Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/151

 the urine was non-albuminous. The blood gave 3,800,000 red cells, and 2,000 white cells. A relative count gave polymorphonuclears 48 per cent., large lymphocytes 27 per cent., small lymphocytes 25 per cent.

There was irregular fever and a fast pulse. These symptoms continued, the fever being of an undulant character. During the height of the fever a small quantity of blood was drawn off from the liver, and Leishman bodies, both singly and in groups, were found. He was put on atoxyl, calcium lactate, iron, and bone-marrow; under this treatment, the atoxyl being pushed to 12 grains a day, the haemorrhages stopped, the fever passed off, and he is now gaining weight.

A glance at the chart (p. 124) will explain how possible it is in such a case to confuse this condition with Mediterranean fever, as Bentley did, more particularly so, as I have myself had one case of eighteen months' standing, with such marked cachexia and splenic enlargement that I drew off some blood from his spleen to seek for the bodies, which blood instead gave a pure culture of the Micrococcus nielitensis. Only 0.5 cc. was drawn off from the liver of the present case; it contained some liver cells, fairly abundant Leishman bodies, most of which are single and pyriform in shape, but collections of eight to fifty were found. The blood was sterile bacteriologicall}'. A portion of the fluid drawn off was mixed with a citrate solution incubated at 20 deg. C, and daily examined for developmental forms. On the second day fission forms were seen, but from that day the bodies rapidly broke up, the swollen nuclei alone taking up the stain. The attempt at culti- vating the organism was then only partially successful; the bodies on the second and third day were like some seen on slides of Indian cases which were given me by Leonard Rogers; they also resemble very much some stage in the evolution of trypanosomes as seen in rats.