NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
32
malaria by adequate quinine treatment, our conjecture would be verified. Such
a case would present little or no difficulty to the clinician with a sound
knowledge of the signs and symptoms of malarial fever as it occurs among
natives of India, and it is chiefly with the object of aiding those who desire to
gain this knowledge that I have written the present section. I have shown
that as regards the native of India the notion that untreated malarial infections
result in a condition characterised by the presence of long-continued irregular
fever and, as the text-books say, "by the reduction of the patient to a most
distressing condition of emaciation and weakness in which he is a prey to any
secondary infection," is incorrect ; and that, in short, malarial fever as it occurs
among natives of this country is a disease which, even in the stage termed
"malarial cachexia," presents very definite characters by the study of which
it can be diagnosed without difficulty. Thus we are able to exclude the only
disease which, so far as at present we know, is liable to be confused with
kala azar ; and I do not doubt that if those whose duty it is to diagnose cases
of this disease keep constantly in mind the conclusions I have attempted to
summarize in this section, they will find the problem as easy as it has seemed
to myself to be.
33
III
I SHALL now give the results of my examinations of the blood of 68 patients
who suffered from kala azar in different parts of Assam and Bengal. The
method by which a diagnosis of kala azar was arrived at in these cases has
been described in the preceding section.
Assam.
Result of examination
of finger blood,
Result of examination
of splenic blood.
GAUHATI AND ULLOOBARI.
Case 1.—Elizabeth, a female child, aged 4 years ;
seen in her mother's house at Gauhati ; has been
suffering from fever almost daily for 11 months ;
is extremely emaciated ; has had several attacks
of dysentery and is now suffering from diarrhœa
and cough. It appears to me that she cannot
live at the most more than a month or two longer.
Spleen enlarged to umbilicus. Liver enlarged
1 inch below costal margin.
No malaria parasites ; no
pigment ;
no other
parasites.
A large number of " Leish-
man " parasites both
free and enclosed in
mononuclear cells ; no
malaria parasites ; no
pigment.
Case 2.—Hudoo, native boy, aged 13 years ; an
out-patient at Gauhati dispensary ; has been ill
for 2 years ; is very emaciated and anæmic, but
walks about.
Spleen enlarged to umbilicus. No enlargement of
liver detected.
No malaria parasites ; no
pigment ;
no other
parasites.
A large number of" Leish-
man " parasites ; no
malaria parasites ; no
pigment.
Case 3.—Seban, girl, aged 13 years ; an out-patient
at Gauhati dispensary ; has been ill 6 months ;
gets fever every day ; is very anæmic, but not
markedly emaciated.
No malaria parasites ; no
pigment;
no
other
parasites.
Many " Leishman " para-
sites ; no malaria para-
sites ; no pigment.
Case 4.—Jadoo, man, aged 24 years ; seen in his
house at Ulloobari village ; is extremely ema-
ciated and too weak to stand. It appears to me
that he cannot live more than a week or two longer.
Spleen and liver greatly enlarged ; they stand out
prominently as large tumours under the stretched
skin of his sunken abdomen.
No malaria parasites ; no
pigment ;
no other
parasites.
Many
" Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 5.—Durrang Singh, boy, aged 14 years ; seen
at Ulloobar i village; is walking about, but has
high fever ; his father says that he is rapidly
losing flesh and he is greatly emaciated now.
Spleen enlarged beyond the umbilicus, liver 2 inches
below the ribs.
Many Simple Tertian
malaria parasites ; no
other parasites.
Numerous " Leishman "
parasites, a few pigment-
ed large mononuclear
cells, but no malaria
parasites seen.
Case 6.—Coonkee, sister of previous patient ; gets
fever occasionally and is very weak and thin.
Spleen enlarged to umbilicus. Liver 1i n c h b e l o w
ribs.
No malaria parasites ; no
pigment ;
no other
parasites.
Many
" Leishman "
parasites ; no malaria
parasites ; no pigment.
35
Result of examination
of finger blood.
Result of examination
of splenic blood.
GAUHATI AND ULLOOBARI—Concld.
Case 14.—Asanadi, boy, aged 12 years ; seen at
Ulloobari village; has been ill for one year, is
very emaciated and weak, but can walk about ;
no fever at time of examination.
Spleen 11/2 hands' breadth below costal m a r g i n .
No enlargement of liver detected.
No malaria parasites ; no
pigment ;
no
other
parsites.
A few " Leishman" para-
sites ; no malaria para-
sites ; no pigment.
TEZPUR AND THE SURROUNDING DISTRICT.
Case 15 .—Godhala, man, aged 28 years. Admitted
into hospital on 8th May 1904. His illness began
6 months ago with an attack of fever of conti-
nued type which lasted about a month ; then the
fever left him for about 3 weeks ; then it came on
again and has not left him for more than two or
three days at a time since. His spleen is now
enlarged beyond the median line ; no enlargement
of liver detected ; he is very weak and has the
characteristic dull, anxious expression so fre-
quently seen in cases of kala azar. He remained
in hospital until—mainly, I believe, as a result of
good feeding—he recovered.
Temperature chart XII.
No malaria parasites ; no
pigment ;
no other
parasites.
At the time of his admis-
sion numerous " Leish-
man " parasites ; no
malaria parasites, nor
pigment ; at the time of
his discharge no para-
sites nor pigment of
any kind.
Case 16.—Jettoo, a hospital servant, aged 26 years ;
formerly a tea-garden cooly. Admitted into the
hospital five years ago for debility : he recovered
and became a hospital servant ; for the last nine
months he has suffered from occasional attacks
of fever and his spleen has become enlarged ; he
is also losing flesh rapidly. On 3rd June 1904 he
took to his bed with a severe attack of pneumonia,
from which he died on 12th June 1904.
Temperature chart XV.
At an examination made after death the spleen
was found to weigh 3 lbs. 13 ozs., and the liver
4 lbs. 12 ozs. T he right lung weighed 2 lbs.
2 ozs. and the left 2 lbs.
8 1 / 2
o z s .
N o
u l c e r
w a s
found in the intestines.
No malaria parasites ; no
pigment ;
no other
arasites.
parasites.
Many
" Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 17.—Chanahia, aged 10 years ; an out-patient
at Tezpur dispensary ; illness began 4 months
ago with remittent fever and enlarged spleen ;
is very anæmic and weak and the muscles of
arms and legs are very wasted ; face and feet
oedematous.
Temperature at time of examination 99.2°.
Spleen beyond umbilicus. Liver
1 i n c h b e l o w
costal margin.
No malaria parasites ; no
pigment ;
no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 18.—Sunavaram, aged 20 years ; an out-
patient at Tezpur dispensary ; illness began
4 months ago, the fever being intermittent at first,
but afterwards almost continuous ; he is very
emaciated.
Spleen to umbilicus. Liver 2 inches below costal
margin.
No malaria parasites ; no
pigment ;
no
other
parasites.
Many
" Leishman "
parasites ; no malaria
parasites ; no pigment
F 2
37
Result of examination
of finger blood.
Result of examination
of splenic blood.
TEZPUR AND THE SURROUNDING
DISTRICT—concld.
Case 26.— Sankopaha, aged 26 years ; an inmate of
Tezpur Lunatic Asylum. He gets an attack of
acute mania about twice a year. His present
disease was discovered at the end of May ; he is
losing weight very rapidly and his spleen and
liver are greatly enlarged. The temperature has
ranged between 99° and 101° for the past month.
Spleen beyond umbilicus. Liver 2 inches below
the ribs.
Temperature chart XVI .
No malaria parasites ;
no pigment ; no other
parasites.
Many
" Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 27.—Ramkooar, woman, aged 35 years ; seen
in the hospital of the Bootiachang tea garden • has
been in hospital 2 months suffering from fever
and enlargement of the spleen ; quinine has been
given daily without effect. Temperature 102.4°.
Spleen to umbilicus. Liver I inch below ribs.
No malaria parasites ;
no pigment ; no other
parasites.
A few
" Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 28.—H iradhan, son of previous patient ; seen in
the hospital of the Bootiachang tea garden ; has
been ill about 8 months ; suffers much from
dysentery. Temperature 99.2°.
Spleen to umbilicus. No enlargement of liver
detected.
No malaria parasites ;
no pigment ; no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 29.—Fudnee, woman ; seen in the hospital
of the Bootiachang tea garden ; has had fever
off and on for a year.
Spleen 3 fingers breadth below costal margin.
Liver more than
1 h a n d ' s
b r e a d t h
b e l o w
costal margin.
No malaria parasites ;
no pigment ; no other
parasites.
Many
" Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 30.—Seboo, a tea-garden cooly, aged
30 years ; seen at the Sonajuli hospital of the
Takibari tea gardens ; admitted for fever and
anæmia on 8th April 1904 ; is a typical case of
kala azar.*
N o malaria parasites ;
no pigment ; no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment.
SALONAH DISTRICT NEAR NOWGONG.
Case 31.—Sindhoo, a tea-garden cooly, aged
about 30 years ; seen in the hospital of Salonah
new lines. In 1898 he was placed in the segrega-
tion camp for 18 months as a case of kala agar,
and while resident in the camp his wife and
daughter died of the disease. At the end of
that time he was discharged as cured and
enjoyed good health for 3 years. He has
now been suffering from constant low fever for go
days.
Spleen enlarged to umbilicus. No enlargement
of liver detected.
Temperature chart X.
No malaria parasites ;
no pigment ; no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment.
* During my visit to Borjulie I saw a large number of characteristic cases of kala afar among the tea-garden coolies.
In the spleen-blood of all cases which I should have diagnosed as kala agar Dr. Bentley had already found ' Leishman "
parasites. For this reason I did not think it necessary to examine their blood again and they are not entered here.
38
Result of examination
of finger blood.
Result of examination
of splenic blood.
SALONAH DISTRICT NEAR NOWGONG—contd.
Case 32.—Koondi, woman, a tea-garden cooly ;
seen in the above hospital ; her illness dates
from 6 months ago; since April she has had
several attacks of dysentery and is much ema-
ciated. In 1900 her sister died of kala azar,
and her husband and three other members of her
family are now suffering from chronic fever.
Spleen enlarged to umbilicus. Liver I inch below
costal margin.
No malaria parasites ;
no pigment ; no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 33.—Toolsa, tea-garden cooly ; seen in
the above
hospital ; was quite well until six
weeks ago, when she developed remittent fever
and her spleen began to enlarge. The fever
and enlargement of the spleen have continued in
spite of vigorous treatment with quinine. In
1903 two of her relations died of kala azar.
Spleen 2 fingers' breadth below the costal
margin. Liver not enlarged.
Temperature chart Xl.
No malaria parasites ;
no pigment ; no other
parasites.
A few " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 34.—Keora, woman, a tea-garden cooly ;
seen in the above hospital ; has been ill for
2 months ; her illness commenced with dysen.
tery and fever ; she now has considerable
œdema of the feet and legs and a greatly
enlarged spleen.
No malaria parasites ;
no pigment ; no other
parasites.
A moderate number of
" Leishman " parasites ;
no malaria parasites ;
no pigment.
Case 35.—Bongi, woman, a tea-garden cooly ;
seen in the above hospital. In March 1904 she
had an attack of pneumonia and her present
illness dates from that time. In May she suffered
severely from dysentery. It is said that she
contracted the disease from her mother, who
died of fever and cancrum oris.
Spleen nearly to umbilicus. No enlargement of
liver detected.
Temperature chart IX.
No malaria parasites ;
no pigment ; no other
parasites.
A few " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 36.—Dookahwa, boy, aged 13 years ; seen in
the above hospital ; has been ill 5 months ; has
improved considerably since admission to hos-
pital.
Spleen to umbilicus. Liver 1 inch below ribs.
Temperature chart XIV.
One Quartan malaria
parasite ; no other
parasites.
Many " Leishman " para-
sites ; two Quartan
malaria parasites.
Case 37.—Raymuti, woman, tea-garden cooly ;
seen in above hospital ; is nct emaciated, but has
constant fever, which is not influenced by
quinine. Spleen and liver enlarged.
No malaria parasites ;
no pigment ; no other
parasites.
Many " Leishman "
parasites : no malaria
parasites; no pigment.
39
Result of examination
of finger blood,
Result of examination
of splenic blood.
SALONAH DISTRICT NEAR NOWGONG—concld.
No malaria parasites ;
no pigment ; no other
parasites.
No " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 38.—Mohan, aged about 30 years ; horse-keeper
working at Salonah. I was informed that he
had suffered very severely from kala azar, but
that he had now recovered and was rapidly
regaining weight and strength. He has no
fever now and looks fairly robust, but his spleen
is still enlarged to the level of the umbilicus.
Case 39.—Sarasati, a tea-garden cooly ; seen
in the hospital of one of the tea-gardens between
Salonah and Silghat. Several of his relatives
have died of kala azar and he now suffers
almost daily from fever ; his spleen is enlarged
nearly to the level of the umbilicus.
No malaria parasites ;
no pigment ; no other
parasites.
Many " Leishman "
parasites ; no malaria
parasites ; no pigment.
SYLHET DISTRICT.
No malaria parasites ;
no pigment ; no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 40.—Maya Ram ; seen in the village of
Panchgaon ; has been ill for 8 months.
Spleen enlarged beyond the umbilicus.
Case 41.—Ayaj Khan ; seen in the village of
Panchgaon ; has been ill for 6 months,
Spleen to umbilicus.
Many crescents, rings
and pigmented leuco-
cytes.
Numerous " Leishman "
parasites ; a few cres-
cents and two pigmented
leucocytes.
Case 42.—Lob Mali ; seen in the village of
Panchgaon ; has been ill for 4 months ; tem-
perature at time of examination 104°.
Spleen 1½
hands'
breadth below costal
margin.
No malaria parasites ;
no pigment ; no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 43.—Sharo Deb ; seen in the village of
Panchgaon ; has been ill one year.
Spleen beyond umbilicus. Liver 2 inches below
ribs.
Two " Leishman " para-
sites in polynuclear
leucocytes ; no malaria
parasites ; no pigment.
Very numerous " Leish-
man " parasites ; no
malaria parasites ; no
pigment.
Case 44.—Jasu N ath ; seen in the village of
Panchgaon ; has been ill for 2 years.
Spleen midway between umbilicus and pubes.
Liver 1 hand's breadth below ribs.
No malaria parasites ;
no pigment ; no other
parasites.
Scanty " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 45.—Anoor Mahomed ; seen in the village
of Panchgaon ; has been ill 4 months.
Spleen 1 hand's breadth below costal margin.
No enlargement of liver detected.
No malaria parasites ;
no pigment ; no other
parasites.
Very numerous " Leish-
man " parasites ; no
malaria parasites ; no
pigment.
Case 46.—Arfan Mia ; seen in the village of
Panchgaon ; has been ill 6 months.
Spleen to umbilicus. Liver 1 inch below ribs.
No malaria parasites ;
no pigment ; no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 47.—Suraj Mia ; seen in the village of
Panchgaon ; has been ill 6 months.
Spleen beyond umbilicus. Liver 2 inches below
costal margin.
One pigmented leucocyte;
no parasites.
Many " Leishman " para-
sites ; one Malignant
Tertian ring parasite
and two pigmented
leucocytes.
40
Result of examination
of finger blood,
Result of examination
of splenic blood.
SYLHET DISTRICT—contd.
No malaria parasites ; no
pigment ; no other
parasites.
Many " Leishman " para-
sites ; no malaria para -
sites ; no pigment.
Case 48.—Mountaj ; seen in the village of Panch-
gaon ; has been ill 1 year.
Spleen beyond umbilicus. Liver 1 inch below
costal margin.
Case 49 .—Abi Ram ; seen in the village of Panch-
gaon ; has been ill 1 year.
Spleen midway between umbilicus and pubes.
Liver 1 inch below costal margin.
No malaria parasites ; no
pigment ; no other
parasites.
Many " Leishman " para-
sites ; no malaria para-
sites ; no pigment.
Case 50.—Dinai ; seen in the village of Panchgaon ;
has been ill 6 months.
Spleen 1 hand's breadth below costal margin.
No malaria parasites ; no
pigment ; no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 51.—Khuki ; seen in the village of Panchgaon ;
has been ill 7 months.
Spleen beyond umbilicus. Liver not examined.
No malaria parasites ; no
pigment ; no other
parasites.
Scanty " Leishman" para-
sites ; no malaria para-
sites ; no pigment.
Case 52.—Hem Dyal ; seen in the village of Panch-
gaon ; has been ill 8 months ; has cancrurm
oris.
Spleen nearly to pubes. Liver more than 1 hand's
breadth below ribs.
One full-grown Quartan
malaria parasite ; no
other parasites.
Very numerous " Leish-
man" parasites ; scanty
malarial pigment, but no
malaria parasites found.
Case 53.— Jamini ; seen in the village of Panch-
gaon ; has been ill 4 months.
Spleen 1 hand's breadth below costal margin.
No enlargement of liver detected.
No malaria parasites ; no
pigment ; no other
parasites.
Scanty" Leishman " para-
sites ; no malaria para-
sites ; no pigment.
Case 54.—Bipin Bihari, aged 15 years ; an inhabit-
ant of Jaintia ; both hisp a r e n t s a n d t w o b r o t h e r s
have died of kala azar within the last two years ;
has been ill about a year ; at first he had remittent
fever for about 3 weeks followed by relapses at
irregular intervals. He is very emaciated and
his gums bleed on slight pressure ; he has a
chronic ulcer on the leg.
Spleen enlarged beyond umbilicus. Liver 2 inches
below ribs.
No malaria parasites ; no
pigment ; no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment.
Case 55.—Rahim Khan, aged 30 years ; seen in
the village of Kolapara ; has suffered from
irregular fever for 1½ years. He is very emaciated
and the enlarged spleen stands out as an enor-
mous tumour. He is profoundly anæmic.
Spleen enlarged to the crest of the ilium. Liver
1 hand's breadth below ribs.
No malaria parasites ; no
pigment ; no other
parasites.
Very numerous " Leish-
man " parasites ; no
malaria parasites ; no
pigment.
Case 56.—Nojibulla, aged 24 years ; seen in the
village of Kolapara ; has been ill 6 months.
Spleen to umbilicus. No enlargement of liver
detected.
No malaria parasites ; no
pigment ; no other
parasites.
Numerous " Leishman "
parasites ; no malaria
parasites ; no pigment .
41
Result of examination
of finger blood.
Result of examination
of splenic blood.
SY LHET DISTRICT—concld.
No malaria parasites ; no
pigment ; no other
parasites.
Many " Leishman " para-
sites ; no malaria para-
sites ; no pigment.
Case 57.—Sarat ; seen in the village of Kolapara ;
has been ill 1 year.
Spleen and liver enlarged.
Cases 58 to 61. —Idatulla, Satyavama, Fagoo and
Robia. I can find only the finger blood and
spleen blood slides of these patients, and beyond
the notes on the slides, viz., " Sylhet," " typical
case," I have no particulars regarding them.
None of the finger blood
slides contain malaria
or other parasites or
malarial pigment.
In all the spleen blood
slides " Leishman "
parasites, in greater or
less numbers, are pre-
sent ; no malaria para-
sites, nor pigment.
DHUBRI.
No malaria parasites ; no
pigment ; no other
parasites.
Many " Leishman " para.
sites ; no malaria para-
sites ; no pigment.
*Case 62.—Apeswari ; aged 10 years. Said to have
been ill 1½ years.
Spleen enlarged beyond the umbilicus. Liver 1
inch below the ribs.
*Case 63.— Jagat Mohan, female ; said to have died
from bursting of an aneurism.
Spleen and liver greatly enlarged.
Not examine
.
. Many "Leishman " para-
sites ; no malaria para-
sites ; no pigment.
*Case 64.—Pashin, said to be a typical case ; died.
Spleen much enlarged.
Not examine
.
. Many "Leishman " para-
sites ; no malaria para-
sites; no pigment.
Bengal.
DISTRICT OF DACCA.
No malaria parasites ; no
pigment ; no other
parasites.
Many " Leishman " para-
sites ; no malaria para-
sites ; no pigment.
Case 65.—Behari, aged 8 years ; seen at the village
of Kharipagla ; has been getting fever almost
continuously for 4 months.
Spleen to umbilicus. No enlargement of liver
detected.
Case 66.—Jogesh, aged 13 years ; seen in the village
of Kumarbhoga ; suffered from intermittent fever
five months ago in the Bogra district. The fever
lasted about 3 weeks, after which he was well for a
month, then remittent fever for 3 weeks followed
by daily low fever to present time ; is very anæmic.
Spleen beyond umbilicus. Liver 1 inch below
ribs.
A few Simple Tertian
malaria parasites ; no
other parasites.
Numerous " Leishman "
parasites ; some mala-
ria pigment, but no
malaria parasites seen.
Case 67.—Bose ; seen in the village of Kharipagla.
He is an inhabitant of Kalna in the Burdwan
district, where he contracted his disease two years
ago ; is very weak and anæmic, but says he has
improved greatly of late.
Spleen nearly to umbilicus; liver not enlarged.
No malaria parasites ; no
pigment ; no other
parasites.
Very scanty " Leishman"
parasites ; no malaria
parasites ; no pigment.
Case 68.—Umeshori, formerly an inhabitant of the
Burdwan district, where he suffered severely from
" B u r d w a n f e v e r . " H e n o w h a s c o n s i d e r a b l e
œdema of the legs and face, and his spleen and
liver are greatly enlarged.
No malaria parasites ; no
pigment ; no other
parasites.
Many " Leishman " para -
sites ; no malaria para
-
sites ; no pigment.
* The diagnosis in these cases was made by the Civil Surgeon of Dhubri.
G