CHAPTER XLIII. 



KALA-AZAR RABIES. 

 Eala-azar. 



CERTAIN fevers of severe malarial-like types known in different sec- 

 tions of the tropics by different names (dum-dum fever, cachexial 

 malaria, kala-azar) have recently been shown to be due to the same 

 cause by the finding of similar protozoan-like bodies in the lesions. 

 These bodies were first minutely described by Leishman in 1900 as 

 being present in certain cells in the spleen of cases called by him dum- 

 dum fever occurring in India. In 1903 Donovan described similar 

 bodies in cases of what he called malarial cachexia. The bodies have 

 been called the Leishman-Donovan bodies or, more properly, the Leish- 

 man bodies. They have since been found in different parts of India, 

 in China, Tunis, Algiers, Arabia, and Egypt, and quite recently Wright 

 has reported in a case of Delhi boil from Armenia bodies which, accord- 

 ing to his excellent photographs and description, must be identical with 

 or very closely related to Irishman's bodies, though he does not call 

 attention to that fact. 



The bodies have been found in large endothelioid cells in the spleen, 

 liver, mesenteric glands, bone-marrow, kidney, lungs, testes, skin, and 

 ulcers in intestines. 



The symptoms, in the cases of general infection are: (1) very much 

 enlarged spleen and less enlarged liver; (2) progressive anaemia with 

 peculiar earthy pallor of skin, progressive emaciation, and muscular 

 atrophy; (3) long-continued, irregularly intermittent fever (97 to 104) ; 

 (4) hemorrhages, such as epistaxis, bleeding from gums into sub- 

 cutaneous tissue, producing purpuric eruption; (5) transitory oedemas 

 of various regions. There are often complications such as congestion 

 of lungs, dysentery, cancrum oris. The blood count shows practically 

 no loss of haemoglobin, but there is a decrease in the leukocytes, prin- 

 cipally polynuclears, giving a relative increase of mononuclears. 



Negative points which help in the diagnosis are : absence of malaria, 

 no typhoid or Malta fever reaction, resistance to medication, quinine, 

 as a rule, having no effect, though in early cases a few good results 

 have been reported. Splenic puncture with the finding of Leishman 

 bodies makes the diagnosis certain. The duration of the disease is 

 from a few months to several years. The percentage of deaths is great; 

 in some forms of the disease it may reach 90 per cent. 



Morphology. The bodies are circular to elliptical in shape, from 2/J. to 

 4/JL in diameter, and contain a double nucleus, a large oval one at one part 

 of the periphery and a small circular or rod-shaped one near or at the 



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