Anemia splenica (second paper) / by William Osler.

  • Osler, William, Sir, 1849-1919
Date:
[1899?]
Catalogue details

Licence: Public Domain Mark

Credit: Anemia splenica (second paper) / by William Osler. Source: Wellcome Collection.

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    only two above normal, in one 7000 per cubic millimeter, and in one 20,000 per cubic millimeter. In some of these cases the history, course, and blood condition suggest progressive pernicious anemia. Case XIII., reported in my first paper, had, as I then remarked, many of the features of this disease. She returned (as noted in the early part of this article), and died with all the features of a pernicious anemia, plus great enlarge- ment of the spleen. This group is of unusual interest, and brings up the question of the frequency of enlarged spleen in pernicious anemia. Hunter' says “ in a certain number of instances the spleen has been found enlarged, this condition being even recognizable during life.” He mentions a number of cases reported by different observers; the largest mentioned “ was in a case reported by Wilks (500 grams). In four cases of his own, the spleen weights were 19 ounces, 11 ounces, 10 ounces, and 13 ounces.’’ In a great majority of the cases the spleen is either described as normal or no mention is made of the condition at all. Cabot^ notes enlargement in 13 of 110 cases; Billings^ in 5 of 20 cases. Among 40 cases from my wards, reported by McCrae‘‘ the spleen was felt in only 6 cases, and in none of them was the enlargement at all marked, it being noted that ‘ the spleen was just felt.’ ” 2. Chronic Anemia, with Enlarged Spleen, 26 cases. Eighteen of these were in males. The duration of the disease is most interesting ; eleven years, 1 case; nine, 1; eight, 1; seven, 3; six, 2; five, 1; three, 2; four, 1; two, 3; between one and two years, 3 ; in 1 doubtful, “ many years.” In 9 of the cases the disease had lasted for more than five years; in 7 the duration was unknown. Hematemesis occurred in 9 cases, jaundice in 4 cases, ascites in 5, and in 7 cases the liver was enlarged. Several of the cases had been regarded as Banti’s disease, or the terminal stage of anemia splenica. In only 7 of the cases were the red blood corpuscles below 2,500,- 000 per cubic millimeter. In 22 cases the hemoglobin percentage was relatively low, in 3 it was normal, and in 1 it was not given. In 13 cases the leukocytes were below 5000 per cubic millimeter. In a ^ Pernicious Anemia (monograph), I90i. 2 American Journal of the Medical Sciences, 1900, p. 1. 3 Itiid Journal of the American Medical Association, 1902,1.