line, the latter extending almost to the umbilicus. A blood count gave the following : —
Red blood corpuscles - 3,100,000 White blood corpuscles ... ... 3,700 Haemoglobin ... ... ... ... 70 per cent.
Differential. count of white blood corpuscles : — Polymorphonuclear ... ... 37.5 per cent. Large mononuclear Lymphocytes Transitionals 24 29.5 9
On November 8th the liver was punctured with a fine needle, and in the liver tissue and blood so procured Leishman bodies were found in abundance. Diagnosis was now clear, the patient was suffering from kala-azar.
Treatment by intramuscular injection of atoxyl was at once begun, the dose being gradually raised from 10 minims of a 7^ per cent, solution to 34 minims, about 3 grains. The injections were made usually every second day, sometimes every day.
On January 16th, 1907, in consequence of the appearance of symptoms suggesting arsenical poisoning, coryza, inflammation of the fauces and bleeding from the gums, the injections of atoxyl were suspended till February 15th, when the arsenical symptoms having subsided, the injections were resumed and continued till March 11th. On the latter date, the patient apparently making no progress, bone marrow tabloids were substituted for the atoxyl, but as the tabloids seemed to upset the digestion they, too, were stopped at the end of a fortnight.
The patient was now exceedingly weak, and had fallen in weight to 9 stone 1 lb., notwithstanding a fair appetite and good digestion. He had an irregular temperature, and, almost nightly, profuse sweats. He complained also of
