KALiA-AZAK IN THIS ANGLO-EGYl'TIAN SUDAN 
lOti 
Blood is free from malarial parasites;— 
Red corpuscles . 5,0UU,UUU 
White „ . 872 
On splenic puncture the Leishmau-Douovau parasite is found in small numbers; chiefly free in the blood, 
but a few in leucocytes. 
The stools were frequently and carefully examined. On one occasion they were found to contain very 
numerous organisms of a peculiar kind, small disc-shaped bodies, slightly larger than a red coriiuscle, and 
apparently ciliated, being very actively motile through the agency, apparently, of some lashing organ, as 
surrounding particles were thrown into motion by it. These were only found on one occasion; subsequent careful 
search proving negative. I have since found somewhat similar bodies co-existing with Amceba coK, in a case 
of acute dysentery. 
PROGREHti. The temperature continued to show an irregular double daily rise, until at the end of June, 
the patient was put on very large doses of quinine, fifty grains a day. The result was a great improvement, the 
temperature falling to, and remaining at, normal a few days later. This improvement lasted about three weeks, 
the patient gaining iu weight and looking much better. Splenic puncture, at the end of that jieriod, was normal; 
and the leucocyte count had risen to about 3UUU, the red corpuscles being about 4,8UU,UII(I. Some weeks later, 
the temperature had recommenced (August 5th). On eu(iuiry it was found that, owing to the patient’s complaints, 
the medical officer in charge had stopped the cjiuniue about a week before. Sharp attacks of diarrhcea from 
time to time. Patient looking very ill. No parasites to be found in peripheral blood. Careful search iu films of 
leucocytes, made from artificially produced pustules, ])roved to be negative. Splenic puncture again shows 
Lcishman-Donovan bodies, though iu very small numbers. Quinine resumed. 
CONCLUSION. The patient had been recently exempted from military service on legal grounds, and no 
longer belonged to the army. Ho now insisted, against all advice, on leaving the hospital (20th of August). 
His death occurred at his village a week later. No post mortem possible. Duration of illness thirteen 
mouths. The remarkable improvement of this iiatieut under vigorous quinine treatment (fifty grains daily) was 
most striking. I was at one time almost prepared to see him recover; but he found the large doses of quinine 
difficult to tolerate, and succeeded iu getting the drug stoijpcd. Whether the recurrence would have conic iu any 
case, it is impossible to say. 
CASES D AMD E 
Auau Police Naeu. .Abdallah Ahmed I ■ o. u- 
, i beiiuar Province blan 
., .. ,, .Abd el Wauab J 
I'UEUlOUS UlSTollY. These two men had spent most of their police-service together in Scuiiar District. 
They were iu good health when they proceeded to Mafaza iu May, H)U7. 
Both were recalled to beuga early iu July, and both reported sick with fever towards the end of that mouth, 
being admitted to Seuga ilospital. They were diagnosed “ malaria ” by the medical officer in charge, but thought 
to be uiiiisiially bad cases. In transferring them to Wad Medaui for change of air and further treatment, he 
calls attention to theii’ peculiar temperatures, and to his failure to iiitluence them by quinine. 
ON ..lltltirAL AT ir.lLl MEIJANI. Both patients were extremely ill, the temperature being of the 
high intermittent type, while there was great emaciation, slight diarrhoea, cough, and sometimes delirium. 
The spleen was considerably enlarged iu both cases, and the liver to a less degree. No malarial parasites 
could be found. 
On September 12th, Nafr. Abdallah .Ahmed developed a sore mouth and cedema of the face and neck, which 
declared itself as “gangrene of the check” on Seiitember 14th. He died on the morning of September IGth. 
The postmortem examination showed that the heart, lungs, kidneys and gastro-iutestinal tract were normal; 
the liver enlarged, but of normal colour and consistence; the spleen greatly enlarged, purplish in colour, and 
soft and grumous. 
Nafr. .Abd el Wahab, after a few days, also suffered from gangrene of the face, eommeuciug at the upper 
lip. He died on the morning of September 18th, l'J07. The post mortem report closely resembles that of 
Abdallah Ahmed. 
The close similarity in the history of these two men is most striking, iu view of the fact that they were 
probably infected by the same strain of parasite and at the same time. 
These notes are furnished by Mulaziem .Awal .A. E. Kaniar, Medical Corps, who diagnosed them kala-azar, 
the diagnosis being confirmed by Dr. A. Balfour, Gordon College, Khartoum, from spleen smears sent for 
examination. 
C.ASES F AMD G 
Two cases of kala-azar have hitherto come to light iu British officials iu the Sudan. The late Dr. MacTier 
Pirrie, who returned to England suffering from a chronic fever contracted south of the Blue Nile, was diagnosed 
as kala-azar by Dr. Gulland, of Edinburgh and Major Marshall, I.M.S., the diagnosis being confirmed jiost 
mortem by the discovery of the Lcishman-Donovan bodies in spleen smears. 
The case is to be published elsewhere by the gentlemen who observed it, and through whose kindness I have 
been enabled to mention it.' 
.A British officer of the Egyptian .Vrmy, who returned to England ill, after having been stationed at Gallabat, 
has now been found to be suffering from kala-azar. 
This discovery was made by Sir Patri(^k Mansou, K.C.M.G., who has kindly made me aware of the confirmation 
of the diagnosis by the finding of the parasites iu blood withdrawn from the liver. 
A remarkable fact is that iu both the above cases a positive reaction to Widal for enteric was given at one 
period of the disease. 
' Lancet, August 15th, 1908. 
- Uuhai)pily this case has also terminated fatally. 
