Chronic splenic anæmia and Banti's Disease / by H.D. Rolleston.

  • Humphry Rolleston
Date:
[1914?]
Catalogue details

Licence: In copyright

Credit: Chronic splenic anæmia and Banti's Disease / by H.D. Rolleston. Source: Wellcome Collection.

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    lion, for after a haemorrhage the blood condition may steadily improve until another bleeding occurs. (iii) Enlargement of the spleen, due to some unknown cause, may induce anaemia as the result of haemorrhage, which is brought about mechanically. Thus, torsion of the splenic vein would divert the venous blood from the spleen into the vasa brevia, the normal blood current being reversed, and cause great dilatation of these veins and so oesophageal varices, from which copious or occult bleeding might result. This hypothesis satisfactorily explains the anaemia, but not the subsequent hepatic cirrhosis in the further stage of Banti's disease. In conclusion, with our present knowledge it seems most reasonable to believe : (a) that in splenic anaemia a chronic infective or toxic process has its headquarters in the spleen, which therefore undergoes fibrotic enlargement; (b) that the large spleen mechanically causes gastric haemorrhage, which is responsible for the anaemia; and (c) that, poisons conveyed from the spleen eventually induce cirrhosis of the liver. Morbid Anatomy.—The spleen preserves its general outline. The surface is smooth except for thickening of the capsule, and in some cases for adhesions. The spleen is much increased in size, and there may be enlarged splenunculi in the hilum. The weight naturally varies with the patient’s age. The average weight of 21 cases which I have collected was 27*6 oz«, and the extremes 52 oz. in a woman aged 53 (L. B. Wilson50), and 8j oz. in a girl aged 10 years (F. Taylor46). The weight of the organ is therefore far less than in Gaucher’s disease, in which the average weight in 13 authentic cases was 7*2 lbs. (Brill and Mandlebaum). On section, the spleen shows fibrosis, and is usually dark-red in colour. Microscopically, according to Banti, whose description Ledingham 26 follows, the spleen shows great thickening of the trabeculae, fibrosis and hyaline change in the Malpighian bodies, thickening and hyaline change in the reticulum of the pulp (ftbro-adenie), and a rich lining of the endothelial cells in the blood sinuses which are not dilated, as in the spleen of portal cirrhosis; this distinction, however, Gilbert and Lere- boullet22 and others do not admit. L. B. Wilson50 sums up the appearances as those of a primary chronic diffuse paren-
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