OBSERVATIONS ON KALA-AZAR IN KASSALA PROVINCE 115

He was given quinine by injections and by the mouth; the fever lasted only eight days,

and he was discharged comparatively well after eighteen days with a diagnosis of malaria. The spleen had considerably decreased in size.

He was not seen again till he was brought to hospital very collapsed on December 18th,

1907. His spleen was enlarged to one inch below the umbilicus, but there was no obvious

liver enlargement. He had high intermittent fever for three days, sub-normal two days, and death occurred on December 22nd, 1907. Typical parasites were found in the spleen blood

on December 19th, 1907.

Probably he was suffering from kala-azar when first admitted in August, and was unwittingly discharged wrongly diagnosed, possibly to be a source of infection to his neighbours during the following three months.

TREATMENT EMPLOYED. Many were treated with prolonged large doses (30-50

grains daily) of quinine, or by hypodermic injections (10-18 grains). Temporary improvement occurred in several cases, but as others similarly improved, not on quinine, it

is doubtful if it is due to this drug.

One was treated with thymol 6 grains daily, but with no beneficial result. Two were treated with intramuscular injections of atoxyl and corrosive sublimate

alternately, combined with fuchsin pills'; charts and notes of these cases are given. All

the cases were advanced, and so probably this treatment did not have a fair chance.

NOTES ON CASE II

S. S. a Wakin OmBASHI, MEDICAL Corps

PREVIOUS HISTORY. No serious previous illness. Arrived Kassala Province May 16th, 1906.

In 1906 proceeded to Gedaref for three days and then returned to Kassala. On April 23rd, 1907, proceeded with S. M. O. on his inspection tour, and spent three days at Gedaref, three days at Gallabat, and three days at Mafaza, where he slept on an angareeb with the resident Medical Corps Tumergi, who has since gone on leave in good

health. 7 He was sure he was not bitten by bed-bugs at Mafaza. Proceeded on leave on June 15th, 1907, to Nazlet Ali Pasha, Benisuef Mudiria, Upper

Egypt.

Good health on leave and returned healthy to Kassala, August 14th, 1907. There was a very severe outbreak of malaria, and he was admitted to hospital October

12th, 1907, till October 21st, 1907, with malaria (?)—his spleen was enlarged to the costal

margin. He was re-admitted on October 30th, 1907, and his temperature chart gives his pyrexia till the day of death.

No malaria was found in his blood, but it was quite the exception (7 per cent. positive)

to find parasites, owing to all taking prophylactic doses of quinine regularly.

At first quinine by mouth and by injection seemed to have a beneficial result, but weakness and emaciation progressed steadily ; his spleen continued to enlarge ; his liver was

distinctly increased in size, and kala-azar was suspected and ee puncture proved positive

on December 30th, 1907.

On December 19th, 1907, he had an attack of ees diphtheritic tonsillitis, due to

Bacilli fusiformes—no spirochetes were found, and there was no albumen in the urine. He was 8 then placed on atoxyl- fuchsin- sublimate treatment (see Chart, ‘page 116).

* Dosage, etc., as suggested by A. Nierenstein for Trypanosomiasis, British Medical Siuasel ae 27th, 1907,

Treatment

Notes on Cases