EXCISION OF THE SPLEEN. IO3 



operating are those of death from haemorrhage or shock ; the 

 former must be guarded against by careful clamping and liga- 

 turing of every vessel along the splenic omentum or those 

 which supply the portion to be excised, and to avoid the latter 

 the operation should be performed as rapidly as possible, hypo- 

 dermic injections of stimulants being at hand for immediate use 

 if required. 



For extirpation of the whole organ, the patient is prepared, 

 secured, and operated upon as in an ordinary laparotomy, the 

 incision being made on or near to the median line, about an 

 inch behind the sternum. The spleen is then sought for and 

 brought as much out of the orifice as necessary, each vessel, 

 however small, being clamped or ligatured in two places before 

 being cut through, after which the organ is removed. 



In six cases in which Mr Jordan removed the whole spleen, 

 ' all the dogs suffered greatly from shock and there were three 

 deaths," one being from marasmus and two from shock. 



For partial excision Jordan recommends the following method 

 of continuous ligature, by which he obtained a practically blood- 

 less section : " A long needle threaded with fairly coarse silk 

 twist I J ft. long is inserted on the inner or under surface about' 

 half an inch from the edge or border and passed through the 

 thickness of the spleen, emerging on the outer or upper surface 

 about the same distance from the edge ; the ligature is drawn 

 through until the ends are equal ; the free end is brought up 

 round the border of the spleen and a double turn made with 

 the two ends and drawn as tightly as possible, this turn being 

 kept over the exit of the needle. The needle is then passed 

 back through the spleen on the occluded side of the organ as 

 close to the line of ligature as possible and an eighth of an inch 

 from the edge or border side of the turn ; this being done in 

 order that the next loop shall include the spleen where the 

 needle has previously passed through, so that any oozing along 

 this track should be stopped when the loop was drawn tight. 

 The needle is then re-passed through the spleen from the under 

 to the upper surface half an inch further on, and a double turn 



