118 OBSERVATIONS ON .KALA-AZAR IN KASSALA PROVINCE
Aorta. Yellowish tinge, small raised patches (1 to 4 mm. long) beneath the internal
coat.
Liver. Weight 5lb. Much enlarged, slightly nutmeg. Marked fatty degeneration, especially noted in right lobe. No amyloid degeneration.
Spleen. Enlarged, weight 2 lb. 30z.; dark maroon; soft, but not diffluent. No sign of position of spleen puncture.
Stomach. Normal, but a large gland (?) 3 inches long, 1 inch broad, and + inch thick beneath submucosa on lower border of anterior wall.
Parietal and Visceral Peritoneum showed many small sub-peritoneal hemorrhages.
Duodenum. Two inches from the pylorus there were two small ulcers (4 inch by 1 inch and ¢ inch by ,ginch) with shelving edges, red bases, and apparently of not very acute formation.
The subjacent peritoneum was not thickened, and presented no tubercles. Probably
the epigastric pain complained of four days before death was due to these ulcers.
Small Intestine. Marked congestion near the ileocecal valve, with a few submucosal hemorrhages.
Large Intestine. Intense congestion of cecum and first eighteen inches of colon. Appendix normal.
Lymphatic Glands. These, draining the small intestine, were all greatly enlarged
($ inch to 1} inch long), of fleshy consistency, and deep maroon in colour.
Kidneys. Hach weighed about 9 oz., and presented no morbid appearances.
Pancreas, ureters, bladder and prostate, healthy. Red marrow of bones, brain and
spinal cord were not examined.
Many specimens were taken and sent to Dr. Andrew Balfour for examination.! Smears were taken from liver and spleen, some were sent to Dr. Andrew Balfour and some examined here; and certainly it is a very striking fact that although some twelve hours were spent in examining various smears, in no case could I find anything similar to a Leishman parasite. Further, Dr. Balfour could not find any, though one of the films sent was too thick for proper examination.
There is no doubt that the Leishman parasite was found in smears taken on December 30th, 1907, and Dr. Balfour verified this, his report being, ‘‘ unmistakable Leishman-Donovan bodies present.”
Thus the very important point arises—Did the application of the bio-chemical treatment
free the patient from the parasites, though too late to prolong life and procure recovery ?
NOTES ON CASE IV
Ipris ADAM, AGED 26, ARAB POLICEMAN HISTOR Y—
Sent to Mafaza, January, 1907. Lived in police tukls. Fever started in August, 1907, and then was constantly present except for intervals of
five to seven days.
The medical orderly gave him daily quinine, 5-10 grains.
He was sent from Mafaza on January 20th, 1908, and on admission to Kassala Civil Hospital on February 1st, 1908, he was found very emaciated and weak and suffering from
fever (see Chart, page 116).
! Unfortunately all the tissues were destroyed in the fire of May 11th.—A.B.