26
Para. 17
lasting for a fortnight. Was examined again on 15th October and was found to bave
pleuro-pneumonia on the left base. Had become very ill and was unable to walk ; very
anæmic and considerably emaciated. Spleen more than 4 indies below ribs and liver 1 inch ;
both very tender ; high fever. Hospital Assistants think the case is kala-azar; Captain
McNaught thinks it may be so. Peripheral blood, no parasites. Splenic blood ; numerous
spleen-cells obtained, many of which contain black pigment, while others contain yellow pig-
ment. The melanin is in small granules, scattered singly or numerous in the cells. No
agglomerated masses larger than 3μ in diameter. It is not copious. The yellow pig-
ment is in characteristic, small, angular, bright-yellow granules within isolated cells ; much
less abundant than the black, and does not blacken with ammonium sulphide. No parasites
at all found. The patient had been taking quinine regularly. Improvement followed from
this date to the 20th October, when I last saw him.
NOTE.—Sufficient search for parasites was not made in this caso at the beginning of the second conflagration
of fever occurring on 30th September ; but the splenic melanin ; which had every appearance of being recent
(and, I think, belonged to the quartan parasite), proved the presence, at least lately, of a parasitic invasion. The
high continued fever was probably partly due to the pleuro-pueumonia, but the extreme tenderness of the
liver and spleen almost suggested an inflammatory condition in them also. Note also the presence of
yellow pigment and rapid enlargement of the organs.
Case 28.—Nur Baks, m., 30, one month ill (?). Says that two men died of kala-azar in
his house a year ago, examined 8th October. Liver 2 inches below ribs. Spleen to umbilicus ;
both tender. Does not look at all ill, but is a little anæmic. Peripheral blood, no parasites or
melanin. Not seen again.
NOTE. — The case is probable of longer duration than one month.
Case 29.—Gubinath, m., 18, one month ill. Says his fever is continuous, but that rigors
occur. His mother died of kala-azar five years ago, and his uncle has been having fever for
four months. Examined on 10th October, at 7-30 A. M. ; temperature 97.5° F. Looks ill ; con-
siderable anæmia and some emaciation. Spleen three inches below ribs ; liver not enlarged.
Peripheral blood, numerous tertian parasites of two generations. They contain particularly fine
pigment of a very light colour (paragraph 20). Quinine. Seen again on 12th ; temperature
95.8° F. Says fever has left him. No parasites. Recovery. Spleen remained enlarged to
20th October.
Case 30. — Nial, m., 45, one and a half months ill. Says fever is irregular, with rigors, and
that he is now better. Examined on 3rd October, morning ; temperature 98.2° F. Does not
look ill. No œdema or emaciation ; but marked anæmia. Spleen 3 inches, and liver 1½ inches
below ribs. Peripheral blood, no parasites nor melanin. Seen on 17th October ; the spleen
was found to have decreased to 2 inches below ribs, and the liver increased to 2 inches.
Says he has been having no fever lately after taking quinine. Blood not examined.
Case 31.—Kandura Riot, m., 25, policeman, one-and-a-half months ill. Says fever comes
with rigor, lasts six days or so and then remits for about three days. Examined 4th October,
morning. Temperature was 103° F. last evening, and is 99° F. this morning ; very slight
anæmia; looks not very ill. Peripheral blood, one small unpigmented æstivo-autumnal
amœbula only. Spleen 3 inches and liver ½ inch below ribs ; both tender. Spleen pricked,
but no blood obtained. Not examined again. Recovery.
Case 32 —Amiran, f., 10, 2 months ill. Says she gets fever every three days with rigor.
Is well known. No one in her house is now getting fever, Examined 20th September, at
9-30 Δ. M. ; temperature 97.6° F. Looks considerably ill, but is not very anæmic ; emaciated.
Spleen 3 inches and liver 2 inches below ribs ; tender. Peripheral blood ; a few quartan para-
sites, many in small, dark green corpuscles; only one generation. Was watched for some weeks,
the blood being frequently examined. The fever occurred with exactness every third day and
parasites were constantly present ; being little influenced by quinine, which, however, was not
taken regularly. Typical quartan sporulating parasites were occasionally observed in the
peripheral blood. There was practically no change by the 20th October, the condition of the
organs and numbers of parasites remaining the same.
Case 33.— Bagu Sing, m., 30, out-patient, 2 months ill. Says fever begins with sharp
rigor every evening at 6 P. M., examined 20th September at 8 A. M. Spleen enlarged to
umbilicus ; liver not enlarged. Looks well and is not anæmic nor emaciated. Peripheral
blood ; no parasites. Not seen again.
Case 34.—Manu, m., 25, latterly in-patient, two months ill (?). Diagnosed kala-azar in
the hospital. It is difficult to ascertain the duration of the illness in this case ; bat
patient says it is only two months, and that a month ago he was driven out of his village (in
consequence of his having kala-azar ?). Says that the fever came daily with rigor and was
very severe, but that he is now better somewhat. Examined on 6th October at 8 A. M. ; tem-
perature 96.2° F. only. Looks thin and starved ; fairly anæmic (not very) ; no œdema now, but
says that his feet were swelled a month ago. Spleen occupies a third of the anterior surface
of abdomen and reaches nearly to the umbilicus ; liver three inches below ribs ; both very
tender. Peripheral blood, no parasites nor pigment. Splenic blood ; numerous spleen-cells.
No parasites and not a particle of pigment, black or yellow, obtained in three specimens. Three
punctures of the liver failed ; two drew nothing and the third drew only blood without paren-
chymatous tissue, the blood containing no pigment. Temperatures taken for eight days from
this date show a subnormal temperature, (Appendix C—Chart 1). Motions examined on two
occasions showed only a few trichocephalus eggs, but were constantly loose and were passed
three or four times daily (he says). On 11th the liver was again punctured twice. The first
drew a little cellular substance without blood ; the second much cellular substance with a little