Epidemic Jaundice (Weil's Disease) Or Malaria in Kandi Subdivision of Murshidabad District in 1928
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EPIDEMIC JAUNDICE (WEIL'S DISEASE) OR MALARIA IN KANDI SUBDIVISION OF MURSHIDABAD DISTRICT IN 1928. * By S. N. SUR, m.b., d.p.h., d.t.m., Assistant Director of Public Health, Malaria Research, Bengal, and HARIPADA SARKAR, l.m.s., d.p.h., Assistant to the Assistant Director of Public Health, Malaria Research, Bengal. In October 1928, Mr. S. C. Singha of Panchthupi village of Kandi Subdivision stated in a letter addressed to the senior writer that " in the subdivision of Kandi a new malady has been in evidence; it is like epidemic jaundice." On asking particulars from him as to the place of occurrence of such cases he informed me that the medical officer of the local S. S. Charitable Dis- cured all the three cases which had come pensary " under his treatment. Several other cases were treated bv various other medical practitioners of the locality. The largest number of cases, some cf which proved fatal, occurred at and about Kandi. Malaria is less in evidence this year owing, I think, to the excess in rainfall. The cases of jaundice have cropped up during the break which has continued since the middle of August." The junior author of this paper was deputed to investigate the matter in the same month. He called on the Assistant Surgeon-in-charge of the Kandi Charitable Dispensary and three other private medical practitioners of_ the town. No acute cases of jaundice were available at the time and most of the cases that had suffered from jaundice had got over the trouble, while only one old woman had died. The history of the attack was taken of the three cases who'still showed signs of jaundice, e.g., slight yellow tinged con- junctivae, etc. The attack started with slight fever and pain all over the body in general, about three weeks before the visit, and there was no history of epistaxis or hsemoptysis or purpura. One of the patients only had a tender and enlarged liver, while all of them had enlarged spleen and one only had slightly injected conjunctivae. Both urine and blood films were examined in all the three cases. 620 THE INDIAN MEDICAL GAZETTE. [Nov., 1929. Their condition at the time of investigation is Malignant tertian parasites were found in 6, shown below in the table:?? benign tertian parasites in 2, and quartan in 1. a ? c o 3 o ?-? g a Qj ? u ?. a; qj ? a e." G rv ? rt o c c ^ * w E " r o a-*" w W W w PQ H 1-K Muhammadan 20 + + 2-0 Hindu 38 + + + + + B. T. (all stages). 3-8 Hindu 16 + + + + Do. *"Acetic Acid Test"?"The urine of a case of Weil's disease from the 5th to 8th day is said to give an intense green reaction when one or two drops of acetic acid are added to about one inch of the urine in a test tube."?(Manson-Bahr). " The acetic acid test" as noted above in all .Malignant tertian was therefore the most pre- valent the month of at the cases gave negative results. In addition to species during October the ordinary chemical tests of the three samples Kandi. There is thus little doubt that the cases of urine, bacteriological examination was also reported of were due to the infection with made in the following manner. They were jaundice heavy centrifuged and the deposite injected intra- malarial parasites. There was n6 evidence of peritoneally into three guinea-pigs. The guinea- spirochetosis. The writers are therefore of that the referred to pigs did not develop any symptoms and continued opinion epidemic jaundice was of malarial not to be quite healthy for over one month, and their by Mr. Singha origin and due to Weil's disease. / blood did not show any Leptospira icterohamor- rhagicc (the causative organism of Weil's disease) under dark-ground illumination. Blood films of all three cases that suffered from jaundice were examined. Two of them showed heavy infection with benign tertian malaria parasites, while one was negative (vide table above). The person whose blood was negative for malaria parasites had been taking quinine during the visit. From the above results it seems clear that all the cases of jaundice were possibly of malarial origin and not due to Weil's disease. Castellani and Chalmers mention a type " " of a subtertian malaria which simulates " typical " " yellow fever and Weil's disease" (vide Castellani and Chalmers, 3rd Edition, page 1172). These authors mention malarial jaundice being caused by malignant tertian infection. But at Kandi this type of jaundice was apparently excited by benign tertian infection also, as both the positive cases showed benign tertian parasites in all stages of development. That this area is a hyperendemic area is shown by random sampling of blood films from the inhabitants of that village. Altogether 11 films were examined, of which 8 were positive for malaria parasites as shown in the table below:? Case. Caste. Age. Sex. Type of malaria parasite. 1-B. Hindu 6 Male .. Nil. 2-J. Mubammadan 3 Female + + B.T? (all stages), 3-0. Hindu 30 Female -f + M.T. rings- 4-U. Hindu 11 Female + + + Quartan & M.T. rings. 5-1. Muhammadan 8 Male 4- + M.T. rings- 6-B. Hindu 40 Male .. Nil. 7-S. Hindu 30 Female + + M.T. rings. 8-Sr. Muhammadan 3 Female + M.T. rings. 9-K. Hindu 35 Female .. Nil. 10-H. Muhammadan 6 Male + + B.T. (all stages). 11"B. Hindu 14 Male + M-T. rings. .