Pathology and nature of kála-ázar.

105

healthy people, to constitute them an important factor in the
production of the affection.

      As to the lesions caused by the bites of the anchylostoma,
I was fortunate enough to get several autopsies within a very
few hours after death, when the large majority of the worms
were still adherent to the mucous membrane of the small
intestine. I was surprised to find that, although under many
of them a small hæmorrhage was easily seen, yet on close
examination it was found that at the point of attachment
of the majority of them, no hæmorrhage was visible, even
with a magnifying glass, but only a very small white dot or
circle. Doubtless, whenever they bite a new place, one of
these small hæmorrhages must be formed, which will certainly
take at least a week to be absorbed at the very lowest estima-
tion, so that it is evident that the worms usually remain
attached to the same place for at least that time, which is only
what might naturally be expected. Again, I found fresh blood
in only a minority of the worms which I examined under the
microscope, although it does not clot in the bodies of the
parasites, and would keep its natural appearance for some
time, which seems to show that the worms are not constantly
sucking blood out of the intestine, but only take sufficient
to nourish them, and to allow of the rapid formation
of ova; and as they are quite small and their food is of
the most nutritious kind, there is no necessity for their
taking more than a drop or two of blood a day, or for their
changing their feeding ground more than once a week,
perhaps, when the minute scar, which they make, begins
to contract around them. Now Dr. Braddon, of the Malay
Peninsula, in a criticism of Dr. Giles' report, estimates that,
even if it be allowed that a hundred parasites are present and
inflict several fresh bites daily, it would take a year to produce
such considerable erosion as would destroy even one-twentieth
of the digestive area of the small intestine alone. Yet Dr.
Giles writes that—

      "The mere loss of the nutritive matter required for the support

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