"تقارير إدارة أقسام ومناطق الأراضي المحتلة في بلاد الرافدين لسنة ١٩١٨. المجلد I" [ظ‎‎١‎٣‎٩] (٤٧٠/٢٨٣)

neighbouring refugee camp, and only to a small extent in the town proper. By the
end of the year, 98 cases had been reported.
(24) In Basrah an average of four or five cases monthly was reported throughout
the first three quarters, but in October the numbers increased, and in all 110 cases
occurred. From evidence which was forthcoming at intervals, it would appear
that small-pox was continually being introduced into surrounding villages from
places lower down the river, and that the town was infected and reinfected in the
same way. For example, the Assistant Political Officer reported in July excessive
sickness among the Bani Hawa encampment near Qurmat ‘Ali, and in August
among the villages of Qardalan and Salhiyah, and inspection by this Department
resulted in the discovery of a large number of cases. When village epidemics were
thus discovered, this Department arranged for vaccination on the spot.
(25) Difficulties arise in the control of small-pox in Basrah from the light
estimation in which the disease is held by the public generally, and from their
confidence in the efficacy of the one vaccination in childhood which is commonly
practised, except among the poorer Mahommedans. Every endeavour has, however,
been made to bring home to the people the necessity of complying with the Military
Governor’s order requiring notification of infectious disease, and somewhat better
results are now being obtained, in part due to successful prosecutions undertaken.
As regards vaccination of contacts in the town, it is difficult to get attendance at
the hospitals or dispensaries, and the Woman Health Visitor has been sent into the
homes for this purpose.
(26) Malaria .—The ordinary anti-malarial measures were continued in force
from preceding years, and wells, cesspools and borrow pits were sprayed with oil at
frequent intervals. Water in the domestic wells in Basrah showed considerable
culex breeding, and opportunities were taken for the abolition of such wells in the
city, while new constructions were forbidden. It is not possible to give an accurate
statement as to the deaths due to malaria, but, including those registered as “ fever,”
malaria was ascribed as the cause of death in 7 per cent, of cases in ‘Ashar and in
5 per cent, of cases in Basrah.
(27) Influenza .—The pandemic of influenza, which, beginning in Spain in the
spring, spread northward through Europe and eastward to India, began to be
evident in the Basrah civil area in the first week of September, co-incident with a
general outbreak throughout the whole of the Base. The death rate rose sharply
to a figure not previously recorded even during the cholera epidemic in May; and,
during the first week in October, when the epidemic was at its height in Basrah City’
164 deaths were registered (the average weekly death rate in 1917 being 10*3). The
infection in ‘Ashar was slightly retarded and first showed its influence on the death
rate in the first week of October, the height of the curve being reached in the following
week with 75 deaths (as against the 1917 weekly average of 13-3).
(28) From observations collected from the civil hospital and from local practi
tioners, it was found that about one-fourth or one-fifth of the cases were complicated
with pneumonia, and to this the high mortality may be ascribed. In all it is
estimated that the epidemic, which lasted seven or eight weeks, resulted in about
700 deaths in the urban district alone.
(29) Puerperal Fever.—During the last six months of the year in Basrah (earlier
records were lost in the Health Office fire), 16 deaths were registered as due to
puerperal fever, with 18 deaths during the year in ‘Ashar. In October the Civil
burgeon, Basrah, raised the question as to the necessity of the registration of
midwives in practice, and as to the importance of superseding the present “ iiddah ”
or grandmother, by women who had received an elementary nursing and obstetric
trammg at the civil hospital ; and as a result the following scheme, framed by the
Ciyfi Surgeon and the Health Officer, was approved by the Military Governor and
will shortly be acted upon :—
(i) Registration with the Health Department of present midwives, i.e., of
women who prove that they have attended women in childbirth in the past, and who
signify their intention of continuing to do so for gain.
(n) Engagement by Civil Surgeon of two trained midwives for domiciliary
^ e T? C u Ur S ged t0 take pUpils in the hos Pital, who would be
admitted to the Midwives Roll after approval by Civil Surgeon.
(in) Inspection of midwiyes, who would be required to conform to a code of
rules, and who would be able to call on Civil Hospital for help in difficult cases.