2
extended. He found that the disease attacked persons of all ages, but that children were,
on the whole, more liable to be attacked than those of a more mature age. Both sexes suffer
equally from the disease, and all classes are attacked by it, though, in his opinion, the
mortality is greater among the poorer classes. He had reason to believe that opium-
eaters did not suffer so much from the disease as those who were not addicted to that
habit.
5. He found that the principal symptoms of the disease were the following :
(a) Fever is the most constant feature of the disease, and is of an intermittent or
irregularly remittent type. The fever usually relapses several times during
the course of the illness, and a marked characteristic of it is that, after two
or three attacks, the patient is often not aware that he is suffering from fever,
though his temperature may be as high as 103°.
(b) The spleen is enlarged in every well-defined case of kála-azár, and in most
cases it is very much enlarged.
(c) The liver was found to be enlarged in 93 per cent. of 70 cases examined, and
in about one-quarter of the cases the enlargement was very great.
(d) Anœmia, as shown by the pallor of the conjunctiva, was present in 93 per cent.
of the cases examined, and was markedly present in 62 per cent. of the cases.
(e) Dropsy was met with in about one-third of the cases. In some cases there was
slight œdema of the feet, and in others there was marked swelling of the
lower extremities. Œdema of the face was found to be very rare. This is a
marked contrast to the œdema of anchylostomiasis, which is most frequently
seen in the eye-lids and cheeks.
(f) The heart was found to be smaller than normal, chiefly due to the general
wasting of the body. Cardiac and venous murmurs were very rare. In
anchylostomiasis hcemic murmurs are frequent.
(g) Changes in the nervous system are very slight.
(h) Pneumonia and diarrhoea are frequently met with in the later stages of the
disease, and often play an important part in bringing about a fatal result.
These symptoms are very similar to those of chronic malarial fever, and, in order to
observe cases of chronic malaria in a place in which kála-azár was not known to exist,
Dr. Rogers visited Sylhet, and the Civil Surgeon of that station, after several days'
search, was able to collect six well-marked cases of that disease. Dr. Rogers found that
the symptoms were almost identical with those of kála-azár, but he found that in Sylhet
chronic malarial fever required as many years to develop the extreme form of malarial
cachexia as kála-azár produced in as many months.
Dr. Rogers found that the mortality from kala-azar was very great. He was of
opinion that in villages in Nowgong and Mangaldai the death-rate was over 90 per cent.,
and in a severe outbreak in a garden in the Nowgong district he found that 96 per cent.
of those attacked died. This is a marked contrast to the mortality from anchylostomiasis,
in which disease the death-rate is stated not to exceed 8 per cent.
In pages 57-76 of the report he gives the notes of 12 cases of kála-azár. These
notes give a clear idea of the symptoms of the disease as observed by him. Opposite
page 57 there is a photograph often persons who were suffering from kála-azár in the
Nowgong dispensary in August 1896. This photograph shows in a very graphic manner
the general appearance of advanced cases of kála-azár.
6. In Section IV, Dr. Rogers compares the blood changes found in kála-azár with
those observed in anchylostomiasts. As he was under the impression that the blood of
healthy natives of Assam differed from the European standard, he first made experi-
ments in order to find the standard of ordinary natives of the country. By a series of
experiments he found that the average composition of the blood in healthy natives and
in cases of kála-azár, chronic malaria, and anchylostomiasis was as under :
—
1
Healthy natives
Kála-azár
Chronic malaria
Anchylostomiasis
...
Amount of
hæmoglobin.
2
62 per cent.
33.45 „
31.6
„
15.16
„
Number of red
corpuscles in a
cubic millemetre.
3
4,734,000
2,462,000
2,000,000
1,145,000
Hæmoglobin
value.
4
•65
•65
•73
•31
Number of
white
corpuscles.
5
7,325
2,600
1,600
5,338
Proportion of
white to red.
6
1 to 684
1 „ 1,170
1 „ 1,400
1 „ 524
Specific gravity.
7
1,054
1,048
1,042
1,034