Chronic splenic anaemia and Banti's disease / by H.D. Rolleston.

  • Rolleston, Humphry Davy, 1862-1944.
Date:
1914
Catalogue details

Licence: In copyright

Credit: Chronic splenic anaemia and Banti's disease / by H.D. Rolleston. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    20/22 (page 18)
    to the left lobe of the liver. The suggestion that the cirrhosis is due to arsenic given medicinally for anaemia (Broadbent7), can apply to those cases only which had been vigorously treated. The Clinical Features have already (p. 16) been given and need not be repeated. Diagnosis.—Diagnosis is only possible in the third stage, and then only after the exclusion of other conditions, such as hepatic cirrhosis with a large spleen, syphilitic splenomegaly and hepatomegaly, thrombosis of the splenic and portal vein, kala-azar. In the first, and often in the second, stage, the diagnosis must be made from the various conditions with which splenic anaemia may be confused (vide p. 11). Portal cirrhosis exactly resembles Banti's disease, which can only be diagnosed by the history of long-standing spleno- megaly and anaemia. The Egyptian splenomegaly studied by Day and Richards16 presents progressive hepatic cirrhosis, splenomegaly, and anaemia, and so far the condition resembles Banti’s disease ; but there is fever, and hepatic cirrhosis instead of being a terminal feature is an essential part of the disease from the start (RichardsSG). But it is noteworthy that splen- ectomy in the early stages, before the onset of ascites, arrests the course of the disease. Syphilis of the spleen and liver may produce the picture of Banti’s disease, as has recently been emphasized by Osier34; but the diagnosis can rapidly be decided by the Wassermann reaction. Thrombosis of the splenic and portal vein is as difficult or impossible to distinguish from Banti's disease, as it is from splenic anaemia (vide p. 12). Kala-azar can be recognized by the presence of Leishmania in the blood obtained by puncture of the spleen or liver. Treatment.—Treatment is on the same lines as in splenic anaemia; but splenectomy, which gives the only chance of recovery, is attended with a much higher mortality than in splenic anaemia. Banti estimates the operative mortality at 50 per cent., and Rodman and Willard17 (1913) state that in the last four year 16 cases of true Banti’s disease have been operated upon with a mortality of 9, or 56 ’25 per cent. Stein47 quotes Rehling’s optimistic estimate of a mortality