February. 1917.] Annual Address. xxiii 



recently been wiped out by the epidemic, no one being left to 

 cultivate their land. I myself saw an unfortunate girl, who 

 shortly after her marriage into a village not yet affected by 

 the disease, showed signs of kala-azar, in consequence of which 

 she was made to live in a grass hut outside the village, where 

 her food was brought to her: so great was the dread of the 

 infection being introduced. The Garos also segregated patients 

 in this way, and I was told that occasionally if they took 

 too long to die they were made comatose with drink and 

 their huts burned over their heads : an effective, but scarcely 

 humane, method of sterilizing the infective agent. But I 

 must pass on to show you some photos of cases taken during 

 my investigation. The first group was taken in the Nowgong, 

 and the second in the Mangaldai dispensary. Both show the 

 great emaciation contrasting with the tumid abdomen due 

 to great enlargement of the spleen and often also of the liver, 

 while the skin becomes darker and more muddy, which accord- 

 ing to some gave rise to the term kala-azar or black fever. 

 Now it will no doubt occur to many of you that you have 

 seen precisely similar cases in malarious areas around Calcutta, 

 and you will ask how do you differentiate between kala-azar 

 and chronic malaria ? That indeed was the problem which 

 confronted me in Assam, with the added difficulty that the 

 disease was spreading and causing an awful mortality such 

 as malaria was not known to do in Lower Bengal, and that 

 , the people themselves had no doubt that the disease was an 

 infectious one, which malaria was not believed to be at the 

 time of my investigation, which of course was several years 

 before the mosquito-borne theory of malaria was established. 

 In fact there were at the time two rival theories regarding 

 kala-azar — one that the disease was malarial therefore it could 

 not be infectious, and the other that it was infectious and 

 therefore it could not be malarial so must be some undeseribed 

 disease. 



I first set to work to find out if kala-azar was infectious, 

 and in the cold season I tramped 130 miles in ten days from 

 village to village by paths and across dried-up rice fields in an 

 area where the disease was still spreading making inquiries. 

 I found that the disease always began in a village through an 

 infected person coming to reside there, the next to be attacked 

 being those living in the same house with the infected visitor. 

 If time sufficed I could give many graphic instances proving 

 infection in this way, but can only state that the evidence was 

 conclusive that the disease was communicable in some way, the 

 infection being usually a house one. This naturally led me to 

 suspect that the disease was not malarial, vet I frequently found 

 malarial parasites in their blood (it was not then known that 

 in malarious parts many apparently healthy persons harbour 

 malarial organisms in their blood), and search as I could, I could 



