1823 the thyroid gland in Graves's disease. The thyroid is distended with blood, its tissues are in a state of hyperplasia, and its normal secretion is poured out in increased and toxic amount. We do not wish to press the analogy, but to emphasise the point that a disease of the thyroid is not assumed to be present in Graves's disease, but only a disturbance of function, and that similarly a disease is not necessarily present in the spleen in splenic anaemia, but simply a disturbance of

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... . If this be accepted, and if it be recognised that this disturbance of function will usually hava a fatal termination, the operation of splenectomy will be fully justified and will probably be more extensively carried out in the future than it has been in the past. As regards the ultimate result of the operation we can only give particulars in one case, the other having been so recently operated on. The first patient when seen at the age of 17 years, four years after the operation, was a healthy girl without any signs of splenic anaemia. This result may be contrasted with the fate of her sister, who died at the age of 13 years from progressive anasmia and debility. In the published cases of this disease in which the spleen was successfully removed the ultimate result seems to have been a complete cure, records having been obtained up to eight years after operation. It is probable that the two factors present in our cases, the youth of the patient and the comparatively early stage of the affection, were of importance from the point of view of prognosis. While a preliminary course of medical treatment will naturally be adopted in all cases of splenic anasmia, experience has shown that it is never curative, and if the diagnosis is clear treatment by splenectomy should not be unduly delayed.