17
No.
Date.
Particulars of
source of blood.
Brief clinical
history.
Enlargement of
spleen and liver.
Finding of
Parasites in
peripheral blood
smears and
result of other
examinations.
Result of
blood
culture.
Final
clinical
diagnosis.
1920.
8 31st July Ponnuswamy; Hope
ward.
Continued fever. Liver
normal
spleen—2n.
Negative
... Negative. 1st diag-
nosed as
Ankylosto-
miasis and
then
as
Kala Azar.
9 17th Aug. Miss E. Brisson ;
Landsdowne, 10.
? Present
...
Do.
. . .
Do.
Kala Azar.
9A 30th Aug. The same patient.
. . .
Do. ...
Do.
. . .
Do.
Do.
10 6th Oct. Manikkam ;
æt.
9; argyle 11.
...
Do.
...
Do.
...
Do.
Do.
10A 25th Oct. Same patient
...
. . . Do.
...
Do.
. . .
Do.
Do.
11 14th Oct. Mr.
Chadwick ;
æt. 32 ; Harris
ward, 5.
Continuous fever Liver
normal
spleen 2 fingers
below
costal
margin.
Enteric positive.
Do.
Enteric
fever.
12 15th Oct. Narasiah ; Have-
lcck, 21.
Anæmia
... Slight ...
... Nil
...
Do.
Ankylosto-
miasis.
13 25th Oct. Ruby ; Victoria, 8. Continuous fever Nil
...
... Enteric reaction
positive after 1
month.
Do.
Enteric.
14 27th Oct. Palniandy ; Mar-
tha, 2.
Do.
Spleen and liver
both enlarged.
Nil
...
Do.
Kala Azar.
15 29th Oct. Raghavalu ; Roya-
puram Hospital.
Low fever
... Spleen
below
costal margin.
Malarial
para-
sites
benign
Tertian
very
scanty.
Do.
Malaria.
16 10th Nov. Hopkins; Napier,I. Low fever con-
tinuous.
No liver ; spleen
slightly palpa-
ble.
Enteric reaction
positive after
23 days.
Do.
Enteric.
17 16th Nov. Holding ; Potting-
er, 14.
Do.
Slight ...
... Enteric reaction
positive after
4th week.
Do.
Do.
18 18th Nov. Doraikkan ;
Ar-
gyle, 5.
Continued fever. Liver enlarged... Liver puncture
showed
Kala
Azar bodies.
Do.
Kala Azar.
18A 15th Dec. Doraikkan ;
Ar-
gyle, 5.
Do.
Do.
. . . . .
...
Positive.
Do.
Only two positive findings were obtained from the cultivations, eight of the remaining
sixteen were subsequently diagnosed to be other infections. In the rest which were
clinically diagnosed to be Kalar Azar no flagellates could be cultivated. A few interesting
points were observed as regards these cultivations. In Nos. 4, 5, 9, 10 and 18, it was possible
to get a second specimen of blood after one to three weeks. In case No. 4 a positive finding
was obtained at the first examination but at the second the result was negative. In cases 5,
9 and 10 both examinations failed to reveal any flagellates in the cultivations. In case 18,
however, the first specimen of blood did not show any flagellates, while at the second,
flagellates were recovered in culture. In this case, a liver puncture made at the General
Hospital, subsequent to the negative finding in the peripheral blood, revealed the presence
of Kala Azar bodies. These results lead to the inference that these parasites either did not for
some reasons grow in our media or were not always present in the peripheral blood in
sufficient number to reach the culture media. The method of cultivation adopted was that
described by Lt.-Col. J. W. Cornwall, I.M.S., on page 700 of volume III of the Indian
Journal of Medical Research and consisted of taking a dozen N.N.N. culture tubes to the
bedside, drawing off a few c.c. of blood from a vein in the patient's arm and distributing it
among the culture tubes.
During the course of these experiments, several subsidiary points of interest bearing on
the preparation of the media, the effect of temperature, and variations in the technique, were
noted and recorded.
(1) It was found that N.N.N. medium prepared at this laboratory differed from the
N.N.N. medium used by Lt.-Col. Cornwall, in the following respects :
—
(a) Rabbits' blood here was added to the tubes containing the melted medium while
the latter was at 50° C., and the tubes slanted and allowed to set at the ordinary room
temperature which varied from 37° to 40° C., while at Coonoor the method was to mix the
blood and melted agar and rapidly cool the tubes over ice. The latter method prevents undue
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