92

Report on Kála-ázar.

once that they presented blood changes which were exactly
intermediate between those met with in the two contributing
diseases, thus showing that the worms had in these instances
been present in sufficient numbers and for a long enough period
to bring about characteristic alterations in the blood. Thus,
in five such cases, which were met with out of a total of 77
examined, or 6.49 per cent., the hæmoglobin value averaged
.43, which is just intermediate between the same figures for
the anchylostomiasis and kála-ázar, respectively, as were also
the other figures which will be found in the table on page 95,
and thus served as a test as to whether any number of the
worms, which might be met with in a given case, had been a
factor in the production of the anæmia or not, for, if they had
materially assisted in the production of the anæmia, then the
type of the blood changes found would show the charac-
teristic variation from that which is typical of kála-ázar.
Further, I have even been able to correctly suspect the
presence of anchylostoma in active numbers in an early case
of kála-ázar before anæmia was a marked symptom, and
when there was clinically no suspicion of them. I have,
moreover, been able, by an examination of the blood, to
diagnose from each other with certainty cases of both
kála-ázar and anchylostomiasis, which I had previously
either been unable to differentiate without it, or in which I
had even made a wrong diagnosis by the ordinary methods
in spite of considerable experience, for cases do not very infre-
quently occur in which kála-ázar very closely stimulates
anchylostomiasis, and this doubtless accounts for the former
confusion between the two diseases. Thus, on one of the tea
gardens, when working with Dr. Price, we picked out three
cases, one typical of kála-ázar, the second of anchylostomia-
sis, whilst the third man in some respects resembled the latter
disease, but he had an enlarged spleen, and dropsy of the legs
and abdomen, with only slight fullness of the face, and, on the
whole, we thought was probably suffering from kála-ázar. The
following table gives the blood changes which were found in