13
N u m b e r .
Place.
Name.
A g e .
Condition of spleen.
Condition of liver.
Other particulars of
the case.
Results of examination of
slides obtained by spleen
puncture and by scraping
of ulcers.
2 4 Soneput
. Molar .
40 Beyond umbilicus . No enlargement
detected.
Has a large chronic ulcer on
leg ; for which he was
admitted.
No malaria parasites or
pigment ; no Leishman para-
sites; no parasites in scrap-
ings from ulcer.
2 5 Karnal
. Ali Mahomed 14 Nearly to pubes
. Five inches below
costal margin.
Evening rises of temperature
to 99° ; is taking quinine ;
very weak and anæmic.
Spleen and liver punctured :
no mal arial parasites or pig-
ment; no Leishman para-
sites.
26 Karnal
. Nan hin
. 27 To umbilicus
. No
enlargement
detected.
Admitted for chronic ulcer
of leg; is taking quinine.
No malaria parasites or pig-
ment ; no Lehman para-
sites.
27 Karnal
. Abdulla
. 3o Beyond umbilicus .
Ditto
. Has occasional attacks of
fever, but has been taking
quinine and says he is well
now.
Ditto
ditto.
28
Karnal
. Setaram
22 Nearly to umbilicus
Ditto
. Admitted for a chronic ulcer
on leg.
No malaria parasites or pig-
ment ; no Leishman para-
sites ; no parasites in scrap-
ing from ulcer.
So far as I could ascertain these cases were typical of the class of more
advanced chronic fever cases attending the dispensaries of such places in the
Punjab as I visited. It seemed unnecessary to carry out the operation of spleen
puncture upon more than the above 28 cases, for from the absence of parasites
resembling those of Delhi Sore in any of these cases, selected on account of their
apparent resemblance to cases known to be caused by such parasites, it was
reasonable to conclude that parasites resembling those of Delhi Sore do not occur
as a cause of enlargement of the spleen in the Punjab.
During a subsequent tour in Assam it was possible to carry out an investigation
converse to that just described, viz., to ascertain whether parasites similar to those
causing kala azar ever exist in Assam as a cause of local sores resembling Delhi
Sores. Although I took every opportunity while in Assam of examining speci-
mens from sores of all kinds, I obtained no evidence there either of the occurrence
of sores resembling Delhi Sores or of the occurrence of parasites resembling
those of kala azar as a cause of only local lesions.*
These facts seem to me to be important for, if on the one hand we regard the
parasites of Delhi Sore as being identical with those of kala azar, they show that
while these parasites produce in one part of India only a local infection of minor
*I am aware that when a chronic ulcer of the skin exists in a case of splenomegaly caused by the so-
called Leishman-Donovan parasites, a few parasites may be found in sections made from the tissues in the
neighbourhood of the ulcer, but I believe I am in agreement with Dr. Christophers in considering that the
ulcers are not caused by the parasites. Similar chronic ulcers are as common in cases of true malarial
cachexia as in cases caused by the parasites under discussion, and in the latter disease the presence of one
or two parasites in the neighbourhood of the ulcers probably indicates no more than that such ulcers are
possib l y a path of exit of the parasites from the body.