198 SOME MINUTE ANIMAL PARASITES 



circulating blood varies considerably, more being 

 present at one stage of the disease than at another, 

 but compared with the numbers in the spleen, they 

 are relatively rare. The disease is a most serious 

 one, for 80 per cent, of those infected with it in 

 India die from its effects. It is most insidious, and 

 often a patient is unaware that it is present. It 

 develops slowly, and often takes months before it is 

 fatal. Often it has been diagnosed first as typhoid 

 or malaria, and death may be caused by exhaustion, 

 dysentery, pneumonia, or peritonitis intervening. 

 Enlargement of the spleen and liver is characteristic 

 of the complaint, and acute attacks of dysentery may 

 occur at one stage. Emaciation also is common. 



Various treatments have been tried, but with little 

 success. Quinine, so useful in malaria, is not so 

 here when taken by the mouth, but when injected 

 beneath the skin it is said to be beneficial. The 

 high death-rate in India is remarkable, and its im- 

 portance not to be underestimated. It is probable 

 that it might be even greater than hospital statistics 

 give, for sufferers, know now that very little as a rule 

 can be done for them, and hence are averse from 

 entering hospitals. With such a deadly disease dev- 

 astating parts of our Indian Empire, and spreading 

 also because of the movements of the natives from 

 place to place, the importance of all accurate work 

 on the subject cannot be exaggerated. Kala-azar is 

 already known in Egypt and the Sudan, and fatal 

 cases have occurred among both Europeans and 

 natives there. It is possible that it may be endemic in 

 Egypt and be always present, but on the other hand, 



