THE ROLE OF THE SYMPATHETIC IN SENSORY CONDUCTION AND CERTAIN NEURALGIAS *

the danger in this condition is too considerable; it is unfortunate that the splenic vein runs into the portal, but so it is. Of malarial spleens, of kala-azar, and of Egyptian splenomegaly, which some people think is bilharzial, I have no experience, but in the latter the practice of splenomegaly is well established. Gaucher's disease is now well recognized as a metabolic fault, a lipoidal dystrophy, in which the spleen is involved, and no hope of affecting the fundamental disturbance by splenectomy would be held out if that were the whole story. It may, however, be associated with a critical haemopathy. In one of my cases there were attacks of haemoglobinuria in which the haemoglobin fell as low as 17 per cent. Blood transfusion in that case was of no help, for it precipitated a lysis and determined haemorrhages that threatened death. It is now some years since that patient's spleen was removed and, though at times blood crises of minor severity have occurred, she remains in what she considers good health and leads an active life. The von Jaksch type of splenic anaemia that occurs in childhood has been supposed to have a toxic or specific infective origin and to be recoverable, but in my small experience it has not been possible to demonstrate any source of poisoning, and the duration of the disorder-even though much improved by splenectomy-makes it improbable that the disease is different in origin from other forms of splenic anaemia. In lymphatic leukaemia nothing at present is to be gained by operation. It is perhaps permissible to say this in defence of splenectomies that do not cure the underlying disease: that the patient when asked is always ready to state that he or she would not willingly return to the preoperative state.