40 



Scientific Proceedings (70). 



age 28; civil engineer. Family history negative. Patient had 

 no important antecedent illnesses. Physical examination revealed 

 no associated disease of any organs. Blood was practically normal 

 in the beginning, but showed numerical increase in large lym- 

 phocytes and decrease in small lymphocytes as the disease ad- 

 vanced. Polynuclear leucocytes showed no suggestive changes. 



Patient died in diabetic coma about two and one half years 

 after illness began. There was nothing unusual in the general 

 course of the disease. It progressed in spite of all efforts to 

 combat it. One thing deserves noting, namely, that fat was 

 metabolized poorly, the acidosis increasing whenever the fat in 

 the diet was increased to offset the loss in body weight. 



Post-mortem Examination. — The body was embalmed with a 

 fluid containing about 8 per cent, of formalin one hour after death, 

 and the tissues were fixed in formalin, Zenker's fluid and osmic 

 acid twelve hours later. 



There was some enlargement of the spleen, its size being 

 13 X 10.5 X 6 cm. and the weight 338 gm. The enlargement 

 was only slight, therefore. Other organs appeared normal. 

 Microscopically, the kidneys and adrenals were normal. The 

 pancreas showed no general structural change except slight atrophy 

 of the acinal tissue. The islets were normal, though there was 

 some tendency towards hypertrophy. The capillary walls were 

 somewhat thickened. There was no hyaline change in the islet 

 epithelium. The spleen was extensively invaded by large round 

 and oval cells of the endothelial type of Goucher. These cells 

 were especially abundant in the pulp. Mesenteric lymph glands 

 and liver showed the same type of foreign cells, but they were not 

 so numerous as in the spleen. The liver was normal except as 

 mentioned, though there was some vacuolization of the liver cells. 

 The foreign endothelial cells were found only in the blood capil- 

 laries of the lobules. Pigmentation of the lymph glands was 

 absent. Unfortunately, we did not examine the bone marrow, 

 as we did not suspect this complication. 



We believe that the findings in this case warrant the conclusion 

 that splenohepatomegaly existed. This condition is now thought 

 to be connected in some way with faulty fat metabolism. The 

 etiology, like that of diabetes, is obscure. Whether there was 



