2gS 



NATURE 



[June 7, 1917 



completely stamped out of ten coolies' lines, in one 

 of which three-fifths of the whole population had the 

 disease in their households, while the new lines had 

 afterwards remained free from the disease in every 

 case, namely, from twelve to eighteen years in five 

 of them, and for shorter periods in the others, no 

 recurrence having ever taken place where Dr. Price 

 had been able to get his orders carried out by the 

 garden managers to prevent any infected person 

 being allowed to live in the new lines. That this 

 success was not due t) the decline of the disease in 

 the Nowgong district was clear from the fact that 

 on two gardens where he could not get the managers 

 to adopt my measures the disease was still present at 

 the time of my 1913 visit, having persisted on 

 them for twenty years When it is stated that 

 the population of the new kala-azar-free lines in 

 1913 amounted to 6727 souls, and that the deaths 

 from kala-azar alone in the old lines before removal 

 had amounted to 1393, er no fewer than 207 per mille, 

 more than one-fifth; that the loss would have con- 

 tinued indefinitely, as shown by the fact that the 

 disease remained present for twenty years on two 

 gardens where the plans were not adopted ; and that 

 coolies cost about Rs.200 a head to recruit by the 

 time they reached Assam, the saving to the tea 

 industry in this one district alone must have amounted 

 to lakhs of rupees. I am glad to be able to say that 

 the industry has shown its gratitude in a very prac- 

 tical way by promising Rs. 20,000 a year for five years 

 for investigations in connection with the School of 

 Tropical Medicine 



The more difficult question remained as to whether 

 anything could be done to check the spread of the 

 disease up the Brahmaputra Valley. On turning once 

 more to the map, vou will see that the only traffic 

 eastward is along the narrow strip between the 

 hills and the Brahmaputra River, which also has com- 

 paratively few inhabitants. I found it to be free 

 from kala-azar in 1897, so recommended that steps 

 should be taken to stop infected people from passing 

 up into the Golaghat eubdivision of the Sibsagar dis- 

 trict, and that if any villages became infected in 

 Golaghat the segregation measures should at once 

 be carried out and the healthy people moved to a 

 new site. This was actually done later with success, 

 and as the epidemic has abated in Nowgong, although 

 sporadic cases remain, there is good reason to hope 

 that the main danger has been averted and the 

 eastern part of the vallev saved from devastation little, 

 if at all, less disastrous than the war itself. A recent 

 investigation by Major McCombie Young, Sanitary 

 Commissioner, Assam, has shown that the disease 

 remains in a sporadic form in just those parts of 

 Assam which I found to be infected with the epidemic 

 twenty years ago — an important point I shall return 

 to presently. Before leaving this part of the subject 

 let me emphasise the fact that all the above prac- 

 tically important prophylactic measures were worked 

 out as a result of my epidemiological studies before 

 we had any accurate knowledge of the true nature and 

 causation of the disease, so that, however wrong my 

 theories proved to be, I have the satisfaction of know- 

 ing that my earliest important investigation in India 

 led to much saving of life and suffering, which has 

 always been a greater satisfaction to me even than 

 the making of purely scientific discoveries without 

 much practical value. 



In the meanwhile, my theory that kala-azar was an 

 epidemic malaria, although supported by the high 

 ' authority of Sir Ronald Ross, was criticised by others, 

 and Dr. Bentley, on the strength of what ultimately 

 proved to be erroneous blood tests made at Kasauli, 

 declared the disease to be an epidemic of Malta fever, 



NO. 2484, VOL. 99] 



but at the same time brought forward Some strong 

 arguments against the disease being malarial. While 

 opinions were thus divided in India, researches on 

 two other continents led to a solution of the difficult 

 problem— so closely is scientific thought all over the 

 world united by medical ifterature at the present day. 

 In Africa the late Dr. Dutton, the most brilliant 

 worker yet produced by the Liverpool School of 

 Tropical Medicine, discovered a trypanosome in 

 the blood of a patient suffering from a fevcr, which 

 was later proved by Sir David Bruce to be the early 

 stage of the deadly sleeping sickness. Sir William 

 Leishman then recorded having found some minute 

 bodies in the spleen of a soldier who died in England 

 of a fever contracted in Dum Dum, and suggested 

 that they were degenerate trypanosomes. Lt.-Col. 

 C. Donovan, of the Madras Medical College, 

 immediately announced that he had independently 

 found the same bodies some months before, and added 

 the important fact that they could be obtained by 

 spleen puncture during life, thus disproving Leish- 

 man 's theory that they were degenerate trypano- 

 somes. Donovan also suggested that the so-called 

 malarial cachexia and kala-azar might also be due to 

 this parasite. Leishman and Donovan were there- 

 fore the joint discoverers of the parasite of kala-azar 

 which is called after them, and I am glad to say that 

 the Asiatic Society has been the first to recognise the 

 importance of Donovan's work by electing him to our 

 fellowship last year, although it is but a small recogni- 

 tion for such an important discovery. The way was 

 now cleared for more rapid advance, an(^ Dr. Bentley 

 and myself independently found the same parasite in 

 epidemic kala-azar in Assam, and I also found it 

 in cases in the north-west of the Dinajpur district, 

 where the disease had been known as kala-dukh. 

 Thanks to the kindness of the physicians of the 

 Medical College Hospital in 1904-5, and especially 

 to Surgeon-General Harris, I was able to investigate 

 scores of cases of what had hitherto been always 

 regarded as malarial cachexia, with the result of 

 showing that a large proportion of them were kala- 

 azar. 



These observations established the important fact 

 that a sporadic form of kala-azar is widely prevalent 

 in Lower Bengal, and I found it to be exactly similar 

 to the cases I had formerly studied in Sylhet. The mys- 

 tery of the nature of kala-azar was thus cleared up, 

 the destructive Brahmaputra Valley wave having been 

 an epidemic form of the disease which is epidemic in 

 Lower Bengal and Sylhet ; so that, although I was 

 wrong in regarding it as malarial, I was correct in 

 saying it was an epidemic variety of the disease I had 

 found in Sylhet, which had always been regarded as 

 malarial cachexia, but which we now know to be 

 sporadic kala-azar. As special skill and laboratory 

 facilities are required for demonstrating the parasite 

 of kala-azar, while the treatment of kala-azar is 

 different from that of chronic malaria, it still remained 

 a matter of great practical importance to solve the 

 century-old oroblem of finding a simple clinical dif- 

 ferentiation between kala-azar and malarial cachexia. 

 Only in January I recorded the results of three years' 

 investigation of this problem' in the Medical College 

 Hospital, thanks to facilities kindlv afforded me by 

 my medical colleagues, which has, I believe, resulted 

 in a simple and practical solution of this difficulty, 

 and will enable the curative treatment I shall come 

 to presently being successfully used by the general 

 practitioner, even in places remote from laboratories. 



The discoyerv of the parasite of kala-azar in 1903 

 placed me in a position to study it with the view of 

 ascertaining its life-historv, and so to obtain a clue to 

 the mode of infection. In the following year I was 



