120

Report on Kála-ázar.

cases on which to try the effect of various modes of treat-
ments in checking the fever. In fact, if I had begun work
at this time of the year, I should probably have fallen into
the same error that Dr. Giles did in this respect. Once
more, malarial complications are more frequently present in
the apparently healthy people of the Kamrup district than
in Nowgong, and anchylostomiasis is also more common in the
former, than I have found it to be in the latter district; and here
again I have had a great advantage over Dr. Giles. Indeed,
the facts just mentioned afford the true explanation of the
very different clinical results arrived at by Dr. Giles and my-
self, and it is only fair to point out the great advantages
which I have had over him, both in my happening to begin
my clinical studies in the fever season, and still more in having
the help of all the work that has been done by the Civil
Surgeons and private practitioners of Assam during the last
six years, and especially of the knowledge of the frequent
presence of the anchylostoma worms in healthy people of
both Assam and other parts of India.

      To return to the question—Is kála-ázar anchylosto-
miasis? In reply, it may be said that I have shown these
parasites to be present in sufficient numbers to complicate
the disease, as proved by their effect on the type of the
anæmia in under 7 per cent. of kála-ázar cases, while
in 83 per cent. of a series of cases taken in as early a stage as
possible, and which had not previously been treated by
thymol, there were less than 20 of the worms present—a
number which I have proved to have no effect whatever on
the blood of healthy persons in the Nowgong jail, while Dr.
Thornhill, of Ceylon, admits that 50 or less anchylostoma
form a number "altogether too small to have any deleterious
effect." It is also worthy of note that Dr. Dobson found
less than 20 anchylostoma to be present in 82 per cent.
of 547 healthy coolies, which he examined in Dhubri, which
agrees with my results in kála-ázar cases. Again, I find
an average of fewer anchylostoma on the average in a series