SUPPLEMENT 627 



and other biting insects seems to be of most service. Domestic and 

 personal cleanliness is of great importance. Patients should be 

 segregated. It would probably be as well if houses in which many 

 cases of kala-azar occurred were destroyed. Dodds Price, in Assam 

 tea gardens, moves the coolie lines 300 to 800 yards from old infected 

 ones, with satisfactory results. 



(ii) Infantile Kala-azar due to Leishmania infantum. 



This malady is found among children, rarely in adults, along the 

 Mediterranean littoral. 



The disease commences insidiously and is often unrecognized until 

 some intestinal disturbance occurs. The spleen is then found to be 

 somewhat enlarged, and the case has often been regarded as one of 

 malaria. The child becomes anaemic, suffers from diarrhoea, alternat- 

 ing with constipation, and has attacks of irregular fever. The spleen 

 continues to enlarge and protrudes from under the cover of the ribs. 

 Haemorrhages from the nose and gums and into the skin occur. 

 Anaemia and wasting set in. The abdomen then becomes very 

 enlarged. The child becomes much less active both physically 

 and mentally, and looks prematurely old. Death often occurs from 

 exhaustion, though some cases of spontaneous recovery are known. 



Treatment up till recently has been unsatisfactory. Some of the 

 remedies tried, as quoted by Castellani and Chalmers, are 15 eg. doses 

 of atoxyl, benzoate of mercury (2 to 4 mg. as a daily injection), 

 thiarsol (5 to 15 mg. by subcutaneous injection), salvarsan, etc. 

 Recently Cristina and Caronia (I9I5) 1 have given repeated intravenous 

 injections of i per cent, aqueous solution of tartar emetic, the dose 

 varying from 2 to 10 eg. The treatment in various cases has lasted 

 from 15 to 40 days. 



Prophylactic measures seem to lie in the destruction of infected 

 dogs and diminishing the breeding of fleas (see p. in). 



B. Oriental Sore, due to Leishmania tropica. 



Oriental sore, known under many other names (see p. 107), is a 

 local infection of the skin due to Leishmania tropica. The incubation 

 period varies from a few days to some weeks, or even months, and 

 then one or several small itching papules appear. Each spot becomes 

 red and shotty, the papules increase slowly in size and the surface 

 becomes covered with papery scales. After a variable time, usually 

 not exceeding three to four months, ulceration occurs and a yellowish 

 secretion is exuded that soon dries into a scab. Under the scab 

 ulceration continues by erosion of the edges, and subsidiary sores 

 arise around the parent ulcer and usually fuse with it. Healing com- 

 mences after six to twelve months. Granulation begins at the centre 



?//. Soc. Path. Exot. t vhi, p. 63. 



