HYPERTROPHY OF THE SPLEEN. 747 



their decided enlargement depending on simple increase 01 the normal 

 elements. In some cases the spleen is most affected (splenic form), 

 in others the lymphatic glands (lymphatic forms). 



ANATOMICAL APPEARANCES. As a result of hypertrophy, the 

 spleen may become so enormous as to measure one foot to a foot and 

 a half long, over six inches wide, and over four thick. It may attain 

 a weight of twelve pounds or more. The form of the enlarged organ 

 is not changed ; its resistance is increased, so that it occasionally be- 

 comes as hard as a board. In recent cases, the color of the paren- 

 chyma is dark-brownish red, in older ones it is usually the color of the 

 muscles or pale red. If the hypertrophy has resulted from malarial 

 affection, the pale, homogeneous, and dry cut surface usually has a 

 gray tinge, or we find dark spots in it. In the appendix to this sec- 

 tion, when speaking of melanaemia, we shall more particularly describe 

 the extensive deposits of pigment which occasionally remain in the 

 spleen after pernicious intermittent fever. The capsule of the hyper- 

 trophied spleen is usually thickened, cloudy, and not unfrequently ad- 

 herent to its surroundings. The thickened and rigid trabeculae of the 

 spleen appear as white striae on the cut surface. 



Besides the closely-packed normal elements of the pulp of the spleen 

 and interspersed pigment, microscopical examination does not show 

 any foreign formations. In the idiopathic as well as in the leuchaemic 

 enlargements of the spleen, we not unfrequently find wedge-shaped 

 masses similar to the haemorrhagic infarctions to be described in Chap- 

 ter IV. 



SYMPTOMS AND COURSE. While examining a previously healthy 

 and fresh-looking person for an acute disease, we not unfrequently find 

 a great enlargement of the spleen. Such cases prove either that a 

 morbidly-enlarged spleen can fulfil its functions, or that other organs 

 may act vicariously for it. In favor of the latter supposition is the 

 well-known fact that dogs, from which the spleen has been removed, 

 may live a long while, be well nourished, propagate the species, etc. 



The relative or even perfect good health, often found in persons 

 with old enlargement of the spleen, is very analogous to the perfect 

 health and blooming looks of persons who, for years, have had enlarged 

 lymphatic glands in the neck or elsewhere. If we carefully examine 

 the history we shall find that when the enlargement of the spleen 01 

 the swelling of the glands occurred, the patient's state was not by anj 

 means so fair as at the time of examination, but that there were at 

 that time more or less decided signs of anaemia and cachexia. This 

 appearance of anaemic symptoms, at the time of the occurrence of the 

 enlargement of the spleen and lymphatic glands in question, and the 

 subsequent disappearance of the anaemia, in spite of the continuance of 



