674 LEISHMANIOSIS 



readily seen in films or sections of the organs in which we have 

 mentioned its occurrence. These should be stained by the 

 Eomanowsky stains. Fluid taken from the enlarged spleen with 

 a perfectly dry needle during life may be examined, but it is 

 probable that in this disease puncture of the spleen may not be 

 a very safe operation, as death from haemorrhage from this 

 organ is a not uncommon natural terminal event. During life 

 the main points on which a pathological diagnosis may be based 

 are the demonstration of the parasite in the circulating blood, 

 which should always be attempted by means of thick films, the 

 absence of the malarial parasites from the blood, and the features 

 of the leucopenia which have been alluded to. 



Leishmania Infantum. — Nicolle, working in Tunis, observed 

 a disease clinically identical with kala-azar, affecting children 

 between two and five years of age. He found in the spleen, 

 liver, and bone marrow in such cases an organism microscopically 

 indistinguishable from the Leishmania donovani. The disease 

 is very widespread, and occurs along the whole of the south and 

 east littorals of the Mediterranean, in Portugal, Greece, Sicily, 

 and in Italy as far north as Home, in the Soudan and -Abyssinia. 

 The organism can be cultivated on Novy and MacNeal's medium, 

 which was modified by Nicolle as follows : — 



Agar carefully washed to remove salts, 14 grms. ; sea salt, 6 grms. ; 

 water, 900 c.c. ; sterilise in autoclave and tube ; melt tubes, cool to 

 50° C, and add to each one-third of its volume of whole rabbit blood 

 removed aseptically from the heart ; keep tubes in store in dark. 



The cultures present characters similar to those observed by 

 Kogers and Leishman in the other Leishmanias. It has been 

 found that the organism can be successfully inoculated in the 

 dog, monkey, rabbit, guinea-pig, and rabbit by intrahepatic and 

 intraperitoneal injection of spleen pulp from fatal human cases, 

 and Novy and MacNeal have produced the disease by inocula- 

 tion with massive doses of cultures. The fact that animals had 

 not, up to the time of his observations, been infected with the 

 Leishmania donovani, and the further fact that the disease, as it 

 occurs in the regions named, is apparently confined to young 

 children, led Nicolle to look upon the organism as a separate 

 species to which he gave the name Leishmania infantum. He 

 considered the infection of the dog to be significant, as this 

 animal might be the channel through which children become 

 infected, for in most regions where the disease prevails, there 

 occurs a disease of dogs which may be either of an acute or 

 chronic character, and which is apparently due to an identical 



