138 



REMARKS ON KALA-AZAR 



Types of 

 parasites 

 encountered 



Examination 

 of dogs 



In chronic cases it was frequently extremely difficult to demonstrate the parasite, 

 though on several occasions structures were seen which I boliove to be degenerated 

 parasites. These are illustrated in Plate VIII., figs. 10 luid 11. The cytoplasm in these 

 bodies was often degenerated, staining badly, often taking a reddish tinge and showing 

 granulation and excessive vacuolation ; the macronucleus was often ill-defined and 

 faintly stained, the blepharoplast (?) diffuse and staining like the macronucleus. 



These, however, appeared to be parasites owing to their definite borders, the 

 protoplasm staining blue and containing a chromatin mass, and what appeared to be an 

 altered and degenerate blepharoplast. These changes were never noted in the smaller 

 and younger parasites, nor in those of virulent cases. Excessive vacuolation was seen 

 in parasites after a single injection with orsudan (vide Plate VIII., figs. 19-22). 



Further, in chronic cases, parasites (?) were found which showed no signs of a 

 blepharoplast as usually seen, but two more or less equal chromatin masses usually 

 equally deeply stained — sometimes one, usually the smaller, somewhat more deeply 

 coloured (vide Plate VIII., figs. 7, 8, 9, 15 and 16). Such structures were only seen 

 in kala-azar cases, or those clinically like this disease. These forms did not appear 

 degenerate like the others already described. 



Occasionally parasites were observed of about the diameter of a normal red corpuscle, 

 sometimes quite circular in outline, but typical in the possession of nucleus and 

 blepharoplast. The cytoplasm, however, was more granular and vacuolated than in the 

 younger oval forms. One parasite seemed to be within a red cell and appeared to be 

 exactly in focus with the edge of the corpuscle, but since this was the only one seen in a 

 very large number of films, it is probable that it was superimposed. Parasites within 

 cells were not seen with any great frequency, possibly due to the fine type of needle used. 



In only two cases (both acute) were parasites found in the peripheral blood, in one 

 case free, and in the other free and in phagocytes ; no attempt was made to find parasites 

 in centrifugalised blood. 



Occasionally a parasite with a bi-partite blepharoplast was observed ; in one case 

 the adjacent ends of this divided inicronucleus were distinctly enlarged (vide 

 Plate VIII., fig. 17). 



Smears from the blood and various organs of the " Urmoot " fish were examined with 

 negative result ; this fish is largely eaten at Mafaza. Bed-bugs {Cimex lectularius) were 

 dissected on several occasions and smears made from various parts but with no definite 

 results — considerable previous practice and experience is required for this work, and 

 without such knowledge and experience the observations are not trustworthy. 



I can only say that two structures, very like kala-azar parasites, were observed in 

 a smear from the mid-gut of a bed-bug, gorged with blood, which I had caught on the 

 angareeb (bed) of a very virulent case of kala-azar. 



Tw'o dogs were killed and smears made immediately from the spleen, liver, kidneys, 

 mesenteric glands, and heart's blood — 



1. A dog, male, about 4 years' old, belonging to an extremely acute case of kala-azar 

 and living in the same tukl with the patient, was killed and examined at Gallabat. It was 

 very w-ell nourished and exceptionally clean for a native dog. No ecto-parasites were found. 



Nothing abnormal was noted in the organs except that the mesenteric glands in 

 connection with the small intestines were greatly enlarged and of a deep maroon colour, 

 while the two largest appeared lighter in colour, and as though they were about to break 

 down and suppurate. The intestines connected with the glands showed no macroscopic 

 disease. 



