NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
80
General effect of anti-larval operations.—Whilst in Special circum-
stances it may be desirable to treat by drainage, training of streams, or
petrolage, some large source of anopheles' within a quarter or half a mile
of a bungalow or coolie lines, we do not believe that any" general attempt
to reduce malaria in the Duars by anti-larval operations would have the
slightest effect. The conditions met with offer very great difficulties.
The area involved on even the smallest gardens, the changing na-
ture of the breeding places, the torrential character of the streams and
the jungly conditions of many portions of the country have to be con-
sidered. It must be rememberd also that labour is everywhere at a pre-
mium at the very time when such measures' would require to be carried
out on a large scale, and there is little doubt that were the tea gardens
to undertake, however energetically, anti-malarial operations on these
lines.the scheme would result in failure and disappointment. The crux
of the whole matter lies not in the question as to whether anti-larval
measures could, or could not, be made effective (for the treatment of
any breeding place can be ensured by sufficient expenditure and atten-
tion), but in the impossibility of carrying out such measures in the
Duars under the most hopeful conditions as regards money and labour
that is ever likely to be available for this purpose.
It would be no advantage to the tea community to demonstrate
experimentally that malaria could be combated by such means in some
particular spot. The tea industry is concerned, not in the improve-
ment of one particular garden, but in the bringing about of a better con
dition throughout a wide district ; and if by concentrating its energies
on a single garden it were to produce effects, the problem of malaria
in the Duars would still be untouched, for it is certain that they
could not extend operations of the necessary thoroughness generally
through the district. The sources of anopheles in the Duars would
be very difficult to control, and the effect of only partial measures
would be unimportant, for in districts of this nature nothing
short of absolute extinction would appear to offer much hope of
reducing malaria by measures directed against anopheles. Fortu-
nately perhaps no attempt on a large scale involving great expenditure
has been made on these lines in the Duars.
81
QUININE PROPHYLAXIS.
A considerable proportion of the gardens have made large pur-
chases of quinine in tabloid form for the purpose of instituting quinine-
prophylaxis among their coolies. But the measures that have been
Usually adopted have generally lacked system and method, and success
or failure in producing an appreciable effect upon the incidence of
malaria has been proportionate to the care employed in quinine
distribution ; for quinine prophylaxis on the scale required even on
a small garden necessitates much care, thought and organization.
At present we know of no garden in which quinine prophylaxis
has been carried out in such a manner as to reach the portion of the
population whom it is most desirable to reach, and among whom its
effects are likely to produce the greatest benefit. In general where
quinine prophylaxis has been attempted the administration of the
drug has been almost entirely confined to coolies actually turning out to
work, the weakly, the sick and the young children receiving little or no
attention. Under such a system the result, if apparent: can only be
partial and very disproportionate to the expenditure involved. And
though it is a promising sign that some attempt to combat malaria
should have been made there is a general want of appreciation as to—
(a) The scale upon which action must be undertaken.
(b) The necessity for an efficient organisation and proper
supervision.
(c.) The importance of reaching the classes of the population
who suffer meat frequently and become the most dangerous
disseminators.
(d) The value of a properly directed system as calculated
to give both the best results and to enable the actual im-
provement to be demonstrated and recorded.
In the majority of instances which have coma under our notice the
duty of quinine administration has been handed over to a babu possess-
ed of little knowledge and no idea as to how to perform the work ; and
as a result of casual and inconsequent methods of distribution great
ISC
L
so
82
waste has followed and but little success has been attained. Suck
efforts can only lead to disappointment and final abandonment as
valueless of a measure which, under expert advice and direction and
with proper organisation, appears to offer, in conjunction with belter
attention to the material wants and the comfort of the coolie, the most
likely solution of the problem of Duars' malaria.
PREVENTION OF MALARIA AMONG EUROPEANS.
Already a number of European bungalows in the Duars have been
partially protected with wire gauze screens to doors and windows.
But in many cases the protection afforded is very limited or used
in so perfunctory a manner as largely to nullify its value. It is
our impression that a very undesirable ecomony is often exhibited
on this matter, a single room being screened while the verandah,
which during the greater part of the year is most used, is left un-
protected.
The removal of collections of native huts from the vicinity of bun-
galows has in a few cases been effected, and the improvement has in
this respect led to little or no inconvenience, and has been carried out
at small cost, the majority of the native houses being of such a tempo-
rary nature. Some gardens have adopted petrolage ; but we know
of no instance in which this measure is being carried out at the present
in a manner which can produce any result. In no case, except the
one to which we have previously alluded, has the magnitude of the
work or the difficulties to be overcome been at all understood.
The most efficient measure of prophylaxis, and one which has
been largely adopted by the Europeans in the Duars, public opinion
having recognised its value, is the habit of taking quinine daily in
5 grain doses. Tabloids are almost universally used and in many oí the
sub-districts only a small minority of European residents fail to
make use of this remedy or complain of any difficulty in doing so.
In our experience 5 grains of quinine taken daily has, after the first
week or so, no apparent physiological effect ; and we have ourselves
taken this dose for many months at a time without experience any
83
ill result. A dose of 15 grains or even 10 grains twice a week is, on the
contrary, much more difficult to remember and more trying in its
effects and it does not appear to give such good results.
The benefits of systematic quinine prophylaxis have been so
marked among Europeans during the past year that the value and
practicability of this method we think has been definitely proved.
This measure, together with efficient protection of bungalows gen-
erally, so that a man need not be exposed to infection either in his own
house or when visiting friends, should give Europeans resident in the
Duars the power to minimise the so-called climatic effects of the
district.
GENERAL SANITATION.
General arrangements regarding sanitation in the Duars and es-
pecially arrangements for water-supply are very backward. In cer-
tain posts of the districts near the hills mountain springs have been tap-
ped and water led for several miles to the gardens ; but the number of
gardens supplied in this - manner is limited, as few are so favourably-
placed as to be able to obtain water in • this way. In some of these
cases the water is Ied in pipes-to taps or small tanks in the different
lines and in some facilities for washing are given. Such arrangements
are, however, rarely met with in the Duars and form striking exceptions
to the general want of attention to the subject of wate-supply.
It is safe to say that with very few exceptions the garden water-
supplies consist of primitive shallow wells, streams, springs, and so
on. Quite commonly coolies arc dependent for their water on holes
in the bed of a river or upon water taken from the nearest jhora.
Such sources of supply are used indiscriminately for washing and
latrine purposes. It is quite common, to see coolies getting water
from a stream in which a few yards further up clothes are being
washed. A walk along the bank of the bed of such streams invari-
ably demonstrates their habitual contamination by fæces, since at
all times of the year, and especially during the dry season it is evident
that such places arc practically latrines. Nevertheless such conta.
minuted sources of supply are in daily US3 and appear to pass withe at
L2.
84
comment on the part of those responsible for the direction of the gar-
den.
In other cases out of deference to an idea that something resembl-
ing a well should be provided, wooden boxes, iron cylinders or earth-
en well-rings have been sunk for from two to twelve feet in the soil
usually in or near a stream bed.
Where the sole source of supply Is from kuteha wells or water-
holes these are of ten sunk in the midst of a coolie line, often within
a few feet of houses and cattle sheds.
As the dry season advances and greater and greater difficulty
is encountered in getting water, all the evils of such insanitary arrange-
ments become markedly increased. Even for physical wants the
supplies are not infrequently insufficient, leading to much hardship
and a tendency to make use of water that would otherwise be scru-
pulously avoided. Conditions which appear to casual inspection
passable will often be found on careful examination'to be far from sa-
tisfactory. Coolies will be seen, for instance, carrying water from long
distances and enquiry will show that they are debarred from the use
of nearer supplies which have been practically commandeered by the
older coolies. In one case we learned of eleven coolies, just up from
their country, who left the garden the day after their arrival on account
of difficulties they encountered regarding a supply of water. In this
instance there was a well some 70 feet deep and the only other available
supplies were about a mile away. The difficulty was that the older
coolies already using this well would not allow the new-comers to draw
water.
Every now and again it happens that severe outbreaks of cholera
occur on a garden and steps are then taken to improve matters. This
has led to some gardens using water pumped from wells into cisterns
and distributed by pipes to the different lines. But although some
supplies of this kind are good, in the others the wells are open to pollu-
tion a fact which does not usually appear to receive the least atten.
tion or consideration. In parts of the district the water level is far
below the surface and wells require to be sunk in a depth of from 50 to
85
90 feet. A few of these wells are excellently built, but in no instance
have we seen draw wells of this nature provided with proper mean 8
for raising the water.
Some gardens situated in the lower parts of the district in most
instances as a result of outbreaks of cholera, have lately been making
use of Norton tubs pumps. The pumps are, however, too few in num-
ber for the population ; and in no instance, where they have been seen,
have they been sunk with proper precautions, and no measures have
been taken to prevent contamination or waste water percolating
through the extremely porous soil to the base of the pump tube.
86
X.—MALARIA AND BLACK-WATER FEVER AMONG EURO-
PEANS IN THE DUARS.
Malaria among Europeans in the Duars is a secondary pheno-
menon dependent upon the widespread existence of the disease among
the native population, the health of a scattered European commu-
nity such as that to be found in a tea district being a good index, until
its members learn to protect themselves, of the actual conditions rela-
tive to malaria to be met with among the natives surrounding them.
When, therefore, we find that European residents sufier very severely
from recurring ill-health, dependent upon frequent malarial infections,
we can predict with certainty that malaria is very prevalent among
the general population with whom they are brought into close relation.
Examination has shown that in the Duars we have no exception to
this rule.
In this district the European lives in circumstances entirely
different from those encountered in many parts of India, where Euro-
peans live without taking any precautions against malaria and yet
escape infection entirely ox for "long periods, for the resident in the
Duars is exposed to the certainty of almost daily inoculation through
the bites of infected anopheles. The man who does not adopt pre-
cautions in these circumstances either almost invariably suffers from
recurring attacks of fever or becomes the subject of more or less masked
symptoms of malaria. If not actually ill he is almost always on the
verge of becoming so, and constantly complains of being liverish
troubled with bile, feeling off colour, and so on, symptoms often indi-
cating more or less modified attacks of malaria,, usually of the malignant
tertian type. In circumstances like these the Europeans arc said
to suffer from "the effects of climate", and after a year or two
of such a life become liable to be attacked by black-water fever.
This condition is the result of a change brought about in his blood by
the effects of constant and. repeated infections with malaria.
We have dealt fully with this side of the question in another
report, and it is not necessary to go into further details here beyond
saying that wherever a European is exposed to malarial infection
in hyper-endemic areas, we may expect him. to become liable to suitor
87
from black-water 'fever. Hyper-endemic areas may be defined as
regions in which the endemic malarial index is maintained at 50 per
cent. or over throughout the year. The Duars is such an area and
there are others to be found in various parts of India. The distribu-
tion of black-water fever in India is the same as that of hyper-ende-
mic malaria. But areas in India at present not hyper-endemic may
become so as the result of labour aggregation, and we have good rea-
sons for believing that new foci of black-water fever will result from
time to time as circumstance's lead to the formation of new hyper-
endemic areas.
The question of black-water fever in a district, therefore, resolves
itself into one of anti-malarial sanitation especially directed to the
prevention of the disease among Europeans, a subject we
\ill\
with in the last chapter.
88
XI.—SUMMARY OF CHIEF CAUSES AT WORK IN BRINGING
ABOUT A CONDITION OF INTENSE MALAEIA IN
THE DUARS AND THE POSSIBLE REMOTE EFFECTS
OF THIS CONDITION.
(1) The Duars is not merely malarious ', it is an area of malaria
hyper-endemicity, i.e., the conditions more or less general throughout
the year are those rarely seen except when malaria is epidemic. The
endemic index of malaria ranged from 50 per cent. to 100 per cent. and
remains persistently high from year to year throughout the whole dis-
trict, and a very large portion of the adult population suffers more or
less constantly from the disease.
(2) Black-Water fever among Europeans, Bengalis, and to a less
extent among the coolies, is one of the consequences of hyper-endemic
malaria.
(3) The explanation of the special intensity of malaria in the Du-
ars is to be found in the fact that it is an example on a large scale of the
tropical aggregation of labour, a condition which plays an important
r61e in the epidemiology of malaria in the tropics and especially in India.
(4) What largely determines existing conditions in the Duars is
its labour system. Indirectly it is also this system Which prevents the
Use of any but the best class of labour such as that recruited from
Chota Nagpur.
(5) One of the chief causes leading to increased intensity of
malaria in the Duars is the fact that at the commencement of
their life in the district all new coolies are placed under the disad-
vantages imposed by the present labour system. The defects in the
system as they affect malaria are—
(a) The burdening of the new coolie from the very outset of life
in the Duars, when all his resources are necessary to enable
him to combat malaria successfully, with the repayment
of debts largely incurred in the course of his recruitment.
(b) Want of direct relations between the planter and the coolie,
the position held by the " sardar " and the making of
89
garden sardars responsible for losses connected with the
coolie, thus almost necessitating the attempt on the part of
the sardar to recoup himself as far as possible indirectly,
or directly from the coolies he controls.
(c) The lack of compulsory registration of vital occurences re-
sulting in a general want of knowledge regarding the actual
amount of sickness and mortality in the Duars.
(d) The absence of any arrangement for the " protection of the
coolie " especially new-comers, particularly in relation to—
(a) Arrangements to ensure drawing of subsistence allow-
ance when sick.
(6) Arrangements for adequate treatment when sick.
(c) Arrangements to ensure a due proportion between pay
and prices of food.
(d) Absence of all sanitary precautions or efforts to prevent
the bad effects necessarily the outcome of uncontrolled
aggregation.
(6) These defects work chiefly by entailing—
(1) An inadequate dietary in the case of new coolies leading to
the vicious cycle of—inadequate diet—physiological po-
verty—increased liability to sickness especially to malaria—
less wages earned—increased hardship and privation with
still less adequate diet, and so on.
(2) Hardship clue to inability to provide themselves with many
things which, if not absolutely necessary to life, are at least
essential for plysiological well-being, e.g., good housing
sufficient clothing and other comforts.
(3) Sickness entailing the introduction of a train of vicious-
cycles ending in the deterioration of labour and the frequent
partial or complete loss of the labourer as an active
worker.
(4) Difficulty so induced in working a garden with such labour-
leading to the existence of large coolie populations only a
portion of whom actually work with any regularity, and the
1 SO
M
90
necessity for excessive immigration with its attendant in-
crease in the incidence of malaria.
(7) All new coolies entering the Duars have to pass through a pro-
cess of " acclimatisation " which includes, besides immunisation to
malaria, their ha bituation to absolutely new and often hostile condi-
tions. Only races inured to hardship can combat such a combination
successfully and many even of these succumb. In such circumstances
no natural increase of even the most prolific and hardy races can take
place.
(8) In the Duars general sanitation is practically non-existent,
questions regarding water-supply and other matters being usually ar-
ranged without sanitary knowledge and without reference to expert
opinion, or to precautions which sanitary science has shown to be
necessary.
(9) Anti-malarial sanitation presents two problems in the Du-
ars : (a) the prophylaxis of malaria among European residents which is
comparatively easy ; and (6) the reduction of native malaria, which is
very difficult.
European prophylaxis is already making way and the adopt on by
a large number of European residents of the precaution of taking
5 grains of quinine daily, the protection in some cases of bungalows, and
increased care in the use of the mosquito net, has apparently led to a
marked reduction in malaria among Europeans during the past
eighteen months.
In regard to native malaria mosquito destruction or anti-larval
operations offer no hope of even partial success. Far more hopeful are
operations involving the adoption of—
(a) Active measures to ascertain all malign influences affecting
the coolie in his new home, and the taking of steps to
combat these and to ensure the general prosperity and
comfort of the new coolies.
(6) Quinine prophylaxis on a basis organised under expert di-
rection.
91
(c) The automatic reduction of the factor of 'non-immune immi-
gration by these means leading to—
(1) Diminished loss of life and labour in the district, reduc-
ing the amount of annual immigration necessary.
(2) Increased efficiency of the labour forces and a greater
proportion of the total garden population turning out
to work.
(3) Permanent colonization by coolies in good circumstances
able to combat malaria successfully.
(4) Breaking off the vicious cycle at present holding sway
by which increased immigration means increased mala-
ria and consequent increased immigration.
(10) The remote effects to be considered are—
(1) The drain on the best labour available in Bengal.
(2) The possibility of the formation of foci resulting from the
return of infected persons to the recruiting districts from
which they were drawn, with the result, in some specially
favourable circumstances, of great epidemics of malaria in
districts now comparatively healthy.
M2
93
APPENDIX I.
List of endemic indices on a number of gardens in the Duars.
Gardens.
Dam Dim District.
Ellenbari
..
..
Washabari
. .
. .
Bagracote
Phulbari
Pathajora
. .
. .
Manabari
...
. .
Ranacherra . .
Rungamutty ..
..
Mean Glas —
(a) Bungalow lines ..
(b) Factory lines
Butibari
Dewars lines . .
Narkati
Bullabari
Moneys Hope
Sissibari
Hati-jungle
Barons —
(a) Hazodcherr
(b) Jamadars
(c) North Grant
Hyapatha
. .
. .
Chelsa District,
Chalouni
. .
. .
Sam Singh
. .
. .
Kilcot
Indong
. .
Race.
(a) Paharias
(b) Madeshis
..
...
..
..
..
..
..
..
..
..
••
..
..
...
..
••
..
..
Coles and Santals
••
(a) Paharias
(6) Chota Nag-
puris ; Santals.
..
..
••
Month.
September
September
October
September
August
October
October
October
August
August
August
August
August
October
October
August
September
••
October
October
October
January
August
. .
August
. .
December
. .
December
February
. .
Number
of
children.
20
46
50
68
66
40
30
100
69
27
33
28
25
50
104
26
40
..
44
50
28
25
25
25
40
44
16
Spleen
rate.
Per cent.
95
30
78
67
92
78
90
89
90
93
91
96
92
84
89
92
93
..
89
90
82
96
72
72
55
95
87
Parasite
rate.
Per ent.
75
87
60
72
62
65
83
82
58
78
91
75
96
96
86
85
90
..
98
94
93
88
52
52
35
83
87
94
List of endemic indices on a number of gardens in the Duars—concld.
Gardens.
Nagrakata District.
Luksan
Dina-Torsa District.
Biniguri
. .
Huntapata . .
.
Lankapara . .
.
Dulsingpara
Huldabari
. .
Telepara
. .
.
Gayakuta
.
. .
Hindupara , .
. .
Gundyapara . .
.
Lakhubari
Torsa District.
Jaigon
. .
. .
Jalpaiguri.
Nayabusti
Jalpaiguri Town
Race.
..
..
..
..
..
..
..
..
..
..
..
..
..
..
Month.
August
. .
November
April
April ..
May
November
November
November
November
November
November
May
September
September
Number
of
children.
17
53
33
..
..
34
112
90
25
108
34
40
36
20
Spleen
rate.
Per cent>
99
..
..
50
75
85
95
93
100
83
91
75
61
40
Parasite
rate.
Per cent.
82
70
70
20
60
94
89
85
96
73
94
60
36
25
95
APPENDIX II.
Tabular statement of results of observations on vital occurrences in a test line.
House number.
1
2
3
F 4
First observa-
tion end of
May.
Man
Wife.
Child, 5 years.
Child, 2 years.
Old coolies.
Youth.
New coolie.
Man with phthisis
Wife.
Boy, 8 years.
Oedema.
Child, 4 years.
Child, 2 years.
Old coolies.
Man
Wife.
4 children.
Old coolies.
3 men . .
. .
New coolies.
Number of
persons.
5
5
6
3
Second observa-
tion end of
August.
Man and boy both
worse.
Young child very
ill ; intense anæ-
mia and sores.
One woman extra
Number of
persons.
5
5
6
4
Third observation
end of
November.
New wing built. Youth
and a wife occupy-
ing it.
....
Man died in October.
Boy died a week
later.
New-born baby, one
month old.
One man gone recruit-
ing.
Number of
persons.
6
3
7
3
BIRTHS.
First 3
months.
..
Second 3
months.
1
DEATHS.
First 3
months.
Second 3
months.
2
Entering Garden.
1
1
Leaving Garden.
..
1
Changing into house.
Changing out of house.
Old Coolies.
5
5
6
New Coolies.
..
3
Gone to Country.
..
1