No. 836S., dated Shillong, the 16th July 1897.
From-Surgeon-Colonel A. STEPHEN, M.B., Principal Medical Officer and Sanitary
Commissioner, Assam,
To-The Secretary to the Chief Commissioner of Assam.
I have the honour to forward Surgeon-Captain Rogers' report on his investigation
into kla-azr in Assam, with the following remarks.
2. Before proceeding to Assam to commence his enquiry into this disease,
Dr. Rogers spent a few days in Calcutta, in order to study the literature of kla-azr
and allied subjects available at that place. Leaving Calcutta on the 16th of April
1896, he visited Dhubri, Gauhti, Shillong and Tezpur, in order to learn the views of
the Civil Surgeons of those places on the disease which he was about to investigate,
and, on the 27th of that month, he arrived at Nowgong, the capital of the district in
which the disease was at that time most prevalent, and which he was requested to
consider as, for the time being, his headquarters. He spent the next five months in
the Nowgong district in investigating the disease. During these months he studied the
cases of the disease which he met in the Nowgong dispensary and jail, and in a large
number of infected places in that district, including a considerable number of tea gardens.
In October he proceeded to Shillong, in order to study the minute pathology of the organs
of persons who had died of kla-azr in the Nowgong district, and on whom he had
performed post-mortem examinations. He afterwards visited Sylhet to study cases
of ordinary chronic malarial fever there, and to notice the differences, if any, between
them and kla-azr. After leaving Sylhet, he paid a short visit to the Gro Hills,
and then made tours in the Nowgong district, in the Mangaldai and Tezpur subdivisions
of the Darrang district, and in the Golght subdivision of the Sibsgar district, and
in March 1897 he proceeded to Shillong to complete his report.
3. In the first section of his report, Dr. Rogers gives a short history of kla-azr.
The disease was first described in the Assam Sanitary Report for 1882, in an appendix
to which it is stated that the attention of administrative officers became directed to
it in the Gro Hills as far back as 1869. The disease gradually spread up the Brahmaputra
river, especially on its south bank, and, when Dr. Rogers commenced his investigations, it
had reached the eastern portion of the Nowgong district, and was beginning to make
its appearance in the Bishnath portion of the Darrang district. Dr. Rogers points out
that for several years, after the disease was first described in 1882, medical officers
were of opinion that kla-azr was of malarial origin, and that it was not contagious.
In 1889, Dr. Giles was appointed to enquire into, and report on, the cause or causes
of kla-azr and beri-beri of Ceylon, and in October 1890 he published his report.
In this report he gave it as his opinion that the increased mortality in the districts
invaded by so-called kla-azr was due to anchylostomiasis. It was afterwards
ascertained, especially through the investigations of Dr. Dobson, that anchylostoma were
found in the majority of healthy people in Assam, and that the worm was present in
persons not suffering from kla-azr in as great numbers as in those affected with
that disease. At the time when Dr. Rogers was appointed to enquire into the nature of
kla-azr, the majority of medical officers were of opinion that the disease in most
respects resembled chronic malarial fever, but, as there seemed to be evidence that it was
contagious, they considered that there might be some other factor in it besides malaria.
All medical officers, with one exception, believed that the disease was quite distinct
from anchylostomiasis.
4. In the third section of his Report, Dr. Rogers gives a clinical description of kla-
azr. He defines it as a chronic and relapsing form of fever of an intermittent or
irregularly remittent type, very resistent to treatment, producing progressive anmia,
great wasting, and, in many cases, dropsy, and terminating either in a final attack of
fever or in asthenia, often accompanied by diarrha or lung complications. He states
that the disease usually attacks several members of a household, and spreads slowly
in a wave of increased fever mortality, and dies out in about six years from its com-
mencement. He is of opinion that the disease may last from two months to three years,
and that its usual duration is from four to nine months. From what he saw on tea
gardens, he came to the conclusion that the number of cases begins to increase in April,
that the disease is most prevalent during May, June and July, and that the months of
minimum prevalence are December, January and February. He states that this seasonal
incidence agrees closely with that of ordinary malarial fevers, except that it is more