CHAPTER XLVII 



THE KALA-AZARS AND PSEUDO-KALA- 



AZARS 



General— Tropical kala-azar — ■Mediterranean Kala-azar — 'The pseudo-kala- 

 azars — -Tropical febrile splenomegaly — Toxoplasmosis — Krempf 's spleno- 

 megaly — Tropical afebrile splenomegaly — 'References . 



GENERAL. 



The present chapter is devoted to those fevers which are known 

 as the kala-azars and those alhed conditions, tropical febrile spleno- 

 megaly and tropical afebrile splenomegaly, which clinically resemble 

 kala-azar, in one variety of which Castellani has obtained protozoal 

 bodies from spleen which are classified, at present, in the genus 

 Toxoplasma. 



With regard to the kala-azars, of which Ross has pointed out that 

 the correct name is ' kala-jwar ' — i.e., black or mortal sickness — we 

 have already in Chapter XIX., p. 369, pointed out that we consider 

 that tropical kala-azar should be treated, at all events at present, 

 separately from Mediterranean kala-azar, and this we shall do in 

 the present chapter, although the general tendency of modern 

 thought is to consider the two diseases to be identical. We invite 

 the reader's attention especially to the first half of Chapter XIX., 

 in so far as it deals with the Herpetomonince, and especially to the 

 experimental work of Fantham' and Porter (p. 363), as having 

 a direct bearing upon the unknown method of infection of man 

 with the germs of kala-azar. 



TROPICAL KALA-AZAR. 



Synonyms. — Indian Kala-Azar, Kala-Jwar, Kala-Dukh, Sirkari disease, 

 Sahib's disease, Dum-Dum fever, Non-malarial remittent fever, Cachectic 

 fever, Tropical splenomegaly, Tropical Leishmaniasis, Internal Leishmaniasis. 



Definition. — Tropical kala-azar is a subacute or chronic febrile 

 disorder characterized by splenic and often hepatic enlargement, 

 progressive wasting and anaemia, and caused hy Leishmania donovani 

 R. Ross, 1903. The method of infection is unknown. 



History. — In 1869, when the district of the Garo hills was first 

 occupied by the British, a disease believed to be a very severe form 

 of malarial cachexia was found to be endemic. This disease Ihe 

 Garos called ' kala-azar,' which means the black fever, so named 



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