Cut into its surface.   A red black pulp like raspberry jelly oozes out and between the pulp are islands of white tissue, called Malpighian tubercles. 

The red pulp is composed of large blood spaces or sinuses lined with columns of cells.  The blood passes slowly though the sinuses and the cells filter it, destroying  bacteria, viruses, protozoa .  Similar arrangements of fixed macrophages exist in the sinuses of the liver (Kupffer Cells) and in the lymph nodes.  Together they comprise what is known as the body’s ‘reticulo-endothelial system’.  But the spleen also destroys tired red blood cells, worn out and dysfunctional after their 120 day journey round the vascular system,  recycling the haemoglobin to bile pigments and iron stores.   

The white nodules contain lymphoid follicles rich in B lymphocytes, which produce antibodies and sheaths of T lymphocytes, responsible for ‘hand to hand’ cellular conflict.  They are also major producers of monocytes, which are despatched to sites of injury where they transform into dendritic cells and macrophages and assist wound healing.  So both white and red components of the spleen are important parts of the immune system.  The same functions can be carried out in other parts of the body, but without a spleen, immunity is seriously compromised.      

In other mammals, the spleen is also an important reservoir of blood.  In the horse, 30% of the blood is stored in the spleen; in the dog 15%. Operate on a dog and you can see the spleen shrink before your eyes.  The spleen used to produce new red blood cells but loses that ability just before birth when that function is taken over by the bone marrow.   

Doctors have known about the spleen since ancient times.   It was, they thought, the origin of black humours, the source of melancholy (literally black bile) and hypochondria (below the ribs).   In the eighteenth century, women were often diagnosed as suffering from The Spleen when they were sad, bad tempered and out of sorts in mind, body and spirit.  Alternatively they might be said to be suffering from the Vapours (of the Spleen).   The term splenetic indicated that somebody was in a foul mood, though the same term in French meant sad and melancholic. 

So don’t ignore the spleen or provoke it, for if it ever gets ‘vented’, take cover immediately!

The little bastards that that bloody insect injected into me have swollen my spleen from 11cm to 15cm.  The insurance company seem to think it will explode in the low pressure environment of the aircraft cabin. It’s a solid organ, I insist!  Physics doesn’t work like that!  It’s enough to give anybody The Spleen!   

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‘I can’t eat these. I have sensitive teeth.’

‘Well just try swallowing them and feel the cold go all the way down,’ I suggested. ‘Look it’s easy.’  And with that I popped one into my mouth, let it roll down back into my pharanx and swallowed, then waited for the wave to slide it down.   

The grape was as hard as a marble and cold as a lump of ice.  It got so far and stopped just behind the sternal notch, generating a dull ache that spread like a band around my chest.   I swallowed again. It still wouldn’t budge.  In fact I could feel it coming back up again and the pain intensified.  I swallowed a third time.  Nothing.  I could feel my face turning red and a wave of nausea rising up from my stomach. 

I stood there, my neck sunk into my chest, eyes bulging, not sure what to do. Simon was laughing, tears rolling down his face. ‘You’re such a  daft bugger!’

At that I started laughing too and then stopped.  There was a real risk of asphyxiation and while it might be a good way to go, I wasn’t ready for that yet. I needed to stay calm. I breathed gently in and out and when I felt in control, swallowed some water and felt the grape move painfully down.   

I turned to Judy, who was a scientist.  ‘Why don’t you write this up as an experiment  – the induction of reverse peristalsis by an ice cold bolus?  But first we need to test its reproducibility.’  Emboldened by experience,  I took another grape and swallowed.  The  obstruction behind my breastbone was exquisitely painful this time and it was so hard not to laugh when others were swaying about with general mirth.  But another glass of water did the trick.  Eureka! 

‘Now, Judy, we need to try this on somebody else. What about Roz?  And we need a genetic control.  Simon would do. And then you must do a series.  You could put a capillary tube down and measure pressures or you could fill the grape with contrast medium before freezing and then X-ray your volunteers.  Reverse oesophageal peristalsis is controversial in humans, but this could be the proof.  You could be famous, Judy.  It could be known as the Donnelly Provocation Test.  You could patent it.’ 

Ah well,  you can lead a scientist to water, but ………  Judy was not impressed.  Another opportunity missed! 

All of this reminded me of a demonstration forty five years ago in Cambridge. Dr Giles Brindley, then a young lecturer in physiology, stood on his head on the class bench and swallowed water through a rubber tube from a large Winchester bottle, just to prove that swallowing does not occur by gravity but by persistalsis.  The next issue of the Med. Soc. magazine demonstrated the trick.  Beneath the bench was the laboratory assistant who was opening a stop cock to drain the bottle. 

Who said science wasn’t theatre?

A Health and Safety Warning.  These experiments are risky. Please don’t be tempted to try them at home.

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