Clinical description of Kála-ázar.

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in this disease, while in the anæmia of kála-ázar, as will
be shown in detail in Section IV, the most important elements
of the blood are reduced in much more equal proportion than
they are in anchylostomiasis.

Nervous system.

    The changes in the nervous system are very slight, as might
be expected in a slow-wasting disease of
this nature, for this system has been proved
to be the last to lose weight in starvation. Sensation does not
appear to be ever affected in the way it is in the true form
of beri-beri, which is met with in the Straits Settlements (but
has never been found in Assam, so that the use of this name
for anæmic conditions is incorrect), nor is the knee-jerk lost,
although it may be somewhat difficult to elicit it in the
latter stages of the disease.

    The retina was examined in a good many cases in the
latter stages, and showed some changes of interest which
account for the diminution of vision, which is not unfrequently
met with, and which usually takes the form of night blindness,
or inability to see after sunset, when the light is fading, and is
accompanied by diminution of the field of vision. The change
most commonly seen was a remarkable diminution of the
size of the retinal arteries, while the veins remain of nearly full
size. This was usually most marked in those cases in which
the pulse was also noted to be small and of low tension.
The disk was also pale, and probably the retina shared this
change; but owing to the great variation in the shade in
different natives, this cannot definitely be stated to be the
case. Hæmorrhages were very rarely, if ever, present, although
carefully looked for, especially in view of the fact to be presently
mentioned, that hæmorrhage from the nose was frequently
noted to have occurred. Their absence seems to be partly
due to the contraction of the retinal arteries, and partly that
these vessels were found to be unaffected by the fatty degener-
ation, even in a case in which the cerebral arteries were so
affected. The anæmia of kála-ázar is moreover rarely so
great, as that seen in so-called pernicious anæmia. The

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