668 LEISHMANIOSIS 



degenerating forms of Tr. brucei, he suggested might be 

 trypauosomes, and on publishing his observations in 1903 he 

 put forward the view that trypanosomiasis might prevail in 

 India and account for the aberrant cases of cachexial fever met 

 with there. Soon after Irishman's paper appeared, his observa- 

 tions were confirmed in India by Donovan, and the bodies 

 associated with the disease are usually called the " Leishman " or 

 the " Leishman-Donovan " bodies. They were found by Bentley, 

 and later by Rogers, in the disease known in Assam as kala-azar, 

 the pathology of which had long puzzled those who had worked 

 at it, from the fact that, while it resembled malaria in many 

 ways, no parasite could, be demonstrated to occur in those 

 suffering from it. This disease has gone under various synonyms, 

 e.g., cachetic fever, Dum-Dum fever, non-malarial remittent 

 fever, but is now recognised as a single entity. 



Kala-azar (or "black, disease," so called from the hue 

 assumed by chocolate-coloured patients suffering from it) has 

 been known since 1869 as a serious epidemic disease in Assam, 

 where it has spread from village to village up the Brahmaputra 

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

 tropical centres cases where the Leishman bodies have been 

 found having been met within many parts of India, China, the 

 Malay Archipelago, North Africa, the Soudan, Syria, and Arabia. 

 The disease is characterised by fever of a very irregular type, by 

 progressive cachexia, and by anemia associated with enlarge- 

 ment of the spleen and liver, and often with ulcers of the skin 

 and with transitory 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 in, at any rate, 80 

 per cent, of the cases has a fatal issue. Post mortem, there is 

 little to note beyond the enlargement 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. 190). They are round, oval, or, as Christophers has 

 pointed out, cockle-shell shaped, and usually 2'5 to 3 '5 yu, in 

 diameter, though smaller forms occur. The protoplasm stains 

 pink, or sometimes slightly bluish, and contains two bodies 



