DISEASES OF THE SPLEEN. 



the tumors, are perfectly in accordance with the doctrine that the spleen 

 and lymphatic glands are the places where the blood-corpuscles are 

 formed. Apparently the state of affairs is as follows : When the cells 

 formed in the intertrabecular spaces of the spleen, or in the cells of 

 the lymphatic glands, are retained in any way, and are not normally 

 borne along by the blood and lymph, they accumulate in these places ; 

 the spleen or the lymphatic glands, as the case may be, swell up and the 

 blood becomes poor, as the used-up blood-corpuscles are not replaced 

 by others. If the obstruction to the passage of the young cells into 

 the circulation be removed, the growth of the spleen and lymphatic 

 glands ceases, and the blood is gradually improved by a sufficient sup- 

 ply of young cells, even if the enlarged spleen or lymphatic glands do 

 not decrease in size. 



If the spleen continues to enlarge for a long time, there is great 

 impoverishment of the blood. The patients become excessively dull 

 and feeble ; their skin grows waxy, and brunettes acquire a clayey look 

 (" splenetic "). The lips and visible mucous membranes also appear 

 very pale and bloodless. Since the number of blood-corpuscles aerated 

 in the lungs is diminished, the usual number of inspirations no longer 

 suffices to supply the blood with oxygen, and to remove the carbonic 

 acid. Hence the patients are short-breathed, and, where bodily ex- 

 ertion and similar causes increase the demands for oxygen, they suffer 

 from dyspnoea. The nutrition of the walls of the capillaries also 

 suffers from the impoverishment of the blood, and they become morbid- 

 ly fragile, causing a hsemorrhagic diathesis. Capillary haemorrhages 

 occur without perceptible cause, apparently spontaneously, particularly 

 epistaxis, and we have petechiae from hsemorrhages in the tissue of the 

 skin. The common assertion, that in disease of the spleen the bleed- 

 ing usually proceeds from the left nostril, is false. If the disease con- 

 tinues to progress, the anaemia, or more properly the hydraemia, finally 

 increases to a so-called dropsical crasis ; there is usually oedema of the 

 lower extremities, and in severe cases there is gneeral dropsy. 



If the above symptoms be observed in a patient who has enlarge- 

 ment of the spleen, as a result of malarial infection, or as a complica- 

 tion of cirrhosis of the liver, it may be difficult to decide what part of 

 the symptoms is due to the disease of the spleen, and what to the 

 original disease ; nevertheless, the fact that the grade of the hydraemia, 

 both in the malarial infection and in the cirrhosis, has a certain relation 

 to the amount of enlargement of the spleen, justifies us in not rating too 

 iow the effect of the spleen-disease on the impoverishment of the blood 

 even in such cases. This influence is far more striking in cases where 

 the enlargement of the spleen is independent of other diseases, and 

 occurs as a primary and idiopathic affection. 



