The Spleen. 255 



in malarial poisoning, anaemia, etc. In diseases of the 

 liver, heart or lungs, in which there is obstruction to the 

 circulation through these organs, the spleen would be ex- 

 pected to show the effects of the retarded circulation by 

 enlarging from the chronic congestion that is usually 

 present. But this enlargement does not always occur 

 since the elastic and the non-striated muscular tissues of 

 the organ possess sufficient resisting power to prevent 

 such enlargement. Roy has shown by means of the onco- 

 graph that the circulation in the spleen is peculiar, in that 

 it does not depend so much on the blood pressure present 

 in the arteries, as it does on the rhythmical contraction of 

 the musclar fibres of the capsule and trabeculae, and fur- 

 ther, that the diastolic and systolic actions together, oc- 

 cupy about one minute. Rupture oi the spleen may oc- 

 cur spontaneously in cases in which the organ is enlarged, 

 or, it may result from traumatism, such as from blows, 

 kicks, penetration by the ends of a broken rib, etc. Such 

 cases of rupture, however, are rare, because of the pro- 

 tection afforded by the depth of its situation in the ab- 

 domen. 



Operations. Splenectomy, or removal of the spleen, 

 has been performed for leucocythemia, hypertrophy, neo- 

 plasms, wounds, or for movable spleen. Statistics show 

 that for leucocythemia splenectomy is unjustifiable, since, 

 in thirty-six operations recorded, there were thirty-one 

 deaths. For simple hypertrophy, there were fifty-nine 

 operations with twenty-five deaths, while for wounds, 

 movable spleen, etc., there were forty-three operations 

 with eleven deaths. 



Operation. The incision may be made either in the 

 median line, or, at the outer edge of the rectus muscle on 

 the left side. During the operation the spleen must be 

 handled with the utmost gentleness on account of the ex- 



