bar country. It is a
typical " canal " tract and its villages for the most part have been formed only
since the introduction of irrigation. The subsoil water is at a great depth and the
country resembles generally that about Bhalwal and Kot Momon.
Mortality.
One might have expected from the physical conditions of the tract that the
mortality during the 1908 epidemic would have been low. As a matter of fact the
67
epidemic figure was 7. But the distribution of mortality (shown in Map 10) shows
that this high rate was mainly due to villages around the borders of the thana, espe-
cially to villages lying close up against Jaurian thana, which it will be remem-
bered was severely affected. Another group of villages with rather high figures
lies to the south at the foot of the very peculiar isolated Karana hills which rise
here suddenly from the plains to a considerable height. Unfortunately I was
unable for want of time to visit any villages in this thana, but passing through in
the train I was able to ascertain that the ground sloped rapidly downwards towards
the severely affected villages Uttian and Lakh shown in the map ; and the fact
that these villages are designated by name rather than by numbers shows that
they are old established villages, and suggests that as they existed prior to the
canals they naturally occupied the lowest lying portions of the thana.
IV.—CONDITIONS AT AMRITSAR AND DELHI DURING THE NON-EPIDEMIC YEAR
1909.
Mortality.
The mortality returns of Amritsar for 1909 were studied in the same manner
as those for 1908. The number of deaths after the large numbers dealt with in
1908 seemed absurdly small. In the month of October there were in the whole
city only 570 deaths or a rate of 45 per mille. In Khazana (division 9) the
deaths numbered only 88 or a rate of 60 per mille. In some of the other divisions
and areas the returns were as follows :—
October
1908.
October
1909.
Rate in
October
1909.
Divisions 1, 2 and 3 .
.
.
.
.
.
.
.
835
102
35
Divisions 5 and 7
.
.
.
.
.
.
.
.
889
90
48
Divisions 6 and 8
.
.
.
.
.
.
.
.
387
78
43
Division 9 .
.
.
.
.
.
.
.
.
.
665
88
60
Divisions 10 and 11
.
.
.
.
.
.
.
916
125
43
Division 12
.
.
.
.
.
.
.
.
.
452
42
36
Not located including Division 4 .
.
.
.
.
.
54
45
..
TOTAL
.
4,198
570
45
In the case of admissions to the Amritsar dispensary there was also very
little increase during the fever season, the highest weekly admission being 100 as
against 566 in 1908.
K 2
68
It is clear therefore that in this autumn there was no increase of mortality
beyond that more or less normal in India. And the year as far as Amritsar is con-
cerned may safely be considered a non-epidemic year.
Though no study of the statistics at Delhi has been made it may be stated
that here also there was no serious mortality in 1909.
Spleen Rate and Parasite Rate.
A community in Khazana, the children of which were examined at intervals,
gave in percentages the following results :—
February
1909.
April
1909.
August
1909.
October
1909.
November
1909.
Infection over 100
.
.
.
2
..
3
5
4
Infection over 20
.
.
.
25
7
14
5
8
Infection over 5 .
.
.
.
16
7
23
16
19
Infection under 5
.
.
.
28
39
23
31
27
Negative .
.
.
.
.
2 8
47
36
42
42
Total percentage
.
.
.
72
53
63
58
58
Number of children
. .
.
36
28
42
38
26
The spleen rate in percentages among the same children were—
February
.
.
.
.
.
14 19 50
8
8 92 %
August
.
.
.
.
.
4 27 31 23 14 86 %
October
.
.
.
.
.
4 15 44 26 11 89 %
November
.
.
.
.
.
4
8 58 19
9 91 %
June 1910
.
.
.
.
.
0
5 29 38 28 72 %
These figures show that whilst there are fluctuations especially as suggested
by the spleen rate in June 1910 after a very dry summer the spleen and parasite
rate in this community was always high.
The spleen rate in Mahan Singh in February was 90 per cent. In August
1909 it was again exactly 90 per cent. In June 1910 it was 85 per cent. The
rates in February 1909 and June 1910 compared in detail are in percentages
—
2
14
41
33
10
90 %
70
5
15
42
23
15
85 %
60
The differences are very slight.
Delhi was visited in February 1910. At this time in Ward XI the spleen
rate in percentages was as follows :—
20
25
40
15
0
100%
40
69
A small community of Dhobies in Ward IV also gave 100 per cent. spleen rate,
the size of spleen being equally remarkable.
In Ward VI the spleen rate in November 1909 in percentages was
—
2
2
37
21
37
63%
48
So that in Delhi conditions as regards spleen rate were apparently as severe
as when seen immediately following the epidemic.
V.—CONDITIONS IN THE VILLAGES OF THE AMRITSAR AND GHERINDA THANAS IN
1909 AND 1910.
It was thought possible that although in a non-epidemic year the massed
mortality figures for rural areas were low, there might still be villages exhibiting
high epidemic rates, especially as the rainfall in the monsoon of 1909 was over the
normal, and some extensive collections of water were seen.
Examination of the statistics of the Gherinda thana showed that at Atari in
October 1909 there had been 9 deaths, whilst in October 1908 the number had
been 35. At Mahawa, a village we have referred to as situated on low water-
logged ground, the deaths in October 1909 were 3, whereas in October 1908 they
were 58. At Kasel, a village with an epidemic figure in October 1908 of 16 and a
recorded rate of 330 per mille, there were in October 1909 only 11 deaths or a rate
of 32 per mille. Examining the returns to find any examples of villages with
high rates, it was found that the only high epidemic figure reached in this thana
were Neshta 5, Bhaini 5, and Nathupur 5, villages which in October 1908 had epi-
demic figures of 16, 8 and 18, respectively ; otherwise, with the exception of two
small villages whose figures were doubtful, the 71 villages of this tract uniformly
showed a figure which was unity or at most 2.
As regards this thana then the year was a non-epidemic one; but the spleen
rate at Atari in November was not perceptibly different from what it was after
the epidemic of 1908.
All the facts we have brought forward merely show what one had learned
to expect, namely, that though the spleen and parasite rate fluctuate somewhat,
these values are more or less fixed for any given area, and the rates recorded in
Chapters VI and VII, though they may have been enhanced by the epidemic, are
not solely or even mainly the result of this condition.
When it is recollected that, even under the conditions seen in the thana of
Kot Momon, villages still showed very considerable spleen rates, it is obvious that
the Punjab is very differently situated as regards malaria to Egypt, in which out of
7,000 spleens examined by E. H. Ross1 only 6.8 per cent. were enlarged, and that
1 Quoted by Day and Ferguson. Annals of Tropical Medicine and Parasitology, Vol. III, No. 3,
November 1909.
70
measuring malaria by spleen rates or the presence or parasites this disease is
always very prevalent in the Punjab.
But though malaria is always present and in a sense may be extremely intense
as for example we have seen in parts of Delhi, the disease is only associated with
high epidemic mortality under certain conditions.
It is probably quite evident by now that this distinction of epidemic or mor-
tality producing malaria from the ordinary endemic condition is very important.
71
CHAPTER IX.
Epidemic and Endemic Malaria.
I.—DISTINCTION BETWEEN ENDEMIC AND EPIDEMIC MALARIA.
Before going further we should clearly appreciate the importance of this "mor-
tality causing" or speaking generally "virulent" type of malaria as distinct
from endemic malaria, and realise that in the investigation of malaria in the Punjab
we have to consider not only the conditions associated with mere transmission of
malaria which resemble as will be seen those frequently described in different parts
of the world, but even more urgently to ascertain what are the causes of the pecu-
liar epidemics, which as we have seen are such a prominent feature of this pro-
vince. The most essential characteristic of the condition is the mortality with
which it is associated. Indeed to measure fulminant malaria we have at pre-
sent only one criterion, namely, the degree of mortality which results from it.
A high degree of endemic malaria we have seen may on the contrary co-exist
with a more or less normal death rate.
Probably with severe endemic malaria there is a certain amount of increased
mortality. But whatever the effect of endemic malaria upon mortality may be,
it is the epidemic and especially the fulminant type of the disease which most
severely affects the Punjab and which alone forces itself upon the public notice, so
as to cause comment and alarm.
In "epidemics" in fact we see the instrument by which malaria attacks the
Punjab and possibly part explanation of the fact that the recorded death rate from
"fever" for this area, contrary to what one might have expected, is higher than
that of the more tropical and one might have thought more malarious southern
portions of India.
When we talk of malaria ridden tracts we must know clearly what we are refer-
ring to, whether the decrease of the population is inherent in the region or due to
the chance involvement in the area of an epidemic or several epidemics follow-
ing one another. We shall see more of the relation between the two conditions
later.
II.—RELATION BETWEEN EPIDEMIC AND ENDEMIC MALARIA.
If we investigate the frequency with which different portions of the Punjab are
affected with severe epidemics of malaria, we see at once that the western half or
comparatively rainless portion of the Punjab is relatively unaffected.
Passing eastwards we come to a tract we have called elsewhere the Northern
Epidemic Area and which, in the forty years or so for which we have data, has