Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/164

 no parasites. The tumours of the adrenals were found to be non-malignant adenomata, and he should mention that the patient never had any signs of Addison's disease, and there was no bronzing. That was a very interesting case, clinically indistinguishable from kala-azar, but revealed on the autopsy table to be of an entirely different character. He had since seen other cases, but unfortunately had not been able to follow them up so completely as the one he had just mentioned. Two of them were men from the Navy, one of whom had served on the East Coast of Africa, Zanzibar, and on various other stations, having had malaria once or twice. Personally he did not consider the disease in either instance resembled kala-azar, and he thought the spleens were more like those seen in splenic anaemia. He had, too, examined the blood in both instances, but never could find any parasites, and therefore the cases must be put down as doubtful. Ordinary splenic anaemia seen at home in people who had never been out of the country had a very close resemblance to kala-azar. They had similar blood counts, with big spleens, but the result of examinations made at Haslar had been that no Leishman-Donovan bodies had been found. There could be no doubt of the existence of such a disease, and that it closely simulated kala-azar, but what the nature of it was he could not say. Therefore, in a diagnosis of kala-azar, proof could only be admitted if the parasite was forthcoming, either as obtained from the spleen, from the liver, or from the peripheral blood. Though liable to be missed there, it had been frequently found in the peripheral blood by Donovan and Rogers. If the case was one of kala-azar, the parasite ought to be got after not more than two punctures of the liver. He thought it safer to puncture the liver rather than the spleen, because several deaths had resulted from the latter procedure, and a constitutional reaction followed if needles were inserted indiscriminately into that organ. To