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Appendix A
Q. What effect does quinine have ?
A. Not the same as in malaria, even given up to 30 grains three times a day, and even if
given at the outset of disease, that is, after four or five days.
Q. Have you seen "black-water "in kala-azar ?
A. Never.
Q. Do you think that kala-azar is ankylostomiasis ?
A. No, certainly not. They are quite different diseases ; though a kala-azar patient may
have any number of anklostomes.
4. Statement of Dr. D. F, Dodds Price in additon to that of Dr. Lavertine, taken
on the 23rd October 1898.
I have seen kala-azar (in this district) only since January 1893. My experiences agree
with those of Dr Lavertine, except in a few particulars which are as follows :—
"(1) As to the communicability, I do not think for an instant that the disease is
communicated directly from patient to patient, but from the patient to a second agency, such
as the ground, house, bedding, and the like; and from this agent to a healthy person. The
burning roof of a house has been dropped into it and the floor dug up, the walls and the
ground outside remaining untouched, without the infectiousness of the premises being
destroyed.
"(2) I do not at all agree that the anæmia, even in the worst eases of kala-azar, is so
severe as in ankylostomiasis. I have never seen the hæmoglobin below 30° by Gower's appar-
atus; while that of parallel cases of ankylostomiasis is often at 20° and has been known by
me as low as 12°. The average for coolies should not be taken higher than 65°.
"(3) With regard to pneumonia, I have known a good many cases get it in the cold
weather, not in the rains. I have seen several cases die of hyperpyrexia in Dr. Lavertine's
second stage. Bowel troubles generally occur in the later stages of the disease, and have
carried off the bulk of my patients, I have lost only a few from cancrum oris.
"(4) I think that kala-azar has become modified during the last years, becoming briefer
and more severe, but not so common.
"(5) I think that in kala-azar the liver is much more enlarged than in chronic malaria."
Q. Is kala-azar ankylostomiasis?
A. No, certainly not. But mixed cases, of course, occur.
Q. What are the differences between kala-azar and malarial fever?
A. I have satisfied myself that kala-azar is malarial fever of a very fatal type, with
special incidence on the liver. The communicability of the disease is, however, hard to
explain ; but I am certain that it exists.
Q. Does quinine do any good ?
A. I think that quinine does do good; it is difficult to say, because when a case is cured,
we have our doubts whether it has been kala-azar. I think that small doses frequently
repeated, up to 30 grains a day, are more useful in the early stages than larger single doses.
The best results have been obtained from intra-muscular injections.
The following questions were asked of Dr. Lavertine and Dr. Dodds Price together,
Q. Do you both think that large doses of arsenic, gradually increased, are useful?
A. We have given it up to one drachm of the liquor thrice daily without bad symptoms.
Q. Do you think that kala-azar originates in the cold weather?
A. No; we both think that it generally begins in the month of March or April.
Q. Do you think that segregation is useful?
A. We both agree that it is very useful; both as regards the sick and those who have
lived with the sick.
5. Statement of Major Macnamara, I.M.S., taken on the 25th October 1898, at
Tezpur.
"I have been 18 years in this province; for 8 years in Sylhet, 2 years in the Sibsagur Dis-
trict, one year at Gauhati and 5 years in Tezpur. 1 have seen cases of disease called kala-azar
for the last six years. I must have seen some thousands of cases. The symptoms are definite
enough for me to give a description of them. I have treated cases. I have known at least
three Europeans who have died of it; and have enquired the history of the disease from
native patients, and in some eases from their relatives. I think the disease is communicable
from the sick to the healthy. At any rate, the oases appear to occur in connection with each
other.
"The disease begins with a severe attack of fever, which I think occurs in every case.
The fever is usually remittent, but it may be intermitent. Rigors do not often occur, neither
is the fever often preceded by mere chills. The fever lasts about a week. The patient then
feels better and gets about. After that he has slight attacks of fever which become more
and more frequent; until eventually his temperature never falls to normal, lying between 99°a
nd 101°F., though the patient is generally unconscious of it. Three months after the fever
has begun, the spleen always, and the liver in about one-third of the cases, begins to enlarge
and in the majority of the cases may become very big. There is no tenderness in them on pres-
sure and no pain, though, of course, some discomfort. I have seen cases which I have had every
reason to suppose were kala-azar, but in which there has been no enlargement of the liver; and I
have found the same thing in autopsies. In this opinion I know I differ from others. I
think that the constant fever first referred to is more apparent in long-standing cases in which
the tumefaction of the spleen, or of the spleen and liver together, has been established. The
spleen and liver reach their maximum enlargement in about a year and a half. I have never