15fi 



KA1..\-A!!ATI rOMMISSION 



Clinical notes 



Prrsrncc of 



Lcisliman- 



Donovan 



bodies in Ihr 



peripheral 



bloofl 



out-patient and stcivrlily improved. On Feb. 27, 1910, he was able to return to 

 scliool and on April 25, 1910, the splenic enlarf^eiiient had disappeared. Leishinan- 

 Donovan bodies were found in the peripheral blood. Treated witli tincture of senega. 



Piinf 7. Z.B.B., girl, aged 11. Admitted into hospital on Dec. 7, 1909, with enormous 

 enlargement of tlie spleen, fever, extreme emaciation and pigmentation of the skin. 

 Liver slightly eiilarg(!d. Died on Dec. 19, 1909. Leishman-Donovaii ]iarasites found 

 in tiie periplieral blood. Treated witli tincture of senega. 

 CafP 8. A.W.B., boy, aged 10. .Admitted into liospital on Dec. 11, 1909, suffering from 

 fever, enormous enlargement of tlic spleen, and (edema of tiie face. Died on Doc. 17, 

 1909, six days after admission. Leishman-Donovan parasites found in the peripheral 

 blood and in the spleen. Treated with tincture of senega. 

 Case 9. G.E.S.M., boy, aged 11. Admitted into hospital on Dec. 13, 1909, with enormous 

 splenomegaly, fever, oedema of the feet and face, and sliglit emaciation. Died on 

 Jan. 5, 1910. Leishman-Donovan parasites found in the peripheral blood and in 

 the spleen. Treated with tincture of senega. 

 Cage 10. Y.E.T., boy, aged 10. Admitted into hospital on July 26, 1910, with splenomegaly, 

 fever, cedema of face and feet, and cougii with blood-stained expectoration. lie died 

 on the day of admission. Leishman-Donovan parasites found in the i)eri])lu'r;il 

 blood and by spleen puncture. 

 Case 11. Y.K., boy, aged 19. Admitted into hospital on July 25, 1910, witli splenomegaly 

 and slight fever. He also complained of splenic pain. Two days after admission 

 he complained of severe pain in the abdomen, and his temperature rose. The 

 pain continued, diarrhoea set in and he died on July 31, 1910. Leishman-Donovan 

 parasites found in the peripheral blood and in the spleen. Treated with tincture 

 of senega. Post mortem examination showed acute general peritonitis from rupture 

 of an ulcer in the upper part of the descending colon. 

 Cnjie 12. M.E., boy, age about 12. Admitted into hospital on May 31, 1910, with high 

 fever, splenomegaly, oedema of the feet and face, and slight emaciation. He died 

 on June 23, 1910. Leishman-Donovan bodies found by splenic puncture but not in 

 the peripheral blood. Treated with tincture of senega. 



Pathological material was also sent by Captain Thomson from cases seen by him 

 which were not admitted into Singa Hospital. The outstanding clinical features of 

 the disease in this Province are splenomegaly, fever, and oedema of the face and feet. 

 With the exception of Case 7, the emaciation was usually slight, this being probably 

 accounted for by the comparatively short duration of the illness. • Dyspncca was a common 

 terminal symptom. Diarrhoea was present in two cases, epistaxis in one, and one died from 

 rupture of an ulcer in the descending colon. One case suffered from extreme deafness 

 and another from middle ear disease. (We have since seen in Khartoum Military Hospital 

 a boy with kala-azar who also had suppuration in the middle ear.) Splenic pain was 

 frequently complained of and death was often sudden. Two cases had rigors. The fever 

 was usually irregular, the maximum rise occurring about 4 in the afternoon. 



Treatment. In view of Major Ensor's favourable result witli Tinct. Senega this 

 drug was tried in the treatment of the disease. It was given in doses of i to 1 drachm 

 3 times a day. When rigors were or had been present, quinine was also given. One 

 of the cases, No. G, has apparently recovered, and senega was the only drug used. In 

 another case (Case 3) there appeared to be a marked diminution in the number of parasites 

 found by spleen puncture, and in the same case the flagellated bodies found in the faeces, 

 and to be described later, disappeared after its administration and reappeared again 

 when it was stopped, so it would seem to have a definite toxic effect on protozoa. 



Peripheral Blood 

 (r() Prenrnri' nf Lehhinau-ThDiiivfDi hnilies in the periplifnil lilond 



Out of 15 cases of kala-azar in which the peripheral blood was examined the parasites 

 were present in 13 or in 8G-6 per cent. In one of the negative cases only 4 slides were 



