30
Para. 17
Case 55.—Upar Singh, m., 8, six months ill (?). Kala-azar. No reliable history obtained.
Examined frequently from 14th to 19th October. Temperatures Appendix C.—Chart 3.
Fat and cheerful. No appreciable anæmia ; no œdema. Belly protuberant ; spleen 2 inches
and liver 1 inch below ribs; no enlarged abdominal veins. Peripheral blood frequently
examined ; no parasites nor pigment. Splenic blood on 19th October ; few cells obtained ; great
rush of blood ; no parasites ; no pigment whatever, black or yellow. Has been well dieted
and treated with cinchona febrifuge for some months. Motions contain no eggs of entozoa
nor protozoal parasites.
NOTE.—Slight daily rise of temperature ; absence of parasites and pigments.
Case 56.—Bedesi, m., 4, 6 months ill (?) Kala-azar. Mother died of Kala-azar two years
ago. Has been in hospital since January. No other history. Examined from 14th to 19th
October. Section of chart, Appendix C—Chart 4, shows daily rise (which had been going on
for a long time previously). Fairly fat ; slight anæmia ; no œdema of feet ; conjunctivæ
yellow. Protuberant belly ; spleen to umbilicus and ilium ; liver 3 inches below ribs ;
neither tender. Peripheral blood, no parasites on frequent examination. Splenic blood ; large
masses of pulp obtained ; no pigment, black or yellow ; no parasites. Motions, a few eggs of
richocephalus only.
NOTE.—Daily fever and absence of parasites and pigments from spleen.
Gase 57.—Adiram, m., 6, one year ill. Kala-azar. Was admitted last July. Mother, a
sister and a young brother died from kala-azar 2½ years ago. When asked if he ever felt
cold during his illness, the child replies that he used frequently to shiver when it first began.
Examined from 27th September to 19th October. Chart 5 shows a low fever. A little
emaciated ; no œdema of feet (though there was some formerly). Considerably anæmic ;
conjunctivæ rather yellow. When first examined the spleen extended to umbilicus, and the
lower edge of the liver half-way to the same from the ribs; both organs were tender. At
the end of the period oí examination the spleen had receded by more than an inch and the
liver by two inches. The belly was not very prominent, and the abdominal veins not
enlarged ; no parasites ever found, after several careful examinations, in peripheral blood.
Motions contained at first very numerous eggs of ascaris and trichocephalus , also a few eggs
of ankylostomes and a thread-worm's egg ; no protozoal parasites. After vermifuges
(including thymol) a very few trichocephalus and ankylostomum eggs were still found.
Splenic blood on 13th October ; splenic cells fairly numerous. Black pigment present in small
collections of minute granules, always inside spleen cells in one out of twelve fields. No
parasites or yellow pigment observed. The melanin tends to lie in streaks, and appears to be
fairly old deposit.
NOTE.—The presence of melanin proves at least that a parasitic invasion of the blood has lately taken
place.
Case 58.—Kali, f., 10, one year ill (?) Kala-azar. Her parents, two brothers and three
sisters all died of kala-azar some years ago. Examined from 28th September to 20th October ;
chart 6 ; temperature shows an occasional tendency to rise above normal, but is frequently
subnormal. Diarrhœa ; about 4 motions daily. Stools contained numerous ascaris eggs
and a considerable number of ankylostomum eggs, which were not entirely got rid of by
vermifuges. Considerable anæmia ; marked emaciation ; no œdema ; abdomen slightly
protuberant and abdominal veins slightly enlarged. Tongue fairly red ; conjunctivæ slightly
yellow. Much pulsation of carotids, but no cardiac bruit, even anæmic. Spleen 3 inches and
liver 2½ inches below ribs ; neither tender. Patient says both are decreasing rapidly. Ad-
mitted 22nd September. Hepatic blood on 23rd nil. Splenic blood on 14th October;
numerous cells obtained. A few found to be unmistakably pigmented with melanin after long
search, melanin very scarce. One cell found containing typical yellow pigment ; no more seen.
Patient improved while under examination. No parasites ever found in peripheral blood after
frequent examination.
NOTE.—Diarrhœa, ankylostomes and decrease of organs (?) Also pigments, and their small quantity.
Case 59.—Aiti, f., 8, one year ill. Kala-azar. Parents died from kala-azar three
years ago ; and two brothers and three sisters about a year and a half ago. She herself has
been ill for about a year, and has been in hospital since July. The child is old and intelli-
gent enough to answer questions She repeats that the illness began with daily attacks of
cold and shivering and with great heat. Examined from 26th September to 19th October.
Not at all emaciated ; slight anæmia ; protuberant abdomen ; enlarged abdominal veins ;
no œdema of face or feet ; pulsation of carotids. Liver 2 inches below ribs and spleen to
umbilicus ; neither tender. Spleen decreased by more than an inch during the period of
observation. Tongue red ; heart, no bruit. Chart 7 shows daily fever between normal
and about 101.2° F. Finger-blood frequently examined , no parasites nor pigment. Splenic
blood ; cells obtained, but not numerous ; no pigment, black or yellow. Motions , numerous
ascaris eggs, a few trichocephalus and a very few ankylostomum eggs. No amœbæ nor
cercomonads. Quinine and cinchona regularly since admission, no marked influence on
chart.
Case 60.—Bedu, f., 8, one year ill. Kala-azar. Parents and one brother died from
kala-azar two or three years ago. Examined from 6th to 19th October. Is quite fat and
cheerful ; slightly anæmic, has been in hospital for some time. Spleen 2 inches and liver
3 inches below ribs, both slightly tender. Enlarged abdominal views and and protuberant