4. Later, after many months, a moderate eosinophilia occurs.
We have ourselves been able to investigate three conclusive cases.
The first was a patient, which we were ourselves enabled to investigate by the courtesy of Dr A. Neumann. The patient's spleen was removed by E. Hahn on account of an echinococcus on Feb. 5, 1895. One may well assume that before the operation the spleen no longer discharged its normal function. On Sept. 2, 1897, we found the following numerical proportions:
| Polynuclear neutrophil | 76.5%, |
| Lymphocytes | 18.4%, |
| Eosinophil | 3.4%, |
| Large mononuclear | 1.1%, |
| Mast cells | 0.4%. |
A condition therefore which was quite normal. In this connection it must be mentioned that an incipient phthisis pulmonum existed at the time, to which we must attribute an increase of the polynuclear elements, and without which the percentage figures of the lymphocytes and eosinophils would perhaps have been greater.
For the knowledge of the two other cases we are indebted to the kindness of Professor Jounescu of Bucharest. The one case was of a man of about 40 years of age, in whom splenectomy was undertaken on Sept. 27, 1897, for an enlarged spleen. Healing by first intention. The white blood corpuscles were permanently increased. The proportion of white to red was 1:120 to 1:130, the average number of red was 3,000,000. Our own examination of preparations obtained some two months after the operation, shewed a distinct lymphæmia, and also a preponderance of the larger lymph cells. The eosinophil and mast cells were plainly increased. We are unable to give more exact numerical data, as the preparations sent to us were not spread with sufficient regularity.
From the second case, which was also operated upon for enlargement of the spleen, we unfortunately only obtained much damaged preparations. Nevertheless so much could with certainty be established—that there was no considerable increase of the lymphocytes. The eosinophils on the contrary were increased distinctly, the mast cells to a lesser extent. It is probable that the increase of both of the latter kinds of cell was not a consequence of the extirpation of the spleen alone, but rather the expression of the reactive changes, which had already begun before the operation, from the exclusion of the splenic function.
Cases of splenectomy of this kind are transitional to the chronic diseases of the spleen. The latter present great difficulties, for one never knows how far in the most chronic diseases the other organs are damaged or influenced by the general illness.
An increase of the lymphocytes, so long as an affection of the lymphatic glands may be excluded, should be referred to functional exclusion of the spleen.
On the other hand, an increase of eosinophil cells associated with a chronic tumour of the spleen, is analogous to Kurloff's secondary reaction of the bone-marrow. Such cases are frequently found in the literature. For instance Müller and Rieder bring forward three cases of splenic tumour caused by congenital syphilis, cirrhosis of the liver, neoplasm in the cranial cavity, and in which the numbers of the eosinophils amounted to 12.3%, 7.0%, 6.5% respectively. In three cases of acute splenic tumour in typhoid fever the figure 0.31% with a maximum of 0.82%, was found. These authors have already raised the question "whether the increase of the eosinophil cells is connected with the splenic tumour or the bone-marrow? Perhaps the functional activity of the latter is vicariously raised to meet the more or less complete exclusion of the spleen from the formation of the blood; since Ehrlich has distinctly asserted that the probable place of formation of the eosinophil cells is the bone-marrow."