Rogers reports very favorable results from the administration of alkalies by mouth.
Recently hectine has been recommended in infantile kala-azar.
Following the successful employment of intravenous injections of antimony tartrate in American leishmaniasis it has been used in Indian and infantile kala-azar.
Rogers has used the same treatment in Indian kala-azar with a considerable degree of success. He has also used a 5% ointment of finely divided antimony. The treatment should be continued until the temperature has been normal several weeks and the leucocyte count approach the normal.
Antimony may now be considered as a specific in the treatment of the leishmaniases.
Knowles, at Shillong, has had long experience and striking success with the intravenous administration of tartar emetic in kala-azar. The heavy powder alone should be used—not the light powder. A 1% solution is prepared in normal saline and the solution autoclaved for 10 minutes at 110°C. If there is any opalescence or deposit discard the solution. Knowles begins with the intravenous injection of 3 to 4 cc. for an adult and gives the injections on alternate days, increasing the dose until we are giving from 10 to 12 cc., the maximum dose. It will be noted that the dosage ranges from 3 to 10 centigrams (½ to 1½ grains). The amount of drug given for a complete course of treatment is 200 cg. (33 grains). In the latter part of the course of treatment the effects on the patient are more marked so that caution must be observed, and it may be necessary to lengthen the interval or reduce the dose. The injections should not be given within two hours of a meal. Organic disease of the heart or kidneys contraindicates the antimony treatment. Coughing, a metallic taste in the mouth and constriction of the chest are frequently noted following the injection. Nausea, colic and diarrhoea show that the limit of the drug has been reached and albuminuria and jaundice are signs of warning to decrease the dose or stop the treatment. Christopherson considers that 5 to 8 grains will cure oriental sore, but for kala-azar 60 grains may be necessary. This authority considers 3 grains of tartar emetic as the maximum dose intravenously. For children under 1 year of age the intravenous dose of the 1% solution is ¼ to 1 cc., from 1 to 5 years old 1 to 3 cc. and from 5 to 10 years of age 1 to 5 cc.
Manson-Bahr has reported the successful use of an organic preparation of antimony, the sodium salt of p-acetylaminophenylstibinic acid. It is a powder, readily soluble in water and has the trade name of “stibenyl.” It can be injected intravenously up to 0.8 gram. The drug contains 36% of antimony. Knowles advises the use of tonics and, when indicated, of anthelminthics. He also recommends cod liver oil to increase the weight.
Cutaneous Leishmaniasis
General Considerations.—There is good reason to believe that much that was written about oriental sore prior to our knowledge of its etiology referred to tuberculous, syphilitic and other ulcerative skin lesions. As regards the work done in the investigations as to etiology Cunningham, in 1885, described deeply staining bodies in cells which were larger than lymphocytes. Later, in 1901, Firth confirmed the findings of Cunningham, but considered the bodies as degenerative changes in the cells rather than entertaining the view of Cunningham that they were parasitic protozoa. The name Sporozoa furunculosa was given these parasites. As previously stated, Wright, in 1903, using his modification of the Romanowsky stain, found round or oval bodies, from 2 to 4µ in diameter, packed in the cytoplasm of endothelial cells, in smears from an oriental sore in a child from Armenia. He called the parasites Helcosoma tropicum.