If this theory of the function of the spleen which I have set forth, which Ecker has adopted, and which J. has now con firmed, be correct, it will be able to explain the diseased conditions of the spleen and their operation on the organism. But this is ,at present impossible, since these conditions are much too little known to allow us to say any thing even approximatively correct and secure concerning their origin and import. There fore, instead of entering upon a discursive detail of possibilities resting upon an alto gether hypothetical basis, it seems to me much more suitable, simply to indicate the points to which future observers might pro perly direct their special attention. It is known that the enlargements of the spleen, which constitute the most serious_diseases of the organ, have a special coincidence with complaints in which either a dissolution, or some other abnormal condition of the blood is present. This is the case in typhus, typhoid cholera, pya,mia, putrid exanthemata (erysi pelas, scarlatina, measles), dyscrasia of drunk ards, ague, scurvy, purpura, chlorosis, acute rheumatism, acute tuberculosis, &c. May not the enlargement of the spleen possibly have a share in the production of these diseases, without being so entirely secondary as most pathologists have hitherto assumed ? Is it not conceivable, that in a spleen which is enlarged and distended with blood, a destruction and dissolution of the blood globules is going on on too large a scale, so that the normal composition of the blood becomes seriously prejudiced thereby ? In such a case the blood would be poorer in blood globules, but its plasma would be rich in colouring matter, and possibly at first in fibrine, as J. Beclard found it to be in his analysis. May not chlorosis or scurvy, in avhieli a considerable diminution of the blood corpuscles has been shown to exist, possibly depend in part on the dispropor tionate activity of an enlarged spleen ? In consequence of such a too considerable de struction of blood globules in other cases, further changes of the blood may be induced, which may then end as an overcharging of the fluid with colouring matter ; to wit, with the colouring matter of the bile; or as a py mmia or the so-culled white blood. On the other hand, is it not possible, that in cases of the temporary diminution, or inflanimation, or de generation, or atrophy of the spleen, other organs may undertake its functions ?—as, for instance, the liver, which, indeed, is usually hypertrophied in such cases.; or the general mass of blood, a state which must again give rise to peculiar phenomena ? Thus, in re spect of its pathology there is much which might yet be observed, if I did not consider it more suitable to conclude with the remark, that in order to the building of a larger super structure upon the anatomical and physi ological basis here given, and in aiming at anything respecting the pathology of the organ, a deliberate, careful inquiry is above all things necessary, an inquiry in which chemical analysis, microscopical research, experiment, and pathological experience, will have to go hand in hand. For if I have perhaps been able
to elucidate the spleen in many respects more correctly than my predecessors, yet this ac count is very far from a final termination of our knowledge, and must be regarded as nothing more than a foundation-stone for an altogether new superstructure.
Morbid Anatomy.— Variations in number and form have already been alluded to. The absence of the organ is usually or always accompanied by that of otber and neighbour ing viscera.
On account of the obscurity which has hitherto attached to the anatomy of the organ, its diseased conditions are little understood ; and it is obvious, that until morbid conditions of the spleen are examined and classified with reference to the appearances of their several anatomical constituents, there will be little to be said under the head of morbid anatomy, besides enumerating the most prominent de viations of its bulk, colour, and consistence.
Enlarg,ement of the spleen is, perhhps, the most common of all the outward deviations. We have already seen that, within certain and very wide limits, the size of the spleen may vary, and that these wide variations are of constant occurrence even in the healthy sub ject, being intimately associated with its !Unc tion and that of the organ. It is, therefore, only when such enlargement becomes exces sive, or is associated with an alteration of texture, or occurs in the course of some of those diseases which it is known usually to accompany, that we are justified in regarding it as essentially morbid.
The enlargement of the organ, to all out ward appearance, depends mainly on the in creased mass of the contained blood, and is hence sometimes called hyperwmia ; and the most obvious distinction of this enlargement is into two kinds :—one in which the conges tion is produced mechanically ; the other, in hich the determination of blood to the organ can only be accounted for on the supposition of non-mechanical causes. The former of the two classes would include the swollen spleens which occur in obstructions of the portal vein, or of the vena cava, as happens in some diseases of the liver and heart respectively.