102
Report on Kála-ázar.
The arteries of the brain were in several cases found to be
in a state of advanced fatty degeneration, which probably also
affected the other arteries of the body, and accounted for the
frequency of the slight epistaxis, which has been previously
noted.
The respiratory sys-
tem.
One or both pleural cavities often contained a small quan-
tity of clear fluid, and in one man who
died of pleurisy, 6th were found in his chest.
The bases of the lungs were almost invariably found to be
congested, especially in the cases who died during the rainy
season of actual fever. During the onset of the cold weather,
deaths were frequent from lung complications, which compris-
ed pneumonia, pleurisy, and also in one case gangrene of the
lung. Œderna of the lungs also caused the death of one of the
dropsical type of cases.
Digestive system.
The stomach was in two or three, cases very small, and its
mucous membrane thick and rough with
projecting ridges. This condition I have
also met with after death by accident in healthy persons, so
its occurrence in kála-ázar is probably accidental, especially as
symptoms of inflammation of the organ, such as vomitting, are
very rare in this disease, while chronic dyspepsia is common
enough among natives. In one case ulceration was found,
but, as a rule, the mucous membrane appeared to the
naked eye to be normal. In one case also, marked pigmen-
tation of the spaces between the rugs of the stomach and
on the valvulæ conniventes only of the duodenum was
found—a distribution which suggested a deposition of the
pigment from the blood stream, rather than its formation
in situ, as a result of chronic inflammation. The case was
a very long standing one.
The small intestine was often thinner than normal, espe-
cially in the more chronic cases which had died of asthenia
accompanied by diarrhœa, and in these instances it was often,
also pigmented, more especially in the upper part, but extend-
ing down to the ileo-cæcal valve, and usually less marked on