FURTHER STUDIES ON KALA-AZAR : LEISHMANIA IN NASAL AND ORAL SECRETIONS OF PATIENTS AND THE BEARING OF THIS FINDING ON THE TRANSMISSION OF THE DISEASE

The summary of our experiments (Table V) including data previously reported is as follows: 1. Twenty-two patients were studied, in all of whom the diagnosis of kala-azar was confirmed by puncture of the spleen or liver, with recovery of Leishman-Donovan bodies. 2. Microscopic examination of the nasal secretions revealed typical parasites in twelve (54.5 per cent) of the twenty-two cases. 3. Microscopic examination of smears from the pharyngeal tonsils of ten patients showed parasites in three (30 per cent). 4. The results of intraperitoneal inoculation into hamsters of nasal discharge from fourteen patients proved that the parasites were present and had retained their infectivity in thirteen (92.8 per cent). 5. Intraperitoneal inoculation into animals of sputum or saliva killed many animals before sufficient time had elapsed for the presence or absence of infection with leishmania to be demonstrated. However, in eight cases animals survived and in two of these (25 per cent) transmission of the disease had occurred. 6. Material obtained from the pharyngeal tonsils of two patients, when inoculated intraperitoneally into hamsters resulted in infection with leishmania in both instances. 7. Single inoculations, into the oral and nasal cavities of hamsters, of nasal discharge from five patients have resulted in transmission of leishmaniasis in one instance only, but these experiments are incomplete. 8. Repeated inoculations by the oral and nasal routes of hamsters and of two human volunteers with nasal secretions from patients with kala-azar have not yet been concluded, but to the present date have resulted negatively. 9. Emulsions of material from the pharyngeal tonsil of one patient, when fed to three hamsters in amounts of from 0.1 to 0.2 cc. on one occasion only, resulted in generalized infection with leishmania in each of the animals. 10. Evidence as obtained from the medical literature both for and against the transmission of kala-azar by direct or indirect contact and by means of the bite of the sand-fly is presented.