11
Para. 9
My reason's are that the prevalence of the anæmia is confined mostly to
the tea-estates, and is not nearly so great on the whole as that of the fever, while
it is the latter disease which has been described as kala-azar by nearly all
observers from McNaught onward. Thus, in Nowgong, while there were very
numerous instances of the fever alone, there were only two or three instances
οf the anæmia alone—which, moreover, had all come from tea-estates. Here,
however, my own experience bears no authority compared with that of the
medical men who have seen cases of both diseases for years, and who pronounce
emphatically on the superior prevalence of the fever. When, further, we recog-
nise from a perusal of the literature and of the statements appended to this report
that it is the fever and not the anæmia which has almost always been described
as kala-azar and is known as such at the present moment, we are inevitably
driven to the conclusion that if there be two epidemics now co-existent in
Assam, the epidemic of fever is far more formidable than that of anæmia, and
is the one which has been and is generally recognised as kala-azar.
It is necessary, of course, to understand that the two diseases may often
be concurrent in the same village and the same individual ; but still it cannot
be conceded for a moment that the term kala-azar is to be confined to a combina-
tíon of them—that only such individuals as are suffering from the two together
can be said to be suffering from kala-azar. While it is likely that the combina-
tion of the two diseases may be more formidable to a patient than each separately,
at least in the first and third stages of the fever, it is not likely to enhance the
illness to such an extent as to create practically a new disease with a very
much greater mortality than each factor separately can produce. Those who
have seen the fever and have noted the extreme gravity of the splenic and
hepatic incidents, will find no hesitation in accepting its power of causing death
without extraneous assistance. "It is even possible to conjecture that the
anæmia may be actually beneficial during the second stage of the fever ; and,
in fine, the " anæmia, with dropsy " does not exist as a factor in many of the
worst cases of the fever.
Those who are inclined to hold that kala-azar is a combination of the two
diseases, the fever and the anæmia, have urged further that it is the latter
which imparts the element of commmnicability to the product. This also is
inadmissible. Each disease can be propagated only after its own kind — the
anæmia can propagate only anæmia. Now, by an irresistible weight of testi-
mony, it is known that a patient suffering from the fever called kala-azar propa-
gates a similar fever amongst Ms relatives (compare, for example, the case of
Sri Jut Gunahash Gasswami in the appendix), and that one after another
these relatives are attacked, and suddenly attacked, by all the symptoms of the
original case. If the anæmia were the only transmissible factor of the disease,
such a patient would transmit only anæmia to his relatives, although he him-
self had suffered also from fever.
To put the matter in a perfectly clear light :—
The fever and the anæmia are quite distinct diseases, and both are com-
municable from the sick to the healthy.
If either were swept out of the country to-morrow the other would remain.
If the anæmia were to be swept away the mortality in the localities now
suffering from kala-azar would be but little diminished.
If, on the other hand, the fever were to be removed, the present epidemic
of kala-azar would cease and the mortality would return to its usual
limits.
Some further remarks on the relations between the two diseases—a subject of
the highest importance in tropical medicine generally—will be found in paragraph
41.
In conclusion, then, and after a quite impartial survey of the matter, I
must record my adherence to the opinion already promulgated by Rogers—that
true kala-azar is the fever with enlargement of the spleen and liver, and not
the anaemia with dropsy.
9. Kala-Dukh. and Kala-Jwar—I have referred in paragraph 2 to a
disease called kala-dukh now prevalent in the Purnea District of Bengal and
lately investigated by Captain E. Harold Brown, M.D., I.M.S., [16]; and
also to a disease seen by me in the adjoining Darjeeling District, called indif-
ferently kala-dukh or kala-jwar. I now propose to give a brief description
of these diseases.
c2