placed in the abdominal cavity, and it also undergoes changes in position in accordance with the position of the body. Less commonly the spleen is attached in its abnormal situation, and it may perhaps have formed firm connective-tissue adhesions with the bladder or the intestines. The spleen is generally situated with its hilus directed upward, while its convex border is directed downward.

In diagnosis, the detection of depressions or notches in the border of the spleen in contact with the anterior abdominal wall is of special importance. In addition, consideration should be attached to the tongue-shaped form of the organ and the absence of splenic dulness in the usual situation. In isolated instances pulsation of the splenic artery could be felt in the hilus of the spleen. In many instances the organ is enlarged. Generally the viscus can be detected only by means of palpation; although in a woman with relaxed abdominal walls it was also visible. In many instances the condition is latent, and is discovered accidentally on careful examination of the abdominal viscera.

Symptoms.-Some patients complain of a disagreeable sense of traction and of pain from pressure. Occasionally pressurephenomena referable to various abdominal viscera appear, as, for instance, difficulty in micturition, constipation, even intestinal obstruction, paresthesia, and weakness in one leg if the wandering spleen exerts pressure upon the nerves for the legs in the pelvis.

Etiology.-Wandering spleen is encountered much less commonly than wandering kidney, but it occurs more frequently in men than in women. Traumatism (falls, shocks, blows, constriction, expulsive effort, lifting) is often the principal exciting cause. The condition develops with especial readiness if the spleen is enlarged. It therefore occurs often in consequence of malaria. I have also observed a leukemic wandering spleen. The development of a wandering spleen is favored by congenital relaxation and undue length of the gastro-splenic ligament. At times wandering spleen is associated with wandering liver or wandering kidney.

Prognosis.—As a rule, the disorder is annoying rather than

dangerous.

The treatment is purely mechanical. Naturally but little can be accomplished by means of bandages. Splenectomy and splenopexy (suture of the spleen) have been recommended, although such procedures will be resorted to only in the presence of severe symptoms or grave complications.

Permanent displacement or dystopia of the spleen may occur as a congenital condition in connection with transposition of the viscera. Less commonly the latter condition is confined to the liver and the spleen, so that the spleen occupies the right and the liver the left hypochondrium. Generally the remaining thoracic and abdominal viscera also are involved in the transposition.

contains an abundance of sodium chlorid or if echinococcus-scolices or echinococ Confusion with abscess of the spleen echinococcus-cyst has undergone suppur then readily result from septicemia.

Treatment.-Cure can be effected measures. It is possible for destruction to be brought about by injections of mer

RUPTURE OF THE

Reference will here be omitted to tra such as may take place when the organ of falls, shocks, blows, or contusions. to be considered is that which occasion connection with acute splenic enlargemen infectious diseases (typhoid fever, typh malaria, miliary tuberculosis), either sp of cough, expulsive efforts, or other With the occurrence of the accident, aloud with sudden pain in the region of the statement that something within rapidly, and exhibits the manifestatio (increasing pallor, small, scarcely pal sounds, obscuration of the field of vision of consciousness). Occasionally death o convulsions. In other instances the sy or generalized peritonitis appear. The dulness is generally found increased. under all circumstances, and generall recent cases the abdomen is found fille splenic tissue.

The treatment consists in the ad (subcutaneous injections of camphorated of cognac or champagne), the applicat spleen, subcutaneous injections of extrac ence of severe pain subcutaneous injecti celiotomy and splenectomy have been su

WANDERING SE

The designation wandering spleen in which the spleen has left its usual si greater or lesser depth in the abdomina organ may be found in one of the iliac pelvis. Generally a wandering spleen ble spleen, so that it can without difficul

air, or the cover-slips are dyed at d

a gas-flame. The dry preparations ate then solutions of certain aniline stalls of 11 ATUITY ong which especially the

¿xylin solution of Ehrlich, may be recommendłod orpuscles with and without granulations can fir clo phocytes, for instance, contain no granulations d-corpuscles with granulation some can 1609 id aniline dyes, as, for instance, comm they are ophile or eosinophile cells. It is especially these cells ber in leukemic blood when the bone marrow is the are especially valuable in the diagnosis of bein colorless blood-corpuscles contain granules that cam .ne dyes, such as methylene blue basophila cel m

mast-cells. These are present in normal blood in extremely small number, while they are more numerous in leukemic blood, when the bone-marrow is the seat of disease, and they are almost even more significant in diagnosis than the eosinophile cells. The neutrophile colorless blood-corpuscles further should be mentioned, among which again those with several nuclei (polynuclear), those with a single nucleus (mononuclear), and those with a constricted or lobulated nucleus (transitional forms) are distinguishable. In triacid preparations the neutrophile leukocytes can be recognized from the fact that they acquire a violet tint. In cases of leukemia large mononuclear neutrophile leukocytes especially appear, which are derived from the bonemarrow and are designated myelocytes. These also are important in the diagnosis of leukemia, as they are not present in normal blood.

In order to determine the number of colorless corpuscles in the blood the Thoma-Zeiss hemocytometer may be employed. In healthy individuals the blood contains from 6000 to 8000 colorless, and from 4,000,000 to 5,000,000 red blood-corpuscles in 1 c.c., so that the proportion of white to red would be about 1 to 500. If large amounts of blood are available, the increase in the number of colorless corpuscles may be demonstrated macroscopically by means of the blood-sedimenting method of Welker. If blood be introduced into a high glass cylinder and be permitted to stand quietly, a red sediment, consisting of red blood-corpuscles, falls to the bottom, over which a much smaller grayish-white layer of colorless blood-corpuscles forms, and over this a layer of blood-serum. In cases of leukemia the gray middle layer undergoes a considerable and readily recognizable increase, in correspondence with the increase in the number of colorless blood-corpuscles. It is noteworthy further that ameboid movements of colorless blood-corpuscles are but slight or are wholly wanting.