CHAPTER XXII 

 KALA-AZAR (BLACK SICKNESS) 



Leishmania Donovani (Laveran and Mesnil) 



"Kala-azar," "Dumdum fever," "Febrile tropical spleno- 

 megaly," "Non-malarial remittent fever," is a peculiar, fatal, 

 infectious disease of India, Assam, certain parts of China, the Malay- 

 Archipelago, North Africa, the Soudan and Arabia, caused by a 

 protozoan micro-organism known as Leishmania donovani, and 

 characterized by irregular fever, great enlargement of the spleen, 

 anemia, emaciation, prostration, not infrequent dysentery, occa- 

 sional ulcerations of the skin and mucous membranes, and sometimes 

 cancrum oris. 



Because of its protean manifestations the disease has been given 

 many names, and has been confused with the various diseases which 

 its symptoms may resemble. It was not until 1900 that it was 

 finally differentiated from malarial fever and came to be regarded 

 as a distinct entity. 



In 1900 Leishman* noticed in the spleen of a soldier returned 

 from India and suffering from "dumdum fever" — a fever acquired 

 at Dumdum, an unhealthy military cantonment not far from Cal- 

 cutta — certain peculiar bodies. He reserved publishing the observa- 

 tion until 1903, so that it appeared almost simultaneously with a 

 paper upon the same subject by Donovan, f As the publications 

 came from men in different parts of the world, appeared so nearly 

 at the same time, and showed that they had independently arrived 

 at the same discovery, the parasite they described became known 

 as the Leishman-Donovan body. For a long time its nature was 

 not known and its proper classification impossible, but after it had 

 been carefully studied by Rogers, J Ross,§ and others, and its de- 

 velopmental forms observed, it was agreed that it belonged in a new 

 genus of micro-organisms, not far removed from the trypanosomes, 

 and eventually Ross, and then Laveran and Mesnil, honored both 

 of its discoverers by calling it Leishmania donovani, which name has 

 been generally accepted. 



Morphology. — As seen in a drop of splenic pulp the organism is a 

 minute round or oval intracellular body measuring 2.5 by 3.5 m- 

 When properly stained with polychrome methylene blue (Wright's, 



* "Brit. Med. Jour.," 1903, i, 1252. 



•f Quarterly Jour. Microscopical Society," XLVin, 367; "Brit. Med. Jour., 

 1904, 1, 1249; II, 64s; "Proceedings of the Royal Society," ixxvn, 284. 

 § "Brit. Med. Jour.," 1903, n, 1401. 



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