NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Agents for the Sale of Books published by the Superintendent of Government
Printing, India, Calcutta.
IN ENGLAND.
E. A. ARNOLD, 37, Bedford Street, Strand, Lon-
don, W.C.
CONSTABLE & CO., 2, Whitehall Gardens, London,
S.W.
SAMPSON Low, MARSTON & Co., St. Dunstan's
House, Fetter Lane, London, E.C.
P. S. King & SON, 2 & 4, Great Smith Street,
Westminster, London, S.W.
LUZAC & CO., 46, Gerat Russell Street, London,
W.C.
KEGAN PAUL, TRENCH, TRÜBNER & CO., Charing
Cross Road, London, W.C.
BEMARD QUARITCH, 15, Piccadilly, London, W .
WILLIAMS and NORGATE, Oxford.
DEIGHTON BELL & CO., Cambridge.
ON THE CONTINENT.
R. FRIEDLANDER & SOHN, 11, Carlstrasse, Berlin,
N.W.
OTTO HARRASSOWITZ, Leipzig.
KARL W. HIERSEMANN, Leipzig.
ERNEST LEROUX, 28, Rue Bonaparte, Paris.
MARTINUS NIJHOFF, The Hague.
IN INDIA.
THACKER, SPINK & CO., Calcutta and Simla.
NEWMAN & CO., Calcutta.
N. CAMBRAY & Co., Calcutta.
S. K. LAHIRI & Co., Calcutta.
THACKER & CO., LD., Bombay.
D. B. TARAPOREVALA, SONS & CO., Bombay.
A. J. COMBRIDGE & CO., Bombay.
RADHABAI ATMARAM SAGOON, Bombay.
HIGGINBOTHAM & CO., Madras.
V. KALYANARAMA IYER & Co., Madras.
G. A. NATESAN & CO., Madras.
RAI SAHIB M. GULAB SINGH AND SONS, Mufid-i-Am
Press, Lahore.
N. B. MATHUR, Superintendent, Nazair Kanun
Hind Press, Allahabad.
Superintendent, American Baptist Mission Press,
Rangoon.
FIRST REPORT OF THE ANTI-MALARIAL OPERATIONS
AT MIAN MIR, 1901-1903.
PART I.—General.|
PART II—Operations.
PART III.—Results.
PART I.
T HE operations to be described in this report were initiated by the members
of the Royal Society's Malaria Commission, with the object of demon-
strating in an experimental way that malarial fevers can be prevented by practical
measures based on the discovery that a particular kind of mosquito is the defi-
nitive host of the malaria parasite.
The original object of the Commissioners was to test the efficacy of
mosquito destruction in the prevention of malaria, and it was necessary, there-
fore, to select a station in which it seemed probable that a marked reduction in
the number of mosquitoes could be effected. It was also desirable to choose
a very malarious station, in order that the results of the experiments might be
more evident. From both these points of view the cantonment of Mian Mir
appeared to be suitable, for as regards the possibility of reducing the number of
mosquitoes it seemed probable that, as the rainy season was short and the total
annual rainfall small, the majority of breeding places could be dealt with com-
paratively easily; and as regards the prevalence of malaria, this cantonment is
recognised as being one of the most unhealthy in the Punjab.
Mian Mir cantonment is situated on a level plain six miles to the south-
east of Lahore city and about four miles to the east of the civil station. The
locality was selected in 1851-52 when it was decided to abandon the former
cantonments at Anarkali (in Lahore) on account of their unhealthiness. The
new cantonment was at that time a treeless desert, but many trees have since
been planted, and in all parts to which irrigation extends, good gardens and
grass land have been laid out.
The ordinary garrison of the cantonment consists of-
2 B a t t e r i e s o f R o y a l F i e l d A r t i l l e r y .
1 R e g i m e n t o f B r i t i s h I n f a n t r y .
1 R e g i m e n t o f B e n g a l C a v a l r y .
1 R e g i m e n t o f P u n j a b P i o n e e r s .
1 R e g i m e n t o f N a t i v e I n f a n t r y .
B
2
The total number of officers and men of these regiments averages about
3,900, and in connection with the ambulance and transport establishments
there are in addition about 600 native followers.
The arrangement of the cantonment is as follows :—On the extreme north
is the bazaar of the British Infantry and to the south-west of it is their hospital.
To the south of the hospital are the lines of the European Infantry and the
rifle range, and to the east by south of the range are the Quarter Guard, the
Magazine, and a set of officers' quarters. Still further to the south are the
racket court and Executive Engineer's office to the east of which are the lines of
the Native Infantry. To the south of these again are the lines of the Royal
Artillery and at the extreme south of the cantonment the lines of the Native
Cavalry.
The average annual rainfall in Mian Mir is about 20 inches. The following
table giving the average rainfall for each month of the years 1868 to 1892 shows
the distribution of the rainfall throughout the year:—
Month.
Average rainfall in inches.
January
.
.
.
.
.
.
.
.
.
.
.
.
.6
February
.
.
.
.
.
.
.
.
.
.
.
.
1 . 1
March
.
.
.
.
.
.
.
.
.
.
.
.
. 6
April
.
.
.
.
.
.
.
.
.
.
.
.
.4
May
.
.8
June
.
.
.
.
.
.
.
.
.
.
.
.
1.5
July
.
.
.
.
.
.
.
.
.
.
.
.
5.7
August
.
.
.
.
.
.
.
.
.
.
.
.
4.6
September
2.0
October
.
.
.
.
.
.
.
.
.
4
.
.3
November
.
.
.
.
.
.
.
.
.
.
.
. 1
December
.
.
.
.
.
.
.
.
.
.
.
.
.5
The greatest amount of rain falls therefore from June to September, the
chief fall being in July. The hottest month of the year is June, the temperature
in a carefully shut house in that month varying from 96°—106° F. and unless rain
comes, the heat lasts on into July.
The hot weather indicates its approach in April, but indoors it is fairly com-
fortable until May. Then the air becomes very dry, and hot burning winds
commence. The nights are warm but not troublesome during May, and both
April and May are comparatively healthy months for Europeans. In June the
3
heat increases considerably and hot winds are prevalent. Early in July there is
a burst of the monsoon rain, but owing to its short duration its cooling effect:
only lasts for a few days, and unless more rain comes, the great heat begins
again and is made more trying by the increased moisture of the air. Throughout
July and August the nights are very hot, and in the latter month strong,
hot breezes sometimes spring up. In September the nights begin to be less hot,
and from September 15th the days also are distinctly cooler. Early in October,
it is quite cool out of doors, and by the middle of this month the weather;
becomes very pleasant. This, however, is the month when malarial fevers are;
most prevalent. November and December days are bright and clear and the.
nights cold. In January and February early morning frosts are noticeable.
March is very variable but generally pleasant, and in April the hot weather
begins to make itself felt again.
The European troops are housed in lofty one-storied stone buildings pro-
vided with a wide verandah and raised some feet off the ground. In the hot.
weather punkahs are provided by day and night.
The drinking water for the troops is derived from the main irrigation canal.
After passing through filter beds it is distributed to different parts of the canton-
ment in pipes. Many of the natives, however, obtain their drinking water from
wells, of which there are a large number in the cantonment.
One of the worst features of Mian Mir as a cantonment is the fact that the
plain on which it is situated is so level that very little of the surface water can
drain away. Throughout the cantonment there are numerous brickwork surface
drains, but in none of these is there sufficient fall, and the majority end
abruptly on the level plain. In the construction of these storm-water drains
there appears to have been no definite object, and they are indeed of more harm
than good, for whenever a slight shower of rain falls, they become full of water
which remains in them until dried up by the sun. For this reason they form,
during the rainy season, favourable breeding places of anopheles mosquitoes.
The surface layer of the soil consists for the most part of very dry finely
powdered mud and sand, which, during the fierce winds of the hot weather, is
blown about in clouds of dust. Beneath this superficial layer the soil consists
for the most part of clay and "kankar "—a soil which becomes hard and imper-
vious on treatment with water.
In consequence of the sub-soil being for the most part impervious to water,
after one or two hours' rain the appearance of the cantonment is changed from
that of a dry arid plain to that of a district in flood. Broad expanses of water
often a quarter of a mile in extent cover the plain on every side, and the
inhabitants of the followers' huts on some of the comparatively low-lying parts
are literally flooded out. The majority of these large expanses of water dry up
in the hot sun in three or four days, but numerous small deeper pools are left
B 2
4
which, lasting for a week or ten days, form excellent breeding places of anopheles
mosquitoes.
In the absence of irrigation, Mian Mir would be little better than an arid
desert during the greater part of the year. A branch of the main irrigation canal
enters the cantonment and from this numerous shallow channels (irrigation
watercourses or "cuts") convey water to all the gardens, grass land, and crops in
the cantonment. The water is drawn up from these channels by means of Per-
sian wheels (" jalahars") and distributed over the land in shallow ditches. No
crops requiring continuous irrigation are grown in the cantonment, and the plan
usually adopted is to water a certain area of land one day and another the next,
so that all the water has time to soak into the ground or dry up before the next
supply is given. In the garden portions the Persian wheels are usually worked
for about three hours daily, and all the water used has generally soaked into
the ground by the same evening. At certain times of the year the supply of
water is frequently shut off for ten days or more at a time.
This is shown in the following table:—
Table showing the number of days of each month during which irrigation water was
supplied to Mian Mir Cantonment _for some years between 1892 and 1901.
YEAR.
Jan.
Feb.
Mar. April. May. June. July. Aug. Sept.
Oct. Nov.
Dec.
1892
•
16
13
23
24
26
28
13
14
22
30
30
31
1893
.
.
.
3
0
4
22
21
25
28
31
22
30
0
0
1897
.
.
11
4
22
28
31
29
31
31
30
23
20
18
1898
;
.
7
7
21
30
31
30
29
31
30
21
20
20
1899
.
.
10
19
26
25
31
30
31
31
21
14
10
14
1900
.
.
0
9
22
27
31
21
28
14
19
28
21
15
1901
.
3
0
27
27
30
23
28
21
30
20
16
7
Before anti-malarial operations in a place can be carried out with any
hpe of success, it is necessary to have exact knowledge of the real pre-
valence of malaria in the place, and of the conditions on which this prevalence
depends.
Before commencing operations in Mian Mir, therefore, we spent some time
in a study of the prevalence of malaria there and the conditions which deter-
mine it.
5
As will be seen from the following table, Mian Mir is one of the most
unhealthy cantonments in this part of India:—
Table showing the mean annual admission rate (per 1,000 of average strength) for
ague* among European troops for the years 1896-1900, inclusive, in some stations of
the Punjab and United Provinces.
Mian Mir
.
.
663.0
Delhi
. .
.1,145.6
Sialkot
.
.
271.0
Meerut
.
.
477.2
Rawalpindi
.
.
289.0o
Fatehgarh
.
.
464.4
Amritsar
.
.
445.6
Cawnpore
.
.
294.5
Jullundur.
..
.
260.9
Lucknow
.
. 204.3
Ferozpore
.
.
760.6
Fyzabad
.
. 231.2
Umballa
.
289.8
Fort Allahabad
.
. 400.6
Jhansi
.
.
355.7
Benares
.
.
273.2
Agra
.
.
259.0
The number of admissions per 1,000 for malarial fevers among European
troops at Mian Mir during the year 1901 is shown in the following table:—
EUROPEAN TROOPS AT MIAN MIR.
MALARIAL FEVERS (AGUE AND REMITTENT ).
Admitted per 1,000.
YEAR
Jan.
Feb. Mar. April. May. June. July. Aug. Sept.
Oct. Nov.
Dec.
1901
152.0 68.3 69.5 63.4 159.4 141.4 63.5 136.9 153.1 219 . 8 134.3 62.8
From this table it would appear that malarial fevers are prevalent in Mian
Mir throughout the year. This is not, however, the case, and a large number of
the cases recorded in the hospital returns are doubtless due to relapses. It is
certain also that other diseases than malaria are often returned under intermittent
or remittent malarial fevers. In order to ascertain what proportion of the
admissions for malarial fevers were really due to malaria, a number of men
admitted for these diseases were examined in October 1901 by Dr. Christophers,
and in 40 per cent. of the cases examined, malarial parasites were found. In the
same way I examined a number of men admitted or detained for malaria during
September 1902 before any quinine had been administered to them, and found
malarial parasites in 45 per cent. of the cases. During this month also, through
the courtesy of Major Gordon Hall, R.A.M.C., no quinine was administered as
medicine to a number of cases of " fever " in which I had not found parasites.
All of them recovered in from one to three days without any quinine, treatment,
and from this fact and the fact that several examinations of each case failed to
show the presence of parasites, I conclude that these cases of fever were not due
to malaria, though usually entered as such in the returns. The temperature charts
of some of these cases are given in an appendix to this report (Appendix A).
* The term " ague " in this report includes only intermittent malarial fevers. The term " malaria
fevers" is used to include intermittent and remittent malarial fevers.
6
The following tables exhibit the great variations which occur in the admis-
sion rates for malarial fevers at Mian Mir in different years :-
EUROPEAN TROOPS AT MIAN MIR.
MALARIAL FEVERS (AGUE AND REMITTENT).
Admitted per 1,000.
YEARS.
Jan.
Feb.
Mar. April. May. June. July. Aug. Sept.
Oct. Nov.
Dec.
1892
.
.
56.8 41.4 46.7 40.3 55.6 62.2 57.3 149.3 110.9 165.9 196.7 123.5
1893
.
. 54.2 35.0 55.4 41.2
74.6 109.7 156.9 142.6 81.0 134.3 102.4 88.3
1894
.
. 49.1
14.1
7.4
3.9 56.1 58.1
85.3 146.0 203.9 332.5 223.5 193.0
1895
.
. 118.2 84.1 106.3 189.1 152.9 174.9 143.9 127.6 I25.0
1 4 8 . 0 166.4 32.7
1896
.
. 12.1
3.9
6.7
14.1
10.8 43.5 33.7
9.6 47.2
87.5 37.0 28.9
1897
.
.
1 0 . 6
17.2 23.5
12.3
14.9
15.2
23.5
19.8 106.0 58.4 284.8 186.9
1898
.
.
84.5
33.
30.4 45.0 68.9
5.3 24.0
10.8
86.8 209.1 126.0 97.8
1899
.
.
33.0 37.6
38.6 36.8 80.7
56.7 50.8 29.8
58.2 49.9
18.0
6.6
1900
.
. 15.4
9.0 21.7 24.5 11.1
16.2
9.3 29.7 138.8 356.4 261.3 229.1
1901
.
. 152.0 68.3 69.5 63.4 159.4 141.4 63.5 126.9 153.1 219.8 134.3 62.8
NATIVE TROOPS AT MIAN MIR.
MALARIAL FEVERS.
Admitted per 1,000.
YEARS.
Jan.
Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov.
Dec.
1892
.
.
25.7
12.6
17.1
26.0
33.0
14.2
3.6 31.3 52.2 88.0 54.0 16.1
1893
.
.
6.8
4.9
4.2
6.2
8.2
7.3
15.2 46.5
15.2 27.9 19.9 34.3
1894
.
. 28.3 21.4
6.3
16.8
14.2
8 . 7
23.4 47.8 91.7 136.6 40.2 30.9
1895
.
.
4.6
1.3
4.0
13.7 23.0
7.7 28.7 37.5 120.9 146.3 21.2
19.5
1896
.
.
8.5
5.2
7.6
4.2
4.3
8.3
18.2
12.9
13.7
13.1
13.8
4.4
1897
.
.
3.5
1 . 0
2.7
5.8
10.6 10.4
11.1
20.3
75.5 11 9.0 11 2
48.3
1898
.
.
16.2
9.0
1 1 . 1 13.9
27.6
35.9 22.6 113.6 100.5 219.0 160.3 42.7
1899
.
.
20.8
10.5
16.4
13.6 20.0
6.8
19.9 12.3
8.4 17.8 19.9
9.2
1900
.
.
8.1
2.3
6.9 18.1 28.0 23.2
12.4 23.0 55.9 178.8 88.9 114.5
1901
.
. 49.8 21.2
14.6 47.7 67.9 42.3 32.2 26.5 43.4 114.4 43.9 22.7
It is probable that these variations are not altogether due to differences in
the prevalence of malaria in different years, but to the fact that some medical
officers are much more careful in their diagnosis of cases than others, as well as to
the fact that some medical officers " detain "* slight cases of fever, while others
* Detained cases are not shown in the official returns.
7
" admit " every case at once. For these reasons the statistics of any individual
year may not by any means represent accurately the real prevalence of the disease.
A more reliable method of estimating the prevalence of malarial fevers and
the liability to infection is given, as was originally shown by Koch, by an ex-
amination of young children, in order to find the percentage infected with mala-
rial parasites. Doctors Stephens and Christophers have added to this method
the estimation of the percentage of anopheles mosquitoes infected with sporo-
zoites in the salivary glands, as indicating more accurately the actual danger
of infection. Every cantonment in India has a number of followers' lines and
native bazaars attached to it, and the examination of the children and of the
anopheles mosquitoes in these lines and bazaars affords a ready means of estimat-
ing accurately the prevalence of malaria and the liability to infection.
The following table shows the results of the examinations of children in the
different bazaars of Mian Mir made in October and November 1901:—
TABLE SHOWING THE PREVALENCE OF MALARIA IN MIAN MIR.
L o c a l i t y .
Time of year.
Percentage of children
infected with malaria
parasites.
(Endemic Index.)
Percentage with
enlarged spleens.
British Infantry Bazar .
.
.
October 1901.
52
8 0
Royal Artillery Bazaar
•
•
Do.
35
75
Native Cavalry lines
.
.
Do.
25
36
Syce lines ('A) . .
.
.
.
. November 1901.
56.5
4 8
Syce lines (B) .
.
.
.
.
.
Do.
20
20
The endemic index of some of these bazaars is a high one, and it is evident
that, in the months in which the examinations were made, malarial fevers are very
prevalent in Mian Mir and the liability to infection very great.
In order to ascertain correctly the seasonal variations in the prevalence of
malaria at Mian Mir I have examined a number of the children in the bazaars as
frequently as possible throughout the year, and these results together with
those obtained last year may be tabulated as follows:—
TO SHOW THE SEASONAL PREVALENCE OF MALARIA IN MIAN MIR.
Locality.
Date.
Endemic Index.
Spleen rate.
per cent.
Number
examined.
British Infantry Bazaar .
. October 5th, 1901
.
52
8 0
25
November 25th, 1901 .
20
38
25
June 17th, 1902 .
.
8.3
26
24
July 28th, 1902 .
.
8 . 5
37
35
August 25th, 1902
.
15
60
20
September 17th, 1902 .
32.2
65
31
October 22nd, 1902
.
42.3
69
29
November 19th, 1902 .
27
57
24
8
From a consideration of the above table we may say that the season of new
infections in Mian Mir begins at the end of July or the beginning of August, and
that the number of new infections increases steadily until it reaches a maximum
in October. As soon as the endemic index begins to decrease it may be assumed
that new infections have ceased, and the sudden fall in the percentage of infected
children in November affords a proof of this. From November until July of the
next year any cases that occur are relapses of former infections.*
In considering the factors on which the prevalence of malarial fevers in Mian
Mir depends, the influence of the presence of anopheles mosquitoes is of most
importance. After determining the endemic indices of the bazaars in October
1901 our next object therefore was to find infection in anopheles mosquitoes.
Only two species of anopheles were at all abundant, viz.: A. Rossi (Giles)
and A. culicifacies (Giles). Other species, which will be referred to later, were
present, but not in large numbers. A. Rossi was more abundant than A. cul i ci -
facies, but both species were found in all the bazaars, in the barracks of the troops
and in the hospital and jail.
In view of the fact that our previous work in India had led us to the conclu-
sion that A. Rossi was a very inefficient carrier of malaria under natural condi-
tions, while A. culicifaciesw a s a v e r y g o o d o n e , w e s e l e c t e d a b a z a a r f o r t h e
examination of anopheles mosquitoes where the two species could be caught in fair
numbers in the same houses, in order to compare their rates of infection.
The results of our dissections were as follow :—
Species of Anopheles.
Number dissected.
Number with
sporozoites in the
glands.
Percentage infected
with sporozoites.
A. Rossi .
.
.
.
.
.
.
496
0
0
A. culicifacies
.
.
.
.
.
259
12
4.6
It is evident from these results that A. culicifacies is the chief if not the
only carrier of malaria in Mian Mir, and the knowledge that A. Rossi takes little
or no part in the communication of infection under natural conditions, is of great
importance in connection with anti-malarial operations.
*In Chart II the seasonal prevalence of malarial fevers in Mian Mir as given by the statistics of
admissions into hospital may be compared with the results shown in this table. It will be seen that
although the statistics of any one year taken separately give but little idea of the seasonal prevalence of
malaria, if the decennial monthly rates are taken, the result corresponds very accurately with that obtained
from the examination of children. The comparison of the fever curves in this chart shows also that the rise
in the admission rates for fevers in September and October is really due to malaria and not to any other
cause.
9
Six species of anopheles mosquitoes have been found by us in Mian Mir, viz.:—
A. Rossi.
A. pulcherrimus.
A. culicifacies.
A. fuliginosus.
A. Stephensi.
A. nigerrimus.
The seasonal prevalence of these species in 1901-1902 was as follows. All
the species were found during October and the first week of November 1901.
A. Rossi was exceedingly abundant and almost any number could be caught with
ease in all the bazaars and barracks. A. culicifacies was also present in fair
numbers though not so plentiful as A. Rossi. All the other species were com-
paratively rare, and it would have taken many weeks to catch a sufficient number of
any of these species to render their dissection of advantage. During the second week
of November the number of adult anopheles mosquitoes began to decrease rapidly,
and November 28th was the last date on which any adult A. culicifaciesw e r e c a u g h t
in the houses. Two adult A. Rossi were caught in one of the bazaars on Decem-
ber 5th after an hour's search, but these were the last adults seen during the
winter of 1901, though search was frequently made during December. The
larvæ also diminished very rapidly, but a few were still present in some old pools
on December 20th, and in pools which remained without drying up throughout the
winter, a certain number of larvæ of A. culicifacies could always be found, though
no adult insects appeared to be present in the houses. In newly formed pools,
however, no larvæ appeared, and it is probable that larvæ found during the winter
in Mian Mir are old ones which remain alive, but are unable to develop into
adults until the spring.
A few new larvæ could be found in March but adult anopheles mosquitoes were
so few that it was difficult or impossible to detect them the houses. Indeed it
was not until the middle of May that adult mosquitoes of this genus became
sufficiently numerous in the houses to be detected by searching, and until this
time larvæ also were scanty though gradually increasing in numbers.* From the
middle of May onwards the number of larvæ and the number of adult insects
increased steadily to a maximum in September and the beginning of October. In
November the numbers again began to diminish rapidly. The seasonal prevalence
of the two species A. culicifaciesa n d
A . R o s s i
d o e s n o t e x a c t l y c o r r e s p o n d .
A. culicifacies appears much earlier than A. Rossi. Although moderate numbers
of A. culicifaciesc o u l d b e c a u g h t i n t h e b a z a a r s d u r i n g M a y a n d J u n e , n o t a
single adult A. Rossi was found until the beginning of July. As soon, however,
as this species appears it increases very rapidly, and in a short time becomes
far more abundant than any other species. This difference in seasonal preva-
lence may be accounted for by the fact that whereas A. culicifacies breeds chiefly
* Observations on the methods by which anopheles mosquitoes tide over the winter and reappear in
the spring will be found in Part II.
c
10
in the irrigation watercourses which are running more or less throughout the year,
A. Rossi is dependent for its breeding grounds chiefly on rain-formed pools, so
that it does not appear in any abundance until the heavy rains of July commence.
This connection between the flow of the irrigation water-supply and the
prevalence of Anopheles culicifacies and between the rainfall and the prevalence
of Anopheles Rossi is shown in the following chart :—
(Chart No. I.)
Chart No. I. Red dotted line=curve of irrigation water-supply to Mian Mir (average of 7 years, vide
table on page 4).
Red line=curve of A. culicifacies.
Black dotted line=curve of rainfall (average 1868—1892, vide table on page 2).
Black line=curve of A. Rossi.