NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
134
Report on Kála-ázar.
fevers alone in the period before kála-ázar appeared in the
district, an approximately correct estimate may be formed of
the mortality which is caused by the epidemic; but it must be
borne in mind that the vital statistics of the two last affected
districts more especially, are very far from being accurate, and
the figures obtained are only of relative value for use in com
- p a r i n g o n e y e a r w i t h a n o t h e r , b u t c a n n o t b e t a k e n a s g i v i n g
nearly the real total of the deaths from fevers in these districts.
The chart, however, shows very well the wave of increased
fever death-rate which overtook, one after the other, the
districts named, and also the monthly maxima and minima of
fever death-rates. I worked out separately the monthly dis
-tribution of the deaths returned under the heading of Kala
-ázar in the Nowgong district, and this showed the same
seasonal distribution as that of the ordinary fevers, except that
it was a somewhat more extended one, a variation from the
normal that has been observed in other epidemics of malarial
fever, such as the " Bardwan fever."
A study of the chart shows that the upper tracing, that of
the Goalpara district (that of the Garo Hills cannot be given,
as there was no registration of deaths there at the time of the
outbreak) began to rise markedly in 1883, which is just the
time that this part began to suffer severely from the epidemic,
and the next three years the death-rate was at its height,
declined slightly in the two following years, and in 1889 it
reached much the same height as it was at in 1882. But for
the year 1887 being a very unhealthy one in many parts of the
province, the decline would probably have been seen in
that year. It will be noticed that in the subsequent seven
years the fever-rate has never reached to nearly the height
that it attained to the epidemic kála-ázar years, in spite
of the fact that only the southern portion of the district
suffered severely from the epidemic, with the excepion of
1892, in which the death-rate under the heading of Fevers was
greatly increased by a severe outbreak of influenza. When it
is also mentioned that some allowance must be made for
General course and distribution of the epidemic.
mprovement of registration during these latter years, it will
be evident that the death-rate from fevers was very much
increased during the prevalence of kála-ázar in the Goalpara
district. It is necessary to insist on this point, because
Dr. Giles, judging by the absence of any marked increase in
the general death-rate, including that most variable factor,
cholera, of Kamrup since it had been attacked by kála-ázar,
came to the conclusion that the disease "enhances the sick-
rate more than the mortality"—a statement that is directly
contrary to the very high percentage of deaths among those
suffering from this disease. He, however, admits that "in the
registers all cases of kála-ázar are of course included under
this term," namely, "fever," and he goes on to point out, what
is very evident, that deaths from many different diseases, of
which fever is the main symptom, will also be returned under
this heading. It is then evident that the increased death-
rate from fevers during these epidemic years must have been
due to kála-ázar. The same sequence of events is seen in
the second curve, but here the rise is not very evident until
the upper one has begun to fall, namely, in the year 1888,
and remains very high in 1889 and 1890, after which it also
begins to decline, with the exception again of the influenza
year 1892, and reaches its normal in 1895, while 1894 was
also a very unhealthy year, not only in Assam, but in many
other parts of India; but even then the fever death-rate did
not reach the height that it did in the kála-ázar years, and
the peak of the curve is not so broad as it was in those years,
showing that the excess of sickness was of a shorter duration.
Coming to the third curve, the rise in the Nowgong district
is seen to begin in 1893, although part of the rise of the
influenza year 1892 might have been due to kála-ázar, espe-
cially the increased height towards the end of the year;
1894-1895 were very bad years, but there was a slight
decline in 1896, which is pretty sure, judging from what
I have seen in the district, to be more marked next
year.
135
136
Report on Kála-ázar.
Another point which can be seen from the chart, is that
during the worst years in any district, the death-rate rises
earlier than it does in ordinary years. Thus, in 1889 in
Kamrup, and in 1895 in Nowgong, there is a well marked
rise as early as the month of April, and, moreover, the
decline is often later than in the non-epidemic years, both
facts indicating a longer seasonal distribution of the disease.
It will have been noticed that during the height of the
epidemic in any one district, there are three or four years
in succession during which the mortality from fevers is not
only much higher than the average of the preceding or
following years, but in each of which it is actually higher than
any one exceptionally unhealthy year at other times. Again,
the increased mortality from fevers does not become marked
until two or three years after the district has been invaded
by the disease, that is, until it has had time to diffuse itself
over a considerable portion of its area, so that the returns
from whole districts are of no use in helping to detect the
presence of the disease at an early period of its being attack
- e d . F o r t h i s p u r p o s e , t h e f i g u r e s o f i n d i v i d u a l m a u z a s m u s t
be examined, but still better the tahsildars and mauzadars
themselves can be relied on to furnish very early information
as to which villages in their respective portions of the district
are affected by the epidemic fever, while the revenue returns
are influenced as soon as there has been any great death-rate
in any group of them. The seasonal distri-bution of the diseases.
This, as has already been observed, is very well shown in the
chart opposite page 133, but the point is one
of such extreme importance, that it must
be amplified somewhat here. In Section III it was mentioned
that the seasonal distribution of the disease is exactly that of
ordinary malarial fever, except that it is rather a more extend
-ed one, and it was mentioned that the beginning and end
of the rains were the most fatal seasons of the year. Extend
-ed inquiries in the affected villages and tea gardens confirm
the impression that nearly all new cases of the disease occur
General course and distribution of the epidemic. 137
during the rainy season, beginning with the fall of the first
few inches of rain, which usually takes place in April or some
time in March. Many chronic cases died off early in the
cold weather from lung complications; but from November
to March most of the cases lose their fever, only too often
to relapse at the onset of the next rainy season. This great
decrease of the disease in the cold weather is a most remark
- a b l e f a c t , a n d o n e w h i c h m o s t s t r o n g l y s u p p o r t s t h e v i e w
of the malarial nature of the affection. It is also of the
greatest practical importance, as will be seen in Section X,
and it is for this reason that it is again insisted on in this
place.
Particular attention was paid to this point in order to deter
-mine if any of the peculiarities of the dis
-tribution of the disease could be explained
in by it, for I have shown elsewhere (Indian
Medical Gazette, 1896, page 49) that the prevalence of
ordinary malarial fever varies with the rise and fall of the
ground water in some places at least, and I have confirmed
these observations in the Nowgong district. It may be
said at once that no relation whatever has been made out
between the two phenomena in the case of kála-ázar except
that is places situated just under the hills, that is, in terai
lands, the disease is more fatal, and has a greater tendency to
completely wipe out the inhabitants. I have not been able to
make out any constant relationship between water-logging of
the land and the intensity of the epidemic, except that the
disease is somewhat worse in low lying parts. It can, more
-over, no longer be said that the disease is only found in terai
lands, as might have been considered to be the case as long
as the affection was limited to the strip of country between
the Garo and Khasia Hills and the Brahmaputra river, for
Nowgong cannot be placed in this class, yet it has
suffered most severely. Again, it must be recognised
that there has been absolutely no change whatever in the
soil or ground water-level of this district to account for its
Relation of the dis
-tribution of the dis
- e a s e t o t h e g r o u n d water-level.
138
Report on Kála-ázar.
invasion by an epidemic of malarial fever. No part of the
district has escaped, but it has been most severe, and
has spread most rapidly in those parts which are most
thickly peopled, namely, all along the banks of the Kulung
river.
Here, again, there has been absolutely no change to account
for the origin or spread of the disease in
Relation to sanitary
conditions.
any of the affected districts, and what
little change there has been is for the better, yet this
frightful epidemic of fever has spread itself steadily over
the country in a manner that has scarcely a parallel. It
cannot be due to the water-supply, for this again has
improved rather than deteriorated, and I may say that in
the course of my travels I saw nothing that would lend
any support to the hypothesis that the disease is spread by
means of water, but, on the contrary, I found some villages,
or even parts of villages, that had so far escaped the disease,
although other parts of the same village, or neighbouring ones
with the same, or a similar water-supply, had suffered for sever
- a l y e a r s f r o m t h e p e s t i l e n c e . I t m u s t a l s o b e b o r n e i n m i n d
that the disease dies out of villages and districts in the
absence of any change in the local conditions. I had expect-
ed to have found some local difference between affected and
unaffected villages; but in this I was in error, for no
such differences are to be detected, and, as will be shown
in the next section, the mode in which the disease really
spreads is quite independent of any such changes or
differences.
This rather belongs to the next section, but it may
be stated here that I have been able to
The distribution in
the villages. confirm the facts pointed out by Dr. Giles,
namely, that one part, or certain houses, of a village may
suffer severely from the disease, while other houses in the same
village may entirely escape it for some considerable time,
and that although all are living under precisely the same
conditions.
Distribution of the disease in relation to its spread. 139
THE GENERAL DISTRIBUTION OF THE DISEASE IN RELATION
TO ITS MODE OF SPREAD.
The reports of the Civil Surgeons of the affected districts
have been examined as far back as they are available, namely,
to 1885, and all other possible material has been consulted
in order to try and trace the exact spread of the disease year
by year, but the results obtained have been somewhat dis
-appointing. In order to avoid a wearisome repetition of dates
and names of places, the facts, as far as they could be
obtained, have been embodied in the accompanying map of
the Assam Valley, which will be of use in connection with the
first and eighth sections, as well as this one, and only the
recent spread of the disease, as far as it bears on the way in
which it travels, will be given here. The figures in the map
represent the years in which it invaded different parts, and
thus enable the spread of the disease year by year to be
followed. Every one of them is based either on some actual
record, on my own inquiries, or on the figures of the fever
mortality in the different mauzas, which have been examined
as far back as they were obtainable.
We have seen in Section I how the epidemic spread from
the foot of the Garo Hills to the neighbouring portion of
Goalpara, and from this district up the grand trunk road into
Kamrup, and thence to Gauhati, overwhelming almost every
village in its course; but, except in the case of the low
Garo Hills, never extending far from level of the Brahma
-putra Valley. The north bank, on the other hand, suffered
comparatively little, owing to the population being much more
sparsely and irregularly distributed, for in that part long
stretches of jungle intervene between one group of villages and
another, such as has always, throughout the twenty years that
the fever wave has been spreading up the valley, formed a
great obstacle to its passage, and hence the disease has been
obliged to cross the river again and again in order to attack
the scattered groups of villages on its north bank.
T 2
140
Report on Kála-ázar.
When the disease once got a firm hold on Gauhati, it began
to spread in various directions. In the first
place, it attacked some villages just oppo-
site the town on the north bank of the river severely. Man-
galdai was invaded both from the last-named villages and in
those near the Rangamati-ghát, which is the main line of com-
munication between this subdivision and Gauhati town, and one
along which there is daily intercourse by means of some
three hours' run by the mail steamers. The disease was even
introduced directly as far as Mangaldai town itself in this way,
as will be shown in the next section; and between the years
1890 and 1894, it diffused itself over the whole of the more
densely-populated south-western portions, and has recently
broken out in one or two places in the northern and eastern
parts of this subdivision, having been carried north by some
Kachari labourers, and has now affected a tea garden near the
hills. This invasion of Mangaldai is of great interest, as it
appears to have been more extensive and fatal here than
in any other portion of the north bank of the river,
although Barpeta has also suffered severely, these two
divisions being mainly low-lying rice-land and thickly popu-
lated. Between Mangaldai and Tezpur, there is a stretch
of some 30 miles of jungle with very few inhabitants, and
this has served to check the spread of the disease to a
very great extent in that direction, so that. Tezpur has not
been reached in that way.
At the same time that the disease was passing into North
Gauhati and Mangaldai, it was also continuing its general
easterly direction along the south bank of the river into
the Nowgong district, and here it at first followed its usual
course and crept up along the foot of the hills, but later
on it branched out in a north-easterly direction towards
the Brahmaputra river along the course of grand trunk road
and the thickly-populated banks of the Kulung river. In this
district its spread is of great interest, as hitherto it had
been more or less confined to a narrow strip of country
The recent spread of
the epidemic.
Distribution of the disease in relation to its spread. 141
between the Garo and Khasi Hills and the Brahmaputra
river, but now it was able to wander over a very much wider
area. It is all the more unfortunate that there are so few
details on record as to the order in which the different parts
of the district were invaded year by year; but from what I
have been able to find out in the course of my inquiries,
there is no doubt that the following is broadly the way in which
it has spread. The disease first appeared in some villages of
the Jagi outpost, near the Kamrup boundary, in 1889. In
1890, it had spread somewhat further westward, and at the
end of this year it also appeared in Nowgong town. In 1891,
it had reached Nakhola and Roha, and was more prevalent in
Nowgong town. In 1892, Nowgong town suffered severely,
and the villages and mauzas all around it were affected;
and by 1893, it had spread widely over the district, although it
is still noted to be attacking new villages. It was not until
1894 that it reached the Silghat, or north-eastern end of
the district. The general distribution of the disease was such
that the larger places were first attacked, that is, before many
of the smaller villages between them suffered, and these
were subsequently filled in as it were. This seems to always
be the way in which the affection spreads, but no general move
takes place from one part of the district to another until the
great majority of the villages of the first part are badly affected
by the epidemic, and then it will begin to creep insensibly
into the next part of the district, the same order of proceedings
being repeated.
In the case of the villages along the Kulung river, which form,
for all practical purposes, one continuous straggling community
extending throughout the whole length of the district, and
which must accommodate a very considerable proportion of its
inhabitants, the disease seems to have spread along them in
a steady stream, dying out in the first-affected portions as it
passed on, and its march being occasionally rendered some
-what irregular by large places on the road or bank of the
river, such as Nokhola, Roha, Nowgong itself, and Pura-
142
Report on Kála-ázar.
nigodam, 8, miles to the west of the former, being com
- p a r a t i v e l y e a r l y a t t a c k e d . I t h a s o n l y r e a c h e d t h e e x t r e m e
east end of this series of villages during the last two or three
years, and in the last portion between the place where the
grand trunk road crosses the river, 4 miles from Silghat,
and a place called Joklabanda, some 4 miles to the east of
Silghat; but on the Kulung river, the disease is still on the
increase. Beyond the last-named place there stretches a
long tract of jungle extending for some 40 miles with
scarcely a village in it, and here the spread of the disease
has ceased for the time being at any rate.
Along the base of the hills to the south-west of the
district, on the other hand, the disease early spread as ,far
as Karakhana and Lunka (on the Assam-Bengal Railway),
and it has since got at least as far as Lurnding on the western
border of the Nambar forest—a dense, uninhabited wood,
which stretches between the Mikir and Naga Hills for many
miles, reaching up to the Golaghat district. Across this
forest there is no traffic, but the railway is being pushed
through it, but will not be open for some years yet, by which
time all danger of the disease spreading up that way should
be at an end by reason of its dying out of the Nowgong district,
which it is now taking place, especially in the southern portion
of the district. The Mikir Hills stand then as a bulwark
between the attacked portions of district of Nowgong and
the subdivision of Golaghat, and indeed the whole of the
Sibsagar and Dibrugarh districts, for I visited Golaghat a n d
travelled back to Nowgong along the narrow tract of country
between the Mikir Hills and the Brahmaputra river, but
found no cases of kála-ázar there. The grand trunk road
runs through this part, but there is little traffic on it,
and for some years past a careful watch has been kept
for any persons coming up the road suffering from the
disease, and in one instance a whole village, which had
migrated from Nowgong, was found to be suffering from it,
and was sent back, and this was the very village that had
Distribution of the disease in relation to its spread. 143
infected two tea gardens in the Nowgong district. But
for this constant vigilance and action, it is exceedingly prob
-able that the epidemic would have got a hold on Golaghat
b y t h i s t i me ; b u t a s i t i s , a l t h o u g h t h e r e we r e mo r e d e a t h s
than usual returned from fever in the year 1895, the figures
for 1896 show a decline to the normal level, and this is true
of each mauza considered separately, and the decline is most
marked in just those parts which would be the first to be
invaded by the disease, so that it is certain that this sub
-division is not yet affected by the epidemic to any degree,
although it is not impossible that it may have begun in a few
isolated villages. There is also great danger of the disease
gaining admission by the river, just as it has done in the case
of Mangaldai, Tezpur, and Bishnath, etc., and it is certain to
surmount the obstacles in one way or other before very long,
if no steps are taken to prevent its doing so. With regard
to the south bank of the river then, it may be said that
the present condition of things is more favourable to the
success of vigorous measures directed against the spread
of the disease, than they have never been since the epidemic
first attracted attention in the early eighties; and it is not
too much to say that if the present opportunity is neglected,
the disease will certainly spread up to the end of the valley
beyond Dibrugarh, and from what have seen of the char
-acter of the country in the Sibsagar district, from the allu
-vial nature of the whole of the soil of the valley, and from
the recorded death-rate from fever in these districts, I see no
reason to believe that the epidemic is likely to occasion any less
loss of life and revenue in these more easterly districts than it
has already done in Nowgong, while the vastly greater import
-ance of the tea industry in the upper part of the valley will
double the calamity produced by such a spread of the affection.
The introduction and early spread of the disease in the
Mangaldai subdivision has already been
described, but it has been mentioned that
it has recently appeared among the
The recent exten
- s i o n o f t h e d i s e a s e i n the Darrarg district.
144
Report on kála-ázar.
Kacharis of the north of the district, and has broken out
among some of the labourers of this tribe on a tea garden near
the hills.
In Tezpur the disease has been introduced within the last
three years, and information has been obtained with regard to
many of the first cases, which is of great interest and import
- a n c e . T h e t o w n i t s e l f , a s m i g h t h a v e b e e n e x p e c t e d , w a s t h e
first to suffer; but fortunately, although several imported cases
have died there, it does not yet seem to have spread exten
-sively among the regular inhabitants, although some, in whose
houses imported cases have lived, have suffered and died of
the disease. With regard to its introduction into Tezpur town,
it will suffice to record that the Civil Surgeon, Dr. Macnamara,
writes in his report for 1896 as follows:
"As far as I can ascertain, there are six or eight cases in the town,
all of which are traceable to Nowgong. They form two groups, one
on the river bank above town, and the other in the town on the
north side of the dispensary."
I can confirm this observation from personal observation,
for Dr. Macnamara was kind enough to take me to see them,
an I it is worthy of note that the first-mentioned group is in a
Dom village above the town, at the very spot where a ferry
from the Nowgong side lands its passengers, and the villagers
have asked to have this ferry moved from near them, on the
ground that it has been the occasion of the disease being
introduced amongst them.
In the country around Tezpur, I found the disease had
attacked nearly all the villages to the north-west of the town,
extending out for at least 5 miles, and there are other affected
villages , considerably further north of the town among the tea
gardens. The number of cases that I saw in any one village
was small, but there can be no doubt that the epidemic has
got a hold on the district, although it may be hoped it will
follow the general rule, to which Mangaldai was an exception
in not being so severe as it is on the south bank.
Bishnath, which is to the east of Tezpur, is also beginning