76
Paras. 41 & 42
to examine the blood of every simple fever case which comes to hospital, I do
think it necessary for all medical men practising in the tropics to make them-
selves familiar with this, the most important part of the study of the most
important tropical disease. It is impossible to ignore the exigency of this duty,
however troublesome it may be.
I should like to commend to those who care to undertake research the
further study of the secondary fever ; and to those who have opportunity for
making autopsies, the condition of non-pigmented enlargement of the spleen.
42. Official Recommendations.—With regard to the prevention of the
present epidemic of kala-azar, I have little to add to the recommendations of
Captain Rogers in Section X of his Report, which I beg to endorse.
I am of opinion that kala-azar is communicable from the sick to the healthy
in some indirect manner, and that the infection tends to cling to houses.
I think also that there is a certain external condition required for the
extension of the disease—probably the presence of some particular species of
mosquito or other suctorial insect.
Any attempt to control the epidemic by the elimination of this external
condition is not likely, in the present state of our knowledge, to be successful.
It is necessary, then, as regards preventive measures, to treat the disease
simply as a communicable one, and as one the infection of which adheres to
dwellings—in other words, as a disease which spreads in a manner somewhat
similar to plague.
The measures already proposed by Rogers appear to me the only ones
likely to affect this; namely, (1) the control of communication between affected
and healthy sites; and (2) the vacation of infected sites.
I have been informed by Drs. Lavertine and Price that these measures
appear to have been successful to a large extent in the tea-estates near
Nowgong.
In my opinion, however, based on a considerable experience, no measures
aimed at controlling epidemics in India are likely to be successful unless
placed in the hands of capable officers specially deputed for the purpose—as in
the case of plague.
One or more energetic medical officers employed in this manner may be
able to do much. If it be found feasible to make such appointments, the
organisation may be briefly as follows :—
(1) Each special officer should be placed in charge of a locality where
numerous cases of early kala-azar or severe fever are occurring.
(2) Hospital assistants who have now been allotted to village dispen-
saries in that locality should be placed under his orders.
(3) It should be his duty to make himself acquainted with the incidence
of the disease in his district ; to conduct any preventive opera-
tions which may be decided upon ; and, above all, to superintend
closely measures of medical relief in the most acutely-affected
villages.
Frankly speaking, I do not think that any organisation falling short of
this is likely to be of much avail. If one junior medical officer be appointed
for a preliminary trial, the cost will not be much, as numerous additional
subordinates are already employed on the duty.
I lay particular stress on medical treatment, because I believe that much
can be done in this line if, and only if, the treatment be carried on under close
European supervision. I refer specially to the treatment of early cases of
fever by quinine. If camp dispensaries, under hospital assistants and super-
vised by the special medical officer, be placed near to villages where acute fever
is raging; if the special officer be sufficiently active to visit these dispensaries
frequently in turn and to attend personally as often as he can to the fever
cases; if the patients be encouraged by his influence to take quinine freely,
I think it likely that a great saving of life will result. I say early cases of
fever, because the old cases of eachexia are probably beyond treatment by
quinine; hence the most recently affected villages should be selected for the
experiment.
It would be fatal to the experiment to give the special officer too large
an area to work over. An extension of the method could be adopted if the
first results be at all encouraging.