These considerations should induce one to advise in suitable eases in the human being—e.g., abscess, tumor, or cystic dis ease confined to the lower half, or in hypertrophy which resists medicinal treatment—the excision of the lower half in preference to that of the whole spleen, as the same object would be at tained (the removal of the disease or the enlargement), while a considerable por tion of the spleen would be left to carry on its function: and, further, there would be as a reasonable inference, a considerable reduction in the death-rate. H. M. Jordan (Lancet, Jan. 22, '9S).
Left half of the abdomen sprayed with ether in twelve eases of enlarged spleen. From 6' to drachms of ether were sprayed over the splenic area. once daily, through a Richardson atomizer. Marked reductions in volume of the spleens were observed in all twelve cases. No bad re sults. As a rule, the affected area only was played upon, the remainder of the abdomen was covered with cotton-wool. Moscueci (Riforma med., Apr. 23. '98).
Spleneetomy has been growing rapidly in favor. and, as the operative technic improves. the mortality percentage has greatly lessened. It has been shown by experiments on animals and by observa tions on persons that it is entirely pos sible to remove the spleen form an otherwise healthy man without having any serious symptoms develop. Three hundred and sixty cases of extirpation of the spleen quoted, 138 of which were followed by death. In another series of eases quoted, 97 operations before the year 1890 showed a mortality of 42.02 per cent., and 164 between 1891 and 1900 showed a mortality of only 1S.9 per cent. Total extirpation of the spleen should never be done for leukmmie hy pertrophy, as statistics show a mor tality of 71.4 per cent. F. B. Hagen (Archly f. kiln. Chin, B. 62, H. 1, 1901).
Infarcts. — Embolism of the splenic artery most frequently arises from par ticles of blood-clot or vegetations dis lodged from the left side of the heart. If the emboli originate from ulcerative endocarditis they will contain pyogenic bacteria and infarcts will result. Such emboli occur also in pyrernia, originating in suppurative foci in various parts of the body and give rise to multiple abscesses of the spleen.
Simple non-infective emboli usually arise from benign endocardial lesions or from blood-clot, and cause simple in farction. Thrombosis of a branch of the splenic artery in acute fevers and in leu kmmia may occur and infarction result.
A simple splenic infarct is usually at first pale, but, after some hours or days, the veins of the ischremic area become filled with blood, which easily passes through their walls, as they have been rendered more permeable by the long continued amemia.
The infarct forms an irregularly tri angular mass with its base projecting slightly above the surface of the spleen. Decoloration soon takes place, and the infarct is gradually converted into a cicatrix.
If the embolus contains pyogenic micro-organisms the early stages do not differ from those of non-infectious em boli; later the infarct becomes converted into an abscess.
Abscess.—Occasionally a large single abscess is found in the spleen with signs and symptoms indistinguishable from subdiaphragmatic abscess, an abscess of some other abdominal organ, or of the abdominal wall itself.
Infective emboli from malignant en docarditis are among the most frequent causes of splenic abscess. "Hence a ten der swollen spleen with pyrexia and a cardiac murmur is a. certain sign of ulcerative endocarditis" (Fagge). In such cases softening and suppuration soon follow the occurrence of infarction. In general embolic abscesses are similarly produced and often met with. The emboli may come from suppurating foci in any part of the body. The abscesses are usually small and multiple.
Extension of inflammation from a neighboring organ usually only causes local perisplenitis, but perforating ulcer of the stomach or intestine that becomes adherent to the spleen may cause abscess in it.
Injury of the spleen may lead to sup puration by lessening its resistance to pyogenic bacteria that gain access to it through the blood.
Abscesses are occasionally met with in typhoid fever, malaria, suppurative pylephlebitis, etc.
The treatment is the same as that of any other abscess in this situation.
Tuberculosis.—In general tuberculosis the spleen is always much affected. The tubercles are more evident on the capsule than in the substance, where they are with difficulty distinguished from the Malpighian bodies. The spleen is large and soft. In chronic tuberculosis large caseous masses are not common, but oc cur in children oftener than in adults. Miliary tubercles are usually found about the masses. Before caseation takes place the masses resemble lymphadenomatous deposits, and can only be differentiated by the microscope.