Create her child of spleen; that it may live.

WILLIAM SHAKESPEARE

The Tragedy of King Lear

Understanding splenic function eluded man for more than 2500 years. Hippocrates (460–377 BC) taught that the spleen “drew the watery part of food from the stomach.” Aristotle (384–322 BC) believed that it had no vital function. Pliny, in the first century AD, felt that the spleen's weight might hinder the speed of runners and could be removed “by way of incision,” resulting in the inability to laugh. The ancient Greeks also believed the spleen impaired athletic abilities, and applied hot irons to reduce its size.

Described by Galen (130–200 AD) as the “organ of mystery,” the spleen was later believed to be the source of melancholia (black bile or choler) as the theory of bodily humors arose. This theory persisted more than 1000 years, giving rise to the idea of “venting one's spleen.” In the Babylonian Talmud (second to sixth centuries) and the ancient Jewish writings of Judah Halevi (1086–1145), the notion of the spleen's role in laughter evolved. Because laughter was believed to be a cleansing process, it followed that the spleen “cleanses the blood and spirit from unclear and obscuring matter.” Maimonides (twelfth century) also stressed the spleen's function in purifying blood. The overall image of the spleen, however, was that of a nonessential organ that could be removed without adverse effects. This image persisted until the early 1900s.

In 1919, Morris and Bullock were the first to recognize the spleen's role in infection, based on animal studies, stating: “It is an observation of great antiquity that the operation of splenectomy is not followed by death. Indeed one may live for years without suffering any apparent ill effect from the absence of the organ; but this does not settle the problem as to whether or not a splenectomized person can weather a critical illness.”<sup>67References 1, 8, 9, 31, 42, 64, 78, 85, 90, 92, 98.

Cliccare qui per andare alla sezione Riferimenti</sup> Cases of infection in splenectomized hosts were noted but roused little attention, probably because septic death was common. In 1952, King and Shumacker<sup>48References 1, 8, 9, 31, 42, 64, 78, 85, 90, 92, 98.

Cliccare qui per andare alla sezione Riferimenti</sup> reported five cases of fulminant sepsis in splenectomized infants. Following this report, the association between splenectomy and fulminant, lethal sepsis has been firmly established, and knowledge of the spleen's role in the response to bacterial infection has expanded.^{*References 1, 8, 9, 31, 42, 64, 78, 85, 90, 92, 98.} The evolution from good health to death within 1 day has been repeatedly documented in the asplenic patient. Septic death rates of up to 600 times greater than the general population have been reported for this syndrome of overwhelming postsplenectomy infection (OPSI).<sup>6References 1, 8, 9, 31, 42, 64, 78, 85, 90, 92, 98.

Cliccare qui per andare alla sezione Riferimenti, 90References 1, 8, 9, 31, 42, 64, 78, 85, 90, 92, 98.

Cliccare qui per andare alla sezione Riferimenti</sup> Despite the large amount of published cases, insufficient data exist to determine the true incidence, exact nature of infection, risk factors, and the contribution of underlying conditions to overwhelming infection in the splenectomized host, a true medical emergency.