LEISHMANIA DONOVANI 631 



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

 tropical centres between the forty-ninth parallels cases where 

 the Leishman bodies have been found having been met with 

 in many parts of India, China, the Malay Archipelago, North 

 Africa, the Soudan, 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 the white cells are always reduced in greater ratio 

 than the red corpuscles, which condition, again, does not occur in 

 malaria. The disease is chronic, often going on for several years, 

 and, at any rate in the great majority of cases, has a fatal 

 issue. Post mortem, there is little to note beyond the enlarge- 

 ment of the liver and spleen, but in the intestine, especially 

 in the colon, there are often large or small ulcers, and there is 

 evidence of proliferation in the bone marrow, the red marrow 

 encroaching on the yellow. 



In a film made from the spleen and stained by Irishman's 

 stain, the characteristic bodies can be readily demonstrated 

 (Fig. 173). They are round, oval, or, as Christophers has 

 pointed out, cockle-shell shaped, and usually 2*5 to 3*5 /x in 

 diameter, though smaller forms occur. The protoplasm stains 

 pink, or sometimes slightly bluish, and contains two bodies 

 taking on the bright red colour of nuclear matter when stained 

 by the Romanowsky combination. The larger stains less 

 intensely than the smaller, is round, oval, heart-shaped, or 

 bilobed, and lies rather towards the periphery of the body in 

 the region of the " hinge " in the cockle-shaped individuals. 

 The other chromatin body is usually rod-shaped, and is set 

 perpendicularly or at a tangent to the larger mass, with which 

 only exceptionally it appears to be connected. Usually the 

 protoplasm contains one or two vacuoles. Though in spleen 

 smears many free bodies are seen, the study of sections shows 

 that ordinarily their position is intra-cellular, the cells con- 

 taining them being of a large mononuclear type (Fig. 174). The 

 view held is that on their entering the circulation they are 

 taken iij> by the mononuclear leucocytes and by such cells as 

 the endothelial lining of the splenic sinuses or by those lining 

 capillaries or lymphatics, that in these cells multiplication takes 

 place it may be to such an extent as to rupture the cell, and 

 that if thus the bodies become free they are taken up by other 



