Aelia hall ie eee Dad A NESE A EN OT COREY te 98 REVIEW—TROPICAL MEDICINE, ETC.

Leishmaniosis was recently discussed! in London. Bassett-Smith referred to the occasional similarity of the temperature chart to that of Malta fever, the occurrence of hemorrhages (epistaxis), the benefit resulting from atoxyl treatment, the drug being pushed to 12 grains a day, and the danger of splenic puncture. Liver puncture, he thought, was safe.

Precautions for puncture are: (1) Warn patient to avoid movement. (2) Thoroughly sterilise the skin. (3) Use a small needle and withdraw the blood quickly. (4) Apply a firm binder and make patient lie quite still in bed for several hours afterwards.

Manson described a case in a Huropean which seemed to be about to terminate fatally and then markedly improved. This may or may not have been due to the atoxyl used in treatment.

Others spoke to the value of change of air and a sea voyage. The general impression was that when cure resulted, nature had been the successful physician.

Low mentioned a case clinically indistinguishable from kala-azar in which no parasites were found on spleen and liver puncture and in which, post mortem, double tumours of the adrenals were found, although there was no bronzing of the skin. He also mentioned other conditions, such as splenic anemia, closely resembling kala-azar, and pointed out that for a certain diagnosis the parasite must be demonstrated.

Leishman mentioned Cummins’ suggestion to produce artificial pustulation and thereby obtain polynuclears without having to resort to splenic or hepatic puncture.

Woolley? has described cases in the Philippines with symptoms of splenomegaly, rheumatic pains, edema, diarrhea, with or without hepatic enlargement, and remittent fever, but in which no Leishman-Donovan bodies could be found. He believes they may be associated with a chronic infection or intoxication originating in the intestinal tract and that, while a certain number of cases of tropical splenomegaly may be due to infection with the Leishman body, it will be found that various organisms are associated with the clinical picture and that the symptoms will depend chiefly on intestinal conditions and pathological changes in the intestinal walls.

Nicolle and Cassuto* have an interesting paper on three cases of splenomegaly in children at Tunis, in which cases the Leishman bodies were observed. There is a good coloured plate showing amongst other things a capillary of the liver with parasites in the endothelial cells and the forms met with in culture. The authors conclude :— 1. That there exists in Tunis an illness of infants with symptoms similar to those of kala-azar and apparently identical with certain cases of infantile splenic anszamia, described more especially in the south of Italy. It usually seems to terminate in death, but treatment by atoxyl may possibly prove beneficial. The etiology is unknown and the diagnosis can only be made with certainty by splenic puncture.

2. The pathogenic agent is a protozoan indistinguishable from the Leishman body. Its habitual site appears to be the endothelium of the vessels, and it is found in the blood and liver and more rarely in the lymphatic glands and in the blood.

3. This parasite is easily cultivated at 22° C. in the condensation water of blood-agar (Novy and McNeal’s medium). The culture forms are identical with those of the Leishman parasite in citrated blood.

4. Until the identity of this parasite either with the Leishman body or the organism of oriental sore described by Wright, is established, it is proposed to group the following under the generic name Leishmania.

Leishmania wrighti, the cause of oriental sore.

Leishmania donovani, the cause of kala-azar.

Leishmania infantum, the cause of an infantile splenic infection closely resembling kala-azar, observed in Italy and in Tunis.

One’s impression is, however, that the three cases recorded were merely examples of kala-azar affecting infants, and that there is no need to accord them special distinction.

In a later paper, Nicolle and Comte‘ mention the very interesting fact that they have found the parasite in a dog in Tunis. They also state that the children whom they found 1 “Kala-azar” (March 16th, 1908). Journal of Tropical Medicine, p. 85, Vol. XI. if pe ifoollen, P. G. (June, 1906), “Tropical Febrile Splenomegaly.” Philippine Journal of Science, p. 533, ol. I.

® Nicolle, C., and Cassuto, E. (February Ist, 1908), “Sur Trois Cas d’Infection Splénique Infantile 4 Corps de Leishman observés en Tunisie.” Archive de l’Institut Pastewr de Tunis, p. 3. * Nicolle, C., and Comte, C. (April 11th, 1908), “Origine Canine du Kala-azar.” Archive de l'Institut Pasteur de Tunis, p. 59.