31
Para. 17
abdomen. No œdema. Pulsation of carotids, but no cardiac bruit. Blood frequently
examined, no parasites nor pigment. Splenic and hepatic blood not examined. Motions, a
few eggs of ascaris only. Temperature subnormal—Chart 8.
Case 61.—Puai, m., 8, one year ill. Kala-azar. A very intelligent boy, well known in
hospital. Seven relatives died from kala-azar recently. Repeatedly questioned, says his
illness began with daily attacks of shivering followed by high fever. Spleen become enlarged
after he had had fever for some time. Examined from 15th September to 19th October;
greatly emaciated, very anæmic, no oedema, cheerful and energetic, enormous enlargement
of organs; spleen to ilium, liver three or four inches below ribs; both very tender. Extreme
pulsation of carotids with loud aortic bruit. Enlarged abdominal veins. Constant fever-
Chart 9 ; the morning rise of temperature beginning at about 9 A.M., often with a slight feel-
ing of chilliness. Quinine frequently given has had absolutely no effect. Motions 3 or 4 daily,
contain numerous eggs of ankylostomes and trichocephalus ; the former only diminished in
number by thymol. Finger-blood very frequently and methodically examined; no parasites,
nor pigment. Splenic blood frequently obtained ; pours out of needle, showing great con-
gestion ; no parasites nor black nor yellow pigment ever found. Hepatic blood (once) pours
from needle, several cells containing typical yellow pigment; no melanin. Case remained
unchanged during the month of observation.
NOIE.—A typical case of kala-azar. Complete absence of parasites and melanin.
Case 62.—Daneesh, m., 15, 15 months ill. Kala-azar. An intelligent lad, says fever
began after the great earthquake in June 1897 and lasted a month, during which there were
frequent attacks of shivering. Then an "internal fever" set in, during which his spleen
enlarged. This condition has continued to the present. He says his parents and a brother
and sister died from kala-azar before and during his illness. They all had fever and enlarged
spleens. Has taken much quinine, which he thinks does him good. Examined from 18th
September to 19th October. Moderate anæmia and emaciation. No œdema now, but feet
were swelled formerly. Pulsation of carotids ; no bruit, enlarged abdominal veins, but belly not
protuberant. Liver halfway to umbilicus, but spleen only 5 inches below ribs; both tender.
Conjunctive rather yellow. Daily fever—Chart 10. The amplitude is rather large, and
there is a fall below normal sometimes before the daily exacerbation. This begins at about
3 P.M., often with a slight feeling of chill. Quinine frequently given has produced no effect
whatever. Finger-blood examined very frequently at all hours ; spleen pricked twice and
liver once ; no parasites, melanin, nor even yellow pigment found. Organs congested, mo-
tions twice or thrice daily ; an occasional ascaris egg, no ankylostomes eggs ever found on
repeated examinations. Improved somewhat during period of study.
NOTE.—Another typical case of kala-azar. The fever is very interesting, being extremely like a quotidian.
The daily constancy is, however, too great ; quinine was useless, and no parasites were ever found, even after the
most careful search. Great enlargement and congestion of liver.
Case 63.—Domila, f., 8, 2 years ill (?). Kala-azar. Parents, brother and sister died of
kala-azar 2 or 3 years ago. Examined from 27th September to 19th October. Fairly fat, but
considerably anæmie. Belly protruberaut, no enlarged veins. Face and eyelids œdematus ;
feet not swelled, conjunctivæ slightly yellow. Great pulsation of carotids ; slight bruit.
Liver 3 inches and spleen 4 inches below ribs ; both tender ; slight daily fever—Chart 11.
Quinine did not affect it. Finger-blood frequently examined ; no parasites nor pigment.
Spleen, once ; few cells obtained ; no pigments. Motions, three or four daily, diarrhœa ; nume-
rous eggs of ankylostomes ; also of trichocephalus, no amœbse, but swarms of cercomonads,
on several examinations.
Three Recovered Kala-Azar Cases.
Cask 64.—Konoka, m,, 8, out-patient, Recovered Kala-azar. Is being treated for commen-
cing goitre. Formerly had enormously enlarged liver and spleen, but has recovered during the
last six months. Examined 18th October, fat, not anaemic. No enlargement either of liver
or spleen, no parasites. Mother has goitre.
Case 65.—Mahomed Safi, m., 15, out-patient. Recovered Kala-azar. Was taken ill three
years ago with kala-azar ; relatives had the disease. Nearly died a year ago with great enlarge-
ment of organs and other symptoms, as certified by Hospital Assistants who attended him.
Recovered completely, but has had a little fever lately. Examined from 15th September, very
slightly anæmic ; otherwise appears well. Spleen slightly enlarged and hard. Finger blood
contains a few crescents. Spleen blood, copious melanin and one crescent found. Recovery;
crescents disappeared early. No enlargement of liver.
NOT E.—This attack of fever is probably quite unconnected with the previous kala-azar. Slightness of
symptoms connected with the present parasitic invasion is remarkable.
Case 66—Sri Jut Gunahash Gosswami, m., 29. Recovered Kala-azar. See Appendix A, 1 ;
not clinically examined,
Nine Autopsies.
NOTE.—In the following autopsies interest was confined almost entirely to the two pigments and the
parasites of the intestine, as immediately required for the purpose of this report. For the pigments, pieces of
the organs taken here and there were crushed in the fresh state and examined, while cubes were cut for section-
ing afterwards. I have thought it best to hand over the latter work to Dr. Daniels, Colonial Medical
Service, now attached to the Malaria Commission, and sent by the Colonial Office to work with me in Calcutta.
His large experience in such pathalogy gives his opinion great weight, while hie independent testimony in the
matter is valuable.