The epidemic malarial fever of Assam, or kala-azar, successfully eradicated from tea garden lines / by Leonard Rogers.

  • Leonard Rogers
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: The epidemic malarial fever of Assam, or kala-azar, successfully eradicated from tea garden lines / by Leonard Rogers. Source: Wellcome Collection.

    3/6
    MroiBAi, JovBAiX My experience leads me to differ from all these writers in regard to ipecacuanha being useless. In the course of ray long service in various parts of the East, Ceylon among the rest, I have found it most valuable in cases of acute tropical dysentery. In a pamphlet published in Rangoon in 1870, and in subsequent papers in the Indian Medical Journals, the Lancet, and British Medical Journal, on the Treatment of Hepatic Disease by Chloride of Ammonium, I pointed out, not only the special curative action of the ammonium chloride in congestion of the liver and other hepatic affec¬ tions, but its efficacy also in dysentery, more especially when that disease was dependent on hepatic trouble, simple en¬ largement, hepatitis, etc. In my pamphlet I gave the case of an officer who was invalided from the Andamans on account of dysentery, and who en route to England came under my care at Rangoon. In his case ipecacuanha and other treatment had failed, the dysentery being the result of hepatic and portal congestion. One or two doses of chloride of amn^onium re¬ lieved him of all his distressing symptoms ; the salt acted characteristically and effectually. Indeed, he was so well in the course of a few days that he was undecided whether he should take advantage of the leave granted him for the re- , covery of his health. At p. 25 of my book on the Treatment of Hepatic Disease by Chloride of Ammonium, London, 1879, 1 gave an explanation of the special action of the drug in hepatic disease, and showed how a local depletion is not only effected in the con¬ gested or inflamed liver by each succeeding dose but how the entire portal circulation is relieved from congestion, pre¬ venting the occurrence* of dysentery, so apt to supervene in hepatitis, and particularly in hepatic abscess. In a paper in the Lancet, 1891, vol. ii, p. 707, will be found my latest views on the subject. The case of the officer above described shows the value of the ammonium chloride in what may be called hepatic dysentery, and points to the necessity of a careful examination of the hepatic region in all cases of dysentery, inasmuch as the usual symptoms of hepatic congestion, pain, etc., may be masked by the severity of the dysenteric sym¬ ptoms, the patient, perhaps, never complaining of liver sym- toms at all. In but 1 of the 153 cases of hepatic disease (shown in Table II, p. 78 of my book, in which chloride of ammonium was persistently administered from an early period of the disease) was dysentery observed to supervene, an occurrence which under previous methods of treatment was not infrequent. Its occurrence in this instance was in all probability owing to the inflammation of the liver going on unchecked for six days after admission to the hospital through the early symptoms simulating and being mistaken for gastritis. The true nature of the disease having been ascertained by careful examination, the chloride of ammonium treatment was at once commenced. After five days (during which the remedy was persistently administered with much relief to. the pain in the hepatic region and decrease of the fulness and tenderness of the right side of the chest and the abdomen) dysenteric symptoms supervened, and for three or four days the dejections were foetid and frequent, as many as seven or eight in the twenty-four hoars, and this in spite of ipecacuanha administered in large doses in enemata, as there was fear of damage to the repair going on in the liver and re¬ lated parts through vomiting if given by the mouth. At length, as the patient was rapidly sinking, 30 gr. were given by the mouth, with attention to the usual precautions to prevent vomiting. The dose was retained without dis¬ comfort, and acted like a charm ; from that time the patient was free from dysentery. Under the continued use of the chloride of ammonium for the hepatitis, he ultimately made a good recovery. Here, then, we find a single dose of ipecacuanha ad¬ ministered with due precautions as to its being retained in the stomach, once and for all arresting acute dysentery secondary to hepatic trouble, which the chloride of ammonium failed to subdue single-handed. The older writers held that the “ antidysenteric root ” was less efficacious in cases of dys¬ entery coexistent with, or secondary to, hepatic congestion or inflammation. The result attainable by the combined ipecacuanha and ammonium chloride treatment of such cases is confirmatory of this view, and offers one explanation of the apparent inutility of ipecacuanha in certain cases of dys¬ entery—that is to say, in those cases coexistent with, or secondary to, hepatic congestion or inflammation. Again, the uselessness of trying to cure dysentery with small doses of ipecacuanha should ever be borne in mind, for in addition to the large dose being the only effectual one, it is less likely to cause vomiting than a small one. Ipecacuanha can now be obtained from which the emetine has been extracted. It is said to act equally well in dysentery. Should this prove to be the case it will be a great desideratum. The diseases under consideration being so often associated, and being the cause of so much sickness, invaliding, and mortality among Europeans resident in the tropics, must be my excuse for the length of this communication. The subject is one of much interest and importance in view of the great colonial expansion now taking place. THE EPIDEMIC MALARIAL FEVER OF ASSAM, OR KALA-AZAR, SUCCESSFULLY ERADICATED FROM TEA GARDEN LINES. . By LEONARD ROGERS, M.D., M.R.C.P., B.S., F.R.C.S., Indian Medical Service. # ————— t The Mode op Spread of Kala-Azar. I have shown in my report1 on the diseases known in Assam under the name of kala-azar, or black fever, which has deci¬ mated a tract of the Brahmaputra Valley over 200 miles in length, that it is an epidemic malarial fever which arose owing to the intensification of that of the notoriously un healthy district of Rungpore in Lower Bengal by an extra ordinary succession of five out of six years of deficient rainfal in the Seventies. I traced its spread along the lines of commul nication throughout the affected districts of Assam up to th ■ present time. I also showed that the disease is undoubtedle slowly communicated from person to person, although it iy generally necessary for a person to live in the house of s sufferer from the disease, or at least to reside for some tima in a badly-infected village in order to contract the fever, e also recorded my opinion that the infection (using this worl in its widest bacteriological sense) is usually indirect afted the virus has passed through the soil. This, it will be obr served, is a very different thing to saying that it is as infec¬ tious as small-pox, an opinion which some of my critics hav- incorrectly attributed to me. I further recorded evidence te prove that the disease has a very seasonable distribution too that of ordinary malarial fevers in Assam, and declines to a very great extent in the cold dry four months of the year, when the ground is dried up, during which time infection rarely occurs. Advised Means to Check its Spread. On these and other observed facts I based my recommenda¬ tions for controlling the epidemic, the most essential of which was that during the cold .weather months when the fever was at a minimum, all the healthy people in any in¬ fected coolies’ line or village should be removed to a new site, which need not be more than a few hundred yards from the old ones. - .! ; ' •T ’' Results. ” ' •/ Fortunately, as several medical officers of tea gardens in Assam (from whom I received much assistance in the course of my investigation) were willing to carry out my plans in anticipation of the publication of my report, I am now able to give the results of this measure, the importance of which can hardly be overrated in face of the continued spread of the disease, and the fact that although my recommendations with regard to the treatment of infected villages were sanctioned by the Chief Commissioner of Assam, but little progress has yet been made in carrying them out. Dr. Lavertine* of the Nowgong District, writes that as yet he has only been able to carry out my recommendation that all new coolies should be placed in new lines and not in old infected ones. The result is that “there has been no case of kala-azar amongst 264 new coolies who have been up for eight months or over,” and that although “ we are still getting new cases amongst the coolies in old lines.” He is now segre¬ gating every case of the disease and all their relations, and destroying the old houses that they occupied. This is the measure that I advised in the case of lines which were only
    No text description is available for this image
    No text description is available for this image
    No text description is available for this image