. Les maladies de l'enfance et l'enfance : conçu pour l'utilisation d'étudiants et de praticiens de la médecine. ughpalpation. J'ai rarement manqué à palper la rate satis-bien. L'élargissement de la rate est trouvé dans rachitisme, chronicgastro-entérite, septicémie, la fièvre typhoïde, paludisme, la varicelle, l'ilis-syph, anémie infantile pseudoleukemica, leucémie, maladie de Hodgkin, la syphilis congénitale, la cirrhose du foie, la dégénérescence amyloïde, heartdisease, et l'ictère catarrhal simple. Les MALADIES DE LA RATE 719 de ces déclarations, il sera considéré que l'élargissement de l'thespleen dans une fantaisie

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. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. ughpalpation. I have rarely failed to palpate the enlarged spleen satis-factorily. Enlargement of the spleen is found in rachitis, chronicgastro-enteritis, sepsis, typhoid fever, malarial fever, varicella, syph-ilis, anemia infantum pseudoleukemica, leukemia, Hodgkins disease, congenital syphilis, cirrhosis of the liver, amyloid degeneration, heartdisease, and simple catarrhal jaundice. DISEASES OF THE SPLEEN 719 From these statements it will be seen that enlargement of thespleen in fancy and childhood is pathognomonic of no one disease, and should not lead to any one conclusion. It is only corroborativein the presence of other signs and-SATnptoms. Without a very thoroughand painstaking examination of the blood, the significance of theenlarged spleen in the febrile and afebrile affections cannot be deter-mined. In enlargements of the spleen such as are met in rachitis, heart disease, syphilis, chronic gastro-enteritis, icterus, varicella, examination of the blood mav not be llecessar^?.. Fig. 19S.—Method nf p:t, li>i, tiii[i the spleen. Splenic and Kidney Tumors.—In rare cases in which sarcoma ofthe left kidney is suspected, it may be necessary to exclude tumorof the spleen. An enlarged spleen is smooth on the surface and has a sharp anterioredge interrupted by an indentation—the hilus. The tumor is pointedand sharp below. It can be grasped deep in the lumbar region behind. Kidney tumors are irregular on the surface and marked out intolobes, some of which may be cystic. The tumor projects upwardbehind into the lower part of the chest. The whole lumbar regionis flat on percussion. The borders of the tumor are rounded. On theother hand, I have made an autopsy in a case of cirrhosis of the liverand spleen in which the latter organ during life showed uneven tumorson its surface (gummata). The physician must be partly guided by the history of a case. Theurine shou

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