THE PSEUDO-KALA-AZARS 



1303 



undulating type; the enlargement of the spleen is much greater; the 

 articular symptoms are lacking, and Wright's agglutination test is 

 negative. 



Enteric Fever. — ^From enteric, infantile kala-azar differs by the 

 splenomegaly, by the irregular fever, by the absence of Widal's 

 reaction. 



Malaria. — ^The absence of the typical blood parasites, and the 

 fact that quinine has no influence on the irregular fever, are points 

 of diagnostic value. 



Other Forms of Splenic Ancemia. — ^From the splenomedullary 

 leukaemia, infantile kala-azar is distinguished by the leucopenia; 

 from syphilitic splenomegaly, by the history and inutility of mercury 

 and salvarsan; from the various types of infantile afebrile spleno- 

 megaly, by the fever and the presence of the parasite; from the 

 splenomegaly found in rickety children, by the absence of deformity 

 of the bones and by microscopical examination. 



Prognosis. — ^The prognosis is much more favourable since the 

 introduction of the tartar emetic treatment, the mortality having 

 been reduced from 90 per cent, to less than 20 per cent. 



Treatment. — ^This is the same as for tropical kala-azar (p. 1297). 



Prophylaxis. — ^As canine leishmaniasis (p. 377) is now considered 

 to be a separate disease, and as the flea is doubtful as an infective 

 agent, prophylaxis cannot be advised until more is known as to the 

 method of infection, but the suggestions made under the heading of 

 Tropical Kala-Azar may perhaps be applicable, and in any case 

 it is unnecessary to keep dogs and fleas in a house. 



Basile has sufflciently indicated the possibilities of this method 

 of infection being correct to make the simple methods of prophy- 

 laxis of such a fatal disease imperative even before the full proof 

 of the researches has been obtained. 



THE PSEUDO-KALA-AZARS. 



These are febrile and afebrile diseases which resemble kala-azar in 

 that they are associated with splenomegaly, anaemia, and often 

 emaciation. They can be divided into : — 



Tropical febrile splenomegaly. 



Toxoplasmosis. 



Krempf 's splenomegaly. 



Tropical afebrile splenomegaly. 



TROPICAL FEBRILE SPLENOMEGALY. 



Synonyms. — -Tropical splenomegaly, Pseudo-kala-azar, Esplenomegalia 

 tropical (Columbia), Wenku (Karon^a), Gobora or Tebi (New Guinea). 



Definition. — ^A chronic irregular febrile disorder of unknown 

 causation, characterized by splenic hypertrophy and gastro-intes- 

 final disturbance, followed by emaciation. 



History. — ^A form of febrile splenomegaly resembling kala-azar 

 has been long known in the tropics; but the typical parasites of 



