98 REVIEW — TROPICAL MEDICINE, ETC. 



Leish- Leishmaniosis was recently discussed' in London. Bassett-Smith referred to the 



maniosis— occasional similarity of the temperature chart to that of Malta fever, the occurrence of 



cuntimifd hcemorrhages (epistaxis), the benefit resulting from atoxyl treatment, the drug being pushed 



to 12 grains a day, and the danger of splenic puncture. Liver puncture, he thought, was 



safe. 



Precautions for puncture are : (1) Warn patient to avoid movement. (2) Thoroughly 

 sterilise the skin. (3) Use a small needle and withdraw the blood quickly. (4) Apply a 

 firm binder and make patient lie quite still in bed for several hours afterwards. 



Manson described a case in a European which seemed to be about to terminate fatally 

 and then markedly improved. This may or may not have been due to the atoxyl used in 

 treatment. 



Others spoke to the value of change of air and a sea voyage. The general impression 

 was that when cure resulted, nature had been the successful physician. 



Low mentioned a case clinically indistinguishable from kala-azar in which no parasites 

 were found on spleen and liver puncture and in which, post mortem, double tumours of the 

 adrenals were found, although there was no bronzing of the skin. He also mentioned other 

 conditions, such as splenic ana3mia, closely resembling kala-azar, and pointed out that for a 

 certain diagnosis the parasite must be demonstrated. 



Leishman mentioned Cummins' suggestion to produce artificial pustulation and thereby 

 obtain polynuclears without having to resort to splenic or hepatic puncture. 



Woolley- has described cases in the Philippines with symptoms of splenomegaly, 

 rheumatic pains, ccdema, diarrhoja, with or without hepatic enlargement, and remittent 

 fever, but in which no Leishman-Donovan bodies could be found. He believes they may be 

 associated with a chronic infection or intoxication originating in the intestinal tract and 

 that, while a certain number of cases of tropical splenomegaly may be due to infection 

 with the Leishman body, it will be found that various organisms are associated with the 

 clinical picture and that the symptoms will depend chiefly on intestinal conditions and 

 pathological changes in the intestinal walls. 



NicoUe and Cassuto^ have an interesting paper on three cases of splenomegaly in 

 children at Tunis, in which cases the Leishman bodies were observed. There is a good 

 coloured plate showing amongst other things a capillary of the liver with parasites in the 

 endothelial cells and the forms met with in culture. The authors conclude : — 



1. That there exists in Tunis an illness of infants with symptoms similar to those of kala-azar and 

 apparently identical with certain cases of infantile splenic ansemia, described more especially in the south of Italy. 

 It usually seems to terminate in death, but treatment by atoxyl may possibly prove beneficial. The etiology "is 

 unknown and the diagnosis can only be made with certainty by splenic puncture. 



2. The pathogenic agent is a protozoan indistinguishable from the Leishman body. Its habitual site 

 appears to be the endothelium of the vessels, and it is found iu the blood and liver and more rarely in the 

 lymphatic glands and in the blood. 



.3. This parasite is easily cultivated at 22° C. in the condensation water of blood-agar (Novy and McNeal's 

 medium). The culture forms are identical with those of the Leishman parasite in citrated blood. 



4. Until the identity of this parasite either with the Leishman body or the organism of oriental sore 

 described by Wright, is established, it is proposed to group the following under the generic name Leishmania. 



Leishmania wrighti, the cause of oriental sore. 



Leishmania doiwvani, the cause of kala-azar. 



Leishmania infantum, the cause of an infantile splenic infection closely resembling kala-azar, observed iu 

 Italy and in Tunis. 



One's impression is, however, that the three cases recorded were merely examples of 

 kala-azar affecting infants, and that there is no need to accord them special distinction. 



In a later paper, Nicolle and Comte'' mention the very interesting fact that they have 

 found the parasite in a dog in Tunis. They also state that the children whom they found 



» "Kala-azar" (March 16th, 1908). Journal of Tropical Medicine, p. 85, Vol. XI. 



' Woolley, P. Q. (June, 1906), " Tropical Febrile Splenomegaly." Philippine Journal of Science, p. 533, 

 Vol. I. 



= Nicolle, C, and Cassuto, E. (February 1st, 1908), " Sur Trois Cas dlufection Splenique Infantile a Corps 

 de Leishman observes en Tunisie." Archive de I'lnMitiU Pas/cur de Tunis, p. 3. 



* Nicolle, C, and Comte, C. (April 11th, 1908), " Origine Canine du Kala-azar." Archive de I'Inslitui 

 Pasteur de Tunis, p. 59. 



