750 DISEASES OF THE SPLEEN. 



is best when we combine the preparations of iron with quinine, or if 

 we order the use of chalybeate mineral waters in some mountainous 

 region, and at the same time let the patient take quinine continually. 

 Treatment does no good in hypertrophy of the spleen due to cirrhosis, 

 pylephlebitis, etc. 



CHAPTER III. 



LARDACEOUS SPLEEN AMYLOID DEGENERATION OP THE SPLEEN. 



ETIOLOGY. In lardaceous spleen the walls of the vessels and the 

 cellular elements of the pulp degenerate just as the liver-cells do in 

 lardaceous liver. More rarely, in the so-called sago-spleen, the pulp is 

 unaffected, the cells and nuclei only undergoing the lardaceous or amy 

 loid degeneration. 



Regarding the etiology of lardaceous spleen, we may refer to what 

 was said of the analogous disease of the liver. The dyscrasise there 

 mentioned, scrofula, rachitis, tertiary syphilis, and mercurialism, also 

 induce amyloid degeneration of the spleen. Lardaceous spleen only 

 exceptionally complicates tuberculosis ; on the other hand, it occurs 

 quite frequently in malarial diseases, although far more rarely than 

 simple hypertrophy. 



ANATOMICAL APPEARANCES. Amyloid degeneration may cause as 

 great enlargement of the spleen as results from the hj^pertrophy men 

 tioned in the last chapter. The lardaceous spleen is very heavy, and 

 excessively hard ; if we attempt to bend it, we find that, besides being 

 hard, it is very friable. The color is usually a pale violet red ; the 

 little blood contained in it is watery ; the cut surface is homogeneous, 

 smooth, dry, and has a lardaceous, waxy lustre. On microscopical ex- 

 amination, we find the cellular elements of the pulp enlarged, of a dull 

 color, with pale, homogeneous contents. On adding a solution of 

 iodine, the preparation becomes yellowish red, and on a further ad- 

 dition of sulphuric acid it becomes violet and blue. 



If the degeneration be limited to the Malpighian bodies, the organ 

 is not usually so much enlarged. On incising the spleen, we find 

 roundish, gelatinous granulations, resembling swollen sago, scattered 

 through the moderately firm parenchyma. Microscopical examination 

 shows that the cells and nuclei of the Malpighian bodies are changed 

 in the manner above described for the spleen-pulp. 



SYMPTOMS AND COURSE. In lardaceous degeneration of the spleen 

 also, the patients are very ansemic and cachectic. Epistaxis, petechise, 

 and dropsy, are more frequent than in simple hypertrophy. And in 

 this form of enlargement of the spleen it is even more difficult than in 

 the preceding ones, to say how far these symptoms depend on the 



