A treatise on the structure and use of the spleen : being one of three unsuccessful essays for the Ashley Cooper prize, awarded July, 1853 with additional notes and an appendix, containing an exposé of the numerous errors in the prize essay / by Edwards Crisp.

Edwards Crisp

Date:: [1855]

Credit: A treatise on the structure and use of the spleen : being one of three unsuccessful essays for the Ashley Cooper prize, awarded July, 1853 with additional notes and an appendix, containing an exposé of the numerous errors in the prize essay / by Edwards Crisp. Source: Wellcome Collection.

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$of tlie Spleen is not mentioned. In 25 cases of disease of the liver and its ducts, related by Andral, the condition of the Spleen is not spoken of. Mr. Twining, in the 3rd vol. of the Transactions of the Medical and Phy- siological Society of Calcutta, 1827, says, In chronic engorgement of the Spleen, very fi-equent in Bengal, mercmy in every form was found to be peculiarly injurious, a very few doses producing great debility, profuse sali- vation, and sloughing of the gums and cheeks, which in many cases proved fatal. A preparation of Sulphate of Iron and Bitai-trate of Potash was found to be the most efficacious medicine The chief symptoms besides tlie enlargement of the side, were extreme debility, paleness of face, dry and soft skin, and a leaden appearance of the conjunctiva. The Spleen, when examined after death, broke down in the hands and became a putrid gore. Pain in the side.—The fi-equent occurrence in females of pain, and the sensation of a lieavy weight over the Spleen, is probably due to distension of this organ with blood, and the aching of the side often experienced in child- hood, after running a quick pace, may, I suspect, arise fi-om the same cause. Dr. Bree, whojmbUshed a paper in the Philosophical Transactions, vol. 2, *' on painful affections of the side fi-om tumid Spleen, found this pain relieved by htemoiThoids and the mensti'ual flux. Hcmnorrhaye.—The tendency to hsemon-hage in enlai'gements of the Spleen is very great, as shewn in the cases already related. My brother. Dr. Hem-y Ciisp, Surgeon to the 63rd Eegiment, was some yeai's in Scinde, and he wiites me, that in this coimtry, where continued, remittent and intei-mittent fevers are very prevalent, enlargement of the Spleen is fre- quently met with ; the organ sometimes reaching to the pubes, the coun- tenance bloated and of a leaden hue; pain in the shoulder and side, and hasmoiThage from the mucous membranes being some of the chief symptoms. Mr. Thomas, {Lancet, 1830, p. 585,) mentions a fatal case of haemorrhage from leech bites, in a child 5 years of age; the Spleen weighed 3 lbs., and was of a firm texture, Like liver. A similar case is related by Dr. Bon, (Lancet, 1836.) It will be interesting hereafter to inquii-e minutely into the condition of the Spleen in those cmious cases of hsemorrhagic diathesis prevailing in certain families? In Mi-. Wardi-op's lectures, published in the Lancet for 1833—34, vol. 1, p. 132; he says, I attended a patient, where the inti-oduction of a common seton-needle in the side was followed by a fatal hsemon-hage. A gentleman, who had an enlai-ged spleen, was advised to have a seton introduced in his side, and this was done, in the usual manner, by Sfr Astley Cooper. Alarmed by the quantity of blood oozing fi-om the wound, I was sent for to see the patient in the evening of the same day.- On withdrawing the cord, pressm-e, cai-efully applied, with graduated compresses, did not avail, and the hfemorrhage being so profiise, as to make It appear probable that some vessel of considerable size had been wounded, I thought It expedient to divide that portion of integument which existed between the two perforations of the seton-needle. Having done tliis, I foimd that the blood issued fi-om numei-ous oi-iflces, and I secm-ed no less than nme vessels with ligatures. Blood continued, however, to ooze fi-om numberless small oiifices over the whole sm-face of the wound, which every mode of treatment usuaUy employed failed in ai-resting, and the patient died in a lew days. ^ Eupture.—ln addition to the ease of spontaneous nipture of the Spleen related at page 159, others have been recorded. In the Archives Generales de Medecme, ] 854, p. 85, a case of spontaneous ruptm-e of the spleen is related m a soldier who had had intermittent fevei for 0 months. He died rnn^?,wl^?f^,^ ^°^*^'® first accession of pain; the Sjileen (enlarged) was luptuied in three places; the hver was hai-d, lai'ge, and yellow. M 2$