IvALA-AZAi: Commission 



TO INVESTIfJATE THE PREVALENCE AND CaUSE OF 



THE Disease in the Eastern Sudax 

 (2) Pathological Retort 



BY 



Lieutenant W. E. Marshall, M.E., Ch. B., D. P.H., R.A.M.C. 

 Attaclied Egyptian Army 



Clinical Notes 



The material for carrying out the pathological investigation into kala-azar in Sennar 

 Province was obtained for the most part from the 12 eases of kala-azar admitted into 

 Singa Hospital between the months of December, 1909, and July, 1910. 



The clinical histories of these cases were briefly as follows : — 



Case 1. A.A.B., boy, aged 10. Admitted into hospital on April 19, 1910, with enlargement Clinical notes 

 of the spleen, irregular fever, and an oedematous swelling of the right cheek. His 

 condition remained the same till May 21, 1910, when the fever became more irregular, 

 jaundice set in, and he died suddenly on June 20, 1910. He had a progressive leucopenia, 

 the white blood corpuscles numbering 5200 on April 24, 1910 ; 4531 on May 3, 

 1910; 4375 on May 14, 1910; and 2200 on May 26, 1910. Leishman-Donovan ^j 



parasites were found in the peripheral blood and by spleen punctui'e. Post mortem 

 examination showed enormous enlargement of the spleen with white patches on the 

 capsule and some adhesions at the upper end. The liver was also enlarged. The 

 bone-rnarrow was red but the intestines appeared healthy. Treated with Tinct. Senega. 



6'a.^■'• 2. A.S.W.O., boy, aged 14. Admitted into hospital on Dec. 7, 1909, with enlargement 

 of the spleen, fever and emaciation. He had had occasional rigors before admission. 

 He became deaf without associated pain, and suffered from night terrors. His ^ 



temperature was very high and very irregular, and he died on Jan. 26, 1910. The 

 leucocytes numbered 4500. Leishman-Donovan parasites were found in the peripheral 

 blood and by spleen puncture. Treated with tincture of senega and quinine. 



Case 3. A.W.T., boy, aged 10. Admitted into hospital on Nov. 30, 1909, with spleno- 

 megaly, constant fever, and cpdema of the feet. He did fairly well, and had periods 

 of apyrexia, the temperature sometimes remaining normal for four clear days. He 

 went home on April 23, 1910, but died there on May 16, 1910. He had albuminuria 

 and also sufl'ered from tapeworm, the ova of Tien.ta nana and T.vnia sujinm being 

 both present in the fseces. Leishman-Donovan bodies were found in the peripheral 

 blood and by spleen puncture. Treated with tincture of senega and quinine. 



Claso. 4. F.B.A., girl, aged 13. Admitted into hospital on Dec. 7, 1909, suffering from 

 diarrhoea, splenomegaly, fever and emaciation. She had attacks of epistaxis, and 

 sufl'ered from suppuration in the middle ear. She died suddenly on January 9, 1910. 

 Leishman-Donovan bodies were found in the peripheral blood and by spleen puncture. 

 Treated witli tincture of senega. 



Case 5. S.K.W.T., boy, aged 12. Admitted into hospital on Dec. 1, 1909, with fever, 

 swelling of face and feet, and splenic pain but no splenic enlargement. History of 

 rigors every second day at 4 in the afternoon. Leucocytes 5859. He died suddenly 

 on Dec. 10, 1909, complaining of severe pain in the abdomen and chest. Leishman- 

 Donovan bodies were found by spleen puncture, and in the peripheral blood. Treated 

 with tincture of senega and quinine. 



Gase 6. A.A.K., boy, age about 12. Admitted into hospital on Dec. 1, 1909, with fever, 

 splenomegaly, slight enlargement of the liver, and leucopenia, the white blood cells 

 numbering 3125. After a short stay in hospital he was allowed to attend as an 



