13
Paras. 10—11
while eighteen seemed to be ordinary paludism and two were probably " the
anæmia with dropsy."
I may say at once that the appearance of the kala-jwar cases was in every
respect similar to that of the more advanced cases of paludism ; in fact it was
impossible to determine how the people themselves drew a distinction. More-
over the general picture presented was almost identical with that of kala-azar,
except that the liver was certainly not so frequently or so much enlarged. It
rarely extended to two inches below the lower end of the sternum, and as a
rule could be said to be only slightly enlarged ; in one or two cases, however, it
was as large as in kala-azar. The spleen was often enormous, in one case
apparently filling the whole abdomen, and generally occupying half the surface.
Neither the anæmia nor the emaciation struck me as being very severe ; in-
deed some of the cases were almost fat and others showed a very fair blood.
Most of these patients were examined only once, and before noon. The
temperature of all, except one, was above the normal, lying between 98 . 4º and
101° F., and averaging about 100° F. The exception had a temperature
of 97'1° F. This raised morning temperature without any tendency to
rigor suggests the " constant low fever " of paragraph 6 ; in fact almost all
the cases were obviously in a condition corresponding with the second
stage of kala-azar. I cannot speak definitely about any darkening of the skin,
or of the exact history of the cases ; but all agreed in saying that their illness
commenced with high fever. Many of the patients, moreover, told me that
relatives had suffered from the same complaint.
It would appear, then, from the similarity of the symptoms and the evidence
as regards communicability of the diseases, that kala-dukh in the Purnea Dis-
trict, kala-jwar in the Darjeeling District, and kala-azar in Assam are all the
same disease.
The result of my examination of the blood of the Naxalbari cases is given
in paragraph 19.
10. Nomenclature,—Major "Waddell, LL.D., I.M.S., furnishes me with
the following details. Kala (Sanscritic) means black or deadly.
Dukh
(Sanscritic) means suffering or pain ; literally disease, i.e., want of ease. Jwar
(Sanscritic) means fever, i.e., raised bodily temperature. Azar ( ? Assamese)
means sickness ; but in Nowgong the words jwar, or bimari (Urdu), illness,
are more frequently used by the people.
The popular use of the adjective kala does not appear to me to imply
necessarily blackening of the skin. Perhaps the original meaning was deadly.
It is possible that the meaning has now become transferred to the more literal
significance of the adjective black. Thus black death meant only plague
originally ; until, the word stimulating the imagination, people saw a blacken-
ing effect in the disease which it does not possess. Just, possibly, the same
thing has happened in kala-azar.
lll.-PATHOLOGIOAL ENQUIRY.
11. Prima Facie Evidence regarding the Nature of Kala-Azar.
—A clear clinical picture of kala-azar having been arrived at, it is now possible
to examine more deeply into the nature of the disease. We can already draw
some important inferences regarding this from the description of its grosser
features just given.
Throughout the tropics generally there is a group of animal parasites of
man prevalent almost everywhere, but more so in some localities than in others.
These are, several species of worms—filarise, round-worms, whip-worms,
ankylostomes, and certain flukes ; some minute protozoal parasites of the liver
and intestine, notably amoeba coli and cercomonas or trichomonas intestinalis
(the protomyxomyces coprinarius of Cunningham) ; and at least three species
of protozoal parasites of the red corpuscle.
I have found most of these very frequently in various parts of India—the
Southern Presidency, Rajputana, Bengal, Assam ; namely, filarise nocturnæ,
round-worms, whip-worms, ankylostomes, amœbse coli and cercomonads, and
the parasites of the red corpuscle. They have also been noted here and there
by many observers ; and it is likely that they all have a very wide prevalence
throughout the Indian Empire. Sce for instance [15, 17, 18, 19, 20, etc.]