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Symptomatic Enlargement of the Spleen

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SYMPTOMATIC ENLARGEMENT OF THE SPLEEN The spleen is enlarged in many infectious diseases, as for example in typhoid, malaria, tuberculous meningitis, and parotitis. Enlarged spleens are present in leukaemia, pseudoleuktemia and also in ecchino coccus of the spleen.

Ptosis of the spleen is an anomaly of position of rather frequent occurrence. It is found in nursing infants and is almost invariably associated with a general relaxation of the musculature, especially the abdominal muscles. A diastasis of the recti muscles is quite frequently present. A general enteroptosis is usually found in older children, associated with ptosis of the liver and kidneys.

These children as a rule are easily fatigued, show nervous irritability and poor appetite. The symptoms depend more on their nervous condi • tion than on the ptosis. This disturbance among adults is seen only occasionally, depending on this condition of the spleen (twisting of intestines).

The diagnosis is made on the general condition. The spleen in ptosis is found to be softer than in a really enlarged spleen.

The treatment should be directed toward the improvement of the nervous condition, circulation of the blood, forced feeding, etc., as in anemia of children, among whom this condition of enteroptosis is occasionally seen. Arsenic is of special value.

The so-called rachitic spleen tumor is not a typical concomitant symptom of rachitis, as pointed out by Henoch. Lasuchin found enlarged spleen present in 12 cases among 66, Geissler and Japha in 22 cases among 75, Cohn of S5S eases in only 58 cases. At times a ptosis of the spleen with resulting congestion resembles an enlarged spleen when on autopsy the spleen is not found enlarged but which during life was distinctly palpable. A real spleen tumor, however, may occur in connection with

aniemia. It is certain that splenic enlargement is not caused by rachitis, but is rather secondary to a similar pathological process.

Syphilitic spleen tumor sometimes appears quite independently. In young children with congenital syphilis it does not occur nearly as frequently as is stated. But very large spleen tumors are seen in older children with congenital syphilis even when no recent syphilitic symp toms are present.

The diagnosis may depend only on the history; in some eases it may be made from the greatly weakened physical condition, Hut chin son's teeth, and in doubtful cases from a positive Wassermann reaction. As a rule there is associated with it an enlargement of the 1k-er and in rare cases severe bone- and joint-syphilis. These lesions do not yield readily to the most energetic antisyphilitic treatment.

There is a disease, endemic in India and occasionally occurring in Russia, which is characterized by anemia, swelling of liver and spleen, called kala-azar. Fever is present but no icterus. Cachexia is marked as the disease approaches a fatal termination. Aspiration of the spleen yields a fluid containing Leishman's bodies, stained after the method of Gientsa-Roinanowski. Bedbugs are believed to be the carriers of the disease. Among those afflicted are many children. Sluka and Zarfl reported a case of a Russian child coming from Russia, so it is well, therefore, to keep this disease in mind.