INTESTINAL FLAGELLATES 271 



to make a splenic puncture. Manson and others have pointed out the dangers 

 from splenic puncture in kala-azar and have rather preferred puncture of the liver, 

 although recognizing that the chances of obtaining parasites from a liver puncture, 

 are less than from a splenic one. 



Statistics have been given where a mortality approximating i% has followed 

 spleen puncture. Bousfield, however, using an all glass syringe with a i^-inch 

 needle did not have a fatality in 1 20 spleen punctures. 



For diagnosis the spleen or liver juice, rather than pure blood, is 

 smeared on a slide and stained by some Romanowsky method, pref- 

 erably that of Giemsa. 



Cultures on N. N. N. medium can also be made. 



One should always first examine a smear of the peripheral blood for parasites in 

 polymorphonuclear or large mononuclear leukocytes. The Sudan Commission 

 found leishman bodies in the peripheral blood of 13 out of 15 cases so examined, but 

 rarely did they find more than one parasite-containing leukocyte to a slide. 



Quite recently Wenyon and others have noted the desirability of 

 culturing the peripheral blood in N. N. N. medium. Diagnosis may 

 be made in this way, provided one wait from two to three weeks 

 before reporting negatively as to the presence of flagellated Leishmania 

 in the cultures. As before stated, strict asepis and a room temperature 

 are requisite for flagellate development. 



It has been noted that artificial pustulation might assist in diagnosis by giving 

 a multitude of polymorphonuclear leukocytes for examination for phagocytized 

 Leishmania. 



Cochran has recently noted the advisability of excising a lymphatic gland and 

 making gland smears to examine for Leishmania. Others have reported success 

 with gland puncture as utilized in the glands of trypanosomiasis. 



NOTE. Darling has reported from Panama a protozoon somewhat 

 like Leishmania in which the cells .of lungs, liver, spleen, and lym- 

 phatic glands contained numerous parasites about 3 to 4^ in diameter, 

 slightly oval in outline, and containing a large and small chromatin 

 staining mass. He has given it the name Histoplasma capsulata. 



INTESTINAL FLAGELLATES 



These parasites of the intestinal tract are separated according to 

 the number of their flagella. 



These flagella can easily be counted in a preparation mounted in Gram's iodine 

 solution. For this purpose I take a clean slide and make a vaseline line across it 

 about i inch from the end. A drop of the iodine solution is placed on the slide about 



