Blood changes in kála-ázar and anchylostomiasis.

91

the lowest figure obtained in any uncomplicated case of kála-
ázar, so that this alone serves to absolutely differentiate the
two forms of anæmia, and consequently also the two diseases
from one another. Again, the number of white corpuscles in
ten cases averaged 5,333, and their ratio to the number of red
was as 1 is to 524, showing that, although they are actually
reduced in number, as compared with the standard of healthy
Assamese people, yet relatively to the red corpuscles, they
are increased in number, or, in other words, they are not
reduced in as great proportion as are the latter. This again
is in marked contrast to the state of affairs in kála-ázar, in
which in the intervals between the fever, when the tempera-
ture is not raised, they are much reduced, both actually and
relatively, to the red corpuscles.

    Once more, the specific gravity of the blood is always very
much reduced in anchylostomiasis, varying from 1,038 down
to as low as 1,030, and the average of eight cases was only
1,034. This is partly due to the greater degree of anæmia in
the series of cases of anchylostomiasis as compared with
those of kála-ázar; but if cases of the two diseases present-
ing the same degree of anæmia be taken, the specific gravity
of the blood is still found to be much lower in the anchylosto-
miasis ones than it is in the kála-ázar cases. Here, again,
this point is of the greatest importance, as it serves to differen-
tiate the two diseases, and as the estimation can be made in
two minutes with very little practice, it is likely to prove of
practical importance, for the treatment of the two different
types of anæmia should be quite different.

    The type of the anæmia produced by anchylostomiasis
then differs so materially from that found in kála-ázar, as to
absolutely differentiate the two diseases from one another.

   Mixed cases.

    It has already been mentioned that a small percentage of
kála-ázar cases were found to be compli-
cated by a sufficiently large number of
anchylostoma to constitute them a factor in the production of
the anæmia met with in these cases, and it may be said at

N 2