NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
28
the whole year they are never free from the soakage of water from springs. In
-stances of such gardens are—Barons, Neora Nuddy, Baradighi, and Telepara, in
all of which the whole garden areas are intersected by innumerable streams and
swampy hollows with running springs ; it will be seen from the list of endemic
indices that the rate on these gardens is more than usually high.
MALARIA AMONG EUROPEANS AND BENGALIS.—Though the European in the
Duars is generally to all appearances in good health, enquiry will often show that
he is constantly getting what he calls " touches of fever," and even if he re
- p u d i a t e s e v e r g e t t i n g f e v e r , i t w i l l b e f o u n d t h a t h e i s s u b j e c t t o " g o e s o f l i v e r "
or " bile, " which are but the interpretation he puts upon the symptoms of
a malarial attack. Among some sixty persons resident in the Dam Dim district
to our knowledge over fifty have suffered from attacks of fever (malaria) during
the year. In many cases the attacks have been very mild, probably because
quinine is now being very generally used as a prophylactic, some forty-five out
of the sixty persons having made more or less systematic use of this drug since
May 1907.
The parasite most frequently found is the malignant tertian, although among
native children the proportion of different forms of parasite is about equal. Among
effects of malaria in Europeans may be noted the common presence of anæmia at
the end of the rainy season, a large number of observations having shown that at
this time of the year the average hæmoglobin percentage is ab out 85 per cent. of the
normal; some four or five months later at the end of the dry weather it approxi
- m a t e s , h o w e v e r , t o 1 0 0 p e r c e n t . E n l a r g e m e n t o f t h e s p l e e n w a s f o u n d i n f i v e
out of thirty-two residents in the Dam Dim district.
The Bengali babus are still more subject to malaria. They live in houses
that are generally situated in the very midst of the tea-house lines ; and they
and their families suffer often in a terrible way from malaria. So much so is this
the case that it is customary for babusto leave their families in their own country
or to have them up for a few months at a time only; and the explanation
invariably given is that ill-health makes this necessary.
LIABILITY TO INFECTION.—A factor which we must emphasise, since it is to Our
minds one of the conditions always associated with Black-water Fever countries,
is that, quite apart from the amount of malaria any resident may appear to be
suffering from, he is exposed almost daily to inoculation with sporozoits.
Anopheles, especially the small dark M. Listoni and M. Funestus, the most
notorious malaria carriers, are not easily detected within a mosquito net;
they are also much more persistent in gaining an entrance and they
frequently bite by day. The result is that very few Europeans, even when
29
they take precautions, altogether escape being bitten ; the majority take no
adequate precautions and must certainly become the prey of anopheles night after
night. When it is realised that the salivary glands of one in, every four anopheles
may contain sporozoits (56), it becomes evident that the amount of fever suffered
from is not a question of a man having received a certain number of infections
each resulting in due course in an attack, but one of some interaction between
the parasite and the tissues resulting from time to time in the mastery of
the former. It is very noticeable that in infection with the malignant tertian
parasite there is a period of immunity following an attack so that, however
heavily and frequently infected a person may be, he exhibits actual fever only at
recurring periods of a week, ten days, or a fortnight.
CONSTANT INFESTATION.—The condition in the communities we are study
- i n g t h e r e f o r e c a n n o t b e c o n s i d e r e d o n e o f s o m a n y i n f e c t i o n s o r s e p a r a t e a t t a c k s ,
but is a process of continuous infestation calling strongly to mind, if we sub
-stitute anopheles and malaria for ticks and piroplasma, what is recognised as
occurring in the case of cattle living in a piroplasma country.
CIRCUMSTANCES IN RELATION TO MALARIA INFECTION.—A liability of Euro-
peans and babus to pass through periods of more than usually frequent and
severe spells of malaria, the attacks recurring every week or ten days for months
together is very commonly observed in the Duars. The explanation as a rule is
comparatively simple and depends more than anything else on mere circumstance.
While malaria can be contracted without difficulty in nearly every bungalow
in the district, there are some bungalows where the conditions are so favourable
to malaria that those who live in them are more than ordinarily exposed to in
- f e c t i o n o n t h i s a c c o u n t ; b u t a b o v e a n d b e y o n d t h i s t h e r e a r e o t h e r c i r c u m s t a n c e s
concerned.
1 .
T h e n a t u r e o f t h e p o p u l a t i o n o f h i s s e r v a n t s ' l i n e s.
— I t m a y h a p p e n
that his servants are more or less immune and that they have few or no
dependants ; on the other hand, owing to pure circumstance he may have
not only susceptible adults, but a swarm of young children in his servants' lines.
When this happens a European who has stood the climate very well for years,
may enter upon a period of ill-health quite noticeable to himself and his friends.
2 .
T h e c o n s t i t u t i o n o f t h e l a b o u r o n t h e l i n e s n e a r h i s b u n g a l o w.
— W i t h
large influx of susceptible coolies there may result in any particular season
or succession of seasons what is known as an " unh ealthy year for coolies."
If a European is so situated as to be much exposed to infection from his coolie
lines, he will probably suffer along with his servants from the general exala
- t i o n o f i n f e c t i o n .
227 H. D. H
30.
OTHER CONDITIONS LIKELY TO BE THE CAUSE OF BLACK-WATER FEVER.—
If it were not for malaria, the Duars, for a tropical country, should be un
- u s u a l l y s a l u b r i o u s . T h e r e i s a c o o l s e a s o n l a s t i n g s e v e r a l m o n t h s a n d t h e h o t
season is, on account of the heavy monsoon, much cooler and less trying than it:
is in Calcutta, Bombay, and Madras. The Europeans live an open and healthy
life, and are not unduly exposed to fatigue or hardship. Diet is co
m - p a r a t i v e l y g o o d ; a n d n o t l a c k i n g s o . f a r a s w e c a n s e e i n a n y e s s e n t i a l
particulars. Yet Europeans in the Duars die from Black-water Fever,
whilst those in Calcutta and the plain's of India, broadly speaking,
not. In what respect are the conditions different? If diet were at fault
the disease should be as common on the healthy gardens of Assam as
among the planters of the Duars ; nor should Black-water Fever occur among the
babus, who do not modify their diet with a change of district. If exposure to
the sun be a cause, the disease should not appear as it does among babus
engaged entirely in office work. That the mere moisture of the atmosphere unac-
companied as it is by great heat should produce such an effect is inconceivable.,
We append a letter in the form of a diary, received from a plan
ter who was simply asked for particulars regarding his Black-water Fever.
attacks :
Arrived in India December 1894. Age 21.
1894-95. South Sylhet
—
Constant attacks of malaria. Treatment 60 grains of quinine daily during attacks.
No quinine taken between intervals of attack. No sign of anything approaching
Black-water Fever.
1895-96. Alipur-Duars —
Constant attacks of malaria. Treatment daily doses of quinine 15 to 30 grains during
and subequent to attacks. No quinine between intervals. No sign of any.
thing approaching Black-water Fever. Constipation general throughout the year
and weight reduced from 12-5 to 11 stone.
1896-97. Alipur-Duars
—
Constant attacks of malaria. Treatment 15 to 30 grains quinine daily during and sub
- s e q u e n t t o a t t a c k s . N o q u i n i n e i n i n t e r v a l s . M a l a r i a l a t t a c k s c u l m i n a t e d i n
June i n bad at t ack of Bl ack- wat er Fever . The di sease r aged f or 10 days and as l i f e
was despaired of I was carried to railway terminus and taken to Darjeeling.
Began to recover rapidly and returned to garden six weeks later. Weight 10 stone.
Quinine was taken in small lots of 10 to 30 grains on odd days just before the attack as,
I felt " seedy." Was treated for liver, dosed with mercury and black draught, and
31
the day after developed Black-water Fever. Throughout the attack was given
quinine and Tincture of Warburg—the former hypodermically when vomiting
. badly. Constipation bad throughout the year.
1897 to August 1898. Alipur-Duars
—
Constant attacks of fever, with quinine treatment as above. Attacked by Black-water
Fever in July. Treatment much as before. The disease considerably lighter
than before. Shipped to Darjeeling five days after Black-water Fever developed
and recovered rapidly. Civil Surgeon refused to allow me to return. Constipation
bad throughout. Weight 11 stone.
August 1898 to April 1899. Lucknow
—
Occasional slight attacks of fever and usual treatment. No sign of Black-water Fever
and health very good. Constipation bad. Weight 12-6.
April 189,8 to December 1899. South Sylhet
—
Occasional attacks of malaria. Treatment as usual. Health very fair. Weight,
11-12.
1899-1900. Dam Dim Duars (Phoolbarrie ) —
Frequent attacks of malaria and usual treatment. In October a sudden and violent
attack of Black-water Fever lasting two days only. Cut short by removal to
Darjeeling where recovery was remarkably rapid
.
Quinine was taken during the attack and before in the usual fitful fashion. Constipa-
tion as usual, treatment for this considerably more successful. Weight 11 to 11-8.
1900-01. Phoolbarrie Duars
Frequent attacks of fever throughout the year and usual treatment. A sharp attack of
Black-water Fever towards the end of December 1901. Perhaps the lightest of the
five. Quinine treatment during attack I forget. Constipation answering to treat-
ment. Fair health.
1901-02. Phoolbarrie Duars
—
Usual attacks of fever and usual treatment with quinine. Black-water Fever suddenly
developed in the end of September 1902 and though not virulent it lasted quite
seven days that is of actual Black-water. Dr. Brown was careful in regard to
quinine and I think treated me with Cassia Beariana. Constipation same as last
year. Weight 11 stone.
River trip made me perfectly right in two weeks.
1902 to May 1903 Phoolbarrie
—
Fair health.
32
May 1903 to November 1903. .England on furlough
Took quinine regularly and no fever.
Note.—Up to 1903 all quinine treatment was with ordinary sulphate or bisulphate. From
1903 on, quinine hydrochloride only was used in S. C. Tabloids.
November 1903 to December 1904. Kilcott Duars
—
Very careful to take 30 grains quinine and very little fever. Only fair health.
1904-05. Phoolbarrie
—
Only two attacks of fever in the twelve months. Most regular in quinine treatment, 30
grains weekly. Constipation responding to treatment.
1905-06. Phoolbarrie
—
I don't think I got any fever this year. If I did it must have been slight. Most regular
with quinine. Constipation as above.
The doses of 15 grains each twice a week on consecutive days constituted a great strain
mentally and physically. Doses of 5 grains daily passed entirely unnoticed.
1906-07. Phoolbarrie
—
No fever. Most regular with quinine, but substituted 5 grains daily for 30 grains a week
taken in 15 grain doses. Constipation as above.
1907 to July 1908. Barrackpore
—
No fever. Most regular in quinine treatment.
The experience of this man as regards malaria is not that of a special case, but
represents the life of a great many of the Europeans living in the more malarious
parts of the tropics; it is a good example of what we have come to look upon as life
under Black-water Fever conditions.
No one who knows anything of India can confuse such a history with that of
the life of the ordinary Englishman in the plains or great cities of India.
It is misleading in our opinion to cite from Black-water Fever countries cases
of men who are supposed not to have suffered from malaria, or to speak even in
this connection of men having been exposed to the "chance" of malarial infection,
for we are here dealing with a certainty of frequent or even daily infection without
Possibility of escape except by the adoption of the most stringent precautions.
To sum up: we find in the Duars conditions which are already familiar to us as
those prevailing in tropical Africa. The same conditions ate seen in the Jeypore
Agency and in just those parts of Assam where Black-water Fever has been shown
by ourselves and others to occur. These conditions are not rightly defined as
merely malarious. We know of several districts where there is malaria, but where
the condition we have tried to picture is not present.
33
CHAPTER II.
BLACK—WATER FEVER—AETIOLOGICAL.
The first published record of Black-water Fever from the Mars were four
cases described by Stephens and Christophers in 1900. But Dr. Brown, Medical
Officer of the Dam Dim district, assures us that the disease was present when he
first came out to the country in 1887, but that it was not then recognised as Black-
water Fever. The first to name the condition in the Duars was Dr. Wheeler who
had previously seen the disease on the west coast of Africa.
Owing to the kindness of Dr. Brown we have been able to secure records of the
cases seen by him during his twenty years' residence in the Dam Dim district; and
from Dr. McCutcheon and Dr. Stone we have obtained similar information,
extending over the last ten and five years, respectively, in regard to the neigh-
bouring Chelsa and Nagrakata districts.
This information we give in full in an appendix. By means of it we have been
able to form conclusions as regards the seasonal incidence and local distribution
of Black-water Fever not obtainable from a lesser number of cases; it also serves
to show that Black-water Fever was present among Europeans as far back as
1888.
The increase in cases during the later years is probably only apparent: in the
first place Dr. Brown had not, when first in the district, charge of the whole of the
gardens; also a certain number of cases which have occurred during Dr. Brown's
absence have been added by us, these being chiefly recent ones. Apart from this there
is the important fact that everyone in the Duars now knows and dreads Black-
water Fever, and it is doubtful if latterly any cases in Europeans have been over-
looked, though they might have been ten or more years ago.
The influence of enquiry and recognition of the disease is well exemplified by
those cases recorded among babus. It will be noticed that there are but two cases
in babus in the years 1887—1898. In 1900 the Duars was visited by the members
of the Royal Society's Commission on Malaria and two cases in babus were seen by
them in the space of a fortnight. More attention was then turned to such cases,
it having been more or less taken for granted previously that the disease chiefly
occurred among Europeans. Since this time there have been one or more cases
recorded every year. In 1907 public interest was much aroused in regard to
Black-water Fever, with the result that a great increase in reported cases occurred.
We see no grounds whatever for regarding these facts as indicating a real increase
in frequency.
227 H. D.
34
RACIAL INCIDENCE.
The Europeans in the Dam Dim district are about sixty in number. Among
these in the years 1887—1907 forty-four attacks of Black-water Fever have
been recorded. In the Chelsa district among forty Europeans there have
been in the years 1898-1907 eight recorded attacks. These figures would give an
apparent incidence of about 3 per cent. and 2 per cent, per annum, respec-
tively, among Europeans in the district. But as previously noted older residents
are but little liable to the disease, and an allowance has to be made for this.
The number of cases recorded among babus in the Dam Dim district has
been twenty-four and in the Chelsa district thirteen: but since we have
ourselves seen thirteen cases in these two districts in a little less than a year,
it is evident that many cases have previously escaped observation. In the
years 1907-1908 the incidence of Black-water Fever among the babus in the
Dam Dim district as shown by the cases seen by ourselves, has been about
10.2 per cent per annum , while during the same period it has reached 15 per
cent. in the Chelsa district. The incidence among Chinamen is also heavy, as we
have seen two cases in little less then a year and the number of Chinamen resi-
dent in the Duars is not large. Among Mahomedan bearers, syces, and other
servants we have seen several cases, but we can give no definite information
as to the incidence rate, as the number of people of this class is unknown and
they come and go at frequent intervals.
Black-water Fever seems to be less common among the coolie class than
among the bungalow servants and other natives from the actual plains of Bengal;
but we have seen three cases in coolies from Chota Nagpur, and the disease may be
more frequent than is apparent, the difficulty in finding such cases under the labour
conditions existing in the Duars being great. Native children from shortly after
their birth are subject to continuous malarial infection, and it seems probable that
the condition might occur among them at the age from six months to two or three
years; among coolie children entering the Duars with their parents for the first
time also the disease might be encountered, for many of them die in the first two
years of residence: but so far in spite of a good deal of enquiry we have been unable
to get satisfactory evidence of hæmoglobinuria among young coolie children.
35
SEASONAL INCIDENCE.
Arranged in the months in which they occurred the cases of which we have
been able to get particulars are—
Months.
DISTRICTS.
Total.
Dam Dim.
Chelsa.
February
...
...
...
...
4
1
March
...
...
...
1
. . .
8
April
...
...
...
...
2
. . .
May
...
...
...
...
4
2
June
...
...
...
...
3
1
16
July
...
...
...
...
5
1
August
...
... ...
...
6
2
September
..
...
...
...
8
5
34
October
... ... ... ... ...
10
3
November
...
...
...
5
1
December
...
. . .
. . .
. . .
6
4
25
January
... ... ... ...
8
1
In both the Dam Dim district and the Chelsa district therefore the months
that are healthy as regards malaria are notable for the low incidence of Black-
water Fever cases; whilst in those at the latter end of the year when malaria is
rife the incidence is much higher.
Our own cases seen between August 1907 and July 1908 have occurred as
follows:—
August
... ... ... ... ...
6
September
... ... ... ... ...
4 13
October
... ... ... ... ...
3
36
November
... ... ... ... ...
1
December
...
... ...
... . . .
2 5
January
... ... ... ... ...
2
February
... ...
...
...
...
1
March
... ... ... ... ... ...
3
April
... ... ... ... ...
2
May
... ... ... ... ...
1
June
... ...
...
... ...
2 6
July
... ... ... ... ...
3
A closer study of these cases shews up the relation to malarial incidence still
more strikingly. The thirteen cases in August, September and October were dis-
tributed over the gardens Chengmari, Meen Glas, Chalouni, Nagasuri, Bagracot,
Ranicherra, Monabari, Pathajora and Nagrakata, all gardens situated on high
ground, which at this time of the year having many running streams is very suitable
for malaria.
The cases in November, December and January occurred, one case at jalpai-
guri, the other four in the gardens Baradigi, Bentguri and Hahiapathia, all low-
lying gardens noticeable as still having much water when the upper gardens were
mainly, and in some cases entirely, dry. Meen Glas, for instance, which gave us
3 cases in August when it was intersected by innumerable small streams was
found by us in January to be free from water.
Of the three cases in February, March and April two in April occurred in low-
lying gardens, Baridighi and Ellenbari notable as gardens where breeding places
still existed when over most of the district they had long dried up.
The case in May just before the onset of the rains was on a low-lying garden
(Huldibari) with perennial streams. Four cases in June and July were on upper
gardens (Mateli, Indong and Monabari) and occurred after the onset of the rains,
at a time when anopheles on these gardens were in great profusion and the fever
season had commenced. The remaining case was in a European who had a slight
attack in May, and a recurrence in June, after returning (from a sea trip) to the
low-lying garden on which he had contracted the disease. These are remarkable
examples of the close association of Malaria and Black-water Fever, showing that
the occurrence of attacks of the latter bear a close relation to the incidence of
the former.
37
LOCAL INCIDENCE.
This may be shown by a table in which the cases have been arranged accord-
ing to the gardens on which they have occurred
—
DAM DIM DISTRICT.
Gardens.
No. of residents.
Cases of Black-water Fever.
Figure re-
presenting
liability
to attack
among
Europeans.
European. Babus. European. Babus.
Others.
Neora Nuddy
. .
. .
. .
1
3
3
1
1
3
Barons
. . .
. .
. .
. .
4
4
7
5
. .
1.75
Sissibari
. .
. .
. .
. .
2
3
3
1
. .
1.5
Bullabari ..
..
. .
. .
3
3
4
2
1
1.3
Phoolbari
. . ..
. .
. .
3
3
2
. .
. .
.75
Glencoe
. .
..
. .
. .
3
3
2
..
. .
.75
Meen Glas ..
..
. .
. .
4
4
2
2
1
.5
Bagracote ..
..
. .
. .
2
3
1
2
..
.5
Manabari ..
. .
. .
. .
2
3
1
2
. .
.5
Sungachi ..
..
. .
. .
2
3
1
..
..
.5
Toonbari ..
. .
. .
. .
2
2
1
1
. .
.5
Pathajora ..
..
. .
. .
2
3
1
. .
1
.5
Ranacherra ..
. .
. .
..
3
3
1
. .
1
.3
Ellenbari ..
..
. .
. .
3
3
1
. .
. .
.3
Bentguri
..
. .
. .
. .
2
3
. . ..
1
. .
Washabari ..
. .
. .
. .
1
3
. .
. .
1
. .
Rungamuttee
. .
. .
. .
6
5
. .
1
4
. .
Hahiapathia
. .
. .
. .
2
3
. .
2
. .
. .
Sylee
. .
. .
..
. .
2
3
. .
. .
. .
. .
Needem
. .
..
..
. .
1
2
. .
..
. .
. .
Narkati
..
. .
..
. .
2
3
. .
. .
. .
. .
Kumli
. .
. .
. .
..
2
3
. .
. .
. .
. .
227 H. D. X
38
CHELSA DISTRICT.
Gardens.
No. of residents.
Cases of Black-water Fever.
Figure re-
presenting
liability
to attack
among
Europeans.
European. Babus. European. Babus. Others.
Engo
.. ..
. . ..
1
2
1
. .
. . 1
Nagasuri .. ..
. . ..
3
3
2
4
1
. 67
Chelsa
. .
. .
. .
. .
6
4
2
. .
. .
.3
Sathkaya ..
. . .. ..
3
2
1
. .
. .
.3
Kilkote
. . ..
. .
. .
2
2
. .
1
. .
. .
Mitale
. .
. . ..
. .
4
3
1
. .
. . .25
Baradighi .. ..
. .
. .
. .
4
..
2
..
..
Moortee
. . ..
. . ..
2
2
..
..
1
..
Chalouni . .
. . ..
. .
3
3
. .
1
2
. .
Aibeel
. .
. .
. . ..
2
3
..
. .
. .
. .
Sam Sing .. ..
. .
. .
4
4
..
. . ..
. .
Yang Tong .. .. ..
. .
2
2
..
. .
. .
. .
Indong
. . ..
. .
. .
3
3
. .
. .
. .
. .
Kumai
.. .. ..
. .
3
3
..
..
..
..
Zeranti
. .
. .
. . ..
2
3
..
. .
. . ..
Our own cases have occurred as follows:—
Dam Dim.
Chelsa.
Nagrakata.
Dina Torsa.
Meen Glas
. . .. 3 Baradighi .. .. 4 Chengmari
. . .. 1 Huldibari .. .. 1
Manabari
.. .. 2 Nagasuri
. . .. 3 Nagrakata .. .. 1 Tussati .. .. 1
Bagracote
. .
. . 1 Chalouni
. . .. 1
Ranacherra .. .. 1 Moortee
.. .. 1
Pathajora
. . .. 1 Indong
. . .. 1
Hahiapathia .. .. 1
Bentguri
. . .. 1
Ellenbari
.. .. 1