THE ALKALINITY OF THE BLOOD SERUM IN KALA-AZAR 175 



The serum reaction was tested and sliowed a diminished alkalinity : — 



Pooled normal serum ... ... 0'03 expressed as a fraction of normal 



Patient's serum ... 0'024 ,, „ „ 



Oa.te 3. — An Egyptian soldier, about 30 years of age. He vv-as admitted into hospital 

 with a previous history of fever in the Kassala Province. 



The general condition of the patient was fairly good. Both spleen and liver w^ere 

 enlarged, but the former was not sufficiently enlarged to justify splenic puncture. 

 Eepeated examinations of the peripheral blood having given negative results as regards the 

 presence of the malarial parasite, the liver was punctured and a few Leishman bodies were 

 found to be present. The alkalinity of the patient's serum was estimated two days after 

 the diagnosis had been confirmed, and the results were as follows : — 



Pooled normal serum ... ... 0'0.3o expressed as a fraction of normal 



Patient's serum ... ... ... 0'02.3 ,, ,, ,, 



There was obviously a marked diminution in the alkalinity of the patient's serum. 



Gase 4. — A Sudanese boy, aged 14, a native of the Blue Nile Province, admitted 

 to hospital suffering from epistaxis and diarrhoea. The previous history was very indefinite. 

 On admission, a history of epistaxis since childhood was obtained. Patient was somewhat 

 thin and cachectic, and when lying in the prone position an abdominal swelling was 

 apparent. This, on palpation, proved to be an enlarged spleen extending downwards 1 inch 

 below the umbilicus. The liver was also enlarged. Examination of the peripheral blood 

 was negative as regards the presence of malarial parasites, and splenic puncture was 

 resorted to as an aid to diagnosis. Examination of the splenic smears revealed the presence 

 of a large number of Leishman bodies. 



The alkalinity of the patient's serum was tested soon after the diagnosis had been 

 confirmed, and was as follows : — 



Pooled normal serum ... ... 0'033 expressed as a fi'action of normal 



Patient's serum 0'0'20 „ ,, ,, 



A blood count and an estimation of the haemoglobin were undertaken in this case, and 

 the figures were as follows : — 



Red blood corpuscles 2,916,000 



White blood corpuscles ... ... 4,680 



Haemoglobin 60percent. 



A differential count showed : — 



Polymorphonuclear leucocytes 



Large mononuclears 



Lymphocytes 



Transitionals 



Eosinophiles 



43 per cent. 

 32 „ 

 23 



1 „ 



1 



