NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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Report on Kála-ázar.
if they were, it is much more reasonable to suppose that the
changes which they have been seen to undergo outside the
body, are only those which naturally take place in such organs
as the liver and spleen during life, and account for the relapsing
nature of the cases in which they occur. The facts can be
easily explained in a much simpler way. We know that in the
great majority of cases malarial fever originates from the
inhalation of the germs which have obtained access to the air
either by being carried up by the evaporation of moisture from
drying up marshy ground, or, as I have shown elsewhere, by
the displacement of the air from the soil by rising ground water
forcing them up into the atmosphere. They pass down into
the alveoli of the lungs, and have only about one thousandth
of an inch of tissue to traverse, in order to reach the blood
in which they live and multiply, and this they can get
through by means of the power of motion that they possess.
When they have completed that part of their life history,
which is passed in the human body, it is equally easy for
them to get back again into the air-sac, and it will be easier for
them to escape from there into the air, than it was for them
to effect their entrance from it, for the fine hair-like cilia,
which are constantly waving upwards in the air passages, will
assist their exit while they would oppose their entrance. When
it is remembered that kála-ázar is essentially a very chronic
and relapsing kind of fever, and that every day on which the
temperature rises each of the malarial germs in the blood
will divide up into some ten to fifteen little ones, it is easy to
understand that when a man with the fever is constantly exhal
-ing them, not only day after day, but week after week, and
month after month, then anyone else living in the same house
will be very likely to breath them in; and if his white blood-
cells are not very active in killing them as fast as they gain
entrance to his blood, then he will fall a victim to the disease
and contract the fever. The way in which whole house
-holds die of the affection, is thus easily accounted for. But
in addition to this, the germs must also gain access to the soil
Nature of epidemic and method of infection.
201
in the immediate neighbourhood of a house that is occupied
by anyone who is suffering from the disease. During the early
rainless cold-weather months, when the ground is dried up,
the germs which have reached it will lie dormant; and as those
who have the disease so often lose their fever at this time of
the year, the opportunities of direct infection through the air
will be also less than at any other time and new infections will
be at a minimum. As soon, however, as the first few inches of
rain fall, as usually occurs in Assam in April, and sometimes
even in March, then the ground will once more become moist
and warm, and the conditions will become most favourable for
the multiplication and escape into the air of the temporarily
dormant germs, new infections will again become common, and
the ordinary outbreak of the rainy season will recur. When
this has gone on for some five or six years in any place, a
large number of the inhabitants will have died of the disease,
while others may have had a slight attack which is not distin-
guishable from ordinary malarial fever, but which protects from a
more serious one, while the rest are insusceptible to the disease
or have not come into sufficiently intimate contact with infected
persons to get it, and so the epidemic fever declines. The
fact that the later cases last a much longer time before they
are fatal than the earlier ones, while more of them recover,
shows that the most susceptible die first, and later those who
have more power of resistance succumb, or in other words, the
disease loses its power of attacking the surviving inhabitants
of the place, and so it gradually dies out. Whether it leaves
the place or district more unhealthy than it was before is very
difficult to say. There is also evidence to show that a site
which has been deserted on account of the fatality of this
epidemic, may yet be safely inhabited by the people who had
previously deserted it, after it has been unoccupied for some
years, for this is recorded to have taken place at the foot of
the Garo Hills, in the very part where the Deputy Commis-
sioner of the district was subsequently unable to find a single
case of the disease. This indicates that the intensified germs
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must be frequently passing through the human system in order
to keep up their intensity, otherwise they will revert to the
ordinary type, just as artificially intensified bacteria require
every now and then to be repassed through susceptible animals
if their power is to be maintained at a very high pitch for long
periods. Whether these are the correct explanations of the
facts recorded relating to the spread of the disease, is of much
less practical importance than the knowledge of the facts
themselves, for they at least may be safely relied on in consi-
dering the measures which are necessary to check the spread of
the epidemic, and it is for this reason that all controversial
matters have been treated of in this section separately from
the previously recorded facts which require to be explained.
203
SECTION X.
RECOMMENDATIONS.
We have seen in Section VI that the nature and past history
of the epidemic fever, which has been spreading slowly, but
surely, up the Assam Valley for over twenty years, affords no
hope that it will spontaneously subside until it reaches the hills
that form the easternmost limits of the valley beyond Dibru-
garh, for although the Mikir Hills will doubtless delay its
spread into the Golaghat subdivision for a longer or shorter
time, yet the fact that it has already invaded Bishnath, and
the facility with which it crosses the Brahmaputra river,
render it certain that even if the tract of jungle between the
Nowgong and Golaghat districts forms an insurmountable
obstacle to its progress in that direction, it will nevertheless
gain admission by the lines of communication along the
waterway which forms such a magnificent highway for the
trade of the valley.
Nor will the policy, which has hitherto been adopted of
watching its progress and building dispensaries to help to
mitigate the miseries and death-rate which it causes, suffice
to check its progress in the smallest degree, while no sanitary
measures short of an entire alteration of the soil of the whole
valley into one which is unfavourable to the development of
the malarial organism, will suffice to check its spread, though
they would doubtless in some degree lessen its severity.
It may at first sight appear that the proof afforded in the
earlier sections of this report that the disease is entirely malarial
in its nature, and the light that has been thrown on its origin, will
not help us much in finding a remedy for the evil; but on the
other hand, the facts given in Section VII, illustrating exactly
how the disease really travels from village to village and house
to house, indicate the lines on which any preventative measures
must necessarily be based. The great difficulty lies in proposing
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Report on Kála-ázar.
any means of checking the disease which come within the
bounds of practical policy, but the difficulty must be faced.
It will then tend to clearness if I first lay down the measures
which are likely to be efficient in staying or limiting the
ravages of the epidemic, and afterwards indicate the manner
in which they can best be carried out. The measures to be
taken on tea gardens will be separately considered, as here it
is possible to lay down a definite plan of action with a cer-
tainty that it can and will be carried into effect.
The only way in which the spread of the epidemic can
possibly be checked is (1) by cutting off inter-communication
between infected and non-infected villages and districts, and
(2) by moving the houses of attacked villages from the
infected sites to a short distance only during the cold-weather
months, when the fever is at a minimum.
The extreme difficulty of carrying out such measures will
be at once apparent ; i n fact , t hey wi l l be absol ut el y i mpossi bl e
without the cordial assistance of the people of the affected
districts. If, however, the native population are willing to
adopt a few simple measures based on the knowledge that
we now possess regarding the methods and ways in which
the disease is spread, then very much may be done to check
the mortality and spread the disease.
Now, I have shown in Sections VI and VII that the people
in isolated instances in various districts have themselves, on
their own initiative, adopted the very measures which are
best fitted to check the mortality and spread of the epidemic,
and it is indeed only from the favourable results that have
followed their action that clear evidence of the efficiency of
the very measures which I am about to propose has been
obtained. Moreover, I have shown in Section VII that the
people of the affected districts are in such terror of the
disease, that they have even broken through their social and
religious customs in their endeavours to escape the infection.
I am therefore strongly of the opinion that in spite of
the essentially lazy, easy-going, and intensely conservative
Recommendations.
2 0 5
character of the Assamese people, they are in this instance
most willing and anxious to carry out any measures that are
in the least degree likely to mitigate the ravages of this
decimating disease. I made a special point in the course of
my tours of inquiry from the villagers if they were prepared
to adopt certain measures for the prevention of the infection
of their villages, or the eradication of the disease when once
it had broken out amongst them, and found that they were
quite ready to adopt any suggestions, even to the extent of
moving their villages to a new site, although in this latter
case they were confronted with a great difficulty, which was
that if they moved unless they gave up the land on which
their houses stood and took over the new site on January 1st,
which was obviously impossible, for it would take them at least
a month to effect the move, they would have to pay a year's
rent for both pieces of land, which they were even less able to
do when affected by the epidemic than when in health. It is
all the more surprising that they should nevertheless have
moved their villages to new sites in several instances in both
the Nowgong and Mangaldai districts, purely and solely in
order to escape annihilation by the disease. In this con-
nection the following extract from the administrative report
of the Garo Hills district for 1886-87 showing the good effect
of the above measure among the Garos, who so extensively
adopted it will be of interest. "In other villages it would
seem as if a wave of malaria had passed over them, so numer-
ous were the cases. I was urgent with the people in such
cases to move their villages at least during the rains, and to
betake themselves to temporary houses on the hill tops, and
near good hill streams. This the people had done in some
instances of their own accord with most successful results."
Again, I have shown that in Mangaldai there is good evidence
to show that the spread of the disease to certain villages has
been prevented by the people finding out for themselves that
it was infectious, and cutting off all communication with the
affected villages.
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Report on Kála-ázar.
I propose then to take advantage of this attitude of the
people, and to assist them to help themselves in the following
two ways:
(1) By writing a pamphlet, to be translated into Assam-
ese, Kachari, and any other languages that may be thought
advisable, setting forth in the simplest words the methods in
which the disease is commonly spread, and the precautionary
measures which should be taken in order to avoid the intro-
duction of the disease into previously unaffected villages,
and the best measures to adopt to prevent its spread through
a village when once it has begun, etc.
(2) To give facilities to those villages which are already
severely affected by the disease to move from the infected
sites to new ones, a short distance off, while still retaining the
land which they are cultivating, which will prevent their going
to a distance and so running a risk of carrying the infection
to new places. The move should be made during the dry
cold-weather months, from December to February or the
middle of March, being the most favourable ones.
As regards the first suggestion, I have written a pamphlet
(see Appendix No. 2), which, I hope, will prove suitable for
the purpose, and which should be distributed gratis to the
heads of villages in both the affected and threatened districts,
and to any other persons whom it may be thought advisable
to instruct on the subject.
The second proposal is based on the fact that if the
people of an affected village move their houses from the
infected site to a new one, which need not be more than
two hundred yards from the old one, during the cold-weather
months, when the fever is at its minimum, then the usual
severe annual recurrence of the fever in the following rainy
season does not ensue. It must be admitted that so far this
has usually been carried out after the village had suffered
from the epidemic for some years, and when it may have
been on the decline, so that it is not certain if quite as good
results would be obtained by moving a village during the
Recommendations.
207
height of the epidemic. There is, however, no reason why it
should not, and if carried out in the first cold weather after
infection it should even be more likely to be successful than
if delayed for some years, and at least it would be certain
to very much lessen the mortality during the next year,
while if the disease did eventually recur to a severe degree,
the measure might have to be repeated. It may be objected
that such a move would be the very way to spread the
disease, and this would be true if it was proposed to remove
to a considerable distance, or into a previously uninfected
part. Fortunately it is only necessary to go a very little
distance in order to escape from the infected area, as is
conclusively proved by the examples both in villages and on
tea estates, such, for instance, as those given on pages 154 and
163 of Section VII. In the cases of villages it is impossible to
separate the healthy from the sick as is recommended on tea
gardens further on in this section; but in the instances I have
met with, the presence of a few chronic cases has not caused
the re-appearance of the disease after removal from the
infected site.
The proposed form of assistance to encourage them to
move will at the same time ensure that they do only go a
short distance, and is moreover one that my enquiries in the
villages leads me to believe would be sufficient inducement
to them to move, in at least a great many cases. It is in the
first place, that the necessity of their paying a year's rent for
the land on which their village stands, and also for the site
to which they remove, should be done away with, which
would be sufficient in case of many of those villages which have
already severely suffered from the epidemic to induce them to
abandon the infected place in which they are living; but
further, in order to get the villagers to move during the first
cold weather after their village has become infected, and con-
sequently before they have realised to the full extent the
decimation which it will be certain to cause among them, it
will be necessary to give them the land for a new site for
Report Kála-ázar.
their village rent-free for one year, while to prevent their
moving to a distance it should be a condition of their receiving
this aid that they still retain and cultivate the same land
that they previously held.
One difficulty that was pointed out by some of the villagers
was that they might not be able to find a suitable high piece
of ground big enough to accommodate the whole of their
village. This may be true of some of the more thickly-popu-
lated districts, such as the southern part of the Mangaldai
division, but is rather of the nature of an advantage than other-
wise, as it would necessitate the splitting up of some of the
larger villages, which would help to prevent a recurrence of
the disease among them for the smaller communities into
which they would have to divide would be less likely to
become re-infected by the disease than a single large one
would be.
The question remains—what would be the cost of such a
measure as this? As I only propose that the rent of the
actual sites of any infected villages, which can be induced
to move, should be remitted for one year, and the revenue
from cultivated land would be untouched, while it is probable
that it will only be carried out in some of the districts at first,
the initial cost would be small, and would, I feel sure, be
ultimately more than recouped by the resulting saving of lives,
preventing the great loss of the revenue from wholesale fall-
ing out of cultivation of the land owing to the great mortality
among the active able-bodied workers, which has always
followed the invasion of any district by this epidemic.
The application of the above-described measures to the
different districts will be discussed under the following three
heads: (1) Those which have been infected for some years,
such as Nowgong and South Mangaldai; (2) Recently
infected parts, such as Bishnath and Tezpur, the north
of Mangaldai (3) Uninfected, but threatened districts, such
as Golaghat and the more easterly divisions of Upper
Assam. The Garo Hills, Goalpara and Kamrup districts
do not require consideration, as there appears to be no
Recommendations.
209
epidemic manifestation of the disease in these parts
at the present time, although cases of ordinary malarial
fever and other conditions are still returned under the head
of kála-ázar. The nomenclature of these diseases will be
discussed later.
(I) (a) Nowgong. —The epidemic reached the extreme
north-east end of this district some three years ago, as far at
least as it is inhabited, which is only a few miles beyond
Silghat. It has largely subsided in the southern and western
parts of the district, and is on the decrease in the central parts
also, including the station and surrounding villages, but is still
increasing in the north-eastern corner, especially along the
eastern end of the Kulung river, and also in a few of the more
sparsely-populated parts between the Kulung and the Brahma-
putra rivers which have been comparatively recently attacked.
This decrease is probably greater than is indicated by the
slight fall in the number of deaths returned from fever and
kála-ázar in 1896, for there appears to have been a distinct
improvement in registration during the last year in this
district. A further decrease in the mortality of the district as
a whole may be looked for during the current year (1897), so
that no very active measures are required. There is still
some scope for the beneficial effects of instructing the people
in the necessary precautions to be taken for preventing
the spread of the disease in the more recently infected parts.
The villages along the Kulung are practically continuous,
so that this would not be a favourable part for moving the
villages from the infected sites, but some of the more
scattered places towards the Brahmaputra river would be
much more suitable for the carrying out of this measure.
(b) South Mangaldai. —Here again, the disease has
greatly decreased in the south-western parts, especially
around Sipajhar and west of Rangamati. North of Mangaldai
town, and especially in Bor Autola, it is still bad, but has only
just begun to affect a few villages in the southern parts of the
Kalaigaon tahsil, which is more sparsely populated than the
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Report on Kála-ázar.
southern parts of the district. It was here that the people
seemed most alive to the infectiousness of the disease, and most
ready to adopt measures against it, so that by teaching them
exactly how it is really spread and the necessary precautions
to be taken against it, and at the same time encouraging
and helping them in moving their villages from the infected sites
during the cold weather, much may be done to both to check
the spread of the epidemic and to reduce the mortality and
consequent reversion of cultivated land to a state of jungle,
such as I have seen taking place in parts of this division.
(2) Recently affected parts of the Darrang district. —Here
we have to deal both with a rural and an urban population.
Taking the Tezpur division as a whole first, it must be remark-
ed that although both the town and the villages around it
have been affected for some three years, the death-rate appears
to have been small and the spread of the disease less rapid
than it always has been on the south bank of the Brahma-
putra. The soil is probably less favourable to the multiplication
and survival through the cold, dry weather of the intensified
malarial organisms. Nevertheless the disease has undoubtedly
gained a footing in the district, but its slower spread should
render it easier to check than it otherwise would have been,
and vigorous measures are therefore still more imperative, and
likely to give better results than in the lower and damper parts
of the valley. Most of the villages for 5 or more miles
around Tezpur town, are affected by the disease, although not
yet very severely; and, as far as I could ascertain, there
are also other isolated villages much further out in the district,
right among the tea gardens, which are consequently threatened,
although I do not know of any that are as yet infected; and, if
this is the case, the measures detailed in the latter part of this
section should be efficient in preventing any great mortality on
them. The measures already described will then also be ap-
plicable to this district, only they should be carried out in a more
systematic way than is necessary or advisable in districts
that are already severely and universally attacked, with a
Recommendations.
2 11
view to prevent the disease from spreading to the unaffected
parts, and to stamp it out of those in which it has already
got a foothold. For this purpose all attacked villages on the
margin of the affected area, as well as isolated newly-infected
ones should be carefully sought out, and the neighbouring
ones warned against intercourse with them, while in the cold
weather active steps should be taken to move the infected
ones, as already described. If this was systematically and
thoroughly carried out for two or three successive years,
I believe the march of the epidemic would be most materially
checked. Similar steps should be taken, as far as possible,
in those around the-town itself. The same remarks apply to
the northern part of Mangaldai, which is beginning to be
affected, and as it is largely inhabited by Kacharis, who are
less loath to move than the Assamese people, the necessary
measures should be easier to carry out here.
With regard to Bishnath, the disease is only just begin-
ning near the river-ghât, although it is present in the more
western parts towards Tezpur in the same degree that it is
in the Tezpur division itself. Vigorous measures should be
taken on the lines already described to stamp out the disease
and to check its spread, especially from the recently affected
portion near the landing place.
Tezpur town. —It has been pointed out in Section VI
how rapidly the disease became widespread soon after
Gauhati was badly infected, owing to its travelling along
the much frequented lines of communication from that town
to the Nowgong and Mangaldai districts. The same was
true of the "Bardwan fever" when it reached the town of
that name. That the disease is already beginning in Tezpur
town is then a fact of the gravest significance, although for-
tunately it is not yet attained to epidemic proportions, so there
may yet be time to do something to lessen the danger of
its widespread dissemination from this centre. Now we have
seen in Section VI, page 144, and Section VII, page 160, that
the disease has been introduced here as elsewhere by means of
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