37
Paras. 18 & 19
cases with most ankylostomes had also the most yellow pigment ; but the
one with the next largest number (102) of ankylostomes, case 74, was the only
one without any yellow pigment. The cases with iron reaction, 69, 70 and
72, were of rather early duration.
General Summary.
The 75 cases may be divided into two groups at the four months' limit.
There were 42 cases of less than four months' duration ; malarial parasites were
found in 26 (62 % ) of these, while melanin alone was found in three more.
There were 33 cases of more than four months' duration ; parasites were found
in only four (12 % ), and melanin alone in ten more. Hence, putting the parasites
and melanin together (the latter being as clear evidence of malaria as the
former), we find that either one or the other was detected in 69 % of the cases of
less than four month's duration ; and in 42 % of those of more than four months'
duration. It is evident that, taking all the cases together, there was an in-
creasing difficulty in finding the parasites as the cases advanced in duration.
Out of the total 75 cases, parasites were found in 30, or 40 % ; melanin
alone in 13, or 17.3 % ; and either parasites or melanin in 43, or 57 %.
Six of the cases were considered to be possibly kala-azar. These were
18, 19, 20, and 22, all of the same family, of which the first three contained
quartan parasites ; also 23, which contained both mild tertian and sestivo-
autuninal parasites ; and 27, which contained both black and yellow pigments.
Twenty-six of the cases were definitely diagnosed as kala-azar—exclusive
of the three recovered cases. They were cases 34, 39, 41, 43-48, 54-63 and 69-75.
Parasites were found only in three, namely 43 (sestivo-autumnal quotidian),
44 (sestivo-autumnal tertian), and 75 (sestivo-autunmal). But in the last the
parasitic invasion appears to have been an epiphenomenon. Melanin was
detected in nine more, namely 34, 41, 45, 57, 58, 69, 70, 73, and 74. Yellow
pigment was found in eleven, namely, 34, 45, 48, 58, 61, 69-73, and 75 ; occur-
ring alone by itself in 48, 61, 71, and 72. Nothing whatever was found in ten
of the cases, namely 39, 46, 47, 54, 55, 56, 59, 60, 62 and 68 ; but in cases 39, 46,
and 60, the blood from the organs was not examined ; while in none were
autopsies performed. In all the seven autopsies on kala-azar cases either black
or yellow pigment was observed.
The cases of kala-azar in which no melanin was detected after what I
consider pretty thorough examination, were cases 47, and 56 (spleen
only examined) ; 48, 61 and 62 (both spleen and liver examined) ; and 71 and 72
(autopsies). To these should be added case 75 (autopsy), in which the melanin
belonged to a recent parasitic invasion possibly unconnected with the previous
morbid condition. Hence we may, I think, conclude that eight out of the 26
kala-azar cases contained no melanin, or melanin in such small quantities as
to be inappreciable,
Thus, inclusive of case 75, parasites or melanin were found in twelve of the
26 kala-azar cases, or in 46%. Neither were found after pretty careful search
in seven, or 27%. Of the remainder, 27%, parasites were found in none, but
melanin was not exhaustively searched for.
Out of the nine kala-azar in-patients, the eggs of ankylostomes were
detected in cases 57, 58, 59, 61, 63; and out of the seven kala-azar autopsies,
ankylostomes were found in all but case 75. Thus, the worms were present in
11 out of 16 cases, or 69 %.
19. Summary of Observations at Naxalbari.—I have already
mentioned (paragraph 9) that I examined 34 cases of sickness at Naxalbari in
the Darjeeling Terai. Of these 14 were said to be cases of kala-jwai\ I could
distinguish no marked clinical difference between the kala-jwar cases and 18
of the rest, which were said to be ordinary fever. The blood of all alike was
examined ; generally only once, as the patients carne to me mostly from a dis-
tance ; but sometimes on two or three occasions.
It is unnecessary to give the cases in detail. They were of varying periods
of duration from three days to two years. Parasites were found only in five, or
15 per cent. of them, and only in recent cases. The forms observed were as
follows. Two sestivo-autunmal cases, without crescents, one of three days, and
the other of six weeks' duration ; two cases of mild tertian of one or two months,