persons for the presence of anchylostoma, and the statistics recorded by him showed
that out of 797 healthy persons examined, no less than 620, or 77 79 per cent., har-
boured anchylostoma in numbers ranging from 1 to 230; they also proved that the
worm in question is more commonly present in natives of other provinces than it is
in those of Assam.
In the Sanitary Report for 1894 the Principal Medical Officer and Sanitary Com-
missioner (Surgeon-Colonel A. Stephen) recommended that the services of another
specialist should be obtained to investigate the disease. This recommendation led
to the appointment, in April 1896, of Surgeon-Captain Leonard Rogers, M.B., B.S.,
F.R.C S., who, after most painstaking enquiries, submitted his report in May last.
The delay on the part of the Chief Commissioner in dealing with his report is due partly
to the dislocation of work caused by the earthquake of the 12th June, which destroyed
the Secretariat, and partly to delay in the receipt of the plates and chart prepared
in the Surveyor-General's office.
3. The first portion of Dr. Rogers' report deals with the theory advanced by Dr.
Giles that kal zr was identical with anchylostomiasis, and the conclusion arrived at is
that this theory is entirely untenable. Dr. Giles observed that all cases which he admitted
to be kal zr were found to be infected with the dochmius duodenalis. It was not then
known, as Dr. Dobson has since shown to be the case, that this parasite is very common in
healthy persons, both Assamese and foreigners, and does not cause any apparent injury
to health unless present in very large numbers. Dr. Rogers states that the parasite
is not present in greater numbers in persons suffering from kal zr than in those not
so suffering, and he also points out that anchylostomiasis is not a very fatal disease.
The death-rate rarely reaches 8 per cent., whereas in kal zr recoveries are very
rare indeed. Moreover, though anchylostomiasis might perhaps spread as kal zr
has done, it would not again die out as the latter does without any alteration in the
sanitary conditions; but, on the contrary, it would tend to become more and more
prevalent. It is added that, while thymol is a specific in cases of beri-beri, it is of no
use against kal zr. This was admitted by Dr. Giles himself, but was explained on
the ground that patients of the latter class came too late for treatment.
4. Leaving these general considerations, Dr. Rogers states that Dr. Giles was in
error in holding there was no special fever history in kl zr, and urges that it is the
most essential and constant feature of the disease. He illustrates this by twelve typical
cases, of which he gives a full clinical history. Dr. Giles's failure to observe the fever
symptoms is ascribed partly to the fact that his observations were made in the cold
weather, when the fever frequently disappears for a time, and that Dr. Giles had no case
under observation for more than a month, and partly to the fact that after a time the
sufferers lose reaction to the fever, and have fairly high fever on them without knowing it.
Dr. Giles's assertion that there is no abnormal enlargement cf the spleen in kal
zr is similarly controverted, and Dr. Rogers says-
It is then evident that the spleen is enlarged four times as frequently in kil, zr as it is in
healthy persons in Nowgong; while if the size be taken into account .......this organ is markedly
enlarged 15 times as often as it is in the ordinary inhabitants of Nowgong.
5. Dr. Rogers points out some marked differences in the symptoms of anchy-
lostomiasis and kal zr, viz.-
(1) In the former all the constituents of the blood are destroyed equally, whereas
in the latter the haemoglobin or colouring matter is not lost to the economy,
but is converted into pigment, which accounts for the darkening of the face
noticeable in kal zr.
(2) The anmia in kal zr is in direct proportion to the fever.
(3) dema or dropsy occurs usually in the feet and rarely in the face, whereas the
reverse is the case when dema is a result of anchylostomiasis.
(4) Diarrha is very common and constipation is very rare in kal zr, but in
anchylostomiasis diarrha is rare and constipation common.
(5) In kal zr the heart is smaller than normal, while in anchylostomiasis it is-
enlarged.
6. The general arguments adduced against the identity of kal zr with
anchylostomiasis apply, it is said, with almost equal force, against the theory that the
former disease is a combination of the latter with malarial fever. Moreover, if anchylos-
tomiasis were the propagating agency, it would be a constant and marked feature, while
the malarial complication might be sometimes absent, but Dr. Rogers reports that the