BANTI'S DISEASE 383 



tion between them; therefore quite properly this combination is designated 

 as Banti's disease. 



The chief symptom by which cirrhosis of the liver may be recognized is 

 ascites. Yet this may occur, as I have seen, in pseudo-leukemia in which the 

 liver is not attached, or to hut an insignificant extent, so that besides cirrhosis 

 of the liver, to which Banti refers the ascites in all cases, other causes 

 may be operative. As such a cause I have mentioned displacement of the 

 lymph channels in the aldominal cavity by enlarged lymph-glands, which, 

 especially if combined with an anemic composition of the blood, and perhaps 

 with stasis due to the marked enlargement of the spleen, may give rise to 

 ascites. In some cases, disease of the portal vein may possibly be the cause. 

 [A calcified thrombus of the portal vein has been found by Warthin in two 

 cases of this disease (splenic anemia). — Ed.] 



Banti reports that in the disease named after him the intima of the portal 

 vein from the anastomosis of the splenic veins to the liver has been found 

 covered with coarse plaques similar to the sclerotic and atheromatous coats 

 of the aorta. He assumes that toxic substances from the originally diseased 

 spleen have reached the portal vein through the veins of the spleen, and later 

 reached the liver, thus causing the pathological changes. In two cases belong- 

 ing to this category upon which autopsies were held, and in which neither 

 ascites nor liver cirrhosis was present (which, therefore, did not strictly rep- 

 resent Banti's disease), these changes were not found either in the portal vein 

 or in the splenic vein. They belong perhaps to a more advanced stage of the 

 disease. 



But even if ascites is present the clinical picture deviates in many essential 

 points from ordinary hepatic cirrhosis, that form known as " alcoholic liver." 

 The enlargement of the sj)leen in pseudo-leukemia is much greater than in 

 the latter, and the skin does not show the grayish yellow discoloration which 

 is so usual in cirrhosis of the liver. On the contrary, it is pale, as in anemia, 

 provided unusual circumstances do not bring about a darker pigmentation. 

 For example. Osier has observed in some cases a melanotic discoloration due 

 to an old malaria. Furthermore, the urine is usually of a different compo- 

 sition, without bilirubin and urobilin, provided special complications, such as 

 decided stasis due to ascites and the like, are not present. 



"We must, however, agree with Banti that in the clinical condition named 

 after him the enlargement of the spleen is the primary affection and not the 

 result of enlargement of the liver. In the other cases of splerlic pseudo-leu- 

 kemia not associated with hepatic cirrhosis, it can no longer be doubted that 

 the enlargement of the spleen is the primary affection to which the other 

 disturbances, particularly the anemia and the abnormal composition of the 

 blood, may be attributed. 



The anatomical condition of the splenic tumor is usually reported as 

 dependent upon hyperplasia, but microscopic investigation shows variations 

 which depend upon the extent to which the pulp and the Malpighian bodies 

 as well as the trabeculae are implicated in the hyperplasia. It appears, or so 

 I conclude from a case observed by me, that in early cases only the tissue of 

 the pulp is hyperplastic owing to a decided increase of the lymph-cells in the 



