§ 218. Inflammation of the spleen, splenitis, lienitis. Affections of the spleen, even when amounting to disorganizations, do not affect the general organism in any great degree, and are not easily diagnosed.

An acute inflammation of the parenchyma of the spleen is characterized by the following symptoms: Violent sticking, boring, tensive, throbbing pains in the region of the spleen, extending to the shoulder, clavicle, nipple, or towards the stomach, back, kidneys, with oppression of breath, constriction of the epigastrium, with aggravation of the pain on turning to the left side, on pressing on the left hypochondrium, or during motion, exertion, cough, sneezing, etc. This painfulness is constant; sometimes there is an increase of heat in the region of the spleen; and if the lower and anterior portion of the spleen be affected, a hard, round, not very moveable swelling, is felt in the region of the ninth and tenth ribs, anteriorly, which is extremely painful when touched. Accompanying symptoms are: Oppression, anguish, cough, dyspeptic symptoms, vomiting, burning in the region of the stomach, bitter, or sometimes sour taste, with burning eructations, retching, vomiting without relief, singultus. Vomiting of blood is always present, even at the commencement; the blood, particularly at the commencement, is scarcely ever pure blood, but is mixed with bilious, slimy matter, looks like serum, but assumes a blackish venous colour; afterwards the blood becomes thick, blackish, and is vomited in larger quantity. Obscuration of sight, vertigo, disposition to fainting, are frequently present, particularly in an erect posture. The fever is a synocha, with intense thirst and changing pulse, which is sometimes suppressed and intermittent at the left wrist; the urine is burning, of a dark brown-red, less frequently of a dingy saffron colour. The fever is remittent, and has sometimes a quartan or tertian type.

§ 219. Splenitis runs a course of from 5 to 14 days, and terminates with critical sweats, urine, phlyctaenae around the mouth and nose, and sometimes bleeding from the nose or other orifices. It may leave adhesions, induration, or permanent enlargement. Splenitis is seldom directly fatal; death generally ensues by softening or suppuration; the former termination being much more frequent than the latter; hence the frequent tearing of the spleen.

The distinction between inflammation of the capsule and parenchyma of the spleen is of no practical value. Splenitis is frequently epidemic in hot summers, and is sometimes confounded with melaena, hepatitis, peritonitis, pleuritis, nephritis, gastritis, or carditis. Gastrodynia likewise frequently depends upon or co-exists with an affection of the spleen. In such a case the spleen is probably more or less inflamed, which we may infer from a previously existing abdominal plethora, or from one actually present and occasioned by the suppression of an habitual discharge of blood from the bowels. Among the numerous violent symptoms which come under our observation in such a complicated case, those pointing to an inflammation of the spleen are frequently overlooked.

Splenitis is most frequent among persons of middle age or among old people. It occurs more frequently among men than women. It may be caused by mechanical injuries, concussion of the trunk, long running, dancing, colds, sudden suppression of habitual discharges of blood, suppression of ulcers on the feet, or the inflammation may reach the spleen by spreading from adjoining organs.

§ 220. In acute splenitis, with violent synochal fever, Aconite is the first remedy. If, under the influence of Aconite, the pain does not subside simultaneously with the fever, other remedies should be resorted to.

Nux vom. is indicated by a sensation of swelling, increase of the stinging pain by contact or motion, spasmodic pains in the left hypochondrium, with qualmishness in the pit of the stomach, aversion to food, with fainting spells, vomiting of blood or gulping up of dark blood from the stomach, pains in the stomach, retention of stool, dyspeptic symptoms, etc. The constitution and disposition of the patient should likewise be considered.

Arnica deserves attention when the blood is coagulated, between light and dark-red, with constant aching-sticking pain in the left hypochondrium, and consequent arrest of breathing.

Cantharides is indicated when the kidneys are likewise inflamed, with constant retching and some discharge of blood by the mouth, sticking pressure and feeling of fulness in the left hypochondrium, extending to the dorsal vertebrae, tossing about in despair and agony.

Belladonna is likewise suitable for splenitis.

Chamomilla corresponds to a tensive and burning pain in the left hypochondrium, pressure in the pit of the stomach, frequent hiccough, etc.

China, although not generally indicated in inflammatory diseases, will be found useful in splenitis, after the fever has been subdued by Aconite, when the frequent vomiting of blood induces great debility, and the pinching and pressure change to lancinations, with swelling and hardness of the spleen; frequent diarrhoeic stools, with discharge of dark, coagulated blood, do not counter-indicate China, although in such a case Arsenic deserves a preference, particularly if the patients complain of a burning pain in the spleen, with swelling, attended with constant anguish and pulsations in the pit of the stomach. China is likewise indicated by painful swelling of the spleen, and tearing stitches in that organ, preventing the patient from lying on the affected side. The fever is characterized by dry burning heat, great thirst, restlessness, anguish about the heart, yellow, livid countenance, dry and parched lips, white-coated tongue, bitter taste in the mouth, nausea, aversion to food, etc.

Bryonia is counter-indicated by haematemesis and diarrhoea; it corresponds to constipation and sticking pains in the spleen. I think Bryonia and Pulsatilla particularly adapted to an inflammation of the capsule of the spleen, with sticking, aching pains, aggravated by motion, and when the affected part is visibly swollen.

Laurocerasus, Mezereum, Drosera, Stannum, Plum-hum, Spigelia, Lycopodium, Carbo veg., and other remedies, may sometimes prove useful in splenitis.