I  I 
ii  ' ; 
',!f. 
390 
Condition  of  the  spleen.  In  the  entire  series  of  cases  under 
consideration,  enlargement  of  the  spleen  is  the  result.  While  splenic 
enlargement  from  other  causes  is  of  course  frequently  met  with,  it 
may  be  affirmed  generally  that  distinct  and  sometimes  great  enlarge¬ 
ment  of  the  spleen  is  more  regularly  associated,  in  Egypt,  with 
cirrhosis  of  the  liver  than  with  conditions  unconnected  primarily  with 
this  organ.  As  might  be  anticipated,  the  greatest  degree  of  enlarge¬ 
ment  is  found  in  cases  w^here  the  cirrhosis  is  of  the  more  advanced 
and  contracted  type  just  described.  In  several  such  cases,  the  weight 
of  the  spleen  has  been  between  1,000  and  1,250  grammes,  and  in  one 
case  (that  of  a  girl  aet.  fourteen  with  advanced  cirrhosis)  the  weights 
of  the  liver  and  spleen  were  identical,  viz.,  1,450  grammes.  Apart 
from  such  exceptional  instances,  however,  the  average  weight  of  the 
organ  has  been  found  to  be  450  grammes. 
Tn  consistence,  the  spleen  is  firm,  frequently,  indeed,  quite  hard, 
and  presents  a  uniformly  and  deeply  congested  pulp  in  which  the 
Malpighian  bodies  are  generally  only  detected  with  difficulty. 
Apart  from  the  facts  already  stated  in  connection  with  the 
examination  of  the  splenic  tissue  in  films  stained  by  the  Giemsa  or 
Romanowsky  methods,  the  examination  of  sections  of  splenic  tissue 
has  yielded  few  results  of  any  significance. 
These  may  be  summarised  as  follows  :  — 
(1)  Hyperplasia  of  the  lymphocytic  elements  of  the  pulp. 
(2)  General  increase  of  the  connective  tissue.  This  occurs  either 
in  the  form  of  a  definite  increase  of  the  compact  fibrous  trabeculae 
of  the  organ,  or,  in  the  case  of  the  larger  spleens,  as  an  infiltration 
of  spindle-shaped  cells  diffusely  distributed  throughout  the  entire 
pulp. 
(3)  Distension  and  congestion  of  the  vascular  sinuses  and  frequent 
interstitial  haemorrhages. 
(4)  Active  pheigocytosis  on  the  part  of  the  macrophages  towards 
red  corpuscles  and  leucocytes.  The  occurrence  of  intracellular 
pigment  from  the  former  source,  is  commonly  noted. 
Condition  of  the  intestine.  In  view  of  the  lesions  reported  in  the 
intestine  in  cases  of  Kala-Azar,  the  condition  of  the  bowel  has  always 
been  carefully  scrutinised.  It  is  not  possible,  however,  in  our  opinion, 
to  uphold  the  association  of  any  definite  lesion  of  the  intestine  with 
the  condition  in  question,  notwithstanding  the  clinical  fact  that 
