Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/150

122 British Medical Journal, November 11th, 1905. I attribute the want of success in finding any parasitic organisms then to the large quantity of blood drawn off, and not to their being absent from the organ.

Case 3 was a chief stoker, aged thirty-eight. There was a history of chronic anaemia, commencing while in South Africa, attended with slight fever, recurrent haemorrhages from nose, stomach, and bowel (at times severe), great enlargement of the spleen, a reduction of the red cells to 2,000,000, the white being 2,100, and haemoglobin 40 per cent. The polymorphonuclears were relatively much decreased. In this case no parasitic bodies were found in the peripheral blood, and he refused to have any drawn off from either spleen or livor. Therefore, although all the symptoms pointed to kala-azar, it was not proved.

Last November a fourth case was received, being admitted for malarial cachexia. He gave the following history : From 1894 to 1896 he served on the East and West Coasts of Africa, and contracted malarial fever. From 1896 to 1901 he was on the Australian Coast. During 1902-03 he was on the East Indian station, and lived on shore in Bombay and Trincomalee. From 1904-06 he was in China, being quite well. He lived on shore at Hong Kong and Wei-hai-wei. He visited Shanghai, Tientsin, Hankow, Siam, etc. On arriving in England in 1906 he began to feel ill. He was treated for influenza for a month, then, improving, went to the Mediterranean. After three months, vomiting, anorexia, loss of flesh, pallor, headaches, and fever set in. He was treated for malaria, and invalided to England. On admittance to Haslar, he was seen to be a very old, cachectic-looking man; the skin was dry and earthy, he complained of headache, dyspepsia, epistaxis, and general weakness. His spleen extended to within 1 in. of the middle line and nearly down to the crest of the ilium, it was smooth and hard; the liver was also enlarged;