404 FAMILY: TRYPANOSOMID^ 



leishmania (Fig. 188). This condition has led him to suggest the possi- 

 bility of the spread of infection by the escape of parasites from the body 

 in the dejecta. Shortt (1923c), and Shortt, Swaminath, and Sen (1923), 

 have demonstrated the escape of L. donovani in the urine. 



© 



Fig. 188. — Section of Disorganized Villus of Small Intestine, with Leish- 

 mania donovani in Macrophages (x ca. 750). (After Perry, 1922.) 



DIAGNOSIS BY DISCOVERY OF THE PARASITE.— Diagnosis of the 

 disease is established by the discovery of the parasite. This is usually 

 accomplished by making films of material obtained by puncture of the 

 spleen, and staining by Romanowsky stain. The operation is not entirely 

 free from danger, as in some cases, especially when the spleen is very soft 

 and large, the wound has continued to bleed and death has resulted. AVhen 

 due care has been taken, however, there is little risk of haemorrhage. An 

 ordinary hypodermic syringe may be employed, and it should be perfectly 

 dry. The best result is obtained when very little blood is abstracted, on 

 which account suction should be discontinued as soon as blood appears 

 above the needle. If this be done, there will be a greater number of spleen 

 cells, which are the ones required for finding the parasites. The less danger- 

 ous operation of liver puncture will often reveal the organism, and some 

 observers maintain that it is as reliable for diagnosis as puncture of the 

 spleen. Examination of ordinary blood-films will sometimes reveal the 

 parasite as first pointed out by Christophers (1904), but many films may 

 have to be examined before a single parasite is seen. In some cases, 

 however, they seem to have been easily found in the peripheral blood. 



