49
Paras. 27 & 28
It should be noted that though the writers did not distinguish the para-
sites, they employed the detection of pigment during life for diagnosis—which is
almost the same thing, especially in the older cases in which crescents exist in
the æstivo-autumnal infections.
The authority borne by these citations cannot be questioned ; and, on the
whole, I am disposed to allow that on the strength of them alone a satisfactory
affirmative reply has been obtained to the two questions, (a) and (b), pro-
pounded in paragraph 25. The second quotation from Kelsch and Kiener would
seem to establish that in ordinary paludism the melanin (and therefore, of
course, the parasites) may not be found in the organs a few months after the
beginning of the illness, thus satisfying question (a). The passage from
Vandyke Carter and the third quotation from Kelsch and Kiener, describing very
emphatically a febris secondaria post malariam, certainly accord in a remark-
able manner, not only with each other, but with my picture of the low fever in
advanced kala-azar—thus apparently satisfying question (b).
It may, however, be pointed out that while we may admit the secondary
fever as not due directly to the parasites, there is yet no express statement in
Kelsch and Kiener's work to the effect that this fever can occur after the
disappearance of melanosis—they and Vandyke Carter merely state that it is not
associated with the presence of parasites and the deposition of fresh melanin.
It may be further objected that a few quotations of this nature, however
authoritative, do not justify us in finally deciding a question of such impor-
tance.
How obtain more definite proof ? The logical course would be to do so by
the exhaustive examination of numerous cases of paludism in many parts of India,
and, indeed, of the world. But this would imply many autopsies and months,
if not years, of research—an affair quite beyond the conditions of this report.
Fortunately, however, I have been able to obtain just the particular
information required from Dr. C. W. Daniels, M.B., Colonial Medical
Service.
Dr. Daniels, who has been appointed by the Colonial Office to the Malaria
Commission instituted conjointly by that Office and the Royal Society, was sent
to Calcutta to study with me, and I have consequently been able to avail
myself of his large experience. He has been able to study no less than 2,000
autopsies in tropical countries, in 1,600 of which he has searched microscopi-
cally for the pigmentary deposits. He has also studied the parasites of malaria,
as well as tropical parasites generally, to a large extent. His knowledge of
these subjects, he says, was acquired chiefly in British Guiana, where he was
able to see much malaria, partly among Indian coolies ; and it will be perceived
that his experiences are likely to be of the greatest value touching the present
subject.
His statement, in which he is kind enough to reply to certain definite
questions of mine, is given in Appendix A, 6. It may be summed up as
follows :—
(a) He finds malarial parasites much less readily in cases of chronic
enlarged spleen than in early cases of malarial fever.
(b) He frequently finds an apparently non-malarial fever, not amen-
able to quinine and not accompanied by parasites, in cases of
enlarged spleen.
(c) In a very large number of enlarged spleens examined post mortem,
even of patients who suffered from this fever at the time of their
death, he detected no black pigment at all.
These observations apply to members of the East Indian race in British
Guiana, and have already been published by Dr. Daniels [37].
They complete my citations on the point at issue.
28.—Points still requiring Explanation.—It must now, I think, be
frankly admitted that the condition of enlarged organs with fever but without
melanin, observed by me in Nowgong, is not confined to that locality.
The question, however, remains whether this condition is due to malaria at
all—whether, indeed, it is not some quite different disease which has been every-
where mistaken for malaria. If there is no melanin in the affected organs, how
be certain that their enlargement is caused by the parasites of malaria at all,
and not by something else ?
Η