Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 1.djvu/170

 lady came to him saying that she was saturated with malaria. She had been sent home from India with this diagnosis of malarial saturation, and she was said to have an enlarged spleen. She certainly looked as if she had Leishinan's disease, but on making a careful examination he found the li er slightly enlarged, although he could not find any spleen at all. Palpating about the abdomen, he came on an enormous tumour in the right pelvis, and accordingly thought that some uterine or ovarian trouble existed, and that the case was one which did-not belong to his own department of medicine. He therefore decided to send her to a gynaecologist, but before doing so he took some blood smears, which he put in his desk and, not having leisure to examine them, they were left there. A little later the gynaecologist came to him and said he did not understand the case; he thought it was not uterine, but it might be ovarian, and he wished to see him (Sir Patrick) in consultation before proceeding further. The lady, therefore, came to his house a second time with the gynaecologist, and, on careful examination being made, they diagnosed a pelvic tumour, and decided that the right thing to do was to remove it at once. The patient was sent to a nursing home, the day of operation was appointed, and everything was in order for a serious surgical operation. Fortunately he remembered the blood films, and on examining them was horrified to find that the lady was suffering from leucocythaemia, and that what they thought was a tumour in the right pelvis was probably a dislocated spleen. That was the case. Had they proceeded upon their mature diagnosis to open the patient's abdomen, he had not the slightest doubt she would have died from haemorrhage. He was now very careful to make a complete examination of the blood before deciding to "break skin," whether it were an abdominal section or splenic or liver puncture, because it might well be that the case was