. The spleen and anæmia; experimental and clinical studies . he earlier changesare therefore to be found in the neighborhood of the fol-licular arteries, and later in the pulp, splenic and portalveins, culminating eventually in the liver changes of thethird stage. The symptoms, according to Banti, are dueto general toxaemia, and the anaemia to a depression ofbone-marrow activity rather than to excessive the degenerative changes in the spleen are too faradvanced to permit conclusions as to such a sequence ofevents, this theory has never been confirmed by experimentor observation.
. The spleen and anæmia; experimental and clinical studies . he earlier changesare therefore to be found in the neighborhood of the fol-licular arteries, and later in the pulp, splenic and portalveins, culminating eventually in the liver changes of thethird stage. The symptoms, according to Banti, are dueto general toxaemia, and the anaemia to a depression ofbone-marrow activity rather than to excessive the degenerative changes in the spleen are too faradvanced to permit conclusions as to such a sequence ofevents, this theory has never been confirmed by experimentor observation. The intimate relationship between thespleen and liver renders intelligible a possible pathologyof the third stage, especially as Mallory271 and, later,Breccia56 have shown that injury to the spleen is followedby focal necroses in the liver. Banti has objected to sug-gested etiological relationship of intestinal disturbances,despite the many cases in which digestive disturbancesare known to precede or usher in the disease. The fact PLATE IV .^fL >■ ^ v. V.*? Histology of spleen of early Bantis disease. TYPES OF SPLENOMEGALY 251 that the spleen is involved earlier than the liver wouldpoint to a hematogenous rather than an enterogenoustoxin, and the unquestioned improvement that usually fol-lows splenectomy indicates that the altered spleen is in someway an important pathogenetic factor. This is still fur-ther emphasized by Umbers444 unique observation. Aboy, fifteen years of age, was splenectomized for Bantisdisease, and during the operation a small piece of the en-larged liver was excised for histological examination anda distinct peripheral infiltration of the lobules found. Laterthe liver returned to normal size, a strong indication of thesplenogenous origin of the hepatitis, which, if undisturbed,should have progressed to the usual cirrhosis. Trauma to the spleen has been offered as a causativefactor in some cases (Armstrong 12), while another groupof authorities consid
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