25
Para. 17.
10 A.M., temperature 98.4° F. Does not look as ill as last case ; is cheerful and fat, though
anæmic. Spleen and liver both one inch below the ribs and tender. Peripheral blood, exactly
the same parasites as last case, but only one half-grown generation in dark green corpuscles,
which they pucker as they move ; less numerous. Quinine. Seen frequently. Improved
gradually ; enlargement of spleen gradually almost disappeared, but that of liver remained.
Case 20.—Ramad Ali, m., 11, two months ill. Brother of above. Says fever, which was
formerly continuous, now comes every third day.
Examined 8th October, 9 A.M., tempera-
ture 97.9° F. Boy says he had fever yesterday. Does not look very ill, and is not emaciated
or œdematous ; but is of a yellow colour and considerably anæmic. Spleen 2 inches and liver
half an inch below the ribs ; both tender. Peripheral blood, no parasites nor melanin.
Examined again on 9th October, 8 A.M., temperature 97.7° F. Boy insists that he had fever
on the 7th at 2 P.M., and that it left him at 4 P.M. ; and adds that it will come on to-morrow
at about the same time. Peripheral blood, one single medium sized quartan parasite rapidly
amœboid for quartan, in a dark green corpuscle. No other parasite found. Improvement
under quinine as last cases.
Case 21.—Bussor-u-din, m., 50, two months ill. Father of the last three cases. Says
he gets fever only occasionally now, and that he has not had it lately. Begins with rigor.
Examined on 8th October, 8 A.M., temperature 97.7° F. Spleen 4 or 5 inches below the ribs,
not tender. No enlargement of liver. Looks nearly well. Peripheral blood, no parasites
nor melanin. Not examined again, as he had no more fever after taking quinine. Spleen was
little reduced in size on the 19th October.
Case 22.—Amir-u-din, m., 2½, one year ill. Son of last case and brother of the three
preceding cases. Had severe fever formerly, but has been better for a long time, though he
still has slight fever. Father says his spleen was formerly greatly enlarged. Examined on
8th October, 10 A.M., temperature 99.7° F. Looks anæmic and slightly ill. No enlargement
of spleen, but liver is palpable. Peripheral blood, no parasites. Examined on several future
occasions in the morning; the temperature was always found to be between 99° and 100° F.,
and no parasites or pigment were observed in blood. Spleen not permitted to be examined.
No change on 19th October.
NOTE.—This family of five persons is interesting. The same parasite was found in three of the earlier
cases, accompanied by considerable enlargement of the organs, the general condition of these cases approaching
that of established kala-azar. In the first cases the morning temperature was generally subnormal and the
fever was easily affected by quinine. In the last case (of a year's duration), however, the morning reading
always showed a slightly raised temperature suggesting a continuous fever ; and this fever remained entirely
unaffected by quinine.
Case 23.—Sadur, m., 12, one month ill (?). Comes from Roha, where there has been
much kala-azar (paragraph 5). Says father and mother died of fever (? kala-azar). Says
he has had fever for one month, but this statement is not reliable. States that the fever comes
every other day with shivering (information volunteered) at about 2 P.M. Examined on 22nd
September at 8-30 A.M., temperature 98.4°. Does not look very ill ; considerably anæmic ; no
œdema; spleen nearly to umbilicus ; lower edge of liver half-way between lower end of sternum
and umbilicus (much enlarged). Peripheral blood, a leucocyte containing spring tertian pig-
ment, a large spring tertian parasite and small unpigmented amœbula—nothing else. Splenic
blood ; numerous spleen-cells. A cluster of black pigment in a spleen-cell in about every
four fields ; pigment not at all copious. Numerous parasites having the appearance of red
corpuscles containing several large rounded grains of black pigment, the plasma of the para-
site being extremely undefined—like æstivo-autumnal tertian parasites, nearly mature (para-
graph 21). No yellow pigment found. Few spring tertian parasites here. Patient not seen
again.
NOTE.—The duration of this case appears to be more than one month. There are two varieties of parasite
present. Thought to be possibly kala-azar.
Case 24.—Bhawan, m., 35, one month ill. Says fever comes every evening. Examined
26th September, at 10 A.M.; temperature 97.4° F. Not at all ill, but anæmic. No emaciation or
œdema. Spleen approaching umbilicus ; liver not enlarged. Peripheral blood, two æstivo-
autumnal amœbulæ in one corpuscle ; nothing else, 3 P.M., one similar amœbula ; no fever.
Not seen again.
Case 25.—Bhorali, m., 15, one month ill. Says fever comes every other day or every
third day, with rigor. Examined 4th October, morning ; considerable anæmia and emaciation ;
no œdema. Spleen 2 inches below ribs ; liver just palpable. Peripheral blood, a few typical
quartan parasites, some within small dark green corpuscles. Patient not seen again.
Case 26. — Mahomed Ebrahim, m., 25, one month ill. Says he caught fever from his sou.
No kala-azar in his house. Examined on 24th September at 3-30 P.M., temperature 99.5° F.
Not looking ill ; no anæmia. Liver not enlarged, spleen 4 inches below ribs. Fever just begin-
ning with rigor. Peripheral blood, no parasites or pigment. Examined again next morning ;
one doubtful ring form (æstivo-autumnal) in blood. Spleen pricked on 17th October ; no blood
obtained. Not seen again.
Case 27.—Koram Ali, m., 9, one month ill. Is well-known in the hospital. His father
and sister died of kala-azar a year ago, and his mother now has it, but is better. Severe fever
began a month ago, lasted ten days and then stopped ; came on again yesterday. Examined
1st October, 10-30 A.M., temperature 99.8° F. Looks ill and yellow ; anæmic ; no emaciation
Spleen 2 inches below ribs ; liver not enlarged. Peripheral blood, no parasites. Examined,
again on 3rd and 4th October. Spleen increased to three inches below ribs ; blood, no para-
sites. Temperatures taken twice daily showed a high continued fever from 100.5° to 104.2° F.,