NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
67
their services. We have not heard that the medical staff of a garden
is responsible for vaccination in any way.
Epidemic dropsy.—Several considerable outbreaks of epidemic
dropsy occurred during the course of our enquiry in the Duars. In
some gardens a hundred coolies or more were attacked, but the mor-
tality from this disease appeared to bo trifling. We saw a considerable
number of cases on one garden, but no serious ones, and the epidemic
soon disappeared.
Plague.—No case of .this disease has come under our notice, and we
have not heard of any case having been recognised in past years in
any part of the district.
ARRANGEMENTS FOR TREATMENT OF THE SICK.
The arrangements for the treatment of the sick in the Duars con-
sist of—
(1) A European medical officer in each sub-division.
(2) A so-called " doctor babu " on most gardens.
(3) A building or part of one, utilised as a medical store-room
and dispensary.
(4) A coolie to assist the " doctor babu " and carry round medi-
cines to the lines.
The European medical officer, to quote Mr, Arbuthnott's Report
on the Duars (vide page 8), " is not retained on account of the coolies,
nor is attendance to the labour force regarded as his legitimate work,
though he would "be called in to attend to a serious case or in the
event of an epidemic."
In some instances the medical officer is supposed to give some
general oversight to the medical arrangements for the coolies ; "but the
" doctor babus " do not appear to be.directly responsible to the me-
dical officer, while the absence of real facilities for serious medical
work among the coolies renders such supervision as may be given more
or less futile.
12
68
The native medical officers or " doctor babus, " except in a, very
few cases, are unqualified or possessed of qualifications of the most
doubtful character. We have only met six of them who held the
diplomas of a hospital assistant. Apparently anyone who cares to
call himself a " doctor babu " may be engaged.
Their medical knowledge in our experience is extremely limited
and their treatment of the sick as it affects the general coolie popula-
tion is in our opinion in the great majority of cases of no value what-
ever. The making up and the administration of coolie medicines is
generally done in a most casual and unprofessional way. Fever, if
treated at all, is, as a rule, ignorantly and inadequately heated. In
a case of fever lasting several days we have seen a single five-grain
tabloid of quinine given. Ulcer cases are almost completely neglected,
and, except when a manager interests himself specially in some case, a
little powder or carbolic oil is given to the coolie, who is left almost
entirely to his own resources for dressing the sore.
The following instances will serve to indicate the general laxity and
incompetency of the methods of medical treatment afforded the coolies
by some Duars' "doctor babus":—
(1) A " doctor babu " was found preparing a gargle for a woman
dying of tetanus.
(2) A " doctor babu," as we were informed by one of the
European-medical officers, gave a woman gr. 20 of calomel
and was not aware that he had done anything unusual.
(3) A " doctor babu " was seen on his rounds interrogating
a sick coolie who appeared to have fever. Having decided
to administer a dose of opening medicine he told the coolie
following him with a box of medicine bottles to give the
coolie some jalap. His " dawai-wallah " promptly took a,
small piece of dirty newspaper and poured into it by guess
a small quantity of P. Jalapæ Co., not more than 10 grs.,
a quite inadequate dose, which he wrapped in the paper and
handed to the coolie. The " doctor babu " took no interest
in the matter beyond giving the coolie his orders.
69
(4) A " doctor babu " was seen during an epidemic of ulcers
to be cauterising all his cases with strong nitric acid and in
such a manner that the acid ran down over the limb bun-
ing deeply and increasing the mischief. So far as we could
see these ulcers got no further treatment than appli-
cations of acid.
In our experience coolies are by no means averse to accept treat-
ment if they realise that it is likely to be of any use. That they do not
trouble to avail themselves of treatment under present conditions is
not surprising in view of what we have seen of the character of the
treatment usually meted out to them.
The recording of sickness and the number of births and deaths
which is generally the duty of the " doctor babu ", is performed in a
most perfunctory manner, many of the babus being grossly careless
or wilfully deceptive in regard to these matters. Many believe that the
report of too many deaths will lead to their being considered incom-
petent.
In regard to sick records it was interesting to note that on one
garden where a sick register was being kept, the average number of
sick shown rose during the four days of our stay from 13 to 15 to as
many as 33 to 34 per day. The working population of this garden
was about 450 and the sick shown were workers who were incapacitat-
ed for more than one or two days. On another garden with a very
large population numbering over 2,000 the record of daily sick on the
occasion of our visit was only 6 persons.
As we have already stated hospitals do not exist in the Duars,
and there are no facilities for the treatment of surgical or other in-
patients. Dispensaries also, in the ordinary acceptance of the word
are almost entirely absent. "We know of three or four only to which
the term might be applied with any accuracy. In almost all gardens,
however, a room or part of a building is set aside for the use of the
" doctor babu " in preparing and keeping his medicines. On some
of the larger gardens seen by us the medical stores were ample in
70
amount, and there were the usual dispensing appliances and dress-
ing instruments, but in many cases the supply of necessary drugs was
altogether inadequate and out of proportion to the actual sickness on
the garden, while too often it appeared that the stocks of medicines
accumulated from year to year with little evidence of any intelligent
attempt to use them in actual treatment.
We have been informed that at one time an attempt was made
to introduce hospitals as in Assam, but that the scheme failed as the
coolies refused to utilise them. That many coolies dislike becoming
in-patients at a hospital, we are aware, but how far the supposed
failure of hospitals in the Duars was due to defective administration
and the nature of the medical treatment offered it' is impossible
to say.
GENERAL EFFECT OF MEDICAL ARRANGEMENTS.
The present system under which the coolie population of the
Duars obtains medical treatment is most inadequate. However large
or however scattered the population of a garden may be, the same staff
of a single " doctor babu " is considered as amply sufficient. Even
this staff, as we have noted, is often selected without reference to quali-
fications. When leave is taken it is rarely considered necessary to
appoint a deputy, and a " doctor bubu " may even be sent away for
months to the recruiting districts while his duties are unattended to ;
or he may for part of his time be employed on clerk's duty, it being
thought or taken for granted that his medical duties are insufficient
to require his whole-time service.
The origin of the mischief seems to be that, no one being res-
ponsible for the health of the coolie, the treatment of the sick as well
as sanitary arrangements are matters to which no serious attention
is paid. Deep at the root of the whole matter is the present labour
system with its lack of registration and general irresponsibility for the
life and health of the coolie.
Under it the idle and incompetent " doctor babu " has everything
in his favour, for there is no possible means of checking his work or its
71
results. Provided the daily muster of coolies at work is not below the
average he may attend and report as sick as few coolies as he Hies.
Even were well-trained and qualified native hospital assistants to find
employment in the Duars the absolute lack of hospitals and all facili-
ties for successful treatment of disease would immediately discourage
any capable man from remaining, for such a man by his very keenness
would at once gain the reputation of being both expensive and un-
successful.
72
VIII.—VITAL STATISTICS.
By the census of 1891 the tea garden population of the Duars
was shown to be 62,313, and ten years later the census of 1901 gives
the population at 133,207 ; recently it has been roughly computed
at about 150,000 people—'men, women and children. This increase
is the result of large and continual immigration, with one aspect of
which we have dealt in another chapter. Precise information regard-
ing the amount of immigration is not available ; but there are, as we
have seen, reasons for supposing that the annual influx into the tea
gardens of the Duars has rarely fallen short of 15,000 persons and
may sometimes have been as great as 30,000.
Regarding the number of coolies leaving the Duars for their
own country, there are even less data. Each garden sends down
annually a number of recruiters, who generally return, and in addi-
tion there are people who return home independently. But the num-
ber returning home is not, so far as we can ascertain, more than 10
per cent. against 25 per cent. of the total in the case of those entering
the district annually. On this question Mr. Arbuthnott says (vide
page 6 of his report):—" The impression that the bulk of any labour
force visit their homes annually in. the cold weather to return after
the harvest is over is, however, incorrect, whatever may have been
the case formerly."
On one garden with a total population of about 1,200 we were
informed that 28 people were returning to their villages for recruiting
purposes in 1908. Mr. Arbuthnott records that a garden with 900
working coolies sent down in 1904 some 38 recruiters and that 78
others returned to their country independently. In the years 1901 to
1903, 12 gardens with an aggregate of 11,000 acres under tea, sent
down a total average of about 700 recruiters each year. These return-
ed with an average of about 3 coolies each.
In addition to this yearly movement to and from the recruit-
ing districts, large numbers of the coolies pass each year from one
garden to another, and a further number definitely leave the gardens
and become settlers in the villages. There are no figures to indicate
73
to what extent this colonisation takes place, but it does not appear to
be very extensive.
The population on particular gardens varies greatly, but, roughly
speaking, appears to average nearly two persons per acre of cultivated
tea. An aveiage garden has a population of from one to three thou-
sand, but on large gardens as many as from three to six thousand
residents may be found. On a few very small gardens the popu-
lation may number only some hundreds.
REGISTRATION OP VITAL OCCURRENCES.
The Chaukidari Act is not in force in the tea gardens of the Duara.
The chaukidars who are responsible for reporting births, deaths, etc.,
to the nearest police station once a week, are maintained under
a special arrangement and paid by the estates.
The birth and death rates on the tea gardens in the Jalpaiguri
district for 1906 and 1907 are given in the Sanitary Report for East-
ern Bengal and Assam as follows :—
1906
1907
Birth-rate,
8.34
19.54
Death-rate.
22.23 per millo.
18.45
„
It is needless to remark that these low figures are due merely
to defective registration, the returns submitted by the gardens under
the present system being in the main quite worthless.
There are several causes in operation which must tend to render
registration on the tea gardens as at present carried out practically
futile :—
(1) There is no responsibility entailed upon the gardens to
submit accurate returns.
(2) The books of a garden do not show the total coolie popula-
tion, but only a labour roll ; and in the last census it is
generally admitted that frequently double the population
supposed to have been resident on the garden were actu-
ally found.
ISC
K
74
(3) The garden managers, though they keep a register for deaths
among working coolies and are stated to report these to
their agents in Calcutta, have generally the idea that,
in the case of deaths among those not in the actual labour
force, registration is not very important. As the majority
•of deaths occur among young children and adults who
•by reason of long sickness have very frequently ceased to
appear upon the labour roll, and have practically been lost
sight of as members of the population, there is introduced
a very serious source of error.
(4) The returns to the thana are frequently not prepared by
the chaulddars themselves, the usual practice being for
the garden clerk or ' doctor babu ' to write them up in the
chaulddar' s book.
(5) Under the present system it is a matter of pure chance
whether the clerk or ' doctor babu ' are even informed
of a death or birth, there is, moreover, no check upon their
figures, and there is no reason to believe that they are made
to consider it an important matter to give complete or
accurate returns.
(6) It is the aim of some ' doctor babus ' to report as few deaths
as possible.
The general carelessness and want of method displayed is parti-
cularly evident in the birth returns and is exemplified in a statement
that was made to us on one occasion, that from one garden no birth
return was submitted to the than a for two years. It is probable for
reasons such as have been pointed out that the registration of vital
occurrences on tea gardens in the Duars is much less accurate even
than that obtaining in villages where chaukidars or headmen are res-
ponsible.
ACTUAL DETERMINATION OP MORTALITY.
Since statistics compiled under the present system have no
value, we endeavoured to arrive at an approximate idea of the death-
sate in the Duars by actual observation.
75
A line was selected in which conditions appeared neither better'
nor worse than the average ; it was mapped and numbers given to the
houses. Three enumerations were made, one at the end of May, the
next at the end of August, and the third at the end of November.
The lines population comprised people from the following" locali-
ties :—
Chainpur.
Beru.
Banchi.
Gumla.
Palkot.
Surgaja.
Jaspu.
These are all thanas or sub-divisions in Chota Nagpur, and the
race that which, it is universally admitted, stands the' Duars better
than any other.
The period of six months during which our observations are
recorded also represents a portion of the year in which the total re-
corded deaths in the Jalpaiguri district have averaged during the last
three years 48*9 per cent. of the total for the year.
The full observations are recorded in Appendix II, but an ab-
stract of the results is as follows :—The total population at the end
of May was 302, consisting of 115 men, 97 women and 90 children.
Of these, 219 were old coolies and 83 coolies who had come up within
the last two seasons. Among old coolies 145 were adults and 74 were 1
children, and of the new' coolies 67 were adults and 16 children. Of
102 adults in 38 houses, 70 were away at work and 32 at home. Of
44 children from the same houses 22 were at home. Of the 32 adults
at home 5 had fever when seen.
During the six months of observation the following changes
oceurred :—
(1) Deaths numbered 14 and were distributed as follows :—
Among 115 men
Among 97 women
Among 76 children over 2 years . .
Among 14 children under 2 years
3 }
2 }
3 }
6 }
or 5 deaths among
212 adults.
or 9 deaths among
90 children.
K2
76
Classified differently these figures showed—
Among 83 new coolies deaths were as follows—
67 adults
14 children over 2 years
2 infants under 2 years
4 deaths,
0
„
0
„
Among 212 old coolies deaths were—
145 adults
. .
. .
..
62 children over 2 years
12 infants under 2 years
1 death.
3 deaths.
6
(2) Births among the whole population numbered 8, there being
4 among 28 new coolie women and 4 among 69 of longer
residence.
The number of persons concerned is so small that these figures
are only approximately representative, but the extraordinary results
obtained are exactly in accordance with the general observation of
what we believe holds good throughout the Duars.
In one case, on a garden with a total population little more than
1,000 persons, 28 deaths were recorded in three months, though only
19 were returned to the local thana, and two more deaths among young
children were subsequently discovered to have taken place. In this
connection it is interesting to recall that as a result of a special enquiry
conducted in the Darjeeling terai in 1892, it was shown that the mor-
tality among the tea garden population there was 106'6 per mille for
1891 and 91.0 for 1892, whilst on one garden we were informed on
good authority the death-rate was 115 per mille. The Darjeeling
terai forms what is practically a continuation of the Duars west of the
Teesta and conditions there are little, if at all, different from those
obtaining in the Duars.
Our figures refer to a community of people drawn entirely from
Chota Nagpur. What the death-rate among Paharias, Kols and
Santals is we cannot say, but it is probable that the Paharia and weaker
plains people die in far greater numbers than our figures for good
class Chota Nagpuris indicate.
77
With regard to children born or introduced into the Duars at
least half seem to die before reaching maturity. An enquiry among
27 married coolie women belonging to various tea gardens showed
that they had between them 47 living children, while no less than 56
or 57 (one woman could not say whether she had lost 5 or 6 children)
had died upon gardens in the Duars. Four of these women stated
that they had lost no children, but three of them were quite young
and had only become mothers comparatively recently, and possessed
but a single child each. One woman with three living children stated
that she had lost none.
It is significant that of the fourteen infants we had under obser-
vation six died within six months.
78
IX.—SANITATION.
Within the last year or so, owing to an increased general inter-
est, certain measures of anti-malarial sanitation have been adopted'
here and there in the Duars ; and although they have in the main
been more or less lacking in systematic application, they appear to
have had, in the case of European residents at least, a very notice-
able effect in improving the health of the community. Measures,
against native malaria, however, cannot be considered to be adequate
to the situation, or to have affected to any great extent the incidence-
of the disease among natives.
Put the prevalence of native malaria in an intense form is the
primary condition making the elimate unhealthy for Europeans ; and
it also forms the one real bar to satisfactory colonisation of the whole
tract. It is, also responsible for the fact that only certain classes of
labour can be employed, while at the same time it reduces the effi-
ciency of even this labour in a very marked degree. Anti-malarial
sanitation and efficient prophylaxis' for the native population must
therefore be considered the chief sanitary problem of the district and
requires the most careful consideration.
DRAINAGE AND ANTI-LARVAL OPERATIONS GENERALLY.
Selection of suitable sites for dwellings.—The situations of coolie
lines vary very greatly in the relation to anopheles breeding places.
Many lines. have streams running through them, others are as far
removed from running or stagnant water as. it would be possible to
place them : but as we have pointed out, malaria is equally prevalent
in all. We believe that only in very few cases would the selection of
line sites so as,to avoid anopheles breeding places, have any marked
effect in reducing malaria under the existing conditions.
Gardens- with abundance of high land usually have their coolie
lines built on sites possessing good 1 natural surface drainage, but on
many gardens on lower land it would be a matter of great difficulty,
if not impossible, to suggest sites for lines more favourable as regards
the danger from malaria than those already occupied. Only in spe-
79
cial parts of the district is it possible to find sites removed mote
than 400 yards from anopheles breeding places ; and in this very
portion we have seen that malaria is just as rife as in the apparently
more unfavourably situated areas.
Drainage.—Where swamps or maish lands exist it might be pos.
sible by circumferential or other systems of drainage to reduce the
breeding places of anopheles, but this would often necessitate the
stoppage of rice cultivation, and the initial outlay and cost of main-
tenance would be heavy, and Bo great in the case of gardens where
swamps are numerous as practically to prohibit such measures on a
scale likely to prove of any benefit.
In the case of many streams it might be possible to train the
edges and by arranging the pebbles and boulders to confine the water
to one channel, and perhaps prevent the formation of isolated
pools. Also Such pools when formed could often be filled in with
sand or stones ; but though Such operations might prove of value in
special cases they cannot have a very wide or general application, and
it is not likely in existing circumstances that work of this kind would
have any appreciable effect in reducing malaria,
Petrolage.—-For small Streams and for more or less permanent
collections of water spraying at regular intervals with kerosene would
be an excellent method of treatment, but the wide extent of ground
to be covered and the systematic and thorough treatment necessary
is a matter not generally appreciated. There is a tendency among
the planting community to arrange for some absurdly inadequate
measure such as the appointment of a man to "oil the streams "
and to rest satisfied that this will have some effect. All such systems
of attempting to combat malaria are to be deprecated since they are
not only themselves useless, but give rise to a false idea of what should
be done. In the general run they may be likened to the now rightly
ridiculed practice of placing a saucer of condy's fluid on the floor of
a room to disinfect the air. We have, however, seen one very
thorough attempt in the Duars to combat malaria on these lines
carried out by a very keen and capable planter, but as noted
elsewhere the measure served only to demonstrate the difficulties to be
encountered.