752 DISEASES OF THE SPLEEN. 



usually called haemorrliagic infarctions sometimes occurred in the parts 

 of the spleen supplied by the nerves that had been divided. 



As it is doubtful whether the parenchyma of the spleen be nor- 

 mally separated from the current of blood by the walls of the vessels, 

 it becomes a question whether hasmorrhagic infarction be due to an 

 escape of blood from the vessels, or whether it be not rather owing to 

 a coagulation of the blood in the vessels and in the intertrabecular 

 spaces. In the latter case haemorrhagic infarction would represent 

 thrombus of those spaces, as it were, and, like other thrombi, would 

 be the result of a retardation of the current of blood. 



Primary inflammation of the spleen is an exceedingly rare disease. 

 Even injuries are more apt to cause rupture than inflammation of that 

 organ. Consecutive inflammation and suppuration of the spleen are 

 more frequently induced by haemorrhagic infarctions, particularly by 

 those occurring during infectious diseases. If the infarction be a 

 primary coagulation in the vessels and in the intertrabecular spaces 

 (which is at least as probable as the opposite view), then the splenitls 

 would hold the same relation to the infarction that phlebitis does to 

 thrombus of the veins. 



ANATOMICAL APPEARANCES. Haamorrhagic infarctions of the 

 spleen are roundish, or more frequently wedge-shaped collections (with 

 the bases outwardly) of the size of a pea or a hen's egg. At first they 

 are dark brown, or brownish red, and quite hard. The entire spleen is 

 enlarged by fluxionary hyperaemia, the peritonaeum over the infarction 

 is freshly inflamed. Later the collections become of a dirty-yellow color, 

 starting from the centre. The final result varies : either fatty degen- 

 eration occurs, and the mass is reabsorbed, and in place of the infarc- 

 tion we have a retracted, callous cicatrix, or else a yellow, cheesy 

 mass, which may become calcareous, remains ; or, lastly, the infarction 

 softens, and there is an abscess filled with detritus, in which pus-cor- 

 puscles also appear after a time. The latter course chiefly is taken by 

 those cases where small but numerous infarctions occur in typhus and 

 similar diseases. 



We know nothing about the anatomical changes in primary splenitis 

 before it has induced abscess. Occasionally we find the abscess in- 

 capsulated in a proliferation of connective tissue ; in other cases it is 

 surrounded by disintegrated connective tissue, or the entire spleen, 

 except its capsule, has become disintegrated, so that the latter forms a 

 large sac, which is filled with pus. Finally the capsule of the spleen 

 is perforated, and the contents of the abscess either enter the abdo- 

 men, or, if the capsule has previously become adherent to the parts 

 around, it enters some neighboring organ. Cases have been reported 

 where the pus, from an abscess of the spleen, has entered the stomach, 



