TREATMENT OF KALA-AZAR 81 



bone marrow and lymph glands. When the chronic condition 

 is reached the patient presents an appearance not unlike that 

 resulting from chronic malaria, and it is little wonder that the 

 diseases were long confused. Usually complication by some 

 other disease, especially dysentery, which gets a severe hold on 

 account of the low vitality of the victim, causes death (accord- 

 ing to Rogers in 96 per cent of cases), but in a relatively small 

 per cent of cases there is recovery. A steady gain in weight, 

 however slight, is said by Mackie to be a fairly accurate sign of 

 recovery. 



Treatment. — Within the past three years (1914-1917) the 

 remarkable destructive effect of antimony, especially in the form 

 of tartar emetic, on Leishman bodies has been thoroughly es- 

 tablished. Tartar emetic as a cure for Leishmanian diseases 

 was first tried out in 1912 with astonishing success by Vianna, 

 a Brazilian investigator, on the Leishmanian ulcers of the face 

 and nasal mucosa. Similar treatment has been applied with 

 equal success to oriental sores and to infantile kala-azar. Its 

 application to the more severe Indian kala-azar has been attended 

 with great success, and even advanced stages of the disease can 

 sometimes be cured by its use. Rogers and Hume have used 

 it extensively in India. Injections of metallic antimony have 

 also been found of great benefit in treatment of this disease. 



The usual method of giving tartar emetic is by injections into 

 the veins, as in trypanosome diseases. From one to ten cc. of a 

 one per cent solution is given, the dose being gradually increased 

 in accordance with the age and tolerance of the patient. The 

 drug is a powerful one, and if given in over-doses may cause 

 severe disturbances of the digestive tract and of the kidneys, but 

 if it is given in small quantities to begin with, and its effects 

 carefully watched as the doses are increased, it can be used with- 

 out danger and constitutes a treatment as specific in its effects 

 as is quinine on malarial parasites, or salvarsan on spirochsetes. 



Prevention. — On account of the uncertainty which exists con- 

 cerning the mode of transmission of kala-azar, victims of the 

 disease and those who have closely associated with them should 

 be quarantined and their houses thoroughly disinfected to kill 

 any bedbugs or other vermin, as well as any Leishman bodies 

 which might exist in any body excretions. The safest method 

 in the case of the native huts which are hopelessly filthy and 



