6
Para. 6
At this point a perusal of these statements (Appendix A) may be suggested.
It will be seen that all these gentlemen are describing either the same disease,
or else diseases indistinguishable from each other by their symptoms.
My own observations with regard to the clinical features are in general
accordance with theirs.
It is obvious, then, that the disease now existing in the Nowgong and
Tezpur districts and called kala-azar there is a very definite entity, charac-
terised chiefly by fever, enlargement of the spleen, and in many cases by enlarge-
ment of the liver.
6. Symptomatology of Kala-Azar in the Nowgong District.—This
being the case, I think that I may now safely proceed to discuss in greater detail
the history and symptoms of the disease referred to. As the course of the sickness
may last for years, it is impossible for me to describe the entire history altogether
from my own experience ; I can do so only from my own observations made on
different cases taken at various points in their history and afterwards collated ;
from the more protracted observations of others ; and from enquiries of the
patients themselves. As I wish to give here the results only of my own en-
quiries and observations, I exclude previous literature on the subject.
The history and symptoms of cases of kala-azar as now existing in the
Nowgong District are as follows :—
It is difficult to obtain any definite information regarding the prodromata.
In cases 35 and 66 (paragraph 17) preliminary "uneasiness" and "feeling ill"
are recorded. It must, however, be clearly understood that there is no gradual
access by way of initial anæmia, emaciation, weakness, or dyspepsia ; the dis-
solution of health is abrupt.
The onset is always characterised by fever [all] ; often severe, sometimes
very severe [McNaught] ; severe [Macnamara] ; generally severe [Lavertine,
Price, Ross].
The fever may be continued [McNaught] ; or remittent [all] ; or inter-
mittent [Lavertine, Price, Macnamara, Ross] ; usually remittent [Macnamara] ;
not intermittent.[McNaught].
It begins sometimes with rigors, sometimes with mere chilliness [Mc-
Naught, Ross] ; rigors and chills are rare [Lavertine, Price, Macnamara] ; chills
occur especially in the intermittent forms [Lavertine, Price].
The fever lasts for 10, 14 or even 20 days [McNaught] ; about a week
[Macnamara] ; from three weeks to three months [Lavertine and Price].
During this period the spleen and liver become slightly enlarged and
often painful, sometimes even in a condition of inflammation [McNaught] ;
the enlargement begins generally after three or four weeks [Lavertine and
Price] ; generally after three months [Macnamara]. Some confusion has proba-
bly existed in these account« in regard to the degree of enlargement referred to.
After the first febrile period there is generally an apyrexial period [all]
which lasts for a week or two or more; indefinitely [McNaught]. This is
followed by a second or third attack, or more attacks, of a similar nature to the
first [all] ; not preceded by rigors [McNaught] ; but with apyrexial periods
between [McNaught].
During the whole of this stage the spleen continues to enlarge in every case
[all]. The liver also, in every case [all] ; only in one-third of the cases [Macna-
mara].
Anæmia progresses with the illness [all]. There is an access of anæmia with
each attack of fever, with improvement in the interval [Lavertine, Price, Mc-
Naught, Boss] ; anæmia begins at the third or fourth month and is a continuously
progressive anæmia [Macnamara]. It ultimately becomes extremely marked
[Macnamara and Lavertine] ; not so extremely marked [Price, McNaught,
Ross].
Emaciation is progressive throughout [all].
By this time the tumefaction of the spleen has reached large proportions
[all]. The liver also is enlarged, generally much so, in all cases [all except
Macnamara] ; typically so [Price, Ross] ; only in one-third of the cases [Mac-
namara]. The organs are both tender and painful [MoNaught, Ross] ; there is
no pain nor tenderness, but discomfort [Macnamara].
At this stage, too, " when the enlargement of the organs has reached a
certain degree, " "the temperature as a rule remains above normal day and