CASE OF KALA-AZAR TEEATED BY 



'606" 



for the presence of Leishuian parasites but with negative results. 

 was present in the films. A differential leucocyte count showed : — 



189 

 One nieKaloblast 



Polymorphs 



Mononuclears 



Large lymphocytes 



Small lymphocytes 



Eosinophiles 



Trausitionals 



Myelocytes 



37-4% 



22-2% 



24-6% 



8%- 



•2% 



7-4% 



•2% 



The patient's health continued to improve, his weight going up to i st. 2 lb. impKJ^eiiient 

 The spleen had diminished in size and now measured 3 inches in its greatest length. 

 The liver showed no alteration, still measuring 5 inches in the parasternal line, and the 

 patient's girth at a point two inches below the xiphisternum still remained 27 inches. 



It was now considered advisable to carry out another splenic puncture in order to see 

 what effects the drug "606" had produced on the Leishman parasites. Accordingly, a 

 spleen puncture was made and the smears examined. 



Many unchanged parasites were present. The rosette forms were also seen in fair 

 numbers, but in certain parts of the films, especially along the edges, there were clumps 

 of Leishman bodies which had undergone degenerative changes. In many of them the 

 trophonuclei had disappeared and the kinetonuclei had broken up into granules. Many 

 of the large endotlielial cells showed gaps in their cytoplasm. These spaces looked as 

 if they had contained parasites which had vanished from them. Plate XII., figs. 10-14. 



On December 6, '5 gramme of " 606," in sterile olive oil, was injected into the buttock.' 

 This was not followed by any unpleasant symptoms. 



On December 11 another differential count was carried out. The patient's general 

 condition had distinctly improved. The sj)leen was smaller, the abdomen was quite lax. 

 The count was as follows : — 



I-'ffect on 

 parasites 



Polymorphs... 

 Mononuclears 

 Largo lymphocj'tes 

 Small lymphocytes.. 

 Transitionals 

 Basophiles ... 



37-6% 



21-8% 



26-4% 



7-2% 



6-6% 



■4% 



No myelocytes, normoblasts or megaloblasts present. One Leishman parasite was 

 found lying free on a red cell. The parasite showed no evidence of degeneration. 



December 23. — No further change has occurred except that for a few days there 

 was a slight loss of weight, but at the time of writing the loss has been made good 

 and the patient's condition remains satisfactory. 



' This form of administration was suggested by Captain W. B. Fry. We note that it lias recently licen 

 employed by Volk. - 



- Volk R. (1910). irien. Med. Klin. No. 35. 



/- 



