HYPITKTROPHY OF THE SPLEEN. 749 



I would find it difficult to make a distinction between the so-called 

 pseudoleuchaamia (a very unsuitable name) and the chronic spleen-dis- 

 ease which has been recognized for ages and has frequently been care- 

 fully described. Steadily increasing impoverishment of the blood, 

 great paleness of the skin and visible mucous membranes, haemorrha- 

 gic diathesis, and in severe cases dropsical symptoms, together with 

 the enlargement of the spleen which is often decided, form the symp- 

 toms of the pretended new disease. These symptoms, which are often 

 considered as pathognomonic of spleen-disease, reach a very high grade, 

 and finally cause death in idiopathic enlargement of that organ : first, 

 because we cannot arrest the enlargement ; secondly, because in many 

 cases the affection of the spleen is accompanied by a similar disease of 

 the lymphatic glands. In most of seven cases of idiopathic enlargement 

 of the spleen that have come under my own observation, and have 

 been reported by my assistant, Dr. M&tter, in the " Berliner klinischen 

 Wochenschrift," besides the enlargement of the spleen, there was de- 

 cided swelling of numerous lymphatic glands. After what we have pre- 

 viously said, it cannot appear strange that the simultaneous disease of 

 the spleen and of the lymphatic glands, which also participate in the 

 formation of the blood-corpuscles, is a very dangerous complication, and 

 that it should induce the highest grade of impoverishment of the blood. 



As hypertrophy most frequently causes very great enlargement of 

 the spleen, the enlargement may be recognized, on physical examina- 

 tion, both by inspection and palpation as well as by percussion. The 

 tumor preserves the characteristic form of the spleen ; its resistance is 

 increased, although not so much so as lardaceous spleen, which we 

 shall describe in the next chapter. 



TREATMENT. Recent hypertrophy of the spleen, resulting from 

 malarial infection, calls for the same treatment that was recommended 

 in chronic hyperaemia of that organ. Change of residence and the use 

 of the preparations of Peruvian bark, particularly of quinine, are exceed- 

 ingly useful ; but the patient should not return to the malarial region 

 too soon, and should perseveringly use the quinine for a long time. 

 Even in old cases of hypertrophy we should try the effect of these 

 remedies. Of the numerous derivatives recommended for the treatment 

 of chronic enlargement of the spleen, the cold douche alone appears 

 serviceable, while blistering-plaster, issues, the actual cautery, etc., 

 over the spleen, promise but little benefit. The preparations of iron 

 are very extensively and very properly used in the treatment of this 

 affection; among these, muriate and iodide of iron are particularly 

 celebrated. We will not undertake to say whether they have any in- 

 fluence in decreasing the size of the spleen, or whether their beneficial 

 effect is due to the improvement of the quality of the blood. The effect 



