72

Report on Kála-ázar.

bone marrow in the hope of producing a more rapid improve-
ment in the blood than by other means, it was the general
improvement in the state of the patient that was its most
marked effect, together with an increased appetite and power
of digesting and absorbing food. On September 7th she
was fat compared to what she had been, while her spleen
now only reached to just below the navel, and her liver
could not be felt. The blood on this date was hæmoglobin
38 per cent., red corpuscles 2,900,000, white 5,500, or
1 to 527 red; hæmoglobin value.66. On September 14th, she
weighed 77½ lbs., but a month later she had improved up to
90lbs. She continued to gain weight after the tabloids were
left off, but somewhat more slowly, and was discharged cured
on November 11th, and is now quite well, and has married.

     Remarks.

    This is by far the worst case in which I have seen
recovery take place, and the rapidity
with which marked improvement in nu-
trition occurred was in striking contrast to anything I have
witnessed in other cases, for, as I have before remarked, a
characteristic feature of the disease is the way in which the
patients remain in an emaciated state long after the fever has
left them, and the frequency with which such cases fall a
victim to lung and bowel complications. Unfortunately I
could not continue my trials of this treatment owing to all
the tabloids I could get in India having been exhausted; but
Dr. Dodds Price and Dr. Lavertine are now using it in the
treatment of kála-ázar cases, and are so far well satisfied
with its effects, and we may hope to hear shortly if my results
are confirmed or not. The only explanation that I can
think of to account for the improvement of nutrition from
the use of bone marrow tabloids, is one which assumes that
the yellow marrow in the shafts of long bones has the func-
tion of secreting some substance, which affects the digestive
powers and nutrition in a somewhat similar way to the action
of the internal secretions of the thyroid or suprarenal capsules,
and that the changes found in the bone marrow in