OBSBKVATIONS ON KALA-AZAB IN KASSALA PROVINCE 
117 
After the first atoxyl injection he vomited at night, whicli he had not done before. 
Half an hour after the second injection he vomited again. 
Otherwise he had no signs of any trouble from the arsenic ; there was no gastritis, no 
diarrhoea, no pigmentation, no neuritis, and no ocular trouble. 
The type of atoxyl used is unknown, but it was probably of English manufacture. 
There was no medicinal fuchsin, so that used for microscopical purposes was employed, 
and this drug produced no ill effects. 
On .January 31st, 1908, the conjunctiv® were noticed to he distinctly yellow, hut no bile 
could be found in the urine. 
Four days before death he complained of epigastric pain, but there were no physical 
signs, and it was considered to be due to cod liver oil, which was then being administered. 
His tongue was clean and his appetite good throughout, his sole complaint being of 
extreme weakness, except the terminal epigastric pain. 
During the last three days his circulation began to fail, and his lungs presented 
hypostatic congestion. 
The Source of Infection is a subject of great interest and importance in this case. 
He lived in a barrack room with some 18 other soldiers, who appeared healthy except 
for malaria. It is practically certain that there were no bed-bugs, and angareebs (native 
bedsteads of wood and string) or iron bedsteads were not used. The only biting insects 
were ants or mosquitoes, mainly Pyretophorus costalis. 
In May, 1906, he spent three days at Mafaza, but the man on whose angareeb he slept 
was quite healthy in March, 1906, when last seen. 
He was quite well on leave, and I do not know if kala-azar exists at Nazlet Ali Pasha, 
but I find that a Tumergi (No. 1128) from Mafaza came to Kassala on December 3rd, 1906, 
and lived in the barrack-room with this man. 
This Tumergi was admitted to hospital December 16th, 1906, and discharged 
December 19th, 1906, diagnosed as simple continuous fever. He was again admitted on 
March 23rd, 1907, as enteric fever and discharged April 21st, 1907. 
Ee-admitted on April 30th, 1907, as malaria, and remained in hospital till -Tune 5th, 
1907, when he was sent by sick convoy to Cairo, and there was definitely diagnosed as 
kala-azar by Captain Cummins. 
Thus, during the periods he was living in the barrack-room he may have infected the 
patient S. S. 
But the question “How?” still remains unsolved. No bed-bugs have been found, 
and all the soldiers declare they have never seen or been bitten by them, and, if such an 
occurrence had taken place, I am sure they would only too readily have complained. 
Further, the building is not very old, and has very little woodwork. 
If infected from this source, S. S. had a quiescent incubation period of at least five and 
a-half months, the disease lying dormant during the hot weather. 
SUMMARY OF POST MORTEM EXAMINATION. Autopsy was performed twelve 
hours after death. Only pathological conditions found are noted. Subcutaneous fat very 
scanty and distinctly yellow. Opposite the ninth right rili beneath the pleura an encapstded 
mass I^ inches long and 1 inch broad was discovered. 
On cutting the capsule, soft, white, chalk-like material was found, like an old caseous 
gland ; but if so, of very long-standing duration. 
Right Pleural Gavity obliterated, except at apex, by a layer (;J to \ inch thick) of 
coagulated serum intersected by soft fibrous bands. 
Lungs. No signs of tubercle, recent or old. Bases cndematous. 
Post mortem 
findings 
