Infantile Kala-Azar 571 



hence great difficulties surround all investigation of the 

 problem of transmission. 



Diagnosis. The anemia of kala-azar is usually not pro- 

 found. The erythrocytes number about 3,000,000 in ordi- 

 nary cases and the hemoglobin is correspondingly diminished. 

 As in malaria, there is leukopenia, but it is usually more severe, 

 the white corpuscles sometimes being as few as 600 to 650 per 

 cubic millimeter of blood. The enlargement of the spleen 

 and liver suggest malaria. 



The only certain way to make a diagnosis, except in those 

 rare cases where one has the good fortune to find occasional 

 parasites in the leukocytes of the circulating blood, is by 

 splenic culture. A large hypodermic needle should be used, 

 should be carefully sterilized, thrust into the spleen, and a 

 bit of splenic pulp secured by firmly withdrawing the piston. 



Before making such a puncture, leukemia should be ex- 

 cluded, lest hemorrhage occur. 



INFANTILE KALA-AZAR. 

 ' LEISHMANIA INFANTUM 



Nicolle,* while in Tunis, observed a form of kala-azar that 

 was peculiar to childhood and most frequent in babies of 

 about two years of age. Mesnil has identified the affection 

 with a disease known as "ponos" in Greece. In the spleens 

 of such patients Nicolle found an organism that was not dis- 

 tinguishable either by microscopic examination or by culti- 

 vation from Leishmaniadonovani, but, finding that it was in- 

 fectious for dogs, he came to the conclusion that it was a 

 separate species, and called it Leishmaniainfantum. He also 

 found that the dogs in Tunis frequently suffered from spon- 

 taneous infection from this parasite, and it is possible that the 

 dogs are the source from which the children become infected. 



Pianesef found infantile kala-azar in Italy, and in the 

 children suffering from it he was able to find the Leishmania 

 infantum. 



Further experiments with this parasite by Nicolle and 

 Comte have shown that in the form in which it occurs in the 

 human spleen it is capable of infecting monkeys, and Novy 

 has succeeded in cultivating the organism and infecting dogs 



* "Ann. de 1'Inst. Pasteur," 1909, xxm, 361, 441. 

 f'Gaz. Intern, di Medicin," 1905, vm, 8. 



