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nourishing food and the avoidance of all debilitating morbid
conditions would indicate the principles of therapeutic management.
HYPERÆMIA—CONGESTION OF THE
SPLEEN.
Four hours after full meal in splenic diastole. In well fed, high conditioned. From
obstruction of splenic or portal vein or vena cava, heart, liver, or pulmonary
disease, inhibition from encephalon acting through splanchnics or vagi, microbes,
ptomaines, toxins, paresis, albuminoid diet. Spleen may be seven times its normal
weight. Lesions: simple blood engorgement: proliferation of pulp cells: increased
friability; rupture; dark color; hyperplasia of trabeculæ—hypertrophy. Symptoms:
none; or colic; palpation in ruminants; tenderness. Treatment: directed against the
causative disease; quinine, cinchonine, eucalyptus, ergot, cold douche, electricity,
puncture.
Considerable hyperæmia of this organ takes place physiologically
in connection with active digestion in the first four or five hours after
an abundant meal, and especially at intervals of a minute, during
what may be called the diastole of the viscus. The supply of blood is
also much greater in the well fed animal, than in the emaciated and
impoverished one.
Pathological hyperæmias of a passive kind may occur as the result
of obstructions in the veins leading from the spleen, such as the
splenic veins, the posterior vena cava, or that part of the portal vein
comprised between its junction with the splenic and the liver.
Diseases of the right heart or its valves, of the lungs (emphysema), or
of the liver which hinder the onward flow of blood and increase the
blood tension in the vena cava or portal vein have a similar action.
Perhaps we should include inhibition of the nerves (splanchnic, vagi)
and nerve centres (medulla oblongata, cerebral cortex) which preside
over the contraction of the splenic vascular walls, and of the capsular
and trabecular muscles. There is reason to believe that the ptomaines
and toxins of several microbian diseases, operate through these
centres, while other such microbes and toxins operate directly on the
spleen itself.
Active congestions of the spleen are most commonly associated
with microbian diseases and may be attributed partly as above stated
to the action of the toxic products on the contraction nerve centres,
and on the splenic vessels and parenchyma, but also in no small
degree on the active proliferation of the germs themselves in the
splenic pulp, and of the splenic cells. Among the most notable
instances of this kind are, in man, malarious, yellow and typhoid
fevers, and, in animals, anthrax, and Southern cattle fever. In most
febrile diseases, however, there is a tendency in this direction, which
may be fairly attributed to the paresis of the organ and the delay of
the blood in its pulp channels and spaces with the consequent local
increase of microbes and toxins. The microörganisms can usually be
found abundantly in such cases, in the liquid of the pulp, and in the
interior of the leucocytes and other cells that go to make up its solid
constituents.
It has been long recognized by veterinarians that acute congestion
often arises in connection with a sudden transition from a poor or
insufficient diet to an abundant and nutritious one and especially to
one that is rich in albuminoids (beans, peas, vetches, lucerne,
sainfoin, clover, trefoil, in the fresh or preserved condition). If these
are not in themselves the direct causes of acute and fatal
engorgements of the spleen, they at least contribute in no small
degree to the overdistension of the pulp spaces, the paresis of the
organ and its successful invasion by pathogenic microbes.
The acute congestion attendant on specific microbian infection
may be estimated by the increase in weight of the spleen. In the
Southern Cattle fever this organ, which is normally 1.45 ℔., is
habitually 2 to 5 ℔s., and may reach 8 or 10 ℔s. and in anthrax an
equal increase may be noted.
Lesions. In such cases the organ may appear as if there were a
simple blood engorgement, and this is largely the case in the early
stages, but with the persistence of the disease there occurs an active
proliferation of the splenic cells and especially those of the pulp.
With the hyperæmia the consistency of the organ is diminished, and
still more so with the cell hyperplasia, so much so that in extreme
cases rupture may ensue. The color is always darker (purple or blue),
but this is only in part due to the abundance of blood and in part to
the thinness of the splenic capsule. If the condition persists a
hyperplasia of the capsule and trabeculæ ensues, and the condition
becomes essentially one of hypertrophy.
Symptoms. In the slighter congestions there are no appreciable
symptoms. In the more severe there may be more or less violent
colic, but this is usually marked to some extent by the profound
depression attendant on the specific fever which is the cause of the
congestion. Palpation of the spleen is impossible in the horse. In
ruminants it may sometimes be felt along the upper border of the
rumen just behind the last rib on the left side. It is soft and yielding
retaining the indentation of the finger. If manipulation produces
signs of pain it is all the more significant.
Treatment. As a rule this is the treatment of the fever which
determines the hyperæmia. Apart from this, laxatives, quinia other
alkaloids of cinchona bark, eucalyptus, a current of cold water
directed to the region of the spleen, or induction currents of
electricity to the same region are also decided stimulants to
contraction. Ergot has been used with alleged advantage. In cattle
acupuncture of the spleen has been put in practice in anthrax.
CHRONIC CONGESTION OF THE SPLEEN.
HYPERTROPHY.