13

History of Kála-ázar.

abundantly shown by the terrible mortality which, under the name of
beri-beri, the same disease has caused amongst the labourers on the
tea gardens."

     I have, I think, quoted enough to show that granting the
correctness of the statements on which Dr. Giles' views are
based, the fact that he found anæmia to be the one constant
feature of the disease, while fever and enlargement of the
spleen were accidental complications, and finding the anchylos-
toma constantly present, which had been proved to cause
anæmia in every part of the world where they had been found,
he could not have come to any other conclusion than that
recorded. He spent the rest of the year, over which his
investigation lasted, in a study of the life history of the an-
chylostomum, which resulted in his coming to the conclusion
that the disease is spread much more by earth and dust
getting into food, etc., than by water, and consequently
recommending conservancy improvements as the main way
to combat the spread of the disease.

     The reception of Dr. Giles' report, and the subsequent re-
searches of the Civil Medical Officers of the province, which
have led to the re-investigation of the subject, only remain to
be considered.

     In the report for 1890, Dr. Costello writes:

     " My conclusion now is that Dr. Giles' views as to the cause of
kála-ázar are quite true, it and beri-beri being due to anchylosto-
miasis, the apparent difference being due to kála-ázar being fre-
quently complicated by malarious fever and its results; as in the dis-
tricts of the Lower Assam Valley, the inhabitants are much more
subject to malarious causes than those in the districts in the northern
section of that valley."

     He recommended a trial of the conservancy measures
advised by Dr. Giles, and also directed systematic clinical and
microscopic observations to be made in the affected districts
for one year. As a result of this, two very valuable reports by
Drs. Dobson and Campbell appeared in the 1891 Sanitary
Report, a summary of which will be given here. Dr. Neil