NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
42
The results of the blood examinations made in this series of cases may be
tabulated thus :—
Number of cases of kala azar
examined.
Number in which the so-called Leishman-
Donovan parasites were found
Number in which evidence of
malaria was found.
68
67
7
Now, these 68 cases had been diagnosed as kala azar before blood examinations
were made, and I have no doubt that all were true cases of the disease.
I believe, therefore, we are justified in concluding that the disease. known as
kala azar is always associated with the presence of the so-called Leishman-
Donovan parasites. Sometimes (according to the above results in about 10
per cent. of cases)* it is associated in addition with the presence of malaria
parasites or pigment, and very often it is associated in addition with the
presence of ankylostomes : doubtless other parasites are also present in many
cases.
The problem for solution is, which of these parasites, if any, is the cause of
kala azar ?
It will be remembered that same years ago one observer, who found
ankylostomes in every case examined, regarded this parasite as the cause of the
disease ; and a few years later another observer, who found evidence of malaria
in every case examined, thought that the malaria parasite must be the cause : so
now that in the disease yet another parasite has been found, it behoves us to
examine with some care the evidence concerning its causal relationship. The
finding of the Leishman-Donovan parasite in a number of cases—and this, I
believe, is the sole ground upon which many observers base their opinion that
this parasite is the cause of the disease—is in itself, of course, no more a proof
of its causal relationship to the disease than is, let us say, the finding of
ankylostomes or of malaria parasites in a number of cases a proof that the
disease is due to either of these organisms. In a country like Assam, where a
large proportion of the population harbour parasites of several kinds, the finding
of any particular one in a patient suffering from some disease affords at the most
a probability that it bears a relation to some of the signs and symptoms present.
But there are other reasons than its presence in every case for the opinion
that the Leishman-Donovan parasite is the cause of kala azar, and, so far as my
experience enables me to do so, I shall summarize them as follows :—
(1) Kala azar is not due to the presence of the Ankylostomum duodenale.
This is agreed upon by all observers.
* Nearly all the patients seen in hospitals had been treated more or less vigorously with quinine ;
if they are excluded, the percentage is between 14 and 15.
43
(2) It is not due to malaria. This has been proved in Section I of the
present report.
(3) It is invariably associated with the presence of the Leishman-Donovan
parasite in the spleen and some other organs of the body.
(4) I failed to find this parasite in the splenic and finger blood of forty-eight
cases of the disease I have described under the term " malarial cachexia," the
signs and symptoms of which are very different from those of kala azar.
(5) The recovery of patients suffering from kala azar is coincident with
the disappearance of the parasite from their spleens ( ? and from other organs).
This was well illustrated in the patient named Godhala (case 15), and we may
assume that it was exemplified also in the patient named Mohan (case 38).
(6) The parasite is present in parts of Assam where kala azar is prevalent,
and apparently it is absent from parts where this disease is unknown (e.g., the
Golaghat district : pages 28 to 30).
This group of facts affords evidence sufficient, one would imagine, to justify
the belief that the Leishman-Donovan parasite is the cause of kala azar : but
the proof is not complete, any more than was the proof of the causal relation-
ship of the malaria parasite to malarial fever until the developmental cycle of
the parasite in the mosquito was established and the experimental infection of
man by the bite of this insect effected. And, in the absence of the conclusive
proof afforded by the experimental production of kala azar, there are certain
facts which require explanation before all doubt that the Leishman-Donovan
parasite is the cause of the disease can be removed from our minds. Perhaps the
most important of these is the presence of the parasite (or of one which in
appearance is indistinguishable from it) in the disease known as Oriental or Delhi
Sore. In a previous memoir* I have drawn attention to the following facts :
(1) a parasite indistinguishable from the Leishman-Donovan parasite is present in
the great majority of ulcers known in India as Oriental or Delhi Sores ; (2) the
sores and the parasites in them occur in the Punjab where I was unable to find a
single case of kala azar ; (3) kala azar and the parasites found in it occur in
Assam where I was unable to find a single case of Oriental Sore. Now, if the
parasite found in Oriental Sore is identical with that found in kala azar, it will be
obvious from these results that two conclusions are justifiable : one is that some
other factor than the mere presence of the parasite in a district is necessary for the
production of kala azar, the other that something more than the presence of the
parasite in the tissues of the skin is necessary for the production of this disease.
Again, if the parasites found in Oriental Sore and in kala azar are identical,
there is, secondly, the fact that in most cases of Oriental Sore, even though
the number of parasites present in the sores may be very great, fever is absent.
* Oriental or Delhi Sore: Scientific Memoirs by Officers of the Medical and Sanitary Departments
of the Government of India, New Series, No. 13.
G 2
44
Some months ago I saw a European on whose body and limbs there were no
fewer than 35 Frontier Sores. In films made from five of the sores (all that
were examined) the parasites were found, and it is reasonable to suppose that
they were present in all, and that the total number of parasites present in the
tissues of this patient was enormous. Yet the patient, although many of the
sores had been present for six months, had not suffered from fever, his spleen
was not enlarged, and the only constitutional symptoms complained of were
attributable to the anxiety and worry caused by the presence of the sores.
I advised him to take two months' leave and gave him careful instructions
regarding the treatment of the sores by local applications. At the end of the two
months he wrote to inform me that all the sores were healed, and that he was
feeling perfectly well. Now, kala azar is a disease characterised by almost
constant fever and very severe constitutional symptoms ; but a parasite indistin-
guishable from that which is said to be the cause of this disease does not produce
fever when present in cases of Oriental Sore: is there any reason to suppose
that a protozoal parasite which is incapable of producing fever when present
in the skin is capable of doing so when present in the spleen ?
The simplest way of getting over these difficulties is to say that the parasites
found in Delhi Sores and those found in kala azar, although indistinguishable in
appearance, are, in reality, distinct, because their geographical distribution is not
the same, and because they produce entirely different pathological effects ; but
are these reasons sufficient ?
Finally, in addition to the difficulties arising out of a study of the parasites
of Oriental Sore, there is a point of some importance in connection with kala
azar and the parasites found in it that is not easy to understand. It is that the
fever met with in cases of kala azar bears no relation whatever either to the
number of parasites present in the spleen or to their condition. I was particularly
struck with this in the patients Hudoo (case 2), Elizabeth (case 1), Mangu
(case 9) and others. In the splenic blood of Hudoo the parasites were present
in enormous numbers, and I marked out the case for special study on account of
the large number of dividing forms of the parasite present. Yet the temperature
carefully taken thrice daily for 33 days only rose above normal on five occasions :
on three occasions it rose to 99°, on one to 101.4º, and on the fifth to 99.8°.
Similar facts were observed in the cases of Elizabeth and Mangu. On the
other hand, I have records of cases in which the temperature, remained continu-
ously high for a long period, yet in which extremely few parasites were present
in the spleen. These facts raise the suspicion that the fever met with at
some time or other in all cases of kala azar is not due to the presence of the
parasite under discussion ; and if it does not cause the fever, may we not
reasonably doubt that it causes any of the other signs and symptoms ?
45
So far as my experience enables me to do so, I may therefore summarize
the evidence against the Leishman-Donovan parasite being the cause of kala
azar somewhat as follows:—
(1) Although I found the Leishman-Donovan parasite in 67 out of 68 cases
of kala azar, this finding, taken alone, affords no proof that the parasite is the
cause of the disease. Let us suppose, for the purpose of illustrating this truth,
that I had found the malaria parasite in 50 successive cases—and it is possible
that, if one were permitted to select the cases carefully, such a result could be
obtained—it would afford no proof that the malaria parasite is the cause of the
disease, because by methods which are unimpeachable I have shown that kala azar
is not due to this parasite. (See Section I.)
(2)Although the Leishman-Donovan parasite is present in every case of
kala azar—a disease in which enlargement of the spleen, fever, and wasting
are prominent features—it (or a parasite indistinguishable from it) is also
present in every case of Oriental Sore—a mild local disease in which constitu-
tional signs and symptoms are absent.
(3)Although the parasite is abundantly present in parts of India where kala
azar is prevalent, it (or a parasite indistinguishable from it) is also present in parts
of India where this disease is unknown. If it produces kala azar in one part of
India, why not in another ? Obviously some other factor than the parasite is
necessary for the production of this disease.
(4)Even when enormous numbers of parasites indistinguishable from the
Leishman-Donovan parasite are present for many months in ulcers on the
bodies of persons, no disease like kala azar results.
(5)There is no evidence to prove that the fever observed in cases of kala
azar is due to the presence of the parasites ; the fever in kala azar bears no
relation either to the number or condition of the parasites present : and there is
evidence that parasites indistinguishable from the Leishman-Donovan parasites
(namely, the parasites of Oriental Sore) are incapable of producing fever. If the
parasites found in kala azar do not cause one of the chief, and earliest, signs
of the disease, is it not reasonable to assume that they do not cause the other
signs and symptoms present ?
(6)Until kala azar has been produced experimentally by some form or other
of the parasite, it will be necessary, before the causal relationship of the parasite
to the disease is established on sure grounds, to prove that every other kind
of parasite which has been found in the past, or may be found in the future, in
patients suffering from kala azar has no causal relationship to the disease.
This has already been done with regard to the malaria parasite and the
Ankylostomum duodenale, but it is not impossible that other parasites, not yet
discovered, may have some share in the production of the disease. So far as
46
I am aware, the recently-discovered fluke Schistosomum cattoi* has not yet been
looked for in patients suffering from kala azar, and it is daily becoming more
evident that our knowledge regarding even mammalian blood parasites is not yet
complete.
(7) Although I consider that the finding of the Leishman-Donovan parasite in
67 out of 68 cases of kala azar justifies me in saying that in all probability the
parasite is present at some period or other in every case of this disease, the number
of cases examined is, after all, comparatively small, and it seems to me not
impossible that cases of kala azar may be found in which the parasite is not present.
When some able clinician gives us a complete account of the symptomatology
of kala azar, this problem can be studied more easily.
It is not with any idea of attempting to minimize the great importance of the
Leishman-Donovan parasite that I bring forward these objections, the answers to
some at least of which are possibly not far to seek, but rather because, in these
days of rapid discovery and hasty deduction, it behoves some of us, at any rate,
to be cautious ; and therefore, at the risk of being considered unnecessarily so,
I would express the opinion that until proof more conclusive than has yet been
adduced is forthcoming, we shall be wise if, while we agree that the Leishman-
Donovan parasite is present in every case of kala azar, we suspend our
judgment concerning its causal relationship to the disease.
* The symptoms of the disease produced by this parasite are said to be : enlargement of the liver and
spleen, morbid appetite, diarrhœa, fever, anæmia, cachexia, ascites, etc.
47
IV
T HE following are some opinions I have formed as a result of the work
described in this paper and in my previous paper upon Oriental Sore :—
1. Kala azar is a disease distinct from every other. Its symptomatology
requires to be re-written.
2. It has no connection with malaria, and its presence and spread depend
upon conditions different from those requisite for the presence and spread of
that disease. It exists in some places where malaria is not present, and is
absent from some places where malaria is intensely prevalent.
3. Its geographical distribution in India is more limited than that of
malaria. Subject to correction as a result of further study, I would say at present
that it is confined to low-lying, more or less water-logged districts where the rain-
fall is heavy. I was unable to find a case in the Punjab. As regards Assam, it
appears to be most prevalent at present in the Sylhet district, but it is common
in the Goalpara, Kamrup, Darrang, and Nowgong districts, and perhaps in some
others that I did not visit. I believe that it does not occur in the Golaghat
and some other districts (pages 27 to 30).
4. In all probability the Leishman-Donovan parasite is present at some
period in every case, and very probably is the cause of the disease, but the proof
is by no means complete.
5. The geographical distribution of Oriental Sore and of kala azar and
therefore of the parasites found in these two diseases do not correspond, and it
is probable that the parasites of these diseases, though indistinguishable in
appearance, are different species of a hitherto unknown group of organisms.
Probably other species will be discovered in the near future ; we may conjecture
that they will be found in other diseases than Oriental Sore and kala azar.
6. True "malarial cachexia" must still be regarded as an important disease
in India. I have endeavoured to show in this paper that erroneous ideas regard-
ing its signs and symptoms and its fatality have existed and have attempted to
correct them.
7. The prevailing idea that Assam as a whole is intensely malarious is wrong :
a great portion is only very slightly so, and in some parts the disease does not
occur. I examined a number of tea-gardens and found only one in which the
amount of malaria approached that in the tea-gardens of the Darjeeling Duars.
G. I. C. P. O.—No. 455 S. C —15-9-1905.—1140 —Marum.
Chart 1.
Name, Hira.
Age 14 Years.
Disease, Malarial Cachexia.
Chart II.
Name. Hira.
Disease, Malarial Cachexia.
Chart III.
Name, Baghan .
Disease, Malarial Cachexia.
Chart IV.
Name, Baghan.
Age 10 Years.
Disease, Malarial Cachexia.
Chart V.
Name, Man Singh.
Ag e 1 2 Ye a r s .
Disease, Malarial Cachexia.
Chart VI.
Chart VII.
Name, Man Singh.
Disease, Malarial Cachexia.
Name, Amir Khan.
Disease, Malarial Cachexia.
Chart VIII.
Name, Amir Khan.
Age 25 Years.
Disease, Malarial Cachexia.
Name, Bongi.
(Case 35.)
Age 20 Years.
Disease, Kala Azar.
Chart IX.
Chart X.
Name, Sindhoo.
(Case 31.)
Age 30 Years.
Disease, Kala Azar.
Chart XI.
Chart XII.
Name, Toolsa.
(Case 33.)
Age 22 Years.
Disease. Kala Azar .
Name, Godhala.
Case 15.
Age 25 Years.
Disease, Kala Azar.
No. 19.
(NEW SERIES. )
SCIENTIFIC MEMOIRS
BY
OFFICERS OF THE MEDICAL AND SANITARY DEPARTMENTS
OF THE
GOVERNMENT OF INDIA.
ON KALA AZAR, MALARIA AND MALARIAL CACHEXIA.
BY
CAPTAIN S. P. JAMES, M.B., I.M.S.
ISSUED UNDER THE AUTHORITY OF THE GOVERNMENT OF INDIA
BY THE SANITARY COMMISSIONER WITH THE GOVERNMENT
OF INDIA, SIMLA.
CALCUTTA:
OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING, INDIA.
1905.
Price Re. one Annas four or 1s. 11d.
ICAR. 15. X / 600
Vol. X
1940
THE
Indian Journal of Veterinary Science
AND
Animal Husbandry
Issued under the authority
of
The Imperial Council of Agricultural Research
Annual subscription
Price per part
Rs. 6 or 9s. 9d.
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PUBLISHED BY THE MANAGER OF PUBLICATIONS, DELHI
PRINTED BY THE MANAGER, GOVERNMENT OF INDIA PRESS, NEW DELHI
1941
Price annas 5 or 6d.
The Indian Joural of Veterinary
Sciece and Animal Husbandry
EDITORIAL COMMITTEE
P. M. KHAREGAT, C.I.E., I.C.S., Vice-Chairman, Imperial Council of Agricultural
Research.
W. BURNS, C.I.E., D.Sc., I.A.S., Agricultural Commissioner with the Government of
India.
F. WARE, C.I.E., F.R.C.V.S., F.N.I., I.V.S., Animal Husbandry Commissioner with
the Government of India.
RAO BAHADUR B. VISWANATH, F.I.C., F.C.S., Director, Imperial Agricultural Research
Institute, New Delhi.
F. C. MINETT, D.Sc., M.R.C.V.S., Director, Imperial Veterinary Research Institute,
Mukteswar.
J. N. MUKHERJEE, D.SC., Ghosh Professor of Chemistry, University College of Science
and Technology, Calcutta.
JAMES N. WARNER, M.SC., Professor of Animal Husbandry and Dairying, Allahabad
Agricultural Institute, Allahabad.
S. BASU, I.C.S., Secretary, Imperial Council of Agricultural Research.
EDITOR
F. M. DE MELLO, B.A., B.Sc. (ECON.)
The Editorial Committee, in its work of examining papers received for publica-
tion, is assisted in an honorary capacity by a large number of scientists working in
various parts of India.
Contributions and books and periodicals for review should be addressed to the
Secretary, Imperial Council of Agricultural Research, Publication Section, New
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Communications regarding subscription and advertisements should be addressed
to the Manager of Publications, Civil Lines, Delhi.
ORIGINAL ARTICLES.
A SHORT HISTORY OF AYURVEDIC VETERINARY
LITERATURE
BY
LESLIE HAMILTON SHIRLAW, B.A. (HONS.) (LOND.)
(Received for publication on 17 January 1940)
I. INTRODUCTION
T HE work of the would-be chronicler of India's remoter past is greatly-
complicated by an entire absence of exact literary chronology ; and
the conscientious historian must endeavour to strike a middle course
between the over-ardent claim of some Hindus to a fabulous antiquity for
their culture, and the disinclination of European scholars to admit the
very great age of any book, thought or institution that is not Greek. Bhandar¬
kar himself warns his fellow countrymen against the ' most uncritical spirit
that had come over us of praising ourselves and our ancestors indiscriminately,
seeing nothing but good in our own institutions and in our ancient literature,
asserting that the Ancient Hindus had made very great progress in all the
sciences
greater even by far than Europe has made hitherto', and finding
' in the Rigveda an allusion to X-rays, railways and what-not '. But, while
this is not the place to discuss the relationship between the Indian and Greek
systems of medicine, it is important to note that the greatest authorities on the
subject [Wise, Royle, Dietz, Hoernle and Macdonnell] are unanimous in
ascribing a pre-Hippocratian date to the Golden Age of Hindu medicine, and
that there is considerable justification for the contention that Egyptian,
Greek and Arab, and, consequently, modern European medicine owe more
than is generally recognized to the early inhabitants of India.
Though it is reasonable to suppose that the ancient peoples of India
practised a primitive kind of veterinary surgery, performing such operations
upon their more valuable animals as they did upon each other, the writer is
inclined to disagree with Drs. Mitra and Iyer in their contention that veterinary
medicine developed contemporaneously with human medicine. Indian
fables and writings point to primitive medicine as having been originally
learnt from observation of the behaviour of the lower animals in disease. It is
known that dogs eat grass to excite vomiting, that the bear cures his stomach
disorders with leaves of arum ; that the deer applies leaves of dictamnus to his
wounds ; and that the licking of salt is natural to buffaloes, horses and camels.
There is an Indian fable that the mongoose poisoned by a snake applied Mimosa
octandra as an antidote. The medicinal use of hellebore was believed in ancient
times to have been revealed to man by the goat. One verse of an Atharvavedic
hymn runs :—
' Well doth the wild boar know a plant,
The mongoose knows the healing herb,
Plants are known to the sylvan beasts. . . . '
which would seem to prove that the Indians of old recognized that animals
could distinguish medicinal plants, and that they themselves made use of
their example.
1