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REPORT ON THE WORKING OF THE KING INSTITUTE, GUINDY
APPENDIX No. III.
REPORT ON THE WORKING OF THE INVESTIGATION UNIT SENT TO
INVESTIGATE RELAPSING FEVER IN THE TANJORE DISTRICT,
BY
CIVIL ASSISTANT SURGEONS RAMAKRISHNAN.
Under instruction from the Director I proceeded to Tanjore with a Laboratory Attender
and the equipment necessary for a camp laboratory on the 10th April 1922. The next
morning, I met the District Medical and Sanitary Officer who gave the names of a few of
the infected villages in the district. Captain Ubhaya, the Assistant Director of Public
Health, also arrived at Tanjore on the 11th and we inspected a group of these villages
every day.
A full and detailed investigation was rendered impossible, as the epidemic was already
dying out when we started our investigation. No data were available to make general
clinical observations except such information as we could obtain from the examining of very
few cases which we saw lingering, or from those fewer still, who were recently attacked.
The history of the spread of the epidemic cannot be trustworthy as the information
bearing on the same could be gathered only from hearsay evidence, and that too given at a
period so remote from the beginning of the outbreak. Facts and figures available are
summarised in the following pages and some general observations are made permissible under
the circumstances.
Origin and spread of the epidemic.
During our investigations at Tirukattupalli, a village near the south-western corner of
Tanjore taluk, about 3 miles from the river Coleroon, we were able to ascertain from the
villagers that cases of fever in epidemic form were noticed early in September 1921, and that
these cases occurred as a result of infection contracted from certain villages in Lalgudi
taluk, Trichinopoly district, just on the other side of the Coleroon River.
From an examination of the death registers of the various villages inspected, and also
from the information given by the villagers themselves, we were able to form a general idea of
the spread of the epidemic.
The epidemic spread in a north-easterly direction through successive villages along the
Coleroon bank from the taluks, Tanjore, Papan āsam, and Kumbakō nam. In many cases,
there was definite evidence of infection having been carried from village to village either by
the inhabitants of a healthy village having gone to an infected village and returned or by
convalescents coming to healthy villages for a change.
The villagers themselves were able to tell us that the infection was generally contracted
by intermingling with people of infected villages. The epidemic seems to have been very
severe in January, February and March in all the three taluks—Tanjore, P āpanāsam, and
Kumbakō nam, while at the end of the epidemic a few cases were reported from the Mann ā r
-gudi taluk.
Etiology.
Relapsing fever has always been recognised as a disease of scarcity, poverty and desti
-tution. It attacks the lower, and in fact, only the lowest strata of humanity. Over-crowding
dirt and other insanitary conditions of life, want of proper food are powerful aids in the
prevalence and spread, of this fever.
The class of people affected by this epidemic were of the lowest strata
society, the Adi-Dravidas or the depressed classes. The two main divisions of the
Adi Dravidas are the Pariahs and the Pallars. They form the lowest class in the graduated
scale of Hindu society. The epidemic was entirely restricted to this community. Though
social intermingling is very much restricted between these two classes, the epidemic was
found to be equally prevalent in the two. As a contrast it is extremely interesting to note
that neighbouring hamlets or villages solely inhabited by caste Hindus, though sometimes
situated within a few hundred yards of the panchama village, completely escaped the infec
-tion. Enquiries failed to obtain information of a single case of the infection among caste
Hindus. Yet I found that in many cases, the hygienic conditions under which the caste
Hindus lived were not much better than that of the affected community. I am inclined to
attribute their immunity from the disease to their greater personal cleanliness. The pariah
class as already mentioned are very dirty, and scantily clothed. I failed to find Pediculus
corporis on them, but in almost every case their head was full of P.capitis.
A group of thatched huts always forms the abode of the Panchamas. The two classes
live in separate groups known as Cheries—Paracheri or Pallacheri as the case may be. A