Abstract of the Milroy lectures on kala-azar, its differentiation and its epidemiology. Lecture I, The origin and course of the epidemic / by Leonard Rogers.

  • Leonard Rogers
Date:
1907
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Credit: Abstract of the Milroy lectures on kala-azar, its differentiation and its epidemiology. Lecture I, The origin and course of the epidemic / by Leonard Rogers. Source: Wellcome Collection.

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    * r) a@ Gecreace of 24 per cent. in the total population of the district, or, if the indigenous population alone be con- sidered, the loss amounted to no less than 31-5 per cent., or almost one-third of the people, a death-rate which far exceeds that of the recent plague and to which it would be difficult to find a modern parallel, unless it be that of the closely allied sleeping sickness of Africa. On the other hand, Sibsagar and Lakhimpur again showed a substantial increase of the population, after allowing for immigration, indicating once more that this part of the valley was still unaffected by the disastrous fever. Moreover, the land has fallen out of cultivation in proportion to the loss of their inhabitants, for some figures kindly supplied me by Mr. Gait showed that one-fourth of the land in the affected parts of the Mangaldai was abandoned within five years and one- tifth of Nowgong within a similar period of time ending 1895 before the outbreak had nearly expended itself there, while no less than 54,179 persons were estimated to have died from kala-azar in this district within nine years. I myself frequently saw patches of grass jungle springing up in the midst of rice fields and on inquiry always found that it had belonged to some family which had been exterminated by kala-azar shortly before, no one being left to till the land, which had also lost its value completely, as there was no demand for it. Happily, this particular outbreak appears to be practically at an end, but it behoves us to study it carefully, so as to be prepared to check at its outset any future epidemics which may arise and also to inquire into any previous ones of a similar nature, from which further lessons of value can be learnt. THE BURDWAN FEVER EPIDEMIC oF LOWER BENGAL, 1856-1873. When studying the literature of kala-azar I was struck by the similarity of its main features to those of a previous fever outbreak in Lower Bengal, known as the Burdwan fever, from the name of the division it chiefly affected, anda close examination of the records of the latter disease con- vinced me that the two epidemics were of the same nature, although independent of each other, so that kala-azar of Assam is not an isolated phenomenon. I have dealt with this Bengal fever elsewhere, so need only now recall its main features. It began in Jessore to the east of Calcutta, where it reached its height in 1854-55, and then began to spread to the east through Nadia in 1857 to 1864, while in 1862-63 it invaded the Burdwan division, in which its course was carefully traced in a very excellent report of 1872 by Dr. J. Jackson, the sanitary commissioner of Bengal. He pointed out that it spread along roads and lines of communication and was checked by the absence of ready intercourse between different villages. Further, it ultimately stopped when it reached the edge of the alluvial soil, as it failed to get a firm footing on the drier laterite formation and in the hill tracts of Chotta Nagpur ; just as kala-azar was limited by the higher hills sur- rounding the Brahmaputra Valley. Owing to the density of the population of the affected parts it is said to have carried off no less than a quarter of a million people in the Burdwan division alone and it converted this previously very healthy district into a still notoriously feverish place. The exact nature of the disease gave rise to almost as much controversy as its Assam prototype, the question of its contagiousness especially being warmly debated. Dr. Jackson concluded : ““While I believe the fever to be malarious in origin, and to have some malarious characteristics, I believe it to be not a simple but a contagious malarial fever; that is probably typho-malarial, and that it was not produced in Burdwan but imported.” I have recently found the parasite of kala-azar in some sporadic cases of the disease from Burdwan, so this outbreak seems to have permanently left behind it the endemic affection. Kala-Dukh.—Another smaller outbreak of a similar nature, described by Major E. H. Brown, I.M.S., in 1898, occurred in the north-east of the Purneah district, immediately adjoining Dinajpur, and hence doubtless an off-shoot of the great Rungpur-Dinajpur fever outbreak, which gave rise to kala- azar in Assam. Kala-dukh depopulated a number of villages in the Nepaul terai, but when I visited the place in 1904 it had nearly completely died out, only a few chronic cases remaining, while in the neighbouring part of the Dinajpur district there were fairly numerous sporadic cases of the disease, in some of which I found the parasite of kala-azar, thus establishing the identity of this small outbreak with the more extensive ones already described. ee ————— I have now completed my survey of the subject from the epidemiological point of view, having treated it in consider- able detail, because I think the vast. economic importance of these terrible spreading fevers is not yet fully realised out of India, and the necessity of clearly distinguishing between the epidemic and the sporadic forms of the disease cannot be too strongly insisted upon. The two disastrous outbreaks I have described both occurred within the last half century, their spread being conceivably assisted by improved com- munications in the affected tracts, especially in Assam, and as it is impossible to say when a fresh epidemic may be started we must be on our guard against them, for of no disease is it so true that knowledge is power, as I shall hope to show you in the course of my remaining lectures. Ghe Lettsomian Weetures THE DIAGNOSIS AND LOCALISATION OF CEREBRAL TUMOURS, Delivered before the Medical Society of Lendon, By CHARLES E. BEEVOR, M.D. Lonp., E.B.G.P., PHYSICIAN TO THE NATIONAL HOSPITAL FOR THE PARALYSED AND EPILEPTIC, QUEEN-SQUARE, LONDON; AND THE GREAT NORTHERN CENTRAL HOSPITAL. LECTURE II,} Delivered on Feb. 18th. MR. PRESIDENT AND FELLOWS,—We will take next the region of the cortex which is situated in front of the ascend- ing frontal convolution and comprising the superior, middle, and inferior frontal convolutions. With the exception of the posterior part of the middle frontal convolution, where, as we have already seen, electrical stimulation produces conjugate movement of the eyes to the opposite side, this part is inexcitable to electrical stimuli. We can therefore divide this region into two parts, an anterior and a posterior. Professor Hitzig and Dr. D. Ferrier have shown in their experiments made over 30 years ago that removal of the frontal lobes in dogs and monkeys produced a decided alteration in the animals’ character and behaviour. They remained apathetic or dull and bad lost the faculty of atten- tive and intelligent observation. In tumours of the frontal region this stupidity and want of attention is, as we shall see, a very marked symptom and it seems to be present mostly with tumours of the anterior half of the frontal region. . TUMOURS OF THE FRONTAL REGION. In the frontal region, besides the tumours which are found in the cortex, there are on the one hand tumours which grow from the bones or the dura mater covering them, and especially from the orbital plate. These tumours are outside the brain substance and compress the brain, but they do not involve its tissues. They are therefore most favourable for removal. On the other band, there are tumours which grow inside the white matter of the frontal lobe and which either do not reach the cortex or only come to the surface and involve the cortex at one spot. We have therefore: 1. Tumours outside thé brain. 2. Tumours growing in the cortex on the outer surface and situated in (@) the anterior half or (2) the posterior half of the three frontal convolutions. 3. Tumours growing within the white substance of the frontal lobe. Of the first class a very typical case was the following. A woman, aged 37 years, was admitted under my care on Dec. 18th, 1903, into the National Hospital. The onset occurred seven months before admission with headache in the frontal region two or three times a week, then every day ; @ \Gd)Beadache she was very drowsy and it was : i MAiting lasting an hour. For two months had sleepy aftacks in which she became drowsy ; this deepened) into, cdma} so that she could not be awakened and fays, then the sleep gradually passed off. mATYIND (blished in Tur Lancer of Feb. 9th, 1907, p. 343. Se delivered on March 4th,
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