LEISHMANIA TROPICA 423 



and three unidentified wiJd sand flies also gave a negative result, bringing the total 

 of the controls to 857. Christoi)her8, Shortt, and Barraud (1925, 1925fl), and Shortt, 

 Barraud and Craighead (1926), in Assam find the flagellates in massive numbers in 

 the pharynx and extending to the buccal cavity. They state that this seems to be 

 all that is required, short of a final proof of a transmission experiment, to demon- 

 strate that kala azar is transmitted by the bite of the sand fly. With Culicoides 

 macrostoma the first-named observers (\^2ob) obtained no development in forty-eight 

 flies fed on cases. 



ACTION OF DRUGS ON LEISHMANIA DONOVANI.— As regards the action 

 of drugs on the parasites, a great advance was made by the introduction 

 of tartar emetic treatment in kala azar by Di Cristina and Caronia (1913), 

 after the success obtained by Vianna earlier in the same year with this 

 remedy in dermal leishmaniasis of South America. Rogers (1915) intro- 

 duced the treatment into India, and the drug is now widely used. It is 

 recognized as a specific against the leishmania, and has so far influenced 

 the mortality that, whereas formerly the majority of cases died, now the 

 great majority recover. 



The drug (or the corresponding sodium salt, which is supposed by some 

 to be less toxic) is given intravenously. A dose of 10 c.c. of a 1 per cent, 

 solution {i.e., 1-5 grain) can be given once or twice a week during two to 

 three months till a total of about 2 grams (30 grains) has been adminis- 

 tered. Improvement, as shown by loss of fever, reduction in the size of 

 the spleen, and a better general condition, takes place rapidly, but it is 

 found that parasites still persist in the spleen, and are culturable even up 

 to two months after the commencement of treatment, which must there- 

 fore be continued beyond this period. 



Knowles (1920) found by culture that living leishmania might still be 

 present in the spleen after 174 centigrams of tartar emetic had been 

 administered intravenously. Stibacetin, or stibamine, first used in the 

 treatment of kala azar by Caronia (1916), is an organic antimony com- 

 pound which appears to be equally efficacious, but liable to a decomposition 

 which renders it toxic. It can be administered intramuscularly. Urea 

 stibamine, introduced by Bramachari (1922), stibamine glucoside and " von 

 Heyden 471 " have given good results, even in cases which were resistant 

 to tartar emetic. 



The Parasite of Oriental Sore. 



Leishmania tropica (Wright, 1903). — This organism, which is morpho- 

 logically indistinguishable from L. donovani, is the cause of the cutaneous 

 infections known as oriental sore (Plate IV., p. 406). The disease occurs in 

 the New as well as the Old AVorld. In the latter, in the vast majority of cases 

 the lesions are limited to the skin of the exposed part of the body, but as a 

 very rare exception they may extend to the mucous lining of the mouth, 

 nose, and pharynx. In the New World, though in most cases the lesions 



