24:6 LECTURE X. 



secreting organs offer, through which the matters have 

 to be excreted. 



It was for some time believed that tumefaction of the 

 spleen was characteristic of typhoid fever, inasmuch as it 

 formed a parallel to the swellings of the mesenteric 

 glands occurring in that disease. But more accurate 

 observation has shown that a great number of feverish 

 conditions which follow a more or less typhoid course, 

 and affect the nervous system in such a manner that a 

 state of depression is brought about in its most important 

 central organs, set in with swelling of the spleen. The 

 spleen is a remarkably sensitive organ, which swells not 

 only in intermittent and typhoid fever, but also in 

 most other processes in which noxious, infectant matters 

 have been freely taken up into the blood. No doubt the 

 spleen must always be considered in its near relationship 

 to the lymphatic system, but its diseases in addition usu- 

 ally bear a very direct relation to analogous diseases of 

 the important glands in its vicinity, especially the liver 

 and the kidneys. In most cases of infection do these 

 three organs exhibit corresponding enlargement con- 

 nected with real changes in their interior ; but since these 

 changes do not, even on microscopical examination, ap- 

 parently present anything remarkable, the attention of 

 the observer is chiefly attracted by the result which is 

 obvious to the naked eye, namely, the great swelling. 

 On careful comparison, however, a good deal is disco- 

 vered, so that we can affirm with certainty that the gland- 

 cells quickly become changed, and that disturbances 

 early show themselves in the elements by means of which 

 the secretion is to be accomplished. I shall revert to 

 this subject hereafter. Allow me now, in elucidation of 

 these conditions, in the first place to advert to one or two 

 more obvious examples which are accessible to direct 

 observation. 



