192 TROPICAL MEDICINE AND HYGIENE 



search of stained films is necessary to discover any. In 

 examining fresh films it is an advantage to use dark- 

 ground illumination. 



The best staining method is probably Leishman's or 

 other modifications of Romanowsky's stain. Failing this, 

 gentian violet or carbol-fuchsin may be used. The spiril- 

 lum is described under the heading of Etiology, p. 193. 

 The blood of patients suffering from relapsing fever 

 shows a condition of leucocytosis. The number of both 

 polymorphonuclear and mononuclear leucocytes is in- 

 creased. Sometimes this is very marked, and as there 

 is also a diminution in the number of red corpuscles the 

 excess of these over the leucocytes is greatly reduced. 



The spirillum has not been demonstrated in any of the 

 patient's secretions or excretions. 



MORBID ANATOMY. 



The bodies of patients dying of uncomplicated relapsing 

 fever do not show any very characteristic gross changes. 

 The condition is that of a general septicaemia with en- 

 largement of the spleen and liver and catarrhal inflamma- 

 tion of the stomach often also of the intestines and 

 of the bronchi. Subserous haemorrhages under the 

 peritoneum, pericardium, and pleura are common. The 

 enlargement of the spleen is usually very considerable, 

 its weight sometimes reaching 5 lb., and its size exceed- 

 ing the normal by five or six times. 



The splenic capsule is distended and smooth, and the 

 whole organ is rounded. The spleen substance shortly 

 after death is firm and dark and mottled with small white 

 spots, which are the enlarged Malpighian corpuscles ; 

 these may sometimes be breaking down into minute 

 abscesses. Large wedge-shaped infarcts are common, 

 usually having their base at the capsule, though they may 

 be met with throughout the organ. When recently formed 

 they are of a dark red colour, but later they become pale 

 and may be found breaking down into pus. 



