384 PSEUDO-LEUKEMIA 



reticulum. Afterward an enlargement of the Malpighian bodies with an in- 

 crease in their cells is observed, so that they stand out as grayish white nodules 

 of the size of a pea, having the characteristics of lympliomata. Finally, with 

 the lapse of time the connective tissue proliferates, the capsule of the spleen 

 becomes thickened, the spleen itself hardens and is permeated by more or less 

 . tense connective tissue strands by which the pulp is more and more obscured 

 or absorbed. The follicles become thickened and enlarged and gradually lose 

 their reticular structure and cellular stratification, being changed into tough 

 fibro-cellular nodules. At last the normal structure of the spleen disappears 

 to a greater or less degree, and only tough trabecular tissue remains. 



In this process, the larger vessels, the arteries, and particularly the veins, 

 are often found thickened, sometimes also covered with chalk plates, such as 

 Banti observed in the trunk of the splenic vein in cases complicated with 

 hepatic cirrhosis. 



The cause of the enlargement of the spleen, i. e., the actual cause of the 

 disease, is unknown. In the relation of the spleen to the blood, which, as I have 

 already stated, may be compared to that of the lymph-glands to individual 

 areas of tissue, it may certainly be considered that a deleterious element pres- 

 ent in the blood exerts an irritation upon the spleen. What the nature of 

 this irritation is we do not know. Specific bacteria or toxins, which nowadays 

 so readily come into consideration, have not been found. Much favors the 

 view that the damage originates in the gastro-intestinal canal, and thence 

 reaches the blood. The circumstance that digestive disturbances, especially 

 diarrhea, frequently precede enlargement of the spleen, and the fact that 

 swelling of the lymph-glands in the abdominal cavity is rarely absent, favor 

 this hypothesis. 



From this point of view the assumption is certainly justified that the dis- 

 ease of the liver is not necessarily caused by enlargement of the spleen, hut that 

 it is the independent consequence of the same deleterious process. By this we 

 do not intend to deny that the abnormally constituted blood which circulates 

 from the spleen to the liver may cause pathological effects. It may be in con- 

 sequence of the simultaneous action of both poisons — that of the gastro-intes- 

 tinal canal and that of the spleen — that the hepatic cirrhosis sometimes devel- 

 ops very early, at other times hardly at all. 



As a contribution to our knowledge of the etiology of pseudo-leukemia, it 

 must be stated that in a fair proportion of cases the malady develops in the 

 course of diseases in which enlargement of the spleen or a chronic splenic 

 tumor already exists, or in the course of which it appears, e. g., in malaria, 

 syphilis, particularly in that form which occurs in children, hereditary syph- 

 ilis, and in rickets. The characteristic symptoms of the latter diseases grad- 

 ually retrograde, while the splenic tumor persists or even increases; anemia 

 and cachexia become more prominent, and gradually the boundary line between 

 these maladies and pseudo-leukemia disappears, and it becomes impossible to 

 say where the one begins and the other ceases. 



The character of the blood may in such instances decide the diagnosis, 



particularly if the change described by Ehrlich and Pinkus is present or, 



at all events, a relative increase of the lymphocytes with a low count of leuko- 



