HYPER.EMIA OF THE SPLEEN. 



able that, in atrophic nutmeg-liver, hypersemia of the spleen is even 

 absent as a rule. 



ANATOMICAL APPEARANCES. Except in cases where the capsule 

 of the spleen is thickened and unyielding, we find the hypertrophied 

 organ larger and heavier than a healthy spleen. The increase in size 

 and weight may be so great that the organ will have from four to six 

 times its normal weight. The normal spleen of a healthy adult is four 

 to five inches long, three to four inches wide, and one to one and a half 

 inches thick ; its weight is about eight ounces. The spleen enlarged 

 by hyperaemia maintains its form, its capsule usually appears tense and 

 smooth, and where the swelling has somewhat subsided, it is occasion- 

 ally relaxed and wrinkled. The consistence of the spleen is dimin- 

 ished. This is also true of the enlargement of the spleen occurring in 

 malarial diseases, as long as it is recent, and as long as other changes, 

 that will be spoken of hereafter, have not occurred. The enlarged 

 spleen, found in patients who have died of typhus, puerperal fever, 

 septicaemia, etc., is often so soft that, when cut through, the paren- 

 chyma flows off like pulp. In judging of the consistence of this tumor, 

 we must, however, remember the early decomposition of the bodies. 

 The color of the spleen is darker in proportion as the hyperaemia is 

 recent and excessive. In the most recent cases and in high grades of 

 hyperaemia, the parenchyma often looks like a blackish red-blood 

 coagulum, later it appears lighter colored, or from admixture of pig- 

 ment is somewhat gray. 



On microscopical examination, we find no foreign elements with 

 the normal cells of the spleen pulp, and numerous blood-corpuscles, 

 so that we have no right to refer this enlargement of the spleen to a 

 process of inflammation and exudation. Acute splenic enlargement 

 appears to depend either solely on increase of the blood contained in 

 it, and serous infiltration of the tissue, or on a coincident temporary 

 increase of the substance of the spleen. 



When the hyperaemia has existed a long time, the increase of the 

 pulp of the spleen is unmistakable ; it greatly changes the appearance 

 and consistence of the organ; the spleen remains permanently en- 

 larged, and we have the state called " chronic spleen tumor " or hyper- 

 trophy of the spleen, which we shall describe in the next chapter. 



SYMPTOMS AND COURSE. Hyperaemic swelling of the spleen al- 

 most always develops without the patient complaining of pain ; usually 

 he is only sensitive on deep pressure in the left hypochondrium. This 

 observation corresponds to the general experience that tension of tis- 

 eues which are very expansible causes little pain, while tension of 

 membranes, ligaments, etc., which are stretched with difficulty, excites 

 severe pain. If, during an intermittent, a typhus or similar state, the 



