70

Report on Kála-ázar.

of red hepatisation, and was loosely adherent to the
pleura. The base of the left lung was congested. The
spleen weighed 1 lb. 6 oz., and was rather hard on section.
The liver weighed 6 lbs. 2 oz., and was of a yellow colour,
showing marked fatty changes. The mucous membrane of
the stomach was thick and corrugated, but the small intes-
tine was normal, and contained only two round worms, and
no anchylostoma. The bone marrow was of a light-red
colour, lighter than I have usually found it in cases dying in
the stage of cachexia.

   Remarks.

    This case well shows from what a very bad condition
these cases may sometimes greatly im-
prove if the fever only ceases, and yet
eventually succumb to complications.

    Case 10 .—(The girl on the right of the central child).
Alagae, female, aged 17, admitted May 14th.

   Family history.

    Father, mother, one sister, and two young brothers died in
one house of kála-ázar one sister only
living.

   History of illness.

    She has been ill for one year, and was in hospital in March
and April 1896. Illness began with fever
of an irregular type, which has continued
with longer or shorter remissions ever since. She has never
had any œdema of the feet or face, but her menses have
stopped since she had fever.

Condition on re-ad-
mission.

    She is very thin, especially in the arms and face, and
her face is very dark. Her conjunctivæ
and buccal mucous membrane are pale,
and the former also yellow. Vision good, but the arteries
of the retina are very small, but no hæmorrhages could
be seen. Heart and lungs normal. Spleen extends to
the level of the anterior superior spine of the ilium, and
is rather tender, and the liver extends from the level of
the fifth rib to two fingers' breadth below the costal
margin, and is rather hard. Urine light straw colour, sp. gr.
1,010; no albumen or phosphates. No ova of any intestinal