Vital s t a t i s t i c s.
“ Btjb d- WAN ” FEVEB.
The duty of [reporting deaths was imposed on the village ohaukidars in 1869, and in 1>76 they were ordered to • report births as well. The system proved a failure as the returns
•obtained were so incomplete and inaccurate as to be practically useless, and, exoept in towns, deaths alone were reported until 1892, when the present system of collecting vital statistics was introduced. Under the present orders deaths and births are reported by the ohaukidars to the police on ehaukidari parade days, and the police submit monthly returns to the Civil Surgeon who consolidates the statistics for the whole distriot. A s in every other distriot where this system is in vogue, little or no reliance can be put on the statistics as regards the cause of death..
The ohaukidars are mostly illiterate .and uneducated, and they can hardly be expected to possess the amount of medical knowledge required to distinguish one disease from another. T o them fever is a comprehensive term, and is made to include practically everything with febrile symptoms, from malaria or typhoid to pneumonia. Experiments were recently made in selected circles in the Burdwan distriot under the supervision of the Sanitary Commissioner to the Government of India in order to check the a c c u r a c y of the ohaukidars’- reports. In the Galsi thana 618 births and 919 deaths during six months as reported by ohaukidars were inquired into by Assistant Surgeons, who visited the houses where these were reported to have taken place immediately on thd reports being received at the thanas. Out of these 919 deaths it was found that 508 cases were wrongly diagnosed, i.e., 55 3 per cent. In another experiment 2,616 deaths 'were recorded in the thana registers out of which 1,056 cases were wrongly reported.
In spite of this defect, however, the vital statistics may be regarded, as sufficiently accurate for the purpose of calculating the growth of the population.
Before 1862 the distriot was noted for its healthiness, and the town of Burdwan particularly was regarded as a sanitarium. In fact it was customary for persons suffering from chronic malarial fever to come to Burdwan where cures from the disease were common. But in 1862 the terrible epidemic fever, whioh for several years had ravaged the neighbouring districts of Jessore, Nadia and H ooghly, crossed the border of Burdwan appearing first in the Kalna subdivision. Thence it spread gradually but steadily over the district, following the mam lines of communication, until it was fairly established in all the eastern thatfas. The towns of Burdwan, Katwa and Kalna suffered severely, and throughout the district the mortality was enormous. Dr. French, who made a special enquiry into the
PUBLld HEALTH.
79
outbreak, estimated th^total mortality at about one-third of the 1 population in the traots attacked b y the epidemio. T he instances given by him show that this was no exaggeration. In 1869 the population of the town of Burdwan was estimated at 46,(WO. • Three years afterwards the population had fallen to 32,687, a deorease of over 30 per oent. In seventeen villages of the Katwa subdivision, containing an estimated population of 14,982 upon the appearance of the epidemio, no less than 6,243 persons, or 41*7 per oent. of the population, died of fever in these disastrous years, while the figures for fifty villages in the Katwa subdivision showed a similar mortality. Still more significant proof of the enormous mortality is to be found in the faot that the population was in 1872 not muoh in «xcess of the estimate formed by Mr- Bayley, nearly sixty years before. I n the census report for 1881 it \fras estimated theft during the twelve years from 1862-1874 the epidemio had carried off not less than three- quarters of a million of persons. The fever was either intermittent or remittent and of a very malignant type, relapses being the almost invariable rule when the patient survived the attacks. It reourred every autumn and lasted throughout the winter up to the dose of the year 1875. It is reported that sinoe that date no fever exactly similar to this fatal type has been known to oomir. N o special cause for the outbreak has ever been discovered. B y some it was supposed to result from the inter
ference of the natural drainage of the country by river and railway embankments, b y ohanges in the oourse of the large rivers, and by the silting and drying1 up o f the ohannels of the smaller streams. Others regarded the drinking water as the eause of the disease. Neither theory has ever been proved. But as a rule it was the overcrowded, low-lying,, badly drained, filthy village that suffered most severely, while the villages situated on higher ground with good natural drainage and scanty population escaped. Relief was given by Government on a [large scale and no expense was spa'red in order to oheok the ravages of the epidemio as far as possible. In spite of all efforts, however, it spread slowly aoross the district, travelling always westwards, un til on reaching the laterite soil of the Asansol uplands it was finally cheoked and eventually died out altogether. On the 3.1st M arch 1876 Government operations for the relief of the fever were brought to a olose, as the improved health o f the distriot no lon ger required suoh measures. Between August 1871 and that date nearly four million persons were treated in the local dispensaries: the expenditure of quinine alone amounted to 3,212 lbs. valued at Rs. 16,245; and the total cost of European
80
BTTTimVAN.Pe in- OIFAlt
Dis e a s e s.
Fevers.
medioines during the four and a half years was Rs. 2,45,071.
The expenditure on acoount of the extra establishment of medioal officers during the same period was Rs. 2^82,559. Thus the
>total publio expenditure on fever relief amounted to nearly 5J lakhs of rupees. The after-effects of the epidemio continued to be felt for two deoades after the real Burdwan fever had disappeared. The oensus of 1881 showed that the population was decreasing, and during the next ten years it remained practically stationary. The distriot has since made a rapid reoovery, and in 1901 the population exoeeded by some 30,000 persons the numbef returned in 1872. If, however, the vital statistics for the past ten years are to be trusted, they seem to show that at present the population is not increasing, the average birth-rate for the last ten years being oi)ly,32'15 as compared with a death-rate of 34'15. During these years the highest birth-rate recorded was 37‘ 63 in 1904, and the highest death-rate 44-62 in 1908. In 1909 the birth- and death-rates were 31‘89 and 25-94, respectively.
The following aocount o f the diseases prevalent in the district has been contributed by Captain N. W . Maokworth, i.m .s ., the Civil Surgeon. Tljere are so many varieties of fever prevalent in the distriot, and the knowledge of their nature is often so partial that the classification attempted below cannot pretend to be either complete or altogether scientific:—
1. Intermittent fever—
(a) quotidian; | (c) quartan;
(b) tertian; c j (2) double quotidian.
2. Remittent fever—
(a) bilious remittent; | - (b) typho-malarial.
3. ’ Pernicious malarial fever.
4. Unclassified fever.
5. Pernicious caoheotio fever.
6. Typhoid fever.
7. Kala azar.
Intermittent fever is the prevailing disease. It is very generally associated with the enlargement of the spleen, and not infrequently ^wth that of the liver also. The tertian variety is many times less common than the quotidian, while the double quotidian and quart&n types are rare. The double quotidian variety mq,y occur where quinine has failed to eradicate the poison in a patienf who has suffered from remittent fever
whioh afterwards becomes intermittent.
Bilious remittent fever is a true malarial fever, and is associated with gastro-hepatic complications, with slight jaundioe, and
enlargement of the spleen. I f unchecked before the close o f the second .week, typhoid symptoms appear, and death may result.
Typho-malarial fevffr is due to the oombined action of malaria and some septio poison, There is tenderness in the right iliao , fossa, but no eruption ; both liver and spleen undergo enlarge
ment, and jaundice is of frequent occurrence ; the motions are dark and offensive. During the seoond week typhoid symptoms may appear, with dry furred tongue frequent, fluttering pulse, and delirium. Improvement may set in after the fourteenth day, or death from coma may take plaoe. T his fever as a rule yields to quinine. Pernicious malarial fever is a malignant and destructive fever characterized by dangerous looal mischief in important organs. It may be intermittent or remittent.
It may assume a oomatose, delirious, or -algid form, and terminate fatally in fro*m tine to three days. Quinine is less efficacious here. In addition to the above types of malarial fever may be added a choleraic variety of the disease whioh may very readily be mistaken for Asiatic cholera, since the fever is accom
panied by watery stools, but these are not altogether devoid of bile. Several o f these cases oocurred in Burdwan in September of 1909 when there was no cholera about. The infection was confirmed microscopically. Unclassified fever is a fever attended with slight evening rise of temperature, general uneasiness and a burning sensation in the eyes, palms o f the hands and soles of the feet. It does not .yield to quinine. Pernicious caoheotio fever generally assumes an intermittent type, but attaoks of a remittent type may supervene. It generally terminates fatally after a prolonged course, the immediate cause of death being anaemia with dropsy and diarrhoea,- dysentery or cancrum oris.
Both liver and spleen ar6 enlarged, but towards the close of the disease the enlargements often tend to disappear. A case of this type has been known to last for over a year in whioh quinine had no specifio action, even in very large doses.
Typhoid fever is not at all an uncommon disease in Burdwan muoh more common than was hitherto supposed. Several oases were observed throughout their course during 1909 and the diagnosis confirmed bacteriologically. The disease would seem to manifest itself in a more severe form than that seen in England.
Lysis is much delayed. There is more ulceration of the bowel, and haemorrhage from the bowel is common. A large proportion'of the cases prove fatal. Typhoid is most often»oonfused with malaria and dysentery, but very often there is a mixed infeotion of typhoid and malaria present. The municipal water-supply o f the town 'is.
free from typhoid contamination, but it is not difficult to trace