Illustrative cases of Kálá-ázar.

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cases, such as that depicted in the photograph opposite this
page, which included all the cases in the Nowgong dispensary
at the time it was taken, namely, early in August 1896. These
cases were followed up, as long as possible, usually till death put
an end to their miserable existence. It must be remembered
that the class of cases seen in a dispensary consists, for the
most part, of the more chronic type.

     Case 1 .—(First from the left in the group). Nankee, male,
aged 30, a native of Bhagalpur, Bengal, but has been in Assam
for the last seven years. He came to live in Nowgong in June
1895.

History of illness.

     Family history.— He has no relatives in Assam, but one of his
companions died of kála-ázar. He began
to suffer from fever in December last, at
first every day, and with a few days' remission now-and-then
it lasted up to the time of his admission on 28th April 1896.
He had some hæmorrhage from the nose last December; has
never taken opium, and takes very little alcohol. Diet good.

Present condition.

     (Notes taken on June 2nd, 1896).— He is thinner than he
used to be; conjunctiva pale and slightly
yellow, but the vessels are still visible;
mucous membrane of the mouth pale; palate pigmented;
vision good; retinæ normal; sensation normal; no pains in
limbs; appetite not good; bowels irregular; has never
suffered from sickness. Temperature 104.8°F. at 8 a.m.
During May it had been normal, except in the last week, when
it varied between 101° and 102°. Pulse 128 a minute; artery
full, but very soft. Heart dulness normal; apex beat feeble;
loud systolic murmur at the pulmonary cartilage, and a soft
one at the apex. Lungs normal. Liver dulness extends from
the fifth rib to the costal margin; its edge can be felt, and is
rather hard. Spleen extends to one finger's breadth below the
navel and to the middle line; over its upper anterior border is a
prominent rounded swelling, which is well seen in the photo-
graph, and which I thought might be an abscess in the organ.
No dropsy of abdomen; legs, or face. Urine:—sp. gr. 1,006;

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