?3
reverse is the case. He also states that anchylostomiasis is not more prevalent in Nowgong
than it is in other districts where ordinary malarial fever is equally prevalent, and
says that he found one garden in that district where there were many cases of
anchylostomiasis and much malarial fever without a single case of kalá ázár, although
that disease was raging on another garden only three-quarters of a mile away.
7. Dr Rogers next proceeds to expound his own views as to the nature of kalá
ázár. He holds that it is nothing more or less than a very intense form of malarial
fever. The weight of medical opinion has always been in favour of a malarial origin, but
it has been felt that its communicability, which has always been believed in, and which
is most clearly established by Dr. Rogers in Section VII of his Report, indicated some
complication of communicable disease, it being thought that malarial fever by itself could
not become communicable. To this belief was probably due the partial acceptance
of the anchylostomiasis theory discussed above, and the typhoidal complication attri-
buted years ago to the Burdwan fever. Dr. Rogers, however, does not share this belief,
but holds that ordinary malarial fever may become so intensified in a succession of
very unhealthy years as to become communicable, and he points to the introduction of
malarial fever into Mauritius in 1865 by coolies from India as an instance of proved
communicability.
In order to show that there is nothing inherently improbable in the view that the
poison of malarial fever may become so intensified as to become communicable, he
brings forward the fact that certain bacteria can be artificially intensified, and he notes
that some persons are of opinion that pneumonia, and perhaps the plague, may have two
types,-one contagious and the other non-contagious. Dr. Stephen points out, however,
that these diseases are believed to depend on vegetable micro-organisms, whereas
malarial fever is supposed to be caused by an animal micro-organism.
8. There can be no doubt of the very close resemblance which kalá ázár bears to
malarial fever, from which in the early stages of the disease it is impossible to differen-
tiate it. The cases of chronic malaria found by Dr. Rogers in Sylhet differed in no
apparent respect from kalá ázár : but it took some days' search over a wide tract of
country to collect them; their history showed that it had taken as many years, as in
kalá ázár it takes months, to produce the extreme state of malarial cachexia, and
no two cases occurred in the same family. The fever of kalá ázár has no special
characteristic type, but the disease spreads along lines of communication without reference
to water-logging of the soil or other conditions favouring or impeding the spread of
ordinary malarial fever. It also diminishes in intensity, and disappears without any change
in the sanitary conditions. It is peculiarly resistent to quinine, and the villagers often
recognise the very first case in their midst as something quite different from anything
they had previously experienced within the memory of the oldest. The symptoms are
nevertheless in no way different from those of a very intense form of malaria, and Dr.
Rogers says that the malarial organisms (plasmodium malarić) are a constant accom-
paniment of the fever of kalá ázár, and that they do not differ from those seen in the
blood of sufferers from ordinary malarial fevers in Assam, except that they are possibly
less frequently pigmented. He does not, however give diagrams of the forms determined,
and he does not say that he determined that there was no specific bacterium in kalá
ázár which could produce the disease. Dr. Stephen is of opinion that in this most
important branch of the enquiry, Dr. Rogers' investigations were incomplete, and that
he has consequently lailed to establish his contention that kalá ázár is nothing more
than malarial fever, which by intensification has become communicable. Dr. Rogers
himself admits that he was not able to devote as much time as he would have wished to
the microscopical part of the work.
It is noticed that Dr. Rogers says he has the material by him for a future discussion
of this, the more scientific side of the question, and it is possible that he may have more
evidence than he has adduced in his report. But if so, it is unfortunate that he did not
adduce it; as, unless and until this evidence is given, it cannot be taken as proved that
kalá ázár is simply "a very intense form of malarial fever and nothing else."
9. It is unnecessary to discuss Dr. Rogers' theory of the origin of kalá ázár viz., by
introduction from Rangpur, nor his comparison of the disease with Burdwan fever, to which
it is very similar in the manner in which it spread, although the latter was of a more acute
nature and was more rapidly fatal, with cerebral symptoms. It may be noted, however,
that Dr. Jackson, who enquired into the causation of Burdwan fever, came to the con-
clusion that its contagiousness was due to a typhoidal complication.
10. But whatever the nature of the disease may be, Dr Rogers has removed all
doubts as to its communicability, and the measures suggested by him in Section X of
his Report to prevent its spread are eminently useful and practical. The most