88

Report on Kála-ázar.

that of 12 cases of the latter was 15.16 per cent., while
Sandwith, of Cairo, found the average of 173 cases to be 26
per cent. The most important point, however, regarding the
anæmia of Kála-ázar is that in this disease the hæmoglobin
and the number of the red corpuscles are equally, or nearly
equally, reduced, so that the hæmoglobin value does not differ,
as a rule, very much from the normal. Thus, the number of
red corpuscles in 50 observations averaged 2,462,000 per cubic
millimetre, or 49.24 per cent., and the hæmoglobin value
works out to be.65, which, it will be seen, exactly corresponds
with what was found to be the normal figure for healthy
natives of Assam.

    The number of white corpuscles differs very widely in
Kala azar from the normal, but it is complicated by the
occurrence of leucocytosis, or an excess of white corpus-
cles, actual or relative, during the presence of fever. In the
very early stages well-marked leucocytosis occurs, just as in
an attack of ordinary acute malarial fever, and I have seen
the white corpuscles number 23,000 per c.m., or 1 to 174 red,
in a case which I have very good reason for believing to be one
of a very early kála-ázar (see page 74). In all well marked
cases, on the other hand, during the absence of fever, the white
corpuscles are very much reduced, there not unfrequently
being only about 2,000, and, in spite of the red corpuscles also
being greatly reduced, there may be only 1 white to over 2,000
red. The average number in 36 observations made during
the absence of fever was 2,600 per c. m., or 1 to 1,170 red.
Repeated estimations made in the same cases show, however,
that during the occurrence of fever, especially if the tempera-
ture is over 102°F., the white corpuscles will be present in
considerably larger numbers than they are in the same case in
the absence of fever. For instance, in one case, on a day
when the temperature was normal, 1 white to 1,225 white
corpuscles were found; but on another occasion, when the
temperature was 103.2, they were present in the proportion of
1 to 672, and many other similar instances might be given;