The epidemic malarial fever of Assam, or kala-azar, successfully eradicated from tea garden lines / by Leonard Rogers.

  • Rogers, Leonard, 1868-1962.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: The epidemic malarial fever of Assam, or kala-azar, successfully eradicated from tea garden lines / by Leonard Rogers. Source: Wellcome Collection.

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    Tb Bum 1 slightly infected. Dr. Lavertine’s adoption of this measure leaves no doubt as to his belief in the communicability of the disease, which is all the more important as he has had several years’ daily experience of it. The same is true of the other two medical men who have carried out these measures, and, further, they all agreed with me that the disease is entirely malarial in its origin and nature. Dr. McIntyre, of the Mangaldai District, also writes to me that the moving of the recently-infected coolie lines on a garden he was in charge of has proved a success ; but as he has since been transferred to a different part of the district, he has not been able to furnish me with any figures. Thirdly, again I am indebted to Dr. Dodds Price, of the Nowgong District, for the following very instructive and con¬ clusive figures, showing the good effect of moving out the healthy coolies from a veiy badly-infected line to a new one on a site about one-third of a mile away. As I saw this measure carried-out myself, I can testify that the new lines were on a similarly-situated site to the old ones, and the sur- “roundtng and sanitary conditions were similar in the two cases, so that any result must be due solely to removal of the coolie3 out of the range of infection. I cannot do better than gite. Dr. Price’s report verbatim. In the Old Solona lines (the infected ones) there were 240 working souls, including boys and girls, and in the lower lines 60, the latter being •free people (not under contract), having lived in these lines from time immemorial, figuratively speaking. Of the 240 souls in the old lines, I found 146 either suffering from kala-azar or with it in their houses (in other words, infected people). Of these we cancelled the contracts of 17 adults and cleared them out; the remainder we sent to the infected lines at Rangamati. The 94 healthy people we drafted into the new lines at Old Solona, and all new coolies as they arrived were sent there, so that yester¬ day (June, 1898) the population stood at 416 souls without a single kala- azar case among, them. To begin with we had one or two doubtful cases among the old line coolies, but these were immediately sent over to the camp at Rangamati. To be accurate, there were 5 cases, 2 of which sub¬ sequently died ; the other 3 recovered, and were kept at and are still at Rangamati. By acting promptly we thus kept the new lines free from kala-azar, and now fifteen months since their completion there has been no death from the disease. Now, as to the 60 coolies living in the lower lines. These, being old residents and free people, could not be interfered with, and refused to be saved from themselves. Kala-azar has spread to them, and accounted for 6 deaths up to the end of the year ; 2 more deaths have taken place this half, and there are 10 cases now in the lines, several of which I consider will end fatally. Of the 12Q souls that we sent to the infected lines and houses in Ranga¬ mati 8 died, 10 had their contracts cancelled and were cleared out (all of them would have died), and 22 were yesterday still suffering either from the disease or from debility after a mild attack. These people are kept entirely to themselves, and are not allowed under any pretext into the : lines on the Solona side of the manager's bungalow or in the new lines we have started towards Rungagora. From the above it will be seen that with the excep¬ tion of the five cases which appeared shortly after the removal from the infected lines, and which had evidently contracted the disease before removal, there has not been one case of the epidemic disease among the 94 healthy coolies moved, although the lines in which they had lived before were so badly affected that more than half their entire population were either suffering from the fever, or had cases in their households, and over one-third of them subse¬ quently suffered from the disease. Again nearly’one-third of the old coolies living close to the infected lines suffered from the disease within 15 months of its spreading to them. The success of the measure adopted is evident, and will be very encouraging to those who have to face the suffering and loss which this epidemic has hitherto inevitably caused when once it has got a footing on a tea garden. It is also to be hoped that their success on tea gardens, where they can be easily carried out, will lead to more energetic steps being taken to afford the villages in the affected districts the benefits which the measures I have recommended will assuredly bring to them in exact proportion to the efficiency with which they are carried out, although the problem is admittedly a more difficult one in their case. . _ j Kala-Azar and the Plasmodium Malari.e. Lastly, I wish to point out that the facts detailed in this paper afford strong support to my view that the infection in this epidemic malarial fever is an indirect one, by means of the passage through the soil of the plasmodium malariae which i3 constantly found in this disease. How the organism escapes from the body, whether by the aid of some living- agent as the mosquito, or by passing out in one or more of the evacuations or secretions, or as I am disposed to believe by being breathed out from the lungs, it is impossible to say at present. When this stage of the life-history of the organ¬ ism is finally settled, then we may also hope for a solution of the mystery of the communicability of this decimating epi¬ demic malarial fever of Assam. Reference. 1 Report of an Investigation of the Epidemic of Malarial Fever of Assam or Kala-Azar. 1897. REMARKS ON THE DEATH-RATE OF DYSENTERY AND ON DYSENTERY AND LIVER ABSCESS. By W. J. BUCHANAN, B.A., M.B., Dipl. State Medicine, Dublin ; Captain I.M.S.; Superintendent, Central Gaol, Dacca, Bengal. Tne Case Mortality of Dysentery. On reading Dr. Manson’s valuable book on Tropical Diseases, I find he quotes 37.0 per cent, as a case-death-rate from dysentery among natives, as also does Davidson. Such a death-rate can only have reference to natives admitted to public hospitals after days or weeks of self-neglect in their own homes; it certainly does not apply to dysentery treated promptly and efficiently. In old days dysentery used to be the opprobrium of our Bengal prisons, but within recent years great improvement has taken place. In the years 1806-7, of 7,626 cases admitted to all gaol hospitals only 293 diea ; that is, only 3.8 per cent, of the cases—about one-tenth of the above-quoted percentage. Even in the extremely unhealthy malarious year, 1894,1 find from the figures of certain prisons which I happen to have collected, that the death-rate from dysentery was only 9.0 per cent. Such figures include all forms of dysentery, from the mild to the chronic relapsing (non-amoebic) form, which in Bengal is too often the terminal episode in many cachectic conditions—malaria, tubercle, syphilis, famine, etc. Among Sepoys—picked men in the prime of life, and living under good sanitary conditions compared with the populace gener¬ ally—the dysentery death-rate is also said to be about 3.0 per cent. The explanation of these low death-rates is that in regiments, as well as in gaols, a man who is ill, being unfit for work, is at once sent to hospital and treatment begins in time ; in public hospitals natives often do not come till they are in the last stage of weakness and emaciation from this exhausting and anaemia-producing disease. For a similar reason, the prison death-rate from pneumonia in Bengal is only 12 to 14 per cent.—a very low figure for pneumonia among malaria-stricken people. (Sturges gives 19 per cent, for pneumonia in England.) Liver Abscess and Dysentery. > In over six years’ prison experience, in charge of over 1,200 prisoners daily, I have never seen in gaol a single case of liver abscess, while I have had abundance of dysentery (I refer to natives of India only). Few natives escape dysentery; hence in them a mere history of the fact of previous dysentery is worth little in the etiology of liver abscess. Nevertheless, some French and American authors write as if “amoebic dysentery” and “tropical dysentery” were synonymous terms, though they themselves have shown that liver-abscess follows “ amoebic dysentery ” in the proportion of 1 case in 4. I believe the B. coli, the B. pyocyaneus, etc., are more often the cause of dysentery than the much-talked-of amoeba. “Everywhere,” says Davidson, in Allbutt’s System, “natives of tropical countries are less liable to liver abscess,” and we may add that everywhere they are extremely liable to dysentery. If dysentery is so important a predisposing cause, how is the rarity of abscess of the liver to be explained among natives in the Straits Settlements, West Indies, among native Egyptians, at Zanzibar, in the Seychelles, and in Brazil and Cayenne ? (v. Davidson’s chapter, op. cit.). In most of these places malaria is common and in some very severe, and in all dysentery is common. Liver abscess of pyaemic origin is certainly not uncommon outside public hospitals in India, but I am here only concerned with the fact that while dysentery has been extremely common in Bengal prisons, liver abscess has been extremely rare. A medical subordinate of mine in this large central gaol (1,200 prisoners), who has served here for ten years, has seen many hundred