568 Kala-Azar 



vani. The fleas, which are the vectors of infantile kala-azar among 

 dogs, show only the rounded and oval forms of the parasites, never 

 the flagellated forms. 



Quite recently Patton and Donovan have been successful in infect- 

 ing puppies with Leishmania donovani, though the mature dogs seem 

 never to be infected, the examination of 2000 street dogs in Madras 

 and other cities failing to reveal any of the parasites in either the 

 liver or spleen. Patton inoculated a white rat with 3 cc. of an emul- 

 sion of human spleen containing the oval forms of Leishmania dono- 

 vani from a case of Indian kala-azar, and fifteen days later found the 

 spleen several times the normal size and containing large numbers of 

 the parasites. 



Diagnosis.' — The anemia of kala-azar is usually not profound. 

 The erythrocytes number about 3,000,000 in ordinary cases and 

 the hemoglobin is correspondingly diminished. As in malaria, 

 there is leukopenia, but it is usually more severe, the white 

 corpuscle sometimes being as few as 600 to 650 per cubic milli- 

 meter of blood. The enlargement of the spleen and liver suggest 

 malaria. 



The only certain way to make a diagnosis, except in those rare 

 cases where one has the good fortune to find occasional parasites 

 in the leukocytes of the circulating blood, is by hepatic or splenic 

 puncture. A large hypodermic needle should be used, and it should 

 be carefully sterihzed. It should by preference be thrust into the 

 liver and a drop of fluid secured for examination. If nothing be 

 found it may later be necessary to puncture the spleen, though it 

 is dangerous because of the probabihty of subsequent hemorrhage. 

 If decided upon as a justifiable method of examination, the needle 

 is thrust into the spleen, and a bit of splenic pulp secured by firmly 

 withdrawing the piston of the attached syringe. 



Before making such a puncture, leukemia should be excluded, lest 

 hemorrhage occur. 



INFANTILE KALA-AZAR 



Leishmania Infantum (Nicolle) 



Pianese* found infantile kala-azar in Italy, and in the children 

 sufi'ering from it he was able to find Leishmania. 



Nicolle, t while in Tunis, observed a form of kala-azar that was 

 peculiar to childhood and most frequent in babies of about two 

 years of age. Mesnil has identified the affection with a disease 

 known as "ponos" in Greece. In the spleens of such patients 

 Nicolle found an organism that was not distinguishable either by 

 microscopic examination or by cultivation from Leishmania dono- 



* "Gaz. Intern, di Medicin," 1905, viii, 8. 



t "Ann. de I'Inst. Pasteur," 1909, xxm, 361, 441. 



