KALA-AZAR 163 



One recovery has been known of a patient invalided to 

 England in whom the diagnosis was fully confirmed 

 by liver puncture, and in whom parasites were also found 

 in leucocytes in the peripheral blood. Rogers, however, 

 believes that a fair proportion of the cases recover if 

 properly treated. 



Pathological Anatomy. The most noticeable feature in 

 the morbid anatomy of kala-azar, apart from the great 

 emaciation, is the enlargement of the spleen and liver. 

 Besides this, inflammation and ulceration of the large in- 

 testine, and some degree of ascites or oedema are common. 

 The spleen is almost invariably very greatly enlarged, 

 sometimes weighing over 80 oz. ; it is of firm consis- 

 tence, retaining its shape on removal. There is usually 

 no thickening or inflammation of the capsule. On sec- 

 tion the surface is dark red, and the spleen substance is 

 firm and friable ; should, however, the examination have 

 been delayed, especially in warm weather, the spleen 

 substance will be found to be soft. There is no malarial 

 pigmentation, and there are no infarcts. Microscopical 

 examination reveals great dilatation and enlargement of 

 the splenic capillaries, with reduction in the lymphoid 

 elements. Scattered irregularly throughout the organ 

 are enormous numbers of parasites, the Leishman bodies. 

 These are contained chiefly in the cells lining the lymph 

 spaces and in the endothelial cells of the capillaries. 

 They also occur in the spleen cells themselves, and in 

 leucocytes, chiefly in the mononuclear, but also in some 

 of the polymorphonuclear cells. They are not met with 

 in the Malpighian corpuscles or lymphatic follicles. 



The enlargement of the liver is usually less than that of 

 the spleen in proportion to the relative sizes of the organs. 

 Like the spleen, the liver is of firm consistence and 

 friable. It is usually rather paler than normal and 

 presents a nutmeg appearance, this being due partly to 

 the growth of mononuclear cells, chiefly in the centre 

 of the lobules, and partly to fatty degeneration of the 

 liver cells. Parasites are numerous in the endothelial 



