The spleen is not very frequently affected by syphilis. Nevertheless, this viscus may become the seat of syphilitic disorder during either its early or late phases. It has even been asserted by Weil that the spleen may become enlarged in the interval between the appearance of the primary sore and the first cutaneous eruption. Whatever changes the spleen may undergo during the course of early syphilis are essentially of the simple congestive type, and are comparable to the acute splenic enlargements of the ordinary specific fevers; certainly, no essentially syphilitic changes can be detected at this stage. In fact, throughout the whole secondary period the splenic derangement is of the nature of simple hyperplasia. In the later stages of syphilis there is a more permanent enlargement of the spleen, due to a chronic interstitial inflammation that should be distinguished from that very much more common result of old syphilis, lardaceous degeneration. The histological characteristics of these enlargements are not known to differ essentially from the simple chronic enlargements of the spleen already considered.
It is only toward the end of the secondary period, and during tertiary syphilis and in inherited syphilis, that products essentially syphilitic can be recognized. Gummy infiltrations and tumors of the spleen have been observed by a few writers—not, however, clinically, but for the most part in the dead-house. These tumors are found scattered throughout the substance of the organ, but most commonly near its surface. They vary in number within not very wide limits, and in size from that of a pinhead to that of a pea or larger. They may be sharply circumscribed (but not encapsulated) or more diffused. The portions of the spleen affected become changed by the syphilitic material into grayish-red, homogeneous masses in recent cases. At a later stage they are "gray or grayish-yellow, homogeneous, somewhat dry, tough, almost cheesy."12 The spleen under these circumstances is, as a whole, somewhat enlarged.13 Gummy tumors of the spleen may be confounded with tubercle and old hemorrhagic infarction.
12 Wagner, Mosler, Ziemssen's Cyclop., vol. viii. p. 485, Am. ed.
13 Gold, Viertelj. f. Derm. und Syph., 1880, p. 463.
There is a form of circumscribed enlargement from new growth that is sometimes observed in the spleens of syphilitics, and which is probably of syphilitic origin, producing changes similar to certain forms already described as a variety of perisplenitis. It is situated at the surface of the spleen, and consists of hard whitish or pale-yellow plates but slightly elevated above the normal level, but of considerable superficial extent. When incised, these plates remind one of cartilage.
Splenic enlargements are common in the subjects of inherited syphilis. According to Cornil, infants syphilitic by inheritance have very frequently enlarged spleens, the capsule being inflamed and thickened and the splenic tissue abnormally hard. The organ may thus become sufficiently enlarged to be detected by palpation. Sée considers that enlargement of the spleen is present in one-fourth of all cases of inherited syphilis, and Haslund reports splenic enlargement in 58 of 154 necropsies of such infants.
The clinical signs of syphilitic spleen are almost beyond recognition, if indeed they can be said to exist. Circumstances of growth, etc. may excite the suspicion that a given splenic tumor may be syphilitic. Jullien, it is true, describes symptoms of splenic syphilis, but his views do not seem to be well founded.
TREATMENT.—In recent enlargements therapeutics may effect much in reducing the tumor, and the facility with which its reduction is effected will afford a valuable indication of the success of treatment. Gummy tumors are probably within the reach of antisyphilitic treatment, and it is not unlikely that some of the shrunken, indurated areas often detected post-mortem, and usually ascribed to infarctions, are in reality due to the cicatricial remnants of old gummata. Chronic diffuse splenic enlargements of syphilitic origin are but little influenced by treatment.
Rupture of the Spleen.
The peculiar texture of the spleen renders it especially liable to rupture—more so than any of the other abdominal viscera. By far the most common cause of splenic rupture is external violence from blows, kicks, falls, squeezing force, and wounds incised or punctured. It may be the direct result of the injury, or the rent may be made by the penetration of broken ribs or of foreign bodies. The rupture may even occur spontaneously from causes located within the organ itself. It has been previously observed that in the enlargement accompanying the acute infectious fevers, malarial fever, etc., while the distension of the capsule renders the spleen tense and elastic, section through its substance will often reveal a semi-diffluent condition, the exact nature of which is not well understood, but which undoubtedly originates in excessive vascularity. This occurs especially in malarial fever and typhus. Rupture may here take place spontaneously, or, as is commonly the case, a very slight degree of violence is sufficient to produce it: a wrench, the effort to preserve a disturbed equilibrium, an otherwise insignificant blow, may determine the lesion. Pregnancy and the puerperal state may be the predisposing causes to the accident, and vomiting has been known to produce it. It has also been known to follow the softening and breaking down of a hemorrhagic infarction or the rupture of varices and aneurism. The normal spleen is only with the greatest rarity subjected to a degree of violence sufficient to rupture it, while in countries where enlargement of the spleen is of common occurrence, as from malaria, the accident occurs more frequently.