i8(; 



CASE OF KAI,\-AZAH TRKATKI) HY 



600 ' 



l>iagnosis 

 confirmed l»y 

 spleen 

 puncture 



Injections 

 commenced 



a little pale. Jamulice was absent. The toiij^iie wan clean and the teetli were in excellent 

 condition. No al)rasions or ulcers were present in the }»unis or mucous inenihrane of 

 the luouili. There was no evidence of either a general or a circumscribed oedema being 

 present. Epistaxis and diarrhoea were absent and no trcniors were visible. 



On palpating the abdomen, enlargement of the spleen and liver could be detected. 

 A careful examination failed to reveal tiie presence of ascites. 



The spleen measured 5 inches in its longest diameter. It was very firm to the touch 

 and had well-detined edges. Its lowest limit was on a level with the undjilicus. The 

 greatest length of the liver in the parasternal line was five inches. The patient's girth 

 ineasurenient, taken at a point 2 inches below the apex of the xiphisternum, was 27 inches. 



Neither the spleen nor liver were tender on palpation. 



Spleen puncture was performed by one of us (R.G.A.) on Novenibei- 7, and the 

 smears nuide were examined and showed the presence of a large inmiber of Leishman 

 bodies, indicating a very heavy infection with these parasites. Not only were there the 

 usual types of Leishman bodies, Init there were also seen peculiar rosette-like forms 

 (Plate XII., fig. 8), in which six or more parasites were found clumped together and 

 surrounded by a cell wall. Dividing forms were also present like those described and 

 figured by Visentini' (Plate XII., figs. 5-7). Rapid multiplication of the parasites was 

 evidently taking place. 



It may be explained here that this spleen puncture was carried out for the purpose 

 of serving as a control experiment prior to the administiation of the drug " 606." 



Three films taken from the peripheral blood showed the presence of two parasites, both 

 of which were phagocyted inside leucocytes. 



A differential leucocyte count showed the following percentages : — 



Polymorphonuclear leucocytes 



Large mononuclear leuiwcvtes 



Large lymphocytes... 



Small lymphocj'tcs... 



Eosinopbiles 



Transitionals 



Basopbiles ... 



38% 



39-8 % 

 9-2% 

 6-8% 



1-2% 

 4-8% 



■2% 



The patient's red blood corpuscles numbered 3,133,333 per cm. The white corpuscles 

 numbered 5,176 and the blood showed 60 per cent, of haemoglobin. The patient weighed 

 3 St. 8 lb. 



On November 8, 2 gramme of " 606," in liquid paraffin, was injected into the 

 gluteus maximus muscle. In the evening the temperature fell two degrees lower than that 

 recorded the previous night. The patient appeared to be fairly comfortable but complained 

 of a little pain. On the following day the report of the ])atient was favourable, i)Ut towards 

 evening his temperature rose, possibly as a result of his getting out f)f bed and walking 

 about without permission. 



On November 10 the patient's condition appeared to be quite good and no ill-effects 

 were apparent as a result of the injection. 



' Visentini, A. (.July, I'.IIO), " Ulier die Morphologie und den Kntwioklungskrcis der lici Kranken Kalabricns 

 iinil Sigiliens heoliarhteten Leishmania." Archiw f. Schifa uml Trnpcnhi/ijiciir, Hrihcft 4. 



