42

Report on Kála-ázar.

population," but he produces no evidence in favour of this
view beyond quoting Dr. Dobson, as having found 21 out of
42 children in a Goalpara village to have enlarged spleens,
and this in a district which was at the time affected by kála-
ázar, and that he had found about the same proportion in
the Chaygaon district (also affected by the disease), but he
could not give the figures, as he had lost his notes on the
subject. On the other hand, he does not state in what pro-
portion he found the spleen enlarged in kála-ázar, although
he admits that it is so in "most of the cases;" but as he
included pure cases of anchylostomiasis among them, the
absence of the exact figures is of no account, for, as I shall
prove in the next section, this disease is quite distinct from
kála-ázar. In order to estimate the importance of the en-
largement of these organs, it is necessary to know in what
proportion of apparently healthy inhabitants of the district
they are enlarged, and to what size. To determine this
point, I examined 65 men in the Nowgong jail in the month
of June, with the result that 12 of them, or 18.46 per cent.,
had some enlargement of the spleen; but of these, in only one
was it three fingers or more below the edge of the ribs, and
this man died of kála-ázar very shortly afterwards. Again, I
examined 200 coolies in the lines of a tea garden, where there
were no cases of kála-ázar, except the Assamese wife of one
of the sirdars, who came from an infected village. The
size of the spleen and liver, as well as the presence of
anæmia, pigmentation of the mucous membrane of the
mouth, and the amount of fever from which each coolie
had suffered during the previous two years, were noted.
The results, which are very instructive, were as follows:
The spleen was enlarged sufficiently to be felt in 25 per
cent., but in only 6 per cent. did it reach to three or
more fingers' breadth below the ribs, and in only 1 per, cent.
did it extend below the navel. What was more remarkable
was the fact that in 19 per cent. of the coolies the liver was
enlarged, and the enlargement was in proportion to that of