118

Report on Kála-ázar.

Chief Commissioner of Assam, in reply to the criticisms of
Mr. Melitus, the Secretary to the Chief Commissioner, Dr.
Giles writes:

      "I will now take up the consideration of the objections advanced
by Mr. Melitus to the identity of kála-ázar and beri-beri."

      (Anchylostomiasis), and again:

      "What then is kála-ázar? Kála-ázar is anchylostomiasis."

      This is certainly what he is generally understood to have
meant by all in Assam who have read his report, and the
quotations given in the first section of this report bear this out.

      Unfortunately for Dr. Giles, it was not known at the time
of his investigation that over 80 per cent. of healthy natives
have the anchylostoma worms in them, for the most part in
quite small numbers, so that he regarded the mere presence
of these parasites, or even the finding of the ova in the fæces,
which I have shown, can be done when less than 20 of the
worms are present, as evidence of anchylostomiasis, that is, dis-
ease produced by these parasites, and unfortunately he did not
make any control examinations in healthy persons, or he would
have found out his mistake. But having found "a number of
anchylostomes" in one autopsy, and "enormous numbers
of the ova of the parasite" in the dejecta of five or six other
cases, he writes:

      "Other post-mortems followed, and proved incontestibly that,
whatever kála-ázar might be elsewhere, the disease so called in
Gauhati was undoubtedly anchylostomiasis."

      He does not give the number of the worms which he found
except, in two cases the full notes of which he records, one at
least of which was certainly a pure case of anchylostomiasis,
and not kála-ázar at all, "about a thousand anchvlostoma"
being found, while the spleen and liver were smaller than
normal. Dr. Giles' further statement, after visiting Upper
Assam to study anchylostomiasis, that—

"nothing here struck me so strongly as the absolute identity of
the clinical pictures presented by these cases of acknowledged
anchylostomiasis with those I had just been seeing so much of under
the name of kála-ázar, "