Types of parasites encountered Examination of dogs 138 REMARKS ON KALA-AZAR In chronic cases it was frequently extremely difficult to demonstrate the parasite, though on several occasions structures were seen which I believe to be degenerated parasites. These are illustrated in Plate VIII., figs. 10 and 11. The cytoplasm in these bodies was often degenerated, staining badly, often taking a reddish tinge and showing granulation and excessive vacuolation; the macronucleus was often ill-defined and faintly stained, the blepharoplast (?) diffuse and staining like the macronucleus.

These, however, appeared to be parasites owing to their definite borders, the protoplasm staining blue and containing a chromatin mass, and what appeared to be an altered and degenerate blepharoplast. These changes were never noted in the smaller and younger parasites, nor in those of virulent cases. Excessive vacuolation was seen in parasites after a single injection with orsudan (vide Plate VIII., figs. 19-22).

Further, in chronic cases, parasites (?) were found which showed no signs of a blepharoplast as usually seen, but two more or less equal chromatin masses usually equally deeply stained—sometimes one, usually the smaller, somewhat more deeply coloured (vide Plate VIII., figs. 7, 8, 9, 15 and 16). Such structures were only seen in kala-azar cases, or those clinically like this disease. These forms did not appear degenerate like the others already described.

Occasionally parasites were observed of about the diameter of a normal red corpuscle, sometimes quite circular in outline, but typical in the possession of nucleus and blepharoplast. The cytoplasm, however, was more granular and vacuolated than in the younger oval forms. One parasite seemed to be within a red cell and appeared to be exactly in focus with the edge of the corpuscle, but since this was the only one seen in a very large number of films, it is probable that it was superimposed. Parasites within _ cells were not seen with any great frequency, possibly due to the fine type of needle used.

In only two cases (both acute) were parasites found in the peripheral blood, in one case free, and in the other free and in phagocytes; no attempt was made to find parasites in centrifugalised blood.

Occasionally a parasite with a bi-partite blepharoplast was observed; in one case the adjacent ends of this divided micronucleus were distinctly enlarged (wide Plate VIII., fig. 17).

Smears from the blood and various organs of the ‘‘ Urmoot”’ fish were examined with negative result; this fish is largely eaten at Mafaza. Bed-bugs (Cimex lectularius) were dissected on several occasions and smears made from various parts but with no definite results—considerable previous practice and experience is required for this work, and without such knowledge and experience the observations are not trustworthy.

I can only say that two structures, very like kala-azar parasites, were observed in a smear from the mid-gut of a bed-bug, gorged with blood, which I had caught on the angareeb (bed) of a very virulent case of kala-azar.

Two dogs were killed and smears made immediately from the spleen, liver, kidneys, mesenteric glands, and heart’s blood— 1. A dog, male, about 4 years’ old, belonging to an extremely acute case of kala-azar and living in the same tukl with the patient, was killed and examined at Gallabat. It was very well nourished and exceptionally clean for a native dog. No ecto-parasites were found. Nothing abnormal was noted in the organs except that the mesenteric glands in connection with the small intestines were greatly enlarged and of a deep maroon colour, while the two largest appeared lighter in colour, and as though they were about to break down and suppurate. The intestines connected with the glands showed no macroscopic disease.