The association of anaemia of a severe type and enlargemes of the spleen has been recognized clinically for many years. a considerable proportion of these cases the enlargement of the spleen is due to some well recognized cause, such as he cirrhosis or amyloid disease, but in a certain number the nized causes are absent, and it seems probable that we have to deal with a specific disease of unknown origin. The disease is essentially chronic, and is not incompatible with fair health for many years (25-30). It may occur at any age, but the infantile and adult types vary to some extent, and had better be considered separately.
In the adult form, the disease seems to occur most frequently between the ages of 20 and 40, and does not affect either sex in particular. In well marked cases the spleen is notably enlarged and the liver may also be increased in size. The patient is anaemic, and the skin is often diffusely pigmented. Gastro-intestinal symptoms are not uncommon, in particular gastric haemorrhage which is often profuse, and diarrhoea. The course of the illness is very chronic, but the anaemia on the whole progresses, and death ensues from haemorrhage, complications or asthenia. A terminal cirrhosis of the liver with ascites (Banti's disease) is not unusual.
Splenic anaemia may also occur during infancy, though we are still ignorant as to whether it is the same disease as the adult form, or sui generis. It is met with most frequently in the second year of life, and is generally associated with some degree of rickets. The infants are notably emaciated and anaemic, and sometimes of lemon yellow complexion. The liver and lymphatic glands may be enlarged as well as the spleen. Gastro-intestinal symptoms are the rule, vomiting and diarrhoea being the most consequent.
The general resemblance between splenic anaemia and pernious anaemia is somewhat striking, but the lack of information a large scale prevents any close comparison. The colour of skin is sometimes very suggestive, and a megaloblastic type of blood is the rule in the infantile cases, and sometimes occurs in adult cases. Oral sepsis and gastro-intestinal symptoms may also occur.
With our present knowledge treatment in the adult cases should be based on the lines suggested in the pernicious anaemia secn, and the diet should be bland and suited to the digestive power . The tendency to gastric haemorrhage must be remember a tendency which is probably due to mechanical derange-ment of the venous supply produced by the splenic tumour, and any distension of the stomach by large quantities of food, flatulence, etc., or unnecessary irritation by irritating viands, should be avoided so far as is possible.
The gastro-intestinal symptoms in the infantile form are usually well marked and call for special treatment. Diarrhoea is probably the most common, although vomiting may be persistent and severe. The stools are generally offensive, often green in colour, and may contain much mucus and undigested food. The dietary suitable for these symptoms is considered in the section on Diseases of Children. When gastro-intestinal symptoms are in abeyance, the diet should be that suited to the particular age, but special care must be taken to prevent infec-. tion of the milk ingested, and to prevent or remove any septic condition in the buccal cavity, which may be as marked during the first dentition as during the second.