SPLEEN, DISEASES OF THE. These do not appear to have been much studied in this country, because they do not very frequently occur; they are, however, by no means of unusual occurrence in moist climates, whether warm or temperate, as Italy, Holland, South America, and some parts of India ; in fact, wherever malaria exists. The spleen is liable to many sorts of disease : Dr. Bigsby Cyclop. of Pract. Med.') enumerates as many as ten, but of these only the most important can be here noticed. Spleuitis, or inflammation of the spleen, may be either acute or chronic ; though Dr. Bailie remarks that this organ is much less subject to inflammation than many other of the abdominal viscera. (f Posthumous Lectures and Observations on Medicine,' 1825, unpublished.) Acute inflammation of the spleen, together with heat, fulness, and tenderness in the splenic region, with pain upon pressure, is accompanied with the usual pyrectic signs, and often with a pain extending over the whole of the abdomen, but particularly in the left side, and shooting from the diaphragm to the left shoulder. There is also not unfrequently a dry short cough, and sense of constriction in the priccordia, sickness, or nausea, and a discharge from the rectum of black or livid blood, from a rupture of some of the splenic vessels. Of this disease a remarkable instance, which terminated in nine days, has been recorded by Dr. Ley, in the Transactions of the College of Physicians of London' (vol. v. p. 304). The texture of the spleen after death was in this case so altered as to resemble an extremely soft piece of sponge, of which the cells had beeu filled with an intimate mixture of pus and grumous blood. On placing it in water, innumer able vessels, as fine as the fibres of swans' down, floated separately, rising from every point of the superficies of the organ. The contents of this spongy mass having been removed by repeated washings, some thing like an attempt at the formation of cavities to contain the matter manifested itself. No regular cyst however had been formed. All the other viscera, abdominal and.thoracic, were healthy, except the uterus, whose inner surface was gangrenous. The common causes of inflam
mation of the spleen are much the same as those of inflammation of the liver, namely, suddenly suppressed perspiration, especially from currents of cold and damp air, and excess of spirituous potation ; sometimes, however, the cause is too obscure for detection. With re spect to the treatment, the usual antiphlogistic remedies may be employed, but promptly and energetically. Dr. Baillie says, he is not aware that inflammation of the spleen would require a different treat ment from that of other viscera.
If after a certain period the inflammation do not yield, it assumes the chronic form, in which the variation in the severity and duration of the complaint is very great. If it has accompanied ague, the symp toms may possibly not have been urgent in the outset, but it is almost always a painful as well as formidable disease. It commonly lasts for some mouths, and may continue for years with remissions. With respect to the terminations of chronic resolution does not take place often ; suppuration is also rare upon the whole, and Dr. Baillie says he " had never met with au abscess in the spleen in all the dead bodies which he had examined." When pus is formed, it is of the ordinary creamy kind, but is sometimes concrete ; it varies in amount from a few ounces to many pounds. The matter may find its way into tLe stomach, colon, or peritoneal cavity; it may burst into the left side of the cheat, or into the lungs, inducing symptoms of phthisis ; or it may empty itself outwards through the abdominal walla. Ossification of the spleen after inflammation is rare, as is also gangrene; softening, induration, and hypertrophy, especially the last, are much more common. With respect to the treatment of chronic splcuitis, perhaps the best plan that can be adopted is the combination of aperients with iron and sedatives; the good effects of mercury in this disease being now generally considered precarious, trivial, and at best temporary. Local applications, such as cupping, issues, sctons, are sometimes productive of great benefit.