KALA-AZAH IN THE ANGLO-EGYl’TIAN SUDAN 
105 
Of all the blood-counts given, not one is like that of malaria. On the other hand, none 
of the blood-counts at all resemble kala-azar, and I am informed by Dr. Alec Fergusson, 
who has examined very many pathological spleens at Kasr-el-Ainey Hospital, that he has 
never yet seen the Leishman-Donovan body in spleens examined by him. 
On the whole, there seems to be good reason to consider this cirrhosis of liver and 
spleen as siii. (jenerU, but it must be admitted that the patients usually present a 
picture most similar to kala-azar, and a close study of a number of cases, with enquiry 
as to origin, and an investigation into such points as house infection, is required before 
it can be assumed that the two conditions are not identical. 
My own opinion, formed on admittedly incomplete evidence, is that Egyptian Cirrhosis 
is a disease apart ; and that kala-azar, if present at all, is exceedingly rare in Egypt. 
CASE A 
No. 241)1). Nafb. Eadl Nadi IIapez. Dbpaktment of Wokks 
I'JlEriiiUS IIIHTORY . EiiUstud May loth, 191)5. Was scut to Khartoum and theuce to Seiiga, arriving at 
tlio latter station about April, 191)0. His lirst admission to hospital was for “ intermittont fever ” on 
September 'lOth, 1900. Prom that date until Ueeember, 1900, his medical history sheet shows four separate 
admissions for intermittent fever. He was then sent to Khartoum, where he was at oiioe admitted to hospital for 
■■ malarial fever,” remaining thirteen days under treatment. Ho was then discharged, but was again admitted on 
February 2oth, 1907, and then sent, by sick convoy, to Cairo, for change of air. On arrival he was granted a 
month's sick furlough, after which he returned to hospital very ill. He died on May ICth, 1907. 
He lirst came under my personal notice on ^ldra^ssion to hospital after his sick furlough. 
(iENKllAL CONDITIOX. On April 7th, 1907, I found this man to be in a very serious condition. Tlie 
temperature rose to 104° P. on that evening; the lower extremities were oedematous, the patient greatly wasted. 
The spleen was enlarged to the umbilicus; and the liver to about two linger-breadths below the eosstal margin. 
The temperature continued “ spiky,” but no four-hourly chart was kept. No malarial panisites were found. 
During the first week in May he began to suffer from septic diarrhoea, which was very hard to control, and which 
led to his death on the lOth of May. Spleen smears made after death showed numerous Leishmaii-Douovau bodies. 
CASE B 
No. 1993. Nafk. Said Abddl Wahid, Depaiitment of Wokks 
I'UJiYWL’S HIATORV. The patient was in good health when he was sent to Seuga in the summer of 1900. 
For some eight or nine mouths he was in good health at tliat station, but during the last three mouths has suffered 
constantly from fever, which has lirought about his transfer to Khartoum Hospital. 
/'RESEXT I'OXDIl'IDX, JUL )' And, l'J07. lAitient is very weak and aniemic. He has a constant rise of 
tcnij)erature, but no nightly sweats or cough. 
Diarrhoea has been constant during the past three weeks, and appears to be uninfluenced by drugs. 
The motions are licpiid, normal in colour, and never contain lilood. The liver is cnl:irged and tender. The 
stilecu projects downwards and inwards to the level of the umbilicus. It can quite easily be seen through the 
wasted abdominal walls; and is very hard, but not tender to the touch. 
Patient has been taking (luiniue for a long time without much benelit, and ho is obviously going down hill. 
(The larger doses of quinine, recommended by L. lingers, were subsequently tried, but the patient was too far 
advanced to derive any improvement from them.) 
On splenic puncture, Leishman-Douovau bodies were found in very small numbers, after prolonged search. 
The patient died on July 'ind. 19U8, the de:i.th being caused by diarrhoea and exhaustion. 
The above notes were kindly furnished by Capt. P. P. Carroll, R.A.M.C. 
CASE C 
No. 1128. Nafk. Mohammed Ibkahim Osman, Medical Coups 
I'REVim’R IIJSTORY. This soldier left the M.C. Depot in Cairo on August 23rd, 19U.O, being at that time 
in excellent health, and proceeded to Kassala. On arrival at Kassala he spent seven days in hosjiital as the result 
of a chill contracted on the journey. When discharged ho was at once sent to Mafaza, where, for about ten 
months, he enjoyed good health. 
At the end of that time (t.c. in July, 19Uf)), he was suddenly taken ill with fever, which continued to be severe 
during the next few months, the temperature rising every day in spite of quinine. In November he was 
transferred to Gedaref, still very ill, and remained in hospital there for twenty-five d.'iys, before transfer to Kassala. 
After seven days in Kassala Hospital he was discharged to duty; but after attempting to work for about a 
week, he was re-admitted, and remained under treatment for about two mouths. He was at lirst thought to be 
suffering from enteric fever, but was finally invalided to Cairo, diagnosed “ JIalaria.” While at Mafaza he lived 
in a grass hut in the Zaptea, adjoining the huts of the .Arab police, in the same compound, but he was in sole 
possession of his own hut. He admits that he patronised the .Arab prostitutes, but he declares they were all in 
good health. 
00X1)H'lOX OX AD.MISSIOX. The patient is w.asted and weak. The spleen is enlarged to half a hands 
breadth below the costal margin. The liver is, apimrcntly, about normal. No oedem.a of legs. Bowels normal. 
The appetite is enormous, to an extent that strikes me as pathological. The skin of the face is darkly pigmented. 
The temperiiture shows a douhh rise in the twenty-four hours. 
Cases 
