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JIEMAUKS ON KAIiA-AZAU 



Kelalitin uf 

 nunilx^r of 

 parasites to 

 severity of 

 inffclion 



Other aids to 

 diagnosis 



Absence of 

 malaiial 

 parasites in 

 kala-azar cases 



Nil ciists tliiii pii^si'iited only atypical bodies were included in tlic list of those 

 deliiiituly diat^noscd, though it is a striking fact that these bodies were milij found in 

 those with typical parasites, or in cases that were clinically kala-a/ar. These atypical 

 bodies are illustrated in Plate VIII., tigs. 7, 8, 9, lo and 111, while othi-rs were frequently 

 seen having no signs of a blepharoplast. 



In ten cases the parasites were readily found, and the diagnosis settled by a few 

 minutes microscopic work, but the remaining twelve needed much laborious work before 

 they could be demonstrated. 



Major Cunnnins, R.A.M.C., stated that the number of parasites found had no relation 

 to the severity of the infection. My experience certainly does not coincide with his, for 

 my cases, which were acutely ill with the disease, practically invariably presented a large 

 number of parasites in the splenic films, and only required a few minutes for microscopic 

 diagnosis, provided tliat true splenic blood was withdrawn. In contrast to this, the 

 chronic cases presenting wasting, prominent abdomens, large livers and spleens, and a low 

 fever, and whicii could easily be diagnosed on clinical grounds alone, presented very 

 few parasites, and often it was extremely tedious to demonstrate them, while in 

 several such cases there was an absolute failure. I do not think any of these were 

 chronic malarial cases. 



Fifty-six splenic punctures were performed during this tour, and iweuty-two positive 

 results were obtained. In thirty-nine cases, which were undoubtedly kala-azar from 

 a clinical standpoint, nineteen showed parasites in tlieir splenic blood — i.r. in about 

 48-5 per cent, of the clinical cases the parasite was demonstrated. 



Other aids to diagnosis, such as the type of fever, the effect of quinine, leucopenia and 

 differential counts, could seldom be employed, owing to the impossibility of following 

 up the cases and to lack of time. 



Though a differential count is most useful when one has a patient under constant 

 observation, yet for such a rapid tour of investigation the method was found by me of little 

 value, the percentages varying considerably. Without finding the parasite I felt that 

 a diagnosis, founded on not very definite clinical grounds, together with a differential 

 count supposed to indicate the presence of the disease, was scarcely sufficient to justify 

 isolation and destruction of property. 



In the definite kala-azar cases the finely granular polymorphonuclear leucocytes were 

 usually present in numbers varying from 30 45 per cent., while tlie large mononuclears 

 varied from 16-32 per cent. 



Malarial parasites were not found in a single case of kala-azar, either in the 

 peripheral or splenic blood, and in the suspected cases only in four instances. 

 Considering how extremely common malaria is, this is very remarkable, and 1 can 

 only suggest that it is a case of the survival of the fittest. The weaklings dying off 

 from malaria in early childhood, those with stronger constitutions surviving and growing 

 up, gain an inmiunity, so that, although suffering from malaria during the rainy season, 

 yet they are capable of ridding their general circulation of the parasites when once the 

 malarial season is over, in spite of their not taking quinine. This tour was made 

 during the non-malarial season. 



In several cases the peripheral blood was watery and spread on the slides extremely 

 badly. In three virulent cases it resembled cloudy serum. 



The type of parasite usually encountered was the typical one now so well known as 

 to need no description, Plate VIII., tig. 1. Most of the forms were free and well developed. 



