194
Seen by us about 8 P.M. Spleen two finger-breadths below costal margin. Tempera-
ture 101. Splenic puncture gave a small quantity of blood very rich in cells.
Blood.—Serum separated from clot, deep yellow colour, with a reddish tinge. No
solution of the clot in serum, or deepening of red colour of serum took place even
after many hours. On morning of 9th January 1908 serum is lighter in colour .
Hæmoglobinæmia doubtful.
Isotonic point on morning 9th :—N/13
| Hæmosozic value at 9 A.M., 9th January 1908 | 1.06% |
Films of peripheral blood taken 8 P.M. on 8th January 1908 show no parasites and
no pigmented leucocytes. No parasites or pigmented leucocytes were found in the splenic
films.
A count in each case of 600 gave as follows :—
| 8 P.M. | 9 A.M. | 4-30 P.M. | |
| 8th January 1908. |
9th January 1908. |
9th January 1908. |
|
| Polymorphonuclears | 83% | 67.5% | 54% |
| Large mononuclears | 9.6% | 8% | 13% |
| Macrophages | 1.3% | .. | .. |
| Small mononuclears | 6% | 18% | 30% |
| Eosinophiles | 0% | 6.5% | 3% |
Measurement of red cells showed as follows :—
| 8 P.M. | 4-30 P.M. | |
| 8th January 1908. |
9th January 1908. |
|
| Large cells measuring 140 | 49% | 17.5% |
| Medium cells measuring 120 | 46% | 70% |
| Small cells measuring 100 | 5% | 7.5% |
Examination of splenic films showed two somewhat doubtful malignant rings but no
pigment. The following type of cells are distinguishable :―
1. Large macrophage type. Protoplasm light coloured containing small vacuoles, diffuse
reddish stippling and a few larger reddish granules. Many of these cells contain decolour-
ised red cells and greenish masses. Throughout the film are many globular masses formed of de-
tached protoplasm of this and the next type of cell.
2. Large cells with rounder nuclei and with protoplasm which takes a deeper stain and is
firmer in consistence.
3. Small mononuclear cells with voluminous clear hyaline protoplasm, similar to small
mononuclear leucocytes.