Due to recent events, more so the outbreak of Corona Virus, now called COVID 19 (CO for Corona, VI for Virus, and D for Disease, and 19 for 2019), there has emerged, world over, an interest in the changing nature of virus, and precautionary measures that are to be taken to protect oneself from the virus. The exact cause of the virus is yet to be identified. In light of such events, let us focus on our region and go through the history of some of the diseases in the hills.
The Darjeeling District comprises of two distinct geographical regions. Number one, the Hills, and number two, the Tarai. The Tarai forms the base of the Himalayas, as a result it is intersected by numerous streams, coming from the mountains, and have an exceptionally heavy rainfall. It is a water logged region, with stagnant pools, also ideal for mosquitos (anopheles mosquitos). We know that the major cause for malaria in humans are due to anopheles mosquitos. This tract of land, i.e, Tarai, have been well described by Sir Joseph Hooker. He writes, “the pent up water of the streams, percolating their gravel beds, and partly carried off by evaporation through the stratum of ever increasing vegetable mould, must be one agent in the production of the malarious vapors of this pestilential region.” The Europeans often referred to this area as the home of fever. While returning from Darjeeling, Lady Canning caught fever, which ended her life. Europeans, in the days before the railway, hurried through it as fast as they could travel, in order to get beyond “the fatal fever zone”. The people living in this tract were weak due to fever, and were far from healthy. In 1900, the average mortality rate was around 71 deaths per 1000 lives.
There were many communities living in this region, such as the aboriginal Meches, and the Rajbansis. They were to a certain extent free from fever, because they cleared away the jungles around their homesteads. They also built their huts on high platforms, but many other natives succumbed to the fever.
The Hills form a completely different geographical region. The damp moist heat of the Tarai disappeared at the elevation of 2500 feet, and above that level the tropical zone of fever is passed. Darjeeling was also called as “the Sanitorium” by the British, due to it’s similarities of climate to that of the climate in Europe. It also provided respite for those coming from the plains. Malaria ceased to be endemic, but the chief danger was of having diarrhoea, owing to the great difference of climatic conditions and carelessness regarding diet, clothing and exercise. It was also one of the common disease among the Europeans in the hills, specially among those who had just arrived from the plains. One popular theory stated that it was due to the presence of mica in the drinking water. This theory, however failed to consider the fact that diarrhoea was equally prevalent at other hill stations, where the soil was not micaceous, and that the local inhabitants of Darjeeling who drank the same water were practically immune from it. Further medical observations showed that the diarrhoea was very frequently produced by chills, errors in diet, improper clothing, and over excretion, specially on first arriving in Darjeeling. However intestinal worms, producing symptoms of diarhhoea, were extraordinarily common among the local inhabitants. In 1905, about 3,470 such cases were treated at the Darjeeling dispensary. The major contribution to intestinal worms were food habits, and contaminated drinking water. Phthisis ( pulmonary tuberculosis ), pronounced as “thigh-sis”, was common among the natives, due to thin clothing, constant exposure to cold, damp, and heat, and total disregard of elementary hygienic laws. It was more frequent among those who lived in solid brick stone or corrugated iron houses, than among those who lived in wooden or wattled huts. Among other diseases may be mentioned diphtheria and enteric fever (typhoid fever, most commonly spread due to contaminated food and water), but only few were affected. Rheumatism (inflammation or pain in the joints) were most common during the rains, when it was aggravated by the excessive humidity, which prevailed. A few imported cases of plague occurred among the Europeans in 1905, one in Darjeeling town, and another in Victoria School at Kurseong. The disease was mild, it did not spread, and there were no deaths.
The greatest mortality was caused by fevers, which were generally malarial in nature. Dr. A. D. Humphrey, the then Civil Medical Officer of Kurseong, gave the following information. “The fevers are not prevalent in the hills. Mosquitoes are found widely distributed throughout the district, and are common during the hot season, and at the end of the rains. The genera Culicidae are met with at an elevation of over 6,000 feet, and the larvae of the Anophelina genus have been seen, at the height of 4,500 feet, in a hamlet, the inhabitants of which had no history of malaria, while the children showed no enlargement of the spleen.” He further explained the description of the fevers and the types of fevers that prevailed in the Tarai. He said, “Tarai has an evil reputation for the severity of it’s fevers which may be divided into malarial fevers, including black water fever and kala azar. Simple fevers include tertian and quartan, and those cases in which the parasites are mixed. The cycle of the tertian cases lasts for 48 hours, and of quartan cases for 72 hours. The cycle of malignant fevers, including black water fever, lasts for about 24 hours. They are prevalent all the year round, but are most common during and at the end of the rains. The malignant type of fever is specially frequent in certain localities, such as Sukna, Garidhura, Matighara, and Naxalbari, owing to their marshy situation and to the fact that they are cramped and crowded, and have no room for expansion. Large markets are held at these places, and they are great centres for the dissemination of fevers among the smaller villages in healthier situations. A large percentage of children show considerable enlargement of the spleen, and they are the chief harbourers of the malarial parasite.”
So what are Black water fever and Kala azar ? Black water fever is a malarial infection in which red blood cells burst in the bloodstream (hemolysis), releasing hemoglobin directly into the blood vessels and into the urine, frequently leading to kidney failure. In many cases the color of urine is deep black porter color. The skin turns into a deep saffron color, and in the course of a few hours changes to a deep yellow. The exact cause of this fever has not been satisfactorily explained. On the other hand Kala azar, is an illness with characteristics resembling in many ways those of malaria. Sufferers from this illness complain of an irregular fever, enlargement of the spleen, and liver, loss of flesh and strength. The two principal features which distinguish this fever from malaria are firstly, that quinine has no distinctive control on the fever, as in malaria, and secondly, that the spleen is larger than in patients suffering from malaria, and does not feel soft and elastic, but hard and stony.
Another case is that of small pox. The difference in its prevalence in the Hills and in the Tarai, was the attitude towards vaccination. Compared to the people of the Hills, the people living in the Tarai were either prejudiced against vaccination, or indifferent to the protection it secured. In the Hills, the ratio of those successfully vaccinated during 1905 – 1906 varied from 68 per 1000 in Kurseong subdivision, to 140 per 1000 in Kalimpong, while it was as low as 22 per 1000 in the Tarai. But due to the result of extensive operations and vaccination, small pox was almost wiped off the district.
In order to deal with these diseases, in the town of Darjeeling, there opened three medical institutions. The Eden Sanitarium for Europeans, the Lowis Jubilee Sanitarium for natives, and the Victoria Memorial Dispensary for natives and Europeans.
To be continued…
By,
S. K. Ghising
References,
- L. S. S. O’Malley, Bengal District Gazetteers 1907, pg no 53 – 60.
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