CHAPTER XI. 



KALA-AZAR. KALA-DUKH. DUM-DUM FEVER. 

 TROPICAL SPLENOMEGALY. 



Definition. A chronic infective febrile disease due to 

 a flagellate protozoal organism found in its resting, 

 non-flagellate form in the spleen, liver, intestines, super- 

 ficial lymphatic glands, and other organs. The disease 

 is characterized by long-continued fever, enlargement of 

 the spleen and liver, wasting, debility, and anaemia, and 

 by a very high mortality. It occurs both endemically 

 and in epidemics. 



Geographical Distribution. The principal seat of kala- 

 azar is Assam, in parts of which it has long been pre- 

 valent, though it was first mentioned in 1882. Its name, 

 signifying the " black disease," refers either to the terrible 

 mortality attending the epidemics which for many years 

 devastated district after district of Assam, or to the dark- 

 ening of the skin observed in many of those suffering 

 from it. 



Epidemics have occurred in Lower Bengal, where the 

 disease is also endemic, and the name "Dum-dum fever" 

 was given to attacks of it contracted at this station by 

 British soldiers, many of whom have died of it in 

 England. 



Kala-azar also occurs in Madras, and sporadic cases 

 have been met with in Bombay and other parts of India, 

 also in Burmah and Ceylon. Cases of this or a similar 

 disease, occurring in children on the Mediterranean coast 

 and in some of the islands in the Mediterranean, have 

 also been described. The disease has been reported in 



