ELEMORRHAGIC INFARCTION OF THE SPLEEN. 751 



original disease, and how far on the degeneration of the spleen. More* 

 over, besides the lardaceous degeneration of the spleen, there is usually 

 an analogous affection of the liver and kidneys, which increases the im- 

 poverishment of the blood, Physical examination often shows enor- 

 mous enlargement of the organ. 



In spite of the similarity of the symptoms, the diagnosis between 

 the two forms of chronic enlargement of the spleen is usually easy. 

 The occurrence of enlargement of the spleen in the course of one of 

 the above-mentioned diseases, coincident disease of the liver and kid- 

 neys, steady growth of the tumor, which never recedes, and its un- 

 common firmness, speak in favor of lardaceous spleen, and against 

 simple hypertrophy. 



TREATMENT. Treatment is useless in lardaceous spleen. It is 

 true, iodide of iron has a certain reputation, and it is possible that the 

 impoverishment of the blood, and the dyscrasia causing the splenic 

 disease, may be improved by its use ; but, even if this happens, it is 

 not probable that the size of the spleen will decrease, or that its struc- 

 ture will again become normal. 



CHAPTER IV. 



HAEMORRHAGIC INFARCTION AND INFLAMMATION OF THE SPLEEN 



SPLENITTS. 



ETIOLOGY. In no organ is haemorrhagic infarction more frequent 

 than in the spleen, and in most cases it undoubtedly proceeds from ob- 

 struction of a small artery by an embolus. The size of the splenic 

 artery and the rapidity with which the blood flows through it (a 

 necessary result of the slight obstruction the blood meets in the 

 spleen) explain why emboli from the aorta most readily enter the 

 splenic artery. The emboli usually originate in the left heart, and 

 are fibrinous coagula that have been deposited on rough places on 

 the valves, in endocarditis and valvular disease, and have subsequently 

 been washed off by the blood. When autopsy reveals extensive 

 valvular disease, with roughness or rupture of the valves and chordae 

 tendineae, it is almost a rarity not to find old or recent infarctions in 

 the spleen. Far more rarely the emboli come from necrosed spots in 

 the lungs, and have passed through the pulmonary vein and left heart, 

 before entering the aorta and splenic artery. 



Haemorrhagic infarctions of the spleen also exceptionally occur in 

 those diseases which usually induce only excessive hyperaemia of that 

 organ. We find it as well in malarial infection as in typhus, septi- 

 caemia, and the acute exanthemata. Jaschkowitz found that, when he 

 had divided some of the nerves of the spleen, the pathological changes 



