190 CASK 0|- KALA-AZAK THKATKl) liV " ()0(i " 



.fiiunnnj 7, I'Jll.- -The patieiit appears to have iinprovud in health. The spleen has 

 iliiiiinished considerably in si/e, and gives the impression of lieing tiiiner in consistence. 

 There is no change in the size of the liver. A spleen puncture was carried out and 

 examination of the stained films showed that the parasites had increased considerably in 

 number, but there were evidently degenerative changes occurring in some of them. Many 

 of them had lost their contour and showed vacuolation of the trophonuclei and their 

 cytoplasm. The large rosette foi'nis present were considerably vacuolated and did not 

 appear to bo so numerous as formerly. Some of the spleen juice, removed by puncture, 

 was inoculated into the peritoneal cavity of a Vcrciijutlu-ciis .iiibmus* 



RK MARKS 



The case, not having reached any definite conclusion, little need be said as regards 



k.Miits. the course of treatment and the effects of the drug. On the whole, the latter seem to 



tiimiKh not have been favourable, but there has been no therajna uteriliyann waijua such as is said to 

 conclusive, are . . , . , 



encouraging occur in syphilis and at which Ehrlicli is amung. The parasites, how-ever, certamly seem 

 to bo somewhat susceptible to the drug, and, though it is difficult to be certain, the last 

 examination would appear to indicate that multiplication forms have been discouraged, 

 although single forms of Leishmania are possibly more numerous. These, however, show 

 evidence of degeneration in not a few instances. The case is one of very severe infection, 

 and at first the parasites were reproducing themselves on a large scale. From our 

 experience of similar cases here we are bound to say that we would have expected the 

 boy, if untreated, or treated in the usual manner, to have lost ground rapidly. Hence 

 we are disposed to think that the drug has been of benefit, but one nuist remember that 

 even bad cases of kala-azar may recover, or at least show temporary improvement. 

 Hence it is well to suspend judgment at present, but it may bo advisable to try intravenous 

 injection if it is found possible to persuade the boy's father to remain in Kliaitouiii and 

 agree to an extension of the treatment.' 



A further trial of the drug would also seem indicated in any other cases of the 

 disease which may come under notice. 



We notice that recently NicoUe and Conor- have been employing "606" in the 

 treatment of infantile kala-azar both in the child and in infected dogs. They record 

 the case of a dog, heavily infected, in whieh the drug caused a complete disappearance 

 of the parasites from the spleen and bone-marrow. 



Note 



Captain Byam, R.A.M.C, S.M.O. Kassala, reports that in April, 1911, the boy was 

 still alive, and, ho thought, in rather better health than formerly. 



• This monkey ucvcr lx:canic infected though one which was inwulnted iu a similar way liefore the 

 administration of any "606" became heavily infected and eventually died. 



' This could not he done. The hoy was removed to his home in the Kassala Province and the reci>rd 

 accordingly remains incomplete. 



■■■ NicoUe, C, and Conor, A. (December 14, 1910), "Application dn ' f.o6 ' traitement dn Kala-aair." /iu/l. 

 Hue. Path. EmI. 



