Spirillar Fever in the Darjeeling District, 1912

/ BV A. M. JUKES, M.D., CAPTAIN, Deputy Sanitary Commissioner, Bengal. During the months of September and October 1912, I had the opportunity of commencing the investigation of some cases of fever caused by a spirochete, which I believe to be hitherto undescribed. The materials are very scanty, but sufficient, I think, to enable one to draw some conclusions. In the summer of 1912 there was a good deal of illness in the Darjeeling District, a large proportion of which was described as dengue, influenza, feverish cold, etc., at the same time the death-rate was 41 per mille, and there was, I believe, some difficulty in accounting for this high figure. Whether or not the fever described in this paper is responsible for it, I am not prepared to say. Early in September I was making a few enquiries about dengue in the town of Darjeeling, and was talking to Dr. Baldwin Seal who had recently been ill with it. In the course of conversation he told me that in one of the tea estates in the neighbourhood, Takvar by name, there had been a number of cases of illness amongst the coolies, about the diagnosis of which he was very uncertain. The following is a short account of the epidemic in question, the salient features of which are set out in the accompanying table and house plan. Takvar Epidemic.?Some time shortly before the beginning of June 1912 (the exact date is unknown), two coolies return to the Takvar Tea Estate from a visit they had paid to a village in Sikkirn, where an illness similar to that here described was said to have been prevailing. One of them was slightly unwell when he returned, and very shortly afterwards they were both taken seriously ill. They both recovered, and no particular attention was paid to their illness. About June 7th another cooly was taken ill and died after about a week's illness. About ten days later two more were taken ill and died after a short illness. In this way eight patients in succession were taken ill and died at intervals varying from two to three weeks. Then three coolies were attacked about the same time and recovered after an illness lasting about a week. Then three weeks later three more coolies were attacked and recovered ; and there was one later attack which recovered about the date of which no record was kept. All these cases were attended by similar symptoms and there is no doubt, I think, that they were suffering from the same disease. The illness was characterised by fever, jaundice, headache and pains in the back and limbs. There was no rash and no albuminuria. There was considerable prostration even in the case of those who ultimately recovered. On September 19tli Dr. Seal received information of the illness of patients 14, 15 and 10 in Table Takvar Epidemic.