NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
INDEX TO VOL. II.
XV
Para. Page.
Report, Sanitary, Monthly
...
. . .
...
. . .
...
16
112
————
Q uarterly ...
. . .
. . .
. . .
. . .
16
112
Reports and Returns, annual, from Police Hospitals
. . .
. . .
. . .
117
129
— — — — — t o i n c l u d e s t r e n g t h , s e r v i c e , a n d a g e o f t r o o p s
...
23
114
— detailed, of fatal cases
. . .
. . .
...
...
30
115
— Monthly, from Police Hospitals ...
. . .
. . .
. . .
116
129
— on arrival of Transports at their destination ...
. . .
...
29
139
— on persons of intemperate habits
. . .
...
...
29
24
Resident Medical Officer's duties at General Hospital
...
...
13
55
Responsibility on account of Indents
...
. . .
. . .
...
8
2
Return, annual, from Jail Hospitals
...
...
. . .
... 113
129
— and Reports, annual, from Civil Hospitals ...
...
. . .
108
127
——————— from Lock Hospitals ...
...
... 105
127
————— from Lying-in Hospital
. . .
. . .
. . .
66
66
————— instructions to Medical Officers in making up
...
32
115
— book, miscellaneous ...
. . .
. . .
. . .
. . .
1
107
— Monthly, from Jail Hospitals
...
. . .
...
... 112
128
— of expenditure of Medical Comforts . . .
. . .
. . .
...
85
147
— of men proposed to be invalided ...
...
...
...
22
47
— of monthly Staff
...
...
...
. . .
...
31
115
———— sick from Civil Hospitals
...
...
... 107
127
————— from General Hospital
...
. . .
. . .
5
53
— — — — — f r o m L o c k H o s p i t a l s
. . .
...
... 104
127
— of sick of an Army in the field. ...
. . .
. . .
. . .
100
126
— of surgical operations ...
. . .
...
. . .
... 102
126
— of weekly sick
...
...
. . .
. . .
...
99
126
— of wounds ...
...
. . .
. . .
. . .
... 100
126
———— in Hospital ...
. . .
...
...
... 101
126
— Quarterly, Statistical ...
...
. . .
. . .
...
19
113
Returns of Invalids
...
. . .
. . .
. . .
. . .
10
43
——— Statistical and Sanitary
. . .
. . .
...
...
16
112
Rolls to state if men are married or single
. . .
. . .
. . .
80
147
Route to be named in Medical Board's Proceedings,
...
. . .
19
21
Royal Warrant of 1860
...
. . .
. . .
. . .
. . .
—
185
————
of 1866, extract from
...
. . .
...
. . .
—
187
Rules for indenting on Commissariat Department ...
. . .
. . .
1
1
— for official correspondence
. . .
...
...
. . .
1
102
—
general, for Lunatic Asylums
...
. . .
. . .
...
75
86
—
in regard to Transports, strict observance of
. . .
...
. . .
43
141
—
to be observed in applying for Stationery supplies
. . .
. . .
37
10
Sale of Commissions, B. M. S.
. . .
...
...
...
20
21
—
o f l i q u o r
o n
b o a r d - s h i p , p r o h i b i t e d
...
. . .
. . .
...
99
150
Sanitaria, Soldiers not to be kept too long at
. . .
. . .
...
9
42
Sanitary Annual Report
...
. . .
. . .
. . .
...
16
1 1 3
——
arrangements in Lunatic Asylums
...
...
...
65
85
————— on Transports
s . . .
. . .
...
...
90
149
xvi
INDEX TO VOL. II.
Para. Page.
Sanitary Boards
. . .
. . .
. . .
...
...
...
1
16
—— Committees, Special
. . .
...
...
...
7
17
—— Monthly Report
. . .
. . .
. . .
...
...
16
112
—— Quarterly Report
...
. . .
...
...
...
16
113
Scale of rations, &c., for troops on sea voyages
...
...
...
14
132
Scholarship, Government
. . .
. . .
...
...
...
18
156
— — — L a n e
. . .
. . .
...
...
...
19
156
Screens in Transports
. . .
. . .
...
...
...
54
143
Sealed statement of case to be given to patient
...
...
...
56
31
Second Department, Medical College, admission to ...
...
...
13
153
Selection of Principal and Professors of Medical College
...
...
3
152
—— of recruits
. . .
. . .
...
...
...
7
99
Senior Department, Medical College, admission to ...
. . .
...
12
153
Serjeant, Hospital, of General Hospital
. . .
...
...
...
21
57
———— tent for
. . .
. . .
...
...
...
11
161
Servants by P. & O. or B. I. S. N. Company's steamers
...
...
36
140
—— of Officers and Troops, passage for
...
...
...
35
140
Service bearing letters
. . .
. . .
...
...
...
14
105
Shipwrecks and accidents, Port Surgeon's duties during
...
...
7 2
68
Short-service men, discharge of
. . .
...
...
...
37
51
Sick at General Hospital, report for Brigade-Major of
...
...
7
54
————— return of Military
...
. . .
...
5
53
— c a r r i a g e f o r N a t i v e d e t a i l s
. . . ...
. . .
...
25
163
— — — f o r E u r o p e a n s
. . .
. . .
...
. . .
...
13
161
— — — f o r I n v a l i d s
. . .
. . .
...
. . .
...
22
162
— Carts and Waggons, cattle for
. . .
...
...
...
27
163
— Details landing, Fort Surgeon or Medical Subordinate to be present ...
82
147
— Fort Surgeon to be informed of landing of
...
. . .
...
75
146
— i n T r a n s p o r t s , s p a c e o c c u p i e d b y , n o t t o b e s c r u b b e d
. . .
...
44
141
———— space of, not to be occupied by Effectives ...
...
41
141
— left in Egypt, clothing, &c., of
. . .
...
...
...
12
132
— m a r r i e d S o l d i e r s t o b e s e n t t o P o o n a m a l l e e
...
. . .
...
77
147
— M e d i c a l O f f i c e r o r S u b o r d i n a t e t o l a n d w i t h
...
. . .
...
81
147
— Medical supplies to, while passing through Egypt
. . .
...
11
132
— Officers arriving at Madras
. . .
...
. . .
...
46
28
——— Indian Medical Department
. . .
...
. . .
...
23
21
——— transfer of Medical charge of
...
. . .
...
40
26
— Orderlies to be sent with
. . .
...
. . .
...
84
147
— Soldiers received by transfer without cases
...
. . .
...
25
48
——— women and children, embarkation of ...
. . .
...
28
138
— to be located iu best parts of Transports
...
. . .
...
40
141
— t r a n s i t t h r o u g h E g y p t o f t h e
. . .
...
. . .
...
8
131
— u n m a r r i e d S o l d i e r s t o b e s e n t t o E u r o p e a n R e g i m e n t a l H o s p i t a l , M a d r a s . 76
146
Sickness, undue, occurring in Transports
...
...
...
89
149
Simplicity of prescribing medicines enjoined
...
. . . ...
19
7
Sleeping on deck prohibited ..
. . .
...
. . .
. . .
94
150
INDEX TO VOL. II. xvii
Para. Page.
Soldiers, Boards for examination for re-engagement of
. . .
...
4
16
———— discharged from Hospital
...
. . .
. . .
. . . 79
147
Staff Return, monthly
. . .
...
...
. . . ...
31
115
Space allotted to troops embarking from Port to Port in India or on expedi-
tions ...
. . .
. . .
. . .
. . .
. . . 30
139
——— and accommodation allowed for European Troops proceeding in
Transports to England viâ the Cape
...
. . .
... 45
141
——— and area for Lunatic patients ...
. . .
. . .
... 66
85
——— for Invalids, Pensioners, and Time-expired men on Transports
... 61
144
——— in Emigrant Ships
...
...
. . .
...
...
8
169
Special Committees for examination of men unfit for farther service
... 35
50
——— Hospitals ...
. . .
...
. . .
...
... —
52
Standing berths for Invalids ...
...
. . .
. . .
... 68
145
Station to be named in medical certificates
...
...
...
48
28
Stationery, certain kinds not allowed for Hospitals ...
. . .
... 32
9
———— Estimates
. . . ...
. . .
. . .
... 34
9
———— Indent s
...
...
. . .
. . . ... 35
9
29
9
— — — — — — — f o r m s o f . . .
...
...
...
... —
12
— — — — — — — — t o b e c o r r e c t l y p r e p a r e d
...
...
.... 31
9
— — — — S u p p l i e s , r u l e s f o r o b t a i n i n g . . .
...
. . .
... 37
10
———— to be obtained from Stationery Depôt only
. . .
... 33
9
Statistical and Sanitary Returns and Reports from Depôts
...
...
17
112
———— Nomenclature ...
...
...
...
...
1
106
———— Quarterly Return ...
...
. . .
. . .
... 19
113
Steamers, space in Indian coasting
...
. . .
. . . ...
32
140
Stewards, General Hospital ...
...
. . .
...
... 18
57
Stores and Medical Comforts on Transports
. . .
. . .
... 58
144
————————————————— issue of ...
. . .
... 59
144
Strength, service, and ages of Troops to be inserted in Reports and Returns
23
114
Students' attendance at Eye Infirmary ...
...
. . .
... 48
63
———————— at General Hospital ...
...
. . .
... 33
60
———————— at Lying-in Hospital
...
. . . ... 59
65
———— at Medical College, classes of ...
...
. . .
... 11
153
———— Female, at Lying-in Hospital ...
. . .
...
...
6 0
66
———— Military, at Medical College, education of ...
. . .
...
9
153
—————— cour se of st udy f or ...
. . .
...
... 15
153
—————— discipline of
...
. . .
...
... 16
154
———— Private, at Medical College ...
. . .
...
... 20
157
Substitutes in rations, scale of
...
. . .
...
... 19
136
Superintendent of Lunatic Asylum, duties of
. . .
...
... 94
88
—————— of Lying-in Hospital
...
. . .
...
... 55
65
Supply room on Transports ...
...
. . .
. . .
... 57
144
Surgical operations, return of
...
. . .
. . .
... 28
114
Survey at out-ports of Transports
...
...
. . . ... 25
138
— — — B o a r d s o f . . .
...
...
. . .
. . . ... 3
16
3
xviii
INDEX TO VOL. II.
Para. Page.
Survey of Transports
...
...
...
. . .
...
23
138
————— for Native Troops
...
. . .
. . .
...
79
69
Table expenses of Officers' families in Transports
...
. . .
...
46
142
Tarpaulins for flooring of tents
...
. . .
...
...
28
163
Tattoos or Riding Bullocks
...
...
...
...
...
16
162
Telegraphic messages
...
...
. . .
. . .
...
15
105
Tent for Hospital Serjeant
...
...
. . .
. . .
...
11
161
Tents for Provision Department, Hospital clothing, and cover of medicines
1
160
— for Warrant Officers ...
...
. . .
. . .
...
12
161
— Hospital, for European Troops
...
. . .
...
...
3
160
———— for Native Troops
...
...
...
...
4
160
———— for Royal Artillery
...
. . .
. . .
...
9
161
— Necessary ...
...
...
...
...
...
8
161
— used for Cholera Hospitals, purification of ...
. . .
...
7
161
Text Books for Medical College
...
. . .
. . .
...
25
157
Tonnage allowed to officers and men in Transports ...
. . .
...
39
141
Transfer of medical charge of sick officers
. . .
. . .
...
40
26
—— of Military patients for diseases of the eye ...
. . .
...
43
63
Transit of the sick through Egypt
...
...
. . .
...
8
131
Transport, definition of term
...
. . .
. . .
...
1
130
Transports, area how calculated
...
. . .
. . .
...
24
138
——— articles to be supplied by owners of
...
...
...
56
143
——— authorities to grant passages on
...
...
...
27
138
——— Dispensary in ...
...
. . .
...
42
141
52
143
——— engagement of ...
...
. . .
...
...
22
137
— — — f o r N a t i v e T r o o p s , s u r v e y o f
...
. . .
. . .
...
79
69
——— final report before sailing of all correct on
...
...
60
144
——
— Hospital in
...
...
...
. . .
...
51
142
———
Indian, medicines in
...
...
. . .
...
13
132
——— Invalids and Insanes proceeding on
...
. . .
...
63
144
— — — p r i s o n a n d
s u p p l y
r o o m
i n ...
. . .
. . .
...
57
144
———
reports on arrival at their destination of
. . .
...
29
139
———
sick to be located in best parts of
. . .
. . .
...
40
141
——— space for Invalids, Pensioners, and Time-expired men
...
61
144
——— space for women and children
. . .
. . .
...
62
144
———
space occupied by sick not to be scrubbed
. . .
44
141
52
143
——— strict observance of rules in regard to
...
. . . ...
43
141
———
survey of
. . .
...
. . .
. . .
...
23
138
————— at out-ports of
...
. . .
...
... 25
138
——— to England via the Cape, accommodation and space allowed for
European Troops proceeding in
. . .
. . .
...
45
141
———
undue sickness occurring in ...
. . .
. . .
...
89
149
Travelling expenses for discharged lunatics
. . .
. . .
...
28
75
Troopships, Indian, passengers in
...
. . .
. . .
...
2
1 3 0
Troops, embarkation of, under orders of Quarter Master-General
...
26
138
INDEX TO VOL. II. xix
Para. Page.
Trusses, requisitions for
...
...
. . .
. . .
. . . 26
8
Uncovenanted Civil Service, certificates for leave . . .
. . .
... 69
34
Unmarried Soldier Invalids ...
....
. . . . . .
. . . 5
42
Unserviceable articles, how disposed of ...
. . .
. . .
... 22
7
Utensils and Instruments, certain not to be entered as expended
... 22
7
Vaccination of Lunatic patients
...
. . . ...
... 31
75
— — — — — r e g i s t e r . . .
...
. . . ...
...
1
107
Vegetables and fruits for men on Transports
. . .
. . .
. . .
98
150
Ventilation of Lunatic Asylums ...
...
. . .
... 67
85
Victualling of followers on board coasting steamers . . .
...
... 37
140
Visits to General Hospital of Deputy Inspector-General
. . .
...
3
53
Visitors' Book, Lunatic Asylums
...
...
...
...
5
70
————————————— copy of remarks for Government
...
5
70
——— to patients in General Hospital ...
. . .
. . .
. . .
32
60
——— official, of Lunatic Asylums
...
. . .
...
. . .
2
70
Vouchers and Indents
...
...
. . .
...
. . .
—
1
Ward book
. . .
...
...
. . .
. . .
...
2
107
——— coolies, General Hospital
...
. . .
. . .
. . .
25
58
Warrant of 1860 ...
...
...
. . .
. . .
. . .
—
185
——— of 1866, extract from
...
...
. . .
. . . —
187
——— Officers, accommodation in Transports for ...
. . .
... 49
142
— — — — — — — t e n t s f o r ...
...
. . .
. . .
... 12
161
Washing on board
...
...
...
...
... 96
150
Water closets in Transports ...
...
...
. . .
... 55
143
——— on board Transports ...
...
. . .
. . .
... 18
136
Weekly Return of sick
. . .
...
. . .
. . .
... 99
126
— — — — — — — — f r o m G e n e r a l H o s p i t a l
. . .
. . .
... 18
113
Wellington, selection of cases for change to
. . .
. . .
. . .
6
42
Windsails
. . .
. . .
...
. . .
. . .
. . .
71
146
Women and children in Emigrant Ships ...
. . .
. . .
. . .
8
170
— — — — — — — — s p a c e , & c . , i n T r a n s p o r t s f o r ...
. . .
... 53
143
Wound pension ...
. . .
...
. . .
...
... 29
49
Wounded men, invaliding of
...
. . .
. . .
... 27
49
———— officers applying for compensation on the spot, proceedings of
Medical Board on,
. . .
. . .
... —
19
——————— duties of Medical Boards on
. . .
. . .
... 30
24
—————— form of proceedings of Medical Board on,
... 12
19
Wounds, &c., in Hospital, return of
...
. . .
. . .
... 101
126
——— return of ...
...
...
. . .
. . .
... 100
126
Writer, General Hospital
. . .
...
...
. . .
. . . 20
57
m.63.d 91.e
REPORT ON KALA-AZAR.
REPORT
OF
AN INVESTIGATION OF THE EPIDEMIC OF
MALARIAL FEVER IN ASSAM.
OR
KALA-AZAR.
BY
LEONARD ROGERS, M.B., B.S., London, F.R.C.S., Eng.,
SURGEON-CAPTAIN, INDIAN MEDICAL SERVICE.
SHILLONG :
PRINTED AT THE ASSAM SECRETARIAT PRINTING OFFICE.
1897.
SHILLONG :
PRINTED BY THE SUPERINTENDENT OF ASSAM SECRETARIAT
PRINTING DEPARTMENT.
SUMMARY OF CONTENTS.
SECTION I.
The history of kála-ázar.—The first description of the disease in 1883,
pages 1-3; further spread of the disease up to 1889, and the
early views as to its nature, pages 3-5 ; appointment of Dr.
Giles to report on kála-ázar and beri-beri of Ceylon, page
6 ; results of Dr. Giles' investigations illustrated by abstracts
from his report, pages 6-13 ; report of Dr. Campbell supporting
Dr. Giles' conclusions, page 14 ; Dr. Dobson's work throwing
doubt on Dr. Giles' conclusions, page 15 ; opinions of the various
Administrative Medical Officers and Civil Surgeons of the
province from 1891 to 1895, pages 16-19 ; determination to have
a re-investigation of the question, page 20.
SECTION II.
The nature of the problem, plan of work, and course of the inves-
tigation.—The nature of the problem, pages 21-22 ; plan of work,
pages 22-25 ; early clinical and pathological work, page 26; the
disease found to be indistinguishable from ordinary malarial fever
in its early stages, pages 26-27; the anæmia is in proportion to
the fever, and is of a different type to that produced by anchy-
lostomiasis, page 28 ; anchylostoma are only present in small
numbers in kála-ázar, as in healthy persons, page 28; the disease
in its later stages resembles ordinary chronic malaria, but is
much more intense, pages 29-30 ; cold-weather tours, page 30.
SECTION III.
Clinical description of kála-ázar with illustrative cases and treat-
ment.—Necessity of full clinical description, page 31; definition
of the disease, page 31 ; the diagnosis, pages 31-32; the distribu-
tion of the disease, pages 31-32 ; general description of kála-ázar,
pages 33-34; the duration of the disease, page 35 ; the seasonal
incidence, page 35 ; age and sex, page 36; predisposing
and opposing causes, page 37 ; constancy and type of the
fever, pages 38-41 ; enlargement of spleen and liver, pages
iv
CONTENTS.
41-45 ; anæmia, page 45 ; dropsy, page 46 ; the circulatory
system, pages 47-48 ; nervous system, page 49 ; respiratory and
digestive systems, pages 50-51 ; progress and termination, page
52 ; frequency and number of anchylostoma in kála-ázar, pages
53-55 ; the death-rate, pages 55-56 ; illustrative cases, pages
57-76 ; an early case successfully treated, pages 74-76 ; treat-
ment of kála-ázar, page 76 ; in the early stages, pages 77-81 ;
the value of quinine, pages 78-79 ; treatment in the later stages,
p a g e s 8 1 - 8 2 .
SECTION IV.
The blood changes in kála-ázar and anchylostomiasis.— Importance
of and methods of investigation used, page 83 ; blood standard
of healthy Assamese, and the influence of small and large
numbers of anchylostoma on it, pages 84-87 ; blood changes in
kála-ázar, pages 87-89 ; blood changes in ordinary chronic
malaria, page 90 ; blood changes in anchylostomiasis, pages
90-91 ; in mixed cases, pages 92-94 ; table showing the types of
anæmia in the preceding diseases, page 95 ; explanations of
the differences met with, pages 96-99 ; confirmation of results in
medical literature, pages 99-100.
SECTION V.
The pathology and nature of kála-ázar.—Changes met with post-
mortem, page 100 ; external appearances, and cardio-vascular
system, page 101 ; respiratory and digestive systems, pages 102-
104 ; number and effects of anchylostoma, pages 104-106 ; the
liver, page 107 ; spleen, page 108 ; cerebrospinal system, page
109 ; bone marrow, page 109 ; microscopical anatomy, pages
1 1 1 - 1 1 3 ; a n a l y s i s o f i r o n i n t h e l i v e r , p a g e s 1 1 3 - 1 1 5 ; b a c t e r i o l o g y ,
pages 115-117 ; the malarial organism, page 118 ; the nature of
k á l a - á z a r ,
is it anchylostomiasis ? pages 117-121 ; is it a com-
bination of both anchylostomiasis and malaria? pages 121-125 ;
is it only an intense form of malarial fever ? pages 125-128 ; is it
a new disease ? page 128.
SECTION VI.
The general course and distribution of the epidemic.— The ravage
of the disease, page 129 ; the decrease of the population in the
affected districts, pages 130-132 ; the decrease of land under
CONTENTS.
V
cultivation in the affected districts, pages 132-133 ; description
of chart showing the increased mortality due to the epidemic,
pages 133-136 ; seasonal distribution, page 136 ; relation to
ground water-level, page 137 ; relation to sanitary conditions,
page 138 ; distribution in the villages, pages 138-139 ; the recent
spread of the epidemic in Mangaldai and Nowgong, pages 140
- 1 4 3 ; i n D a r r a n g , p a g e s 1 4 3 - 1 4 5 ; s u m m a r y o f t h e s e c t i o n , p a g e s
145-146.
SECTION VII.
On the communicability of kála-ázar.—Difficulty of tracing the mode
of spread of the disease, page 147 ; a morning's inquiries in
affected villages, pages 148-153 ; evidence obtained in Mangaldai
villages, page 153 ; the effect of moving an affected village from
the old site, pages 154-155 ; the peculiar distribution of the
affected villages, pages 155-159 ; introduction of the disease into
Tezpur town, pages 159-160; infection in Europeans, page 160; in-
troduction into tea-gardens, pages 161-164 ; conclusion, page 164.
SECTION VIII.
The origin of the disease and its resemblance to the "Bardwan fever"
epidemic.— The disease formerly considered to be endemic in the
Garo Hills, page 165 ; evidence obtained from the Garo Hills
district reports, pages 166-170 ; how far has the disease died out
of the Garo Hills, pages 170-171 ; why Mymensingh and Sylhet
escaped, page 171 ; general resemblance of the " Bardwan fever "
to kála-ázar, pages 172-175 ; they are not continuous, page
172 ; the Dinajpore and Rungpore fever epidemic of the seventies,
page 172 ; its origin in an extraordinary series of years of deficient
rainfall, pages 177-180 ; its continuity with the outbreak of
kála-ázar at the foot of .the Garo Hills, pages 180-182 ; detailed
resemblances between the "Bardwan fever " and " kála-ázar
" e p i d e m i c s , p a g e s 1 8 2 - 1 9 2 .
SECTION IX.
Conclusions as to the nature of the epidemic and the method of
infection, pages 193-202.
SECTION X.
Recommendations, pages 203-222 ; conclusion, pages 222-223,
vi
CONTENTS.
APPENDICES.
Appendix No. I.—Anæmia of coolies, pages i to xvii.
,, ,, II.—On the spread of kála-ázar, and how to check
it. (Proposed to be translated and distributed
in the villages in the form of a pamphlet),
pages xvii to xxiv.
GLOSSARY.
Of medical and scientific terms, pages xxv and xxvi.
ILLUSTRATIONS.
To face
page
PLATE I.—Group of cases of ordinary chronic malaria in Sylhet.
29
" II.—Group of cases of kála-ázar in Mangaldai.
33
" III.—" " " " " Nowgon
g
57
" IV.—Group of anæmia of coolies opposite page i of
Appendix I.
Temperature chart of a kála -ázar case
73
Chart showing monthly death-rate from fevers in the affected districts year by
133
REPORT
OF
AN INVESTIGATION OF THE EPIDEMIC OF
MALARIAL FEVER IN ASSAM,
OR
KALA-AZAR.
SECTION I.
THE HISTORY OF KALA-AZAR.
T HE main facts of the origin and spread of the disease
known under the name of Kála-ázar, as far as they can
be gathered from the yearly Sanitary Reports of Assam, will
be briefly given here, as far as possible in the words of those
who have seen most of the disease. Further details, with
statistics and map illustrating its spread, will be found in
Section VI.
The disease was first described in the report for 1882 by
Dr. Clarke, and was based on old records and notes of 120
cases by Mr. McNaught, the Civil Medical Officer at Tura,
the headquarters of the Garo Hills district. As this report
is of great interest, a few quotations will be given from it,
which will show the view which was taken of the disease at
this period :
" There is no registration in the Garo Hills ; but from information
gathered in a general way, and from the depopulation of certain areas,
there can be no doubt but that a very high rate of mortality exists
among the Garos and other tribes, especially those tribes who occupy
the low bill tracts which lie between the hills and the plains. There
is a form of malarial poisoning known among the natives as kála-ázar,
or black sickness, from the darkened colour which the skin assumes