SPLENOMEGALY 221 
one as resembling that of mycelial elements and of mycetoma grains. They 
emphasize, however, that a more minute observation of the spleen sections from 
the Brazilian cases of splenomegaly which they had the opportunity of examin- 
ing did not permit them to verify the presence of a single element which un- 
questionably might be attributed to fungi. On the other hand, all the formations 
found showed transitions to such other elements which clearly could not be con- 
sidered mycelial and in fact were connected with changes of tissues which are 
observed in many different morbid conditions. They agree with Gamna and 
Langeron in the interpretation of these supposed mycotic appearances. 
Jaffe and Hill! have also recently reported upon the subject of splenic my- 
cosis. They however were able to confirm the observations of Nanta, Weil and 
Askanazy that the siderotic nodules of the spleen contain mycelia and fructifi- 
cation organs of an Aspergillus. Such structures were found in two cases of ju- 
venile splenomegalic anaemia, three cases of sickle cell anaemia, and one case of 
tuberculosis of the spleen. It seemed to them that different types of Aspergillus 
can produce similar changes in the spleen. They think that the occurrence of the 
fungus in the spleen under different pathological conditions does not favor the 
theory regarding the existence of a disease entity caused by a fungus, and they 
considered that certain changes apparently rendered the spleen suitable to an 
infection with Aspergillus. These changes consist of the enlargement of the 
pulp with blood, and in intratrabecular haemorrhages which were due either to 
disturbances in the portal circulation or to alterations of the blood. They be- 
lieved the reactions of the body against the fungus were the formation of foreign 
body giant cells and proliferation of the connective tissue. The mycelia and fruc- 
tification organs absorb iron and calcium salts and are finally buried in sclerosed 
connective tissue. The last may also become calcified. They found these forms 
of Aspergillus in enlarged as well as in atrophic spleens and therefore state that 
the term, splenic mycosis, as suggested by Nanta is preferable to mycotic 
splenomegaly. In the one case in which Jaffe and Hill cultivated a fungus the 
spleen weighed only 425 grams. 
It seems obvious that exceedingly great care must be exercised in the prepara- 
tion of cultures from organs where mycotic infection is suspected. Various fungi 
often present in contaminated air and dust are very likely to infect the culture 
medium and the development of a few colonies of fungi in one’s media is some- 
times very perplexing with reference to their origin. In regard to the culture 
obtained in their one case, Jaffe and Hill merely state: ‘‘From this spleen an 
Aspergillus was obtained. It grew on Sabourraud medium in two weeks and 
resembled an Aspergillus fumigatus.” 
MacCarty ? in the study of 320 spleens from cases of splenomegaly made in 
the United States, does not refer to mycotic splenomegaly. 
Finally, MeNee * has made a most careful study of the etiology, pathology, 
and frequency of the forms of splenomegaly occurring in Great Britain. He illus- 
1 Jaffe & Hill: Arch. Path. (1928), VI, 196. 
2 MacCarty: Arch. Int. Med. (1928), XLI, 536. 
3 McNee: Glasgow Med. Jour. (1929), CXI, pp. 65, 193, 288. 
