666 FRANK C. MANN 



the liver are often affected by a disorder simultaneously or so nearly 

 simultaneously that it has never been possible to state which organ was 

 involved primarily. However, this does not mean that there is an en- 

 docrin interrelationship. It is more probable that the same pathologic 

 cause may be operative in each gland and that a vicious circle is established 

 in which the spleen is the weaker link (W. J. Mayo). 



From the evidence submitted, it may be stated that there is some 

 definite interrelationship of function between the spleen and liver, but it 

 seems that all present data on the subject can be explained on a purely 

 mechanical basis. There is no evidence that the spleen elaborates a direct 

 internal secretion which influences the liver. 



A resume of all the extant data on the possible relationship of the 

 spleen to the digestive tract on the basis of an endocrin function leads to 

 the positive conclusion that such a function on the part of the spleen has 

 not. yet been proved. 



The Spleen and Metabolism 



Many investigations have been made of the possible relationship of 

 the spleen to metabolism. Studies have been carried out on the dog and 

 on man, usually of metabolism before and after splenectomy. The experi- 

 mental work was done on normal animals while the observations on man 

 were associated with some pathologic condition for which splenectomy 

 was done. 



Experiments on dogs have involved an investigation of nitrogenous 

 metabolism (Paton, Korenchevski, Goldschmidt and Pearce, King (>)); 

 purin metabolism (Mendel and Jackson, King) ; gaseous metabolism (Ver- 

 zar, Korenchevski) ; carbohydrate metabolism (Austin and Ringer, Gold- 

 schmidt and Pearce, King) ; fat metabolism (Goldschmidt and Pearce, 

 King) and mineral metabolism (King). Owing to the fact that the 

 spleen contains a large amount of iron and is closely associated with the 

 breaking down of hemoglobin, the investigation of the mineral metabolism 

 has included several special researches on the relation of the gland to 

 iron metabolism (Schmidt, Asher, Grossenbacher, Zimmermann, Bayer, 

 Austin and Pearce). In most instances no relation between the spleen 

 and the particular metabolism studied could be determined although 

 positive results have been alleged in a few instances. It may be stated, 

 therefore, that the experiments on animals have given no evidence that 

 the spleen elaborates any product which influences metabolism. 



Results on the metabolism of patients from whom the spleen has 

 been removed as a therapeutic measure have shown that definite changes 

 sometimes occur (Umber, Mendel and Gibson, Minot, Pepper and Austin, 

 Denis). It should be taken into consideration, however, that the various 

 diseases for which the operation was done had altered the metabolism 



