29
Para. 17
three months. Declares that he has become blacker. Examined 19th September at 3 p. M.
temperature 100.2. °F. Considerable anæmia and emaciation ; no œdema. Spleen nearly to
crest of ilium ; liver 2 inches below ribs ; abdominal veins slightly enlarged ; protuberant
abdomen. Blood, no parasites, Temperature taken on several occasions showed constant
fever between 99° and 102°F. Blood never showed parasites. Seen on I8th October ; has
been having quinine in large doses regularly, and his uncle says he is better.
Less
anæmic and emaciated. Spleen much reduced, but liver larger (3 inches below ribs) ; both
organs tender. Temperature 96.0 °F. (8 A.M.). Splenic blood (two punctures) ; numerous
spleen-cells ; no pigment whatever, black or yellow ; no parasites.
NOTE.—Low constant fever, apparently improved by quinine.
Case 48.—Makmal, m., 10, 10 months ill. Diagnosed in hospital as kala-azar. Father,
mother and a cousin died of kala-azar, the last about a year ago. Says illness began with
rigors and very severe fever ; the former were very sharp and carne every day. Is now
feeling better. Examined on 20th September, morning; temperature 98.4 °F. Considerable
anæmia and emaciation ; does not look particularly ill. Spleen to umbilicus, not tender ;
liver 2½ inches below ribs, slightly tender. Peripheral blood, no parasites nor pigment. On
21st September at 9 A. M., temperature 96.8. Splenic blood ; numerous cells, not a particle of
pigment, black or yellow, in three specimens ; no parasites. Examined on 16th October at
8 A. M.; temperature 96.2°F. Says he still gets fever (?). Hepatic blood ; numerous liver-
cells, most of which contain from 5 to 30 angular granules of typical yellow pigment, single
or in small clusters. Do not blacken with ammonium sulphide ; turn green with Löffler's
blue. No melanin nor parasites.
NOTE.—Absence of melanin and parasites from peripheral, splenic and hepatic blood ; presence of yellow
pigment in large quantity in the last only. Nature of temperature-chart not ascertained.
Case 49.—Dharbari, m., 30, one year ill (?), Says has had slight fever for a year ;
worse the last twelve days. Examined 3rd October, morning ; temperature 97.5° F. Spleen
3 inches ; liver just palpable. Does not look at all ill. Blood, no parasites. Not seen again.
Case 50.—Iayob, m., 10, one year ill. Says illness began with fever and rigors ; was
very severe, but is better now. Examined 28th September morning, considerable anæmia ;
no emaciation or œdema. Spleen 4 inches, liver 1 inch below ribs ; slightly enlarged abdo-
minal veins. Peripheral blood, no parasites. Not seen again.
Case 51.—Bagi, m., 30, one year ill. Says he gets high fever occasionally since one
year. Each attack lasts about a week. Acquired the illness outside Nowgong. Examined
9th October, morning ; temperature 97.7°F. Has had high fever for several days with
rigors. Does not look ill or weak; is yellow but not emaciated and very little anæmic. Spleen
to umbilicus, and liver one inch below ribs. Is a gentleman's servant, and is certainly not
considered to have kala-azar. Peripheral blood, numerous unpigmented æstivo-autumnal
amœbula with " tongues ;" many pigmented leucocytes ; not a single crescent. Large doses of
quinine. Examined nest morning ; only one pigmented leucocyte was found. On 12th
October, says fever has left him since he had the quinine. Splenic blood ; melanin in rather
large quantity ; no parasites ; no crescents ; no yellow pigment. Not examined again.
NOTE.—Absence of crescents, but presence of pigment with the unpigmented amœbulae " with tongues "
—suggesting that the mature stage of this is pigmented.
Case 52.—Shorat Chandrade, m., 25, one year ill. Illness began with high fever with-
out rigors and lasted off and on for 9 months. It has left him (he says) for the last three
months. Examined on 19th October at 9 A.M., temperature 98.5 °F. Does not look very
ill ; no emaciation ; some anæmia ; feet slightly swelled ; abdominal veins a little enlarged,
but not much ascites. Spleen past the umbilicus : liver 4 inches below ribs, neither of them
tender. Splenic blood, a few spleen cells, no pigment black or yellow ; no parasites. Not seen
again.
NOTE.—This man was a fairly well-paid official who could afford good food. Hospital Assistants thought it
was not a case of kala-azar, because patient was " not ill enough ;" they thought it was " ordinary chronic
malarial fever." Note also great enlargement of both organs and absence of pigments in specimen from spleen.
Case 53.—Vikhari, m., 52, about one year ill. Is in hospital for some surgical complaint
(not noted). Has had slight fever occasionally. An attack for the last three days. Examined
on 29th September ; not at all ill. Spleen 3 inches below ribs ; liver not enlarged. No anæmia.
Peripheral blood ; no parasites ; one pigmented leucocyte. Quinine. No more fever from this
date. Slight diarrhœa ; motion examined on 8th October ; one ankylostomum egg found ;
swarms of cercomonads in clusters ; no amœbæ. Temperature chart showed normal
readings.
Case 54.—Harmuz, m., 5, 2 years ill. Well-known in hospital ; considered to be kala-azar.
Mother said to have died of it. No history. Examined 2nd October, 7-30 A.M., temperature
99.5°F. Enormous enlargement of organs ; spleen long past umbilicus ; liver 3 inches below ribs
(in small child). Abdomen much distended ; abdominal veins enlarged. But there is scarcely
any anæmia. No œdema, and the child is quite fat and cheerful. In same condition on 18th
October. Temperatures taken occasionally have shown morning readings above the normal.
Splenic blood ; few cells obtained ; great rush of blood ; no parasites ; no pigment, black or
yellow.
Nine Kala-Azar In-Patients.
NOTE.—The following nine kala-azar in-patients cases were all in-patients at the Nowgong Civil Hospital,
and were all returned as kala-azar, being diagnosed as such by Captain McNaught. Sections of their temperature
charts are given in Appendix. C. All were living when I left Nowgong.