Pathology and nature of kála-ázar.

103

the peyers patches than elsewhere, causing them to stand out
in contrast to their surroundings. These changes were cer-
tainly the result of chronic inflammation of the small intestines,
which, doubtless, plays an important part in the pathology
of the disease. The mesenteric glands have also been found
in one or two cases to be pigmented.

      Now in the few cases of anchylostomiasis on which I have
made post-mortems, I have found the intestine to be sometimes
slightly thicker than normal, but not thinner, and I have not
seen any pigmentation of the mucous membrane. As the point
seemed to be an important one, and my experience was too
limited to allow of any safe generalizations being made from it, I
wrote to Dr. Sandwith on the subject, and am much indebted to
him for his kind reply to this and other questions. He writes—

      "The stomach contains no pigment or thickening, but I have once
or twice found hæmorrhage in the stomach as described by Giles.
I cannot explain this. The intestines and mesenteric glands are
neither of them pigmented."

      In his paper on anchylostomiasis in Egypt, he also writes:

      "I have not observed the constant changes in the mucous mem-
brane of the stomach described by Giles."

      The pigmentation,. which I have met with in true cases of
kála-ázar, is moreover of such a distribution and so closely
set, that it could not possibly be due to the remains of the
small hæmorrhages caused by the bites of the anchylostoma
worms; although it might possibly arise from inflammation of
the intestines set up by these parasites, this must be rarely the
case, or it would have been seen by Dr. Sandwith in Cairo.
Most, then, of the cases in which Dr. Giles saw these
changes during his investigation of kála-ázar in Assam, must
have been true cases of the disease, and not, as he thought,
due to anchylostomiasis. His description of the exact
changes which he found, however, is not sufficiently minute
or systematic to allow of accurate comparison with those
which I met with.

      The large intestines showed ulcerations in a very few