HYPER^MIA OF THE SPLEEN. 743 



lively certain, it is very probable, from what was said above, that the 

 overloading of the spleen with blood induces anaemia in the rest of the 

 body, and consequently that the pallor of the patient depends less on 

 impairment of the quality of the blood than on its abnormal distribu- 

 tion. We may compare the effect that overloading of the spleen with 

 blood has on the rest of the body, to that induced by a large aneurism 

 filled with blood, or by the overloading of one of the lower extremities 

 with blood from the application of JunocPs boot. If, after the cessa- 

 tion of the intermittent paroxysms, or after the administration of 

 quinine, the spleen regains its normal size from its elasticity, or from 

 the contraction of the irritable elements of the tissue, the anomalous 

 distribution of the blood will cease. This explains how the redness of 

 the skin and lips, which has been lost during the intermittent fever, 

 may return in a few days. 



The hyperaemia of the spleen that occurs in the course of typhus 

 and similar diseases usually subsides when they have run their course, 

 without leaving any structural change. The case is different where the 

 enlargement depends on intermittent or other fluxionary or obstruct- 

 ive hyperaemia, if it continues for a long time, on account of continued 

 action of the exciting cause. In the next chapter we shall attempt to 

 prove that so-called hypertrophy of the spleen is a necessary result of 

 long-continued hyperaemia. In very rare cases hyperaemia of the spleen 

 proves fatal, from rupture of the distended organ. This termination 

 lias been seen both in paroxysms of intermittent fever, and in typhus 

 and cholera. Death results with the symptoms of internal haemor- 

 rhage either immediately after the rupture of the spleen, or else not 

 for several hours or days. 



Physical examination furnishes the most important, and often the 

 sole means, of diagnosis of hypersemia of the spleen. While speaking 

 here of the physical signs that occur in hyperaemic swelling of the 

 spleen, we shall say a few words concerning the physical diagnosis of 

 diseases of the spleen in general. 



The upper part of the spleen lies in the hollow of the diaphragm, 

 and is covered by the lower border of the left lung ; its lower part lies 

 in immediate apposition with the wall of the thorax, and normally 

 does not quite reach to the angle of the ribs. Percussion is frequently 

 the sole means of recognizing an enlargement of the spleen, as that 

 organ frequently does not reach below the margin of the ribs even 

 when decidedly enlarged. The normal dulness of tne spleen extends 

 from the upper margin of the eleventh rib to the ninth rib ; anteriorly 

 it is bounded by a line drawn from the anterior end of the eleventh 

 rib to the nipple; posteriorly the spleen-dulness cannot be defined 

 from that of the left kidney. Its greatest thickness is about twc 



