22-1 I'KVF.ltS IN Tin; SIDAN 



of the leucocytes which showed chiomatolysis. Major Howard Ensor, D.S.O., has very kindly 

 furnished mo with some notes on the case and with a copy of the temperature chart 

 (No. 6) which was kept in Khartoum. (Infortuniitely the previous record is not availahle. 

 The fever began early in Scptcinbfi , lOlU, iunl was treated by quinine without benefit. 

 Blood examinations made on several occasions piovcd negative for malaria. Eaily in 

 October tiie patient was sent to Kliartoum as a possible case of kala-azar. Tlie sjileen 

 was found to be much enlarged and very hard in consistence. There was no pain or 

 tenderness in the splenic region. The liver had not appreciably increased in size. There 

 was a history of old attacks of rheumatic fever, lint no cardiac lesion was present. Neither 

 Major Ensor nor myself could find malarial parasites in the peripheral blood. Quinine, 

 however, was given together with salicylate of soda. .\ l)lo()d count on Oetoljer U) ^'ave 

 5, .320, 000 reds and only 2000 whites. A confirmatory count gave practically the same 

 result, proving that marked leucopenia was ))r(!sent. Next day liver puncture was 

 performed with the negative resiilt stated on jkkjc 223. I'lider tlie treatment mentioned, 

 the temperature fell, still, however, reaching over 99 F. at night. The condition of the 

 spleen remained unchanged. A blood count on October 10 showed the leucopenia to 

 Successful have somewhat diminished, there being 3,200 white cells. A second liver puncture gave 



ireatinciit i>y negative results, as did frequent examinations of the iieripheral blood. As the patient 

 was improving Major Ensor did not think that splenic i)unctuie was justitialile. He put 

 the patient on his senega treatment, which apparently speedily reduced the spleen to 

 normal size, abolished the leucopenia, eventually even inducing a slight leucocytosis 

 (13,000 whites), and cured the patient. I can only say that both Major Ensor and myself 

 regarded the case as one of early kala-azar, but as no parasites were found and splenic 

 puncture was not performed a definite diagnosis is not possible. 



The other example was also in a British Officer resident in Kliartomn. l)nt was not 

 quite so like kala-azar. Apait from the curious fever {(Iharl 7), the chief symptom was a 

 very great and rapid enlargement of the spleen which, by .January 31, reached to half 

 way between the umbilicus and Poupart's ligament. (Note by Major .1. C. .Jameson, 

 R.A.M.C.). No malaiial parasites were found in his blood and the dilTerential count 

 showed a marked lymphocyte increase, there being 34 per cent, of large and 21 per cent, 

 of small lymphocytes. Some cells resembling myelocytes were also present. I feared the 

 case would turn out to be a leukiemia. I'nder (|uinine treatment, however, improvement 

 speedily occurred. Lack of space does not permit a longer record of this cui'ious case. 

 I believe it was a splenomegaly due to some toxin absorl)ed from the intestinal tract, 

 though it may have been a peculiar attack of malaria. Nowadays, perhaps, an 

 examination of the urine for pigment by Urriola"s method might have cleared up the 

 condition. 



Mention may perhaps be made of septicoemic fever. This is not always easy to 

 diagnose and, indeed, septicaemia, saprajmia and pyjemia are apt to be forgotten in the 

 Sudan where one is on the look-out chiefly for malaria, enteric fever and kala-azar. 

 l-evers of Here is a case which seems worth recording as the temi)erature chart (No. 8) is interesting. 



The following notes are those kindly sent me by Dr. S. A. Saigh, the Mediral Officer 

 at Haifa, who also sent the chart along with them and who, 1 think, look a correct 

 view of the case. — 



" Frerinus llistnrij. Patient complains of having had attacks of pain in the left 

 side, coming on about every four months and lasting 24 bonis; he has bad these attacks 

 since his childhood or, at least, as far back as he can remember, and they were always 

 accompanied with fever. 



pyogenic 

 oriRin 



