OliSERVATIONS ON' KALA-AZAR IN' KASSAEA I'KOVIN'CK 
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lie was given quinine by injections and tiy the inoutli ; the fever lasted only eight days, 
and he was discharged comparatively well after eighteen days with a diagnosis of malaria. 
The spleen had considerably decreased in size. 
He was not seen again till he was brought to hospital very collapsed on December 18th, 
1907. His spleen was enlarged to one inch below the umbilicus, but there was no obvious 
liver enlargement. He had high intermittent fever for three days, sub-normal two days, and 
death occurred on December 22nd, 1907. Typical parasites were found in the spleen blood 
on December 19th, 1907. 
Probably he was suffering from kala-azar when first admitted in .\ugust, and was 
unwittingly discharged wrongly diagnosed, possibly to be a source of infection to his 
neighbours during the following three months. 
'I'BEATMENT EMPLOYE IK Many were treated with prolonged large doses (30-50 Treatment 
grains daily) of quinine, or by hypodermic injections (10-18 grains). Temporary 
improvement occurred in several cases, but as others similarly improved, not on quinine, it 
is doubtful if it is due to this drug. 
One was treated with thymol (> grains daily, hut with no beneficial result. 
Two were treated with intramuscular injections of atoxyl and corrosive sublimate 
alternately, combined with fuchsin pills’ ; charts and notes of these cases are given. All 
the cases were advanced, and so probably this treatment did not have a fair chance. 
NOTES ON CASE II 
Notes on 
S. S. A WaKIL OjiBASHI, iMEOICAI, Coitrs cases 
PREVIOUS HISTORY. No serious previous illness. 
Arrived Kassala Province Alay 16th, 1906. 
In 1906 proceeded to Gedaref for three days and then returned to Kassala. 
On April 23rd, 1907, proceeded with S. M. 0. on his inspection tour, and spent three 
days at Gedaref, three days at Gallabat, and three days at Mafaza, where he slept on an 
angareeb with the resident ^Medical Corps Tumergi, who has since gone on leave in good 
health. 
He was sure he was not bitten by hed-bugs at Mafaza. 
Proceeded on leave on June 15th, 1907, to Nazlet Ali Pasha, Benisuef Mudiria, Upper 
Good health on leave and returned healthy to Kassala, August 14th, 1907. 
There was a very severe outbreak of malaria, and he was admitted to hos))ital October 
12th, 1907, till October 21st, 1907, with malaria (?)—his spleen was enlarged to the costal 
margin. He 'was re-admitted on October 30th, 1907, and his temperature chart gives his 
pyrexia till the day of death. 
No malaria was found in his blood, but it was quite the exception (7 per cent, positive) 
to find parasites, owing to all taking prophylactic doses of quinine regularly. 
.\t first (juinine by mouth and by injection seemed to have a beneficial result, but 
weakness and emaciation progressed steadily ; his spleen continued to enlarge ; his liver was 
distinctly increased in size, and kala-azar was suspected and spleen [uincture proved ])Ositive 
on December 30th, 1907. 
On December 19th, 1907, he had an attack of pseudo-diphtheritic tonsillitis, due to 
UacUli fusiformes — no spirochajtes were found, and there was no albumen in the urine. He 
was then placed on atoxyl-fuchsin-sublimate treatment (see Chart, pu.'/e 116). 
’ I)osiige, etc., jis suggej^ted l)y A. Nierenstciu for Trvpniio.somiasis. liritish Mcdicnf Jouriml,>\\\\y *27th, I9i)7. 
