REMARKS ON’ KALA-AZAR | 141 diagnosis of kala-azar but that of an acute fever; several times that of dysentery.

‘It was a great surprise, therefore, to find the enormous numbers of parasites procured from the puncture of the but slightly enlarged spleen.

These acute cases are extremely important, and medical men must keep the possibility / kala-azar in mind in the case of acute fevers in the Sudan—as for chronic cases they walking advertisements of their disease.

APPENDIX _ Unidentified bodies were found in the splenic blood of a case suspected to be suffering from kala-azar.

The history of the case was as follows :— An Arab, aged about 35, had lived all his life at Tukelein, near the Atbara, near abat. He had been ill two or three months with cough and stated he had at “times expectorated blood. He was very thin and wasted. There was no other history ‘of illness and he stated he had never had fever, but when seen at 10 a.m. his temperature was 100-2’ F. Family history.—His wife had died three months previously after three months ntinuous fever. She had no dysentery, cough or expectoration of blood. His boy, ed about 5, was said to be quite well, but on examination both the liver and spleen 1d the child himself said he had not been ill with fever. The lungs and heart peared normal.

_ Physical examination.—Marked wasting and general weakness. Patient evidently sriously ill. Slightly anemic. Conjunctive not yellow. No edema. No physical signs f lung or heart disease. Spleen enlarged one inch below the costal margin. Liver not enlarged. A splenic puncture was performed, but very little blood could be withdrawn and the films were made with difficulty. Microscopical examination revealed neither kala-azar nor malarial parasites, but some curious bodies were discovered which are ‘drawn in Plate IX., figs. 19-25. The films were bad, many red cells were distorted, but in those which were intact no intra-corpuscular bodies could be found. It is greatly to be gretted the case was only seen once and no peripheral blood taken. Further, the ms were not examined till the next day, as my microscopical apparatus had to be behind owing to the difficult and stony track from Gallabat to Tukelein. Possibly these structures are hemogregarines. The average length was 3p to 5p, breadth about O:5y. The central portion was nearly always narrower than the xfremities, which were rounded. Tlfe outline was definite, the protoplasm stained blue d contained a nucleus which usually extended completely across the structure. No hromatin dots were noted scattered about in the protoplasm and there was no pigment.

trace of an enclosing red cell could be seen.

Possibly Plate IX., figs. 24 and 25 represent vermicules fixed during motion.

Fig. 20 shows a double nucleus, situated in the centre, the smaller lying against the pnvex border of the parasite in its long axis.

Fig. 23 shows forms very similar in shape to the diplococcus of pneumonia, having @ bodies with definite chromatin transverse bars.

It seems worth reporting this case and drawing the structures, and though it is sarcely possible to say definitely what they are, yet they appear ftom their definite orders, staining properties, etc., to be parasites. They are scattered here and there aroughout the two films taken.

‘were found to be considerably enlarged and his temperature was 100°1° F. The father : Unidentified bodies found in spleen of ‘* suspected ” case