626 THE ANIMAL PARASITES OF MAN 



IY. LEISHMANIASES. 



A. Kala-azar. 



(i) "Indian " Kala-azar due to Leishmania donovani. 



Indian kala-azar due to Leishmania donovani is a very fatal disease 

 with a rate of mortality varying from 70 to 98 per cent, of the cases. 



The incubation period is very variable and the early symptoms 

 not well defined. The incubation period seems to range from three 

 weeks to several months after exposure to infection. The onset seems 

 to commence with a rigor and attack of irregular, remittent fever, which 

 may show two remissions per day in a four-hourly temperature chart. 

 Rogers considers the daily double remission almost diagnostic. The 

 duration of this first attack is from two to six weeks. The spleen 

 and liver enlarge, especially the former, and are painful and tender. 

 Towards the end of the time the temperature declines and the first 

 period of the disease ends. After this period an apyrexial interval 

 occurs, which, after some weeks, ends in an attack of fever resembling 

 the first. Periods of pyrexia and apyrexia alternate. Anaemia com- 

 mences and asthenia appears and deepens steadily. The patient is 

 now thin and wasted, the abdomen much swollen and protuberant, 

 the ribs show clearly, the limbs are wasted and skin and tongue 

 darker than normal. In Europeans the skin is of a remarkable earthy 

 hue, and in natives of India darker than normal, approaching black. 

 Intestinal disturbances, often in the form of very obstinate and 

 intractable diarrhoea or dysenteric attacks, are common. Papular 

 eruptions often appear, particularly on the thighs ; haemorrhages also 

 may occur. The disease lasts for periods varying from seven months 

 to two years, and usually ends fatally. 



Treatment, unfortunately, has not been very successful up to 1915. 

 Manson has reported two cases of cure by intramuscular injections of 

 atoxyl daily or every other day in doses ot 3 gr. Rogers has advocated 

 large doses of quinine, 60 to 90 gr. daily until the temperature falls and 

 then 20 gr. daily. Castellani and Chalmers consider the best results 

 are obtained by large doses of quinine given intramuscularly, supple- 

 mented by a course of quinine cacodylate injections or atoxyl injec- 

 tions. Tartar emetic should be tried (see pp. 627, 629), especially 

 as L. Rogers (July, 1915) has had promising results in ten cases. 

 Castellani (1914) and Mackie (1915), have also had successful results. 

 Leishman states that the administration of red bone-marrow, either 

 raw or in the form of tablets, may be beneficial. Good nursing and 

 careful diet are essential, and diarrhoea or dysentery must receive the 

 appropriate treatment. 



With regard to preventive measures, the extermination of bugs 



