KEMAKKS ON KALA-AZAK 141 



diagnosis of kala-azar but that of an acute fever ; several times that of dysentery. 

 It was a great surprise, therefore, to find the enormous numbers of parasites procured from 

 the puncture of the but slightly enlarged spleen. 



These acute cases are extremely important, and medical men must keep the possibility 

 of kala-azar in mind in the case of acute fevers in the Sudan — as for chronic cases they 

 are walking advertisements of their disease. 



Appendix 



Unidentified bodies were found in the splenic blood of a case suspected to be 

 suffering from kala-azar. 



The history of the case was as follows : — 



An Arab, aged about 35, had lived all his life at Tukelein, near the Atbara, near 

 Gallabat. He had been ill two or three months with cough and stated he had at 

 times expectorated blood. He was very thin and wasted. There was no other history 

 of illness and he stated he had never had fever, but when seen at 10 a.m. his 

 temperature was 100'2' F. 



Famili/ hisiorij. — His wife had died three months jireviously after three months 

 continuous fever. She had no dysentery, cough or expectoration of blood. His boy, 

 aged about 5, was said to be quite well, but on examination both the liver and spleen 

 were found to be considerably enlarged and his temperature was 100' 1 F. The father 

 and the child liiniself said he had not been ill with fever. Tlie lungs and heart 

 appeared normal. 



Plti/xi'aiJ I'.rii.iniiKiliiiii. — Marked wasting and general weakness. Patient evidently Unidentified 

 seriouslv ill. Bliulitlv anaemic. Coniunctiva* not yellow. No cedema. No physical signs .° '^^ °"". 



. o . J J 1 . o ,n spleen oi 



of lung or heart disease. Spleen enlarged one inch below the costal margin. Liver not "suspected" 

 enlarged. A splenic puncture was performed, but very little blood could be withdrawn '^^^^ 

 and the films were made with difficulty. Microscopical examination revealed neither 

 kala-azar nor malarial parasites, but some curious bodies were discovered which are 

 drawn in Plate IX., figs. 19-25. The films were bad, many red cells were distorted, but 

 in those which were intact no intra-corpuscular bodies could be found. It is greatly to be 

 regretted the case was only seen once and no peripheral blood taken. Further, the 

 films were not examined till the next day, as my microscopical apparatus had to be 

 left behind owing to the difficult and stony track from Gallabat to Tukelein. 



Possibly these structures are haemogregarines. The average length was Sfi to 5^i, 

 breadth about 0-5p. The central portion was nearly always narrower than the 

 extremities, which were rounded. The outline was definite, the protoplasm stained blue 

 and contained a nucleus which usually extended completely across the structure. No 

 chromatin dots were noted scattered about in the ijrotoplasm and there was no pigment. 

 No trace of an enclosing red cell could be seen. 



Possibly Plate IX., figs. 24 and 25 represent vermicules fixed during motion. 



Fig. 20 shows a double nucleus, situated in the centre, the smaller lying against the 

 convex border of the parasite in its long axis. 



Fig. 23 shows forms very similar in shape to the diplococcus of pneumonia, having 

 blue bodies with definite chromatin transverse bars. 



It seems worth reporting this case and drawing the structures, and though it is 

 scarcely possible to say definitely what they are, yet they appear from their definite 

 borders, staining properties, etc., to be parasites. They are scattered here and there 

 throughout the two films taken. 



