6o DISEASES DUE TO PROTOZOA 



Dysentery carries ofif about 90 per cent, of them, then comes phthisis 

 and pneumonia. 



Usually the tongue is normal and the digestion good. 



THE BLOOD. 



The parasites may be found in the peripheral circulation. 



There is marked anaemia, 4 — 2,500,000 reds per cm. (Rogers). 



Mb. is reduced in proportion. 



The colour index is normal. 



There is marked leucopaenia, 2,000 or less. 



Polymorphonuclears and eosinophiles are reduced. 



Mononuclears and lymphocytes are increased. 



The reduced pohs probably predispose to bacterial invasion. 



Coagulability is decreased; exploratory^ punctures may set up a fatal 

 haemorrhage. 



The whites to reds varv from i to 2,000, i to 4,000 reds instead of 

 I to 625. 



DIAGNOSIS. 



An irregular chronic fever with a very enlarged spleen and a relative 

 mononuclear leucocytosis is probably Kala-azar, but one must find the 

 Leishman-Donovan body to be certain. 



Centrifuge the blood for the leucocytes. 



To puncture the spleen is dangerous, but is practised at times. 



Some artificially excite bullcC for the leucocytes. 



A blood examination will exclude a leukaemia. 



The double dailv remission of fever is important. 



Banti's disease is sometimes troublesome; the microscope only will 

 exclude it. 



PROGNOSIS. 



This is always bad. Moderate estimates state that 70 per cent, die 

 who have had treatment, and 96 per cent, without it. 



The increase of the polys is a good sign. 



Better results may be obtained by tartar emetic, intravenously and 

 in strong doses. The writer suggests Injectio antimonii oxide. 



MORBID ANATOMY. 



The body is emaciated. There is marked muscular atrophy. 



There is some oedema present. 



The spleen is much enlarged, it is firm, deep red in colour, the 

 capsule thickened and congested throughout. Many parasites may be 

 seen. The spleen sometimes weighs 80 ounces. 



The liver is somewhat enlarged, the intra-lobular arteries are 

 dilated, they contain macrophag"es full of parasites, the liver cells are 



