General Considerations of History, Etiology and Relationship
History.—In 1869 the English medical authorities in India became familiar with a very fatal disease among the natives of Assam but regarded it as a very malignant form of malaria. The native designation for the disease was kala-azar. In 1889 Giles investigated this disease and finding hookworm ova in almost all of the cases he came to the conclusion that it was ancylostomiasis.
Rogers (1896) and Ross (1898) after studying the disease were of the opinion that it had to do with malaria, the former regarding it as a malignant form of malaria and the latter that it was malaria plus some secondary infection.
Owing to the very similar temperature charts and misled by agglutination tests of the serum of kala-azar patients, which he regarded as showing agglutinins for the Micrococcus melitensis, Bently, in 1902, claimed that kala-azar was a malignant form of Malta fever.
In 1903 Manson suggested that the disease might be caused by a trypanosome, the absence of malarial parasites and non-response to quinine being against the then usually accepted malarial etiology.
A few months later in the same year, May, 1903, Leishman reported findings which he considered as degenerated trypanosomes in the spleen pulp of a soldier who died in 1900 at Netley Hospital of dum-dum fever. Although first noting the peculiar bodies in 1900, at the time of making the autopsy, he was at a loss to explain their significance but in 1903, while examining a trypanosome-infected rat, he came to the conclusion that there was a similarity in the parasites of the two infections and published his paper entitled “On the possibility of the occurrence of trypanosomiasis in India.”
Fig. 53.—Leishmania donovani. Smear from juice after puncture of spleen of case of Indian Kala-azar. (MacNeal from Doflein after Donovan.)
In July, 1903, Donovan reported the finding of similar parasites in material from splenic puncture of cases of dum-dum fever and taken during life.