Part 96

Symptoms. Most observations of inflammation of the spleen and its results have been made only post mortem, so that we must allow that the simple forms occur and undergo resolution without obvious symptoms. In the perisplenitis supervening on another disease also in infective cases there will be the antecedent symptoms of such primary diseases. In those resulting from traumatic injury, bruises, swellings or wounds, cutaneous or subcutaneous, there will often be suggestive features. In the more purely idiopathic cases symptoms are only shown when the lesions are extensive and acute. In oxen, Cruzel has noted the initial chill, followed by disturbance of the respiration, more or less hyperthermia, and a swelling of the left flank and hypochondrium in the absence of tympany of the rumen. The nature of this swelling is the most characteristic feature, as it gives a flat instead of a drumlike sound on percussion, and does not bulge outward and downward over the whole left side of the abdomen, pit on pressure, nor crepitate uniformly all over from fermentation, as in overloading of the stomach.

If abscess should form, chills and high febrile reaction are marked symptoms. In vomiting animals, anorexia, nausea, vomiting, constipation, and even diarrhœa may appear.

Prognosis. Unless in extreme cases and those due to traumatism or infection, the result of splenitis is usually favorable.

Treatment would consist in depletion from the portal system and spleen by rectal injections, and laxatives which like castor oil, will operate without extensive absorption. Cold water or ice applied to the left flank and induction currents of electricity may also be resorted to. General blood-letting is strongly advised by Cruzel, and Friedberger and Fröhner. In infective cases quinia, salicylates, salol, and the sulphites, or iodides would be indicated.

HÆMORRHAGIC INFARCTION OF THE SPLEEN.

In congestive conditions. Absence of free capillary anastomosis and contraction, absence of valves in splenic veins. Embolism of splenic artery. Clots in pulp spaces. Wedge shaped infarcts, first black, later yellow, later caseated, or cicatrized. Abscess. Prognosis good in non-infective forms. Treatment as for hyperæmia, or infection, or both.

This condition appears in hyperæmia, hypertrophy, splenitis, and splenic infection and largely because the structure and circulation in the organ conduce to such trouble. The splenic arteries terminate in open vascular spaces filled with splenic pulp and where all trace of a freely anastomosing capillary network is lost. The splenic veins in the same manner originate from these open vascular spaces. There is, therefore, an absence of the free communication of capillary network, which virtually acts as a safety valve in other vascular tissues, and the vascular cavities connected with each terminal artery are independent of those belonging to another, and find no way of ready relief when they become over distended, or when there occurs obstruction (thrombosis) of their afferent or efferent vessels. From blocking of arteries or veins there is at once produced a wedge shaped area of stagnation which cannot be relieved through any collateral circulation. Again the splenic veins, being destitute of valves, offer no obstacle to the reflux of blood into such vascular spaces whenever the further access of blood has been arrested by the blocking of the artery. The blocking may occur in the afferent artery through embolism by clots carried from the lungs or left heart, or formed within the vessel by the colonization of microbes on its walls. Even more likely is the formation of coagula in the vascular spaces themselves as the result of the introduction of pus, or septicæmic microbes, which are long detained and have ample time for multiplication in these cavities. In either case the result is obstruction to the sanguineous current, the filtering of blood backward from the veins and the engorgement of the cavity with blood. The plugs consist of fibrinous matter enclosing colonies of micrococci, and the result is not only black infarction of the spleen, but a subsequent general infection of the system at large.

The wedgeshaped infarcts are usually situated at the surface of the organ, the base turned outward and forming a dark projection on the surface, and the apex turned inward. The aggregation of two or three in one group may considerably alter the outline. If recent they are of a dark red color. Later from absorption of the coloring matter and fatty degeneration of the mass they assume a pale yellow hue and the swelling flattens or disappears. Later still through complete fatty degeneration they may be transformed into caseated masses, or through organization into fibrous tissue they may form thick white cicatrices. If pus cocci are present suppuration and abscess may be the outcome.

The simpler forms recover like cases of simple hyperæmia while the severe infecting forms may become the point of departure for the formation of multiple abscesses in other organs, and of more or less fatal general infections.

These conditions can only be discovered post mortem, and any symptoms directing attention to the spleen could only suggest such treatment as would be indicated in hyperæmia. Any purulent or septic disease which might coexist would of course serve to indicate a germicide line of treatment.

ABSCESS OF THE SPLEEN.

In Solipeds: in infectious diseases, pyæmia, embolism. Symptoms: of primary disease or ill health. Involving other organs. In cattle: foreign bodies from reticulum, distomata, embolism, microbes. Enlargement: involving other organs: seen in left hypochondrium, fever, albuminuria. Treatment: aspiration, antiseptic injections, internal antiseptics.

=Soliped.= Abscess of the spleen in this animal is unusual and has only been discovered post mortem. It has been found as the result of the local colonization of pyogenic microbes, in connection with strangles, contagious pneumonia and other infectious diseases and can then often be traced to an infected embolus in the splenic blood vessels. The peculiar vascular structure of the spleen is very conducive to abscess as it is to infarction, as has been already noticed and hence this complication of a pre-existing infection in another part is a natural pathological sequence. Symptoms are rather the general ones of a rigor followed by hyperthermia than any diagnostic ones of splenic disease. Bourges found a splenic abscess in a cachectic, melanic mule but no definite splenic symptom was observed even on rectal examination. Nottel found an abscess as large as an infant’s head, in the base of the spleen, closely adherent by its sac to the left kidney and containing a floating mass of splenic tissue as large as the closed fist. Rutherford found a neoplasm connecting the great curvature of the stomach, to the diaphragm, and hollowed out into a series of pus cavities. Fetzner and Cadeac report cases of extensive abscesses in the head of the spleen and intimately connected to both stomach and diaphragm. Hahn found abscesses in connection with the penetration of the spleen by foreign bodies. In other cases the substance of the spleen was studded with abscesses varying in size from a pea upward and containing necrotic tissue or adjoining such dead tissue.

=Ruminants.= In cattle the penetration of the spleen by sharp pointed bodies coming from the reticulum appears to be the most common cause of abscess. Other cases depend on the penetration of distomata carrying the pyogenic microbes, and still others are due, as in the horse, to local infection with embolism. External traumatisms are unusual causes. There is usually considerable enlargement of the spleen as a whole, rounded swellings indicating the seat of the abscess, and adhesions to surrounding parts, such as the rumen, the left kidney or the diaphragm. When the abscess is chronic, there is emaciation, unusual flatness on percussion of the left hypochondrium, and, at times, of the flank, swelling and tenderness of the flank, above all, according to Imminger, a persistent elevation of temperature (104° to 106° F.), which is not lowered by antithermics, and albuminuria. In cattle it is sometimes possible to diagnose the disease, and if the abscess can be definitely located, aspiration and antiseptic injections into the sac would be indicated, conjoined with calcium sulphide, or sodium sulphite internally.

FOREIGN BODIES IN THE SPLEEN.

In horse: body from intestine. In ruminants bodies from reticulum. Laparotomy.

One such case in the =Horse= is reported by Hahn. A mare had loss of appetite, slight colics, frequent efforts to urinate, dullness, prostration, profuse perspirations, and tremors of the muscular walls of the abdomen. Rectal examination detected a staff-shaped body extended from behind forward in the direction of the stomach. The mare survived twenty days, when it was carried off by a more violent access of colic. At the necropsy, the spleen was found to measure 28 inches by 8; its base was adherent to a loop of intestine, and presented a large cavity filled with a grayish brown fœtid liquid, and a piece of oak measuring 17 inches by ½ inch.

Ruminants. In cattle and especially in those that are stabled, needles, pins, nails, wires and other sharp pointed bodies, that have been swallowed with the food, and have become entangled in the reticulated walls of the second stomach, have been found to penetrate the spleen and determine local abscess and fistulæ. The offending body in such cases is found in the interior of the abscess or in its walls. If such cases can be diagnosed the superficial position of the spleen would seem to warrant surgical interference for the removal of the foreign body.

RUPTURE OF THE SPLEEN.

Solipeds: Causes: Blows, kicks, goring, leukæmia, compression of splenic or gastric veins, anthrax infection. Lesions: Blood may escape into peritoneum or remain confined under serosa. Splenic degeneration or pulpy condition. Fractured ribs, ecchymosis, surface swellings. Spontaneous arrest. Symptoms: Of internal hemorrhage. Vomiting. Trembling. Vertigo. Coma. Treatment: Rest, quiet, locally ice, snow, cold, internally iron chloride, matico, astringents, anodynes. Cattle: Blows, crowding, leukæmia, youth, anthrax, Texas fever, microbes. Symptoms: Persistent lying down, advancing bloodlessness, surface coldness, stiffness, local tenderness, fluctuation. Treatment as in horse.

Horse. This is not a frequent lesion in solipeds, yet the number of cicatrices of the spleen which are found post mortem in old horses would indicate a considerable number of slight and non-fatal cases. The most common cause appears to be external violence and especially kicks or blows with horns on the left hypochondriac region. Horses running at large in pastures, or in yards, or standing side by side in short stalls or tied with too long halters are the usual victims. Cadeac refers to cases reported by Tausch, Millot, Berndt, Humbert and Pont, and one case occurring in a three year old colt came under the notice of the author. The subject stood in a stall to the right of an irritable mare, and though the kick left no noticeable skin lesion the colt died in three hours with symptoms of internal hemorrhage. At the necropsy a laceration of the spleen of about five inches long was disclosed, and a large quantity of blood had accumulated in the peritoneum.

Brandis mentions a case consequent on a violent fall on the left hypochondrium.

In other cases pre-existing disease of the spleen or its blood-vessels have proved active factors. In the friable degenerated spleen of leucocythæmia multiple small lacerations have been found (Peuch, Laulanie); in engorgement of the spleen consequent on thrombosis of the splenic vein (Wiart); in chronic indigestion with habitually loaded stomach compressing the gastric and hepatic arteries and determining a reflux of blood through the cæliac axis into the spleen (Mongin).

Finally, though less frequently than in the ox, the engorgement of the spleen with blood in cases of anthrax may be a cause of rupture.

Lesions. The rupture may be on any part of the spleen and it may be complete or incomplete; in the latter event the capsule may have ruptured while the more elastic peritoneal covering has remained intact enclosing a coagulum of variable size bulging above the level of the spleen. When the peritoneal coat has given way, its laceration is usually smaller than that in the spleen and its proper envelope. Any degeneration of the spleen will affect the appearance of the lesion. In one case caused by external violence the adjacent portions of the spleen were reduced to a soft pulp. In such a case there is a slow but continuous flow of blood in a small stream which may, however, prove fatal (Humbert and Pont).

Again in cases caused by external violence there may be fractures of the ribs, ecchymosis, local swellings or even wounds of the skin, but all these may be absent. The blood effused into the peritoneum is usually clotted. If the effusion has taken place slowly it is more or less coagulated around the edges of the wound or even in its depth and in this way the hemorrhage may be arrested. When the peritoneum is still intact the pressure of the clot beneath it has served to arrest the flow. In such cases the clot may be in part liquefied and absorbed and in part organized into fibrous tissue, constituting the cicatrices of the spleen found in old horses.

Symptoms appear to have been varied. Colicy pains are generally noted. Tausch has observed vomiting, Millot vertigo, and Wiart coma and trembling. In the author’s case the animal was found down, unable to rise, almost unconscious, pulseless, with great pallor of the visible mucous membranes, dilated pupils, and cold extremities. A diagnosis was made of internal hemorrhage, but its actual seat was only revealed post mortem.

Treatment. The early mortality usually forbids treatment. When opportunity is furnished keep the animal absolutely still and quiet, apply snow, ice or other refrigerant to the left hypochondrium, give internally tincture of muriate of iron, matico, or other astringent, and relieve any severe suffering by anodynes (hyoscyamus, belladonna, opium). External wounds may be treated antiseptically.