Splenitis.

Synonyms.—Acute Splenic Tumor; Acute Hyperplasia of the Spleen.

Definition.—An inflammation of the parenchyma of the spleen.

Etiology.—Splenitis is now generally regarded as a secondary disease, the infectious diseases ranking first as causal factors, especially the following: Typhoid, typhus, relapsing, malarial, small-pox, pneumonia, pyemia, and endocarditis. It more rarely attends tonsillitis, pharyngitis, bronchitis, and similar inflammatory diseases. By far the largest number of cases occur, however, from malaria, typhoid, and typhus fever, Collin having found it enlarged in every one of four hundred and ninety-one cases examined of malaria.

Pathology.—At first the spleen is simply hyperemic, red in color, of firm consistency, and the capsule more or less distended. "The malpighian bodies are usually obscure, and there may be visible areas of hemorrhagic extravasation. The size of the organ varies from a little beyond the normal to the extremest grades of hypertrophy, instances occurring in which it is four, six, or ten times the normal size and weight."

Microscopically, at this stage the blood-vessels are found over-distended, and the spaces within the splenic pulp contain masses of white and red blood corpuscles, and very soon degenerated erythrocytes in the form of fragments or of masses of pigment.

"In the later stages the spleen undergoes hyperplasia and degeneration, hemorrhagic extravasations are more abundant, and on microscopic examination, granular degeneration of the cells and fragmentation of the nuclei are observed, while large phagocytic cells containing pigment bodies or broken-down corpuscles may be abundant." (Stengle.)

Symptoms.—There are but few subjective symptoms, and in most cases they are indefinite or absent altogether. Should perisplenitis occur, pain and tenderness will be present. Where there is great enlargement, there will be a sense of weight and heaviness in the left hypochondrium. From involvement of the capsule or from pressure, vomiting sometimes occurs. Cough, dyspnea, and palpitations of the heart may also be present from pressure symptoms.

Physical Signs.—Palpation.—With the patient half reclining, and the thighs flexed, place the fingers of the left hand below the ribs and the outer angle, and with the right hand make firm pressure over the posterior portion, when the lower border of the spleen may be readily felt. If the patient be instructed to breathe slowly and deeply, with the mouth open, the organ can be much more readily outlined.

Percussion.—Increased dullness will be present, but great care must be exercised that we do not mistake a loaded colon or enlarged kidney for an enlarged spleen.

Diagnosis.—This is made chiefly by palpation, being really the only reliable information that can be obtained.

Prognosis.—Save in the very rare case where rupture occurs, the prognosis will be favorable, the disease subsiding with the disappearance of the primary disease.

Treatment.—Generally, no additional treatment will be needed to that used for the primary lesion giving rise to it. Echinacea and other antiseptics will have been given as the symptoms have indicated. In addition, polymnia may be used. Locally, if pain be present, libradol or antiphlogistin may be used.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.