NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
17
If there had been an increase of more than 25 per cent. in the population of
1901 in 1906, there should have been a corresponding increase in the con-
sumption of food, etc., in the City. If we examine the figures in the Adminis-
tration Reports of the City we find that the amounts of grain and other food-
stuffs consumed in Bombay, as shown by the amounts that paid octroi dues in
the years 1899 to 1909, was as follows :—
Year.
1899
DUO
1901
1902
1903
1904
1905
1906
1907
1908
1909
Candies of
Grain.
14,85,140
6,95,271
10,65,640
10,41,474
9,49,052
16,95,010
9,33,513
10,34,788
10,15,669
11,74,695
9,72,280
Maunds of
Ghee.
3,52,392
3,30,744
3,24,243
3,34,745
3,53,018
3,66,895
3,91,157
3,88,371
4,05,287
4,02,793
3,92,288
Candies of
Firewood.
6,47,470
5,66,262
6,74,552
5,56,060
5,77,070
5,S9,196
5,82,525
5,78,700
The figures given above refer to the net amount of goods paying town dues
and as such are supposed to represent local stock and consumption. It may be
remarked that since 1901 there has been a great increase in the number of
buffaloes, bullocks and horses in the City, all consuming a considerable amount
of grain, and tending to swell the total of grain consumed each year. In 1904
also arrangements were made to impose a special check upon the quantities of
goods paying town dues, as fraud had been detected in the claims for rebate
on exportation.
Further evidence is supplied by an examination of the figures which shew
the number of animals slaughtered in the municipal slaughter-houses each year
for food. These figures of course relate only to food consumed by the flesh-eating
portion of the population and they are liable to be influenced very greatly by
increased prosperity, higher wages leading to an increased consumption of meat.
The figures given below show that there has been only a moderate increase
since 1901.
Year.
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
Buffaloes, Cows,
Bullocks and
Calves.
43,547
44,388
42,157
38,793
41,908
48,483
47,834
47,304
49,253
48,665
Sheeps and Goats.
603,208
578,861
616,295
624,341
616,634
650,289
674,191
669,014
653,372
633,057
Pigs.
656
649
680
654
599
628
641
631
568
563
In addition to these facts the census of 1906 only showed an increase of
about 10 per cent. in the number of inhabited houses in the City as compared
with 1901. Taking everything into consideration there does not appear to
have been such an extraordinary variation in the mean annual population
during the past ten years, as that shown by a comparison of the census returns
of 1901 and 1906.
41. Unfortunately it is impossible to say whether the mean annual
population of Bombay amounts to 700,000 or to 900,000 and unless measures
were adopted for keeping an accurate record of all those who enter and leave the
island, so as to correct the estimate of the population from time to time, it is
difficult to see how a definite standard is to be obtained. Many years ago the
B 136—5
19
upon the figures of: a crude death-rate. As a matter of fact 1908 was undoubt-
edly more unhealthy than 1907, owing to the prevalance of malaria, but this
was absolutely masked by the uncorrected death-rates for these years.
44. The causes of death in Bombay.—As has already been pointed out the
registration of causes of death in Bombay is largely a matter of guess-work.
In 1909, 21 per cent. of deaths were certified against 7 per cent in 1901, but
in the vast majority of cases, dependence has to be placed upon enquiries
made of friends or relations. In 1910, 8,394 deaths were certified and 19,607
verified by enquiry among friends and relatives of the deceased. This latter
work is carried out by a special registration staff first appointed in 1902. One
effect of this improved organization was the immediate reduction of the number
of deaths recorded under the head fever, a reduction which might be ascribed
to other causes if this co-incident alteration in the method of registration
were overlooked. Unfortunately in the published returns certified causes of
deaths are pooled with those arrived at as the result of enquiry after death.
45. The principal causes of death, as at present recorded, are plague,
cholera, small-pox, fevers, dysentery, diarrhoea, phthisis and respiratory diseases.
The following table gives the total deaths recorded under different headings,
taken from the Annual Report of the Executive Health Officer for the
City. The rate per 1,000 of the population is not given, as in view of the
uncertainty regarding the actual population at any given period such figures
are fallacious :—
Year.
1901
1902
1903
1904
1905
190G
1907
1908
1909
1810
Mean ...
Small-
pox.
159
28S
1,477
56S
2,161
276
86
1,023
473
l.GOS
S12
Mea-
sles.
67
642
1,116
229
620
93 6
107
65o
75
184
462
Fevers
(iucluding
Sarl et,
Enteric,
Malaria,
Ague,
Remittent,
and
Relapsing).
7,921
4,518
2,333
2,530
2,S7S
4,S82
3,633
3,403
2,800
3,113
3,801
Cho-
lera.
198
75
17
219
26
1,241
439
95
727
107
314
Plague.
18,736
13,820
20,788
] 3,538
1-4,198
10,823
G,389
5,061
5,197
3,656
11,250
Phthi-
sis.
6,510
3,957
2,S42
2,971
2,658
3,569
i',377
2,387
2,41o
2,282
3,237
Distas;
of the
Nervous
system.
2,971
3,027
2,282
2,412
2,026
2,085
1,863
2,083
2.143
2.005
2,289
Disease
of the
Respira-
tory
system.
7,804
7,250
7,101
7,339
9,103
11,731
9,022
8,954
7,974
8,214
$,449
Diar-
rhoea.
2,375
2,266
1,757
1,863
2,402
3,264
2,348
2,007
1,592
2,155
2,282
Dysen-
tery.
1,341
1,377
1,003
921
989
1,514
1,141
1,177
933
1,197
1,159
Acci-
dents.
764
732
Ö47
558
646
714
813
808
698
All
other
cases
(except
still-
born).
10,643
10,46 i
9,25 L
9,642
10,155
1],841
9,969
30,317
9,791
9,830
•
No: II
Govt. Photozinco: Office, Poona, 1911.
PART II-MALARIA IN BOMBAY.
CHAPTER I.
THE HISTORY OF MALARIA IN BOMBAY.
46. Bombay has passed through many periods of ill-health, from the time
when speaking of Europeans it was said that, " Two monsoons were the life of a
man " to the more recent outbreak of plague, hut there are few references ta
malaria to be found in the history of the Island and this fact supports the
assumption that the City has never suffered as severely from malaria as many
other parts of India.
Freyer writing of Bombay in 1673 remarks :—
" I reckon the people of Bombay walk in charnel houses, the climate
" being extremely unhealthy, as first thought to be caused by bubsho,
" rotten fish ; but, though that be prohibited, yet it continues as mortal.
" I rather impute it to the situation which causes an infecundity in the
" earth, and a putridness in the air, which being produced seldom coming
" to maturity, whereby what is eaten is undigested ; whence follow fluxes,
" dropsy, scurvy, barbiers, gout, stone, malignant and putrid fevers, which
" are endemial diseases."
And Aungier, the famous Governor of the Island, in a report written in
the same year as Freyer's memoir, stated that—
" After the first intermission of the rains in May or June and after
" their total ceasing in October the air and water are unwholesome by
" reason of the crude pestiferous vapours exhaled by the violent heat of the
" sun into the air and vermin created in the wells and tanks which renders
" those months mostly sickly to the inhabitants, and especially Europeans."
A few years later Ovington writes of Bombay as follows :—
" Pish manure is a mortal enemy to the lives of Europeans. We
" arrived here at the beginning of the rains and buried of the 24 passen-
" gers we brought with us above 20, before they were ended ; and of all
" our own ships' company above 15
The prodigious growth
" of vermin and of venomous creatures at the time of the monsoons do
" abundantly demonstrate the malignant corruption of the air."
á7. In recent years it has been suggested that malaria was responsible for
the condition of things recorded by Freyer, Aungier and Ovington.
Campbell in his History of Bombay (Vol. I, p. 437), remarks :—
" Various causes were assigned for the alarming mortality amongst
" Europeans in Bombay. The atmosphere was at first supposed to be
" polluted by the putrid fish with which the trees were manured. A more
"reasonable conjecture was that malaria arose from the low plains
" which were overflowed at high tides and left in a swampy state when
" the sea receded."
And, in the recently published Bombay Gazetteer, a comment upon
Aungier's report suggests that : —
" One of the chief reasons for the unhealthiness recorded by him, was
" doubtless the gradual silting-up of the creeks which divided Bombay into
" a group of islets. At high tide the sea swept through the breaches,
" overflowed the major portion of the island, and left a pestilential deposit
" highly productive of malaria ; and the conviction of the truth of this
" suggestion led the Court of Directors between 1684 to 1710 to constantly
" emphasize the need of stopping up the breaches and reclaiming the
" drowned lands."
B 136—8
No: III
25
CHAPTER II.
61. THE MEASUREMENT OF MALARIA IN BOMBAY.—In dis-
cussing the prevention of malaria in a community, Ross has laid down as
one of the first essentials the necessity for a careful measurement of the
malaria present ; and he has pointed out that for this purpose direct observa-
tion is of greater value than inferences drawn from hospital statistics and
mortality returns. Before the present investigation no serious attempt
appears to have been made to measure the amount of malaria in Bombay, but
a few isolated enquiries have been made from timo to time in different parts
of the City.
In Bombay with rare exceptions the microscope is not greatly used in the
diagnosis of malaria. The report of the Municipal Analyst shows that the
following numbers of blood specimens have been examined for malaria in the
municipal laboratory since 1904, but the results are not given :—
Numbers of blood specimens examined for malaria—
1904
1905
1906
1907
1908
1909
S
3
2
12
166
80
As will be seen the number is too small to be of much value as a test of the
incidence of malaria in the City.
62. The most valuable information available regarding the incidence of
malaria in the past is to be found in a paper by Dr. S. A. Powell, previously
referred to, which deals with the occurrence of malaria in 1901 to 1903, as
diagnosed by the microscope, chiefly among the Police. The City Police, who
are stationed in every part of the island and live indifferent localities, numbered
about 2,000 in 1901—1903. They are picked men as regards physique, they
have steady employment, good clothing and shelter, and they receive regular
medical attention. During a succession of years 1901—1903 an average of
nearly 1,000 admissions for malaria or just about 500 per 1,000 of strength
occurred amongst these men, and we are justified in assuming that the incidence
of the disease among the general population of Bombay in those years was not
less than this.
Dr. Powell's paper shows that taking two complete years together the
number of cases of malaria in the first half of the year was 790 and in the
second half 1,425, and the number in each quarter was 385, 405, 648 and 777
respectively. Below is a table extracted from Dr. Powell's paper, which shows
the monthly incidence of malaria. :—
January
February
March
April
May
June
July
August
September
October
November
December
1901.
...
...
44
47
46
94
114
...
111
130
96
1902.
63
57
61
75
71
:
94
106
110
119
150
145
119
1903.
83
53
53
84
64
51
108
108
83
• • «
...
Of the total 2,542 cases, 1,186 showed Malignant Tertian, 1,382 Benign
Tertian and 41 Quartan parasites. None of the cases died—a fact which con-
firms the generally recognized amenability of malaria to adequate treatment
by quinine.
B 136—7
26
Dr. Powell has kindly supplied me with particulars of a further 611 ca9es
of malarial infection met with by him between September 1903 and April 1904.
Of these 393 were Malignant Tertian, 209 Benign Tertian and 11 Quartan.
The monthly incidence of infection was as follows :—
1903.
September
October
November
December
34
83
120
92
1904.
January
February
March
April
115
45
56
66
63. In a recent report the Executive Health Officer records the fact that
in 1906 letters were addressed to those in charge of the ten schools in the
Mazagaon area asking permission to examine the blood of the scholars with
a view to ascertain the prevalence of malaria in the neighbourhood of the
Bhandarwada Reservoir. Most of these requests were refused, but in March
1906 microscopical examination was made of specimens of blood taken from the
children of two of the institutions, with the following results :—
St. Joseph's Home and Foundling Hospital
St. Peter's Boys School
...
Number
examined.
25
28
Number
infected.
15
15
Percentage
infected.
60.00
53.37
In December 1907 owing to complaints regarding malaria at the Governor's
Body Guard Lines, an investigation of the area was made and a few specimens
of blood were examined with the following results :—
No.
1
2
3
4
Name.
Lance-Duffadar
Fatteh
Mahomed Khan.
Sowar Met Sing
Lance-Duffadar
Mumtaz
Ali Khan.
Lance-Duffadar Udesing's
child.
Clinical features.
Enlarged spleen, suffering
from fever of tertian type.
Chronic enlarged spleen,
suffers from fever occa-
sionally.
Fever every day with
shivering.
Suffering from fever for
for some time.
Remarks.
Examination of blood films.
Malarial parasites.
Malarial parasites, a large
number of eosinophilis.
Malarial parasites.
Malarial parasites.
In 1908 Major Liston, I. M. S., and Captain Mackie, I. M. S., investi-
gated the spleen index and parasite index among young children in Frere Road.
The spleen index was ascertained to be 80 per cent. and the parasite index over
50 per cent.
64. Beyond these few facts little or nothing can be learned regarding the
amount of malaria existing in Bombay except what can be gathered from
hospital returns. Unfortunately, with the exception of the Police Hospital, the
systematic examination of the blood of fever cases does not appear to have
received much attention in hospitals and dispensaries in the City and the value
of returns obtained from them is greatly lessened by this fact.
65. The most valuable means of measuring the amount of malaria in a
locality is the estimation of—
(1) The spleen index.
(2) The parasite index.
Section 1,
THE SPLEEN INDEX.—It has been known for very many years that
malaria of ten produced enlargement of the spleen in those who suffered from the
disease. More than fifty years ago certain medical officers in the Punjab carried
out a spleen census in order to estimate the prevalence of malaria among the
population of some of the irrigated tracts ; and the taking of a spleen census has
27
now become a routine method of measuring the malaria of a community, as
it is generally recognized that in the absence of a disease such as Kala-azar,
which also causes splenic enlargement, a very good idea of the prevalence of
malaria may be arrived at by estimating the proportion of a population
possessing palpably enlarged spleens. Usually such a census is taken among
young children only, because observations made upon persons of different ages
resident in malarious countries show that after a certain age splenic enlargement
becomes much less common, owing probably to the occurrence of a condition of
toleration or partial immunity, produced by long exposure to infection.
The exact significance of splenic enlargement is not clear. Many cases of
mild malarial infection fail to show an appreciable enlargement of the spleen
and in a considerable proportion of cases with marked enlargement, undoubtedly
due to antecedent malaria, examination of the blood fails to reveal the presence
of parasites. But although there are grounds for believing that enlargement
of the spleen indicates the previous occurrence of malarial disease more certainly
than the existence of present infection, this fact in no way invalidates the use
of the splenic index as a measure of the malaria present among a community ;
and the taking of a spleen census is the simplest and probably under ordinary
conditions the most accurate method that can be adopted for estimating the
amount of malaria existing among a large population.
66. The Spleen Census in Bombay.—At the commencement of the present
enquiry Captain A. G. McKendrick, I. M. S., conducted a spleen census by a
system of " random sampling " with the following results :—
Result of the First Spleen Census.
Ward.
Ward A.
„ B.
„ C.
D.
...
E
F
„ G.
Total ...
Number of
Children examined.
762
1,304
1,002
846
1,650
1,459
1,302
8,325
Number of
children with
enlarged spleen.
271
154
38
33
91
21
18
626
Percentage of
children with
enlarged spleen.
35.0
110
3.0
3.9
5.5
1.4
13
7.5
By means of this spleen census Captain McKendrick was able to map out the
areas most severely affected by malaria and the results obtained subsequently
coincide very closely with those observed by him.
67. But it has been found that a spleen census by the method of " random
sampling" though sufficiently accurate when dealing with large areas, does not
afford enough detailed information. A second house-to-house spleen census was
therefore undertaken in different sections of the City, and a very large number
of children were examined with the following results :—
Result of Final Spleen Census.
Ward.
Ward A. ...
„ B. ...
„
C. ...
„
D. ...
E
„ F. ...
„
G.. ...
Total ...
Number of children
between the ages
of 1 to 10 in 1906.
7,170
21,108
23,964
14,730
30,942
13,146
14,331
125,441
Number of
children
examined.
5,944
5,980
12,025
7,532
11,646
5,513
3,896
52,536
Number with
enlarged spleen.
1,783
781
711
208
213
66
41
3,803
Percentage with
enlarged spleen.
29.9
13.0
5.9
2.7
1.8
11
1.0
7.2
28
Altogether a total of over 70,000 children have been examined since the
enquiry commenced. Certain sections have been examined more than once and
3,482 children from whom blood specimens were taken were also examined
for spleen enlargement. Of these children, 562 or 16.1 per cent. had enlarged
spleen. A total of 1,265 belonged to A. and B. "Wards and of these 426 showed
enlarged spleens or 33.6 per cent. Of the remaining 2,217 from other parts of
the island, 136 showed enlarged spleens, or 6.1 per cent.
68. In Mauritius, Ross found 10,595 children with enlarged spleen out of
a total of 31,022 examined or 34.1 per cent.; and in Ceylon a spleen census
curried out in 19.08 by the orders of the Principal Medical Officer, showed
31,421 children among a total of 92,258 with splenic enlargement—a percentage
of 34.05 per cent. Compared with these figures the percentage of enlarged
spleens observed among the children in Bombay is low, and it may be said
as a result of the spleen census that, the island of Bombay as a whole
is not very malarious. But as may be seen from a comparison of the figures
for the various wards in the City there are great differences in the incidence
of malaria in different localities. In the north of the Island, which is undrained,
and subject to flooding during the monsoon, and which has generally been
considered exceedingly malarious, the spleen index approaches zero ; in the centre
of the Island the spleen index though a little higher is still very low ; and it is
only in the southern portion of the City that it shows any considerable rise.
69. The result of the spleen ceasus in different sections of each ward is
shown on the following table :—
Result of Spleen Census by Sections.
Sections.
1
f Upper Colaba
,,.
A. Wiird„,-
j Middle and Lower
I Colaba
] South Fort
1 North Fort
Esplanade
( Mandvi
B, Ward...-
C. Ward...
D. Ward...
E. Ward...
F. Ward...
G. Ward...
) Chakla
} Umarkhadi
V_ Dongri
f Market
1 Dhobi Talao
J Fanaswadi
} Bhuleshwar
j Kb ara Talaô
Kumbarwada
fGirgaum
1 Chowpati
•{ Khetwadi
| Walkeslrwar
Mahaluxrni
fByculla
Tardeo
Karoatipura
• <{ 1st Nagpada
2nd Nagpada
Mazagaon
(^Tarwadi
fParel
< Sewri
(Sion
fMabim
fWorli
Time of year.
1
April, July
April, August
April, December ...
April and May
April, January
April and May
April
...']
October
June and July
».,
August
August
December
November
November
February
January
March and April ...
February and March.
January and April...
January and April,.
August
April and May
July
t August
January and May ...
January and June...
August
September
November
October and Nov. ..
Sept. and October .
Number
of children
examined.
212
762
227 i
3,987 !
756
1,223
684
1,939
2,134
1,727
3,150
1,646
1,941
1,841
1,720
1,520
1,030
2,335
1.222
.
1,825
2,177
1,609
1,631
1 fi9Q
3,110
1,490
3,277
1,242
994
1,416
*,4S0
i
Number
with enlarged
spleen.
15
90 :
47
1,311
320
456
74
171
80
247
359
57
105
98
46
48
26
50
39
i
43
!
«
21
IS
1 K
10
86
82
47
9
10
11
30
Percentage
with enlarged
spleen.
7-07
11-8
20-7
33-0
42-3
378
11-34
9-0
3-7
14-3
18-8
3-4
5-4
5-4
2-6
3-06
2-5
2-1
4-7
2-4
1-8
1*3
1-1
A.Q
v y
2-7
2-1
1-4
0-7
i-oe
0-7
1-2
NO: IV
31
75. The spleen census in Fort north and Dhohi Talao shows the following
figures for different races :—
North Fort.
Hindus
Mussulmans
Parsis
Christians
Number examined.
1,480
195
2,168
123
Number with
spleen.
437
66
769
45
Percentage with
spleen.
29.5
33.8
35.4
24.6
Dhobi Talao.
Hindus
Mussulmans
Parsis
Christians
Number examined.
1,961
34
792
Number with
spleen.
324
7
196
34
Percentage with
spleen.
16.5
20.5
24.7
13.3
These figures show that in both North Port and Dhohi Talao Sections
Parsis suffer in greater proportion than in any other race ; and this is in spite
of the fact that as a community they are comparatively well-off, are better
educated than either Hindus or Mussulmans and, as a rule, receive treatment
from qualified medical practitioners.
76. The distribution of enlarged spleen by wards and races is as follows :—
A. Ward.
Hindus
Mussulmans
Parsis
Christians
...
...
Jews
B. Ward,
Hindus
Mussulmans
Parsis
Christians
Jews
C. Ward,
Hindus
Mussulmans
Parsis
Christians
Number examined.
3,158
289
2,187
225
10
4,034
1,596
3
113
234
9,334
1,712
887
263
Number with
spleen.
407
89
783
61
1
525
235
8
23
798
83
204
34
Percentage with
spleen.
16.5
30.7
27.2
27.2
10.0
13.01
14.7
7.08
98
8.5
4.8
22.9
12.8
32
D, Ward.
Hindus
Mussulmans
Parsis
Christians
E. Ward.
Hindus
Mussulmans
Parsis
...
Christians
Jews
F. Ward.
Hindus
...
...
..
Mussulmans
Parsis
Christians
...
...
...
G. Ward.
Hindus
Mussulmans
Parsis
...
...
Christians
Number
examined.
6,097
224
1,088
120
9,310
1,520
189
390
237
5,202
253
1
67
3,374
259
32
231
Number with
spleen.
165
10
29
3
179
24
4
15
3
60
5
» • » •
1
36
2
3
Percentage with
spleen.
2.7
4.4
2.6
2.5
1.9
1.5
2.1
3.8
1.2
M
2.06
1.5
1.06
0.8
12
77. Boss in his report upon malaria in Mauritius states that, in con-
ducting the spleen census among young children there, the size of palpable
spleens were roughly classified as small, medium and large ; and more recently
Christophers has pointed out that it is often very desirable to express the spleen
rate in a more extended form than is usually done.
He suggests the classing of spleens into 5 classes as follows :—
(1) Spleen not palpable.
(2) Spleen palpable up to one finger's breadth below costal margin.
(3) Spleen two to three fingers' breadth below costal margin.
(4) Spleen a hand's breadth below costal margin.
(5) Spleen very large, reaching to umbilicus or beyond.
Unfortunately the measurement of the spleen is difficult, and different
observers are not likely to conform to the same standard very accurately, so that
although a series of different observations by one man may be comparable to one
another, the comparison of figures obtained by different observers is not so likely
to be of value.
In the second spleen censu3 in the North Fort the size of the spleens
observed were roughly noted. The number observed and the percentage of each
size are as follows :—
Talle of Spleens in North Fort classified according to size.
Observations.
Total, 3,987
No. 1.
Not
palpable.
2,676
Per-
centage.
67.1
No. 2.
Enlarged up
to 3 fingers'
breadth.
552
Per-
centage.
13.8
No. 3.
Enlarged up
to 3 fingers'
breadth.
532
Per-
centage
13.6
No. 4.
Enlarged up
to 4 fingers'
breadth.
175
Per-
centage.
4.3
No. 5.
Very large,
above a
hand's breadth
below costal
margin.
40
Per-
centage.
1.0