On splenic anæmia / by Willaim Osler.

  • Osler, William, Sir, 1849-1919
Date:
[1900?]
Catalogue details

Licence: In copyright

Credit: On splenic anæmia / by Willaim Osler. Source: Wellcome Collection.

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    I purposely have not spoken of anaemia with enlarged spleen in very young children, a subject which requires separate consideration. Case I .Malaria in India some years previously; no syphilis; recur- ring attacks of hemorrhage from the stomach; enlarged spleen; pro- gressive anosmia; ascites; death from hcematemesis.—This patient, a man, aged thirty-six years, was admitted to the Montreal General Hos- pital, September 2, 1879, with anaemia. He had a very much enlarged spleen, which extended to the navel, and the lower edge was below the tiansverse navel line. There was no enlargement of the lymph-glands. The red blood-corpuscles were under 2,000,000 per c.mm. The haemo- globin unfortunately was not estimated. There was no leukaemia. He had served with the army in India, and had had intermittent fever. He had had recurring attacks of haematemesis. Two months before admission he began to have dropsy of the legs and abdomen. Case II. Severe hcematemesis at the ninth year, again at the eleventh year; anaemia; swelling of the feet; enlarged spleen.—Girl, aged eleven years, seen August 13, 1879. Two years before she had had a very severe hemorrhage from the stomach, from which she recovered, though she remained somewhat pale. A month before I saw her she had a second attack, in which she lost, the mother said, nearly three quarts of blood in thirty-six hours. She was very anaemic. The red blood- corpuscles were 2,250,000 ; leucocytes, 7120 per c.mm. These two cases were reported in full in the Canada Medical and Surgical Journal, vol. xi. Case III. Recurring attacks of hcematemesis and melcena between 1885 and 1897; excellent health in the intervals; chronic enlargement of the spleen; death in an attack. Anatomical summary : Chronic hyperplasia of the spleen; liver smooth, macroscopically showing no signs of cirrhosis; microscopically showing only fatty changes. —W. M., aged thirty-five years, seen on December 9, 1892, complaining of hemorrhage from the bowels. This patient was very anaemic after each hemorrhage. When I saw him first he was only slightly anaemic. The blood was examined, but unfortunately the slip with the count was mislaid. There was no leucocytosis, no enlargement of the lymph-glands. Case IV. No history of malaria or of syphilis; nearly ten years ago first attack of hcematemesis; since then, at intervals of about a year, very severe attacks, in ivliich he vomited blood and passed blood in the stools ; enlarged spleen; exploratory laparotomy; stomach and duodenum normal; liver smooth, not cirrhotic; removal of enlarged spleen; recovery.—C. D. B., aged thirty-three years, of Fincastle, Va., farmer, admitted on March 9,1898, complaining of hemorrhages from the stomach and bowels, and pain, with enlargement in the left side of the abdomen. On his first admission, four months after the last hemorrhage, the red blood-cor- puscles were 3,000,000, the leucocytes 2800 per c.mm., and hajmoglobin 25 per cent. Differential count: polymorphonuclears, 84.4 per cent.; small mononuclears, 4.4 per cent; large mononuclears, 5 per cent.; transitionals, 3.4 per cent. ; eosinophiles, 2.8 per cent. There was no enlargement of the lymph-glands. This patient has been heard from a year subsequent to the removal of the spleen, and he continues well. Case V. No malaria; no syphilis; eleven years ago first attack of hcematemesis; for four or five years recurring attacks of melcena ; in lo.