35
Para. 18
was distinctly palpable ; in case 27 the spleen increased by 2 inches and the
liver by 1 inch in the same period. In case 6 (tertian) enlargement of both
organs after only five days illness was noted ; in case 8 (æstivo-autumnal) the
spleen was 11/2 inch and the liver 1/2 inch below the ribs after only six days' illness.
In case 10 (quartan) the measurements were 1 inch for both organs after 10
days' fever. In case 14 (crescents) the spleen was 3 inches below the ribs
after 20 days ; and in case 18, the spleen was 3 inches and the liver 1 inch
after 30 days' sickness. In cases 25 (quartan), 26 (nil) and 29 (tertian) the
spleen was 2, 4 and 3 inches, respectively, below the ribs. The maximum sizes
reached were in cases 23, 24 and 28, in which the organs were already enormous
—so much so as to suggest that the cases were of longer duration than they
maintained (obstinately) they were. Neither organs was enlarged in 9 cases ;
5 of these were of less than one week's duration ; 6 of them showed parasites.
Out-patient cases up to two months' duration.
There are 8 of these—namely, cases 17, 20, 21, 30, 31, 32, 33 and 34.
Case 35 is not included, as he was examined into the third month. Of these,
parasites were present in cases 17, 20, 31, and 32. In case 34 the liver con-
tained both black and yellow pigment. Case 21 was nearly recovered when ex-
amined and cases 30 and 33 were not examined sufficiently. Case 17 is
interesting : no melanin was obtained from the spleen after recovery four
weeks after æstivo-autumnal parasites had been found ; and during the same
period the organs decreased rapidly in size (quinine). There was a history of
rigor in all the cases. Typical malarial fever existed in cases 17, 20, 31 and
32 ; but in case 34 (diarrhoea) the curve was subnormal. Case 34 (pigments)
was diagnosed as kala-azar. Enlargement of the spleen was present in all
and of the liver in 6 ; and was most marked in cases 21, 33 and 34. Tender-
ness in one or both the organs was complained of in cases 17, 20, 31, 32 and 34.
Out-patient cases up to three months' duration.
Out of 6 of these (cases 35—40), sestivo-autumnal parasites were found
in cases 36 and 38 only ; the others were not thoroughly searched. Rigors
were recorded in these two cases ; were absent in case 35, and are not referred
to in the rest. The spleen was enlarged in 5 and the liver in 3. Case 35 is
interesting as showing a constant low fever with a progressive enlargement of
the organs, but an absence of parasites from the finger-blood—an attempt to
examine the splenic blood failed. Case 39 (nil) was supposed to be kala-azar.
Out-patient cases up to four months' duration.
There were 3 of these—cases 41, 42, 43. Case 41 was thought to be
kala-azar ; had a greatly enlarged spleen but normal liver ; no parasites, but
a small amount of melanin in spleen. Case 42 appeared to have no illness at
all. Case 43, supposed to be kala-azar, had great enlargement and tenderness
of both organs, with melanin and sestivo-autumnal parasites in the spleen.
Out-patient cases up to two years' duration.
The next 11 cases (44 to 54), and case 22, may be conveniently studied
together. Their duration is from 4 months to 2 years ; that is, they belong to
the period when kala-azar can be definitely diagnosed clinically, and are, there-
fore, particularly interesting. Six of them—cases 44, 45, 46, 47, 48 and 54,
were returned as kala-azar at the hospital ; the remaining five being supposed
to be ordinary malarial fever. All had one or the other of the organs enlarged
and were clinically similar, the kala-azar cases differing from the others only
in being graver. Of these, parasites (æstivo-autumnal) were found only in
the first and most recent, and melanin with yellow pigment in the second
(case 45) only. Yellow pigment alone was found in the liver of case 48.
Cases 46, 47 and 54 showed neither parasites nor pigments ; but in the first
of these, blood from the organs could not be examined. In 3 of the cases
(44, 45, and 48) there was a history of rigors. In case 44 there were slight
occasional rises of temperature ; in case 48 there was no record ; in the rest there
was low fever or an indication of it. Both spleen and liver were very large in
all six and were enormous in the last (54).
F2