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m ARCHIVES OF INTERNAL MEDICINE clinic the values lay within normal limits. The lesions tended to run a chronic course, and neither local therapy nor, in the case of diabetics, general management tended to speed their healing. In some cases the lesions slowly receded and left depressed scars.
Two ideas regarding the pathogenesis of this condition have been considered: (1) that which assumes the occurrence of a primary vas cular injury, possibly by circulating toxins, with secondary thrombosis, necrosis, and fat imbibition and (2) that which assumes a local lipoid disturbance in the skin, based on a general disturbance in fat metab olism. Neither hypothesis has proved satisfactory in the light of studies made both here and elsewhere. Therefore, the pathogenesis of this condition remains obscure.
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BANTI SYNDROME (FIBROCONGESTIVE SPLENOMEGALY)
DEFINITION, CLASSIFICATION AND PATHOGENESIS
PAOLO RAVENNA, M.D.
CHICAGO
The Banti syndrome is still an unsolved problem. The question of cardinal importance is whether the splenomegaly is primary or secondary to portal or hepatic changes.
Banti1 2st3ated the belief that the trouble lay primarily in the spleen and that the portal and hepatic changes were dependent on the splenic ones. The idea that the splenomegaly was the consequence of circulatory disturbances was put forward by Dock and Warthin * and further devel oped with the description of the thrombophlebitic splenomegaly.* This theory occupied a position of definite advantage when it was recognized that the structure of Banti splenomegaly was chiefly congestive 4 and that
1. Band. G.: La splenomegalia con cirrosi epatica, Speriincntalc (sez, bid.) 48:407, 1894; La itiioiiigjilic uvee cirrliotc du foie, ScimiSuc mid. 14:318, 1894; Ueber Morbus Banti, Folia haemat. 10:33, 1910.
2. Dock, G., and Warthin, A. S.: A Clinical and Pathological Study of Two Cases of Splenic Anaemia, with Early and Late Stages of Cirrhosis, Am. J. M. Sc. 127:24, 1904.
3. (<r) Cauchois, A.: Splenomegalies chroniques d'origine pylithrombosique, Thesis, Paris, no. 422, Paris, G. Steinheil, 1908. (b) D6v, F.: Splinomigalie chronique avec animie d'origine pylethrombosique, Normandie mid. 23:109 (March) 1908. (r) Warthin, A. S.: The Relation of Thrombophlebitis of the Portal and Splenic Veins to Splenic Anaemia and Band's Disease, Internat Clin. 4:189, 1910. (d) Eppinger, H.: Hepato-lienale Erkrankungen, Berlin, Julius Springer, 1920. (O Frugoni, C.: La splenomegalia trombofiebitica primitiva, Arch, di pat. e din. med. 3:574 (Dec.) 1924; La splinomegalie thrombophlibitique, Rev. beige sc. med. 10:227 (April) 1938. (/) Ceconi, A.: La splenomegalia trombofiebitica, Gazz. d. osp. S0:26S (March 3) 1929. (g) Klemperer, P.: Cavernom&tous Trans formation of the Portal Vein, Arch. Path. 4:353 (Sept.) 1928.
4. (a) Greppi, E.: II tumore di milza contrattile emorragiparo come probabile forma di splcnoangiopatia primitiva, Minerva med. 2:644 (Sept. 22) 1928; Die contractile MUztumor und seine Beziehungen ztir thrombophlebitischcn Splcnomegalie, Verhandl. d. deutsch. Gesellsch. f. inn. Med. 40:615, 1928. (b) Villa, L.: II signilicato semiologico della contrazione di volume della milza mediante adrenalina par la diagnosi delle splenomegalie voluminosc, Boll. d. soc. med.-chir., Pavia 3:479, 1928; Cuore e circolaz. 12:465, 1928. (r) Larrabce, R. C.: Chronic Congestive Splenomegaly and Its Relationship to Banti's Disease, Am. J. M. Sc. 188:745 (Dec.) 1934. (d) Rousselot, L. M.: The Role *of Congestion (Portal Hypertension) in Sn-Cullcd Banti's Syndrome, J. A. M. A. 107:1788 (Nov. 28) 1936.
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