NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
40
grains of quinine according to age,* once a day for the first ten consecutive days
and afterwards, irrespective of age, a dose of ten grains of quinine twice a week
throughout September, October, and November. In the middle of October when,
in spite of the treatment, a few new infections occurred among the children, ten
d a y s ’ c o n s e c u t i v e t r e a t m e n t w a s a g a i n g i v e n t o t h o s e c h i l d r e n i n w h o s e b l o o d
parasites were found, and again at the end of November when the season of new
infections had passed, all the children were again given ten days’ consecutive
treatment in order to completely kill off any parasites which might still have
resisted the previous treatment.
It was found that even children of one or two years of age could stand a
daily dose of ten grains of quinine without any ill effect. After the first three or
four days most of the children took the quinine readily and apparently got to like
the bitter taste.
The third source of infection of anopheles mosquitoes in order of importance,
was the second series of syce lines.
The children of this series of syce lines, which are situated at a dis-
tance of 400 yards from the nearest barrack, were infected with malaria
parasites to the extent of 20 per cent. in October 1901. From the 10th of
September to the end of November 1902, they were regularly treated with
quinine in the same manner as was being done with the hospital followers’
children. They numbered 103 in all, and each child received a daily dose of
from five to ten grains of quinine for the first ten days, and afterwards a dose of
ten grains twice a week on consecutive days.
The results of these measures are given in Part III (pages 45 and 46).
The fourth important source of infection of anopheles mosquitoes was
the Royal Artillery bazaar. This bazaar was selected as a favourable one for
testing the efficacy of the operations against mosquitoes, and for this reason no
measures other than mosquito destruction were carried out in it.
IV.—Prophylaxis by the administration of quinine to the troops.
In addition to the measures described above, all the British soldiers in the
cantonment received a dose of ten grains of quinine twice a week on consecu-
tive days. The chief object of this measure was to prevent relapses of old
infections. We had found that at the end of November 1901, 22.2 per cent. of
the men of Royal Artillery who were doing their duty and who were apparently
quite healthy, had malaria parasites in their blood, so that it was evident some
measure by which relapses of these infections might be prevented was necessary.
The administration of quinine was commenced on April 18th and con-
tinued throughout the summer. In order to ensure the prophylactic dose being
taken by the men they were paraded twice a week at the hospital and the quinine
given under the supervision of a medical officer.
* Children up to five years of age received a dose of five grains; beyond that age a dose of ten grains.
41
PART III.
Results.
In considering the results of the operations up to the end of May 1903,
the results obtained with regard to the prevalence of anopheles mosquitoes may
be taken first.
On this important point the following conclusions must, I think, be
admitted:—
(1) The operations were commenced in 1902 under favourable conditions,
for very few, if any, adult anopheles mosquitoes were present in the houses and
very few, if any, larvæ in the breeding places.
(2) In spite of the operations the number of adult anopheles mosquitoes
present in the houses and the number of larvæ found in the breeding places
gradually increased month by month to a maximum in September and October,
and then quickly decreased during November and the beginning of December
although the operations were discontinued during the latter month. A similar
disappearance was also noted in places where no operations were carried on.
(3) As a result of the operations the increase in the number of anopheles
mosquitoes which occurred each month was to a great extent checked, so that
the actual number present in the houses at any time of the year was not
nearly so great as it would have been had no operations been carried on.
(4) In spite of the check on the breeding of anopheles mosquitoes the
actual number present in the houses from July to November (1902) was such
that specimens of both species A. culicifacies and A. Rossi could be caught
fairly easily at any time.
(5) The number of adult specimens of A. culicifacies present in the houses
of the area was less than in other parts of the cantonment where no operations
had been carried on.
(6) The number of adult specimens of A. culicifacies present in the houses
during the year 1902, was less than during the preceding year. This cannot
be said with certainty regarding parts of the cantonment where no operations
had been carried on. In the British Infantry Bazaar, for example, if any differ-
ence between the number of A. culicifacies present in the houses during
1901 and 1902 existed, it was so slight as not to be detectable by search-
ing. In the Royal Artillery Bazaar, on the other hand, the difference between
the two years was quite apparent to one who had regularly searched the bazaar
during both the years of observation.
(7) The number of larvæ of A. culicifacies to be found in the cleaned
42
canals was certainly less than in the uncleaned ones, and for this reason
less than could be found during the preceding year.
(8) Regarding A. Rossi it cannot, I think, be said with certainty that the
number of adult insects present in the area was less than in other parts of the
cantonment, nor was it, to any appreciable extent, less than during the preceding
year. In all parts of the cantonment during both years this species was so
abundant that any difference which existed was negligable. Except on the
supposition that they came from some place outside the area of operations, it is
very difficult to account for the almost sudden appearance of large numbers of
this species at the beginning of July. It is also difficult to account for the fact
that in spite of all breeding places of this species within the area (which ex-
tended to a distance of nearly half a mile in every direction from the houses
where the adult insects were caught), being regularly dealt with, the number of
adult insects present in the houses increased considerably instead of diminishing.
(9) During the winter all anopheles adults had, as far as could be ascer-
tained by careful search and experiment, entirely disappeared from the area,
and all larvæ were killed off within a radius of nearly two miles in every direc-
tion from its outer limits. In the spring, however, anopheles larvæ and adults
re-appeared in the area and at the end of May, 1903, A. culicifacies was almost
as prevalent as it had been at the same time in the previous year.
(10) For a few days during May, 1903, the area was flooded with numerous
adult A. fuliginosus, which apparently came from the village of Kora, 2½ miles
away, and which disappeared almost as suddenly as they had come.
It is evident, therefore, that the problem of materially reducing the number
of anopheles mosquitoes in Mian Mir is a difficult one. The chief difficulty arises
from the fact that the majority of breeding places are such that they cannot be
permanently done away with, and it seems doubtful whether any operations short
of permanent extermination of all possible breeding places will produce a marked
reduction in the number of anopheles mosquitoes. It should be remembered,
however, that the operations have only been in progress one year, and that by
continually rendering all possible breeding places inhospitable for larvæ, a per-
manent diminution may in time be effected.
Secondly we may consider whether any reduction in the amount of malaria
has been effected, and if so, the means by which this has been brought about.
The tests of a reduction in the amount of malaria are, in order of importance :—
(1) A reduction in the amount of malaria in the regimental bazaars as
measured by a reduction in the percentage of children found infected with
malaria parasites.
(2) A reduction in the number of admissions for malarial fevers among the
troops.
43
(3) A reduction in the percentage of infection with malaria parasites among
the troops.
I.—The amount of malaria in the Regimental Bazaars.
(I )— The Royal Artillery Bazaar.
In this bazaar mosquito destruction was the only prophylactic measure
carried out.
The percentage of infection of the children and their spleen rates at the
height of the fever seasons in 1901 and 1902 are shown in the following table.
ROYAL ARTILLERY BAZAAR.
DATE.
.
.
.
.
.
. . . . .
October 1901.
October 1902.
Percentage of infected children
. . .. . .
35
20
Percentage with enlarged spleens .
.
.
.
.
75
64
In the year of operations, therefore, there was a reduction in the amount of
malaria in this bazaar. It should be noted, however, that in the British Infantry
bazaar where no operations were carried out and in which, for this reason, control
observations were made, a reduction in the amount of malaria also occurred
during 1902. This is shown in the following table :—
BRITISH INFANTRY BAZAAR.
DATE .
.
.
.
. . .
October 1901.
Oct ober 1902.
Percentage of infected children.
. . . .
5 2
4 2 . 3
Percentage with enlarged spleens .
.
.
. .
8 0
6 9
It may be assumed, therefore, that a reduction in the percentage of infected
children of the Royal Artillery Bazaar would also have occurred in 1902, in the
ordinary course of events, and in the absence of any operations. A closer ex-
amination of the figures shows, however, that over and above the decrease which
would have occurred in 1902 in consequence of the year being an unusually
healthy one, there was an additional decrease which may fairly be ascribed to
the operations against mosquitoes. The decrease which occurred in the British
Infantry Bazaar in the absence of any operations is represented by the proportion
as 1.23: 1, and the decrease in the Royal Artillery Bazaar where mosquito
G 2
44
destruction was carried on, is represented by the proportion as 1.75: 1, a much
greater decrease than can be accounted for solely by the fact of the year being
an exceptionally healthy one.
The difference between the relative decrease of the spleen rates in theses
two bazaars is not so marked, being represented by the proportions as 1.159: 1
in the British Infantry Bazaar and as 1.171 : 1 in the Royal Artillery Bazaar,
respectively, but this may be accounted for by the fact that in places where
there are a large number of chronically enlarged spleen cases, even in the entire
absence of new infections, it takes many months for the spleen rate to diminish
very markedly.* The difference between the percentage of infected children in
these two bazaars in September was much greater than in October and it is reason
able to conclude from the following table that the onset of the season of greatest
liability to infection had, as a result of the operations against mosquitoes, been
delayed, and that the season had been shortened in the Royal Artillery Bazaar.
Table showing the percentage of infected children during some months o
f the years 1901 and 1902 in the Royal Artillery Bazaar and in the British Infan
try Bazaar, respectively.
Oct.
1901.
Nov.
1901.
Dec.
1901.
Apl.
1902.
June
1902.
July
1902.
Aug.
1902.
Sept.
1902.
Oct.
1902.
Nov.
1902.
Royal Artillery Bazaar
35
†
29
21
5
4
4
4
2
12
British Infantry Bazaar
52
22
†
†
8.3
8 . 5
15
32.2
4 2 . 3
27
We may fairly conclude, therefore, that purely as the result of a reduction
in the number of anopheles mosquitoes ( A. culicifacies ), a reduction in the
amount of malaria in this bazaar occurred. We have already seen that the
reduction in the number of anopheles mosquitoes in this bazaar was not very
marked, though it was quite apparent to one who had regularly searched the
bazaar during both the years of observation. Had it been possible to have
effected a still greater diminution in the number of A. culicifacies (the carrier
of malaria in Mian Mir) there is little doubt that the amount of malaria would
have been reduced to a far greater extent. The experiment shows that even a
slight reduction in the number of anopheles mosquitoes affects the amount of
malaria to an extent which is quite measureable.
(2)—The first series of syce lines.
The operation carried out with regard to the inhabitants of these lines was
their removal into tents on a new site.
* See " Malaria in India" (Sc. Memoirs New Series No. 2) page 93.
† N o t e x a m i n e d .
45
.
The results of this experiment were very striking. The old site was situated
within 140 yards of an irrigation watercourse, in which numerous anopheles
mosquitoes (A. culicifacies) were breeding, and many adult insects of this species
were present in the houses in October 1901. At that time 56.5 per cent. of the
children were found infected with malaria parasites. The new site was situated
on t he open pl ai n, ¾ of a mi l e f r om t he near est i r r i gat i on wat er cour se and over
600 yards from the nearest pool. As a result of this no adult anopheles mos-
quitoes were found in any of the tents during September and October of the year
of operations, not a single case of fever occurred among the adults throughout
the season, and on October 24th (the height of the fever season) parasites were
only found in one child out of twenty-five examined. That is, by their removal
from the vicinity of anopheles breeding places and without treatment of any kind,
the percentage of infection of these children had been reduced from 56.5 in
October 1901 to only 4 in October 1902. Their spleen rate also had decreased
from 75 per cent. in April 1902 to 60 per cent. in October 1902.
This experiment proves that if it is possible to do away entirely with breeding
places of anopheles mosquitoes in any place, malaria quickly disappears. It has
already been mentioned that in every respect other than proximity to breeding
places of anopheles mosquitoes, this body of people were under the same condi-
tions on the new site as they had been on the old, except that being in tents they
were more exposed to the sun and rain than they had been in their houses on the
old site.
(3)—The Hospital followers' lines.
The measure carried out in these lines was the treatment of all the children
with quinine. These children were not examined in October 1901, but judging
from the fact that in June 1902 (the month in which malarial fever is least
prevalent in Mian Mir) 60 per cent. of the children had enlarged spleens, it is
reasonable to conclude that had they been examined during the fever season of
901, a large proportion would have been found infected. In the middle of August
before quinine treatment was commenced, I found parasites in two out of twenty-
five children examined. The treatment was commenced on August 30th and on
September 15th I was unable to find parasites in slides from any of twenty-five
children examined, nor again in the same number examined on October 6th. On
October 24th, however, I found parasites in four children out of twenty-five
examined, that is at the height of the fever season 16 per cent. of the children
were infected in spite of the treatment. These new infections, however, were
quickly cured by daily treatment for 10 days, and I consider that this source
of infection of anopheles mosquitoes was minimized, if not entirely eliminated.
Probably a certain number of mosquitoes became infected from these children
before the treatment was commenced, and another year it would be advisable to
46
begin the treatment earlier in the season. The effect of the treatment on the
spleen rate is shown in the following table :—
TO SHOW THE EFFECT OF QUININE TREATMENT ON THE HOSPITAL FOLLOWERS'
CHILDREN (TOTAL NUMBER—34).
Aug. 30th.
Sep. 9th. Sep.29th.
Oct. 6th
Oct.20th* Nov. 4th. Nov. 24th.
Total number with en-
larged spleens.
18
13
12
9
13
12
8
* The height of the fever season.
(4) The second series of syce lines.
Quinine treatment was also carried out on the children in these lines
At the height of the fever season in October 1901, 20 per cent . of these
children had been found to be infected with malaria parasites. As a result of
the quinine treatment no parasites were present in any of 25 children examined
in October 1902. The effect on the spleen rate is shown in the following
table :—
TO SHOW THE EFFECT OF QUININE TREATMENT ON THE CHILDREN OF
THE SYCE LINES (TOTAL NU MBER —103).
Oct. 1901. Sept. 1st,
1902.
Sept.29th. Oct.15th.* Nov. 15th. Nov. 25th.
Percentage with enlarged spleens .
20
1 5 . 5
2.5
4.9
3.9
1.9
II.—The number of admissions for malarial fevers among the troops.
It is generally agreed that the year 1902 was an exceptionally healthy one
for all troops in the Punjab, and for this reason it was an unfavourable year for
testing the efficacy of prophylactics measures by means of hospital statistics.
The number of admissions for ague among British troops throughout the
cantonment of Mian Mir was, I understand, the lowest ever recorded in this
station.
* The height of the fever season.
47
The following tables have been furnished me by the Senior Medical Officer,
Mian Mir :—
TABLE I
STATEMENT OF THE ADMISSIONS AND DEATHS FROM MALARIAL FEVERS AMONG THE BRITISH TROOPS AT
MIAN MIR FOR THE FIVE YEARS FROM 1898 to 1902.
Ratio per 1,000.
Years.
Strength.
Admissions.
Deaths.
Admissions.
Deaths.
1898
869
702
1
8 0 8
1
1899
853
400
1
469
1
1900
814
878
2
1,079
2
1901
8 0 8
1,094
1
1,354
1
1902
731
197
1
269
1
As shown on page 5 the average annual admission rate per 1,000 for
ague in Mian Mir is 663 and the rate of only 269 for all malarial fevers (ague
264 per 1, 000 + r emi t t ent f ever 5 per 1, 000) dur i ng 1902 compar es ver y
favourably with this.
TABLE II.
STATEMENT SHOWING SEPARATELY THE ADMISSIONS AND DEATHS FROM MALARIAL FEVERS AMONG THE
BRITISH INFANTRY AND THE ROYAL ARTILLERY IN MIAN MIR FOR THE YEARS 1900-1902.
Years.
Corps.
Strength.
Admissions. Deaths.
Ratio per 1,000.
Admissions.
Deaths.
Royal Artillery
.
.
259
132
1
509
4
1900 .
.
British Infantry
.
.
555
746
1
1,344
2
Royal Artillery
.
.
225
346
1
1,538
4
1901 .
.
.
British Infantry
.
.
583
748
. . .
1,283
. . .
Royal Artiller
.
.
66
. . .
384
...
1902
.
.
.
British infantry
.
.
559
131
1
234
2
TABLE II .—Statement showing the number of admissions for malarial fevers into
the British Infantry and Royal Artillery hospitals monthly during 1902.
BRITISH INFANTRY HOSPITAL.
Jan.
1902
Feb.
Mar.
Apl.
May. June. July. Aug. Sept. Oct.
Nov.
Dec.
Average monthly
strength.
690
651
667
507
335 321
308
306
314
893
955
601
Admissions..
15
19
13
5
1 0
4
3
0
0
31
25
7
48
ROYAL ARTILLERY HOSPITAL.
Jan.
1902.
Feb.
Mar.
Apl.
May. June. July. Aug.
Sept. Oct. Nov. Dec.
Average monthly
strength.
*
*
98
311
298
287
276
267
272
263
*
*
Admissions. .
4
5
4
8
1
1
2
12†
* The regiment was absent from the station.
† Several of these admissions were chronic malarial cases transferred from hill stations. Others were
cases contracted on the line of march to Delhi.
TABLE IV.—A comparison of the admissions for malarial fevers during the years
1901 and 1902.
HOSPITAL.
Year. Jan. Feb. Mar. Apl. May. June. July,
Aug. Sept.
Oct.
Nov. Dec.
1901 144
61 67 35
6 1
53
15
32
46
58
1 1 6
65
British Infantry .
1902
15
19 13
5
1 0
4
3
0
0
31
25
7
1901
20
2
3
6
38
33
22
42
44
75
40
16
Royal Artillery .
1902
*
*
4
5
4
8
1
1
2
12
*
*
*The regiment was absent from the station.
It is evident from these tables that during the year 1902 the prevalence of
malarial fevers among the troops in Mian Mir as shown by statistics was
remarkably small. It is difficult to determine accurately the factor to which
most credit should be given for this great decrease in the admission rate. In
the first place the year 1902 was, as a whole, far more healthy than 1901. Re
- g a r d i n g t h i s w e h a v e t h e f i g u r e s f o r t h e B r i t i s h I n f a n t r y b a z a a r a s a n i n d i c a t i o n
of the difference between the two years. At the height of the fever season in
1901, the endemic index of this bazaar was 52 and the spleen rate 8o per cent.
At the same time in 1902 the endemic index was 42.3 and the spleen rate
69 per cent. There was certainly, therefore, a marked difference between the
two years, but not, in my opinion, a difference sufficient to account for the large
decrease which occurred in the admission rate of the British Infantry. A large
proportion of the immunity enjoyed by these regiments, therefore, must be
attributed to the prophylactic issue of quinine (which this year was carried
out under strict supervision), for no other prophylactic measure than this was
carried out in the British Infantry lines. In former years it has been usual
to issue the quinine in bulk from the hospital to a non-commissioned officer of
50
the Royal Artillery was greater during. 1902 than that among the British
Infantry. (Table II. Ratio of admissions of Royal Artillery 384 per 1,000 ; of
the British Infantry 234 per 1,000.)
Where so many factors affect the statistics it is in fact impossible to
obtain any results of value from their consideration. It is, however, a matter
for congratulation that although during 1900 and during 1901 the death rate for
malarial fevers among the Royal Artillery was higher than among the British
infantry, during 1902 the results are reversed in favour of the Royal Artillery.
(Table II.)
I regret that from want of time I have been unable to carry out the third test,
viz., the examination of films of blood from a large number of men in the British
Infantry and Royal Artillery respectively in order to ascertain whether a reduc
-tion in the percentage of infection of the troops themselves has taken place.
A few words may be added regarding the respective value of the different
methods of prophylaxis attempted in Mian Mir.
That mosquito destruction, if it can be carried out successfully, will effec
- t u a l l y b a n i s h m a l a r i a , i s I t h i n k s u f f i c i e n t l y p r o v e d b y t h e r e s u l t s o b t a i n e d i n
the Royal Artillery Bazaar and in the first series of syce lines. Even though
it was not possible to reduce the number of anopheles mosquitoes very markedly
in the Royal Artillery lines, a decrease in the amount of malaria in the Royal
Artillery Bazaar greater than can be accounted for by reason of the year being
an unusually healthy one, occurred, which can only be attributed to the opera
- t i o n s a g a i n s t m o s q u i t o e s . I n t h e s y c e l i n e s ( w h i c h b y t h e i r r e m o v a l w e r e
taken entirely out of the range of anopheles mosquitoes) malaria almost entirely
disappeared. The chief drawback to mosquito destruction is its difficulty and
expense. It must be admitted that although we have been given, practically
speaking, a free hand in matters of expenditure and in the amount of labour
employed, and although my own services and those of a hospital assistant have
been confined exclusively to this work, we have, up to the present, made but
little impression on the number of anopheles mosquitoes. It remains to be
seen what the results of the second year's operations, will be, but unless a
more marked reduction in the number of anopheles mosquitoes can be effected
this year than during the previous one, it would, I think, be inadvisable to
continue operations on these lines in Mian Mir during a third year.
I attribute great value to the other operations carried on, viz., the attempt
to lessen the effects of obvious sources of infection of anopheles mosquitoes
in cantonments, and it is, I think, of some importance to have shown the practi-
cability of the method of treating large numbers of native children regularly
with quinine. This is a measure which requires no special knowledge and one
which is applicable to every place where large bodies of native children are
gathered together in the vicinity of European troops. One of the features of