Publisher's Synopsis
Excerpt from Clinical Lectures 0n Subjects Connected With Medicine, Surgery, Obstetrics
But, on the other hand, there are numerous acute febrile diseases in which splenic tumours develope to a size far beyond that of those just referred to, and increase to such an extent as to be easily made out by percussion, or even project so much below the ribs as to be clearly recognised on palpation. For such cases as these the assumption of simple ?uxion, or the fever heat of the blood, as exciting, causes does not appear sufficient explanation, and we are compelled to seek for other causes to account for such enormous hyperplastic proliferation of the pulpous elements of the spleen. In all acute diseases whose origin is cer tainly due to infection (typhus, septicaemia, intermittent fever, the constant occurrence Of large splenic tumours can be demonstrated both clinically and pathologically, and hence we are compelled to recognise foreign substances infecting the blood as special irritants of the splenic pulp. It follows, therefore, . That the existence of a considerable enlargement of the spleen positively justifies us in forming a decided opinion as to the infectious nature of the malady, and thus, with regard to 'the origination of doubtful forms, of disease, a step will be gained in the still extremely Obscure domain of etiology. The readiness with which the spleen reacts to certain substances of an injurious nature, present in the blood, is explained not only by the copiousnress of its blood supply, but also by its anatomical peculiarities. We know that the arteries in the interior Of the spleen break up into very numerous, extremely fine branches and capillaries, perforated by stomata; that the blood passes from the vessels into wide spaces destitute of walls (intermediary blood canals), from which the veins begin to arise, in like manner, principally as cribriform canals. The blood ?ows with extreme slowness through these wide intermediary canals, and both here and in the cribriform perforations Of the capillaries, is in. Intimate connection with the lymphoid cells so susceptible to irritation, and the delicate, fibrous network of the pulp. Hence it follows that matters Of an injurious nature infecting the blood are extremely liable to be retained in the spleen, to accumulate therein, and to act with peculiar intensity as excitants to the splenic tissue.
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