172 TROPICAL MEDICINE AND HYGIENE 



being liable to attack. Rogers states that males and 

 females are attacked in equal proportion, and that infants 

 and old people are less liable than others to the disease, 

 while it is commonest among children and young adults. 



As to race, kala-azar is comparatively rare among 

 Europeans in India, and occurs chiefly among the poor, 

 whose domestic hygiene in places like Calcutta resembles 

 that of natives. In Assam it has been noticed that in- 

 fection of Europeans is often traceable to cohabitation 

 with natives, or to occur in missionaries and others whose 

 duties bring them into close contact with natives. Rogers 

 has pointed out that, in contrast to the case of enteric 

 fever, kala-azar occurs more commonly among Euro- 

 peans who have lived some years in India than in 

 newcomers. 



Treatment. Once kala-azar has become well developed 

 no treatment seems to have any effect upon the course 

 of the disease. It is claimed by some that quinine in 

 very large doses may arrest the disease at a very early 

 stage, but it is possible that cases responding to quinine 

 are malarial. Besides quinine a very great number of 

 drugs have been tried arsenic, the salicylates, and also 

 bone-marrow but with little effect. More recently 

 atoxyl has been given, but the results are not rapid, though 

 in one case so treated, that of which the charts are given, 

 recovery has taken place. Salvarsan has been tried, and 

 in infections with similar parasites in the lower animals 

 with highly satisfactory results. 



In man it is worth an extensive trial, but the results so 

 far recorded are conflicting. 



It is possible that careful attention to the general health 

 of the patient, coupled, in the case of Europeans, with 

 residence in a temperate climate, and living as much as 

 possible in the open air, may prolong life a little, and it 

 is important that such measures should not be neg- 

 lected, for they at any rate add greatly to the patient's 

 comfort, and throughout the disease treatment must be 

 symptomatic. 



