32
Para. 17
Case 67.—Gonhor Ali, m., about 30, medico-legal, An overseer of a tea-estate murdered
by a cooly ; no history ; strong and robust man, spleen and liver very slightly enlarged, but loaded
with melauin—much more so than in any of the succeeding cases. No yellow pigment
found.
Case 68.—Behari Munia, m., 35, three months ill. Diagnosed diarrhoea and anæmia
of coolies in the hospital. Admitted on 10th October. Says he had bad fever three months ago,
which has now left him. Considerable emaciation and anæmia, no œdema. Liver and spleen.
not enlarged, much diarrhoea. Died on 13th October as a result of the diarrhœa. Autopsy.
A medium sized man. Liver, 33 ounces; congested; section normal but somewhat darkened
in colour. Spleen, 11 ounces ; slightly congested; gritty section ; pigmented. Kidneys, pigmen-
tation of cortical substance in patches. Intestines, no entozoa ; inflammatory condition and
pigmentation in patches of lower part of ilium ; no amœbæ or cercomonads.
Microscopically (Fresh—Ross). Very abundant melanin in spleen, liver, sternum marrow,
and in areas of kidneys and intestines ; old and recent. No parasites. Traces of yellow pig-
ment in spleen; more in kidneys, sternum, marrow and coats of ilium ; copious in liver, (Sec-
tions—Daniels). "Spleen, abundant black pigment, partly in coarse irregular masses not
contained in cells, and partly finely-divided and intracellular. No yellow pigment was found
but unless in quantity would be difficult to detect in the midst of the black. There was
little fading black pigment. No iron reaction. Liver, much yellow, intracellular pigment
most abundant at the peripheries of the lobules. Some masses of black pigmentin the
spaces between the lobules, not intracellular. No iron reaction. Kidney, yellow intracellular
pigment in many of the straight tubules. No iron reaction."
NOTE.-—The patient had been given one 3-grain dose of santonin on the 10th October.
Case 69.—Joga Chunar, m., 23, three months ill. Kala-azar. Was never seen by me, but
history and portions of organs were sent to me by Captain McNaught. Admitted on 21st 'Sep-
tember ; said he had been having fever for about a month before admission. Emaciated · fever ·
liver and spleen enlarged. Temperature "varied from time to time, but never rose above
102 F." Was finally attacked with dysentery and died on 19th November. Autopsy.—Liver
41 ounces; "rather soft, greyish-yellow in colour, pigmented.' Spleen, 31 ounces, pigment-
ed. Kidneys, pigmented. Intestine, 7 ankylostomes and 3 round-worms, Large intestines
dysenteric ulceration.
Microscopically. (Sections—Daniels.) —"Spleen, much old and some more recent black
pigmentation. Slight iron reaction. Liver, some black, old interlobular pigmentation. A
considerable amount of yellow intracellular pigment in the cells at the peripheries of the
lobules. A slight iron reaction. There was some increase of the interlobular fibrous tissue.
Kidneys contained a small amount of yellow intracellular pigment."
Case 70.—Rogu Tanti, m., 12, 4 months ill. Kala-azar. Admitted on 3rd September ;
said he has had fever for four months. Emaciated ; liver and spleen considerably enlarged.
No dropsy. Hospital record states that there was no fever after admission. Dysentery set in,
organs decreased in size, and patient died on 25th September. Autopsy.—Liver, 46 ounces,
congested. Spleen, 16 ounces, congested. Intestines, 14 ankylostomes, some 4 feet from ilio-
cœcal valve; one trichocephalus ; commencing dysenteric process.
Microscopically. (Fresh— Ross).—Spleen, a few doubtful specks of melanin ; yellow pig
ment not recorded. Liver, no melanin; a small quantity of yellow pigment. (Sections—Daniels).
"Spleen, a little black pigment, not intracellular, round some of the malpighian bodies. Masses
of yellow pigment in streaks in the stroma. A marked iron reaction was observed in many
of the cells—diffuse; in others, showed granules. It had no relation to either the yellow
or black pigment. Liver, numerous granules of yellow pigment in the hepatic cells, especially
in those at the peripheries of the lobules. There was a marked iron reaction, diffuse in some
cells, but more commonly affecting only granules. In some cases granules in the cells con-
taining yellow pigment were affected, but more commonly those in other cells showed the
reaction ; and in many of the lobules the central cells showed the reaction most readily. No
black pigment.
Case 71-Bogi Ratia, m., 24, seven mouths ill. Kala-azar. Admitted on 9th September ;
suffering from fever and enlargement of organs for six months. Emaciated, but dropsical-
Liver and spleen enlarged. Occasional fever recorded; diarrhœa ; six round-worms expelled
after santonin. Died on 17th October. Autopsy.—A medium sized man ; ascites, dropsy of
feet and face. A considerable amount of fat. Spleen, 18 ounces, much congested ; not softened ·
section not gritty. Liver, 44 ounces ; much congested. Kidneys cougested. Intestines 200
ankylostomes and 8 round-worms ; just below the bulk of the ankylostomes, a considerable quan-
tity of bloody mucus full of their eggs ; a few whip-worms and a dozen amphistomes in
upper part of large intestines. No dysenterie ulceration and no protozoal parasites.
Microscopically. (Fresh—Ross.)—Spleen ; slight traces of black pigment (?) and a small
quantity of yellow pigment in some of the pickings. Liver, some questionable granules of
melauin ; fairly protuse yellow pigment. Kidneys, fairly numerous clusters of pale yellow
pigment. (Sections-Daniels). "Spleen ; no pigment, black or yellow, found ; no iron reaction
Liver ; yellow intracellular pigment in fair amount. No black pigment. No iron reaction!
Kidneys. In patches there was abundant yellow pigment. No iron reaction."
NOTE.-I agree that the melanin in this case is most doubtful ; at the best it was almost indiecoverable..
Case 72.—Hatim Ali, m., 24, ten months ill. Kala-azar. Admitted in May for fever and
enlargement of liver and spleen ; improved ; discharged ; re-admitted in June for the same with
œdema of feet and looseness of bowels. "fever" is frequently recorded in the hospital history