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Radium
n
lytic function, and there is abundant evidence, both microscopical and
clinical, to support this view. Some authorities contend that the spleen
also possesses a homogenetic power, but that this property is only evoked
in response to severe hemorrhages or other special stimuli.
Chronic enlargement of the spleen from congestion is met with in
hepatic cirrhosis, and in chronic cardiac and pulmonary affections. It
also occurs in certain constitutional conditions, syphilis, rickets, malaria.
and lardaceous disease, but in none of these affections is radium therapy
of any practical value. There are. however, three diseases, in all of
which there is great enlargement of the spleen, and in which radium
treatment is indicated, as it rapidly induces a considerable shrinking in
the size of the organ with an associated improvement in the patient's
general condition.
i. Splcnomeijaly—Simple.—A gradually progressive enlargement
of the spleen, unaccompanied by ana-mia or leucocytosis. and with practically
no symptoms beyond the discomfort occasioned by the size and
weight of the organ.
The effect of radium radiation in a case of simple splenomegaly is
usually very striking. A spleen which before radiation reaches down
into the left iliac fossa rapidly recedes under appropriate dosage, and
at the end of six weeks or two months may not be palpable below the
costal margin. The radiation of the enlarged organ i> best accomplished
by means of numerous "half strength" Hat surface applicators containing
from 200 to 400 mgrs. of radium element, screened with 2 mm. of
lead, the total exposure being of from twenty to thirty hours' duration.
2. Splenic Anaemia—fiaiiti's Disease. A chronic enlargement of
the spleen, with marked anemia, but without any leucocytosis. The disease
shows a great tendency to hemorrhages, and is followed after a
period of years by cirrhosis of the liver and ascites.
In ibis condition radium usually induces a definite decrease in the
size of the spleen, with some slight improvement in the color index.
The disease is. however, a steadily progressive one. and the remission
usually proves but temporary, a repetition of the treatment being called
for at intervals of from four to six months.
Radiation is carried out with "half strength" surface applicators.
screened with 2 mm. of lead, and total exposure of from twenty to thirtyhours.
The amount of radium employed varies with the size of the
spleen, but generally quantises of from 100 to 200 mgrs. of radium
element are necessary.
3. Spleno-Medulhry Leukaemia.—This affection is much more
common than lymphatic leukemia. The principal clinical features are
a gradual enlargement of the spleen, with associated changes in the blood
and bone marrow, followed in the later stages by multiple hemorrhages
and progressive anemia. Microscopical sections cut from the affected
spleen show its pulp to be closely packed with leucocytes, but there are,
in addition, many marrow cells "myelocytes." both neutrophilic and eosinophilic.
The Malpighian bodies arc usually hypertrophied. In acute
cases, or in the early stage of the disease, the organ is soft, but as the
condition becomes chronic a fibrosis and thickening of the reticulum
occurs. Examination of the Wood shows ;* great increase in the number
of the white blood corpuscles, the count varying from 200.000 to 1.000.-