NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Report on Kála-ázar.
owing to several families having died of a disease called
" kála-házar, which seems to show that the term was not a
familiar one, as in the reports of subsequent years it is rightly
called " kála-ázar. " From this date onwards, it is regularly
referred to year by year as causing the deaths of a large
proportion of the people of various villages, and thus occasion-
ing a loss of revenue and depopulating certain portions of the
country chiefly at the foot of the hills. With regard to the
spread of the disease, Colonel Maxwell
writes—
"The home of the disease, in my experience, is the Karaibari
Mehal" (to the south-west of the district, and the part above alluded
to as the first place mentioned in the administrative reports as
suffering) "in the west of the hills. There the numerous villages
marked on the map are entirely gone, and there only in 1881, when I
went to the district, was the sickness raging; from this tract the disease
travelled slowly towards Tura" (in the centre of the hills, observe that
it spread up from the foot of the hills to the hills themselves, not in
the reverse direction, as would have been the case if it had arisen in
the hills) "and on to Damra in the plains at the foot of the hills to the
south-east to Goalpara town v iâ the bridle-path to Rongrengiri and
Damra. Thence it spread to the Assam plains, and it also worked
its way back and attacked the Garo villages to the east of the
district.
I am also indebted to Colonel Maxwell for the following
most important piece of information:
"The first time kâla-âzar was brought to notice was at a place
called Bengal Kutta, at the foot of the hills south of Dhubri. I
think this was after 1872, that is, after we occupied Tura, as
the Civil Surgeon of the Garo Hills investigated the sickness.
The people attacked all died, and the disease ceased in that
locality."
This last sentence is a most significant one, as it shows
that the people were quite ignorant of the virulence and
fatality of the disease, which so suddenly attacked them, or
they would have adopted the measures which they subsequent-
ly learnt to be the only means of escape from being annihilated,
and would have deserted the affected sites of their villages, and
dispersed and built new houses in separate places, as they did
Origin of kála-ázar, etc. 169
later on when they became familiar with the epidemic which
was exterminating them, to such an extent that the Deputy
Commissioners of this district to this day complain that when
they visit such and such a village, they have to go over from
one to three square miles of ground in order to find all the
houses.
Still more important is the fact that the place Bengal
Kutta, which appears to have been attacked at just about the
same time as Karaibari, is 50 miles distance from the last-
named place, a distance which would have taken at best four
or five years for the disease to spread over if it travelled at
the same rate as it subsequently did in other districts; so that
the disease must have broken out independently at these two
places. Moreover, Bengal Kutta is just about opposite to the
Jatrapurghát on the other side of the Brahmaputra river,
which is one of the main lines of traffic between Rungpore
and the foot of the Garo Hills, while the other main line is
between Chilmari in Rungpore and the Karaibari or Mohen-
draganj district. The full significance of these facts will be
seen later in this section.
It is evident then that up to 1875 there had been no loss
of revenue due to the ravages of the epidemic malaria, first
called kála-ázar in the Garo Hills, but that subsequently to
that date it spread steadily through the district. Moreover,
it began in two different places, 50 miles apart, and both in
direct communication with the Rungpore district. This made
me think that kála-ázar might possibly be a continuation of the
epidemic of malarial fever of the sixties and seventies in Lower
Bengal, which is generally called the "Bardwan fever." I
found, moreover, that the first two medical officers who investi-
gated the outbreak, namely, Mr. McNaught and Dr. Dobson,
both state that the Garos always said that the disease came
across from Rungpore, and not out of the hills themselves. It
must be borne in mind that, except for the central range
which runs up to a height of 4,000 feet, the Garo Hills are
very low, and between them are patches of flat rice land, so
Z
170
Report on Kála-ázar.
that the greater part of the district is, for all intents and
purposes, a terai country; and consequently the very place in
which an intense form of malaria would flourish when once it
had gained a footing.
The question remains as to how far the disease has died
out, and if it still remains in an endemic form, which may at
any time break out again in the form of an epidemic. When
I went to the Garo Hills, I was informed that the disease was
still present, more or less, all over the district; but as this
statement was at complete variance with what was stated in
the administrative reports, as I shall show immediately, I asked
where it could be seen, and was told of a village only 6 miles
from Tura, which was said to be very bad with it. I accord-
ingly walked out there one morning, but found the headman,
who, I had been told, was dying of kála-ázar, was down with
a slight attack of fever, which he had had for a few days
only; and, although many of the apparently healthy children
had enlarged spleens, showing the malarious nature of the
place, I saw nothing at all characteristic of kála-ázar in this
or in some other villages that I visited, On going over the
administrative reports, I came across the following paragraph
written by Mr. Heath, after he had been several years in the
district. In the report for the year 1887, he writes
—
"Between Parakhasma" (on the south side of the foot of the hills)
"and Singimari" (towards the north-west and some 70 miles from the
former), "it would be hard to find one single case of the real illness,
kála-ázar. The disease travelled northwards to Salmara, and then
turned eastwards along the northern boundary. Its ravages were
somewhat severe; but in the stretch of country between Singimari
and a point south of Goalpara, I can again say that hardly one case
now exists; the disease has disappeared. It was some seven or eight
years ago that it commenced its attacks on the villages of the Muzza-
rana Mahál. Some villages it has quite depopulated, others severely
handled; but what marks the peculiarity of the course of the disease
in this part of the country, is the persistence with which it clings to
this mahál. Elsewhere along the border it has cleared away the
weak and sickly, leaving the strong; but having done this, has cleared
Origin of kála-ázar, etc.1 7 1
itself away. In the Muzzarana Mahál it has found a congenial home
This winter in my tours I found the number of sick something
terrible to look at, or think of, and the number of deaths also has been
appalling."
In the next year he records a similar experience, the por-
tion of the district bordering on the Kamrup border alone
being affected, and this part had suffered for four years only,
so that it could not have been expected to have died out
from it at that time. The completeness with which it had
disappeared from the previously-affected parts is very evident,
although the people were still living in the same places and
villages; and, as has been shown in the previous section, this
is also the tendency in all the districts which have been
affected, in spite of the entire absence of any alterations in the
physical or sanitary conditions. In the report for the year
1889, no mention is made of kála-ázar, and in the subsequent
reports it is usually recorded that malarial fevers and
kála-ázar were prevalent throughout the district as usual, and as
at about this time both the administrative and medical
officers of the districts were both changed, it is evident that
they had very naturally confused the deaths from ordinary
malarial fever with kála-ázar, although the epidemic form of
the disease had quite died out. In fact, I am convinced, both
from my own observations and from a study of the records,
that there is no epidemic, or endemic, communicable, and very
intense type of malarial fever, such as kála-ázar has been
shown to be, in the Garo Hills, or in Goalpara and Kamrup at
the present time.
Lastly, with regard to the escape of Mymensingh and
Sylhet, it appears that the disease did actually spread along
the south side of the foot of the Garo Hills, as far as a place
called Parakhasma, but that between that place and the next
inhabited village, namely, Dalu, there is "a stretch of 20
miles of uninhabited forest, and over this stretch it has not
leaped": another excellent example of the way the spread of
the epidemic is limited to lines of communications.
z 2
We have seen then that the disease invaded, decimated
and died out of the Garo Hills just as it afterwards did in the
southern portions of Goalpara and Kamrup, and that it is
therefore not endemic there. The escape of Sylhet is also
explained in accordance with the evidence as to the spread of
the disease given in the last section. The true place and
cause of the orgin of the disease still remains to be demon
-strated, and for this purpose it will be necessary to go back
a little further both as regards time and place.
When studying the literature of the subject in Calcutta
before commencing work in Assam, I was struck by the
general resemblance between the so-called "Bardwan fever"
of the sixties and early seventies and the descriptions of
kála-ázar, and some time afterwards it occurred to me that
the latter epidemic might possibly be a continuation of the
former. I therefore applied for the older Bengal sanitary
reports, and found that just about the time the fever was
dying out in Bardwan itself, there was a marked increase of
fever in the districts to the north, extending right up to and
including Dinajpore and Rungpore. Owing to the vital stati
s-tics being only started in 1870 and to the frequent changes
in the manner in which they were collected in different years,
rendering it difficult to compare the prevalence of fever year
by year, and the further fact that no reports were received
from the Civil Surgeon of one of the districts during several
of the worst years in the northern part of the affected tract
of country, it was not easy to trace the exact sequence of
events. However, a minute study of all the material available,
together with a tabulation of such mortality returns and
meteorological data as were recorded, and a comparison of
these with the more accurate figures of recent years, has shown
that the fever epidemic in the north-western part of Bengal
in the seventies was independent of the "Bardwan fever,'
and was started by a succession of several years of very
deficient rainfall, such as is to this day commonly followed
by an unusual amount of fever in these parts. As the
Origin of kála-ázar, etc.
173
"Bardwan fever" epidemic is certainly an exactly parallel
occurrence to the kála-ázar outbreak, a very brief account of it
will be first given, then the Dinajpore and Rungpore outbreak
of fever will be described, and its connection with the Assam
epidemic fever will be demonstrated, and lastly, the resem
-blances of this to the "Bardwan fever" will be illustrated.
The following extract from the Bengal Census Report of
1881 is the most concise account of the "Bardwan fever"
that I know of:
"This fever, as has been said above, invaded the Bardwan division
from the east. It appears to have originated in the eastern part
of the Presidency division some 30 years ago. Fever was very
fatal in the Jessore district in the years 1847-48, and after a temporary
cessation it broke out again in 1854-56. About this time it began to
spread westwards to Nuddea and the 24-Parganas, and finally
culminated in the severe epidemic which devastated these districts
from 1857 to 1864. No notice of this fever seems to have been
taken by the authorities till the end of 1861, although it prevailed
in a most virulent form in Nuddea from the end of 1856. Towards
the end of 1861, however, its ravages in the Baraset division and
the northern portion of the 24-Parganas attracted the attention of
Government, and efforts were made to combat it. A few months
later, measures of a similar kind were introduced into the Nuddea
district, and in all the three districts then included in the Presidency
division, relief operations were continued until the fever died out
about 1864. Briefly stated, this fever was most severe in the rainy
season and the winter months of the years 1860 to 1862-63. In the
winter of 1863-64 there was a perceptible improvement and a radical
change for the better in that of 1864-65. But while the epidemic
was wearing itself out in the districts of the Presidency division,
where it was first observed, it had spread slowly westward into those
of the Bardwan division. The Bardwan district is separated from
that of Nuddea by the Bhagiratil river, and the thanas of Burdwan
which abut on the river, are three, viz., Cutwa the north, Purbasthali
in the centre, and Culna to the south. It was in the two riverside
villages of the Culna thana that the first cases of the epidemic
occurred in the year 1862. In 1863 the fever re-appeared in the
Purbasthali and Culna thanas, and, attacking first the villages on
the river bank, advanced slowly inland, spreading also southward
1 7 4
R e p o r t o n K á l a - á z a r .
into the northern portion of Hooghly. In 1864 and 1865 the fever
moved still further west both in Hooghly and Bardwan, and extended
in a southerly direction to the boundaries of Howrah. The features
of the epidemic in 1866-67 were the same as in 1865, except that
there was no further spread to the south in Hooghly and Howrah.
In 1868-69 a great advance occurred, the town of Bardwan being
involved in the former year and the epidemic spreading far to the
north and south, besides continuing its usual westerly progress
In 1870 its western extension was not very great; but on the north it
invaded Beerbhoom, and raged along an extensive tract on the southern
portion of the district, the left bank of the Adjai river. In the follow
-ing year, 1871, the extent of its advance was unprecedented; for not
only did it progress many miles to the west in Bardwan, but it spread
to the north and north-west in Beerbhoom, and appeared in a large
tract of country in the north of Midnapore. By 1872 the utmost
westerly limit that the fever reached in Bardwan was attained, for
it was arrested by the high land lying in the extreme west of the
district and along the Bankura border; but the Beerbhoom district
was devastated still further north than in the previous year, and in
the Midnapore district a great southern extension took place, en
-veloping almost the whole of the north-eastern portion of the
district. In 1873 the fever made no further westerly progress in
Bardwan; and, though still severe in the west, it was gradually
dying out in those parts of the district where it had been first ob
-served. In Hooghly and Beerbhoom also there was some slight abate
-ment, but in Midnapore and Howrah the mortality was twice as great
as in the preceding year. The year 1874 may be taken as the last
of the epidemic in this division (the Bardwan); from all quarters came
reports that the fever was less fatal and less prevalent than in the
previous years. In 1875 the same facts were observed again, and
what fever there was wanted the virulence of the epidemic, and had
all the characteristics of the ordinary seasonal malarious fever of the
country."
The deaths in the Bardwan district also are estimated at
"not less than three-quarters of a million of persons," and the
Bardwan division was the only one showed a decrease of
population between the census of 1872 and 1881.
The further history of the epidemic as recorded in the
reports of Sanitary Commissioners of Bengal, was as follows:
Origin of kála-ázar, etc.
175
In 1874 the fever was noted to be less prevalent in both
Midnapore and Beerbhoom, it never having obtained a sure
footing on the dry, porous laterite soil in the former district,
and in the latter it seems to have turned towards the west,
and to have been checked by the high rocky land of the
Sonthal Parganahs border. Fever was, however, unusually
prevalent in the district of Moorshedabad to the north of
Beerbhoom in both 1873-74, and also in Malda further still to
the north; but it is recorded that this was not an extension of
the Bardwan epidemic, although the Sanitary Commissioner,
Dr. Jackson, who had closely investigated its prevalence in
Bardwan during two years, and written a very full report on
it, to which I shall have to refer presently, seems to have been
somewhat doubtful if it was so or not. It was, however, coin
-cident with a great increase of fever in the still more northern
districts of Dinajpore and Rungpore, and was therefore most
likely due to the seasonal causes that the fever of these last
mentioned places will presently be shown to have been due to.
The further fact that the fever would have had to spread many
times more rapidly than it had ever done in Bardwan in order
to have covered so large an area in one or two years, and that
the type of the fever in these northern districts was differ
-ent from that of the Bardwan epidemic, also support the view
that the latter was independent of the former epidemic.
Having thus cleared the ground, we are now in a position
to study the great outbreak of fever in the districts of Dinajpore
and Rungpore in the years 1872—79, which also involved
the continuous northern portions of Rajshahye and Bogra.
It is singularly unfortunate that for some of the years when
the fever mortality was highest in the Dinajpore district, no
report was received from the Civil Surgeon in charge, and
that the monthly rainfall in the affected districts has not been
regularly recorded in the Sanitary Reports, as the absence
of full data prevents me illustrating the origin of the epidemic
by a chart made out from the monthly fever-rates and rain
-fall year by year. I will first give one or two quotations to
show to what a great extent fevers were prevalent in this
part of Bengal at the time mentioned, for it does not seem to
have attracted as much attention at the time as might have
been expected. In the Bengal Census Report for 1881, it
is recorded as follows:
"Dinajpore has made no progress at all during the last nine years,
for the advance of the population has only been 0·28 per cent., which
would be much more than accounted for by better enumeration. This
pitiable result is due only to the ravages of malarious fever, for which
this district has as evil a reputation as its neighbour, Rungpore. In
1872, the reported deaths from fever in Dinajpore were higher than in
any other district in the Rajshahye division. The four following
years showed little improvement, and in 1876, the fever mortality was
22·05 per mille of the whole population. In 1877, which a general
consensus of opinion declares to have been the most unhealthy year
in this district within living memory, this rate rose to 30·06, and
36,000 deaths were reported from this cause alone. Out of 17 adult
Europeans 15 had to leave the district during the year broken by
repeated attacks of fever, and official business could hardly be carried
on. ......... It so happened that this district was at the time that in
which death registration was best carried out in all Bengal; and it
was found that the death-rate in the municipality was 42 per mille,
nearly double the death-rate of London, while the police died at the
rate of 46, and the prisoners in the jail at the rate of 74·6 per mille
per annum."
Again, of Rungpore, it is recorded that
—
"Rungpore fever has passed into a proverb in Bengal, and
though it is now thanks to improved drainage, less virulent than
formerly in the town of Rungpore itself, its effects on the population
of district are still widespread and unmistakable. It is a slow,
lingering fever, usually attended with spleen and liver complications,
and leading in the winter months to dropsy, phthisis, and other
pulmonary affections."
As early as 1874, the Civil Surgeon reported, after a
special inquiry, that
—
"Eighty per cent. of the people were anæmic or suffered from
enlarged spleen, or were laid up with illness, while the 20 per cent.
found healthy could not be considered so in the European sens
e of the word."
Origin of kála-ázar, etc.
177
From the fact that rich were not of more exempt than the
poor from sickness, he rightly inferred that
—
"the unhealthiness of the district was not due to poverty or
privation, but to the malaria in which the whole country is steeped."
And he particularly mentions
—
"the damp banks and islands of the Brahmaputra to the east
and north-east of the district"
as having suffered. There was a decrease of 2·58 per cent. of
the population of the Rungpore district between the censuses
of 1872 and 1881, which was attributed to the fever epidemic.
In 1871, there was no excess of fever in Rungpore, and
the rainfall was normal amounting to 94·15 inches. In 1872,
there was much fever in Dinajpore, more especially in the
south and south-west, and intermittent fever was very pre
-valent in Rungpore, which caused much mortality, and was
of a chronic type. Malarious remittent fever was also very
prevalent. This was the first of the series of years in which
the rainfall was unusually low, although the deficiency was
not very great in this year. There were twice as many
deaths returned from fevers in Dinajpore, and three times as
many in Rungpore in 1872 as in 1871, although the deaths
per mille in the whole of Bengal were 4·62 in the former year
as against 3·32 in the latter, part of the increase having been
due to better registration of deaths.
In 1873, no report was received from Dinajpore, except
that—
"fevers of a malarious type prevailed during the year."
The rainfall was only 43·53 against an average of the five
years previously to 1873; of 84·59, a deficiency of nearly
one-half. Of Rungpore, it is recorded that
—
"fever of the intermittent type was present in the district
throughout the year. From May to December it continued in
-creasing in intensity, so that the majority of the population were
completely prostrated by repeated attacks of the disease. The
poorly-feed and those who did not take advantage of treatment,
suffered most, and were affected with spleen and liver disease,
and subsequently with a fatal type of dysentery and dropsy."
2 A