In plague there is a marked congestion of the liver as of other viscera and there may be some tenderness.
The liver becomes tender as well as showing enlargement in infections with Clonorchis.
Splenic Enlargements and Pains
Splenic puncture has been carried out for diagnosis chiefly in kala-azar, malaria and Malta fever. Some authorities have reported fatalities from spleen puncture in kala-azar approximating 1% so that many advise the safer liver puncture to that of the spleen.
Spleen puncture would only exceptionally be called for in malaria as there is usually no difficulty in making the diagnosis from a blood smear. Malta fever can usually best be diagnosed by blood culture taken at the height of fever and recent work by Wenyon and others would indicate that blood cultures on N. N. N. medium might take the place of spleen puncture in kala-azar.
Kala-azar.—The splenic enlargement is the most conspicuous change in the disease, the spleen often reaching the umbilicus by the third month and later possibly filling up the entire left side of the abdomen. The coincident emaciation of the patient makes the splenic tumor more apparent. When first enlarging the spleen may be the source of considerable pain and tenderness.
Fluctuations in the size of the spleen have been noted in the course of the disease, diminution in size often attending severe diarrhoeal attacks. In spleen or liver puncture the needle must be dry so that the parasites shall not suffer distortion.
Malaria.—Splenic enlargement and tenderness are important points in diagnosis of malaria.
In acute malignant tertian infections the spleen is often diffluent so that it is liable to rupture upon slight injury. One should even exercise care not to palpate the spleen too violently and the possibility of accident should be thought of in making a spleen puncture.