AFFECTIONS OF THE SPLEEN The spleen becomes enlarged in many infectious diseases, as in typhoid, paralysis of recurrent laryngeal nerves, malaria, tuberculous meningitis, parotitis. Considerable enlargements occur in leukaemia. pseudoleukannia, and brief mention may be made of echinococcus of the spleen.
Of rather frequent occurrence is anomaly of position, splenic ptosis. It is found even in infants and is nearly always associated with a general flabbiness of the entire musculature, especially that of the abdomen, often also with a diastasis of the recti muscles. In older children there is usually a general enteroptosis including the downward displacement of liver and kidneys. Generally these children are languid, of marked nervous irritability and Knoll appetite. In these cases the complaints depend not so much on the displacement as on the nerves, and only occasionally has a disturbance originating with the spleen (kinking of the intestine) been observed in adults. The diagnosis is established from the general condition; again, the prolapsed spleen is much softer than one really enlarged. The therapy endeavors to improve, the ner vous complaints, the general circulation, to effect a slight fattening, and is therefore to follow the same directions as in infantile anemia where a similar enteroptosis is occasionally observed.
The so-called rachitic enlargement of the spleen is not a typical accompaniment of rachitis, as has been stated by Henoch. Sasuchin found splenic enlargement 12 times in 63 cases, Geissler and Japha 22 times in 75, Cohn only 5S times in S5S cases. Sometimes it is only simulated by prolapse with engorgement, and for this reason a spleen which was distinctly palpable during life, is sometimes not found en larged at autopsy. Real enlargement, however, may sometimes have a connection with a coexisting anaemia. Enlargement of the spleen is probably not caused by rachitis, but at the most by a factor similar to the one which caused the latter.
Syphilitic splenic enlargement sometimes occurs quite indepen dently. In congenitally syphilitic infants it is not found so frequently as is sometimes stated. On the other hand there are sometimes very considerable enlargements in older children with congenital syphilis, although recent syphilitic manifestations need not be present. Some
times the diagnosis can be established only from the history, in other cases the condition is indicated by infantilism and Hutchinson's teeth. Usually there is also an enlargement of the liver, in rare eases syphilis of bones and joints. These manifestations are difficult to treat even by energetic antisyphilitic therapy.
The so-called Banti's disease (anania accompanied by spleno megaly) begins, according to this author's description, with enlarge ment of the spleen which, in conjunction with anmmia, may in the course of years assume considerable proportions. The an conic stage having lasted for several years is complicated by ascites and hepatic cirrhosis, and the patient dies from hemorrhages under dropsical manifestations (Senator). The blood findings are characterized by considerable oligo chrormemia, then ofigoeythfemia, also leukopenia, with a preponderance of lymphocytes. Banti attributes the affection to an intoxicating process emanating from the spleen, and indeed some authors (Maragliano, Bessel-Hagen) report having effected cures by extirpating the spleen. The affection has often been observed in children (Osier 11-year-old girl, Morse 7-year-old boy, Senator 15-year-old boy, Pribram old boy). The diagnosis can only be established after exclusion of all other causes of enlarged spleen. The only cure is held to be the ex tirpation of the spleen, while leukaemia is not influenced by this opera tion. Latterly, Chiari, Marchand, looked to late hereditary syphilis for the cause of similar cases, because a distinct lobulated liver was discov ered at autopsy. According to this finding the liver must be at least involved simultaneously with the spleen, and the extirpation of the spleen would simply act like Talma's operation on the existing ascites. If these reports should be verified for at least part of the cases, the therapy ought to be antisyphilitic; the effect, however, can only be conditional, because the pathological process has already partly run its course by the time it comes under observation.