ENLARGEMENT OF THE SPLEEN. 709 



turbance of nutrition is coincident, generally diffused, and 

 appears in these different situations simultaneously, or nearly 

 so. Judging from what we know of the rather numerous exhibi- 

 tions of this disease in the spleen, it appears to be somewhat 

 slow in development, and to go on for years before producing 

 serious results. As a concomitant of this change of splenic 

 structure, leucocythasmia — white-celled blood — has been said to 

 have been regularly observed ; this, however, can only be 

 regarded as true in a limited number of cases, seeing that 

 lymphoid growths have been encountered in the spleen with- 

 out this peculiar hiemal alteration, as also that this blood- 

 change appears apart from the existence of internal lymphoid 

 tumours. 



The symptoms of this enlargement and unnatural condition 

 of the spleen are, as a rule, occult, and with the existence of 

 other abnormal and malignant growths in the same organ, of a 

 negative character. When operating prejudicially, either from 

 their extent in the spleen or their dissemination in other parts, 

 anaemia, irregularly or steadily developed, is probably the 

 earliest and most attractive feature ; with this we have 

 blanched membranes, particularly a pale sclerotic, feeble pulse, 

 irregular but rather elevated temperature, capricious appetite ; 

 and in two cases which were rather characteristic, there was 

 noted a distinct amount of follicular change of the membrane 

 of the fauces and tonsil cavities, a continued discharge from 

 the mouth of a somewhat frothy and very tenacious saliva, 

 and steady marasmus, with abatement of strength and vigour. 



Cancer, Melanosis, and Lardaceous Infiltration. — That these 

 abnormal conditions occur in connection with the spleen, we 

 are aware chiefly by after-death examination. Occasionally, 

 by some visible demonstration of diseased conditions and 

 the co-existence of particular symptoms, a fortunate prediction 

 of their existence may be made. There are, however, no 

 symptoms sufiiciently diagnostic by which we may satisfy 

 ourselves of their existence, specially in the spleen, during life ; 

 there is nothing in the physical examination to assist us, and 

 only occasionally are the constitutional indications of such 

 a nature as to concentrate attention on the spleen and satisfy 

 us that textural changes of an important character are taking 

 place there. 



