; (oo 
534 
concensus of opinion in considering these bodies to be the causative 
parasites of kala-azar. 
When present, these parasites are found in large numbers. They are difficult 
to distinguish in fresh specimens, but when seen can be differentiated from the 
platelets by their greater refractive power. They are most easily stained by 
the Romanowsky method or one of its modifications, and under these conditions 
their diameter is from 1.5 to 3.5 w. They are usually circular or oval in form 
and often have a cockleshell appearance. They usually show two chromatin 
masses, a larger one which stains faintly and a small one which takes on an intense 
color. The former often is rod-shaped and the latter rounded, bilobed, or heart- 
shaped. They have been observed in the spleen, in intestinal ulcers, in the liver, 
mesenteric glands, bone marrow, kidneys, and in the skin in the disease known 
as Oriental sore. 
lt was in view of these facts and in the hope of being able to study these 
parasites that Dr. Musgrave, Dr. Wherry, and I began carefully to examine all 
cases of splenomegaly which we could find and control. The results of this study 
were published early in this year in the Bulletin of the Johns Hopkins Hospital.’ 
In this paper we stated that splenomegaly was not infrequent in Filipinos, and 
that it was not difficult to find types corresponding with those of Osler (Briihle), 
Banti, and others. We then proceeded to describe some cases which apparently 
should be classed with the group of tropical, febrile splenomegaly. 
These cases were characterized by the following symptoms: Splenom- 
egaly, rheumatic pains, edema, diarrhoea with or without hepatic enlarge- 
ment, and remittent fever. In none of these could malaria be found, 
neither was the course of the disease influenced by quinine, in none 
were the leucocytes above 8,000 (they averaged about 6,300), and in 
but one was the number of red corpuscles less than 3,000,000 per cubic 
millimeter. Unfortunately, at the time we made our observations we had 
no accurate means of determining the hemoglobin, of which we have no 
record; however, it may be suspected from the appearance that there was 
some diminution. In five cases, splenic puncture was undertaken and in 
four of them examination in smears and cultures, and inoculation into 
guinea pigs and monkeys gave no result. In the fifth one there appeared 
in glucose-ascitic agar a faint growth of a small, coccus-like organism, 
which resisted transplantation. 
In one of the seven cases which we reported the eosinophiles varied 
from 25.5 to 43 per cent, in another from 8 to 11.5 per cent; generally, 
the mononuclears were increased. The duration of the disease at the 
time of the last notes which we took was from three to fifteen years. 
But one case has come to autopsy. In this instance the chief lesion 
consisted in a congestion, hypertrophy, and fibrosis of the spleen. Since 
the report of these cases another very interesting one has been brought 
- to my attention, and for the opportunity of reporting it I have to thank 
Dr. Musgrave, from whose services in St. Paul’s Hospital, Manila, it 
came. 
2 Bull. Johns Hopkins Hospital (1906), 17, 28. 
