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Diseases of the Spleen

enlargement, blood and liver

DISEASES OF THE SPLEEN - of the diseases of the spleen we have still fewer means of diag nosis than of those of the liver. We know that it is often involved in blood diseases, that especially in fevers it becomes almost dis integrated, and that in pyLemia it is the seat of secondary deposits, capillary phlebitis, and suppuration ; but we know nothing of the indications which mark these conditions, as they are wholly obscured by the more general symptoms of disease.

Its enlargement alone becomes cognizable to us by its abnormal extent and by its position in the abdominal cavity. And if per cussion and palpation be properly employed there can be no difficulty, when a tumor is recognized, in tracing it upwards to wards the left hypochondrium, and so making sure that it is the spleen, even when it is first discovered, as in cases of very great enlargement, in the right iliac region. The two essential charac ters by which it is known are these: its oval form, with a smooth rounded surface ; and its point of attachment under the false ribs on the left side; the only possible excuse for a mistake can be when the abdominal cavity is distended with fluid.

In its history it will sometimes be found to be a sequel of in termittent fever, commonly known as ague-cake. Very often no precursory phenomena are discovered, and its cause is quite un known ; occasionally it is associated with enlargement of the liver, and probably then both are lardaceous. It is intimately connected with an anaemic state of blood ; and as its functions in reference to the elaboration of this fluid become better understood, we shall probably obain more direct indications of the changes which it undergoes in disease ; at present we can only affirm that there seems to be some close relation between one of the forms of enlargement and the condition already referred to as white-cell blood. (Chap. VIII., 2.) In consequence of this circumstance it may be also associated with general dropsy ; with ascites it would seem to be connected only through the medium of con comitant disease of the liver.