63
Para. 36
Hence, it now only remains to us to ask, is it possible that malarial fever
is capable of becoming epidemic and of being communicated from the sick
to the healthy ?
36. Epidemicity of Malarial Fever.—As a matter of fact, epidemics
of malarial fever—or at least of a disease extraordinarily like it—have been
very frequently recorded. Thus Davidson [26, p. 146] says, " During the
present century malaria has overrun the greater part of Europe on several
occasions. We have first the epidemy of 1806-12 ; then that of 1823-27,
which made itself felt over many parts of England and even in London ; next
came those of 1845-49; and 1855-60; and lastly that of 1866-72. Griesinger
mentions in addition to these, a considerable extension of the disease during
the period of first invasion of cholera, namely, 1830-35.
"In Bengal we have records of more or less extensive epidemics of malaria
in the following periods : —In 1807-9, reaching Southern India in 1809-11 ; in
1816, extending to Madras ; in 1834, extending to Western Rajputana, Nazir-
abacl, Neemuch and Mhow ; in 1843-44, extending to Scinde, causing a terrible
mortality among the troops in Hyderabad in 1843, and at Sukkur in 1844.
This last outbreak reappeared in the monsoons of 1845-46. Epidemics, more or
less extensive, occurred in 1850-51, 1863, 1866-67, the last corresponding with
the European epidemy, and with the first outbreak of malaria in Mauritius.
The disease was again epidemic in 1869-70 and 1878-79 ; in the latter years
malaria was also widely prevalent in Mauritius, Madagascar, Cyprus, and even
in New England. In the United States similar epidemic extensions have been
observed during this century. The most recent one gradually extended over
Connecticut, Massachusetts, Rhode Island, Vermont, and New Hampshire.
During its prevalence in Connecticut it is recorded that enteric fever, from causing
400 to 500 deaths a year, so decreased that at the height of the malarial epidemic
in 1879 it caused only 159 deaths. Whatever may be the cause of these out-
breaks they are seldom directly to be traced to meteorological causes." The
writer adds in a note, "A malarious fever is reported to have been recently
epidemic in the Transvaal, carrying off more than 10,000 of the native popu-
lation.— Lancet, May 27, 1893." He remarks further (p. 183), "The following
are some of the points in which malarial fever in its epidemic manifestations
differs from the endemic disease :—
" 1. In regions where the tertian and quartan types are endemic, the
quotidian type comes to predominate during the epidemic periods ; and in those
countries where the endemic fever is of the quotidian or double tertian type,
these are replaced by the remittent and pseudo-continued forms ; and fevers of
short intervals, or of the remittent or continued forms, are most prevalent at the
height of the epidemy.
" 2. Pernicious attacks—cerebral and algid—become more prevalent in
epidemic seasons.
" 3. The destruction of the red corpuscles is vastly more rapid, and
hæmorrhages, profound anæmia, and cachexia are established at an early
period of the disease.
" 4. In severe epidemics, adynamic and typhoid symptoms, the result in
part of the anæmia, come to the front, and impart to them their destructive
and fatal character.
" 5. Natives, who are comparatively exempt from the endemic disease, suffer
severely during epidemics."
Lastly, he says (p. 146) that, when epidemic, the disease may rise " to the
intensity of the worst forms of pestilence." In Mauritius, out of a population not
exceeding 130,000 in the area affected, the deaths in 1867 were 31,920."
Such facts appear to have been overlooked by those who consider Rogers'
declaration that kala-azar is an epidemic malarial fever too portentous to be
credible.
Rogers has given a very admirable description, [4] and [5], of the " Burdwan
Fever " and other epidemics, drawing a parallel between them and kala-azar,
based upon his examination of old records. He shows that fever, intermittent
or remittent, enlargement of the spleen and liver, anæmia and dropsy, with a
close of lung or bowel complications, were the symptoms ; that the disease
spread from point to point, and that it was communicated by sick persons to
healthy ones. He gives copious quotations which show in the clearest manner