NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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seen appears to me radically wrong and entirely unsuited to
the climate. What surprises me is that no one has thought
of building their lines on the plan of Burmese villages, in
which the huts are universally raised upon piles, the floor,
which is made of split bamboo, being thus elevated some three
to five feet above the level of the ground; a rude form, in fact,
of the " chang " bungalow in common use among Europeans
in Assam. The plan cannot be an expensive one, as it is to be
seen in the poorest houses in the most wretched fishing villages
on the coast. Moreover, the materials are at least as
cheap and abundant in Assam as they are in Burma. That
they are in universal use among so notoriously lazy a race
as the Burmans, shows that but little additional trouble or
expense can be involved in their construction.
No walls or obstructions of any kind should be allowed
to interfere with the free passage of air beneath the floor, and,
if the ground beneath the huts be kept clean, no better form
of hut could possibly be contrived. In climate, density of
jungle, soil, and all essential conditions, Burma and Assam
closely resemble each other, except that, owing probably to the
inferiority of the cold weather of the former Province, it is, if
anything, rather the more malarious of the two, a fact shown by
the much better health enjoyed by Europeans in Assam over
their fellow-countrymen resident in Burma, and I am inclined to
impute much of the undoubted physical superiority of the
Burmese over the Assamese to the sanitary advantages of the
national style of village architecture. The people here, too, are
adepts in the craft of working with the bamboo. The walls of
their houses being often constructed on exactly the same plan
as the floors of Burmese raised huts, so that there could be no
difficulty whatever in obtaining the necessary skill of labour.
There cannot be the least doubt that, with the exception of
the special measures for the prevention of anchylostomiasis, no
sanitary measure can be expected to do more for the improve-
ment of the health of tea-garden coolies than the adoption of a
style of housing suited to the climate in place of the system at
present in vogue, which is modelled on the plan of village con-
struction in use in India Proper, and which is entirely unsuited
to the very different climatic conditions of the Indo-Chinese
Peninsula.
There is, of course, no necessity for any slavish adherence
to anything but the principle of the Burmese plan, and the
adoption of improved roofing material, as well as of masonry
supports, would be undoubted improvements, and would pro-
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bably result in a saving of expense in the long run ; at least
that is one of the reasons advanced for the adoption of galva-
nized iron by some of the garden managers I have met.
Provided that, as appears to be the case, expense need not
stand in the way, the adoption of an impervious roofing material
in place of thatch would be an immense advantage, for the
mass of continually wet, rotting thatch is, I am convinced, a fre-
quent source of ill-health not only in native, but also in Euro-
pean dwellings.
(&) Clothing.—In this matter the coolies do not seem ill
off', at any rate, they seem to have as much as they care to
wear, though it is probable that the adoption of woollen jackets
during the chilly fogs of the cold weather- would be an im-
provement. Recommendations to this effect occur frequently
in the inspection reports of many medical officers, but the diffi-
culty in providing the clothing would be but a small one in com-
parison with that of inducing the coolies to wear it. While,
however, I doubt if adults suffer in this way, there can be no
doubt that the children are universally wretchedly underclad,
and there cannot be the least doubt that neglect of this kind
is an important factor in the heavy infant mortality. It can-
not, however, be said that tea-garden labourers are any more
careless in this matter than natives of India generally, though
its consequences are probably more serious in Assam than
they are in other, and drier parts of the country. It is,
however, to little purpose discussing the subject, as, pernicious
as the custom undoubtedly is, it is too deeply rooted in native
habits for any improvement to be hoped for.
(c) Food consists mainly of rice, pulse of various
kinds, fish, milk, and vegetables. Its adequacy depends mainly
on the state of the labourer's finances, and, in the case of new
comers, is often none too liberal. Old hands, however, are gene-
rally fairly well off, as may be seen by the large numbers of
cattle and poultry often possessed by them. From what I
saw I am inclined to think that the coolies, when free from
disease, are mostly well nourished.
In the case of immigrants coming from parts of India
where corn forms the staple food, a really serious matter
is the enforced change to the insipid and comparatively unnu-
tritious rice. So much larger a bulk of rice is required to meet
the demands of the organization, that a wheat-eater must needs
contract a certain amount of chronic dilatation of the stomach
before he can accommodate a sufficiently full meal. Unfortu-
nately, wheat is an exotic luxury in Assam, but facilities for its
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purchase should certainly be afforded in the case of men coming
from the corn districts of India, at any rate, for a sufficient
time to enable them to accustom themselves gradually to the
new diet; and, as rice is considered a great luxury in their native
homes, they would not probably be long in doing this. This is
a matter, however, which has been repeatedly adverted to in
reports from various officers, and I think its importance should
not be underrated.
In the matter of vegetables, the coolies are often but ill
supplied. Their own efforts do not go much beyond the
cultivation of a few pumpkins, a vegetable which, however
valuable, is by no means the best of antiscorbutics, while
many of the gardens are placed in portions of the country,
so destitute of indigenous inhabitants, that nothing of the kind
can be bought. Outside the medical profession, people are
too apt to underrate the importance of a due supply of food
of this sort. This is, no doubt, owing to the small proportion
of nutriment they contain, the meagreness of which is so
obvious that it needs no acquaintances with analytical tables
to inform any one on the point. Green vegetables, however,
contain a large amount of certain organic salts which are
absolutely essential to the preservation of health, and which
are not contained in grain, flesh, or the other solidly nutri-
tious articles of diet.
Owing to this want, scurvy is by no means rare amongst
the immigrant labourers, and, as a man in this condition
will never be fit to do a good day's work, I am certain it
would often pay well to systematically cultivate sag, onions,
cabbages, turnips, radishes, plantains, and other suitable vege-
tables, even if it involved the diversion of a certain amount
of labour from the regular work of the garden. For want
of a proper appreciation of the importance of green vegetables,
scurvy is common all over India, as indeed it was in England
when in a similar stage of civilization, so that it is useless
to trust to the coolies' own instincts to overcome any notable
difficulties in this direction, though he will doubtless avail
himself of a cheap and plentiful supply when obtainable.
The question of food-supply cannot be passed by without
some allusion to the " hotel system," of which I have heard
much, though I regret to say I had but few opportunities of
seeing the system in full working order, the time of the year
being unfavourable for this. Sufficient, however, was seen to
convince me of its immense value, which mainly lies in
tiding the new arrival over the time during which the strange-
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ness of his surroundings prevents his being able to look pro-
perly after himself. The only criticism I have to make on
the subject is that, if it is desired to get the full nutritive
value out of the food supplied, more attention should be paid
to its cooking. If properly cooked, so that the grains are
plump but remain separate, rice is one of the most digestible
of foods; but if, as is often the case, it be allowed to get into
a stodgy mass, closely resembling bookbinder's paste, it
becomes heavy and hard of digestion. In the same way,
dal, when properly cooked, is one of the most nutritious and
easily assimilable forms of nitrogenous food, so much so, that,
under the name of " Eevalenta Arabica," it has gained a great
reputation in Europe in the treatment of dyspepsia. Yet this
very same article of food, if imperfectly cooked, as it general-
ly is amongst natives, becomes extremely irritating, and much
of it passes through the intestinal canal unaltered,, and so is
lost, or worse than lost, for not only has it in no way contri-
buted to the nutrition of the body, but it has caused positive
harm by producing irritation. When properly cooked, dal
should form a perfectly smooth uniform pulp, no sign of
the component grains being left, and, when so prepared, it is
unrivalled as a source of nitrogenous pabulum.
Attention to little points of this kind in cooking, may
make all the difference between recovery and death in the
case of patients after treatment with thymol for anchylosto-
miasis, who form a large proportion of the inmates of an
" hotel." The digestive powers of these poor creatures are
always reduced to the lowest ebb, and the mere expulsion of
the parasites is absolutely useless, a mere waste of an expensive
drug in fact, unless it be followed up by a supply of food, not
merely plentiful, but also so prepared that it can be made use
of by their utterly enfeebled digestive organs. Now rice and
dal can both be made, with very little trouble, into food highly
suitable for invalids, but, cooked as they commonly are by
natives, especially when the operation is conducted upon at
all a large scale, they are little better than the loading of the
intestines with indigestible, and, at the best, inert matter.
If, however, we can once check the spread of anchylos-
tomiasis, there will be little further need for " hotels," for, as
long as he is in health, the coolie may be trusted to take care of
himself in the matter of feeding. It is commonly enough
asserted that coolies will half starve themselves from motives of
economy, but I entirely disbelieve in the commonness of such
cases. In nine cases out of ten, miserliness has nothing to do
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with the matter; and the reason of the man's not buying a suffi-
ciency of food is that he is too ill to care for it, and, naturally
enough, will not waste his dwindling resources on the purchase
of food for which he has no appetite.
In quite the earlier stages of the disease, it is true patients
often exhibit an increased appetite, but this is only for a short
period, and, as the digestive powers become more and more
undermined, and the patient a confirmed dyspeptic, the appetite
becomes small and capricious. Arrangements should, however,
be made on all gardens for a cheap and plentiful supply of
green vegetables just as they are in the case of the other ne-
cessaries of life, as it is impossible for the coolie to supply
himself with what is unobtainable.
(d) Water-supply.—More attention has been devoted to
this matter than to any other sanitary point, and there are
large numbers of gardens where large sums have been spent
in the provision of wells, receiving tanks, and even filters, and
the supply is often excellent. This is often especially the case
on "unhealthy gardens" which will be more frequently found
to possess a good water-supply than such as have never been
relegated to the black list. The reason of this is, of course,
that a heavy sick list has directed attention to the necessity of
sanitary improvements, and, as might be expected, a marked
improvement in general health has resulted. The improve-
ment, however, fails to take the garden off the black list, as it
fails to touch the most important factor of the mortality, for I
could not find any instance in which the improvement of water-
supply could be shown to have done much, if anything,
to diminish anchylostomiasis.
In those instances where improvement had resulted from
the carrying out of sanitary recommendations, removal of the
site of lines would generally be found to be one, and as I
believe the, effective agent in the improvement. No one can
be less disposed than the writer to underrate the advantages
of a pure water-supply; but, as has already been said, I do not
think its provision can do much for the prevention of the parti-
cular disease we have under consideration. Let it not, however,
be supposed that the water-supply of tea-gardens in general
is everywhere as it should be ; indeed, so far from this being
the case, a supply of good quality is almost restricted to those
gardens where the spur of a heavy mortality has led to strenu-
ous efforts at better sanitation. A. glance at the table given on
page 32 et seq., will show that the drinking-water of many
gardens is horribly foul, and the introduction of a pure sup-
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ply in such cases must be a crying necessity. Even where
money has been freely spent, mistakes due to want of knowledge
of a very special subject have not unfrequently resulted in a
doubtful, in place of a thoroughly reliable, supply. For
example, in one of the most progressive establishments in the
Lakhimpur district, at the time of my visit, they were busily
engaged in digging a well. It was beinp; sunk through an ex-
tremely porous, sandy soil, and, owing to its shifting character,
the amount of labour that was required was enormous.
In nearly any other situation but where it was placed, it
might be expected, when completed, to yield excellent water ;
but, instead of putting it well away in the midst of the cul-
tivation, they had been at great pains to find it a place in the
very heart of the coolie village, which accommodated many
hundred souls, having actually gone to the additional expense
of demolishing some buildings to find space for the enormous
conical excavation necessitated by the unstable character of
the soil. Placed as it is, and in such a soil, defilement with
the foul surface washings of the lines will be almost in-
evitable, as no masonry tube, however well made, can be
trusted to entirely exclude percolation for any great length
of time. It was intended that the well should be covered, and
provided with a cemented supply tank, and the additional
cost of an iron pipe to convey the water from a well, situated
well away from the habitations, to a tank or tanks in the lines
would have involved an additional outlay so trifling as to be
hardly worth considering, as a part of the large expense that
had already been incurred.
(e) Conservancy.—In this matter the -arrangements in
use upon tea-gardens may be very briefly described. There are
none. The entire neglect of this most essential of all sanitary
necessities is the greatest blot to be found in the condition
of the tea-gardens, and is the essential cause of the spread
and persistence of anchylostomiasis, to say nothing of the evil
effect it must have on the general health. The existing state
of things cannot be described in too strong terms. Crowded
together, as the huts necessarily are, and, indeed, should be,
for I do not use the term in the sense of overcrowding, the
filthy state of these settlements, in even the best-managed
gardens, is revolting. If you ask what conservancy measures
are adopted, you will be told that the people " go to the
jungle," or " amongst the tea-bushes," but a visit to the locali-
ties pointed out will seldom result in the discovery of
anything particularly offensive to either the nose, or eye.
M
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It is between and behind the huts, and in the little enclo-
sures already alluded to, that nine-tenths of the offence
will be found to be concentrated, and, for all practical purposes,
the ground immediately round a man's hut forms his only
latrine. When this is pointed out, you will be told that " it
has been done by the women and children," but the scantiness
of deposits elsewhere makes this improbable ; and, even if it
were true, its source in no way diminishes the harmfulness of
the practice. Besides, even supposing the men do resort to
the tea-bushes, &c., as described, it is difficult to see how we
are more than a degree better off. It is perfectly certain that
they will not go far afield, and that they will habitually resort
to nearly the same piece of ground, and wherever cases of
anchylostomiasis are to be found amongst the coolies, the
result will be the production of a nursery for rearing the
infective embryos of this most fatal of parasites, under the
most favourable conditions imaginable; for the trampling
about of a considerable number of persons on the small
area so used will result in the broadcast diffusion of the
embryos over its whole surface, and the ready supply of
fresh nutriment will ensure their indefinite multiplication.
In addition to human pollution, the droppings of cattle,
stable refuse, and rubbish of every kind commonly litter
the ground, and are seldom cleared away ; and when this
is done, the refuse is seldom remov.ed to a sufficient dis-
tance, or burnt. In one large garden, I found, flanking
the lines, a mass of accumulated sweepings some three to five
feet high extending along the whole of one face of the settle-
ment. It was not more than twenty feet distant from the
nearest huts, and was placed rather above them, on the gentle
slope on which the lines were built. The surface of this
mass, which must have represented the accumulation of
several years, was evidently the "jungle" and "tea-bushes" I
had heard so much about, ,so that the nature of its drainage,
which necessarily flowed into the lines, may be better
imagined than described; and yet in this garden the expen-
diture on good huts, and the provision of a good water-
supply could only be described as liberal in the extreme.
Tea-garden sanitation has, in fact, been commenced at
the wrong end, for water-supply might, with comparative
impunity, have been left to take care of itself, provided
measures had been taken to put a stop to its pollution by
means of adequate measures of conservancy.*
* See Circular from Sanitary Commissioner, No. IS., paras. 3, 7, 25th
March 1890.
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It would be wrong, however, to impute much blame to
the planter for the existence of this state of things, for the
cause lies in the naturally dirty habits of the coolie, and,
unless he resort to illegal means, the planter has no power to
enforce the observance of more decent habits. All that can
be laid to the planter's door is that, by omitting to provide
proper latrines, he has neglected to give his labourers the
chance of becoming cleanly. The cause of this neglect
is mainly a rooted belief that, even if provided, they would
not be used. This belief is, however, based on purely
theoretical considerations of the innate dirtiness of the coolie
character, for I found no garden where they had tested the
theory by actual experiment. The argument is a stock one,
which has been made use of by the opponents of sanitary
measures, wherever proper conservancy has been proposed
in India, and has almost universally proved fallacious when
put to the actual test. Where the introduction of latrines
has proved a failure, it has almost always been owing to
mistakes in the choice of site. If they be placed at a
long distance from the habitations of those who are to use
them, they are naturally enough never resorted to; but if
so placed and arranged as to be an actual convenience,
they will soon come into use, for a man soon learns to
prefer to go to a well-kept latrine, on a dry site, with water,
and a platform for ablution at hand, to wading a longer
distance, through a sea of mud. Once the matter is fairly
faced, the difficulties will, I believe, be found to be mainly
imaginary. During my recent tour I made at least one
convert to these views, and I am told that the success which
has attended the introduction of a simple form of latrine I
recommended to him, has greatly surprised the experimenter,
as the coolies very soon took to availing themselves of the
greater convenience of the arrangement placed at their
disposal.
The disposal of other offensive matter, and rubbish,
which also forms an essential of proper conservancy, is a
less simple matter, as it is hard to make a convenience
of the labour involved in keeping the lines in a cleanly
state. If health is to be improved, however, it is certain
some organization must be instituted for the purpose. The
nature of such an organization is somewhat outside the
province of the sanitary officer; but personally I would
make the coolie himself responsible for the cleanliness of his
surroundings, and would limit the function of the European
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manager to directing the attention of the authorities to cases
of neglect of proper sanitary precautions. There is this much
to be said for the labourer, that he has not the least idea
that there is anything in his mode of life dangerous either
to himself or his neighbours, and that the law as yet puts no
veto on these habits, although they are far more destructive
to life and comfort, than many matters about which it minutely
concerns itself. There is, of course, not the least chance of
being able to convince the coolie that his habits are a stand-
ing danger to himself and every one around him, but what-
ever their faults* Indians are at least a most law-abiding
race, and if they were once made to see that breaches of the
common decencies of sanitation are illegal, they would slowly
come to acquiesce in the inevitable, and adopt more cleanly
customs ; but without some amount of legal coercion it is difficult
to see how any great improvement can be expected. Such being,
then, the conditions under which the coolie lives, it is in no way
surprising that anchylostomiasis should be rife amongst them.
Given the introduction of a single case into a community so
situated, the spread of the disease becomes almost inevitable,
and the result is that very few gardens can now be said to
be absolutely free from it; and, unless strenuous preventive
measures be instituted, the number of gardens on the " black
list" must necessarily go on increasing, even more rapidly than
it already has, until nearly the whole of the establishments of
the province come under this melancholy category.
With this section, this report comes to a close. The inves-
tigation into the method of spread of the disease leads to but
one conclusion, for it follows from the facts I have endeavoured
to set forth, that the only commonsense method of prevention
is to adopt the absolutely sure plan of destroying all chance
of infection, by proper measures of conservancy. From no
other plan can any appreciable improvement be hoped for.
A thoroughly efficient conservancy cannot fail to ultimately
entirely stamp out the disease, and, whatever success may be
achieved in practice will be exactly proportional to the
efficiency of the measures of conservancy adopted.
GEO. M. GILES, M.B., E.R.C.S., SAN. sci. CERT. UNIV. LOND.,
SUKGEON I.M.S., ON SPECIAL DUTY, ASSAM.
Shittong^ 1st October 1890.