96

Report on Kála-ázar.

blood which are sucked out by the worms; while, again in
the latter stages this may be supplementel bý some loss of
digestive power owing to the injury to the intestine which
may be produced by the worms. It is evident that in anchy-
lostomiasis all the elements of the blood will equally be lost
to the economy, including the albuminous parts, which are not
primarily affected in the case of kála-ázar. The different con-
stituents are not, however, equally readily renewed by the sys-
tem. On the contrary, the white corpuscles are more easily
replaced than the red, so that in anchylostomiasis the former,
although actually reduced in number, might be expected to
become increased relatively to the red corpuscles; and this is
just what we have found to be the case. Much more important,
however, is the hæmoglobin, and this element of the blood, con-
taining, as it does, iron in an organic combination, is much less
easily replaced. It has been shown by the analyses of the late
Dr. Bevan Rake, that after death from anchylostomiasis the
amount of iron in the liver is often much reduced. This is due
to the reserve iron in the liver being used up to stock the
newly-formed red corpuscles, as these are turned out by
the bone marrow. As soon as this reserve is exhausted, the
renewal of the hæmoglobin will be entirely dependent on the
amount of iron absorbed from the food through the digestive
canal. Now this has been shown by Dr. Ralph Stockman to
only amount to one-eighth of a grain daily in the case of a diet
containing animal food, and will be even less in a vegetable
one, such as the vast majority of the natives of India subsist
on. Consequently, there is soon a great difficulty in the
formation of enough hæmoglobin to put into the red corpus-
cles, which are being formed, and so a deficiency of hæmo-
globin relatively to the number of the red corpuscles gradually
ensues, and the hæmoglobin value sinks to half, or less than
half, that met with in health. Thus, the change in the com-
position of the blood, which we have seen actually occurs in
anchylostomiasis, is only what might have been expected to
result from a slight, but steady, daily loss of blood, and my