26

Report on Kála-ázar.

many months, a matter of great importance, and one, the neg-
lect of which was responsible for much of Dr. Giles' mis-
fortune. The main impressions I derived from this first
month's work, were the constancy of marked fever and signs
of chronic malaria, and the difficulty of finding anything like
a typical case of anchylostomiasis in other than ex-tea garden
coolies. These cases were nearly all in an advanced stage of
the disease, only such being usually seen in a civil hospital, so
I determined to visit some of the affected tea gardens, where
I hoped to be able to find early cases, and to follow them up
by returning to visit them at intervals. I received most ready
assistance from Drs. Price and Lavertine, who hold medical
charge of the tea gardens of this district, the former in parti-
cular having had a very large experience of the disease, which
he freely gave me the benefit of. A great difficulty, however,
arose, for, although all were agreed that kála-ázar began
with fever, which continued on and off until the spleen and
liver became enlarged, yet no one even pretended to be able
to diagnose the fever of kála-ázar from that due to simple
malaria in the early stages, and only designated cases as kála-
á zar when fever had persisted for a long time, and symptoms
of chronic malaria had become developed.

     I therefore decided to examine a series of cases of early
fever, of such a nature that the patients could not be said to be
suffering from kála-ázar, but some of whom had lost relatives
of the disease, and were therefore likely to be early cases of
it. Notes and blood examinations were made as before, and
temperatures taken four times a day. About a month
or six weeks later, I went around again and re-examined all
the cases. Some of them had recovered, and had apparently
only suffered from ordinary malarial fever, while others had
continued to be affected by it, and now presented the typical
appearance of kála-ázar. On comparing the notes and the
blood examinations, including the search for the plasmodium
malaria, no difference could be found in the early stage