TREATMENT 



1297 



enlargement of the spleen; (5) great leucopenia, especially in rela- 

 tion to the erythrocytes, which, however, may also be found in 

 typhoid and malaria; (6) increase in mononuclear leucocytes; 

 (7) presence oiLeishmania donovani in the leucocytes. 



In advanced cases the diagnosis has to be made from malarial 

 cachexia and ankylostomiasis by (i) the presence of Leishmania 

 donovani in the leucocytes of the peripheral blood, or in the juice 

 from the liver and spleen; (2) by the absence of the typical febrile 

 attacks of subtertian or tertian fever; (3) by the absence during 

 the febrile attack of malarial parasites; (4) by the absence of 

 ancylostomes, or, if they are present, by the continuation of the 

 symptoms after their expulsion. Mixed infections of kala-azar 

 and malaria may occur. 



Prognosis. — The prognosis is much less serious than before the 

 introduction of the tartar emetic treatment. Formerly the mor- 

 tality was about 98 per cent. It is true that some people recover after 

 having nearly died from a complication, or, more rarely, without 

 this episode, but why they recover is not known. 



Leucocytosis and increase of the polymorphonuclears are con- 

 sidered to be good signs, while leucopenia and polymorphonuclear 

 decrease are bad signs. Complications, of course, increase as a 

 rule the gravity of the prognosis. 



Treatment — Essential Treatment. — As soon as a diagnosis is 

 made give tartar emetic either — 



[a) Intravenously (this is the method to be preferred) ; 



{h) Intramuscularly; 



ic) Orally combined with [a) or {h). 



Intravenously. — Give 2-10 cubic centimetres of a sterile i per cent, 

 solution in warm normal saline solution daily for five to ten days, 

 and then every other day, and finally twice a week. This is the best 

 method of treatment. 



Dose for Children. — ^This is as follows: — 



Intravenous Dosage of i per Cent. Tartar Emetic. 



Age. 



Dose. 



Number. 



Under one year . . 



J-i c.c. 



One daily for seven days. 



One to five years 



1-3 c.c. 



Ditto. 



Five to ten years 



1-5 c.c. 



Ditto. 



Ten to sixteen years 



iJ-8 c.c. 



Ditto. 



Important. — ^The sterilization of the tartar emetic solution must 

 be made in flowing steam on two or three consecutive days, and must 

 not be performed in an autoclave, in which the drug is liable to 

 decomposition and may then cause serious symptoms. Some 

 authorities advise using a solution merely filtered through a 

 Chamberland filter. One of us has used a solution containing J per 



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