CASE OF KALA-AZAE TEEATED BY 



606" 



1H7 



Examination of three perii^heral blood smears revealed the presence of a single 

 Leishman body phagocyted by a large mononuclear. The trophonucleus of the parasite 

 stained faintly while the kinetonucleus appeared as if it was being extruded. 



On the 11th the patient had a slight epistaxis, otherwise his condition remained mucli 

 the same. 



Three days after, a swelling appeared in the buttock at the site of inoculation. This 

 was opened and found to contain serum, due possibly to the fact that the drug liad 

 been injected into a bursa. Peripheral blood films were taken and a single typical parasite 

 was found ingested by a mononuclear leucocyte. A differential leucocyte count of 500 cells 

 showed : — 



Polymorphs ... 

 Mononuclears 

 Large lymphocytes. 

 Small lymphocytes. 

 Eosinophiles 

 Transitionals 



53% 

 13% 

 19-2 % 

 10-8 ",_, 

 •6,% 

 3-4% 



The increase in polymorphonuclear leucocytes was in all probability dependent upon 

 the swelling at the site of the first inoculation. 



On November 15, -4 gramme of " 606," suspended by Wechselman's method in second 

 neutral NaCl solution (physiological), was injected subcutaneously below the scapular injection 

 region. No ill-effects followed this second inoculation, in fact the patient's condition 

 showed marked improvement. His weight was now 3 st. 13 lb., showing an increase 

 of 5 lb., and the spleen had diminished appreciably in size. On November 20 

 peripheral blood films were examined, and a single parasite was found inside a 

 mononuclear leucocyte. One megaloblast and two normoblasts were found to be present. 

 A differential leucocyte count showed : — 



Polymorphs 

 Mononuclears 

 Large lymphocytes 

 Small lymphocytes 

 Eosinophiles 

 Transitionals 

 Basophiles ... 

 Myelocytes 



38-6% 



22% 



19-8% 



13-8% 



■4% 



4-8% 



•4% 



■2% 



Judging from this examination there was a change for the worse in the patient's 

 blood. However, in spite of this, the improvement in his physical condition continued, 

 and on November 26 he weighed 4 st. His peripheral blood was again examined 



