Resolution on Dr. Rogers' Report on Kala azar.
Extract from the Proceedings of the Chief Commissioner of Assam in the General
Department, No. 6960G., dated Shillong, the 30th September 1897.
Read—
Surgeon-Captain L. Rogers' Report on Kala azar.
Read also—
Letter No. 836S., dated the 16th July 1897, from the Principal Medical Officer and
Sanitary Commissioner, Assam, forwarding the above Report.
RESOLUTION.
The disease known as kalá-ázár was first noticed officially in the Assam Sanitary-
Report for 1882, where it was referred to as a very severe form of malarial fever, which
bad been prevalent in certain parts of the Garo Hills district since 1869, In 1883 it
spread from ihe Garo Hills into the adjacent portion of the Goalpara district, and in
1884 it had become so prevalent, that relief work was started and numerous dispensaries
were opened in the affected tracts. Since that time it has advanced slowly, but surely,
through the Goalpara subdivision, the part of Kamrup which lies on the south
bank of the Brahmaputra, and the district of Nowgong. The portions of the Goalpara
and Kamrup districts on the north bank oí the Brahmaputra have suffered very slightly,
except in populous localities, such as. Barpeta and Hajo. In the Darrang district,
which lies entirely on the north bank of the river, the Mangaldai subdivision has been
badly affected, although by a less severe type of the disease. The sadr subdivision
has hitherto suffered little, but cases have been reported in villages near Tezpur and
Bishnath. Kalá azar has not, as yet, travelled beyond the eastern boundary of the-
Nowgong district, and Sibsagar and Lakhimpur are still untouched. In each newly-
affected tract the disease has taken two or three years to reach its height, which it
maintains for another three years, and then gradually declines and disappears. The
mortality attending its progress has been very great, and tracts, which before its advent
were densely populated and highly cultivated, have been left by it deserted and waste.
The Annual Sanitary Reports from 1882 onwards contain the record of the gradual
spread of the disease, the mortality attending it, and the opinions of the local medical
authorities as to its causation and origin.
2. In 1888 the Principal Medical Officer and Sanitary Commissioner (burgeon-
Colonel C. P. Costello) applied for the appointment of a specialist to investigate both
kalá ázár and the so-called bet i beri or anaemia of coolies, which was causing a consider-
able mortalicy amongst the tea-garden coolies of Upper Assam. His recommenda-
tion was accepted, and Surgeon-Captain G. M. Giles, M.B., F.R.C.S., was selected to
make the enquiry. Dr. Giles commenced work in the cold weather of 1889-90, and
almost immediately formed the opinion that the two diseases, which he held were
absolutely the same, arose from the attacks of anchylostoma or dochmius duodenalis,
a small worm about half an inch long, which lives in the small intestine. This was
the view already held by Dr. Ruddock and others in the case of beri-beri but was
widely opposed to the opinions of all previous observers, so far as kalá ázár was
concerned. The latter was generally held to be a form of acute malarial fever com-
plicated by something else, which gave it contagiousness. Dr. Giles's views gained
a temporary and somewhat hesitating acceptance from some of the medical officers
in the province, but the general opinion soon reverted to the theory of a wholly or
partially malarial origin. The view that anchylostomiasis was accountable for the
mortality was greatly weakened by the work done by Surgeon-Major E. Dobson at
Dhubri. In the course of four years that officer examined a great number of