the presence of the Leishman body, but to exclude leucocythæmia and obviate the necessity for splenic puncture, and the attendant risk of fatal hæmorrhage so easily induced in that disease. Death from hæmorrhage has frequently followed this seemingly trivial procedure. When the liver is enlarged, being a less vascular organ and less easily torn, it should be selected for punctures in preference to the spleen. The abdomen had better be fixed firmly with a binder to prevent as far as possible movement of the diaphragm and consequent risk of tearing the punctured organ. A fine hypodermic needle, scrupulously clean and dry,*[1] and connected with the barrel of the syringe by a short length of rubber tubing, should be used, the patient being directed not to start or breathe while the puncture is being made. Failure to draw blood is not to be regarded as failure to obtain material for microscopical examination ; on the contrary, it is an advantage, as the object is to procure spleen or liver pulp, not blood. After blowing out the contents of the needle on a slip, a film should be spread and, after it has dried, stained by Irishman's or Giemsa's procedure, and then examined with a 1/12th objective. The parasite is easily recognized by its size, shape, and two chromatin masses.
Treatment.—— Until recently this, as a rule, was most unsatisfactory. Intercurrent malarial attacks may advantageously be treated with quinine, but for the disease itself this drug, even in huge doses and persisted with for long periods, is useless, if not harmful. Arsenic has proved equally unsatisfactory. Intravenous injections of salvarsan have been followed by favourable results. Splenectomy has been tried, but has failed. I have treated four cases with intramuscular injections of atoxyl. In two of these there was no improvement, the disease running its usual fatal course; but in the other two cases recovery ensued, whether as a result of the treatment or not I cannot assert. The arsenical is now quite superseded by the antimony treatment, introduced by
- ↑ * The presence of water in the needle will distort or burst the parasite and render it unrecognizable.
