COMPLICATIONS 



1305 



treme, the average number of red corpuscles being between 2,500,000 

 and 3,500,000, while microcytes, megalocytes, and polychromato- 

 philia are not unusual. The leucocytes are more or less normal. 

 Frequently there is some fever of an irregular type, and there may be 

 exacerbations, and at times there may be a double remission similar 

 to that found in kala-azar ; but there may be long periods of apyrexia. 

 In addition, in a few cases there may be all the signs and symptoms 

 of cirrhosis of the liver, with the abdomen distended from ascites. 



By some authorities the disease has been subdivided into two 

 stages— the first or splenic stage before, and the second or hepatic 

 stage after, the hepatic cirrhosis. The first may last for many years, 

 but the latter is much shorter, lasting a variable number of months, 

 and ending fatally by the patient passing into a condition of coma, 

 sometimes accompanied by jaundice. Death in the first stage is, 

 in our experience, not rare, and may be due to haemorrhages or 

 exhaustion. 



Complications. — Pregnancy is a serious complication, and may 

 hasten the end, even after the child has been born. Ankylosto- 

 miasis and other parasitic diseases may occur along with tropical 

 febrile splenomegaly. 



Diagnosis. — ^The leading features of the disease are the great 

 enlargement of the spleen, associated with wasting and irregular 

 fever, in people in whom examination fails to reveal any obvious 

 parasitic cause. Tropical febrile splenomegaly must be differ- 

 entiated from kala-azar by the absence of Leishmania donovani in 

 the spleen pulp as obtained by puncture. It can also be distin- 

 guished from chronic malaria by the absence of the typical parasites 

 or pigment from the splenic juice, and from cirrhosis of the liver 

 by the presence of the enlarged spleen. From leukaemia it is easily 

 distinguished by the absence of a lencocytosis. From infantile 

 kala-azar it may be distinguished by the absence of Leishmania 

 infantum, as seen in the splenic juice. The disease can be dis- 

 tinguished from Banti's disease by the febrile attacks, and appar- 

 ently splenic removal does not effect a cure. 



Prognosis. — ^The illness is very chronic, but the prognosis is bad, 

 as no cure is at present possible, and the patient tends to go from 

 bad to worse. 



Treatment. — ^Arsenical injections are the most valuable, and sal- 

 varsan may be tried. Removal from the endemic area is advisable. 



Prophylaxis. — ^As the aetiology is unknown, nothing can be said 

 under this heading. 



TOXOPLASMOSIS. 



In 1913 Castellani recorded a case of splenomegaly associated 

 with fever of long standing and terminating fatally, in which he had 

 found protozoal bodies which eventually received the name Toxo- 

 plasma pyrogenes Castellani, 1913 {vide p. 490). 



Morbid Anatomy. — ^The body was much emaciated, and the 

 principal feature was the greatly enlarged, smooth, not very hard 



