SPLENOMEGALY 219 
megaly includes the study of fifteen cases. In twelve mycotic tubercles of the 
spleen were found. These were the cases studied by Pinoy and Nanta and con- 
stitute mycetomas of the spleen. In three cases there were no mycotic tubercles, 
but direct examination for cultures showed forms of bacteria. These were re- 
garded as bacterial forms of splenomegaly. He points out that the question of 
the pathogenicity of these various organisms cannot yet be definitely determined. 
In three cases in which the cultures of the fungus could be identified, it was re- 
corded as Sterigmatocystis nidulans, which has already been accepted as one of 
the pathogenic causes of Madura foot. With reference to the bacteria isolated 
in the different cases, a streptobacillus was found which was extremely virulent, 
for laboratory animals and reproduced in them some of the signs of splenomegaly 
in man. In other cases there was found a spirillum, a pseud-odiphtheroid, a 
streptococcus and the typhoid bacillus. He points out that it is possible that 
some of these organisms were pathogenic agents and others of accidental occur- 
rence in a spleen already diseased. Clinically, there was nothing especially 
characteristic of the different types. 
Askanazy and Schweizer! studied five cases of Egyptian splenomegaly in 
which the spleens had been extirpated. In one of the fatal cases there were pul- 
monary complications and in the others lesions of the liver, consisting of infiltra- 
tion and the formation of pseudotubercular nodules containing the ova of 
Schistosoma mansoni. In three of the cases the spleens contained fibrous granules 
containing fungus hyphae which were frequently enclosed in giant cells and from 
which swollen and segmented hyphae extended into the surrounding tissue. In 
no case were other parasitic organisms encountered in the spleens. Schweizer 
in a second paper concludes that some cases of Egyptian splenomegaly must be 
placed in this new group of ‘‘Splenomegalia mycotica.”’ 
Petridis * has also studied recently six cases of Egyptian splenomegaly in 
Alexandria. The spleens which were removed were examined by Askanazy of 
Geneva, who drew his attention to the fibro-siderotic or sidero-mycotie foci. 
Petridis found in certain cases that the liver contained Bilharzia ova. He points 
out, however, that Egyptian splenomegaly has a dual etiology, one bilharzial 
and the other mycotic. Askanazy, however, believes that the etiological réle of 
the fungus should be regarded as still uncertain until the disease has been pro- 
duced experimentally. 
A number of other authors, Sabrazes and Muratet, Bécart, Coyon, Willemin 
Cloy and Brun, Arsen Prodanos,’ Popper, Raileanu® and Zorini® have also 
published papers in support of the idea of the existence of a mycotic form of 
splenomegaly. Other observers, however, have recently contested this claim. 
Oberling ‘ in connection with the subject, reinvestigated his collection of over 
1 Askanazy & Schweizer: Sch. Medizinische Woch. (1927), LVII, 777. 
2 Schweizer: [bid., p. 1017. 
3 Petridis, P.: Presse Méd. (1928), XXXVI, 546. 
4 Prodanos: Cited by Olympio de Fonseca and A. E. de Area Leao. Inst. Oswaldo Cruz. Sup. das 
Memorias. No. 1. Aug., 1928. 
5 Popper and Raileanu: Bull. et Mém. Soc. Méd. Hépit. de Bucarest (1928), X, 48. 
6 Zorini, A.: “Splenogranulomatosi siderotica’”’ Bologna (1928), L. Cappelli. 
7 Oberling: Presse Méd. (1928), XX XVI, 2. 
