NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Communicability of Kála-ázar.
157
man who had died of kála-ázar, he would be liable to get the
disease. This was also so strongly the belief in the Kamrup
district a few years back, that the property and even the cattle
of persons who had died of kála-ázar, were left untouched by
not only the relatives of the deceased, but by everyone else for
fear of infection. That this is one of the ways in which the
disease may he spread, is very likely, when we consider that
the bargaining over such sales may last two or three days, and
will be carried on in the affected village, and usually in the
infected house, and I found an instance in which the infec
- t i o n h a d p r o b a b l y t a k e n p l a c e i n t h i s w a y i n a n o t h e r p a r t o f
this very village. A few miles further north along this same
road was a small village of Brahmins, who had no relations or
people of their caste in the neighbourhood, and who were free
of the disease. Quite close to them, but the other side of the
road, was a collection of houses in which some fifty people
remained, while some forty had died of kála-ázar. The
history of the introduction here was very instructive. At first
they said they did not know how it came, although they gave
me the name of the first case. On enquiry I found the wife of
this man was still alive, and on questioning her I ascertained
that her deceased husband had a brother suffering from the
disease, who used to visit him, and eat and sleep in his house
while he was ill with the fever, although he lived in another
village, two-and-a-half miles away. My informant's husband
then got the disease from his brother, and his son was the next
victim, after which it spread to other families. Here, again,
another part of this village, which was situated some quarter
of a mile away, cut off all communication with this affected
part, and still remained tree from the epidemic, although the
affected part had been attacked four years ago, and was now
rather better than it had been. A big village further still to
the north had suffered severely for four years, but a small
one of a different caste near them had so far escaped, while
only some two miles further up nearly every village was free of
the disease, and to the west two or three miles in from the
road the disease had not reached so far north by three or
158
Report on Kála-ázar.
four miles as it had along the main road.
The above facts are sufficient to prove that when all com
- m u n i c a t i o n i s c u t o f f b e t w e e n o n e v i l l a g e a n d a n o t h e r , e i t h e r
by caste restrictions or by voluntary abstention, from visiting
between related villages, then the spread of the disease is
greatly, or even entirely, impeded. Further, when there is any
special communication between a village and an infected
part of the country, which is not shared in by the surrounding
villages, then the communicating village may alone be attacked,
as the following instance shows. On enquiry from the tahsildar
of the Kalaigaon division as to what villages were affected in
his part of the district (which as yet is scarcely touched by
the disease), he gave me the names of four or five in which, he
said, the disease was beginning. As I was anxious to test
the correctness of his information, as well as to visit some of
the most recently-affected places, I made a point of going to
some of those he had indicated. I found his information was
perfectly correct, for, owing to his being responsible for the
collection of the land revenue, he is immediately made aware
of any unusual mortality in the villages under his care by the
consequent reduction in the amount of land cultivated. One of
these places was called Berhampur, and after some difficulty I
found it more than two miles from any road, and surrounded
by unaffected villages; in fact, the last place which one would
have expected to have been singled out for attack by the
disease. When, however, I ascertained that it was a farm
belonging to people of the Sipajhar district, which had suffered
very severely from the disease for the last six or seven years,
the mystery was explained, and on enquiry I found the first
cases in this village were in persons who had been brought
from Sipajhar in the hope of the change doing them good,
and other cases had occurred in some of the houses in
which they had lived.
Another very instructive case is the following. It has been
mentioned in Section VI that there is a long stretch of very
sparsely inhabited jungle to the west of Mangaldai town
between it and Tezpur, which the epidemic has not yet
Communicability of Kála-ázar.
159
crossed. There is, however, a village in about the centre of
this tract, 17 miles from Mangaldai town, which has recently
become infected. The first case was a policeman who
returned to his home here from Mangaldai town on sick leave
in October 1896, suffering from kála-ázar. In January 1897
a member of his household had also got the disease. Here
we see the disease carried 17 miles, but it must be noted that
Mangaldai town and district had suffered from the epidemic
for six years before it was carried over this stretch of
jungle.
A few days later I visited the Sipajhar district, and found
that the disease is now dying out of this part; but in the
course of a walk across country there, I was much struck by
seeing patches of jungle gras; of from one to three years'
growth in the midst of stretches of rice-fields. On looking
closer, the low ridges, which se rve to retain the water on
such ground during t he rainy season, were found to also tra
-verse these patches, showing that they had been cultivated
within a short period. On enquiry it was ascertained that
this jungle was growing on land which had formerly been cul
-tivated by families, all of whose working members had died of
the epidemic; and, as there were not sufficient adults left in
the villages to take up this land, it had fallen out of cul
-tivation. Further experience showed that very fairly accurate
estimations of the proportion of deaths from kála-ázar in these
villages could be made from the condition of the fields around
them. The extent of this may be gathered from the fact that
the amount of land under cultivation in this rnauza alone has
fallen from 16,969 big has in 1891-92 to 13,636 in 1895-96, or
a decr eas e of 3, 333, j us t about one- s i xt h of t he whol e.
It is also a fact that nearly all the first cases which oc
- c u r r e d i n T e z p u r t o w n w e r e t r a c e a b l e t o N o w g o n g o r G a u h a t i .
Thus, according to a report by Macnamara, the disease was
first introduced into a house opposite the club, by a man from
Gauhati suffering from kála-ázar, of which he subsequently
died, living in this house for three months, while a second
Report on Kála-ázar.
Gauhati man stayed there for two weeks and went away very
ill with fever. Then a boy in this house died of kála-ázar,
after an illness of two years and subsequently three others died
of the disease in the same house. I myself found there had
been two deaths from the disease in a row of native houses
in the bazar within one week, both in the persons of people
who had come from Nowgong suffering from the disease. In
short, all the facts with regard to the recent infection of Tez
- p u r t o w n g o t o p r o v e t h a t t h e d i s e a s e h a s b e e n i n t r o d u c e d
by sufferers from the disease coming to live here from the
Nowgong and Gauhati districts. I have met with an instance
in which the disease was apparently introduced into a village
some 30 miles from Nowgong station by a school boy returning
from there with the disease, and a place north of Gauhati is
recorded as having become infected in a similar way.
Enough has been written to show, both from specific
instances and from the peculiar distribution of the disease in
neighbouring villages, that it is a communicable affection and
that the infection is often of an indirect nature. The explana
- t i o n o f t h e f a c t s r e c o r d e d i n t h i s s e c t i o n , a n d t h e e x a c t m a n n e r
in which the infection takes place, will be considered in Section
IX after the origin of the disease has been described.
I have not seen any cases myself of the disease in Euro-
peans, but have given in Section II, page
27, the information I have collected with
regard to the instances which have occurred
of their suffering from the affection. In only two cases,
however, was I able to get reliable information as to the
habits, etc., of the sufferers. In one of these a forest officer
had an orderly coming constantly into his bungalow, who had
the disease at the time, and who died of it; and in the other
a police officer employed as punka-coolies more than one boy
who had the disease at the time he was working in the bun-
galow, and who subsequently died of it. These boys used to
sit on the floor of his office within a few feet of him, pull-
ing the punka while he was doing his work. Both the
Infection in Euro
-peans.
Communicability of kála-ázar.
161
officer in question and also his young son contracted and died
of the disease.
The usual ways in which tea gardens became infected is
of importance, as a knowledge of it will
allow of proper precautions being taken to
avoid it. I am indebted to Dr. Dodds
Price, of Nowgong, for nearly all the information I have obtained
on this part of the subject. He has been most kind in work-
ing out various figures and facts for me concerning it in the
gardens under his care.
The disease nearly always appears first in coolies who
have been years on the garden, and who should be acclimatised
against malaria if such a thing is possible. The reason why
they get it is because they have relations and connections in
the surrounding villages, which recently imported coolies have
not, and the old coolies therefore are more likely to visit any
neighbouring infected villages. Now two of the gardens which
suffered most in the Nowgong district were infected in this way
from a small village which was within a mile or so of both of
them, and which had the disease so badly that they nearly all
died of it, and the survivors eventually deserted the site, which
still remains unoccupied. On one of these gardens, moreover,
two of the earliest cases were in the dâk-runners, who used to
go into Nowgong station and stay there a night before return-
ing, and that at the very time when the disease was bad
in the town. The true nature of the disease was not at first
recognised, but it was thought that the garden had become
unhealthy for some unknown reason, as there were more fever
cases than usual, and these were very resistent to treatment
with ordinary doses of quinine, etc. Some of them were
therefore removed to other sections of the garden, and
between this and the general inter-communication between an
out-garden and the headquarters, the disease broke out in
the central, and also in the furthest out-garden, some 6
miles from that first affected. The death-rate in this
furthest out-garden became very high, so some of the Y
Infection on tea
gardens.
162
Report on Kála-ázar.
affected coolies were moved out of it; and in order to
carry on the work, 28 selected healthy coolies, who had
been many years on the garden, and who were thought
to be least likely to suffer from any form of malarial fever
(for the disease was considered to be such from the
beginning) were moved into the infected lines of this out-
garden. No less than 14 of these 28 healthy selected coolies
contracted the disease, and almost all of them died of it, and
many of those who got it were related to each other. Vigor-
ous measures are now being taken to eradicate the disease,—
new lines have been built during the cold weather, into which
all the healthy coolies have been moved, and the old ones will
be burnt down, and not re-occupied for some years at least.
The beginning of the disease on another garden of this
district is very instructive. The first case was diagnosed
early in July by Dr. Price and myself. The patient was an old
coolie, who had settled down on the garden, where he had
worked for many years, and had connections in villages around.
He had had constant fever for some two months, and already
had a large spleen and liver, and was rather dark in the face.
Within a month he had died of kála-ázar, and a brother of
his had got the disease. The second brother died in another
six weeks, and a third brother was then getting fever, and he
died early in January 1897, so that all three brothers had died
within six months of the disease, and there was not another
case on the garden, nor is there one at the time of writing,
namely, early in March. The houses occupied by these people
have been destroyed by fire, and the other inhabitants of the
group are being watched.
In another one garden two successive Assamese wives of
a garden sirdar have died of kála-ázar within 18 months; but
as they were purdah women, there was no opportunity for
other coolies in the lines to come near them, and no other
cases have occurred.
Once more, since the disease has been epidemic at the
headquarters of the garden which has been mentioned as
Communicability of kála-ázar
163
having suffered most severely, as many as possible of the
new coolies have been put in a new line just about 200 yards
from the badly infected lines. In January 1895, a batch
of 200 coolies arrived on this garden, and 150 of them
were placed in the new lines, but 50 were put in the old
infected lines for want of room. During the two following
years, 2 of the 150 new line coolies died from dysentery,
but none from kála-ázar ; during the same period, to out of
the 50 old line coolies died, 8 of the deaths being from kála
- á z a r .
T h u s 1 6 p e r c e n t . o f t h e 5 0 , w h o l i v e d i n t h e i n f e c t e d
lines, died in two years of the epidemic fever, but none of the
1 5 0 c o o l i e s o f t h e s a m e b a t c h w h o l i v e d i n t h e n e w l i n e s o m e
200 yards from the old ones. Comment seems unnecessary,
as the figures speak for themselves.
The exact way in which the first cases occur on any gar-
den is not always very easy to trace, especially if, as has
u s u a l l y b e e n t h e c a s e h i t h e r t o , t h e d i s e a s e i s a t f i r s t t h o u g h t
to be ordinary malarial fever. The following case is an in-
teresting one in this connection:—An out-garden at the end
of a valley, and consequently with no traffic through it, suffered
severely from the disease, and the main garden to which it
belongs now also has the disease rather badly. A neigh-
bouring garden, only one mile from the first-mentioned out-
garden, but under a separate management, has remained quite
free of the disease for several years, during which its near
neighbour was suffering so severely. This peculiar distribu-
tion of the disease was not easy to explain until it transpired
that the badly infected out-garden was almost entirely worked
by old coolies, many of the relatives of whom had settled in
a village, some 8 miles distant, near the out-garden, the lines
of which have been already mentioned as having been moved
on account of the severity of the disease in them. This
village has also suffered from the disease, and through them
doubtless their relatives in the out-of-the-way garden at the
end of the valley became infected.
In another part of the Nowgong district, there had been
Y 2
164 Report on Kála-ázar.
no kála-ázar in any of a series of three or four gardens until
the last month or two. These gardens have recently been
placed under a new manager, whose father also managed a
garden, some 40 miles off, up to three months ago, when he
left the district. A case of kála-ázar has recently been
detected on one of the first-mentioned gardens in the person
of an old servant of the last-mentioned distant garden,
which had suffered very severely from the epidemic. This
man had come to the garden on which he now lives, when
his old master left the district. During the last few months
there has been a good deal of communication between the
two gardens, and the disease is now present in a village near
the newly-infected garden, and in two of the garden coolies,
but active measures are being taken, and the early detection of
the disease should allow of a severe epidemic on this instance
being avoided.
The above evidence regarding the spread of the dis-
ease on tea gardens confirms that derived from the villages
of the affected districts, and the facts recorded in this section,
taken with those relating to the general distribution of the
disease given in Section VI, prove that the disease is a com-
municable one, but that it is usually necessary to visit or
reside in a house or village which is infected in order to con-
tract the disease.
The question remains to be considered—How then did a
malarial fever get this power of communicability? In order to
answer this, the origin of the epidemic must first be ascertained.
(165)
SECTION VIII.
THE ORIGIN OF KÁLA-ÁZAR AND ITS RESEMBLANCE TO THE
"BARDWAN FEVER" EPIDEMIC.
I have not been able to find any attempt whatever in the
numerous reports on the subject of kála-ázar to explain the
origin of the epidemic. It seems to have been generally
taken for granted that the disease is endemic in the Garo
Hills, and has been so far a very long period, and that it
spread from there in the early eighties to Goalpara, at the
foot of the hills, and has been epidemic in the Assam Valley
ever since. Why it should have suddenly spread in this way,
has never been explained. Dr. Giles makes no attempt in
his report to solve the mystery, but in a letter to the Chief
Commissioner of Assam, dated Sanawar, the 27th June 1892,
he writes
—
" My personal opinion is that the disease has been introduced,
within the last thirty years or so, and its appearance in the tea gardens
as what is now called beri-beri and in the Garo Hills as kála-ázar,
are alike phenomena, dependent on the improvement of communica-
tions and increase of intercourse which have resulted from the estab-
lishment of British rule, and the consequent advance in civilisa-
tion."
The question is, however, one of considerable practical
importance, for if the epidemic arose from a disease which is
always present in the Garo Hills, it may do so again at any
time, and unless we know what causes it thus to spread, we
shall not be in a better position to meet it than we were in the
eighties. If, on the other hand, it is not endemic in these
hills, but was introduced therefrom without, a correct know
-
ledge of its true origin will be equally of importance. Again,
it has never been explained why the disease never broke out
to the south of the Garo Hills, and spread to Mymensingh and
Sylhet, as it might have been expected to have done at the
same time that it spread up the Assam Valley, if it really
arose in these hills.
166
Report on Kála-ázar.
In order to try and throw some light in these questions,
I visited the Garo Hills, and examined all the administrative
reports as far back as 1870, at which date they were com-
menced, with the result of obtaining much valuable informa-
tion which, together with a subsequent and complimentary
examination of the Bengal Sanitary Reports of the seventies,
has resulted in a complete solution of the origin of the epi-
demic.
It was mentioned in the first section of this report that
three different statements as to the probable date at which
kála-ázar was first noticed in the Garo Hills, are to be found
in the earliest description of the disease, showing that this
point was not clearly made out at that time. A more definite
idea can, however, be derived from the fact that the Garos
themselves called the disease "Sirkari disease," or "Saheb's
disease," not because the Europeans suffered from it, for up
to that time they had entirely escaped, but because they said
the disease was unknown among them until after the Sahebs
took over their country. Now although Tura, the head-
quarters of the district, was occupied in 1867, the greater part
of the country was not taken over until after the expedition of
1871-72, so that the epidemic was apparently not known until
after this date. On the other hand, Colonel Maxwell, who
was in charge of the district in 1881—83, writes to me
—
" Elderly Garos have often told me their grandfathers died of the
disease, which, however, was not so virulent as it has lately become."
Now it is obvious that, as the disease is only a very intense
form of malaria, the Garo people for generations past, indeed,
as long as the physical conformation of the country has been
in its present state, must have died of chronic malarial disease
indistinguishable, individually considered, from that subse-
quently called kála-ázar, but it does not follow that the disease
has been present in an epidemic and communicable form all
that time; in fact, Colonel Maxwell himself states that it was
not formerly of so virulent a type.
That is the true explanation of the apparent discrepancies
Origin of kála-ázar, etc.
167
is shown by a study of the oldest records, from which it
appears that the statements that the disease has been in the
Garo Hills "as far back as 1869," and that the Garos give
accounts of it "at periods varying from 3 to 30 years," are
based on reports of the disease in 1869 and 1873, in which from
one to five cases of malarial cachexia are described as having
been found in several villages spread over many miles of
country, which are all noted as being at the foot of the hills in
extremely malarious places, and the average duration of which
cases is said to have been about two years. It is particularly
noted that the disease is not met with in the higher land in the
interior of the district. Now, in the accounts of the epidemic
in the early eighties in the Garo Hills, it is recorded that the
disease attacked the villages in the hills themselves, and,
moreover, the cases in the villages were much more numerous
and of much shorter duration than those above described, so
that it is evident that the earlier descriptions apply to the
ordinary malarial cachexia in the terai tracts of the country,
and not to the epidemic malaria of later years, while it also
follows that the term kála-ázar is the Garo term for ordinary
malarial cachexia, which was very naturally also used to
describe the epidemic disease, for the condition induced by
the latter was identical with the former.
Fortunately, it has been possible to get clear evidence as
to the exact date when it did become epidemic at the foot of
the Garo Hills, for it began there, and not in the hills them-
selves. On looking through the administrative reports of
the district, it appeared that the revenue was collected in the
form of a house-tax, and that when for any reason the esti-
mated amount was not realised, an explanation of the reason
of the deficiency was recorded in the reports. Now up to
the year 1875 the revenue was always collected in full, with
an occasional slight remission, owing to the destruction of the
crops in certain places owing to a flood or some such cause.
In 1875, it is recorded that there was a deficiency of revenue
from some villages in the south-west corner of the district