ELEMORRHAGIC INFARCTION OF THE SPLEEN. 753 



or colon, or, passing through the diaphragm, has reached the pleural 

 sac, or has perforated outwardly, through the abdominal walls. It is 

 only in very rare cases that an abscess of the spleen dries up, its con- 

 tents becoming inspissated and calcareous, or breaking through tho 

 capsule, and being evacuated. 



SYMPTOMS AND COURSE. Where hsemorrhagic infarction occurs in 

 the course of an infectious disease, it is almost always first recognized 

 at the autopsy. On the other hand, where it accompanies heart-disease 

 it can often be recognized during life. If endocarditis or valvular dis- 

 ease has been diagnosed in a patient, and he complains .of pain in the 

 left hypochondrium, which is increased by pressure ; if there be vomit- 

 ing also, and physical examination shows enlargement of the spleen, 

 which did not exist a few days previously, we may decide that there is 

 hsemorrhagic infarction of that organ. The pain is due to the partial 

 peritonitis which almost always accompanies the infarction. The vom- 

 iting is a sympathetic symptom. And, lastly, the enlargement of the 

 spleen is the result of fluxionary hyperaemia. In almost all the cases 

 I have seen, the above combination of symptoms commenced with a 

 chill, and was accompanied by repeated chills. We have already said 

 that these do not justify us in deciding on a septicaemia affection. 



Most cases of abscess of the spleen that have been described have 

 been latent, and were not recognized during life. Chills, hectic fever, 

 cachectic appearance, rapid emaciation, and dropsical symptoms showed 

 that there was some severe disease, but its nature was not discovered, 

 ff, besides these symptoms, there was pain in the left hypochondrium, 

 and enlargement of the spleen could be detected, it was occasionally 

 possible to form a probable diagnosis. Distinct fluctuation was very 

 Barely found. 



If the abscess perforate the capsule of the spleen, and its contents 

 be emptied into the abdomen, we have the symptoms of diffuse peri- 

 tonitis ; or, if they have entered a capsulated space, those of a cir- 

 rmmscribed peritonitis. If its contents enter the stomach or colon, 

 mixed blood and pus are vomited or passed at stool. If the perfora- 

 tion take place into the pleura, into the lungs, or outwardly, the symp- 

 toms are similar to those described for perforation of abscesses of the 

 liver in these directions. 



TREATMENT. In haemorrhagic infarction, as in suppurative spleni- 

 tis, treatment is of no avail. We can only give palliatives for the 

 moot urgent symptoms. Where the pain is severe, we should order 

 local abstraction of blood and cataplasms ; for the sympathetic vomit- 

 ing carbonates and bicarbonates of the alkalies, or, if it be very obsti- 

 nate, we may give narcotics ; fluctuating abscesses should be opened 

 early, and with the same precautions as in abscesses of the liver. 

 49 



