764: APPENDIX TO THE DISEASES OF THE SPLEEN. 



branes, cellular tissue, and lymphatic glands, also have a more or less 

 decidedly gray color. Frerichs sums up the appearances in melanaemia 

 by saying : " In marked cases of the disease pigment is found wher- 

 ever the blood goes, and is the more abundant the smaller the capilla- 

 ries of the part, that is, the more readily impaction of the flakes may 

 occur." 



SYMPTOMS AND COURSE. Many cases of melanaemia cause no per- 

 ceptible disturbance of function, and the organs have been found over- 

 loaded with pigment, on autopsy of persons who have died of the most 

 varied diseases. This was true in more than one-third of the cases ob- 

 served by Planer. On the other hand, patients often die quickly with 

 severe brain-symptoms, and on autopsy we find the evidences of mela- 

 nasmia, particularly an accumulation of pigment in the vessels of the 

 brain, or numerous small extravasations of blood through the brain- 

 substance. Former observations of great pigmentation of the cerebral 

 substance in persons who had died of comatose intermittent, as well as 

 the experience of the tropics, which shows that the brain is very dark- 

 colored in most persons who have died of severe remittent fever, have 

 acquired greater significance, since we know that the dark color of the 

 brain depends on an accumulation of pigment in its vessels, and have 

 rendered it very probable that the obstruction of the cerebral ves- 

 sels (with or without consecutive rupture of the walls of the capillaries) 

 caused the brain-symptoms in severe malarial diseases. This view, 

 advanced by Meckel, appeared to be supported by numerous observa- 

 tions of Planer and Frerichs. Both of these observers described cases 

 of melanasmia where the patients had severe cerebral symptoms, either 

 headache and dizziness, delirium or convulsions, but particularly coma. 

 The cases observed by Frerichs all occurred during a malignant epi- 

 demic of intermittent fever ; they developed partly from simple inter- 

 mittent paroxysms, had an irregular intermittent or remittent course, 

 and partly yielded to quinine ; they presented exactly the symptoms 

 of a febris intermittens comitata, maniaca, epileptica, comitosa, apc- 

 plectica. With all this there are important reasons for doubting the 

 dependence, at least the constant dependence, of the cerebral symp- 

 toms in pernicious malarial fever on an obstruction of the vessels of the 

 brain by pigment. In opposition to the hypothesis of such a connec- 

 tion, Frerichs calls attention to the fact that in many cases, even when 

 the brain is very dark-colored, no decided disturbance of the circulation 

 can be perceived ; and further, that in spite of the dark color of the brain, 

 there are often no cerebral symptoms ; and lastly, that severe cerebral 

 symptoms have been observed where there was none of this pigmenta- 

 tion of the brain (hi twenty-eight cases of intermittens cephalica that 

 Frerichs observed, the dark color of the brain was absent in six). The 



