Nature of kála-ázar.

119

can only be reconciled with the unanimous opinion of the
meeting of planters' doctors at Kokilamukh in October
1894, that—

"as the disease observed in the patients (kála-ázar cases) brought
before the meeting by Drs. Dodds Price and Lavertine, and from the
history of similar cases, appears to be entirely unknown in Upper
Assam above Nowgong, and differs in every particular from anchylos-
tomiasis, with which it has been confounded; and as the disease is
prevalent in certain districts, and is slowly, but most certainly,
advancing up the valley, an expert is necessary,"

on the supposition that, considering as he did that, enlarge-
ment of the spleen and liver and fever were only accidental
complications, and not ordinary symptoms, of the disease, he
compared such cases of simple anchylostomiasis as he saw
in Gauhati with similar ones in Upper Assam. Dr. Giles'
opinion that fever was not a common or marked feature of
the disease, is accounted for by the fact that he was unfor-
tunate enough to happen to commence his clinical work in
Gauhati late in November, which is just the very time when
the fever is at a minimum, and remains so until the
commencement of the next rains, by which time Dr. Giles was
engaged on microscopical and other work in Shillong, so that
he only studied the disease at the season when most of the
cases, which have survived the previous rains, have lost their
fever, and fresh infections are at a minimum. Moreover, as
he admits in his preliminary report, the longest time that he
had any one case under observation was one month, while
the majority of them he could have seen but once or twice
in the villages which he visited. Now I have seen fever
remain absent from typical cases for more than a month, even
in the rainy season, and yet a fatal relapse occurs, while at the
time of writing (February) out of seven cases in the Now-
gong dispensary, just about the number that Dr. Giles
commenced work on in Gauhati, only one has regular fever,
and then only a temperature of 101° or 102°F., and this has
been the kind of thing ever since the end of November,
so much so that I have found great difficulty in getting