766 APPENDIX TO THE DISEASES OF THE SPLEEN. 



tration of quinine. In these cases, also, it would be difficult to believe 

 in an intermittent obstruction of the blood-vessels. 



It may be offered as an objection to referring the above symptoms 

 to melanaemia, that there are but few symptoms that we certainly 

 know belong to that disease itself, and are not the immediate effects 

 of malarial poisoning. Among these are the dark color of the skin, 

 which is caused by the quantity of pigment in the blood-vessels of the 

 skin, and the microscopical observation of pigment in the blood. In 

 mild cases the skin is of an ashy-gray color, in severe ones it is yel- 

 lowish brown. If we find this color in a person who has had an ob- 

 stinate and severe intermittent fever for some time, or if it appears 

 that this intermittent belonged to a malignant epidemic, and had the 

 symptoms of a febris comitata, we should strongly suspect melanaemia, 

 and make a microscopical examination of the blood. 



TREATMENT. Prophylaxis and the causal indications demand the 

 same general rules as we shall give, in the second volumej for the 

 treatment of pernicious intermittent fever. We cannot fulfil the indj,- 

 cation from the disease, as we know no remedy that will remove the 

 pigment from the blood. In recent cases the symptomatic indications 

 may require the administration of iron, and a nourishing diet ; for, as 

 Frerichs justly says, the excessive loss of red corpuscles causes chloro- 

 sis, as well as melanaemia. Later the former often disappears, while 

 the latter continues. In one case that I saw, several months passed 

 before the patient recovered under the use of iron ; subsequently he 

 was equal to the hardest work, and presented no anomaly except the 

 color of his skin. When he died, several years afterward, of pneumo- 

 nia, the autopsy still showed distinctly the signs of melanaemia. 



ADDITION TO THE REVISED EDITION OF 1880. 

 1. P. 761. 



Neumann is probably correct in supposing that in the medullary 

 form the disease of the marrow of the bones is a frequent occur- 

 rence, without causing special symptoms. There is a diffuse hyper- 

 plasia of the marrow ; cellular elements of the same quality as in 

 leuchaemic blood form the chief constituents ; they fill the central 

 medullary cavity and interspaces of the bones, and give to their 

 interior a dirty-yellow color, exciting a suspicion of extensive sup- 

 purative osteomyelitis. 



