23
Para. 17
Spleen and liver noticeably larger than on 18th. Boy says now that both are tender. Peripheral
blood, one æstivo-autumnal amœbula. Not examined again.
NOTe.—Rapid enlargement of the organs, especially liver ; and tenderness in the latter.
Case 9.—Metabadal, m., 30, from distant village, ill about six days. Says almost continuous
high fever with rigors. Examined 18th September. Looks ill ; high fever all day; old enlarged
spleen ; no appreciable enlargement of liver. Temperature 102.8°F. at 5 P.M. Peripheral blood,
several tertian parasites of different generations; numerous small amœbulæ, unpigmented, form-
ing rings, some in small dark green corpuscles ; one nearly mature æstivo-autumnal parasite—a
mixed infection. Admitted; quinine. Re-examined 21st September, much better ; no para-
sites. Recovery forthwith ; no decrease in spleen.
Case 10.—-Bharu, m., 10, 10 days ill. Boy says his fever comes one day on and two
days off. No history respecting relatives recorded. Examined 1st October morning. Says
fever began this morning with rigor which is just passing off. Looks ill and half-starved,
but not emaciated ; considerably anæmic. Spleen one inch below ribs; liver one inch below
ribs and tender. Declares repeatedly that he has had no fever for years until this attack ten
days ago. Temperature 103.4°F. Peripheral blood, one full-sized quartan parasite, and a few
medium-sized; no pigmented leucocytes. Blood from spleen, numerous quartan sporulating
forms and a few half-grown parasites. Spleen ceils procured ; they contain a small quantity
of melanin—clumps up to 3μ in diameter, and clusters of oscillating isolated granules. A
few granules in every field—melanin by no means copious. No yellow pigment found. Quinine
regularly. Examined again 11th October. Says no fever since he last saw me. Enlargement
of spleen has entirely disappeared, but liver still remains enlarged one inch below ribs. Patient
says, however, that it is no longer tender. Blood not examined, not seen again.
NOTE.—Rapid enlargement of organs and persistence of liver enlargement after disappearance of splenic
tumour. Also large number of quartan sporulating- forms in spleen when none were found after careful search
in peripheral blood, also small quantity of melanin in splenic cells, even at height of illness.
Case 11.-Molo, m., 35, 11 days ill. Says fever began with rigor 11 days ago, since
when it has been continuous with only morning remissions. Examined 19th October, 11 A.M.
Temperature 101.5°, rigor just beginning, no enlargement of liver or spleen. Does not look
seriously ill. Peripheral blood, one crescent, becoming flagellate, after careful search; no other
parasites. Not seen again.
NOTE.—Absence of enlargement of organs and of apparent illness of patient.
Case 12.—Iarbee, f., 6, 12 days ill. Mother says fever is continuous. There were
kala-azar cases in the house a year ago. Examined 24th September at 10 A.M., slightly anæmic
and looking rather ill. No emaciation or enlargement of spleen or liver. Peripheral blood,
no parasites or black pigment, numerous leucocytes. Temperature 100° F. ; seen again on 16th
October ; liver one inch below ribs; spleen palpable ; blood could not be examined. Father
says no fever for a fortnight ; much better.
Case 13.—Ramchandra, m., 10, out-patient, 15 days fever. Says he has fever every third
day, severe, with rigor, comes regularly (information volunteered). Examined 30th September
at 7-30 A.M. Temperature 97.4°F. Looks ill ; spleen palpable under the ribs ; no appreciable
enlargement of the liver. Peripheral blood, numerous medium-sized quartan parasites, one
generation; pigmented leucocytes. Splenic blood ; spleen-cells contain melanin in every field
from smallest grains to large agglomerations. The (medium-sized) parasites are not more nu-
merous in the splenic than in the peripheral blood. No yellow pigment ; more pigment than
in Case 10. Not seen again.
NOTe.—No hepatic enlargement.
Case 14.—Silahin, m., 40, 20 days fever. Has lately had severe fever, apparently of
tertian type, with rigors for 20 days, not longer. Is now better, looks pale but not ill.
Not emaciated. Spleen four inches below ribs. No enlargement of liver. Examined 19th
September at 9 A.M.; temperature 97.6°. Peripheral blood, a very few æstivo-autumnal amœbulæ,
not pigmented; a pigmented leucocyte. Again at 3 P.M., three amœbulæ as before ; one crescent
after long search. Examined frequently, one or two crescents found occasionally ; but not
always, very rare. Says slight fever occasionally ; quinine regularly. Not ill ; does hard
work. On 4th October spleen had almost disappeared. No hepatic enlargement. Peripheral
blood, one crescent. Splenic blood, numerous spleen-cells, almost all of which have masses
of melanin from smallest granules to large agglomerations ; no crescents found here. No
yellow pigment noted.
NOTE.—Large amount of melanin in spleen.
Case 15.—Kaila Din, m., 11, 20 days ill. No history recorded. Examined 24th
September at 3 P.M. No enlargement of the organs; slight anæmia. No fever now. Peri-
pheral blood (hasty) ; no parasites. Not seen again.
Case 16.—Bang, m., 25,20 days, ill. Says was taken ill with severe fever with rigors 20
days ago, some weeks after his step-mother, Dipkalia, the next case, who lives in the same
house ; after lasting 10 days, the fever has nearly left him, but he still feels it occasionally.
Examined 24th September, 8 A. M., temperature 98.4°F. Is no longer ill, but considerably
anæmic and quite yellow. No enlargement of the spleen and liver apparent; strong young man.
Peripheral blood ; fairly numerous, rather large æstivo-autumnal unpigmented amœbulæ; one
pigmented leucocyte. The amœbulæ have "tongues" (paragraph 21). No crescents after
careful search, Quinine. Examined again on 29th September, 9 A. M., temperature 99.0°F.