I306 THE KALA^AZARS AND PSEUDO-KALA-AZARS 



spleen, which was reddish in colour. No malarial parasites could 

 be found, but there were some light yellowish pigment granules, 

 quite different from malarial pigment. 

 Toxoplasma Pyrogenes. — ^This was rarely found in the blood, 



but was abundant in the spleen. (For a description, see p. 49^.) 



Symptomatology. — ^The fever starts in youth and lasts many years, 

 defying all treatment. In character it is intermittent, reaching 

 103° to 105° F. at times. The attacks of fever do not start with 

 shivering, and the fall is not associated with sweating. The spleen 

 is much enlarged and hard, while the liver is also enlarged, but 

 neither organ is tender on pressure. All the other organs are 

 normal, and there is no enlargement of the lymphatic glands. 



Blood Counts. — ^The red blood-corpuscles in an advanced case 

 number 2,000,000, the leucocytes 5,200 per cmm. A few nucleated 

 red cells are present, and basophilia and chromatophilia are marked. 

 The leucocytic count is as follows: — ^Polymorphonuclear leucocytes, 

 50 per cent. ; lymphocytes, 40 per cent. ; large mononucleurs, 7 per 

 cent. ; eosinophiles, 3 per cent. ; hsemoglobin, 30 per cent. 



No malarial parasites could be found, and the serum reactions 

 for typhoid, the paratyphoids, and Malta fever, were absent. 



The urine sometimes contained a trace of albumen. 



Course. — ^The case grew gradually worse, emaciation set in, and 

 the patient died. 



Treatment.- — Quinine was given by the mouth and intramuscularly 

 in doses of 30-60 grains a day without effect. 



KREMPF'S SPLENOMEGALY. 



In 1917 Krempf described a case of splenomegaly in a young 

 Chinaman. He suffered from a malarial infection, and stated that 

 in his village near Tientsin splenomegaly was frequently observed 

 in both sexes and at all ages. 



On making a splenic puncture, Krempf found bodies either en- 

 closed in red cells or free in the plasma. They were only found in 

 the spleen. 



The red cells were deformed and contained a capsule 10 X 5 microns 

 in size, inside which lay a vermicular sporont often curved like 

 the letter U . Extracted from a red corpuscle, these bodies measured 

 20 X 1*5 microns. 



These bodies were believed to be the sporonts of a hgemogregarine, 

 and were named Hcemogregarina hominis Krempf, 1917. No 

 further history of the case is given. 



Recently Raubaud, examining the blood, of a lady who had resided for 

 two years in the Congo, observed that some red cells contained a hsemo- 

 gregarina 9-1 1 ^ by i'?>-ys which differed from Krempf 's parasite by 

 having a crescenting, not vermicular shape. Raubaud has named it Htsmo- 

 gregarina inexpectata. There was no fever, and no enlargement of the liver 

 or spleen. The blood, however, showed a marked mononucleosis. 



AFEBRILE SPLENOMEGALY. 

 Synonym. — Pseudo-Banti's disease. 



Definition. — A chronic afebrile disorder characterized by splenomegaly 

 and severe anaemia. 



