capsule of the gland, particularly on its convex surface, is thickened, and, perhaps, the seat of fibrous patches, or even of adhesions to neighbouring organs. Many of the trabeculæ forming the framework of the gland become greatly hypertrophied. On section, the tissues of such a spleen are found to be moderately firm, and usually of a reddish-brown colour; but when death happens soon after or during a febrile attack, the section of the gland shows a dark surface from deposit of hæmozoin, the pulp at the same time being softened. Perhaps from over-distension some of the vessels in the interior of the gland give way, and then there is a breaking-down of the spleen pulp in patches, the remains of splenic tissue floating about in the extravasated blood. Microscopical inspection of these hypertrophied spleens, especially during fever, shows the black and ochre pigments in the situations already indicated.
"Splenic index"—— There are practical points in connection with malarial spleen which deserve mention. The relative absence, or prevalence, of these enlarged spleens or " ague cakes " in the native population is an excellent rough indication of the salubrity or the reverse, as regards malaria, of any particular district. Wherever they are common the district is malarious, and therefore unhealthy, perhaps to Europeans deadly, and should be looked upon as extremely unfavourable for either camping or residential purposes.
Liability to rupture of splenic tumours.—— Another practical point is that these enlarged spleens are easily ruptured by a blow on the belly. In hot and malarious countries many a coolie goes about doing his work although he has an enormous spleen. This is a fact to be remembered in administering even mild corporal punishment to natives of malarious countries. Europeans have more than once been tried for manslaughter in consequence of neglecting it. Owing to this liability to rupture, the subjects of splenic enlargement must not be allowed to play at violent games, as football or even cricket, or at any game in which the diseased organ is exposed to a blow,
