SPLEEN. 



were exhibited by the cut furfac? of the liver, or in the 

 ferum of blood from the vena cava. There was a corre- 

 fponding difference between the effefts ef pota(h on fluids, 

 in which the fubltance of the liver and that of the Ipleen 

 were broken up. The author abandons this notion in a 

 fubfequent communication to the fame fociety, on the paf- 

 fage of fluids from the ttomach into the general circulation ; 

 having found that correfponding phenomena were exhibited, 

 after the fpleen had been removed. Phil. Tranf. 1812. 



Of numerous other dreams about this myllerious organ, 

 fuch as that it forms the red globules of the blood, that it 

 is the feat of laughter, or of the fentient foul, that it is 

 defigned to balance the liver, &c. &c. we can fay no more 

 than that thofe who are interelted in fnch fpeculations will 

 find ample amufement in Mailer's Elem. Phyfiol. lib. xxi. 

 feft. 2 ; or in Soemmerrin^ de Corp. Hum. Fabrica, t. vi. 

 p. 158, et feq. One faft, mentioned by the latter author, 

 may be flated, ijii. that fteel given for fome time to animals 

 has the efFedl of diminifhing the fize of the fpleen. 



Spleen, Difeafes of the, in Medicine. Much more has 

 been written by the older writers refpefting the difeafes of 

 this organ, than by thofe of the latl half century. This 

 may have arifen partly from the greater accuracy of modern 

 pathologifts, but chiefly perhaps from the aftual diminution 

 of thefe maladies, in confequence of the diminution of the 

 prevalence of intermittent fevers, of which many of the 

 chronic derangements of the fpleen were the fequelis, or di- 

 reft refult. The infarSion of the fpleen, of which the older 

 authors fo often treat, was of this nature. The two prin- 

 cipal modifications of difeafe, to which this vifcus is fubjeft, 

 are inflammation, and their indolent enlargement of its fub- 

 ftance, formerly called infarftion. We fliall treat of thefe 

 difeafes feparately ; and then enumerate fome of the other 

 morbid conditions, with which the fpleen has been occa- 

 fionally obferved to be afFefted. 



Spleen, Inflammation of, fpknitis of the nofologifts. 

 This may occur, as in the other vifcera, in two forms ; 

 either attacking the inverting membranes, or the fubftance 

 of the gland. Under both forms, however, it is a rare dif- 

 eafe, but efpecially under the latter, the fymptoms of which 

 are apparently obfcure, and net fatisfaftorily underltood. 



The peritonatal coat of the fpleen is, in faft, feldom in- 

 flamed, according to the teftimony nf that excellent ana- 

 tomill, Dr. Baillie, unleft when the peritonscum in the 

 neighbourhood is alfo affeftcd. The proper capfule of the 

 fpleen, he remarks, is fo intimately connefted with the pcri- 

 tonsEum, which is reflefted over it, that it mud neceflarily 

 partake of any inflammation afFefling that membrane. Ac- 

 cordingly the fymptoms, attending this inflammation of the 

 coats of the fpleen, are not to be diftinguiflied from thofe 

 which characterize inflammation of that portion of the peri- 

 toneum which lies in the left hypochondriiun (fee Perito- 

 nitis) ; that is to fay, there is pain in that rcgioa, more or 

 lefs violent according to the degree of the inflammation, 

 which is increafed by prellure, and is accompanied by a fenfe 

 of heat and tenfion in the part. There is alfo more or lefs 

 of fymptomatic fever, heat of flcin, quicknefs and hardnefs 

 of pulfe, thirlt, &c. ; and, if the inflammation be confider- 

 able, fome difiiculty of breathing. The lall fymptom arifcs 

 from the prcffure of the diaphragm, when defcending, in 

 the aft of infpiration, upon the inflamed parts. As the ufe 

 of the fpleen m health is unknown, we cannot, of courfe, 

 look for any fymptom charafteriftic of its difordercd func- 

 tion, as in the cafe of other large vifcera ; but mull infer 

 that it is the feat of inflammation, from tlic fituation of the 

 pain, and from the abfcnce of dillurbance, in any confider- 

 ible degree, in the funftions of the neighbouring vifcera ; 



Vol. XXXIII. 



as in that of the kidaies, exhibited in the urine ; in that of 

 the ftomach, great inteftine, &c. 



It is probable, however, that the invefting membrane of 

 the fpleen is liable to fome degree of inflammation, which is 

 not always noticed ; for it has been remarked by the able 

 pathologift; juft quoted, that it is not uncommon to find ad- 

 hcfions between the fpleen and the neighbouring parts. 

 Thofe adhefions confift of a white tranfparent membrane of 

 more or lefs firmnefs, and generally conneft the broad fur- 

 face of the fpleen more or lefs clofely to the diaphragm 

 They often alfo conmft the fpleen to the great end of the 

 Itomach, and a part of the tranfverfe arch of the colon. 

 See Baillie's Morbid Anatomy of fome of the moit im- 

 portant Parts of the Human Body, chap. xi. ; and Mor- 

 gagni de Sedibus et Cauf. Morborum. 



The inflammation or fuppuration of the fubttance of the 

 fpleen is a very rare occurrence ; but fuch cafes have been 

 occafionally obferved, and related by authors. (See Lieu- 

 taud, Hiltor. Anatom.-Medica, torn. i. ) This writer ha» 

 even related infliances of mortification of the fubftance of the 

 fpleen ; but neither Morgagni nor Baillie have obferved 

 fuch cafes. The fymptoms which have been defcribed, as 

 belonging to inflammation of the fubltance of the fpleen, 

 are, a dull pain, with a fenfe of fulnefs, in the left hypo- 

 chondrium, the pain being increafed on preflure, and ac- 

 companied by the general difturbance of the fyftem, called 

 fever. The difeafe, liovvever, is fo rare, that fufficient 

 obfervations have fcarcely been made to determine fatij- 

 faftorily the diagnofis of this malady. In two cafes, ia 

 which the inflammation of the fpleen had advanced to fup- 

 puration, which were examined by Dr. Hunter, the patients 

 were unable to define accurately the feat of their pain, which 

 feemed to travel a good deal over the general cavity of the 

 abdomen. 



Ahhough the diagnofis be imperfcftly eftabliflied, how- 

 ever, the fame praftice will be efficacious, which experience 

 has found to be remedial in the inflammation of the peri- 

 toneal coat, or of the fubltance of other vifcera, and of the 

 peritoneum lining the abdomen ; that is, the early ufe of 

 blood-letting, and purgatives, with blilters and local bleed- 

 ing, as circumttances may require ; and the fteady adoption 

 of the antiphlogiltic regimen, as direftcd in the treatment of 

 other vifceral inflammations. (See Peritonitis, Hepa- 

 titis, &c.) We fliall, therefore, proceed to defcribe the 

 fecond form of difeafe peculiar to the fpleen. 



Spleen, Tumid. This difeafe of the fpleen confifts of an 

 indolent enlargement of the fubftance of the viieus, which, 

 at the fame time, becomes much harder than natural. It 

 will occafionally be enlarged to five or fix times its natural 

 fize, and it then forms a tumour very capable of being dif- 

 tinguilhed in the living body. When examined after death, 

 the natural itrufture feems to be prelervcd, except that it it 

 much more compadt, the parts being much more clofely 

 applied together. When this tumour and induration are 

 the confequeuce of intermitting fever, the mafs is called an 

 ague-cake. In general, this Hate of the fpleen is confidcred 

 as fcirrhons ; but its ftrufture, as Dr. Baillie remarks, is 

 not fimilar to fcirrhiis in otiicr parts of the body. It may, 

 therefore, be doubted whether this is a proper fcirrhoiie 

 affeftion of the fpleen, or whether it is not, in faft, fotne- 

 thing eflentially diflerent. 



The fymptoms accompanying an enlarged and indurated 

 ilate of the fpleen, in its early ftages, are not very mani- 

 feft or urgent ; in fa4t, the exiftence of the difeafe is com- 

 monly not lufpedcd, till it has made a confiderablc pro- 

 grcfs. It is ufually not accompanied by any pain or un- 

 cafineft ; and will even bear a pretty ftrong preflure, with- 

 4 E out 



