1300 THE KALA-AZARS AND PSEUDO-KALA-AZARS 



the spleen and hypertrophy of the islands of Langerhans in the 

 pancreas. In the bone-marrow there is hyperproduction of the 

 myeloid and lymphoid tissues. 



Symptomatology — Onset. — The disease begins in a very insidious 

 manner, and is usually first noticed when the child has some dis- 

 turbance of the alimentary canal, such as an attack of vomiting 

 and diarrhoea, when the spleen may or may not be found to be 

 enlarged; and as the child is anaemic and has a very irregular fever, 

 the complaint is wont to be diagnosed as malaria, especially as 

 some seizures are apt to come on suddenly, and to be associated with 

 rigors. 



The child becomes pale, ceases to be interested in its games, and 

 suffers from attacks of diarrhoea [alternating with periods of con- 

 stipation, from attacks of irregular fever separated by apyrexial 

 intervals, and from epistaxis. 



Course. — ^After the above symptoms have lasted some time, the 

 spleen begins to enlarge, and presently protrudes from under cover 

 of the ribs; the attacks of fever become more marked; haemorrhages 

 from the nose and gums and into the skin are seen, and the diarrhoeic 

 or dysenteric attacks become pronounced. The child now wastes 

 and becomes progressively anaemic; the face, conjunctiva, and whole 

 body taking a peculiar white tinge, and the disease may be said to 

 be fully established. 



Witli regard to the special symptoms, the fever is very irregular, 

 with exacerbations sometimes twice a day — in the morning and in 

 the evening — and sometimes several times a day. High tempera- 

 tures at times appear in cycles, or there may be sudden falls to 

 subnormal temperatures. 



The alimentary canal is always disturbed, but the appetite is 

 preserved, and may even be increased, although the little patient 



Fig. 646. — Leishmania infantum 



NiCOLLE. 



(After Marzinowsky.) 



Fig. 647. — Child suffering from 

 Infantile Kala-Azar. 



(After Marzinowsky.) 



