DISEASES OF THE SPLEEN. 



the cells in the lymphatic glands carries cellular elements from the m 

 into the lymph, it is most probable that, if the stream of blood in the 

 spleen is much retarded, the pulp of the spleen must increase, be- 

 cause less of its cells are carried into the blood. The increased size 

 of the current due to distention of the vessels, and still more to disten- 

 tion of the intertrabecular spaces from the hyperaemic swelling, very 

 decidedly retards the current of blood in the spleen ; and, since long- 

 continued hyperaemia of the organ constantly induces hypertrophy, it 

 is very probable that this form of hypertrophy of the spleen, at least, 

 is due to accumulation of the pulp, and not to its excessive formation. 

 When speaking of leuchaemia (see appendix to this chapter), 

 we shall mention a degeneration of the spleen which cannot be ana- 

 tomically distinguished from the one under consideration, but which 

 must be separately considered, because the changes it induces in the 

 composition of the blood are so peculiar that we must suspect a de- 

 cided functional difference. We shall show that in leuchsemia the en- 

 largement of the spleen is not due to retention of the cellular ele- 

 ments, but to their multiplication. 



Among the different forms of fluxionary hypereemia, those caused 

 by malaria most frequently induce hypertrophy of the spleen ; and we 

 find chronic enlargement of that organ, not only when the malarial in- 

 fection assumes the form of an intermittent fever, but also when it 

 induces remittent fever, or a chronic disease, without paroxysms. 

 Where malaria is endemic, numbers of persons have immense spleens, 

 and it even appears as if the largest tumors are found in persons who 

 escape regularly recurring paroxysms of fever. 



Among the congestive hyperaemias, those caused by cirrhosis of 

 the liver and obliteration of the portal vein most frequently result in 

 hypertrophy of the spleen, and this is the strongest proof of the cor- 

 rectness of the hypothesis that this form of spleen-disease is caused in 

 a purely mechanical way, by accumulation of cellular elements, as a 

 result of obstructed escape of the blood. 



Recently a number of cases of decided hypertrophy of the spleen, 

 occurring without any perceptible cause, have been observed and de- 

 scribed. As the anatomical appearances of these "idiopathic" en- 

 largements of the spleen appeared to correspond entirely with those of 

 leuchaemic spleens, of which we shall hereafter speak, and as the 

 symptoms observed during life (except the increase of the colorless 

 corpuscles of the blood) were very similar to those of leuchaemia, the 

 name of pseudo-leuchaemia has been proposed for this disease, while 

 other observers designate it as anaemia or cachexia splenica. In the 

 3o-called pseudo-leuchaemia, besides the affection of the spleen, there is 

 Almost always an analogous affection of the lymphatic glands, that is, 



