Barnetson, Robert Balfour

2018-01-31T11:17:12Z

2018-01-31T11:17:12Z

1918

The primary cause of splenomegaly would seem to be a gastro -enteritis with repression of the glandular digestive activities. In many cases the gastroenteritis is brought about by great mental strain. The changed stomach and bowel condition sets up fermentative and putrefactive processes giving rise to vomiting, flatulence, distention and colic pain, flatus, diarrhoea, frequent micturition. The putrefactive processes are set up by Bacilli of the typhoid group which are facultative anaerobic and thus will draw oxygen.from the surrounding tissue such as haemoglobin and be thus the cause of a slight chlorosis. The intra and extra cellular toxins enter the portal vein and mixing with the portal blood enters the spleen. Some constituent is fixed by the connective tissue cells there and neutralized. The 'aggressin' element destroys the white blood corpuscle and the serum complement the red blood corpuscle.

The destruction of the red blood corpuscle alters the viscosity of the bile in the smaller bile ducts and and produces haemohepatogenous jaundice. The escape of the toxins into the general circulation alters the lining endothelium of the vessels and the coagulability of the serum of the blood so that you have haemorrhages especially from the ill- supported mucous membranes. The irregular pyrexia means an irregular toxaemia. The poisoning process may be repeated in the liver with atrophy of the liver cells and ultimately ascites from portal pressure.

Removal of the spleen throws into greater act - icity all lymphoid tissue of the body which may or may not increase. If it does not increase then in all likelihood this tissue is equal to the toxic qualities present. If it does increase it may be due to greater glandular capacity but more likely to a connective tissue hyperplasia such as is found in the spleen and liver and which brings splenomegaly in close similarity or proximity to Hodgkin's disease.

Finally. Idiopathic splenic enlargement. Hanti's disease and splenic anaemia are one and the same disease, all being dependent upon a bowel toxaemia and differing only in the degree and intensity of the putrefactive processes in the bowel.

http://hdl.handle.net/1842/26243

The University of Edinburgh

Annexe Thesis Digitisation Project 2017 Block 15

Splenomegaly complicated by pregnancy and followed by splenectomy

Thesis or Dissertation

Doctoral

MD Doctor of Medicine