27
Para. 17
blood. A sprinkling of melanin in the cells ; granules all about 2 μ ; not recent, and about
one mass only in three or four fields, although the cells are very numerous. Many cells
contain typical " pigment ocre" (not bright yellow). Unfortunately the second puncture,
being made with a new needle, yielded much rust, which rendered the estimation of the amount
and reaction of yellow pigment doubtful ; but it was certainly present in small quantity if not
in large. Patient not examined again.
NOTE.—Absence of the pigments from the specimen from the spleen, and their presence in the liver. The
latter organ appears to have been in a very bloodless condition.
Case 35.—Deobar, m., 22, two months ill. A Native Christian belonging to the Ameri-
can Mission. Began to feel feverish and unwell two months ago. Left Nowgong for the
Mikir Hills for a week, and two days after return was seized with high fever. Mr. Parker of
the Mission informed me that the fever was continuous without rigors and reached 105° F. once.
Was treated by quinine, having been given 150 grains before examination by me. Eight days
before examination fever disappeared. Examined 15th December at 9 A.M. Very considerable
anæmia ; not at all emaciated ; feet œdematous ; face pale and puffed, especially under the
eyelids. Spleen very slightly enlarged ; liver not enlarged at all. Peripheral blood, no para-
sites nor pigment. Motion carefully searched ; one trichocephalus egg only—no ankylosto-
mum eggs. Ou 10th September looked much better and less anæmic and œdematous ; colour
returning to lips and tongue ; but spleen had increased for 2 inches below the ribs, and liver
was distinctly palpable and tender. Blood, no parasites. No return of fever. On the 5th
October Mr. Moore of the Mission informed me that the patient was getting fever, and took
the temperature twice daily ; the result showed a low constant fever (Appendix C—Chart 2).
Examined on 6th October, the spleen was found to be 4 inches and the liver 1 inch below ribs ;
both tender on pressure. Anæmia improved and œdema nearly disappeared. Blood, no para-
sites. Two punctures of the spleen were attempted ; one drew nothing, the other drew only
a rush of blood, containing no spleen-cells nor pigment. Seen on 20th October, the enlarge-
ment of the liver had nearly disappeared, while that of the spleen remained.
NOTE.—The examination of the spleen was indeterminate, no cells being obtained. The history, the early
appearance of oedema and of the constant low fever (which was not affected by the daily considerable doses of
quinine given) should be noted.
Case 36.—Ashman Ali, m., 18, Hospital Assistant, 3 months ill. Has been having severe
fever, irregular, recurrent and preceded by rigors. Lived in the Hospital Assistant's house at
the village of Mankola when he was attacked. Several other Hospital Assistants had suffered
in the same house previously. Examined on 15th September 10 A.M. ; temperature 99.0° F.
Slight anæmia. Looks rather ill. Spleen slightly enlarged. No enlargement of the liver.
Peripheral blood, several æstivo-autumnal amœbulæ, not pigmented, with " tongues. " A
pigmented leucocyte. No crescents. Not seen again.
NOTE.—Absence of crescents, but presence of a pigmented leucocyte with unpigmented amœbulæ.
Case 37.—Mulai, m., 20, 3 months ill. No history. Examined on 17th September
morning ; temperature 98.6° F. Considerable anæmia. Spleen to umbilicus ; liver not
recorded. Blood, no parasites Not seen again.
Case 38. — Gulasi, f., 10, 3 months ill (very doubtful). The child, who comes to hospi-
tal without relative, says she has had occasional slight fever for three months, but that a week
ago a very severe attack of came on. Relatives had kala-azar some years ago, and father died
of it. Examined 17th September, 1 p. M.; temperature 103° F. Spleen several inches below
ribs ; liver not enlarged, considerable anæmia, but child appears cheerful and fairly well in
spite of high fever. Peripheral blood, no parasites. Examined next day at 11 A.M. Rigor
well on ; temperature 104.5° F. Blood, numerous unpigmented amœbulæ (æstivo-autumnal)
with "tongues"; no crescents or pigmented leucocytes. On 19th, a few amœbulæ; no
crescents. Quinine was now given regularly and the child appeared quite well on the 19th
October, the spleen having decreased notably.
NOTE.—No crescents ; absence of liver enlargement. It is possible that the æstivo-autumnal infection was
of only one week's duration.
Case 39.— Jhori, m., 16, 3 months ill. Supposed to be kala-azar at the hospital. Says
illness began with high fever. Examined 20th September at 8-30 A.M.; temperature 100° F.
Much emaciated ; considerably anæmic ; feet œdematous. Spleen tills half abdominal area ;
liver a little enlarged. Peripheral blood, no parasites nor pigment. Not seen again.
Case 40.—Grace, f., 6, 3 months ill. Christian child. No history. Examined 12th October,
not emaciated nor anæmic. Spleen not enlarged, but liver one inch below ribs and tender,
temperature 98.9° F. at 9-30 P.M. Examination of blood not made.
Case 41.—Tukai Mikir, m., 35, 4 months ill. Hospital Assistants think it a case of
kala-azar. Says that two persons have died of kala-azar in his house, and that 8 out of 9
families in his village now have the disease. Captain McNaught thinks the case to be one of
kala-azar from the history. Patient says that the disease began with fever, which comes on
every third day, that he "turned black," and that his feet were swelled. He is now much
better. Examined on 23rd September, morning ; temperature 97.4° F. Does not look parti-
cularly ill, but is somewhat anæmic and emaciated ; no œdema. Spleen fills half the abdominal
area ; but there is no enlargement of the liver. Peripheral blood, no parasites nor pigment.
Splenic blood, spleen cells obtained. Black pigment present in very small amount in some
of the cells. No yellow pigment found.
NOTE.—No enlargement of liver, absence of parasites, presence of melanin in spleen.