5
Para. 5
commencing suddenly and succeeded by similar attacks. Enlargement of
the spleen and liver set in later, followed "by 'Swelling of the legs. The patient
nearly died, but finally recovered on being taken to Benares, where he bathed
in the Ganges. He was stout and perfectly recovered and well when I saw
him.
In this case, then, the facts scarcely accorded with my forecast. We next
entered the village, where the hospital assistant of the village dispensary had
collected for my inspection a number of cases. I was told that there could be
no possible mistake about the identity of the disease from which they suf-
fered ; it was only too well known in the village ; and most of the patients
shown to me had lost relatives from it. The appearance of all of them differed
in one very important particular from what I had expected.
It was true that all were more or less emaciated, more or less anæmic ;
but what struck me at once in most of them was a characteristic protrusion of
the abdomen caused by enlargement of the spleen and liver. Both these organs
were greatly enlarged in all the cases. In some they were tender on pressure.
The spleen often extended across to the right side of the abdomen, and the
lower edge of the liver was felt three inches or even more below the lower end
of the sternum. The majority of the cases had fever at the time (2 P. M. on the
13th September), as shown by the burning skin, pulsation of the carotids and
dyspnœa. A second class of the cases, evidently more advanced, in which
there was little or no fever, although the spleen and liver were still enlarged,
exhibited a certain amount of anasarca, especially ascites, as witnessed by the very
protuberant belly, and a slight dropsy of the feet. Only two of them suffered
from dropsy of the face. While in some instances, especially in these two,
there was certainly extreme anæmia, this symptom as well as emaciation were
not generally so marked as I had anticipated, being in fact little apparent
in not a few of the patients. On asking their history of some of them (several
were children and lads, too young to attempt to deceive one [3, p. 10]) the
invariable reply was that the sickness commenced with high fever followed by
enlargement of the spleen and weakness.
It was impossible to accept for a moment the view that the fever and the
enlargement of the organs were merely fortuitous complications due to the
general prevalence of these symptoms among a malaria-stricken population.
Had this been so the members of the crowd which stood round us would have
been affected in a precisely similar manner and to precisely the same degree.
This was not the case. Any general prevalence of these symptoms to the degree
they existed in the patients before me would clearly have almost exterminated
the whole population of Assam in a year or so. It was obvious that so extreme
a tumefaction of the organs could in many of the cases end only in death. On
the other hand, the surrounding crowd had every appearance of being free
from these affections, at least to anything like the same extent. Kala-azar, as
existing at Roha then, was evidently not a mere anæmia but a fever (and, I
judged, a severe one) producing tumefaction of the spleen and liver, and a final
cachexia.
Next day Captain McNaught showed me a number of cases of kala-azar
in the Civil Hospital at Nowgong. He informed me that they were exactly
like those which he had first seen in the Garo Hills. All of them, without
exception, were cases of great tumefaction of the liver and spleen. In most of
them there was constant fever ; in some, œdema, especially of the feet and
abdomen ; while various degrees of anæmia and emaciation were generally
present. They were obviously identical in nature with the cases which had
been pointed out to me as kala-azar in Roha ; and in nearly all of them there
was the familiar history of relatives having suffered and died from the same
disease.
I spent more than five weeks at Nowgong examining these and other cases ;
and before leaving took a statement from Captain McNaught regarding his
experiences of the disease. Next I proceeded to the tea estates in the neigh-
bourhood, where I conferred with Drs. Dodds Price and Lavertine, took their
statements and saw some cases which they showed me. These were exactly like
those which I had seen at Roha and Nowgong. Lastly, I met Major Macnamara
at Tezpur, and through his courtesy was enabled to add his evidence to my collec-
tion.