252 INANITION AND MALNUTRITION 



and lymph glands, differing from the tonsils and other lymphoid structures of 

 the alimentary canal). 



In human rickets, enlargement of the spleen was noted by Whistler (1645), 

 Seibold (1827) and many subsequent observers; but its significance has been 

 much disputed {cj. reviews by von Starck '96 and Sasuchin '00), being frequently 

 attributed to syphilis or other complications. Von Starck ('96) found at Kiel 

 a splenic enlargement (" Milztumor ") in 53 out of 113 autopsies of rachitic 

 children (57 per cent), but it also occurred in 77 out of 148 non-rachitic (52 per 

 cent). A palpable "Milztumor" was also found in 68 out of no living rachitic 

 children, which is said to agree approximately with the findings by Rehn at 

 Frankfort (64.8 per cent), and by Kuttner at Berlin (73.3 per cent). Never- 

 theless, von Starck concluded that the splenic enlargement is merely a frequent, 

 complication, and not due to the same cause as the rickets. Sasuchin ('00) 

 found splenic enlargement in 12 out of 16 cases, the exceptions showing general 

 emaciation. Comby ('01) found the spleen usually enlarged in rickets. Vincent 

 ('04) claimed that it is moderately enlarged in the progressive stage, but not 

 permanently. Cheadle and Poynton ('07) stated that the rachitic spleen is 

 sometimes enlarged; while Stoltzner ('03, '09) found no significant change (aside 

 from complications). Pfaundler ('22) states that in rickets the spleen is often 

 enlarged. 



Wohlauer ('n), from original observations and a review of the literature on 

 human rickets, concluded: 



" Ein besonderes Verhalten zeigt die Milz. Sie ist stets vergrossert manch- 

 mal in excessivem Grade, bis zum Sechs und Achtfachen ihres normalen Masses 

 (Heubner). In leichten Fallen lasst sie sich am Lebenden nicht nachweisen, 

 da auch die aufgetriebenen Darme die Untersuchung erschweren. Wir fiirchten 

 uns zu wiederholen, es muss aber gesagt werden, dass auch hier wieder die 

 Meinungen geteilt sind (v. Starck, Miiller, Kuttner, Fox, Ball, M. Cohn, 

 Stoltzner, Monti). Mit dem Ablauf der floriden Erscheinungen verschwindet 

 der Milztumor, der sich meistenteils bei Kindern im zweiten Lebensjahr findet." 



In rats with experimental rickets, Shipley, Park, McCollum and Simmonds 

 ('21) found the spleen apparently atrophic in some rats, more or less enlarged in 

 others. McCollum, Simmonds, Shipley and Park ('21) noted that the spleen is 

 frequently greatly enlarged; while McCollum, Simmonds, Kinney, Shipley and 

 Park ('22) state that the spleen is enlarged in some cases, but usually not above 

 normal. These conclusions were apparently not based on actual weights. 

 Jackson and Carleton ('23) found the weight of the spleen so irregular and 

 variable in rachitic rats that no conclusion could be drawn, although in most 

 cases the average was below that in the controls (Table n). 



But few observations upon the histological changes in the spleen during 

 rickets are available, and these are all in the human species. Sasuchin ('00) 

 concluded that the changes are very characteristic, appearing early and in many 

 cases proportional to the intensity of the rachitic symptoms. The most marked 

 changes are proliferation of the connective tissue, constriction of the arterial 

 lumina, inflammatory appearances and atrophy of the Malpighian bodies. The 

 lesions resemble those in lues and tuberculosis, but these diseases were carefully 



