Food and Nutrition

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Abstract

be performed dur-ing full inspiration. In Part I of his book the author deals with technique, describes the various cells found in spleen fluid and also the cells of lung alveoli, "for a small amount of pulmonary tissue may be aspirated if the puncture is performed at too high a level or if the costopleural groove extends abnormally low". A special section is devoted to hypersplenism with inhibition of the marrow, for here, according to Moeschlin, spleen puncture is of the greatest value. In Part II the characters of spleen puncture fluid in various types of splenomegaly are described. An exhaustive account of all forms of splenic enlargement is given. Many of the punctures on which the work is based have been performed in a spirit of pure inquiry rather than for diagnosis. Not all the punctures described were performed by the author. A film showing Leishmania donovani was provided by Dr. Farreras, of Barcelona, and one showing Paracoccidioides braziliensis by Dr. Silva, of San Paolo. It is stated that the presence of macrophages containing melanin may allow a diagnosis of malaria to be made even years after injection. Moeschlin claims to have given the first description of tuberculous epithelioid cells in spleen puncture films and believes that this finding may be important in distinguishing cases of chronic splenic tuberculosis from Hodgkin's disease. In five out of seven cases of brucellosis, large epithelioid cells were found in spleen films, and in one patient the diagnosis was made in this way. Theoretically spleen puncture fluid can be used for culture or animal inoculation as well as for films, but as "the material obtained is usually 1 to 3 drops of rather bloody fluid and a few fragments of tissue", there is usually not much material to spare. The author claims that spleen puncture, especially when combined with marrow puncture, is often of great clinical value in diagnosis of diseases of the blood. The use of spleen films is, of course, open to the same objection as those of marrow or any other tissue films. The arrangement of the cells is not seen nor can their behaviour be inferred. On the other hand the structure of the individual cell is seen far better than in histological sections where the cells are shrunken and altered by fixation and embedding. The book Is illustrated by a large number of photomicrographs In black and white and by two really beautiful colour plates showing normal reticulo-endothelial cells and pathological forms of reticulo-endothelial cells in spleen films.