104

Report on Kála-ázar.

cases, and congested patches and thickening or even œdema
of the mucous membrane rather more frequently, and in one
or two cases some pigmentation.

      The anchylostoma were very carefully counted in each
case, and the amount of damage done by them minutely
scrutinised by the help of a magnifying glass, which was very
often necessary in order to enable it to be distinguished. In
4 out of the 25 autopsies, no anchylostoma were found; in 7
more, less than 10 were present, in 5 there were from 11 to
20, in 5 from 21 to 30, and in the other 4 cases, 48, 50, 80, and
103, respectively, the average of the whole being 21.48. In 7
healthy persons, who had died from accidental causes, on the
other hand, the numbers present were 11, 10, 11, 13, 24, 34,
61, and 72, respectively, with an average of 32. The slightly
smaller numbers in the former series is doubtless due to the
fact that some of the kála-ázar cases, but by no means all,
had been given thymol during life. In four cases, on the
other hand, in which the anæmia was really due to anchylos-
tomiasis, as proved by the character of the blood changes,
the numbers found were 161, 350, 40, and 249, giving an
average of 200. Dr. Sandwith, in post-mortems on 18 cases,
which had not had the benefit of the: thymol treatment, found
in six of them less than to worms, in three others 20, 40, and
5o worms, but in the other nine numbers varying from 170
to 381, terminating with the maximum record of 863. Thus,
it is evident that, although in some cases very few worms may
be found after death; yet in a series of cases a very different
record is obtained from that met with in kála-ázar, and the
evidence here given, together with that detailed in the clinical
section, and the figures obtained by Dr. Dobson, prove incon-
testably, apart altogether from the absolute scientific proof
afforded by the differences in the blood changes given in Section
IV, that the anchylostoma worms are not present in the majority
of kála-ázar cases in larger numbers than they are in the
healthy people of Assam, much less are they present in
sufficiently larger numbers in this disease, than they are in