Nature of kála-ázar.

127

be shown that the villagers of Assam readily recognise the
fever of kála-ázar immediately it occurs among them as some-
thing quite different from anything they have previously
suffered from. The other great distinguishing feature, besides
the intensity and frequency of relapse, is the extraordinary
tendency it has to run in families, which at Once suggests the
possibility of the fever being communicable from one person to
another, and this feature and its intensity are the only points
which I have met with in which kála-ázar differs from
ordinary malarial fever.

    To continue, the anæmia of kála-ázar has been shown
to be of precisely the same type as has been met with in
malarial fever in other parts of India, and is totally differ-
ent from that of anchylostomiasis, and it is also propor-
tionate to the fever, and lessens at once if this is absent
for two or three weeks, which could not be the case if it were
produced by anchylostoma. More conclusive still is the
fact that in all early cases that were examined, and which
subsequently developed into typical cases of the disease, the
malarial organisms were easily demonstrated by an examina-
tion of the fixed specimens of the blood under an oil-emersion
lines of a microscope, and these did not differ from those
found by me in simple cases of malarial fever, both in Assam
and in Ranchi in Bengal, while similar organisms were also found
in all stages of the disease. Further, a series of sections of
the liver, spleen, and kidneys showed the constant presence of
marked pigmentation, such as has always been considered an
absolutely constant change in chronic malaria in all parts of
the world, and which to many people is better evidence of
the malarial nature of a disease even than the discovery of
the plasmodium malariæ itself, while the excess of iron in the
liver, as shown by the analysis done in Calcutta, confirmed
this point. Once more, the constant and marked enlarge-
ment of the spleen, and almost as frequently of the liver also,
has never been found in any chronic fever besides malaria, and
all the other symptoms and pathological changes met with in