l6o TROPICAL MEDICINE AND HYGIENE 



has been followed by great improvement in the general 

 symptoms and even in subsequent recovery. 



Diagnosis. With regard to the diagnosis of kala-azar r 

 it may at once be said that this cannot be made with 

 certainty except by the demonstration of the specific 

 parasite. In Assam, where the disease was first recog- 

 nized, medical practitioners who have been familiar with 

 it for many years admit that in the early stages kala-azar 

 cannot be readily distinguished clinically from malaria, 

 or sometimes from enteric, and that even in the later 

 stages a consideration of the history of the patient 

 is necessary before any conclusion can be arrived at. 

 Should the patient be from an infected house or vil- 

 lage, and should the development of his cachexia have 

 been more rapid than is usual in malaria, he is con- 

 sidered to be suffering from kala-azar, otherwise the 

 diagnosis of his disease is likely to be malarial cachexia. 

 In Madras, too, all of the patients in whom the earliest 

 discovery of the parasite had been made during life had 

 been considered to be suffering from malarial cachexia, 

 and this in spite of the fact that no malarial parasites 

 could be discovered by repeated examination of their 

 blood. Of the early investigators of the disease, one 

 believed that it was ankylostomiasis, others that it was 

 a special epidemic form of malaria, while yet another 

 believed it to be undulant (Malta) fever. 



An important feature for the clinical differentiation of 

 kala-azar from malaria is the resistance of the former 

 disease to quinine, and should this resistance be definitely 

 proved, the latter may be excluded. It is important to 

 note, however, that the two diseases may co-exist, and 

 that therefore the demonstration of malarial parasites in 

 the blood and their disappearance following the adminis- 

 tration of quinine cannot be considered as definitely 

 excluding in suspicious cases the diagnosis of kala-azar. 

 In such cases, should the temperature show a double or 

 triple daily curve, and should there be little or no diges- 

 tive disturbance, the likelihood of their being kala-azar 



