MORBUS BANTI Clinical disease begins, according to Banti's descrip tion, with a spleen tumor accompanied by anemia, the tumor becoming quite large in the course of years. After a duration of 3 to 10 years the anientic stage is followed by a transitional stage with icterus and gastro-intestinal disturbances lasting several months; later ascites and cirrhosis of the liver develop, with an occasional rise of temperature in some cases, and there are cedema and hemorrhages as the disease reaches a fatal termination.
Examination of the blood shows marked oligochronnemia, aligo cyt hefemia, also leukopenia, the lymphocytes being increased; the increase of lymphocytes however is not always marked, not even in the case of Caro verified by operation.
disease has frequently been found among children (Osier, eleven-year-old girl, Morse, seven-year-old boy, Senator, fifteen year-old boy, also Pribram, Dose and Finkelstein).
is marked sclerosis of the splenic vessels (also endophlebitis of the splenic veins), sclerosis of the portal vein, change in the stroma of the spleen with formation of new connective tissue and principally with fibrous degeneration and destruction of the spleen follicles; later an interlobular atrophic cirrhosis of the liver develops, which, however, is never very marked.
Banti believes that the disease is a toxemia originating in the spleen, demonstrated by the fact that extirpation of the spleen has undoubtedly been followed by marked improvement. It has been observed that certain material and body substances as spleen cells may reach the liver by way of the splenic veins. Those who regard the disease as a toxlmnia originating in the gastro-intestinal tract may base their opinion on Caro's finding of an achylia gastrica in his case. It seems, however, that many cases of quite a different nature are classed with this disease only because of a certain remote similarity. In a case of Eden, a thrombus of the portal vein was the cause, in a case of lledenin there was found on autopsy a stenosis of the "valvula Bauhini" and the disease no doubt developed from a spreading of the inflammation to the portal vessels.
The recognition of the disease is rather difficult. One case, greatly im proved after operation, showed syphilis of the liver two years later on autopsy. Chiari and Marchand had to diagnose syphilis in some cases resembling typical morbus Banti, because of syphilitic scars found on autopsy. Many pathologic anatomists regard the disease as identical with cirrhosis of the liver and point out the fact that precirrhotic spleen tumors do occur, as well as a greatly enlarged spleen in connection with cirrhosis of the liver. On the other hand, Bleichroeder is of the opinion that cirrhosis of the liver has its origin in the portal vein and should be classed with diseases of the blood. Although not all these conclusions
can be accepted, it is nevertheless possible that the same toxin on the one hand attacks the blood and blood-forming organs, on the other hand the liver, and the favorable result following extirpation of the spleen is not sufficient proof that the origin of the disease is in the spleen.
A positive diagnosis can be made only after all other causes of spleen tumor can be excluded, as for example chronic leukaemia and lympho sarcoma of the spleen. According to above facts, the differentiation from liver cirrhosis (especially on a syphilitic basis) is rather difficult or even impossible. The primary large spleen tumor and the blood picture above described speak for Banti's disease, as well as the patho logical finding, which in case of morbus Banti is an indurated, in case of cirrhosis of the liver a soft, spleen.
Treatment.—Extirpation of the spleen has many advocates. Ac cording to Banti the spleen is the cause of the disease, while others believe this operation beneficial only because of its effect on the existing ascites. The result in some cases is certainly gratifying, as shown by the cases following splenectomy reported by Maragliano, Bessel, Hagen, Armstrong, and Caro. The case of Caro, which was carefully observed, proves that even the anemia disappears after operation. The operation, however, is not without danger. Shiassi has, therefore, advised a spleno cleisis. Owing to the limited material we do not know the duration of the beneficial results of the operation. The course of the disease extends over a number of years even without operation. The writer has under observation a case of morbus Banti in a man who had an enlarged spleen eight and a half years ago, and the first attack of five years a-go, also a case in a boy of sixteen years for five and one-half years. As in the majority of the cases syphilis seems to be the etiological factor, a trial of antisyphilitic treatment would appear rational, although the results are limited because the process has, as a rule, run its course when the disease comes under observation. Hering reports one case where X-ray treat ment was followed by good results after an attempt at operation proved fruitless because of adhesions. The writer can not report success with X-ray treatment in his cases. Continuous sun-baths (the body was exposed to the direct rays) resulted in marked improvement in a case already suffer:ng from serious circulatory disturbances; the improve ment has lasted for years. It is possible that there is a development of vessels between the spleen and the abdominal wall.