86

Report on Kála-ázar.

hand, one man, out of whom 293 anchylostoma were obtained,
had only 42 per cent., although he did not appear clinically
to be at all anæmic. Again, the average amount of hæmo-
globin in 16 men, who had not suffered from more than one
week's fever in the last two years, was 60.8 per cent., while that
of 8 cases, who had had more than a week's fever in the same
time, was only 52.7, so that it is evident that comparatively
slight malarial fever, especially if it recurs at intervals, is a
much commoner and more important factor in causing
anæmia than is the presence of small numbers of anchy-
lostoma. If then only cases who have not had more than a
very few days' fever for two years, and who have not more
than 20 anchylostoma, be taken as healthy men, we shall
be on the safe side. The average amount of hæmoglobin
in 14 such natives in the Nowgong jail in the rainy season
was 62 per cent., while in 12 of them the average number of
red corpuscles in a cubic millimetre was 4,734,000, which is
very little below the European standard of five millions. It
will be noticed, however, that the hæmoglobin falls very much
below the standard of Dr. Gower's instrument, which is, I think,
rather a high one, for I well remember testing the blood
of myself and eight healthy students, when House Physician
to St. Mary's Hospital in London, and finding the average to
be only about 85 per cent., and that of seven healthy Euro-
peans in Assam during the rainy season I found to be but 71
per cent. The higher rate of Europeans over natives is, I
believe, due to the larger amount of animal food consumed
by the former, which contains more iron than vegetable food,
and that in a more assimilable form, for Ralph Stockman has
shown that the diet of Europeans contains only from 1/11 to 1/8
of a grain of iron a day, and the deterioration of the blood is
much greater in tropical than in temperate climates, and so
the need of iron is also greater.

    Quite recently, however, I found that several of these
Europeans had from 8 to 10 per cent. more haemoglobin
towards the end of the cold weather than they had during