29() The Philippine Journal of Science 1915 
up to those nearly three times larger than normal, the average 
being somewhat above normal. The enlargement takes place in 
all directions. In an average of 14 spleens of my series that 
were measured the measurements were 13 by 9 by 4.5 centi- 
meters. The spleens that were measured do not include those 
of the greatest size, so that these measurements are probably 
minimal rather than maximal. The average measurements of 
the spleen given by the Austrian Commission are 12 to 22 by 6 
to 17 by 3 to 6 centimeters. These sizes are stated without ref- 
erence to cases in which the enlargement of the spleen was 
obviously due to chronic preéxisting disease. 
The capsule of the spleen is tense, opaque, and varies in color 
from a reddish brown to a steel gray. Frequently the capsule 
presents numerous, small, discrete or confluent hemorrhages 
scattered over its surface. The consistence of the organ is firm, 
and this is as marked after as before transverse section. When 
placed on the table after removal, the spleen retains its shape, 
and after section the organ does not collapse nor does the pulp 
flow out. In this respect the spleen differs remarkably from the 
acutely enlarged spleen seen in typhoid fever and other septi- 
cemic conditions. 
The cut surface of the spleen is a dull grayish red color and is 
not glistening. Both the consistence and color are remarkably 
like those encountered in cases of diffuse amyloid disease of the 
spleen. The cut surface, however, lacks the glistening appear- 
ance and is not smooth. It is rather rough and has a shagreen 
appearance, the pulp bulging out in the form of small, rounded, 
closely packed masses. Asa rule, the trabecule, smaller vessels, 
and lymphoid follicles are not recognizable. Small hemorrhages, 
which are darker in color than the surrounding pulp, may be 
recognizable on the cut surface. 
Small infarcts and necrotic nodules are visible to the naked 
eye in a small proportion of cases, and in these cases there are 
usually similar lesions in other viscera. In other words, these 
occur in cases of septicopyemia. Three cases with splenic 
infarcts occurred in the series, and their description follows. 
Small areas of focal necrosis were also recognizable in a few 
cases. The color and consistence of the spleen are considered 
among the most characteristic features occurring in plague. 
After having become familiar with them, we have ventured the 
diagnosis of plague even before inspection of the buboes, and 
even in some cases when the bubo was atypical. Furthermore, 
after having become familiar with the color and consistence 
of the spleen in plague, on finding a soft, pulpy, diffluent spleen 
