90

Report on Kála-ázar.

in the high hæmoglobin value, and in the comparatively slight
reduction of the specific gravity. Moreover, in the first two
respects they also agree very closely with some examinations
of the blood in cases of chronic malaria recorded in a paper
in the Indian Medical Gazette of 1883 by Dr. Waddell, which
are the only figures on the subject that I could find in the
limited literature which I have been able to consult.

    It is then evident that the type of anæmia in kála-azár is
precisely similar in all its details to that met with in ordinary
chronic malaria. Let us now see if it resembles that found in
anchylostomiasis.

   The blood changes in
anchylostomiasis.

    In anchylostomiasis, which is the disease produced by an-
chylostoma sucking small quantities of
blood out of the mucous membrane of
the intestine and not simply the pre-
sence of anchylostoma, which may not have been present in
sufficient numbers, or long enough, to produce any disease
whatever), the essential symptom is anæmia. We have just
seen that in kála-ázar also anæmia is a constant and marked
symptom, and it will be obvious that if the two diseases are
essentially the same, except that the latter is more frequently
complicated by malaria, as was maintained by Dr. Giles, then
the blood changes must be also similar, or nearly so while if
the disease is a mixture of malaria and anchylostomiasis, then
the blood changes should present a gradual series interme-
diate between the two primary conditions. Let us see if this
is the case or not, Taking the different observations in the
same order as before, it has been found that the hmoglobin
in twelve cases averaged 15.16 per cent., showing that the
anæmia was more marked than it was in the kála-ázar cases.
The number of red corpuscles in eleven cases averaged
1,145,000, or 42.9 per cent., and the hæmoglobin value in
nine cases averaged only.31, showing that the hæmoglobin was
reduced more than twice as much as the number of the red
corpuscles, and this was a constant feature in the disease, for
the highest figure met with was.39, which is much lower than