39
Paras. 20 & 21
It appears to be inadvisable to attempt any scientific nomenclature for
these parasites until their development in the definitive hosts has been accurately
studied ; hence, I employ the names now in general use.
As regards my observations of the clinical features of cases of enlarged
liver and spleen in various parts of India, I must say without hesitation
that cases exactly similar to the worst ones of kala-azar at Nowgong have been
observed by me during the whole of my service in India and Burma. In other
words, isolated cases of a disease clinically indistinguishable from kala-azar
appear to exist throughout the country ; and in some localities, such as the
Sigur Ghât and the Darjeeling Terai, are to be found in large numbers.
Some observations of mine on the parasites of malaria in India have already
been published [18, 23].
21. The Parasites found at Nowgong.—The only peculiarities worthy
of note were the following.—
In the œstivo-autumnal parasites, I frequently observed that small
amœbse when quiescent exhibited one long pseudopodium which remained pro-
jecting when the other pseudopodia had been withdrawn —the amœbulse with
"tongues."
This recalls the observations of Marchoux in the paludism of
Senegal [22]. Crescents were very scanty and frequently failed to follow the
invasion by the fever-producing forms (possible owing to quinine). As a matter
of fact, they were seen only in three cases and then in very small numbers.
Tlae tertian parasites always had very fine, brown pigment.
The guartan parasites were often contained in small, dark-green corpuscles,
recalling the " old-gold" corpuscles. In one case (10) many more sporulating
forms were observed in the spleen than in the peripheral blood—-which is
unusual in quartan. Some of the quartan cases were very severe and showed
great enlargement of the organs.
In three sestivo-autunmal cases (17, 23 and 43), I observed in blood from the
spleen what appeared at first sight to be simple red corpuscles containing each
one or two large rounded grains of typical melanin. On close observation, how-
ever., it was seen that these corpuscles showed very active amoeboid contractions,
especially round the periphery, with a continually changing internal cloudiness.
Unfortunately, these forms were so rare that 1 failed in staining them ; but I
concluded that the corpuscles contained parasites with a very indefinite outline.
They were very like Marchiafava and Bignanii's drawings of the mature
tertian sestivo-autumnal parasites [24] ; but the body of the parasite was still
less distinct. Case 23 contained also some mild tertian parasites and an impig-
mented amœbtila of the sestivo-autumnal variety. Case 43 contained, as well as
these peculiar forms, some large sporulating elements recalling those of æstivo-
autumnal tertian. Case 23 had great enlargement of the organs and came
from a kala-azar stricken village. Case 43 was definitely pronounced at the
hospital to be kala-azar.
These forms, and the quartan parasites in dark-green corpuscles, were the
only elements which I do not remember to have seen elsewhere, and which have
not been previously described (so far as I know).
As mentioned in paragraph 18, parasites were found in only three out of the
26 kala-azar cases, and were all sestivo-autunmal ; but quartan parasites
were found in three of the suspected cases, and æstivo-autumnal together with
mild tertian in another.
The intestinal purnsites found at Nowgong were referred to in paragraph 18.
They call for no remarks ; save that in two of the autopsies, bloody mucus
full of the eggs of ankylostomes was observed in the intestine below the part
where the bulk of these parasites were attached.
Objects very similar to those figured by Giles [3] and mentioned by Powell
[19] as coccidia were frequently observed by me in the dejecta at Nowgong
and in the Darjeeling Terai ; and in a case in the latter locality were found in
the pus of a cancrum oris of the cheek connected with the mouth. But I
could not satisfy myself that the bodies seen by me were not vegetable cells of
some kind derived from the food.