OBSERVATIONS ON KAEA-AZAR IN KASSAEA PROVINCE 
111 
■Most of the cases in Table “ B ” refused to react to heavy and continued doses of 
(juinine, and other conditions, such as tubercle, malaria, abscess of liver, and spleno- 
inedullary leucocythemia, were usually excluded; malignant disease is practically out of 
court owing to its extreme rarity in this Province. In all cases, when spleen puncture 
was performed, examination of peripheral blood was also made. 
Unfortunately it must be said “ usually excluded” for it must be noted that some cases 
were seen but once, and others were seen by a medical officer who had no microscope and 
was unfamiliar with kala-azar. 
Tliese tables give summaries of the cases, and they have been included, as it was 
thought that they might be useful in following up in the future this disease in the province. 
Five are included in Table “ B,” whose splenic blood was examined with negative 
results, but this is done because, in my small experience, it is extremely hard in many cases 
to find the parasites. 
In the first ease it was not till the third splenic puncture that parasites were seen, and 
in several others the results from the first and second punctures were negative. Often only 
one film out of four or five would present parasites, and even then in very small numbers. 
The average time spent for microscopic diagnosis has certainly worked out at nearly four 
hours each case; in only three cases were parasites found in the first films examined. 
TYP£1S OF FAEASITFS OBSEBVED. In all cases, except two, only free forms 
were found. It was noteworthy that in all cases the free forms seemed to be about the 
same stage of development, smaller and younger forms were seldom observed. 
In cases I., III., IV. and VI., practically all the parasites were of an elongated, almost 
torpedo shape, while in cases II., V. and VIII., nearly all were large and oval. 
Case VI. presented many small parasites, and the splenic blood was remarkable from 
the enormous number of blood platelets it contained; this was the only juvenile case of 
the series. 
In case VII. only one absolutely typical Leishman-Donovan body was found in six 
slides examined. 
In none of the spleen smears from those of Table “ A” were malarial parasites found, 
and in only two were collections of pigment noted ; this is probably accounted for by the 
fact that the patients were drenched with quinine prior to the examination. Peripheral 
blood examinations never exhibited parasites, either free or in leucocytes. 
In none were malarial parasites found, and in none were any marked changes 
observed, except those of anaemia. 
In four of the positive cases there was marked leiicopamia, and in one case nearly all 
the white cells were mononuclear leucocytes. In four cases the blood was very “watery,” 
and spread on the slides extremely badly. 
Spleen puncture was carried out by a small, long hypodermic needle and “all-glass” 
syringe, under strict aseptic precautions, and though some sixty odd splenic punctures have 
been performed, in many cases on very anmmic subjects, yet in no case has any bad result 
followed. 
One case had pain over the site of puncture for twenty-four hours, and another, whose 
temperature was 100“ previoushq had a rise to 105“ on the evening following the puncture, 
but the temperature fell again to 100“ on the following day. 
Thn Source of Infection is unknown, and apparently these cases are sporadic. 
The only instance of house infection occurred at Mafaza, and in these cases no positive 
diagnosis was made, though personally I have no doubt they were kala-azar, and had their 
tiikls and compound burnt down. 
Typt*s of 
parasites 
Splenic 
puncture 
House 
infection 
