NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
March, 1954] S. DATTA 9
7. In addition it is suggested that in States having Veterinary Colleges,
the third and final year students should during long vacation be
taken out with college teachers to assist the field staff in executing
eradication plan in the field. This will need the provision of a small
amount for travelling and subsistence allowance and mechanical
transport.
Considering the magnitude of the task in so far as the numbers of animals to
be inoculated in a short space of time and the area of the country to be covered,
keeping in view the conveniences of the farmer, it is essential that stockmen in
sufficiently large numbers be trained in specially designed course of short duration
at all the available regional and State centres.
In order that the services of the FAO experts now assigned to India for the
purpose may be utilised to the best advantage, action as early as possible to imple-
ment the above suggestions should be taken.
The Directors in the States may submit schemes to their Governments and these
may be forwarded to the Planning Commission for obtaining their blessings.
STUDIES ON THE NATURE, INCIDENCE, DISTRIBUTION
AND CONTROL OF NASAL SCHISTOSOMIASIS AND
FASCIOLIASIS IN BIHAR*
By A. K. VARMA, Ph.D. (Lond.), Department of Parasitology, London School of
Hygiene and Tropical Medicine, London
(Received for publication on 8 May 1953)
(With plate I and one text-figure)
D URING the tenure of a State scholarship, so kindly awarded by the Govern-
ment of Bihar for advanced studies in Helminthology at the London School of
Hygiene and Tropical Medicine, an opportunity was afforded to the author by the
same Government at the instance of Prof. J. J. C. Buckley to go to India. The object
of this visit was to spend a short period collecting helminthological data and material
regarding some important helminthic conditions of man and animals, prevalent
in India, with a view to pursuing further research at London. During this period
a simultaneous effort was made to investigate the nature, incidence and distribution
of some of the important helminthic infections of domesticated animals in Bihar.
Such a work has never been undertaken in the past and to carry oat a thorough
helminthological survey of a big State like this, some years of hard continuous work
would be necessary. Studies were therefore confined to the more important hel-
minthic conditions like nasal schistosomiasis and fascioliasis, which are of great
economic importance.
Bihar is one of the big States of the Indian Union, lying between latitudes
21º58' N—27º31' N and longitudes 83º20'E—88º32'E and has an area of 69745 sq.
miles. It is bounded on the north by the territory of Nepal, on the east by West
Bengal and parts of Eastern Pakistan, on the south and west by Orissa, Madhya
Pradesh and Uttar Pradesh.
This report deals mainly with the endemicity of the infections in Bihar in
relation to topographical features, which have a great influence on the propagation
and spread of the causal trematode parasites. Some scattered infected foci, which
do occur here and there, have not been incorporated in the report, as no data is
available for them. Owing to the extremely limited time at the writer's disposal
and lack of touring facilities and the desired technical assistance a complete survey
could not possibly be made and the author regrets that the work, which provides
only an opening for future research, is not more comprehensive.
Furthermore, there is no recorded evidence of any attempt, whatsoever, made
to study the fresh-water molluscs of Bihar, although they play an important role in
transmitting many trematode infections to man and animals. The present oppor-
tunity was utilised to put on record the available fresh-water snails by collecting
them from different areas of the State and determining their specific identity. The
specific identification was carried out by the writer himself with the kind help of
* Part of a thesis approved by the University of London for the award of the Ph.D. degree.
11
SAR/53.
3
Indian J. vet. Sci., Vol. XXIV, Part
I]
PLATE
1
1. Limnaea auricularia race rufescens (syn: Limnaea acuminata—Lamarck) 2. Limnaea luteola
3. Indoplanorbis exustus 4. Melania variabilis 5. Vivipara bengalensis 6. Unionid species
8 AR/53.
arch, 1954]
A.
K.
VARMA
13
Fig. 1.—Map of Bihar
(Reproduction from a map drawn to the scale, 1 inch = 16 miles)
Patna
2. Fatwah
3. Hilsa
4. Islampur 5. Bakhtiarpur
6. Biharsharif
7. Arrah
8. Piroo
9. Bikramgan
10. Behea
11. Berhampur
12. Bhojpur
13. Gaya 14. Nawada (Hansua)
15. Dhanbad
16. Katras 17. Saharsa
18. Supaul 19. Purnea 20. Forbesganj
March, 1954]
A.
K.
VARMA
15
of nasal schistosomiasis, actually lie in the centre of this canalised zone and are
watered perennially. The subsidiaries of the canals through which water is taken
to the fields for irrigation and the side-drains provided for draining off the excess
water to low-lying areas are physical features of paramount importance in the
ecology of the snail vectors of the parasite. It is noteworthy that not a single snail
was ever found in the main streams of the canals where the water generally flows
swiftly.
The Eastern Canal, with its few branches, irrigates only the western parts of
the districts of Gaya and Patna, while the rest of the central and eastern region,
particularly of Patna district, is a low tract or depression which is annually flooded
with water from the united streams of the Poonpoon, the Phalgu and the Sakri.
These rivers flowing through low-lying land cannot empty into the Ganges when
the latter itself is in high flood and are consequently held up and spread over the
adjacent country. Throughout its long devious course the Poonpoon is extensively
used for irrigation in the districts of Gaya and Patna, the usual practice being to
raise temporary dams across its channels and to divert the water to subsidiary
channels and thence into the adjacent fields. The river is fed by a number of
tributaries, namely the Batane, the Adri, the Madar, the Morhar and the Dardha,
all joining from the right bank. The predominant feature in the physiography of
this part is the presence of innumerable swampy ditches, ponds, pools and low-lying,
water-logged areas, filled with more or less clean water from the canals and the
over-flooded rivers, providing a suitable abode for the molluscan intermediaries.
These places are readily and regularly accessible to the susceptible animals, mostly
for the purpose of drinking; while some are taken there by their owners for washing
and cleaning. These facts account for the continued infections and re-infections
of both the molluscan and the definitive hosts.
Rainfall
Broadly speaking there are three distinct seasons, each having four months'
duration and gradually merging into the other; (1) the rainy season extending
from June to September, (2) the winter from October to January and (3) the summer
from February to May. The rains are torrential from the south-west monsoon
arising from the Bay of Bengal and deviating westward after striking against the
Assam Hills of Garo, Khasi and Jayanti and also from the same south-west monsoon
coming out from the Arabian sea and deviating towards the east in the Gangetic
plains from the Indus valley. The area also gets some more rains from the north-
east monsoon during the winter months.
Average monthly rainfall, as furnished by the State Agricultural Department
is given in Table I.
TABLE I
Average rainfall in inches
District
Patna
Shahabad
Gaya
Jan.
0.51
0.64
0.74
Feb.
0.73
0.90
0.96
Mar.
0.31
0.37
0.47
Apr.
0.28
0.22
0.26
May.
0.99
0.67
0.87
June.
4.98
5.19
5.46
Jly.
10.61
12.59
12.48
Aug.
11.24
13.03
13.50
Sep.
7.47
7.87
7.58
Oct.
1.77
2.04
1.94
Nov.
0.40
0.39
0.50
Dec.
0.17
0.28
0.20
An-
nual
39.40
44.19
44.96
16
STUDIFS ON NASAL SCHISTOSOMIASIS
[Vol. XXIV, Part I,
Temperature
The usual day temperature is about 100ºF. in the summer months and 65°F. in
the winter months. The summer is dry with scorching heat and the temperature
sometimes shoots up during the day to 115°F. or even a little over. During this
period most of the pools and water-logged areas dry up, exterminating thereby the
snail population or at least reducing it to a great extent. It appears that some of
the surviving snails undergo aestivation, as after the rainy season when water
returns to these pools, etc. they are again full of snails, probably as an outcome of
very rapid multiplication of the aestivating snails or fresh ones brought in with
flood water from other sources.
TABLE II
Mean monthly temperature in Fahrenheit
District
Patna
Gaya
Jan.
62
61
Feb.
66
66
Mar.
78
77
Apr.
88
88
May.
90
93
June.
86
90
Jly.
85
86
Aug.
84
85
Sep.
83
85
Oct.
80
80
Nov.
70
70
Dec.
62
60
Soil and cultivation
The area has special alluvial soil called locally 'Karail', which is a black, stiff
and tenacious soil, sticky when wet and which can retain moisture for a long time,
providing suitable aestivating grounds for the snails. It is very fertile, the chief
crops being rice, wheat, gram, maize and all sorts of tropical vegetables in different
seasons according to their natural requirements. Rice is the predominant crop of
the area. It is grown in shallow waters that provide a very suitable ground for
the transmission of the helminth under question through its molluscan hosts.
Another point, possibly of importance in the epidemiology of the disease, is the
close proximity of these unfenced rice-fields and other molluscan habitats to the
villages providing opportunities for the constant exposure of animals to infection
and re-infection.
Livestock population
Livestock is of great importance in the agricultural economy of the area and
cattle outnumber all other domesticated animals, as the entire agricultural burden
lies on the back of bullocks alone. Buffaloes probably come next in order, but it
is interesting that only one or two cases of nasal schistosomiasis in these animals
are on record; although owing to their aquatic habits they are more exposed to
infection. Sheep and goats are also found in almost every village, but very few of
them have been reported to carry the disease, possibly due to their remaining more
or less confined in the villages away from the sources of infection. The area being
densely populated and widely cultivated, there is practically no wild life.
INCIDENCE AND DISTRIBUTION
To quote Malkani [1933],' Nasalgranulomata has not been reported from other
parts of the world and appears to be confined to India, where it is found principally
March, 1954]
A.
K.
VARMA
17
in Burma, Bengal, Bihar and Orissa, Madras, Mysore and C. P. Even in these
provinces the disease shows a curious regional distribution being restricted to low-
lying marshy localities, which are either irrigated with canal water throughout the
year or suffer from inundation during the rains. Its distribution in this province
(Bihar) has been fairly fully worked out from the replies to a questionnaire sent
out from this laboratory'. From this statement it transpires that the distribution
of the disease in Bihar, as worked out by Malkani, is highly theoretical, based
evidently on the cases of Nasalgranuloma treated by the district veterinary staff,
posted at different stations throughout the State. Such a report has little statistical
value and cannot be relied upon in face of the common practice of moving cattle
from place to place, which tends to mislead the veterinarian as to the genuine
occurrence of the disease in his locality, and most likely this caused errors in answer-
ing to Malkani's questionnaire. Also, owing to the ignorance of the people and the
fact that veterinary aid is not easily available, many cases go entirely untreated and
unrecognised.
Bihar, particularly the districts of Patna, Shahabad and a part of Gaya, is
one of the very few States, which has to sustain a heavy economic loss on account
of this wasting disease of cattle. The main routes followed in the present survey
were :
(1) Patna-Fatwah-Hilsa-Islampur
(2) Fatwah-Bakhtiarpur-Harnauth-Biharsharif
(3) Patna-Maner-Arrah-Piroo-Bikramganj-Jitaura-Jagdishpur
(4) Jagdishpur-Behea-Berhampur-Bhojpur-Nawada-Arrah
(5) Gaya-Wazirganj-Hansua-Nawada-Warsaliganj
In these areas enquiries were made regarding the occurrence of nasal
schistosomiasis and a series of samples were examined in nine different locations,
where facilities were available for the work. The results have been summarised in
Table III.
TABLE III
Incidence of infection in different localities surveyed
District
Patna
Shahabad
Gaya
Locality
Hilsa-cum-Islam-
pur
Bakhtiarpur-cum-
Harnauth
Piroo
Bikramganj
Berhampur
Nawada
Hansua-Nawada
Grand total
Total number of
animals examined
C
92
85
170
105
35
82
32
601
B
20
15
20
20
6
14
8
103
G
10
10
12
10
9
8
0
59
Number found
infected
C
57
50
107
61
3
6
2
286
B
0
0
0
0
0
0
0
0
C
0
0
0
0
0
0
0
0
Percentage of
infection
C
61.9
58.8
62.8
58
8.5
7.3
6.2
47.5
B
0
0
0
0
0
0
0
0
G
0
0
0
0
0
0
0
0
C—Cattle
B—Buffaloes
G—Goats
18 STUDIES ON NASAL SCHISTOSOMIASIS [Vol. XXIV, Part I,
Routes (1) and (2) pass through the Poonpoon belt, which suffers typically
from annual inundation and presents numerous swamps and pools that are most
favoured habitats of the molluscan hosts. Areas on route (3) are likewise heavily
canalised presenting many water-pockets, as described before. The aquatic molluscs
of these areas have been discussed in a subsequent section.
Areas on routes (4) and (5) showed very low percentage of infection. This is
accounted for by a topographical contrast of these areas, which are at a higher level
and rather dry being free from the ravages of the rivers and the canals. Many of
the villages in these areas are dependent on well for their water supply in dry
season.
It was interesting to find that some animals were harbouring the parasite without
showing any pronounced clinical manifestation. The typical snoring symptoms of
the disease appears to be associated with more or less older infections setting up
ulcerated nasal polypi with consequent impediment in the normal respiration.
From the foregoing data it may be concluded that cattle are the chief definitive
hosts of the parasite and that the infection rate is much higher in the water-logged
areas of the Poonpoon belt of Patna district and the heavily canalised zone of Shaha-
bad district, where about 60 per cent of the cattle were found infected with the
disease in the months of February and March.
It was also observed during this investigation that both sexes are equally
susceptible; but bullocks, owing to their more frequent contacts with the foci of
infection while doing field work, are more exposed to infection. This accounts for
TABLE IV
Age and sex incidence of nasal schistosomiasis in different areas surveyed
Locality
Hilsa-cum-Islampur
Bakhtiarpur-cum-Harnauth
Piroo
Bikramganj
Berhampur
Nawada
Hansua-Nawada
Total
Total
number
of positive
cases
M
38
36
82
38
3
3
2
202
F
19
14
25
23
. .
3
. .
84
Age and sex group
1 to 3
months
M
..
..
..
..
..
..
..
..
F
..
..
..
..
..
..
..
..
3 to 6
months
M
2
1
2
1
..
..
..
6
F
1
..
2
2
..
..
..
5
6 to 12
months
M
2
1
4
2
..
..
..
9
F
3
1
3
2
..
..
..
9
1 to 3
years
M
10
7
18
13
..
1
..
49
F
4
4
7
9
..
..
..
24
Over 3
years
M
24
27
58
22
3
2
2
138
F
11
9
13
10
..
3
..
46
M—Male
F—Female
March, 1954]
A.
K.
VARMA
21
This knowledge should provide stimulus to the initiation of local control mea-
sures, which may be directed towards sealing the avenues of infection, before the
disease spreads to other areas having ideal conditions for its dissemination. It
is noteworthy that subsequent investigations of the writer in some other districts
of the State have revealed the presence of such areas and the constant movements of
cattle from one part to the other, so commonly practised, provide ample scope to
carry and spread the infection. In the present survey it was actually found that
the disease had established itself in some such villages, where it did not exist before,
as far as the district of Saharsa in the north-east and Katras Goshala in the district of
Manbhum in the south-east of the State.
1. Prevention of contact with infected water
This could be of some practical value in minimising the incidence of the disease.
It needs extensive surveying of the entire endemic zone to mark off the infected foci
with a view to making them inaccessible to animals.
2. Prevention of contact between infected animals and uninfected snail habitats
The common practice of letting loose the animals needs attention in this respect
and it could be stopped if the ignorant villagers were educated about its harmful
effects, which favour the spread of many diseases.
3. Treatment of infected animals
It is suggested to employ a special squad of trained personnel to work in the
area for mass treatment of clinical cases of the disease. Work should be started
intensively in groups of villages only at a time, commencing from higher levels
(south-west to north-east) with a view to guarding against the possible spread of
infection through the flow of infected snails from higher to lower region along with
the streams of flood water. Various antimony preparations are on the market
having curative value against the disease, but the cheap tartar emetic is the drug
of choice to meet the requirements of the poor peasantry. Whatever drug be
selected, the standardisation of its dosage and concentration is a matter of prime
importance wherein lies the secret of success. In view of considerations like age,
sex, size, breed, intensity of infection and individual idiosyncracy, it rests entirely
with the physician to use his discretion in individual cases.
4. Treatment of infected foci
From prevention point of view this is as important as the treatment of infected
animals and much of the success depends on the scientific planning of any scheme
in this direction. Fortunately, the disease has a zonal distribution and has not
yet spread itself widely to other similar areas in the State; this in itself provides a
great possibility to stamp out the disease. Various authorities have suggested
different methods to disinfect the infected foci with suitable disinfectants, or more
effectively to root out the very source of infection with appropriate molluscicidal
chemicals.
(a) Molluscicidal treatment of infected foci with suitably cheapter chemicals
may be schemed on the lines of 'Anti-malarial campaign directed towards the
22 STUDIES ON NASAL SCHISTOSOMIASIS [Vol. XXIV, Part I,
mosquitoes and their breeding grounds', which is already being worked out in
several malarious areas of the country. It needs a special contigent of some trained
labour with a supervisory staff to spray or broadcast the molluscicidal chemical in
proper strength over the snail-infected water. It must be planned systematically,
taking up groups of villages at a time along with the treatment of infected animals
as discussed earlier, without omitting any infected foci. Copper sulphate, owing
to its cheapness and easy availability, provides a good choice and the necessary
molluscicidal concentration should be worked out. Some Japanese workers [Hunter
Freytag, Ritchie, Pan, Yokagawa and Potts, 1952] have tried Santobrite (Sodium
pentachlorophenate) in Japan as a molluscicidal agent, using 30 lb. of the chemical
per acre (current price of the chemical is about $0.25 per lb. according to these
authors) in the dilution of approximately 1:200, with encouraging results.
The infective foci or the molluscan habitats are no doubt very many in the
area but are not very extensive and can be easily controlled.
(b) Weeding out the snails by netting or hand-picking and destroying them
may not be physically possible.
(c) Rearing of ducks and other snail-feeding birds does not appear to be a
practical proposition.
(d) Some authorities have also suggested that by removing the vegetation
from the infected ponds, etc. the snails would automatically be starved and rooted
out.
(e) Channelling the area and draining off the water-logged places is another
devise to control the incidence of the disease.
FASCIOLIASIS
Fasciola indica Varma, 1953
Like other helminthic infections, particularly those caused by the trematodes,
this parasite has also found its habitat chiefly in the low-lying marshy regions of the
districts of Darbhanga, Saharsa, Purnea and parts of Monghyr and Bhagalpur lying
north of the river Ganges. The entire area constitutes almost a consolidated block,
bounded on the north by the territory of Nepal, on the south by the river Ganges,
on the west merging into the district of Mazaffarpur and on the east extending as far
as the eastern boundary of the State.
TOPOGRAPHY
This region of fascioliasis lies wholly in the North Gangetic plain, between
latitudes 25.25' N & 26.50' N and longitudes 85.75' E & 88.25' E and is mostly
watered by the most notorious river Kosi with its many bifurcating and interlacing
off-shoots and tributaries, notable amongst them are the Kamla-Tiljuga, the Old
Baghmati and the Ghugri. The river Mahanadi with its several tributaries waters
the eastern portion of the district of Purnea.
The Kosi takes its origin somewhere in the territory of Nepal and all its seven
streams (called 'Sapta Kosi') join together before the river enters the plains.
24
STUDIES ON NASAL SCHISTOSOMIASIS
[Vol. XXIV, Part I,
lower their vitality to resist the ill-effects of parasitism. This may be one of the
factors responsible for the high incidence of infection in this area, as shown in
subsequent pages.
Rainfall
The area gets torrential rains, chiefly during the months of June, July, August
and September, from the south-west monsoon arising from the Bay of Bengal and
deviating westward after striking against the Assam hills. There is also a few
inches of winter rainfall from the north-east monsoon.
TABLE V
Average rainfall in inches
District
Purnea
Saharsa
Darbhanga
Jan.
0.34
0.41
0.36
Feb.
0.66
0.52
0.60
Mar.
0.52
0.47
0.43
Apr.
1.16
1.05
0.73
May
4.71
3.97
2.77
June
11.12
9.25
7.82
July
15.34
13.39
12.65
Aug.
13.36
11.86
12.01
Sep.
11.53
9.99
9.41
Oct.
3.48
2.87
2.46
Nov.
0.31
0.33
0.29
Dec.
0.11
0.11
0.13
An-
nual
62.64
54.05
49.66
Temperature
Accurate temperature data are not available, but the mean monthly temperature
has been calculated roughly for the area from the monthly weather reports of India
(Table VI).
TABLE VI
Mean monthly temperature in Fahrenheit
Area
Purnea, Supaul and
Darbhanga
Jan.
62
Feb.
65
Mar.
73
Apr.
82
May.
85
June.
85
July.
84
Aug.
84
Sep.
82
Oct.
80
Nov.
70
Dec.
62
An-
nual
76
Cold weather day temperature is usually about 65ºF, while during the hot
weather it rises upto 90ºF. Unlike the area of nasal schistosomiasis, as discussed
earlier, there is hardly any day of dry heat in this area, which is usually moist and
cool.