This is an investigation into how serious the kala-azar (visceral leishmaniasis) situation was in colonial Bihar, what the government's policy was to control it and how the people responded to it. Until 1903, medical men had little idea about the true nature of this disease, which spread rapidly in the wake of the opening up of communication by rail and road. British medical intervention against kala-azar succeeded only in 1919 with the introduction of the antimony treatment. Till then, and after, the powers that be failed to prevent and eradicate the disease, with a lack of qualified personnel, funds, treatment centres, sanitary measures and, above all, political will hampering whatever modest efforts were made.