beknv  the  costal  margin,  in  the  remaining  eleven  attacks.  Tile  illin.^, 
was  severe  m  those  attacks  in  wliich  the  enlargement  ol  the  s|i|eeii 
wa.s  greatest  ;  in  those  in  which  the  enlargement  was  slight  ur  n,,, 
appreciable  (;,  12,  i-|,  16,  17)  the  attack  may  be  described  as  mild 
except  in  dase  i()  (p.  235),  in  winch  death  occurred  seven  days  aftci 
the  haemoglobinnria  had  ceased. 
'r.Ain.K  47.  Coiullrion  of  spleen  in  bhu'kwater  fever. 
Case 
Spleen 
I 
3 
■I 
(i 
fill 
7 
7a 
S 
‘j 
10 
1 1 
12 
13 
14 
14a 
>5 
16 
>7 
f.nwer  hnriler  projects  in.  below  costal  margin. 
,,  „  3:1  ''1-  o  11 
2  in. 
!  .1  in. 
ICnlargetl  and  palpable. 
('I'wo  nmntlis  later)  condition  could  not  be  satisfactorily  detciinined. 
Not  appreciably  enlarged. 
('Two  months  later)  lower  border  projects  tj  in.  below  costal  margin. 
I’jdarged  and  easily  palpable. 
Lower  border  jirojecfs  4  in.  below  costal  margin. 
1)  ]j  *  2  1’  " 
Enlarged  and  easily  palpable. 
Slightly  enlarged,  just  palpable. 
Not  examined. 
Just  palpable. 
(Three  and  a  half  months  later)  condition  not  recorded. 
Condition  not  recorded. 
Slightly  enlarged. 
„  „  just  palpatite. 
'The  parenchyma  of  the  spleen  was  examined  by  means  of  S|)leiiii| 
puncture  in  six  attacks  (Table  4S).  This  observation  is  readiljj 
carried  out.  The  patient  should  be  instructed  to  take  a  luuderakl 
insiiiration  and  then  hold  his  breath.  A  needle,  altnnt  one  niillinielt(| 
in  diameter,  attached  to  a  glass  syringe,  is  then  passed  quickk 
through  the  abdominal  wall  into  the  substance  of  the  enlarged  spleear 
The  piston  of  tlie  syringe  is  then  drawn  out  a  short  distance,  aftfi 
which  the  barrel  is  detaclied,  and  tlie  needle  at  once  withflran. 
J'T'om  tlie  small  amount  of  jiarenchyma  in  the  iioint  of  the  needlf 
fdms  are  then  prepared,  and  stained  by  Irishman's  method.  fai(| 
should  he  taken  not  to  change  the  direction  of  the  needle  at  anytini(| 
during  this  procedure.  After  a  little  practice  puncture  can  he  carrifJi 
out  in  aliout  five  seconds.  Two  of  tlie  smears  olitained  in  rable  1^1 
