Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/149



employed in a naval hospital at home, and dealing with diseases from foreign stations, occasionally it is one's fortune to meet with some of the more obscure cases of irregular fever and cachexia, the etiology of which is unknown, or only partially known. Of the latter, the disease called kala-azar, Dum-Dura fever, etc., is of peculiar interest, especially when attacking Europeans, or when it has been possible to demonstrate the parasitic organism. That the disease is more common than is usually supposed is very likely. I can look back on four cases that have been under treatment in my wards, in which the clinical evidences were very strong, though it is only in the present one that proof has been obtained, and for want of this proof the cases were returned as "splenic anaemia." In the latest account of the disease, by Leishman, the original endemic centre in Assam and Bengal has been widely extended, though definite cases from other regions are not common. He mentions Southern India, Ceylon, Burma, China, Egypt, Tunis, and Algeria.

In my four cases, the first contracted his illness in South Africa; the second was originally a merchant seaman, and had been much to India. In both the symptoms were typical, with very large spleens, very low white blood counts, and relative very low polymorphonuclear counts. In both, 2 cc. of blood were drawn off from the spleen, with negative results. These cases were fully reported in the