OBSERVATIONS ON KALA-AZAR IN KASSALA PROVINCE 1l1

Most of the cases in Table ‘‘B” refused to react to heavy and continued doses of

quinine, and other conditions, such as tubercle, malaria, abscess of liver, and spleno- medullary leucocythemia, were usually excluded; malignant disease is practically out of

court owing to its extreme rarity in this Province. In all cases, when spleen puncture was performed, examination of peripheral blood was also made.

Unfortunately it must be said ‘‘ usually excluded”’ for it must be noted that some cases were seen but once, and others were seen by a medical officer who had no microscope and

was unfamiliar with kala-azar.

These tables give summaries of the cases, and they have been included, as it was thought that they might be useful in following up in the future this disease in the province.

Five are included in Table ‘‘B,’’ whose splenic blood was examined with negative

results, but this is done because, in my small experience, it is extremely hard in many cases

to find the parasites.

In the first case it was not till the third splenic puncture that parasites were seen, and

in several others the results from the first and second punctures were negative. Often only

one film out of four or five would present parasites, and even then in very small numbers. The average time spent for microscopic diagnosis has certainly worked out at nearly four hours each case; in only three cases were parasites found in the first films examined.

TYPES OF PARASITES OBSERVED. In all cases, except two, only free forms were found. It was noteworthy that in all cases the free forms seemed to be about the same stage of development, smaller and younger forms were seldom observed.

In cases I., III., IV. and VI., practically all the parasites were of an elongated, almost torpedo shape, while in cases IT., V. and VIII., nearly all were large and oval.

Case VI. presented many small parasites, and the splenic blood was remarkable from

the enormous number of blood platelets it contained; this was the only juvenile case of

the series.

In case VII. only one absolutely typical Leishman-Donovan body was found in six

slides examined.

In none of the spleen smears from those of Table ‘‘A” were malarial parasites found, and in only two were collections of pigment noted; this is probably accounted for by the

fact that the patients were drenched with quinine prior to the examination. Peripheral blood examinations never exhibited parasites, either free or in leucocytes.

In none were malarial parasites found, and in none were any marked changes

observed, except those of anemia.

In four of the positive cases there was marked leucopenia, and in one case nearly all

the white cells were mononuclear leucocytes. In four cases the blood was very ‘‘ watery,”’ and spread on the slides extremely badly.

Spleen puncture was carried out by a small, long hypodermic needle and “all-glass ’”’ syringe, under strict aseptic precautions, and though some sixty odd splenic punctures have been performed, in many cases on very anemic subjects, yet in no case has any bad result

followed.

One case had pain over the site of puncture for twenty-four hours, and another, whose temperature was 100° previously, had a rise to 105° on the evening following the puncture,

but the temperature fell again to 100° on the following day.

The Source of Infection is unknown, and apparently these cases are sporadic. The only instance of house infection occurred at Mafaza, and in these cases no positive diagnosis was made, though personally I have no doubt they were, kala-azar, and had their

tukls and compound burnt down.

Types of parasites

Splenic puncture

House infection