ENLARGED SPLEENS AND MALARIA 
By C. W. DANIELS, M.B. Cantab., British Guiana Medical Service 
Enlargement of the spleen is so much more common in malarial countries 
than elsewhere that the dependence of this condition on malaria can hardly be doubted. 
The exact relation of the two conditions is, however, obscure. 
In India the ' Spleen Test,' i.e. the proportion of unselected persons who are 
found to have obvious enlargement of the spleen, has by many been relied on as the 
test of the prevalence of malaria in a district. 
Elsewhere, probably, as will be shown, owing to working with a greater 
variety of races, difficulties have been met with in placing reliance on this view. 
British Guiana is certainly a more malarious country than most parts of India, yet in 
a series of two hundred and twelve post-mortem examinations made in the Berbice 
Lunatic Asylum, i 881-1883 {Asylum Journal, Feb., 1883), recorded by Dr. Grieve, 
it was shown that a larger proportion of spleens were below than above the normal 
range of weight. Of these two hundred and twelve, one hundred and twenty-three 
or 58 per cent, were between four and ten ounces, i.e. were about normal ; fifty-five 
or 26 per cent, were under four ounces, or were subnormal ; and only thirty-four 
or 16 per cent, were over ten ounces. Even of these thirty-four, ten were from ten to 
twelve ounces, and only five or 2-3 per cent, over twenty ounces, markedly enlarged. 
These patients were adults, and the majority were probably negroes, but the returns 
are not sub-divided according to race or age. 
From 1893-96, some eighteen hundred post-mortem examinations were 
made, and the presence or absence of malarial pigment was determined in each case 
by microscopical examination. 
The result, as shown in the subjoined table, up to 1895, showed that there 
was no fixed relation, except in cases of acute malaria, between the weight of the 
spleen and the presence of malarial pigment in that organ ; and further, showed 
that great differences existed in the size of the spleen in different races, whilst there 
was comparatively little difference in the prevalence of pigmentation. 
The results were similar in males and females ; but, to avoid repetition, the 
tables for adult males only are given. * 
*Fuller particulars of this portion of this series are given in the British Guiana Medical Annual for 1895, Appendix to 
' Notes on a series of Post-mortem Examinations' 
