33
Para. 17
of the case. Much diarrhœa set in later, and the organs decreased in size. Died 2nd October ;
autopsy, medium sized man, ascites and œdema of feet. Some fat. Liver, 46 ounces ; congest-
ed. Spleen, 40 ounces ; congested ; not softened ; granular section. Kidneys, rather con-
gested. Intestines, 500 ankylostomes ; 2 round and 20 whip worms ; very numerous and large
amœbæ. Below the ankylostomes a considerable quantity of bloody mucus mixed with their
eggs. Dysenteric ulcers of lower bowel containing amœbæ at the surface between the healthy
and necrotic tissues.
Microscopically. — [Fresh-Ross]. Spleen, no melanin ; a small amount of yellow pig-
ment. Liver, no melanin ; much yellow pigment. Kidneys ; no melanin ; a small quantity
of yellow pigment. [Sections-Daniels] "Spleen, granular yellow pigment in patches.
No black pigment. Iron reaction fairly marked, mainly affects granules quite distinct from
the yellow pigment. Liver, very abundant yellow intracellular pigment, massed mainly
peripherally, No iron reaction. Kidneys, unequal, but fairly abundant distribution of yellow
pigment. No iron reaction."
Case 73.—Dashomi, f., 30, one year ill. Kala-Azar. Admitted in September for fever,
enlargement of the spleen and liver and dysentery. Much emaciated; feet œdematous ;
tongue red, Temperatures, recorded twice daily, show the low fever, Dysentery continued
and organs decreased in size. Died on 12th October. Autopsy, considerable emaciation and
anæmia ; œdema of feet and ascites ; no fat. Spleen, 12 ounces; not congested. Liver, 18
ounces, fatty, cloudy swelling, not congested. Mesenteric gland, slightly pigmented.
Intestines, 20 ankylostomes ; 10 young round-worms ; a few whip-worms; and 300 flukes
(amphistomum hominis) in large intestine ; also extensive dysenteric ulcération with swarms
of the protozoal parasites down to the bottom of the ulcers.
Microscopically.—[Fresh-Ross]. Spleen, black pigment not very copious ; no yellow.
Liver, black and dark-brown pigment in streaks ; copious yellow pigment ; fatty degeneration.
Mesenteric gland, black pigment. (Sections-Daniels). "Spleen contained some fairly
recent black pigment and some masses of older not contained in cells, in fair amount. Liver,
some small masses of fading black pigment in the interlobular tissues. There was a very
small amount of yellow pigment in a few of the hepatic cells. Much fatty degeneration.
Kidney, a small amount of yellow pigment; fatty degeneration. A lymphatic gland contained a
considerable amount of fading black pigment. No iron reactions."
Case 74—\ill\hod, m., 12, one year ill. Kala-Azar. Admitted, 4th October. Says his
mother died from kala-azar nine months ago, and that his brother is now suffering from
it. He and his brother were turned out of their village after their mother's death Declares
that his illness began with attacks of shivering and fever, which latterly came with intervals
of two days. Says he had enlarged spleen previously, but that liver increased in size during
this illness (pointing to epigastrium—information volunteered). Considerable anæmia,
great emaciation. Ascites and extreme dropsy of feet. No enlargement of spleen ; but liver
2½ inches below ribs and very tender. Diarrhœa and dysentery. Very slight fever occasion-
ally; temperature generally subnormal. Finger-blood frequently examined, no parasites.
Liver twice pricked, but very few cells obtained and those were not pigmented. Eggs of
ankylostomes found in stools. Two small doses of thymol. Died on 8th November, after
my departure ; pieces of organs sent to me. Autopsy.—Liver, 23 ounces; spleen, 5½ ounces.
Intestines, 102 ankylostomes, 4 whip worms and extensive dysenteric ulceration.
Microscopically.—(Sections—Daniels). "Spleen, considerable old, and more recent, black
pigment. Liver, granules of yellow pigment, but in some of the cells there were rounded
yellow masses, in appearance resembling oil globules, but persistent in Canada balsam. Some
fatty degeneration, No black pigment. No iron reactions."
NOTE.—Absence of yellow pigment.
Case 75.—Methu, m., 14, one year ill. Kala-Azar. Admitted in July with continued
fever and great enlargement of liver and spleen ; discharged ; re-admitted, worse, in Septem-
ber. Some emaciation. Scarcely any anæmia ; no dropsy. Spleen nearly to umbilicus with
a rounded, painful protuberance in front. Liver 2½ inches below ribs, tender. No marked
anæmia. Temperature showed daily low fever—Chart 12. Blood from finger frequently
examined—negative at first. Spleen and liver pricked once each—no parasites nor pigment.
On the 22nd September high fever set in, and patient became comatose on the 26th. On that
date, after a most laborious search, I succeeded in finding two small unpigmented amœbulæ,
probably of the æstivo-autumnal parasite ; but there were no pigmented leucocytes. The
spleen had become extremely tender. Motions, frequently examined, showed one whip-worm
egg, and no eggs of ankylostomes ; but numerous protozoal parasites. Died, comatose, on 28th
September. Autopsy, shortly after death.—No ascites. Spleen, 46 ounces, extremely congest-
ed, but no evidence o£ inflammatory action ; no pus or destruction of tissue. Liver, 60
ounces ; pale; cloudy swelling ; not congested. Kidneys, pale and yellow. Intestines, 4
whip-worms ; no ankylostomes, no dysenteric process.
Microscopically, (Fresh—Ross).—Spleen, one unpigmented, active amœbula found ; no
other parasites. I could not satisfy myself that there was any black pigment at all. No
yellow pigment. Liver, a fair amount of yellow pigment; no black pigment seen by me.
Kidneys, traces of yellow pigment ; not black. Sternum marrow, no pigment. Brain not
examined. (Sections—Daniels). "Spleen ; much engorged with blood. There was a mere
trace of rounded, fine, black, intracellular pigment, such as would be met with in either a
recent slight infection or so early that the pigment has barely commenced to be deposited.
No iron reaction or yellow pigment. Liver; a small amount of yellow intracellular pigment,
F