754: DISEASES OP THE SPLEEN. 



CHAPTER V. 



TUBERCULOSIS, CARCINOMA, HYDATIDS OP THE SPLEEN. 



TUBERCULOSIS of the spleen occurs, sometimes, under the form of 

 numerous gray miliaiy tubercles, as one part of miliary tuberculosis ; 

 sometimes it complicates tuberculosis of the intestines and mesenteric 

 glands, under the form of yellow, cheesy conglomerations of tubercle, 

 which rarely attain the size of a hazel-nut, and only exceptionally 

 break down and form vomicae. Tuberculosis of the spleen cannot be 

 recognized during life, and hence there can be no question about its 

 treatment. 



Carcinoma also is rarely observed in the spleen. Medullary car- 

 cinoma is the only one of the various forms that ever occurs here. In 

 almost all the cases on record, the disease did not affect the spleen 

 primarily, but accompanied carcinoma of the stomach, liver, or retro- 

 peritoneal glands. The spleen may acquire an uneven, nodular ap- 

 pearance from large cancerous tumors. From the great rarity of car- 

 cinoma of the spleen, it should be the last disease thought of when we 

 are trying to determine the nature of an enlargement of that organ ; 

 we should only make the diagnosis of carcinoma of the spleen when 

 the enlargement no longer retains the characteristic form of the spleen, 

 but has an irregular, nodulated surface, and when there is at the same 

 time carcinoma of the stomach or liver. 



Hydatids of various size and number are also seen rarely in the 

 spleen, and almost exclusively in cases where they also occur in the 

 liver. During life they can only be recognized when hemispherical pro- 

 tuberances, with the previously-described peculiarities of fcydatid cysts, 

 can be felt on the enlarged spleen. 



[CHAPTER VI. 



WANDERING SPLEEN. 



THE spleen, more than any of the solid abdominal viscera, is 

 inclined to displacement, which not only results from pressure, as 

 when it is forced down by the diaphragm, or up by tumors, meteor- 

 ism, or ascites, but it sometimes becomes unusually movable from 

 congenital or developed elongation of its peritoneal attachments. 

 The spleen may sink in the abdominal cavity, but this does not 

 usually happen unless the organ is increased in size. In mild grades 

 of displacement the spleen is but little below the ribs, and may 



