174 



Till', ALKALINITY IW THK MLOOD SKIU'M IN KALA-AZAU 



The reading 

 i>f results 



The same amount of indicator was always added to the acid solutions, and when 

 ready for use the mixture of acid and indicator was poured into a watch-f^lass. 



Titration of serum against the slamlurd acid solution. — The blood capsules, after 

 centrifuf^ing, were nicked with a file, and the end nearest the serum broken off. The 

 sera of the control individuals was then " pooled " and placed in a separate glass capsule. 



A fine capillary pipette, such as is used for estimating the Widal reactions, was 

 inserted into the serum, and a column of serum allowed to run up to a mark made with 

 a blue pencil, about 2 cm. up the tube. The pipette was then withdrawn, a small bubble 

 of air sucked in, and the pipette inserted into the acid until the upper column of the 

 acid was level with the l)lue mark. In this way equal volumes of serum and acid of a 

 known strength were obtained. 



The contents of the capillary tube were then blown out on a clean white slab, 

 thoroughly mixed with the cud of the pipette, and aspirated in and out of the capillary 

 tube several times. 



In doing this it was found ad\'isable to avoid the ])iesence of air bubbles in the 

 mixture. If a yellow-coloured fluid resulted, a stronger acid was taken until an orange- 

 red was given, and the dilution of acid which last gave this yellow colour was taken 

 as the index. 



If, on the other hand, a pink or orange colour resulted from the first titration, then 

 a weaker acid was used till a yellovr colour, free from red, was obtained, and the first 

 dilution of acid which gave this yellow colour constituted the index. As far as possible, all 

 the following estimations were carried out under similar conditions. 



All glass tubes, pipettes, and flasks used throughout these experiments were subjected 

 to immersion in pure hydrochloric acid for half an hour, washed in distilled water several 

 times, atui then dried in an oven at 130' C, in order to drive off any residual acid. 

 This precaution was taken for the purpose of avoiding any fallacious results due to the 

 presence of alkali in the glass. After this treatment, distilled water left in the tubes for 

 twenty-four hours gave neither an acid nor an alkaline reaction. 



Cage 1. — An Egyptian soldier, aged 30, with a previous history of irregular fever of 

 two months duration. The general condition of the patient was fair. Several blood 

 examinations failed to show the presence of the parasite of kala-azar. The spleen was 

 enlarged. Splenic puncture showed the presence of Leishman bodies. Soon after 

 diagnosis, and before the patient was placed on any specific line of treatment, the reaction 

 of the blood serum to " dimethyl " was tested, and the result was as follows : — 



Pooled normal senun 

 Patient's serum 



0-033 expressed as a fraction of nurinril 

 0-025 



.Mkalinily 

 diminished 



This was, comparatively speaking, not a very advanced case, but tlie alkalinity of the 

 blood of the patient, when compared with the pooled serum, will be seen to be 

 diminished. 



Case 2. — An Egyptian soldier, about 28 years of age, with a previous history of 

 recurrent attacks of fever when stationed in the Blue Nile Province. Patient was 

 admitted in a weak condition with a high fever and enlarged spleen. Examination of a 

 peripheral blood film failed to show the presence of malarial or other parasites. The spleen 

 extended to about an inch below the umbilicus, and the lower limit of the liver could 

 be palpated below the costal margin. Splenic puncture showed Leishman bodies to be 

 present. 



