KALA-AZAR 563 



Ki.LA-AZAK. 



(Synonyms : Cachectic Fever, Dum-Dum Fever, Non-malarial 

 Remittent Fever.) 



Leishman noticed in several soldiers invalided from India for 

 remittent fever and cachexia that the most careful examination 

 of the blood failed to reveal the presence of the malarial 

 parasite. From the fact that such patients had almost invari- 

 ably been quartered during their service at Dum-Dum, an 

 unhealthy cantonment near Calcutta, he suspected he had 

 to deal with an undescribed disease. In 1900 he noticed in 

 the spleen of such a case peculiar bodies which, from comparison 

 with certain appearances found in degenerating forms of Tr. 

 Brucei, he suggested might be trypanosomes, and on publishing 

 his observations in 1903 he put forward the view that 

 trypanosomiasis might prevail in India and account for the 

 aberrant cases of cachexial fever met with there. Soon after 

 Leishman's paper appeared, his observations were confirmed in 

 India by Donovan, and the bodies associated with the disease 

 are usually called the " Leishman " or the " Leishman-Donovan " 

 bodies. They were found by Bentley, and later by Rogers, in 

 the disease known in Assam as Kala-azar, the pathology of 

 which had long puzzled those who had worked at it, from 

 the fact that, while it resembled malaria in many ways, no 

 parasite could be demonstrated to occur in those suffering 

 from it. 



Kala-azar (or "black disease," so called from the hue 

 assumed by chocolate-coloured patients suffering from it) has 

 been known since 1869 as a serious epidemic disease in Assam, 

 where it has spread from village to village up the Brahmaputra 

 valley. The disease is now known to occur in various sub- 

 tropical centres south of the forty-ninth parallel cases where 

 the Leishman bodies have been found having been met with in 

 many parts of India, China, North Africa, and Arabia. The 

 disease is characterised by fever of a very irregular type, 

 by progressive cachexia, and by anaemia associated with 

 enlargement of the spleen and liver, and often with ulcers of 

 the skin and dropsical swellings. Rogers has pointed out that 

 there occurs a leucopenia which differs from that of malaria in 

 that it is almost always more marked, the leucocytes usually 

 numbering less than 2000, and further in that they are always 

 reduced in greater ratio than the red corpuscles, which condition, 

 again, does not occur in malaria. The disease is chronic, 



