It was not until 1903 that the problem of the true causation of kala-azar was solved, for after Button had discovered the , first human trypanosome in an African fever, later shown by Sir David Bruce to be an early stage of sleeping sickness, Sir William Leishman recorded having found some time earlier small oval binucleated bodies in the spleen of a fatal case of kala-azar, which he now suggested were degenerate trypanosomes. Col. Donovan, I. M.S., at once reported that he had independently discovered the same bodies in malarial cachexia cases in Madras, and he proved that they were not degenerate trypanosomes, as they could be obtained by puncturing the spleen during life. Sir L. Rogers and Dr. Bentley soon after found the same para- sites in the epidemic kala-azar of Assam. In 1904 the former cultivated the protozoal parasite and obtained the development of a flagellate stage, and it was eventually named Leishmania donovani in honour of the joint discoverers. Further cultural studies led him to suggest the bed-bug as the probable carrier of the infection, and later Maj. Patton, I. M.S., and others obtained development of the flagellate stage in these insects after feeding them on the blood of kala-azar patients; but the complete life- history of the parasite has not yet (1921) been worked out.
In 1904 a Mediterranean, or infantile, form of kala-azar was discovered, affecting mainly children, most prevalent in Tunis and other N. African countries, and to a less degree on the N. shores of the Mediterranean, extending from Spain, Sicily and southern Italy and Greece to Asia Minor and the Sudan. Dogs were found infected (though they are not with Indian kala- azar), and the dog-flea is suspected of conveying the infection.
Kala-azar may be briefly described as a very prolonged fever, accompanied by great enlargement of the spleen, and in the later stages of the liver, with marked emaciation, leading to its having been confused with the so-called malarial cachexia in India, which is now known to be nothing but sporadic kala-azar, still widely prevalent over Bengal, Bihar, Western United Provinces and on the Madras coast, ttut absent, except as rare imported cases, from the more westerly portions of India.
The fever is very varying in its character, but frequently presents for a time a characteristic double rise of temperature in the 24 hours of diagnostic importance. The persistent nature of the fever and the failure of full doses of quinine to check it quickly is most im- portant in differentiating it from a true malarial fever. In the Assam epidemic form the average duration of the disease was seven months, sometimes without complete cessation of fever for a single day, while in the sporadic form it often lasts several years with periods of temporary freedom from fever. Another feature of diagnostic and prognostic importance is the remarkable decrease of the leucocytes, or white corpuscules, of the blood, which are commonly reduced to from one-third to one-fifth of the normal numbers; an extreme fall being of serious import, as the consequent loss of re- sisting powers against microbial invasion is the usual cause of fatal terminations due to secondary septic infections, including terrible sloughing of the tissues of the cheeks in children, dysentery, pneumonia and phthisis, which are the common causes of death in kala-azar, the fever of which is comparatively seldom fatal in itself. The mortality in the Assam epidemic form in hundreds of cases, carefully treated from first to last on tea estates by Dr. Dodds Price, was no less than 96 %, while it was not very much less in the sporadic form in other parts of India. The very prolonged nature of the disease and its excessive mortality constitute kala-azar one of the most terrible diseases which afflict mankind.
Up to 1915 the treatment of the disease was very unsatisfactory, although Rogers obtained 25% of recoveries by measures to increase the leucocytes of the blood. The close resemblance in many ways between kala-azar and African trypanosomiasis terminating in sleeping sickness, together with the zoological affinities of the flagellate organisms of the two diseases, raised the hope that any drug which proved efficient in trypanosomiasis might very likely also be effective in kala-azar, while the fact that rats and other animals could be infected with human trypanosomes and the effect of various drugs tested experimentally on the disease in them, even- tually solved this serious problem. Various arsenical preparations, which had proved of some value in trypanosomiasis, produced little effect in kala-azar, but when tartar emetic intravenously was found to be of value in the former, it was also tried by several workers in kala-azar with complete success. Di Cristina and Caronia of Palermo first -reported cures of the Mediterranean form of kala-azar early in 1915, and Sir L. Rogers, who was at the same time using the drug quite independently in India, very shortly after recorded its curative action in Indian kala-azar, and later showed that sodium antimony tartrate and a new preparation, colloid antimony sulphide, were less toxic and rather more effective than the first-used tartar emetic or potassium antimony tartrate, and reported 35 cases in Europeans with only one death from complicating phthisis and 29 complete and lasting cures, so that about 90 % of these unfortunate patients can now be rescued from almost certain death. Moreover, the new treatment has proved of great value in controlling the recent focus of the epidemic disease, while the sporadic form had in 1921 nearly disappeared from a portion of the Bardwan district of Bengal, where numerous cases had been treated, so that there was good reason to believe that kala-azar could eventually be stamped out. The results obtained by segregation methods and the new treatment thus constitute one of the greatest triumphs of modern medical science. (L. Ro.)
KALEDIN, ALEXEI (1861-1918), Russian general, was born in 1861, and entered the army in 1882. For some years he served in the artillery and then, on passing out of the General Staff Academy in 1889, he was appointed on the general staff. He reached the rank of general in 1907, and when the World War broke out in 1914 he was at the head of the 12th Cavalry Division. With this division he served in the Galician campaigns of 1914-5, in which his marked qualities of leadership soon showed themselves. In March 1915 he was seriously wounded. Later in 1915 he commanded the XII. Corps, and in the beginning of 1916 the VIII. Army. With this army, in 1916, he carried out the great offensive campaign of Lutsk. More than 100,000 prisoners and much booty were the results of his summer battles. In May 1917, being out of sympathy with the policy of the Provisional Govern- ment, which was causing the disintegration of the army, he re- signed his post as an army commander. In the summer of the same year he was elected Ataman of the Don. His popularity among the Cossacks did not cease, even after the conflict be- tween Kornilov and Kerensky. Notwithstanding the latter's demand that Kaledin should come to Moscow to explain his conduct during the Kornilov affair, the Cossack parliament for- bade him to go, fearing some treachery in relation to Kaledin. After the seizure of power by the Bolsheviks and the conclusion of their armistice with the Germans, he called up the Cossack regiments to the Don. The great moral influence he exercised over the Cossacks kept them at first from internal anarchy and aroused them to an armed defence of the Don district against invasion by the Bolsheviks. He thus made it possible for Gen- erals Alexeiev and Kornilov, in Dec. 1917, to muster the troops of the Volunteer Army to the south of the Don district. But in the beginning of 1918 an inner fermentation began on the Don; on the front the Cossacks began to surrender to the Bolsheviks. The Volunteer Army left the Don and went to the Kuban district. When all means of saving the Don Cossacks from Bolshevism were exhausted, Kaledin, hoping even at the last to rally the Cossacks by an act of self-devotion, shot himself on Feb. 11 1918. (N. N. G.)
KANSAS (see 15.654). The pop. of Kansas in 1920 was 1,769,257, as against 1,690,969 in 1910, an increase of 78, 288 or 4-6%. Relatively to the other states, Kansas lost its position, falling from 22nd to 24th place. Of the 105 counties, 48 showed an increase and 57 a decrease in pop. during the decade. The average number of inhabitants to the sq. m. was 21.6 in 1920. There were three cities of over 25,000 inhabitants, 14 from 10,000 to 25,000 and 10 from 5,000 to 10,000. The urban pop. (in cities of over 2,500) increased from 29-2% in 1910 to 34-9% in 1920.
The following are the cities with over 12,000 inhabitants, with pop. in 1920 and 1910 and percentage of increase:
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1920
1910
Per cent Increase
Kansas City.
101,177
82,331
22-9
Wichita
72,217
52,450
37-6
Topeka
50,022
43-684
14-5
Hutchinson .
23,298
16,364
42-4
Pittsburg
18,052
H.755
22-3
Leavenworth
16,912
19,363
-12-7
Parsons
16,028
12,463
28-6
Salina
15.085
9,688
55-7
Coffeyville . Atchison
13,452 12,630
12,687 16,429
6-0 -23-1
Lawrence
12,456
12,374
0-7
Agriculture. Kansas is preeminently an agricultural state. It is the largest producer of wheat and corn taken together in the Union, although the wheat crop is in some years exceeded by North Dakota and the corn crop in some years by Illinois. The wheat crop was 61,000,000 bus. in 1910; production was increased by 1914
