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Wellcome History 43

Wellcome History 43

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Published by Wellcome Trust
Wellcome History is an easy and regular channel of communication between all Wellcome historians. It aims to be an informal, user-friendly centre of debate. Issue 43 contents include: Kala-azar in India, the cause of Oriental sore, central Asian tabibs, medicine in the Dead Sea Scrolls, conference reports and book reviews.
Wellcome History is an easy and regular channel of communication between all Wellcome historians. It aims to be an informal, user-friendly centre of debate. Issue 43 contents include: Kala-azar in India, the cause of Oriental sore, central Asian tabibs, medicine in the Dead Sea Scrolls, conference reports and book reviews.

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Published by: Wellcome Trust on Apr 13, 2010
Copyright:Attribution Non-commercial No-derivs


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Feature articles 2
Kala-azar in IndiaThe cause o Oriental sore
WOrK iN PrOGress 6
Central Asian tabibsMedicine in the Dead Sea Scrolls
cONFereNce rePOrts 17
Child health and welareGlobal Health Histories
BOOK revieWs 20
Power, Knowledge, MedicineThe Dying and the Doctors
2Exeter unit
History Issue 41
Fighting the ever
 A local health unitdispensary in India.
Cowpats, used oruel, dying on a housein Bihar. Cow manureis also a vector or theparasite that spreadsleishmaniasis.
 A Bryceson
 A house in Indiashowing its last DDTspraying dates.
 achiNtya Kumar Dutta
Kala-azar or black ever (visceralleishmaniasis) requently gures in the newsin India. Although the disease had nearlydisappeared in the country by the mid-1960s,ostensibly owing to organised public healthmeasures, this success was short-lived.
An epidemic resurgence of kala-azar in North Biharin 1976–77 spread into West Bengal; the outbreakaffected hundreds of thousands of people andcaused the deaths of almost ve thousand. Kala-azar transmission continued thereafter, resultingin more than 250 000 cases and numerous deaths.However, it is believed that the actual impact of thedisease is far greater, as cases have gone unrecorded.The burden of disease was exacerbated by the acuteshortage of drugs necessary for treatment at thebeginning of 1977, which was mainly a result of localrms deciding to limit their production in India.The World Health Organization played an importantrole during the 1977 crisis, providing emergencysupplies of medicine to the region. It was also involved,along with the government of India, in convincingpharmaceutical companies to restart the manufactureof anti-kala-azar drugs, which allowed dispensariesand hospitals to provide treatment to the infected(these services were provided free to the economicallydisadvantaged). Organised vector control programmes,based on DDT spraying campaigns, started during thepandemic of 1977 and were continued in the followingyears. In this context, the WHO provided technicalassistance in the form of technical advisers and eldpersonnel. The National Institute of CommunicableDisease was also involved in these disease controlefforts: its ofcials surveyed affected districts in Biharfor data about epidemiological and social trends.However, these anti-kala-azar measures were notintroduced in an organised or uniform way acrossIndian states, which caused the disease to remainwidely prevalent in Bihar and West Bengal (sporadiccases were also reported from the states of UttarPradesh, Gujarat, Punjab and Tamil Nadu). TheNational Planning Commission considered theproblem to be serious enough in 1990 to approvesignicant nancial assistance to an expandedscheme for kala-azar control; these funds wereintended to provide for the assembling of teamsof workers, chemicals for anti-vector spraying anddrugs for treating people struck by the disease.UNICEF provided additional assistance for publicity
The return o kala-azar in India
History Issue 43
Feature articles
and educational campaigns. These developmentscontributed to a decline in the incidence of kala-azarin the following years, even though these successesappeared transitory; insecticide spraying and activecase detection work was not, for example, carried outin Bihar from mid-1994, even though 30 districts inBihar and nine districts in West Bengal were foundto be severely affected by kala-azar at the very time.Disease surveillance activities, widely accepted asessential to any eradication programme, continueto be poorly organised in affected areas of India.The bulk of cases are concentrated in tribal villages,which have limited access to health facilities. Kala-azar has, for instance, been spreading rapidly in andaround the tribal hamlet of Sarbamangal in SouthDinajpur district in West Bengal; my investigationsthere reveal that its inhabitants have minimal accessto healthcare facilities capable of treating the disease.The Public Health Centre is not even equipped withthe pathological facilities to identify the kala-azarparasite; moreover, the health workers rarely invest timein case detection work or the spraying of insecticide.Acute shortages of effective drug treatments do nothelp either – indeed, sodium antimony gluconate,which is in use for the treatment of this disease, isnot currently manufactured in India. Pentamidineisethionate, a product manufactured outside India, isfrequently considered too costly to import by hard-pressed state governments. The widespread circulationof spurious drugs has created further problems forpatients and health ofcials. Indian bureaucrats andadministrators are also culpable, by refusing givepriority to tackling the kala-azar problem. The availableevidence shows that the disease generally affects themost disadvantaged sections of society. This oughtto stoke more – rather than less – concerted action.The persistent neglect of health matters in public policyis evident from the relatively low levels of expenditureon health. Investment has fallen away gradually afterthe second ve-year plan period; federal support fordisease control programmes, which stood at 41 percent in 1984/85, was reduced to 29 per cent in 1988/89and scaled back further to 18.5 per cent in 1992/93.Health centre efciency in several states continues to beadversely affected by insufcient facilities, medicinesand staff. There is, thus, an urgent need for radicalreform. The political visibility of health issues needs tobe raised, and shortcomings in health delivery need toanalysed, debated and countered both before and afterparliamentary and local authority elections. Diseasessuch as kala-azar can only be eradicated through well-knit integrated campaigns. It is essential to mobilisecommunity participation in health programmes,and special attention needs to be paid to ensuringthe participation of women, since they are often theprimary carers of children and the elderly. The Ministryof Health and Family Welfare recently constituted anexpert committee on kala-azar elimination from India,with the declared aim of eradicating the disease by 2012– this important goal can only be achieved throughthe committed determination of all stakeholders.
Proessor Achintya Kumar Dutta
is attached to theDepartment o History, Burdwan University, India(
 A man with post-kala-azar dermalleishmaniasis.
New publication
Cholera and Confict: 19th century cholera inBritain and its social consequences,
edited byMichael Holland, Georey Gill and Sean Burrell
 This collection o essays presents some local studies on Asiatic cholera, predominantly or the 1832 pandemic;there is a chapter on cholera treatments in the early 19thcentury, some groundbreaking work on Asiatic cholera inIreland, a chapter on the treatment o cholera during theCrimean War, and the intriguingly titled ‘When the FourthHorseman Rides’, which examines art and literature or theperiod based on the belie that the 1832 pandemic was o apocalyptic proportions. The volume came about as a direct result o the CholeraProject that was launched to ascertain the true level o civilunrest associated with the outbreaks o Asiatic cholera orthe years 1832 and 1849 in the UK. A secondary aim wasto identiy medical innovation that was used in thetreatment o the disease. The researchers or the project were recruited rom theOpen University, amily history societies, medical societiesand the Family and Community Historical Research Association, and operated under the auspices o theSchool o Tropical Medicine at the University o Liverpool. Their brie was to trawl through local documents,newspapers etc. or evidence o unrest associated withoutbreaks o cholera and then to eed their ndings to theacademic advisers or inputting onto a database. The Thackray Medical Foundation provided unding or theresearch and the publication o the ndings.Published by the Thackray Museum, Leeds (
 ). ISBN 9781897849095.

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