800 



SPLEEN. 



Many observers, as Lecanu and Letellier, and 

 more recently J. Beclard, have found a dimi- 

 nution in the quantity of blood corpuscles in 

 the venous blood generally, although others 

 have denied this. If this be the case, it con- 

 firms such a supposition, and would effectually 

 explain the results of extirpation. In any 

 case thus much is certain, that they afford no 

 grounds for regarding the spleen as devoid of 

 signification. JFinally, we may remark in ad- 

 dition, that not unfrequently extirpations of 

 the spleen give rise to considerable disturb- 

 ances, and especially of the biliary secretion ; 

 a fact which very well corresponds with my 

 supposition that the colouring matter of the 

 bile arises from the haematin set free in the 

 spleen. 



If this theory of the function of the spleen 

 which I have set forth, which Ecker has 

 adopted, and which J. Beclard has now con- 

 firmed, be correct, it will be able to explain the 

 diseased conditions of the spleen and their 

 operation on the organism. But this is at 

 present impossible, since these conditions are 

 much too little known to allow us to say any- 

 thing even approximative^ correct and secure 

 concerning their origin and import. There- 

 fore, instead of entering upon a discursive 

 detail of possibilities resting upon an alto- 

 gether hypothetical basis, it seems to me 

 much more suitable, simply to indicate the 

 points to which future observers might pro- 

 perly direct their special attention. It is 

 known that the enlargements of the spleen, 

 which constitute the most serious diseases of 

 the organ, have a special coincidence with 

 complaints in which either a dissolution, or 

 some other abnormal condition of the blood is 

 present. This is the case in typhus, typhoid 

 cholera, pyaunia, putrid exanthemata (erysi- 

 pelas, scarlatina, measles), dyscrasia of drunk- 

 ards, ague, scurvy, purpura, chlorosis, acute 

 rheumatism, acute tuberculosis, &c. May 

 not the enlargement of the spleen possibly 

 have a share in the production of these 

 diseases, without being so entirely secondary 

 as most pathologists have hitherto assumed ? 

 Is it not conceivable, that in a spleen which 

 is enlarged and distended with blood, a 

 destruction and dissolution of the blood 

 globules is going on on too large a scale, 

 so that the normal composition of the blood 

 becomes seriously prejudiced thereby ? In 

 such a case the blood would be poorer in 

 blood globules, but its plasma would be rich 

 in colouring matter, and possibly at first 

 in fibrine, as J. Beclard found it to be in 

 his analysis. May not chlorosis or scurvy, 

 in which a considerable diminution of the 

 blood corpuscles has been shown to exist, 

 possibly depend in part on the dispropor- 

 tionate activity of an enlarged spleen ? In 

 consequence of such a too considerable de- 

 struction of blood globules in other cases, 

 further changes of the blood may be induced, 

 which may then end as an overcharging of the 

 fluid with colouring matter ; to wit, with the 

 colouring matter of the bile ; or as a pyaemia 

 or the so-culled white blood. On the other 



hand, is it not possible, that in cases of the 

 temporary diminution, or inflammation, or de- 

 generation, or atrophy of the spleen, other 

 organs may undertake its functions ? as, for 

 instance, the liver, which, indeed, is usually 

 hypertrophied in such cases ; or the general 

 mass of blood, a state which must again give 

 rise to peculiar phenomena ? Thus, in re- 

 spect of its pathology there is much which 

 might yet be observed, if I did not consider it 

 more suitable to conclude with the remark, 

 that in order to the building of a larger super- 

 structure upon the anatomical and physi- 

 ological basis here given, and in aiming at 

 anything respecting the pathology of the 

 organ, a deliberate, careful inquiry is above all 

 things necessary, an inquirj' in which chemical 

 analysis, microscopical research, experiment, 

 and pathological experience, will have to go 

 hand in hand. For if I have perhaps been able 

 to elucidate the spleen in many respects more 

 correctly than my predecessors, yet this ac- 

 count is very far from a final termination of 

 our knowledge, and must be regarded as 

 nothing more than a foundation-stone for an 

 altogether new superstructure. 



Morbid Anatomy. Variations in number 

 and form have already been alluded to. The 

 absence of the organ is usually or always 

 accompanied by that of other and neighbour- 

 ing viscera. 



On account of the obscurity which has 

 hitherto attached to the anatomy of the organ, 

 its diseased conditions are little understood ; 

 and it is obvious, that until morbid conditions 

 of the spleen are examined and classified with 

 reference to the appearances of their several 

 anatomical constituents, there will be little to 

 be said under the head of morbid anatomy, 

 besides enumerating the most prominent de- 

 viations of its bulk, colour, and consistence. 



Enlargement of the spleen is, perhaps, the 

 most common of all the outward deviations. 

 We have already seen that, within certain and 

 very wide limits*, the size of the spleen may 

 vary, and that these wide variations are of 

 constant occurrence even in the healthy sub- 

 ject, being intimately associated with its func- 

 tion and that of the organ. It is, therefore, 

 only when such enlargement becomes exces- 

 sive, or is associated with an alteration of 

 texture, or occurs in the course of some of 

 those diseases which it is known usually to 

 accompany, that we are justified in regarding 

 it as essentially morbid. 



The enlargement of the organ, to all out- 

 ward appearance, depends mainly on the in- 

 creased mass of the contained blood, and is 

 hence sometimes called hyperaemia ; and the 

 most obvious distinction of this enlargement 

 is into two kinds : one in which the conges- 

 tion is produced mechanically ; the other, in 

 which the determination of blood to the organ 

 can only be accounted for on the supposition 

 of non-mechanical causes. The former of the 

 two classes would include the swollen spleens 

 which occur in obstructions of the portal 

 vein, or of the vena cava, as happens in some 

 diseases of the liver and heart respectively. 



