NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
3
Referring specially to the results of the special work against malaria Gorgas says :
" It has reduced the deaths from malaria in the total population from a
maximum of 16.21 per 1,000 in July 1906 to 2.58 per 1,000 in December 1909.
Among employees it has reduced the deaths from malaria from a maximum of
11.59 per 1,000 in November 1906 to 1.23 per 1,000 in December 1909. The
admission rate among employees has fallen from a maximum of 12.63 Per 1,000
in July 1906 to 1.91 per 1,000 in December 1909. The admission rate per thousand
among employees has been as follows:—1904—-125 ; 1905—514; 1906—-821 ;
1907—424 ; 1908—282 ; 1909—215."
Mr. J. A. LePrince, C.E.A.M., Chief Sanitary Inspector, Panama Canal Zone, states
that :—
"From the 31st October 1909 to 1st January 1910 during the period of
heaviest rainfall, only 3.26 per cent. of the force (labourers) were hospital malaria
cases."
441. Wilhelmshaven.—It is recorded that in 1896 during the construction of the
harbour at Wilhelmshaven, a fearful epidemic of malaria occurred, which affected both the
workmen, the crews belonging to the shipping and the residents in the vicinity. At this
time little was known of the possibility of preventing malaria. But during the recent
enlargement of the harbour works, special precautions were adopted from the commence-
ment and as a result there has been no outbreak of the disease.
442.
The result of the preventive work that has been carried out at Panama and
Wilhelmshaven shows that even among aggregations of labourers engaged upon construc-
tion work in malarious areas, the adoption of adequate precautions is sufficient to neutralize
the risk of epidemic outbreaks of malaria, to which these temporary collections of labourers
are specially liable.
REPORT
OF AN
INVESTIGATION INTO THE CAUSES OF
MALARIA IN BOMBAY
AND THE MEASURES NECESSARY
FOR ITS CONTROL
BY
CHARLES A. BENTLEY, M.B., D.P.H., D.T.M.&H.,
Officer on Special Duty.
BOMBAY
PRINTED AT THE GOVERNMENT CENTRAL PRESS
1911
TABLE OF CONTENTS.
PART I.-INTRODUCTORY.
Section I. Brief Description of Bombay
...
,,
2. Population of Bombay.
Education
Occupation
Wages
Rent
Food
Indebtedness
„
3. Municipal Administration
• ••
•••
Sanitation
„
4. Vital Statistics
Annual mortality
Seasonal mortality
Sex mortality
Effect of migration upon mortality
Death-rates
Census population and actual population
Error in death-rates
Causes of death
Page
1
2
4
4
4
4
5
8
9
10
10
11
12
12
14
16
18
19
PART II.-MALAKIA IN BOMBAY.
CHAPTER I.—HISTORY OF MALARIA IN BOMBAY
II.-MEASUREMENT OF MALARIA IN BOMBAY ...
Section 1. Spleen Index
...
...
1st Spleen Census in Bombay
2nd Spleen Census in Bombay
...
...
Racial spleen index
Relative size of spleen
„
2. Blood Examination
...
...
Parasite index
Numerical estimation of parasites
...
...
Relative intensity of infection
...
...
Specie? of parasite
Seasonal infection
Relation of parasites to splenic enlargement
„
3. Malaria as a Cause of Death in Bom-lay
Total fever mortality
Recorded mortality from malaria
...
...
Seasonal mortality indicating malaria mortality
Deaths among children indicating malaria mortality
Effect of malaria upon births, etc.
„
4. Malaria as a Cause of Sichness in Bombay
CHAPTER III.—EPIDEMIC MALARIA IN BOMBAY ...
IV.—THE COST OP MALARIA IN BOMBAY
V.—THE MOSQUITOES OF BOMBAY
Section 1. General
„
2. Malarial infection in Mosquitoes
...
...
,,
3. Mosquito Larvae and Breeding Places
Method of examining breeding places
Anopheline larvae
Neocellia stephensi
Culicine larvae
„
4. The Natural Enemies of Mosquitoes
...
...
Insects
Fish
Plants
„ 5. Artificial means for destroying Mosquito Larva-
Gorgas' larvacide
...
Other larvacides
" XeX " new non-poisonous larvacide
s 136-b
21
25
26
27
27
30
32
33
33
35
37
38
39
41
41
41
43
44
46
48
49
54
59
61
61
66
69
69
70
71
72
74
74
75
76
77
78
79
80
ii
CONTENTS.
CHAPTER VI.—BRIEF SURVEY OF FACTORS WHICH IN-
FLUENCE MALARIA
Section 1. Conditions influencing malaria through the Anopheline factor
in Bombay
Species of anopheles in relation to malaria
Number of malaria-carrying anophelines in relation to
malaria
Character of breeding places in relation to malaria
Rainfall in relation to malaria
Temperature in relation to malaria
Cold
Heat
Atmospheric humidity in relation to
malaria
....
„
2. Conditions influencing Malaria through the human factor ...
Social conditions in relation to malaria
Overcrowding in relation to malaria
Economic conditions in relation to malaria ...
Soil disturbance and outbreaks of malaria ...
Education in relation to malaria
The effect of treatment upon the prevalence of malaria ...
Migration and malaria in Bombay
Page
81
S2
82
82
83
S3
84
84
84
84
84
84
S5
85
86
87
88
88
PART III.-THE PREVENTION OF MALARIA IN BOMBAY.
CHAPTER I.—HISTORY OF MALARIA PREVENTION
IN
BOMBAY.
Section 1. The Past History of Malaria Prevention
2. The History of Malaria Prevention since 1908
Commencement of Investigation of Malaria in Bombay...
Action taken by the Municipality
Action taken by the City of Bombay Improvement Trust.
Action taken by the Bombay Port Trust ...
Action taken by the Railway Companies ...
Section 3. Ad Interim Report of 1910
Preventive measures against malaria-carrying anophelines.
General measures
Measures for cisterns
„
for wells
,,
for tanks, fountains, garden tubs
,,
for special breeding places
CHAPTER II.—RESULTS OF MALARIA PREVENTION IN
BOMBAY
Section 1. Results up to 1909
„ 2. Recent Results of Malaria Prevention
Spleen rate
Fever admissions
Mortality—Total and Seasonal
Child mortality
Other results
Protection of wells
CHAPTER III.—THE LEGAL ASPECT OF MOSQUITO PREVEN-
TION IN BOMBAY
Section 1. Necessity for Legal Powers
„ 2. The City of Bombay Municipal Act
„ 3. The Administration of the Act in regard to Mosquito
Prevention
CHAPTER IV.—THE COST OF MOSQUITO PREVENTION
Section 1. Cost of anti-mosquito work in other parts of the world
Ismailia
Port Said
Havana
Rio de Janeiro
New Orleans
Khartoum
...
Durban
89
89
92
92
98
99
101
103
104
104
104
106
106
107
108
110
110
112
112
112
113
115
115
118
119
119
120
124
128
128
128
128
128
128
128
129
129
CONTENTS.
iii
Klang and Port Swettenham
Free Town
Hongkong
Cairo
Panama
•••
.••
Section 2. Cost of Mosquito Prevention in Bombay
Scheme I
Scheme IT
...
...
„
3. Cost of certain Permanent Measures
CHAPTER V.—THE OBSTACLES TO MALARIA PREVENTION
IN BOMBAY
VI.—THE PLACE OP QUININE IN THE PREVEN-
TION OF MALARIA IN BOMBAY
The sale of Quinine in palatable form
Treatment of cases of malaria in Bombay ...
VII.—SOME REASONS WHICH MAKE IT IMPERA-
TIVE THAT MALARIA SHOULD BE ERADI-
CATED FROM BOMBAY
VIII.—FINAL CONCLUSIONS REGARDING MALA-
RIA PREVENTION IN BOMBAY
Measures to be adopted
Choice of measures against all mosquitoes or malaria-
carrying anophelines
Expenditure
Special Officer
Subordinate staff
Legal Powers
Page
129
129
129
129
129
130
131
133
134
136
141
143
144
147
152
153
154
154
155
155
155
MAPS.
Map of Bombay showing Wards and Ward Sections
...
Map of Bombay showing original group of islets compared with present
island
...
...
Map of Bombay showing area below sea-level
...
...
Map of Bombay showing undrained area
...
Map showing the wells in the North Fort
Map showing the wells in a portion of Dhobi Talao
DIAGRAMS,
Curves of class mortality showing effect of migration
...
...
Map showing distribution of malaria and epidemic centres
Map showing limits and distribution of breeding places of N. Stephensi .
PLATES.
Key to adult Anophelines of Bombay
Key to Anopheline Larvae of Bombay
APPENDICES.
Appendix No. I.—Note upon the non-malarial fevers of Bombay
...
Appendix No. II.—Note upon Black-water fever in Bombay
Appendix No. III.—Climatic Data—
Table I. Average temperatures
Table II. Rainfall, humidity and wind
...
.,,
Table III. Weekly rainfall since 1906
Table IV. Distribution of heavy falls of rain since 190b'
Table V. Maximum and minimum temperatures, weekly
averages since 1906
Table VI. Relative humidity, weekly averages since 1906
Appendix No. IV.—Table I. Area of sections in city, number of houses
and population
Appendix No. V.—Table I. Deaths from various causes since 1848
Appendix No. VI.—Tables I to XIV—
Monthly admissions of fever cases to dispensaries
Front.
To face page 21
Do. page 23
Do. page 29
Do. page 70
Do. page 71
To face page 14
Do. page 81
Do. page 82
To face page 62
Do. page 69
157
158
153
160
161
162
163
164
165
166
167
No: I
The following table indicates the places from which the extraordinarily
mixed population of Bombay is drawn :—
Birth places.
Bombay City
Bombay Presidency
Other Provinces of India
Asia, other than India
Europe
Africa
America
Other places
...
...
1872.
i
61,3251
5,757
4,950
1275
S7
114,961,,
200,613
355,437
- S?,355
1881.
69 619"|
7,907
6,023 .
619 '
114
17,643 J
214,6«5
456,586
• 10',925
1891.
110,037-
6,467
7,063
736
170
2,021
205 732
488,938
j-127,09 i
I
1901.
101.0856
,334
7,707
694
162 |
570J
181,834
477,650
-116,522
1906.
203,692
636,974
137,156
10. Of the total population only about 21 per cent., acoording to the
Census of 1906, are born within the City. Since 1872 there has been a progres-
sive fall in the proportion of Bombay born citizens and a corresponding rise in
the proportion of those belonging to districts in the Presidency.
Year.
1872
1881
1891
1901
1906
Total.
644,405
773,196
*21,764
776,000
977,822
Bombay born.
Per cent.
311
27-7
25-0
23-4
20-8
Districts in
Bombay
Presidency.
Per cent.
55-1
590
59-4
61-5
65-1
Outside
Bombay
Presidency.
Per cent.
137
131
15-4
15-0
14-0
As has already been mentioned, besides those who icome from other places
and settle down permanently or for a few years in Bombay, a very large
proportion of the total population is composed of people who come to the City
in search of employment at certain times of the year, and leave again after a
few months to return to their own homes. The floating population of this kind
is probably not less than 150,000 to 200,000 persons. The influx of these people
commences in November and continues throughout the dry weather. The exodus
occurs in May and June. As the Census figures are recorded in February or
March, they include nearly the whole of fchis temporary floating population.
The following Districts and States in the Bombay Presidency contribute
very largely to the City population :—
District.
Eatuágiri
Poona
Sátára
Kátliiáwár
Cutch.
Surat
Kolába
1901.
145,835
64,791
60.387
45,531
28,179
25,097
21,100
1906»
221,572
76,13S
61,777
67,803
38,112
38,9 S4
29.867
11. The following table shows the population according to raco, etc. :—
Hindu
Jain
Mussulman
Christians Native
European and Eurasian
Parsi
....
Others
1872.
40S,680
15,121
138,815
25,119
9,605
44,091
2,974
IS 81.
502,851
17,218
158,713
30,708
11,619
48,597
8,490
1801.
568,501
...
165^247
29,432
15,878
47,458
5,248
1901.
508,608
14,248
155,747
29,645
15,531
46,231
5,996
1906.
j 706,154
168,677
30,223
18,285
48,824
5,659
5
from 5 to 20 or more other persons and 434,406 lived in single rooms occupied by
from 1 to 5 people. The cause of this extraordinary overcrowding is the high rent,
which makes it impossible for a large proportion of the wage earning classes to
hire a room to themselves ; and the majority of these people live huddled together
in large buildings composed of one-roomed tenements which are known in Bombay
as chauls. The average rent of a room in a chawl is Rs. 5 a month, but in
the more crowded portion of the City such as B. and 0. Wards it rises as high as
to Rs. 4-4 per mensem.
Comparative statement showing monthly rent* of single rooms in chawls.
1. Colaba, Fort and Esplanade
2. Mándvi, Chakla, Umarkhádi and Dongri
3. Market, Bhuleshwar and Kumbhárwada, etc.
4. Girgaum, Wálkeshwar and Mahálaxrni
5. Mazagnon, Byculla, Kámáthipura and Nágpáda
6. Parel, Sewri and Sion
7. Máhim and Worli
Ward.
A.
B.
C.
D.
E.
F.
G.
1893-1899
Average.
Rs.
3-4
3-8
4-8
3-4
2-8
1-10
1-8
1908-1909
Average.
Rs.
5-10
6-8
6-8
6-0
4-4
3-4
3-0
* Bombay Gazetteer.
In the Bombay Gazetteer it is stated that the rise in rentals since the year
1891 has been ascertained to be not less than 22 per cent. and it has become
impossible at present to rent the poorest accommodation suitable for a low-paid
clerk and his family, within reasonable distance of the office, at less than Rs. 10
per month. Personal observation has shown that it is not an uncommon thing
to find a family, of which the father is earning only Rs. 50 or Rs. 60 per
mensem, paying as much as Rs. 25 per month for a tenement of two rooms and
a small kitchen. Frequently a number of men of the same class, perhaps 10 or
more will rent a room in common and share living expenses, which under these
conditions will amount to about Rs. 6 per head per month, or perhaps one man
and his wife will take in a number of lodgers. As many as 22 such lodgers have
been counted asleep on the floor and adjoining verandah of a single-room tene-
ment rented at Rs. 3-8 per month, Pressure of high rents and consequent
overcrowding is responsible for the fact that during the greater part of the
year many thousands of people may be seen sleeping out of doors.
17. Food.—The lowest estimate of expenditure on food appears to be
majority of adult working males of the labouring class appear to spend from Rs. 5
to Rs. 7 per mensem on food and household expenses, excluding clothes. A
number of men of the servant class live in boarding houses, at an inclusive
charge of Rs. 10 per mensem. Indian students, nurses, etc., appear to pay an
average of about Rs. 13 per mensem for food alone.
The expenditure on food of a family of four, a man, his wife and two small
children, was found in one case to be as follows :—
Rent
Tur dal
Rice
Bajri
Ghee
Condiments
Kerosene
Firewood
Toddy
Rs.
4
1
6
3
1
1
0
1
0
18
a.
S
0
0
0
0
0
3
4
S
7
P.
0
0
0
0
0
0
0
0
0
0
The man earned Rs. 10 a month as a peon and his wife made biddis.
B 136—2
7
considerable, upset the balance for a time. If prices fall, the result on the
health conditions of the poorer classes is favourable for a short time ; if they
rise, and especially if the rise is sudden, the effect upon the health of these
classes will be proportionate to the stress produced and will continue until a
balance has been struck, either by adaptation to the changed condition or in
consequence of prices falling again.
The following table shows the prices during the past 40 years of the four
principal food-grains used in Bombay, The table shows the average number
of seers (about 2 lbs. avoirdupois) purchasable for one Rupee in each year:—
Year.
1871
1872
1873
1874
3875
1876
1877
1878
1879-
1880
18S1
1882
18S8
1884-
1885
Ï886
18S7
18S8
1SS9
1SS0
1*91
1892
1893
1894
1895
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1007
1908
1909
1910
Wheat.
10-21
10-94
11-64
12-3S
11-88
11-61
8-21
6-58
6-93
8-93
10-93
10 37
10-29
11-22
11-38
10-38
•J-93
9-6
9-91
10-49
9-7
8-43
9-78
10-95
33-18
11-84
6-66
7'Öl
7-69
6-06
6-üS
7'37
8-12
8-31
833
9-44
9-39
6-54
6-Sü
6-7t)
Jawilv.
16-8S
16-12
19-61
22-28
21-09
18-67
10-76
10-25
11-42
16-H7
22-38
19 62
18-7
17-41
18-54
17-94
17-77
16-07
16-84
17-38
16-92
Î3-7S
13-41
13-5
14-91
14-74
9-54
1343
12-4
8-97
13-00
12-61
13-45
13-üö
12-85
11-78
12-22
9-83
10-79
11-46
Bá..iri.
13-21
12-77
10-41
19-49
18-37
15 19
ÍU-78
:
9-7
:
10-58
:
13-72
18-78 !
1 16-75 1
i
15-85 '
•
14-73 '
14-91
15-07
14-07
13-33
13-14
14-12
J4-01
12-68
13-67
¡
14-02
1304
12-64
8-97
12-94
11-68
8-65
12-21
11-88
¡
14-19
13 49
:
11-39
11-94
!
13-23
!
9-83
10-97
': 10-79
i
Rice.
967
10-75
12-61
14-1
11-33
10-79
9-18
8-01
8-54
10-11
12-03
12-41
12-29
11-05
11-14
10 92
10-92
10-78
10-7
11-16
11-11
10-05
7'78
9-63
30-75
10-24
8-45
9-85
9-82
9-01
9-40
8-73
S-33
8-2S
S2S
8-27
8-12
6 64
S-30
9-03
In 1865 and 1860 prices of grain rose to an abnormal height in Bombay
and did not fall again until alter 1870. In 1877, owing to failure of the
monsoon, they rose suddenly once more and remained high during the whole of
1878. After this for nearly twenty years they remained comparatively low, but
owing to short rains in 1895 and 1896, they rose very suddenly in the last
quarter of the latter year and remained high through 1897. In 1900 there was
a still greater rise owing to famine in the Presidency, but in 1901 they fell
considerably. In the middle of 1907 a very sudden rise took place in the cost of
every kind of food in Bombay and of fuel also, and in December prices were far
in excess of those at the beginning of the year. The cost of wheat rose 60.1
per cent., jawári, bájri and náchni 37.5 per cent., flour 33 7 per cent., common
rice 31.7 per cent., grain and tur dál 20 per cent., cocoanut oil 25 per cent., ghee
20 per cent., and firewood 31 per cent. In 1908 prices still remained high
and a still further rise took place in the prices of bájri, náchni, gram and
14
35. It is the Hindu portion of the population among which the greatest
fluctuations take place ; and an examination of the following table and curve
serves to indicate the extraordinary effect upon the total mortality of the City
produced during the past few years by this variation in the population :—
Year.
1902
1903
1904
Î905
1906
1907
1908
1909
Meaa ...
Deaths among
Hindus.
34,739
36,709
80,246
35,010
39,106
26,847
25,725
;
23,332
!
31,463
Deaths among
Mussulmans.
10,211
10,246
9,176
9,342
10,065
S,714
9,216
8,352
9,415
De aths among
all other
classes.
3,474
3,558
3,254
3,410
3,703
3,126
3,330
3,194
3,381
Number of deaths above and below the mean and percentage variation,
are shown below :—
Deaths above and below the mean and percentage variation.
Year.
!
1902
1903
1904
1905
1906
1907
3908
1909
Mean variation ...
Mean variation above the
mean ...
Mean variation below the
mean ...
Hindus.
+ 3,266 = +10.3 per cent.
+ 5,240 = +16.6
-1,217= - 3*8
+ 3,547= + 11'2
„
+ 7,043= +'¿4-2
„
-4,616= -14-6
„
-5,738= -18-2
-8,131= -25'S
„
4,925=
15-6 percent.
4,925=
15"ß percent.
4.925=
15-0 per cent.
Mussulmans.
+ 796 = + 8*4) per cent.
+ 831= + 8*8
-239= - 2-5
„
-73= - O-7
„
+ (¡50= + 6-9
-701= - 7-4
„
-Ï9U= - 2-1
- 1,003 = -11-2
„
589=
&• 2 per cent.
759=
8*0 per cent.
•Jo5 =
4"S per cent.
Other classes.
+ 93 = + 2-7 per cent.
+ 177= +5-2
-127= -3-7
„
+ 29= +0-8
+ 332= +9-5
—15 5 = - 4*5
„
- 51= -1-5
-1S1= -4-2
142 =
4-2 per cent.
155=
4*5 per cerate
12S =
3-7 per cent.
The mean population of Hindus during the 8 years was probably about
500,000, that of Mussulmans about 150,000 and of other classes about 90,000.
The latter class, which includes Parsis, Native Christians, Europeans and
Eurasians, is probably less liable to great fluctuations than either Hindus or
Mussulmans ; and the difference between the mean variations in the annual morta-
lity among Hindus and members of this class indicates the probable fluctuation of
mortality due to excessive or reduced migration. In the dry season of 1906 the
Hindu population was probably swollen to a figure 10 to 15 per cent. above the
average dry weather population and in 1908 and 1909 it was from 15 to 20 per cent.
below it. From 60 to 80 per cent. of the apparent improvement in
mortality during the past few years is probably due to diminished migration
from the rural districts owing to better monsoons and increased prosperity.
36. Death-rates.—Total mortality figures give but a slight indication of
the true state of the public health and it is usual for comparative purposes to
make use of death-rates, that is the ratio of persons dying each year to the total
population living. Por calculating death-rates it is necessary to have an
estimate of the total population, and the figures obtained at each decennial
census are made use of for this purpose.
In Great Britain it is customary to calculate the population living in each
year of the inter-censal periods and to base birth and death-rates upon these
figures ; but in India no such correction is made, birth and death-rates being
calculated upon the census population.
CURVES SHOWING THAT LARGE VARIATIONS IN
MORTALITY IN BOMBAY ARE PROBABLY DUE TO INCREASED
OR LESSENED MIGRATION OF HINDUS.
Gov t . Photozinco, Office, Poona, 1911.
15
The following table shows the population of Bombay as found in different
Census years :—
Year.
1872
1881
1891
1901
1906
Male.
399,716
464,763
518,093
479,786
012,965
Female.
244,689
308,433
303,671
296,220
364,811
Females to
1,000 males.
612
664
586
617
595
Total.
644,405
773,196
821,176
776,006
977,822
The death-rates calculated upon these populations have been as follows :—
1872
1873
1S74
1S75
1876
1877
187S
1879
1880
1881
1SS2
1583
1884
1885
1886
1887
1888
1889
1890
1891
1S92
1893
1894
1895
1S96
1897
1898
189J
1900
1901
1902
1903
1504:
1905
1906
1907
1908
1909
1910
Year.
...
• •
• • •
...
...
...
...
...
» • •
...
«»a
• » •
. . .
...
• . i
...
a»
• . •
• • •
-« .
• ••
•..
...
...
..»
...
• • •
•
• • •
• • •
•••
ft • •
..
«••
. . .
• • .
t«
• « .
. . .
...
Population of the City
of Bombay.
644,405, Census 1872
...
! 773,196; Census 1881
..
i
j
Í
i
1
' 821,764, Census 1891
¡ 776,006, Census 1901 ...
,977,822, Census 1906
i
¡
Total
'
deaths.
18,990
15,665
15,496
18,734
20,783
33,511
26,999
22,527
21,146
21,856
20,468
23,530
22,544
21,850
20,074
20,513
22,421
23,878
20,534
23,847
j
26,51S
23,142
27,330
25,081
1
33,451
!
47,896
!
51,961
!
56,434
79,350
59,495
43,414
i
50,513
42,676
47,712
52,874
38,627
38,271
34,S7S
34,933
Percentage»
29*46
24-30
24-04
29-07
32-25
52-00
49-90
34-96
32-81
28-27
26-47
30-43
:
29-15
28-26
o-96
;
26-53
!
29-00
30-24
26-56
2901
:
32-26
28-16
32-¿5
30-52
40-S1
58-28
63-23
;
68-67
96-56
77-66
;
62-38
65-39
54-99
;
61-48
56-07
39-56
•
39-13
;
35-66
:
35-71
37. But the results obtained by attempting to calculate death-rates upon the
census figures in Bombay are practically worthless for the following reasons :—
(1) It is an exceedingly difficult thing to obtain an accurate census
in Bombay.
(2) The census is usually conducted in the middle of the dry weather
when the yearly influx of people is at its height ; and the number present
then is far in excess of those to be found a few months later. The mean of
the population present in the City during the dry and the wet seasons is
probably not less than 100,000 below the census population.