1294 THE KALA-AZARS AND PSEUDO-KALA-AZARS 



is a reduction in the polymorphonuclear leucocytes and in the 

 eosinophiles, and an increase in the mononuclear leucocytes and 

 lymphocytes. The diminution of the polymorphonuclear leucocytes 

 is thought to explain the tendency to bacterial infections. The 

 coagulability of the blood is decreased, which explains the tendency 

 to hcnemorrhage, and renders occasionally splenic puncture dangerous. 

 The alkalinity of the blood has been shown by Archibald to be 

 diminished — a fact which may be of some secondary diagnostic 

 importance. 



The Urine. — ^The urine in our cases did not show anything ab- 

 normal. 



Morbid Anatomy, — ^The body is much emaciated, and there is 

 marked muscular atrophy, together with oedema, enlargement of 

 the spleen, and often of the liver, ulceration of the skin and intestine, 

 sometimes haemorrhage in various places, and generally the presence 

 of some complication. The spleen is greatly enlarged, firm, and 

 deep red in colour, though it may at times show malarial pigment. 



Fig. 645. — -Temperature Chart of Kala-Azar from a Sudan Case. 

 (After Christopherson.) 

 4-, Leishman bodies found; XX XX, injection of tartar emetic. 



The capsule and septa are thickened, and the whole organ is con- 

 gested with blood, and contains numerous mononuclear cells and 

 macrophages full of parasites. 



In the liver, which may or may not be enlarged, the most marked 

 changes are in the intralobular capillaries, which are dilated and 

 contain macrophages, derived from their endothelial wall, full of 

 parasites, while the liver cells are atrophied and degenerated. 

 Cirrhosis has been noted in some cases. 



The bone-marrow contains numerous parasites in the usual cells, 

 and, as in malaria, the yellow marrow is converted into red, and is 

 soft and diffluent. The skin may show papules and ulcers, in which 

 the parasites can be found, while the colon is often ulcerated, or 

 shows the cicatrices of old ulcers. 



Symptomatology — Incubation. — ^The incubation period appears 

 to be very variable, and, indeed, it is difficult, in a chronic disease 

 of this nature, to decide when it first begins. It is said to range from 

 ten days to three weeks or several months. 



