KALA-AZAE COMMISSION 159 



available for examination. Out of these 13 cases, in 9 the parasites were present in the 

 large mononuclear cells only, in 3 they were found only in the polynuclear cells, and in 

 one case in both. They were never found in very large numbers seldom averaging one 

 parasite per slide. We have found as many as 4 inside one large mononuclear cell. 

 There seems to be a definite relation between the number of parasites in the blood and 

 the number in the spleen. In the negative cases the parasites were in small numbers 

 in the spleen and in Case 2, where the parasites were also scanty in the spleen, they 

 were not found in the peripheral blood until the eighth film had been examined. In 

 the majority of positive cases, however, the examination of 3 slides is usually sufficient 

 for diagnostic purposes.' The parasites did not appear to vary with the time of day nor 

 with the fever, nor could we find them markedly increased before death. 



{h) Increase in the largp moiuniiiclpar Jeucoci/ten 



This as a rule was well marked, varj'ing from 8'19 per cent, to 38'21 per cent, of Increase 

 the white cells. The case with the lowest percentage of these cells was the one which f 



^ " mononuclear 



recovered. There was frequently marked vacuolation of these mononuclear cells and leucocytes 

 some were comparatively of an enormous size, one measuring 34ji( Ijy 39/( being found 

 on one occasion. 



(c) Other blood changes 



Except in Case G there was a definite diminution in the number of polynuclear cells. 

 Large deeply basophile mononuclear cells were frequently present. These, in our 

 opinion, are plasma cells. The nucleus is exeentrically placed, there are small vacuoles 

 in the protoplasm, and the perinuclear zone, so characteristic of these cells, is well 

 marked. The wheel-shaped structure of the nucleus was absent, but this does not 

 occur, according to Naegeli, when these cells are present in the peripheral blood. It is 

 difficult, however, in the peripheral blood to distinguish the above from Naegeli's 

 myeloblasts. Nucleated red cells were occasionally found and megalocytes were 

 common. Polychromatophilia was often w^ell marked. 



((Z) Ttelation of eosinophilia to kala-a:ar 



In well-marked cases of kala-azar there is undoubtedly a diminution in the number Relation of 

 of eosinophile cells present in the peripheral blood. It is interesting to note, however, that ''°^'J'°P ' '^ 

 a great many cases of fever and splenomegaly suffered from eosinophilia. Out of 43 such 

 cases where the peripheral blood was examined 18 showed eosinophilia, 2 showed 

 eosinophilia and quartan malaria parasites, 2 showed quartan malaria only, and 

 21 showed no special change. Another interesting fact is this : — 2 cases of kala-azar 

 diagnosed positive by Captain Bousfield, and 2 cases put down b}' him as suspicious 

 (one, No. C of this series) were seen by us. The first two were both healthy. One (S.M.) 

 had an eosinophilia of 8'82 per cent., and in the other (R.S.) the eosinophilia is noted 

 as " enormous." Of the two suspicious cases one (G.S.) showed definite eosinophilia in 

 the peripheral blood ; the other (No. G of this series) had, when first examined, an 

 eosinophilia of 2'86 per cent., but after recovery he also showed an increase in the 

 eosinophile cells. The brother of Case 2, who had splenomegaly, also showed eosinophilia 

 in the peripheral blood and a local eosinophilia in the spleen. The sister of Case G, 

 suffering from fever and splenic enlargement, had also eosinophilia in the peripheral blood. 

 Two Abyssinians were admitted into Singa Hospital suspected to have kala-azar. One, 

 Case, No. 11, was proved positive; the other, whose symptoms suggested the disease, has 



