Part 95

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.

Hypertrophy from chronic congestion, over feeding, hepatic cirrhosis. In horse: from mechanical obstruction in heart, lungs, posterior cava, splenic veins, angioma, from glanders or tubercle in lungs, chronic splenic congestion, disease of splenic plexus. Lesions: increase enormous; mainly of pulp, or largely of fibrous framework. Special neoplasms. Symptoms: excess of leucocytes in blood, eosinophile cells, weakness, anæmia, emaciation, bleeding from mucosæ, stretching, right hypochondriac tenderness, stiff gait, ascites, colic, disorder of the bowels, rectal exploration. Treatment: is that of primary disease; not encouraging; quiniae, eucalyptus, saline laxatives, open air, sunshine, electricity. In cattle is habitually enlarged in Texas fever area. In lymphadenoma increase mainly of fibrous framework and Paccinian bodies, and of adjacent lymph glands. Symptoms: leukæmia, employ palpation, percussion, rectal exploration. Treatment as in the horse. In swine: from high feeding, leukæmia, lymphadenoma, tuberculosis, neoplasms, liver, heart and lung disease. Lesions: great increase of Paccinian bodies, fibrous capsule and trabeculæ. In dog: from traumas, leukæmia and lymphadenoma. Enlarged Paccinian bodies and adjacent lymph glands. Symptoms: leukæmia, many eosinophile cells, abdominal enlargement, palpation, icterus. Treatment: as for large animals.

A continuation of passive congestion from the causes enumerated above, leads to permanent increase of the fibrous reticulum and connective tissue and increase of the splenic pulp. Even the stimulus of a rich and abundant alimentation increases the size of the whole organ, the amount of pulp and the number and development of the Paccinian bodies. Apart from disease the spleens of well fed cattle or horses are always decidedly heavier than those of the starved or debilitated. Of mechanical causes the most potent is cirrhosis of the liver or some other obstacle to the free passage of blood through that organ. The most common causes are, however, the continuous operation of those specific poisons which determine the acute hyperæmias.

SPLENIC HYPERTROPHY IN HORSES.

Causes. It occurs as the result of mechanical obstruction of the posterior vena cava as noticed by Varnell, from obstruction in the splenic artery or veins by Ellenberger and Schütz, as the result of an angioma by Martin, as the result of the morbid hyperplasias in specific diseases—glanders, tuberculosis—taking place in the spleen or lungs and thus directly or indirectly causing chronic congestion of the spleen (Morot, Leisering, Nocard, Varnell) and again as the result of innervation, in disease of the splenic plexus of nerves (Varnell).

Lesions. The increase in size may be enormous (42 lbs. (Bouret and Druille), 92 lbs. (Cunningham), and over 100 lbs. (Girard)). The consistency is varied. There may be such a redundancy of blood and splenic pulp that the capsule is distended to its utmost or even ruptured (Peuch). In other cases the splenic veins have given way and the blood has poured out into the abdomen with fatal result (Crafts, Cunningham, Reis). In other cases the spleen is enlarged, unevenly swollen and indurated by the formation of angioma (Jacob), lymphadenoma, glander or tuberculous nodules. In still others the capsule and fibrous framework are greatly thickened and the substance of the organ has assumed the consistency of the hepatized lung (Rodet).

Symptoms. These are suggestive rather than diagnostic. Most prominent is the condition of the blood with excess of leucocytes and especially of the eosinophile cells. Weakness, emaciation, feebleness of pulse, bloodlessness, bleeding from the nose or other natural passages, are attendant symptoms. In cases of extreme hypertrophy distension of the abdomen is marked and even the enlarged spleen may be made out by palpation, there may be special tenderness and dullness on percussion. Even partial sweats over the region of the spleen (Cadeac), and stretching with the fore feet far in advance (Welsby) have been noted as symptoms. In such conditions the animal walks stiffly, groans in turning, or when suddenly started and is with difficulty urged beyond a walk. There may be ascites, signs of colic, or irregularity of the bowels. Rectal exploration may reveal the hypertrophy.

Treatment is usually the treatment of the primary disease. In glanders, tuberculosis, lymphadenoma, or leucocythemia there is little to hope for. Nor is there much in hepatic cirrhosis, obstruction of the vena cava or valvular disease of the heart. In simple hypertrophy we may resort to quinia or other bitters, eucalyptus, saline laxatives, exercise in the open air and sunshine, and local currents of electricity.

SPLENIC HYPERTROPHY IN RUMINANTS.

A moderate hypertrophy is the rule in the case of cattle which have passed through the Southern cattle fever, but have continued to live within the area of its prevalence. Gamgee’s observations in 1868 were very conclusive on this point. In over 1,000 western cattle the average weight of the spleen was 1.45 ℔., in 441 Cherokee (Indian Territory) cattle the average was 2.34 ℔s., and in 262 Texas cattle the average was 2.66 ℔s. All these animals were killed for beef, in what was considered to be perfect health. The difference relative to the weight of the entire animal is even greater than is indicated above, for at that date even more than at present, the Texas steer was a small and thin animal in comparison with the portly western bullock.

In lymphadenoma the organ may weigh 24 ℔s. (Tannenhauser); in simple hypertrophy it has been found to weigh 37 ℔s. (Koch). There was usually a marked increase in the size and number of the Paccinian bodies, and hyperplasia of the fibrous reticulum, while the pulp might be deficient and the cut surface rather dry. The adjacent lymph glands are usually enlarged.

Symptoms. Unless in the case of excessive increase, no symptom is usually observable, apart from leucocythæmia. With enormous hypertrophy the enlarged organ may be recognized by palpation, percussion, and perhaps rectal exploration.

Treatment is unsatisfactory apart from the control and arrest of the primary diseases. For simple hypertrophy, bitters, laxatives and electricity may be tried.

SPLENIC HYPERTROPHY IN SWINE.

Causes. This disease appears to be rather frequent in pigs, in connection with high feeding, and more particularly with leucocythæmia and lymphadenoma. It is further a complication of tuberculosis and of neoplasms located in the spleen, and of hepatic, cardiac and pulmonary disorder.

Lesions. In leucocythæmia there is general enlargement of the spleen, and especially of the Paccinian bodies which may attain the size of a pea (Leisering, Fürstenberg, Bollinger, Siedamgrotzky, Röll, Ellinger). The total weight of the organ may attain to 5 lbs. (Mathieu), or 13 lbs. (Goubaux). In a remarkable case recorded by Zell, the organ measured 30 inches in its longest circumference and 20 inches in its shortest. It had an enormous thickening of the capsule and trabeculæ which enclosed softened contents in a state of fatty degeneration.

Symptoms are wanting, as most of the observed cases were only discovered after the animal had been killed for pork.

SPLENIC HYPERTROPHY IN THE DOG.

This condition has been less frequently seen in dogs, the recognizable causes having been traumatism (Notz), and leucocythæmia (Zahn, Forestier, La Forgue, Nocard). Lymphadenoma is another complication (Nocard, Leblanc, Siedamgrotzky, Bruckmüller). The spleen has been found to weigh 2 lbs., (Bollinger, Siedamgrotzky). As in other animals the enlargement of the Paccinian bodies has been a marked feature. In other cases the splenic lymph glands are enlarged.

The symptoms are obscure as in other animals. Yet the presence of white cell blood, with a predominance of eosinophile cells, enlargement of the abdomen, and the detection of a large solid body in the left hypochondrium which proves tender to the touch may prove more satisfactory than in other animals. In certain cases it has obstructed the biliary duct by pressure and entailed hepatic disorder and jaundice.

The treatment would not differ from that of the larger animals.

Siedamgrotzky has also observed splenic hypertrophy in the cat in connection with leucocythæmia.

SPLENITIS. PERISPLENITIS.

Causes: extension from adjacent inflammations, penetrating bodies, contusions, lacerations, infections, over exertion, cold, damp, over feeding. Symptoms: those of primary disease, visible traumas, chill, fever, swelling, flatness of percussion sound, absence of crepitation, anorexia, vomiting, constipation, diarrhœa. Prognosis usually good. Treatment: castor oil, enemata, cold douche, electricity, phlebotomy, in infective cases quinine, salol, salicylates, iodides.

No accurate border line can be drawn between splenic hyperæmia and hypertrophy on the one hand and inflammation of the spleen on the other. It is, however, not difficult to assign to inflammatory action all cases that tend to suppuration and abscess. Also in perisplenitis with adhesions to adjacent parts like the liver, stomach, intestine, kidney or abdominal wall inflammation cannot be doubted.

Causes. Extension from the disease of adjacent parts—perihepatitis, perinephritis, peritonitis, enteritis—is a distinctly appreciable cause, as are also penetration of the spleen by foreign bodies, contusions, lacerations and infections of the organ. Cruzel, who claims an extensive acquaintance with the disease in working oxen, attributes many cases to violent exertions, overdriving, cold and damp weather, and an overstimulating alimentation. As inflammation may supervene on hyperæmia and hypertrophy we must accept the various causes of these conditions as factors in producing inflammation.