84

Report on Kála-ázar.

and characteristic to be of diagnostic value. For this purpose
the hæmoglobin was estimated by Dr. Gower's instrument,
and the red and white corpuscles counted by the hæmocy-
tometer of the same scientist, while in the later cases the
specific gravity of the blood was determined by the accurate
instrument of Dr. Lloyd Jones, as soon as this was ob-
tained from England. The coagulability of the blood was
also determined in a few cases by means of the instrument
of Professor Wright, of Netley. The results exceeded my most
sanguine expectations, and proved conclusively that the
anæmia of anchylostomiasis differs from that of kála-ázar in
every way it well could, while, on the other hand, that of Kála-
ázar agrees in every detail with that of ordinary chronic
malaria, as met with in districts which were unaffected by
kála-ázar, for, as has been repeatedly said, this latter disease
cannot be distinguished from ordinary chronic malaria in the
affected districts. The evidence on which these statements
are based must be given in this section, and, although the
subject is a very complicated and technical one, an endeavour
will be made to discuss it as lucidly as possible. The blood
of healthy natives of Assam must first be described, as it has
been found to differ from the European standard, especially
in the case of the amount of hæmoglobin, which is much
lower in them than the standard of Dr. Gower's instrument.
Then the changes in the case of Kálá-ázar, ordinary chronic
malaria, and anchylostomiasis, respectively, will be given, and
lastly the explanation of the differences will be pointed out.

     The blood of heal-
thy Assamese.

      In estimating the standard of the blood in the healthy
inhabitants of Assam, it was necessary to
exclude both those who had any number
of anchylostorna in their intestines, and
also those who had had any material amount of fever during
the last two years, for, as will be shown presently, both of these
classes, the latter to a much greater degree than the former, had
somewhat inferior blood. Now it must be constantly borne in
mind that the presence of anchylostoma in the intestines of