324 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



some distance, although his spleen, as the autopsy 

 revealed, was separated into three portions. He lived 

 some days. In severe fractures of the ninth, tenth, 

 and eleventh ribs, the spleen may be damaged and 

 lacerated. 



The capsule of the spleen contains muscular tissue, 

 and must possess some contractile power. This fact 

 may serve to explain cases of recovery from limited 

 wounds of the organ, such as small gunshot wounds. 

 In such lesions the capsule may contract and greatly 

 narrow the hole in the viscus, while the tract of the 

 bullet or knife may become filled with blood clot, and 

 the bleeding thus be stayed. 



The spleen may be greatly enlarged in certain 

 diseased conditions. The hypertrophied spleen may 

 attain such dimensions as to fill nearly the whole 

 abdomen, and in one case a cystic tumour so com- 

 pletely occupied both iliac fossae, that it was mistaken 

 for an ovarian cyst, and the operation for ovariotomy 

 was commenced. It is said that the enlarged spleen, 

 in its earlier stages, encroaches upon the thoracic 

 cavity, relatively more in the child than in the adult. 

 This is explained by the statement that the costo-colic 

 fold, upon which the spleen rests, is much more 

 resisting in the young than it is in those of more 

 mature age. 



Extirpation of the spleen has been very 

 successful in cases of abdominal wounds with pro- 

 trusion of the viscus. It has also been performed 

 with good results in many cases of hypertrophied 

 spleen. The operation is not considered justifiable in 

 cases of leucsemic enlargement of the organ, it having 

 proved invariably fatal in such instances. In cases of 

 wounds with protrusion, the spleen is, of course, re- 

 moved through the wound. In other instances the 

 incision is usually made in the middle line, the most 

 convenient being one so arranged that the umbilicus 



