Treatment of Kála-ázar.

81

could be got at in the early stage and treatment systematic-
ally carried out on these lines, I feel sure the disease
would have a very much lower mortality than it has
at present.

   Treatment in the later
stages.

     Unfortunately, cases are very rarely seen in the early stage
in dispensaries, and only too often on
tea gardens, they do not attend suffi-
ciently regularly, or are treated as ordinary fever cases until
they pass insensibly into the chronic stage. It is in these latter
places, however, that the line of treatment above laid down
could best be given a fair trial; but even then some would
necessarily be seen in the later stages of the disease. Here
again, the principles of treatment are the same as before,
but they hold out much less hope, and require some modi-
fication. Quinine should be given in large doses, and its
effect carefully watched. It will nearly always be found
to reduce the height of the fever, even when it does not
stop it altogether, and this is a considerable gain; for it
has been found that, if the temperature can be kept down
to 100° or 102° F., there is a much less rapid deterioration
of the blood than there is if it rises to 103° or 104°F. If,
however, large doses for ten days or a fortnight fail to
materially check the fever, it will be better to give smaller
doses combined with arsenic and strychnine; and in this
chronic stage, the best results have been obtained by
pushing the arsenic until thirty minims are taken in the
day. In doing so, looseness of the bowels must be care-
fully watched for, as this symptom will be a contra-indi-
cation to this line of treatment. If looseness of the bowels
has already started, the case will be a well nigh hopeless
one, but full doses of bismuth and salol have more effect
than any other drugs in controlling it, while a simple and
easily digested diet will be essential. In the class of cases
in which, after the fever has stopped for the time being, the
patient remains very wasted, and does not appear to be
able to digest his food, or to gain flesh, bone marrow in

M