HYPERTROPHY OF THE SPLEEN. 745 



time without our interference. For those forms that do not subside 

 spontaneously, particularly for those caused by malaria, we have a 

 very effective remedy. If we avoid all exaggerations, and rely on 

 trustworthy observations, it still appears probable that, in the whole 

 materia medica, there are very few remedies that act so certainly 

 against any diseases as quinine and the preparations of Peruvian bark 

 do in the hyperasmia of the spleen resulting from malaria. We do not 

 know whether quinine acts by directly inducing contraction of the 

 muscular elements of the spleen, or whether it acts as an antidote to 

 the malaria, and, by destroying the cause, arrests its results, or whether 

 it removes the hyperaemia of the spleen in some other way ; but we 

 do know that, if, after the attacks have ceased, the spleen remains en- 

 larged or decreases in size very slowly, the disappearance of the swell- 

 ing is caused or hastened by giving large doses of quinine. It is cer- 

 tain that the effect of quinine on hyperaamia of the spleen cannot be 

 solely due to its arresting the fever. 



According to Fleury's observations, the enlarged spleen is reduced 

 several centimetres during the application of the cold douche. Fleury 

 refers to the observations of Andral and Piorry in support of his as- 

 sertions. This procedure deserves attention in treating hyperaemia of 

 the spleen, if circumstances permit it. 



CHAPTER II. 



HYPERTROPHY OF THE SPLEEN CHRONIC ENLARGEMENT OF THE 

 SPLEEN ANAEMIA ET CACHEXIA SPLENICA. 



ETIOLOGY. I consider the name of hypertrophy of the spleen as 

 best suited for that form of enlargement of the organ, where its size 

 and weight are increased, without any change in its texture being ob- 

 servable. But in the form of enlargement of the spleen under consid- 

 eration, the increase of the trabecular tissue is unimportant, as com- 

 pared with the far greater increase of the pulp, and the latter forma 

 the most important factor in the enlargement. 



With our present knowledge, in most cases we cannot fully an- 

 swer the question as to whether the increase of the pulp of the spleen 

 be due to excessive formation, a " hyperplasia" of its cellular ele- 

 ments, or to their abncrmal accumulation as a result of obstruction 

 to their escape. It is almost universally believed that the spaces 

 between the traboculse of the spleen, which contain the pulp, in 

 Borne way communicate with the vessels. If this view is the true one, 

 that is, if the blood flows through those spaces, and constantly car- 

 ries cellular elements out of them, just as the lymph flowing through 



