366 
ENLARGEMENT OF THE SPLEEN. 
ones were of firmest consistence ; the larger ones presented more 
of the appearance of the substance of the brain; and this was 
more perfect in the still larger ones, and some of them individu¬ 
ally of great size, which were collected on the concave surface of 
the spleen. It was a carcinomatous affection of the spleen, and 
the tumours were of that kind which have been termed ceplialo- 
matous. As they approached the surface of the spleen they had 
room to grow, and an opportunity to exhibit another of their 
characters, the forming in groups on the free surface of serous 
membranes. They did strangely and fatally group themselves 
together here, until the spleen was stretched out to the extent, 
and the mass had attained the enormous weight which Mr. An¬ 
derson describes. 
As the tumours increased in size and number, they involved 
the kidney on that side, which was partially surrounded by and 
lost in them. The posterior portion of the kidney preserved its 
healthy appearance and structure; the anterior portion was en¬ 
larged, and had become carcinomatous; or rather, this change 
had taken place in the centre of the cortical matter, and the de¬ 
posit or new formation had grown and spread on every side, and 
carried before it a layer or coat of healthy natural renal sub¬ 
stance. This presented a very singular appearance; and this 
morbid change in the structure of the kidney well accounts for 
the flow of bloody urine, and the opinion of Messrs. Anderson 
and Rowland, that the disease originated in the kidnevs. 
It is singular that in no part of this enormous mass had the 
softening process commenced. There was not the smallest cyst 
or abscess wherever we cut, and that was through the greater 
part of the tumour. This would lead to the supposition (and the 
state of the portion of the spleen that was not involved would 
strengthen it) that, notwithstanding its bulk, it was but of re¬ 
cent growth. 
The rapidity with which these cephalomatous tumours in¬ 
crease is almost incredible. Dr. Carswell, in his admirable his¬ 
tory of “ Scirrhus,” in the Cyclopaedia of Practical Medicine, 
gives a satisfactory illustration of this :—“ The influence of pres¬ 
sure in favouring or retarding the development of carcinomatous 
tumours, and consequently of modifying their bulk, is most con¬ 
spicuously seen when they are situated near the external surface 
of the body (or, we add, of any part of it). In carcinoma of the 
eye, a tumour which may have required several months before it 
reached the external surface of this organ, will, after it has been 
removed, together with the whole contents of the orbit, reappear, 
and, in the course of one or two weeks, acquire a much greater 
bulk than before the operation.” 
