1304 THE KALA'AZARS AND PSEUDO-KALA-AZARS 



that infection cannot be found either during life or after death. 

 Though well known, there is but little literature upon the subject. 

 Woolley first gave an excellent account of the disease as seen in 

 the Philippine Islands, and Day and Ferguson as seen in Egypt. We 

 have repeatedly in local publications called attention to the disease 

 in Ceylon. Gabbi has ably described the disease in Italy, and so has 

 Leys, in 1917, from Karongo, and it is probably the same disease 

 as that described by Breinl, in 1915, in New Guinea. In 1916 

 Spagnolio recorded cases from Calabria and Sicily. 



In one form of this complaint (p. 1305) Castellani has found 

 protozoal bodies. Toxoplasma pyrogenes, which may be causal 

 {vide p. 490), but there may be many varieties of the disease. 



Climatology. — ^The disease has been reported from India, Ceylon, 

 China, the Philippines, Egypt, Arabia, Tunis, Algiers, the Belgian 

 Congo, Italy, and South America. 



etiology. — ^The causation of the disease is quite unknown. 

 Gabbi suggests that it may be a filterable virus. 



Pathology. — It is thought probable that the disease may be a 

 primary infection of the alimentary canal, and that the fibrosis is 

 secondary, but we would rather distinguish this from the ordinary 

 forms of polyfibrosis, and would consider that the seat of the dis- 

 order was in the spleen and liver, and that the alimentary canal 

 signs were secondary. 



Morbid Anatomy. — On post-mortem examination, the body is 

 seen to be emaciated as a rule, but there may be oedema of the feet 

 and legs, and there may be ascites if the liver is seriously affected. 

 Upon opening the abdomen, the principal object of interest is the 

 extremely enlarged firm spleen. The liver may be enlarged and 

 smooth, and does not show the hobnailed appearance of alcoholic 

 cirrhosis, while the lymphatic glands in various regions of the body 

 may be slightly enlarged. The intestines show signs of catarrhal or 

 ulcerative enteritis. The bone-marrow is diffluent and pale in colour. 

 Haemorrhages may at times be found in different parts of the body. 

 Microscopical examination reveals hyperplasia of the lymphoid 

 elements of the spleen, associated with hyperplasia of the fibrous 

 tissue, dilatation of the vascular sinuses, and sometimes haemor- 

 rhages. The microscopic examination of the liver shows the usual 

 appearances of monolobular and polylobular cirrhosis. The bone- 

 marrow is seen to be congested and "haemorrhagic, and the hyaline 

 cells are increased, while the granular cells are reduced. 



Symptomatology.-— The onset of the disease is quite gradual and 

 unnoticed by the patient, although at times a history of diarrhoea, 

 dysentery, or of attacks of fever may be obtained. Usually the 

 patient comes to the hospital complaining of weakness and vague 

 rheumatic pains, although he may come in the later stages because 

 of the ascites. On examination, the patient is found to be more or 

 less emaciated, and to have a large firm spleen projecting from 

 under the ribs, and sometimes making a considerable protuberance 

 of the thin abdominal wall. The amount of anaemia is usually not ex- 



