BANTI'S DISEASE 385 



cytes such as would exclude leukemia. But I have already mentioned that 

 a hematological condition of this kind is not always present, even in cases that 

 are to be strictly considered pseudo-leukemia. In these, another state of the 

 blood combined with a characteristic enlargement of the spleen is of impor- 

 tance in the diagnosis, namely, a simple high-graded anemia, i. e., oligocythe- 

 mia and oligochromemia and this is especially so if leukopenia be also present. 



The recognition of splenic enlargement in cases of this kind can hardly be 

 difBcult, for the spleen early attains a size that is scarcely ever seen except in 

 leukemia. Its lower border may reach anteriorly to the true pelvis, to the 

 median line and even beyond. The surface is smooth, and upon pressure the 

 organ is but slightly or not at all painful. 



In the differential diagnosis all other hypertrophies of the spleen must be 

 excluded, and this is usually not difficult, for acute enlargements do not come 

 into consideration. The chronic enlargements, including tuljerculosis and 

 amyloid degeneration, which are somewhat rare, may be readily recognized, 

 provided the etiologic factors and the condition of the other organs are con- 

 sidered. [" Idiopathic " splenic enlargement with anemia very slight or 

 absent and no other symptoms at all is at times difficult to separate from some 

 of the cases in this group. — Ed.] The diagnosis is made with less ease when 

 ascites is present, not because there is any difficulty in determining the enlarge- 

 ment of the spleen, but because the question then arises whether hepatic cir- 

 rhosis is also present, and whether this or the enlarged spleen is the primary 

 affection, i. e., whether Banti's disease has or has not developed. Here again 

 an examination of the blood will aid in the decision provided the above-men- 

 tioned changes are present. The enlargement of the spleen in primary hepatic 

 cirrhosis is never so great as in Banti's disease, and, according to my experi- 

 ence, the appearance of the skin and the condition of the urine in the latter 

 afEection are not the same as in hepatic cirrhosis. 



The course and termination, and therefore the prognosis of splenic pseudo- 

 leukemia, do not differ greatly in adults from the lymphatic variety. The 

 condition is different in children. Here not infrequently it is possible to bring 

 about a decided improvement in the anemia and in the general condition, and 

 even a diminution in the size of the spleen. I do not know whether or not this 

 retrogression may be complete, but in cases not too far advanced I believe it 

 possible. This difference in the nature of the disease in adults and in chil- 

 dren may depend upon the action of the blood-forming organs, particularly the 

 bone-marrow, which in children shows a more vigorous function. It is for 

 this reason that children react more readily to deleterious agencies, and for 

 this reason also an improvement is more easily brought about in children than 

 in adults. 



In the treatment of this form of pseudo-leukemia the same factors must 

 guide us as are decisive in the other variety, only that here not the enlarge- 

 ment of the lymph-glands but that of the spleen is to be combated. Unfor- 

 tunately drugs have even less power to influence this process than in the former 

 instance. There are a certain number of so-called " splenic remedies," but 

 they owe their reputation chiefly to their efficacy in malaria and in the en- 

 largement of the spleen dependent upon this disease. Quinin is to be men- 

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