I290 THE KALA-AZARS AND PSEUDO-KALA-AZARS 



from the appearance of the victims. In 1875 it began to spread, 

 and became epidemic, and by its high death-rate attracted atten- 

 tion. In 1882 the first account of the disease was pubhshed by 

 Clarke from notes of 120 cases compiled by McNaught, the Civil 

 Medical Officer of the district. In 1889, when it had spread into 

 Assam, following the lines of human intercommunication, Giles - 

 investigated the epidemic, and concluded that it was ankylosto- 

 miasis. In 1894 Stephens, in his yearly report, stated that the 

 disease, though allied to, was distinct from malaria. In 1897 

 Rogers reported that it was malarial, and this was further supported 

 by Ross in 1899. In 1902 Bentley ascribed the disease to Micro- 

 coccus melitensis, on the basis of serum reactions. 



Up to this point the history of the disease remarkably resembles 

 the present history of blackwater fever. A change now comes 

 over the aetiology, for, in 1900, Sir William Leishman found the para- 

 sites already described under the heading Leishmania donovani in 

 films taken post mortem from the spleen of a soldier who died in 

 Netley from fever contracted at Dum-Dum, but he did not publish 

 this discovery till 1903. In July, 1903, Donovan observed the same 

 parasite in blood obtained by splenic puncture performed during 

 life. In 1904 Christophers published a valuable report on the 

 parasite and the disease, and in the same year Rogers observed 

 the development of the parasite into a flagellate organism when 

 splenic blood was incubated at 22° C. in citrate of soda solution. 

 In 1907 Patton showed that the parasite could be found in numbers 

 lying in leucocytes in the peripheral blood, and, further, that it 

 became flagellated in the alimentary canal of bugs. 



In 1904 Neave in Omdurman discovered the existence of this 

 disease in a child coming from the Bahr-el-Ghazal province of the 

 Anglo-Egyptian Sudan, and in the same year Philips in Cairo dis- 

 covered it in two adults coming from the Yemen district of Arabia. 

 In 1907 Pirrie, who had been working in the Sudan, died in England 

 from kala-azar. In 1908 Cummins discovered a case contracted 

 at Singa on the Blue Nile; Carroll recorded a second case from 

 the same district, while Black met with two other cases; Bousfield 

 recorded seven cases from the province of Kassala and one from 

 Mafaza, and Thomson and Marshall found forty-one new cases in 

 children and adults along the Blue Nile towards Abyssinia, which 

 forms an endemic zone, which has been carefully studied by 

 Archibald. It corresponds to the Blue Nile, Sennar, and Kassala 

 districts, while the infection in one case of a woman is regarded as 

 coming from quite a different part of the Sudan^ — i.e., from Um 

 Ruaba near Talodi. Archibald has studied a small epidemic at 

 Kurmok on the Abyssinian frontier. This Sudan kala-azar is 

 peculiarly interesting because of its limited endemicity (as far as is 

 known) and by the peculiar features shown by Archibald to be 

 associated with its parasite. « 



In 191 3 Gaspar Vianna introduced the intravenous injections 

 of tartar emetic for the treatment of the American mucocutaneous 



