47

IV

THE 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.