538 
one than formerly is syphilis. But the assumption that the latter is 
present does not explain the temperature, for this is uninfluenced by 
mercury. 
There remains the possibility of a chronic infection or intoxication 
originating in the intestinal tract. As we have seen, the bowel when 
symptoms of diarrhoea are present, in almost all instances is considerably 
damaged. In the last case described above, there were well-marked 
uleers and in this and in others, trichuris and uncinaria occur. Is it 
not possible that the progressive cirrhosis of the spleen and liver is the 
result of continued absorption from the intestinal tract, aided by the 
increased permeability of the latter? It may be possible that the con- 
tinuous absorption of toxins causes the cirrhosis and the penetration of 
bacteria produces the temperature variation. However that may be, it 
seems reasonable to assume that the condition may be explained upon 
the basis of intestinal absorption and that the condition of the intestinal 
walls may be the factor which determines the presence of a febrile or 
afebrile splenomegaly. 
One striking feature of the symptom complex in the cases which we 
have examined is the sudden onset of the fever which resembles that of 
malaria or dengue. 
I still believe, as I did after studying the first seven cases, that 
although a certain number of cases of tropical, febrile splenomegaly 
may be due to infection with the Leishman body, it will be necessary 
to search for further etiologic data before we can understand and satis- 
factorily classify the whole group of cases which are characterized by the 
general gross features of kala-azar, and I believe in all probability that 
there will be found associated with the clinical picture various organisms 
and that the symptoms will depend chiefly upon intestinal onadiwens 
and pathologic changes in the intestinal walls. 
