Besides the inflammatory softening of the spleen, there is another of a character quite peculiar, and unattended by any of the characteristics of inflammation, wherein the structure of the spleen is more or less destroyed, and it is often reduced to a simple bag, containing a sub stance which varies from the state of clotted or grumous blood to that of tar. This was very frequent in the Walcheren fever, in which cases the spleen was usually found after death of great size, and generally a mere bag filled with a liquid like tar, and weighing from three to five pounds.
One of the most common diseases of the spleen is hypertrophy, the most usual causes of which are ague and remittent fever. It is there fore chiefly to be found where these are cndemical, but it is not very uncommon in any part of Great Britain. The size which this organ sometimes attains is enormous, and it is surprising to find how long persons can carry about with them very enlarged spleens, and at last die of some other disease. Dr. Bigsby quotes from Lieutaud the case of a woman who had for seventeen years a spleen weighing thirty-two pounds; similar facts are to be found in Haller. Dr. Bailie mentions (f Posthumous Lectures ') having met with cases where it was so large as to occupy nearly all the left side of the abdomen, extending from the diaphragm to the pelvis. When the enlargement is so considerable that the lower end of the spleen can be felt under the margin of the ribs upon the left side, there can be no doubt with respect to the disease. When the hypertrophy does not reach this extent, its most characteristic symptoms, are a sense of weight in the left side, with or without evident swelling ; inability to lie with ease on the right vide; debility, without corresponding emaciation ; disordered stomach, irritable buwele, dry cough, and absence of fever. The spleen, when enlarged, is always felt to be harder than in a natural state, but pressure upon it with the hand seldom produces pain. An hypertrophy of the spleen is sometimes followed by aseites; but there will frequently be no dropsy of the abdomen, oven where this organ has been for a long time much enlarged. When this form of disease has been connected with ague, it more frequently subsides than in any other case; and the quince, which has been prescribed to cure the latter affection, will pro bably be serviceable also to the former. " Wlien the enlargement has taken place independently of this cause," says Dr. 13aillie, " it hardly ever subsides of itself, or is materially diminished by medicine. According to my experience, mercury, administered both externally and internally, produces very seldom any good effect ; I have seen, I think, more advantage from a setun inserted under the skin which covers the spleen. In some cases it has appeared to be diminished in size by this remedy, and to be rendered softer ; but I do not recollect a single instance, except after ague, in which it has been reduced to nearly its natural size. Temperate living, abstaining from violent exercise, and keeping the bowels open, must be to a certain degree useful in retarding the progress of the disease." The remedy largely employed in India for the cure of chronic tumour of the spleen is a compound of garlio, aloes, and sulphate of iron. When emaciation
and diarrheas are present, the garlic and aloes are macerated in brandy ; under other circumstances, in vinegar. The proportion of aloes is so regulated as to produce three evacuations daily ; and the medicine also produces copious secretions from the kidneys. The Decoctura Aloes C'ompositum with the Tincture or Acclum would probably prove equally effectual. The mesa, and even the actual cautery, have been recommended for this disease ; and emetic cataplasms of tobacco leaves, renewed constantly so as to keep up frequent vomiting, have in some instances produced the happiest effects.
Atrophy of the spleen is by no means so common as hypertrophy ; and though some instances arc related by modern writers, yet their statements are so meagre and unsatisfactory, that no use can be made of them. It is sometimes found exceedingly small and even shrivelled wheu some other organ is much enlarged, where there have been great discharges of blood, in ascitea, and in extensive chronic" disease. This form of disease of the spleen obviously admits of no remedy.
llydatids in the spleen are found now and then, but not very often ; Dr. 13aillio had never met with s single case of them. It is hardly possible to discover their existence during the life of the patient, nor, even if it were more easy, could the complaint receive any cure, or even amendment, from medicine. The disease arises quite uncon sciously to the patient ; the first intimation of its existence being debility, dyspepsia, and the uneasiness created by a slowly increasing tumour, which in its progress causes further derangement by com pression and displacement of other organs, and becomes itself per ceptible externally. It is only when the containing membrane, or some organ, becomes inflamed, that fever, pain, and their fatal con sequences ensue. llydatids may prove fatal by passing into the peritoneal cavity from ulceration of the containing sac, or by disturbing the circulation, or by irritating other viscera; or the patient may live very long with this complaint, and die eventually of another disease during the indolent continuance of this.
Melanosis and calculi of the spleen are noticed shortly by Dr. Bigsby, but the instances are too rare to require any particular remark's here.
Rupture of the spleen from some external violence occurs not unfrequently ; but in the majority of cases the injury is so over whelming that little ie left for the medical practitioner to do. Free venesection and perfect rest have occasionally saved life; but in many instances the patient dies in a few hours. In these latter cases the symptoms are great shiverings, coldness of body, vomiting, and other signs of extreme collapse : when there is time and strength for reaction, there is considerable fever, with a remarkable heat of skin, and great pain in the left side or all over the abdomen ; the stools and urine are not materially affected.
(Good's Study of Med. ; Gregory's Theory and Pract. of Med. ; Rigsby, in Cvelop. of Pract. Med., from which works, with Dr. &dines (posthumous) Lectures and Obscrr. on flied., great part of the patho logical part of this article is taken.)