17
Para. 13
advanced typical cases during the presence of fever, in all stages of the disease
up to the day before death and in numbers roughly proportionate to the height
of the fever." In his Reply to Criticisms [12, p. 249] he states still more
definitely that " the plasmodium malariæ is constantly present in all stages of
the disease." With respect to the pigment, he states, without specifying
which pigment :—" It may at once be said that it was constantly met with in
the series of cases (autopsies) examined, and that it was roughly in proportion to
the chronicity of the case, being easily seen in properly prepared specimens in
the more acute cases, while in the more chronic ones it was so marked as to be
visible to the naked eye in thin sections floated out in a white vessel" [4, p. 111].
It will be confessed that if these observations are to be accepted, the mala-
rial nature both of kala-dukh and of kala-azar must be taken as finally estab-
lished. The discovery of the pathogenetic parasites and of their product, the
black pigment, in so large a number of the cases, is a full complement to the pre-
sumptive evidence, already strong, based on the symptomatology of the disease.
Here we have a train of symptoms, long and varied, coinciding exactly with those
of malarial disease ; and now, in addition, bodies so peculiar to paludism as
the parasites are not only merely found in the cases (as Brown reports), but
(as Rogers says) are present in all stages of the disease, and are even
proportionate to the height of the fever, while the melanin so characteristic of
paludism, is constantly met with in a series of autopsies. Not only are the
parasites merely present, but they are present throughout the malady " up to
the day before death," and are numerically in proportion to its severity. Ad-
mitting the facts, there can be no escape from the deduction. We have the
symptomatological picture of an illness consisting of, first, attacks of high
fever, secondly, enlargement of the organs, and, thirdly, cachexia due evidently
to the enfeeblement or destruction of those organs ; and at the same time we
actually see the destructive elements, the parasites, at work at every stage of
the disease, and find their excrementitious product, melanin, accumulated in
the organs ; we even have a coincidence between the number of the parasites
and the height of the fever. No demonstration can be more complete : it is
like the destruction of a piece of furniture by white-ants.
Whether, however, these observations are correct or not, it is incumbent
on us here, as in all scientific work, to examine them closely. Unfortu-
nately, Captain Rogers does not give us specific details sufficient to enable us
to do this. His statements regarding both the parasites and the pigments are,
in fact, astonishingly summarised and brief. Nowhere does he present us
with a complete list of all the cases and autopsies examined by him, as Captain
Harold Brown has done in respect to kala-dukh. As a matter of fact, he
records notes of only twelve cases of kala-azar—and very brief notes. On
examining these we find that the parasites were found only in five ; while out
of seven autopsies made on those of the twelve cases which died, the presence
of pigment is recorded only in two, and then it is not specified which pigment
is referred to. A temperature chart is affixed to only one case out of the
twelve. Replying later to criticisms, however, Bogers [12, p. 250] explains
that the reason why the parasites were found only "in five of the twelve
clinical cases of which the notes were given, was simply because they only
happened to have been looked for in those five out of that particular series."
I can find no explanation in his writings of the absence of record of melanin
in six of the autopsies—nor of the absence of charts. Further, there is no
evidence recorded in this series of cases tending to prove the author's state-
ments to the effect that the parasites are " constantly present in all stages of
the disease," and that they were found "in numbers roughly proportionate
to the height of the fever." All that is stated on those points is, in three out
of the five cases in which the parasites were noted, that they were found
when "his temperature was high" or when "he had fever ;" and in the
remaining two cases simply that they " were found in his blood this day "—
apparently on a single occasion. These cases are seemingly given as exem-
plary cases of kala-azar, and it might fairly have been expected that in them,
if nowhere else, the author would have recorded exact details to justify his
very general and yet emphatic declarations respecting the presence of the para-
sites and the pigment in the disease. I should like to note, however, that on
page 100 of his report he expressly apologises for not having been able to devote.
D