APPENDIX.
THE DEVELOPMENT OF THE LEISHMAN-DONOVAN
PARASITE IN CIMEX ROTUNDATUS.
SECOND REPORT.
IN my first report1 I gave a short account of the researches of different investigators on the
extracorporeal stage of the Leishman-Donovan body, and examined the hypotheses advanced
to explain the method of infection of the human body by this parasite, pointing out that the
disease is most probably transmitted by the bite of some blood-sucking insect. In support of
this hypothesis it was shown that Kala Azar is usually contracted by people living in close
contact with others suffering from the disease ; that the parasites occur in the peripheral circu-
lation in a suitable condition for further development and that in those cases with extensive
ulceration of the large intestine they are often found in large numbers.
In order to prove the truth of this theory a number of feeding experiments were carried
out with the common blood-sucking insects of Madras, and at the outset it was shown that the
parasite could be found in the midguts of lice, Pediculus capitis, fed on patients suffering from
Kala Azar, but no changes towards development were observed. In the bed-bug, Cimex
rotundatus,* however, the parasites were not only frequently found but had in a few instances
shown evidences of considerable development.
Since writing my first report I have been able to study in the bed-bug all the intermediate
stages of the development of the parasite up to the formation of the long free swimming
flagellates, and in the present paper I propose to describe these changes and some further
observations on the peripheral blood of cases of Kala Azar.
I have had the opportunity of examining three more patients in whose peripheral blood
parasites occurred in large numbers. In each case diarrhoea was a prominent symptom. The
last patient was a man aged 25, a carpenter by trade, whose illness began in August 1906 with
an attack of fever of a continuous type lasting about 14 days. During the month of September
he occasionally had fever, but was able to continue his work till the first week in October. He
then noticed that his feet were beginning to swell and after a short time he was obliged to give
up his work owing to the œdema, having spread to his ankles and legs. He was treated as an
outpatient in the General Hospital, Madras, during November and December. In the first
week of December he began to get diarrhoea and his relatives noticed that the right side of his
face was swollen, and as his condition was much worse and the œdema had become general he
was admitted to hospital on the 18th.
On admission, the patient was suffering from general œdema, his face was swollen, the
right side being more prominent owing to a hard brawny swelling involving the whole cheek.
On examining his mouth no ulcer was seen, there was marked pyorrhœa alveolaris and his breath
had an offensive smell. On palpating his abdomen the spleen was found to be five inches below
the costal margin, but the liver could not be felt. He complained of great pain over the region
of the large intestine and there was evidence of a quantity of fluid in his peritoneal sac. His
scrotum was also distended with œdema. On auscultating his heart there was no sign of
valvular disease though the sounds in all the areas were muffled; both lungs were oedematous
and there were signs of consolidation at the right base. His pulse rate was 86, his temperature
97° F. and his urine on being tested showed no trace of albumen. On December the 23rd the
patient was much worse, the swelling on the right side of the face having considerably increased,
involving the right eye and the upper and lower lips ; and the skin over the most prominent
part was glistening and suggested the early formation o f an abscess. On this day I examined
a film of finger blood and found twenty-three parasites, all of which were in the polymorphonu-
clear cells. On the 26th the patient was in a semi-conscious condition and passed his motions
under him in bed his pulse rate was 126 and the bases of both lungs were consolidated. On
the 27th there was a marked change for the worse, his face was enormously- swollen, the right
eye being closed while the left was only just open. The skin over the swelling of the cheek
was not much changed and there was no appearance of ulceration in the mouth. I took a film
of finger blood and fed some bugs half an hour before the patient's death, which took place at
10-30 P.M. on the 27th. Next day on examining this film I found 359 parasites, almost every
polymorphonuclear cell containing one or more. Plate I, fig. 1, shows a poly-morphonuclear
Cimex macrocephalus Fieb, was first described by Signoret 2 in 1852 from the Island of Reunion. I have recently
adopted the name Cimex rotunclatus,3 which was originally given it by Signoret.