742 DISEASES OF THE SPLEEN. 



patients of their own accord complain of pain in the region of the 

 spleen, it may either be because the capsule of the spleen has become 

 thickened and unyielding from former disease, or from the occur- 

 rence in the spleen or its capsule of inflammatory processes, which may 

 also occur during these affections. 



In most cases there are no other subjective symptoms either, at 

 least such as can be certainly referred to hypersemia of the spleen, and 

 not to the original disease. Hence the splenic affection would almost 

 always be overlooked if the physician did not know that it very con- 

 stantly occurred in certain diseases, and if he did not examine each 

 case by palpation and percussion, to find whether any enlargement of 

 the organ existed. I will call attention to one symptom of excessive 

 hyperaemia of the spleen, which I think can be readily explained, and 

 referred to mechanical causes. Experience shows that some patients 

 with intermittent fever are very pale and anaemic after a very few 

 paroxysms, and that the pallidity of the skin and mucous mem- 

 branes disappears in a few days when a few doses of quinine have ar- 

 rested the paroxysms. This symptom cannot depend on the rapid con- 

 sumption of the blood and its speedy restoration. Although the tem- 

 perature rises very high during the paroxysm of the intermittent, and 

 we know that high fever is accompanied by decided and rapid con- 

 sumption of the blood, still in no other disease where the temperature 

 reaches the same height, and remains there even longer than in inter- 

 mittent, does the patient become anaemic in so short a time. On the 

 other hand, if a continued and high fever has caused poverty of the 

 blood, the symptoms disappear far more slowly than does the paleness 

 resulting from a few paroxysms of intermittent fever. My observa- 

 tions and those of others, particularly of Griesinger, show that the 

 rapidity with which the symptoms of anaemia develop and the grade 

 that they attain are in direct proportion to the rapidity with which the 

 spleen enlarges, and to the grade that this enlargement reaches ; that, 

 particularly in children, in whom the spleen usually acquires a propor- 

 tionally large size after very few paroxysms, threatening symptoms of 

 excessive hyperaemia develop early, but disappear very quickly after 

 the arrest of the paroxysms and the subsidence of the tumor. Hence 

 it can hardly be doubted that the appearance and disappearance of 

 these anaemic symptoms are associated with the occurrence and subsi- 

 dence of the hyperaemia of the spleen. It is not probable that the 

 excessive anaemia, which develops in a few days in intermittent fever, 

 depends on disturbance of the spleen, caused by the hyperaemia, al- 

 though, in severe disease of the spleen, the blood is gradually impov- 

 erished, apparently from disturbance of the influence of that organ on 

 the formation of the blood. On the other hand, although not posi 



