toxins, protozoal or bacterial; but, on the other hand, in the majority of instances of men with poor blood who had come from India, Africa and China, one should be very careful of making a diagnosis of kala-azar, unless a smear made from fresh spleen or liver showed the parasite. Even in sections it was sometimes difficult to detect the bodies, and fresh sections should always be used. With regard to the question of the developmental forms his cultures, unfortunately, had not been successful. On one or two days fission forms were seen, and one occasionally saw a flagellum, but they were uninstructive and it was impossible to dogmatize on them. In regard to cases similar to those of the sailors mentioned by Dr. Low, one should be careful about making a negative diagnosis. It had been suggested that the parasites might be found in the peripheral blood, but considering how few white cells there were in a cubic millimetre he thought that must be difficult, although in India, Rogers said, it was not uncommon to be able to demonstrate them. The method recommended from the Soudan might be useful ; it was undoubtedly woith trying. In reply to Dr. Sandwith's question as to the precautions to be taken when a puncture of the spleen was made, the procedure was as follows : — First, the patient was warned to avoid movement : there ought to be perfect sterilization of the skin ; the puncture should be made with a small needle, and the blood should be withdrawn quickly ; a firm binder should then be put on, the patient being made to lie quite still in bed for some hours afterwards. But he did not puncture the spleen now ; he had had the unfortunate experience of losing one case, and he decided never to do it again. Liver puncture was, he thought, safe.
The President said there were one or two points to which Dr. Bassett-Smith had not referred on which he desired to make a few remarks. The question of diagnosis
