386 PSEUDO-LEUKEMIA 



tioned first among these drugs, then piperin and eucalyptus. But, even in 

 cases in which malaria has preceded, they have no effect upon the remaining 

 splenic tumor ; and, besides, these patients have already taken quinm, arsenic 

 or other remedies to a considerable extent. If not, arsenic in one of the forms 

 previously mentioned may be employed, at least internally, on account of its 

 stimulation to metabolism, and perhaps also because of its power in blood pro- 

 duction. Suicutaneously atoxyl, which has already been mentioned, is espe- 

 cially worthy of a trial. Parenchymatous injections of arsenic, of carbolic 

 acid, etc., have been resorted to, but as these are not absolutely harmless, and 

 are of questionable value, they are not advisable. Inunctions in the splenic 

 region are useless, nor have I seen any benefit from massage or electricity. 

 Somewhat more effective, it appears to me, is the application of cold to the 

 splenic area, particularly in the form of the cold douche, the jet douche after 

 Pleury, or the fan douche. These are best employed while the patient lies 

 upon the right side of the body in a warm bath, with the left side of the abdo- 

 men exposed. 



The most certain means of overcoming the splenic tumor and (in so far as 

 this is considered to be actually the first of the main symptoms of the disease) 

 to bring about recovery, is splenectomy. But this is neither so easy nor so 

 harmless as the removal of the enlarged lymph-gland. Adhesions of the tumor 

 to surrounding organs and marked hemorrhage present great difficulties in 

 the operation, and endanger the life of the patient. Nevertheless lately, 

 owing to improvements in technic, extirpation of the spleen has been success- 

 fully accomplished in pseudo-leukemia, and in a number of cases has brought 

 about the disappearance of the anemia and of the cachexia ; for what length of 

 time is another question. Of course success is to be expected only when the 

 disease has not existed for too long a time, and severe sequelse, such as cirrho- 

 sis of the liver, multiple lymph-gland enlargement, etc., have not appeared. 



If ascites is present the attempt may be made to prevent its recurrence, 

 and to bring about a decrease in the size of the spleen, producing a collateral 

 circulation with the venous system of the body, by attaching the omentum and 

 the spleen to the abdominal wall (after Talma or Schiassi). 



Extirpation of the spleen in children is less likely to be considered, for 

 in them, as mentioned, the hygienic, dietetic and drug treatments are more 

 effectual. lodin and iron have proven serviceable, as well as arsenic; baths 

 and a change of climate are to be recommended as in the lymphatic form. 

 The same treatment is of course to be employed in adults. 



LITEEATUEE 



Askanazy, Ziegler's Beitr. zur path. Anatomie, Jena, 1888. 



Bonfils, Societe med. d'ohservation, Paris, 1856. 



G. Banti, "Lo Sperimentale," 1894, 1895; Ziegler's Beitr. zur allg. Path., etc., 1898, 



xxiv. 

 Clarke, Brit. Med. Journ., 1901, ii, p. 701. 

 J. Cohnheim, Virchow's Arch., xxiii. 

 W. Ebstein, Berl. klin. Wochenschrift, 1887. 



