36
Para. 18
Of the five cases returned as ordinary fever (49-53), all were of about one
year's duration. Parasites (æstivo-autumnal) were found in one (51) and
melanin alone in one (53). In cases 49 and 50 the peripheral blood only was
examined, showing no parasites ; but in case 52 neither parasites nor pigments
were observed in the splenic blood, although cells were obtained and both
organs were much enlarged. All five cases had enlarged spleens and four had
enlarged livers.
Case 22 (doubtful) showed no parasites, and was of one year's duration.
Except for the greater gravity of the kala-azar cases, it was impossible to
distinguish them, from those supposed to be ordinary chronic malaria.
Kala-azar in-patients.
These nine cases (55 to 63) were carefully examined. No parasites were
found in any of them after repeated search ; but a small amount of melanin
was observed in the spleen of two (57 and 58). Yellow pigment also was
obtained from the spleen of case 58 ; and yellow pigment alone from the liver
of case 61. The organs were not pricked in one case (60) ; in the rest (55, 56,
59, 62 and 63), five cases, the splenic blood showed no pigments whatever,
while in case 62 the hepatic blood was equally negative.
Both spleen and liver were enlarged in all ; greatly so in all except the first.
There were no accessions of typical malarial fever in any of these cases.
Low fever existed in six (56, 57, 59, 61, 62, 63). Occasional slight rises of
temperature occurred in cases 55 and 58 ; and the temperature was generally
subnormal in one, case 60.
The motions of all the cases were repeatedly examined. The ova of anky-
lostomes were found in cases 57, 58, 59, 61, and 63, being rare in cases 57 and
59, and numerous in cases 58, 61, and 63. These three last cases were marked-
ly more anæmic than the rest. None were ever observed in cases 55, 56, 60,
and 62, although none of these patients appear to have been treated with full
doses (if any) of thymol. Bound-worms' eggs were seen in five (57, 58, 59,
60, 62), and whip-worms' eggs in five (56, 57, 59, 61, 63).
Recovered kala-azar cases.
Two of these cases had no enlargement of the organs left ; the third had
slight induration of the spleen. This case also suffered from a slight, probably
accidental, malarial infection (æstivo-autunmal).
Autopsies.
The first two of these (67 and 68) were not returned as kala-azar ; both
had copious black pigmentation of the organs.
The remaining seven were cases of kala-azar (69-75). Case 69 (three months'
duration) showed much melanin; case 70 (four months'), a little ; and cases 73
and 74 (one year), a moderate amount. Case 75 (one year) contained the merest
trace, due to a very recent invasion, before which he must have been free
from it. Cases 71 (seven months') and 72 (ten months') contained no melanin
at all.
Parasites (a very few) were found only in case 75, just previous to death
and just after.
Yellow pigment was found in all the cases except 67 and 74, being present
in case 68, diagnosed "diarrhoea and anæmia of coolies" (no ankylostomes),
as in the kala-azar cases.
Entozoa are not recorded in the first autopsy, a medico-legal case (67).
None were present in the next one (68), " anæmia of coolies." Of the seven
kala-azar autopsies, ankylostomes were present in all except one (75).
They were few in three cases, namely seven in case 69, 14 in case 70, and 20 in
case 73 ; but there were 102 in case 74, 200 in case 71 and 500 in case 72.
Round-worms were present in cases 69, 72 and 73 ; whip-worms in cases 70, 71,
72, 73, 74, 75; amphistomes in cases 71 and 73 ; and dysenteric ulcération in
cases 70, 72, 73, and 74. The two cases with the largest number of anky-
lostomes (71 and 72) were also those in which no melanin was found ; but
the case with no ankylostomes (75) had also the least black pigment. Again, the