54

Report on Kála-ázar.

records that he found anchylostoma in 11 out of 15 cases,
the average number being 10.4.

    Dr. Campbell also found them to be present in 75 per cent.
of 88 cases; but among this number he included 15 cases of
pure anchylostomiasis, and he does not give the numbers
in which they were found. Coming to my own researches,
I examined for the ova of the worms in as many cases as
possible, and to some, who were in a fair state of health,
I gave thymol, and counted the worms which were passed.
In searching for the ova, a small piece of fæces was spread
out under a cover slip, with a drop of carbolic lotion, and the
whole of the specimen carefully and systematically examined
under the microscope. I found this a much surer way of
finding the ova than that described by Dr. Giles, and by this
means I was able to detect the ova in three successive cases,
in which, after giving thymol, only 2, 14, and 8 worms,
respectively, were found, so that it is evident that if only from
ten to twenty were present, they would thus be detected.
In this way it was found that there were either no ova detected
or less than 20 anchylostoma were passed after thymol in
83.33 per cent. of the kála-ázar cases, while in 16.66 per
cent. 50 or more were present; but in only 10 per cent. did the
blood changes show that these had affected its composition.
Again, in 25 post-mortems on kála-ázar cases, an average
of 21.48 worms were found, including three mixed cases, in
which the disease was complicated by 50, 80, and 103 worms,
respectively. Thus it appears that in the great majority of
kála-ázar cases, anchylostoma are not present in sufficiently
large numbers to affect the patient in the least degree. In
view, however, of the argument, that when the worms are
only found in such small numbers during life or after death,
they may have been present in much larger numbers at
some previous stage of the disease, which is true in excep-
tional cases, it is difficult to absolutely exclude their action
in this way. A means of doing so has, however, been found
in the blood changes, as will be shown in the next section.