THE SPLENIC PATHOLOGY OF PERNICIOUS ANEMIA AND ALLIED CONDITIONS
Archives of internal medicine (Chicago, Ill. : 1908)
The spleen is dismissed with brevity in textbooks on pathology. Current medical literature fails to reveal a serious study of its histology, normal and pathologic. In a close association with Professor Dr. Hans Eppinger and his co-workers in the von Noorden clinic during the past year, I had opportunity to study not only the microscopic material obtained from that clinic, but in addition, many specimens loaned by Banti and Weidenreich. The second part of this paper will deal with a study of the
... with a study of the duodenal contents in a series of nineteen cases with a view of presenting a relatively simple yet accurate method of measuring the pleochromie and urobilinocholie so characteristic of the above splenic pathology. PART I From Biermer's first definite and popular clinical conception of pernicious anemia in 1868 to Ehrlich's hematological studies in 1892, a host of workers contributed to the elucidation and confusion of this fatal malady. It was Syllaba in 1904 who first clearly recognized and properly emphasized the icteric feature of pernicious anemia. In a demonstration of the splenic pathology of pernicious anemia, hemolytic icterus and hypertrophie cirrhosis, before the Society for Internal Medicine in Vienna in November, 1913, Eppinger gave the profession for the first time the results of many months of labor, sug¬ gesting what certainly amounted to an innovation, splenectomy for the first and last of the above conditions. Prefacing his study of the pathologic picture in that most difficult and little understood organ with a survey of the normal histology as taught by Weidenreich, he pointed out the necessity of a proper schematic conception, to-wit: Following the blood vessels as they traverse the trabecular par¬ tition, we find when a lumen of 0.2 mm. is reached the artery leaves Submi t t ed for publication Aug. 28, 1915. From the wall and penetrates a follicle. It is now known as the central artery, and is characterized by a fairly heavy wall. From this, laterally, spring numerous follicle capillaries of very delicate structure and first demonstrated in serial section by Weidenreich. These lose their iden¬ tity in the margin of the follicle and the so-called pulp area. Follow¬ ing the central artery out from the follicle we have the pulp artery with its characteristic spindle-celled intima. This last portion now ends its existence as an artery in the so-called "Hülsen arteries" phase with its Schwaiger-Seidel wall. Via a capillary, phase communication is established with the venous sinus. This latter is generally accepted as practically a closed space, making up the bulk of the red pulp of the spleen. Lined with "Stabzellen," with their prominent nuclei, the basement membrane is probably very elastic, supported by ring fibers. The sinus empties by means of a vein, leaving the pulp and following the trabecular wall.