4

SUPPLEMENT TO THE ANNUAL REPORT OF THE

water. They are also aware that mosquitoes (in the vernacular dhomalu) have
enormously increased. They say that mosquitoes are present throughout the year,
but that they are most numerous after a few showers of rain in October and
November when malaria is also at its highest. Despite this, they will not
believe " dhomalu " are responsible for the malaria. Since there are no hospitals
in the area, no direct malaria statistics are available. But there is a dispensary
at Pamur which is 6 miles west of Mopad and outside the irrigated area. This
dispensary, being the only one within a radius of 20 miles from Pamur, is
attended not only by the people immediately around it, but also by those from the
Mopad area, and so we may take the records as furnishing evidence of malaria
both in Mopad and in the other areas surrounding Pamur. Dispensary attend-
ances do not refer solely to fresh cases. Old cases re-attending after a week or
more are usually shown again as new attendances. So long as this practice does
not vary much in extent (and there is no reason to think that it has done so) the
records can serve as an index of the prevalence of a disease. The seasonal
incidence shows a close correspondence of malaria with rainfall, malaria being at
its worst from October to January. If this is correct, and it would seem to be so
from facts mentioned later and from what we learn to be the malarial season in
similar regions all along the north-east coast of the Madras Presidency, then it is
clear that a survey to be full of value should include an inspection during
September and October, for it would be at this time before and during the early
malarial rise that a multiplication in the true anopheles carrier or carriers would
be observed. While chart I (not reproduced) shows the close seasonal corre-
spondence between malaria and rainfall, chart II (not reproduced) distinctly shows
that the severity of malaria has not been dependant on the extent of rainfall
which is an important point. Chart II (not reproduced) also shows a striking
direct correspondence between malaria and the annual death-rate, rather proving
that local opinion is correct in attributing many deaths directly or indirectly to
malaria. The inverse relationship of the low birth-rate is important as contribu-
tory proof because as is well known not only does malaria increase the death-rate
by causing death or illness in adults but it directly lowers the birth-rate
by producing abortion.

        Evidence of extent of malaria.—As is well known such evidence is obtained
by finding the spleen rate—the percentage of children between 2 and 10 years
old with enlarged spleens, the parasite rate—the percentage of such children who
have parasites in the peripheral blood, and by getting such subsidiary evidence as
is possible on the same lines from adults. In each village as many children as
possible were examined. Results are given in Table II.

          TABLE II.—The spleen rate and parasite rate.