Lard a c e o us Disease.—Waxy deposit takes place probably more frequently in the spleen than in any other organ, and it may be alone affected. The deposit may exist in the Malpighian bodies or the substance of the spleen. In the for mer and more common form the capil lary walls in the _Malpighian bodies are affected. The Malpighian bodies are much enlarged and gray in color, re sembling sago-grains; hence the name "sago" spleen. The organ is somewhat enlarged and anemic.
In the latter and rarer form the ar teries of the splenic substance are af fected, the Malpighian bodies usually escaping and later becoming atrophied. Lardaceous deposit takes place in the pulp later, and the spleen may become much enlarged and converted into a large, resistant, pale mass with rounded edges.
Tumors of the Spleen.—Primary car cinoma of the spleen is of doubtful oc currence, and even secondary infection is rare. The peritoneal coat and the connective tissue of the hilum may be come involved by extension of disease from the stomach, peritoneum, or retro peritoneal glands. The growth may then invade the gland directly or extend along the vessels from the hilum. Primary sarcoma may occur, and a few cases have been described. Secondary growths are not very rare.
Cysts of any kind in the spleen are rare. Simple serous cysts are occasion ally met with. Small ones on the surface may result from a dilated lymphatic vessel. Traumatism may be followed by a cyst containing blood or debris from previous hemorrhage. Ifydatid cysts occur occasionally in the spleen, which alone may be affected, or in association with other organs, especially the liver. In half the cases there are no symptoms. Innocent tumors of the spleen other than cysts scarcely ever occur.
Wandering Spleen.—Many errors in diagnosis have occurred from wandering spleen. The organ may be found in any part of the abdomen, and it is often ex tremely mobile, especially in women who have borne children. It may cause great discomfort, rolling about like a foreign body. If twisting of the pedicle occurs
it may be followed by gangrene or atrophy of the organ. It may become adherent to any organ and drag it out of its place.
The diagnosis may be difficult, the mass being liable to be mistaken for tumors of the ovary, kidney, pancreas, etc. Its shape, the notch on its anterior border, and the evidence of its absence from its normal situation may make a diagnosis possible.
TREATMENT.—In some cases it can be retained in position by a well-fitting ab dominal bandage. If this fails it can be exposed and sutured in place. When this fails and it is giving discomfort it should be removed.
Spleneetomy for wandering spleen is not only justifiable, but is a highly suc cessful operation, the rate of recovery being equal to that of ovariotomy in skilled hands. A score of eases per formed within the last twenty years without a death have been collected. Bland Sutton (Lancet, Jan. 16, '97).
Perisplenitis.—This may be local or general.
Local perisplenilis may result from many causes, among the most frequent being the extension of inflammation from diaphragmatic pleurisy and from the pleurisy occurring in pneumonia of the base of the left lung. It may also be secondary to inflammation of some other abdominal organ. In other cases it originates from some cause within the spleen, as infarcts, tubercle, and lym phad enom a.
General perisplenilis usually arises from chronic peritonitis which may affect the whole peritoneum. It resembles closely the condition in perihepatitis. The spleen is covered by a dense membrane of irregular thickness. Its outer surface is fairly smooth, but shows many pit-like circular depressions similar to those seen on the liver. They are probably due chiefly to disturbance of the exudate dur ing the plastic stage by respiratory and other movements of the spleen and partly to ruptures caused by cicatricial contrac tion that took place during the organiza tion of the exudate. Adhesions may be absent in these cases.