in such a manner as to throw him every three or four minutes into dreadful spasms; he could not bear for a moment an horizontal posture, but was obliged to sit continually on a chair, with the back of another chair before him to lean on. This increased on the fourth day, attended with large drops of cold clammy sweat; and on the evening of this day he died. On ex-' amining the liver, I found the concave surface totally sphacelated, and an abscess and adhesion on the convex. It is the justest observation in medicine, that as is the violence of the inflammation: so will its termination be;-when excessively acute, as in this case, if it yields not to medicine, it will be sphacelus; if less acute-suppuration; if still less-resolution. In Morgagni, (Alexander's Transl. Vol. II. p. 143), I find a case nearly similar to this, with this difference only, that the right curvature of the colon, and the contiguous psoas muscle were also affected with gangrene. The subject of this case was 70 years old, and "given to wine. " In an epidemic marsh remittent, which prevailed among the soldiers of the royal artillery in Grenada in September, October, and November, of the year 1791, (an account of which was published in the Edin. Med. Commentaries for 1793), the livers of two of the sufferers by that fatal malady were sphacelated and rotten. Before I quit this subject, I may mention that, in the liver of a clergyman, my intimate and highly respected friend, Mr Wingate of St George's, Grenada, who died of dysentery, a substance of a round form and suetty consist ence, about the bigness of a small pullet's egg, contained in a bag of a semi-cartilaginous structure, was found. The cause of his death, however, was the most usual one in dysentery-mortification of the colon, &c. This gentleman had a fall from his horse about eighteen months before, and immediately after complained much of pain in his right side, and other symptoms, which induced me then to treat him as for hepatitis: but whether his fall gave rise to the formation of the suetty ball, or whether a small abscess was produced, the matter of which in time acquired this consistence, I shall not take upon me to determine. The cysts described by Dr Baillie, I apprehend, are evidently of a different nature from this. His cysts were composed of a kind of cartilaginous substance, mixed with bone, &c. (p. 227). Morgagni, in his 36th Letter, Art. 14., mentions several instances of something similar to this having been seen in the spleen; and Dr Baillie (p. 256) says, that this cartilaginous state may be considered as in a great measure peculiar to the spleen: but in all these instances no mention is made of their cause. It will be deemed a very curious circumstance, that the rup ture of an organ so unsusceptible of pain, and so unproductive of danger when extirpated from the body, as the spleen is said to be, should prove fatal in the case of Morton. How is this to be reconciled with the accounts handed down to us by many respectable authors, and which seem to have been adopted by so experienced and skilful a physiologist as Dr Baillie? (p. 261.) But the opinion of its want of susceptibility of pain, I have much reason to doubt; and a case of splenitis, which I shall subjoin, supports me in this doubt. That it should be an organ whose subserviency to the general purposes of the animal economy is so trifling, as that economy suffers little or no derangement. on its extirpation, is also an opinion I cannot perceive the reasonableness of, seeing it is altogether inconsistent with the wisdom and providence of our Creator, who hath made nothing in vain, and that in many instances it is even combated successfully by opposing facts. Mr Home has rendered it highly probable at least, that the spleen has a use, which he has endeavoured to demonstrate by experiment, viz. to carry off the fluids not necessary for digestion, from the cardiac portion of the stomach. Such a theory does not seem, however, to correspond with a fact which inclines us to assign an office of higher utility to this organ. I suspect indeed we are still to seek for its office; and the following fact increases the mystery of the problem; or, if * *The theory of Mr Home is probably not altogether new, although not before demonstrated by experiment. Hippocrates seems to have had an idea of this kind when he wrote the following passage: "Ventriculus dum plenus est, omium horum (viz. bilis, sanguis, hydrops, et pituita) corpori fons est. Sunt autem et alii fontes quatuor, a quibus unusquisque horum humorum in corpus procedit, postquam sane ipsi a ventriculo acceperunt. Et sane sanguini fons est cor, pituitæ caput, aquæ splen, (τω δε ύδατι, ὁ ςπλην-πηγη εστι), bili locus folliculi in hepate, (De Morbis, Lib. iv. c. 2. ed. Vanden Linden.) In the ninth chapter he proceeds to say how the spleen attracts water from the stomach; but, as may be expected, he is not very intelligible, seeing the connecting vessels between the stomach and spleen he speaks of, are not to be found. Riolanus, in his Enchiridium Anatomicum, (p. 143, ed. Frankfort, 1672), mentions this idea of Hippocrates, adopted by him from Aristotle. "Hippocrates serum superfluum ex ventriculo emulgere credidit, quam opinionem secutus est Aristoteles, &c. Yet Riolanus himself inclined to the opinion of its being reservatory or supplementary in its office (p. 146). This last seems also the opinion of Mr Saumerez. (New System of Physiology, Med. Rev. Vol. V. p. 129). Dr Drake's very singular and instructive case of "Diseased Spleen," I conceive to be likewise referable to this theory of that organ, deranged in its functions by a cause obstructing or preventing the regurgitation of its elaborated blood. (Med. and Surg. Journal of Edin. Vol. II. p. 409). The evident desiderata in the treatment of this well-detailed case, were bleeding and mercury in the early stage of the complaint. When these, particularly the last, were recurred to, the favourable period was gone by. It indeed furnishes an additional illustration of the medical precept, the promulgation and recommendation of which were my motives for publishing the foregoing paper. "" it throws any light on it, it probably does so by strengthening the opinion that the spleen is a saccus succenturiatus, a function attributed to the gall-bladder by Dr Parr, (See Med. Dictionary, Art. Jecur). "Samuel Mitchel, Esq. of the Island of Grenada, late of Devonshire, informed me," (I extract the fact from my Grenada Med. Journal, ending in 1794, when I left that island)," of his having been for many years troubled with a very considerable enlargement of his spleen, brought on by repeated attacks of remittent fever; but on going to England in 1784, and remaining there till the year 1790, the enlargement gradually disappeared. Soon after his return to Grenada, the former fever afflicted him again, and with it the spleen again enlarged; and such was the extent of the disease, that it might be distinctly felt considerably below the navel, and in the right hypochondrium. This was the state of it in the year 1792 when I first felt it; and it is remarkable, that in proportion to the number of febrile attacks was the size of the spleen. A sensible Negro woman, the nurse to the hospital of Bacolet estate, on which Mr Mitchel resided, informed him, about this time, that the complaint was a very common one among the children, and that the most effectual cure she had experienced, was frequent pressure, or kneading, as it were, of the spleen. She advised him to have recourse to the same treatment, and for medicine to use about a table-spoonful of the rust of iron every second morning. He assured me that the spleen, after every operation or kneading, became less; and in fact on the 20th of August (1792), when I last saw him and felt the abdomen, it had evidently diminished more than one half, although during this time he had frequent returns of his troublesome remittent." Is not this case an illustration of Morgagni's theory of the cause of the remarkable large spleens which have been sometimes met with? (See Letter 36, Art. 18). He mentions some weighing 1541b, and others of the almost incredible weight of 231b and 33fb. After all, and giving due consideration to the various theories which have been proposed, I am inclined to think that the principal, if not the only use of the spleen, is to perform the double office of receiving the blood not necessary for the general purposes of the economy, thereby to preserve more important organs from too great distention and rupture (a function for which it is solely designed according to Dr Rush), and during its detention to elaborate that blood into a state necessary to give agency to the bile in the great work of chylification. I am dis posed to adopt this opinion, 1. From its coalescing the opinions of almost all physiologists respecting the use of the spleen. 2. From the spleen being a sac, or a collection of sacs united by a common enveloping membrane. 3. From the disproportioned size of the splenic artery to the organ to which it conveys blood, (arteriæ illæ, satis magnæ, et jecoraria, incredibili mensura, majores Boerh. Instit. 315). 4. From the spleen having no excretory duct. 5. From the splenic vein being the only channel by which the contents of the spleen are discharged. And 6. From these contents being conveyed by the splenic vein into the trunk of the vena portæ, and thence exclusively into the liver. Hence the perspicuity of the aphorism of Sylvius: Non videtur enim tam simpliciter ad vitam, quàm commodiorem vitam datus animalibus lien. (Prax. Medicæ, lib. i. c. 43. s. 6). Hence, too, appears the rational inference which Boerhaave drew from a correct examination of the structure and connexions of the spleen: Apparet quidem manifestissime quod omnis hujus actionis fructus in liene nascatur, sed neutiquam ei inserviat: verum quum omnis sic confectus, humor eat in unam venam Portarum et hepar; patet usum splenis inservire hepati, &c. (Institut. Medicæ, 329-326. Ludg. Bat. 1734, p. 174). I subjoin the case of splenitis.-A man of a strong athletic constitution and cheerful disposition, in the month of December 1784, was spontaneously seized with a pain in the left side, where the spleen is situated, attended with considerable heat and tension of the part, and some degree of fever. His belly after the two first days was regular, and his appetite for food to lerably good. After the two first days of his complaint the fever abated very much, but the least pressure on the part where the pain was felt was intolerable. He had no headach, but some lassitude in his limbs, which continued after the fever disappeared; and his strength gradually diminished notwithstanding his animal functions did not seem much impaired. I saw him three or four days after the accession of the disease, and, imagining at first that the pain proceeded from some degree of inflammation of the left kidney, I drew near a pound of blood, ordered a blister to be applied, and prescribed nitrous and emollient medicines. He continued these for a few day's without experiencing any relief. 1 found now he had no symptoms peculiar to nephritis, a circumstance I was deceived in when I first saw him, but that the pain and other affections evidently indicated inflammation of the spleen, and I therefore determined to treat it as a case of hepatitis. The fever and tension being gone, I ordered calomel in the following form: B. Calomel, ppt. gr. xxx. Camphor, ij. Mic. panis, q. s. ut ft. pilula viginti. Sumat unam mane et vespere. He took the twenty pills by the time I next saw him; they had brought on a gentle spitting, and had almost totally removed the pain. I continued them one morning and evening, in order to support the salivation; and, in about six days more, he was perfectly recovered.* Clifton, 19th April, 1811. C. CHISHOLM. II. Case of Erythema Mercuriale. Communicated to Dr ADAM BURT, by ANDREW Ramsay, Esq. Assistant-Surgeon in the Honourable East India Company's Service. I MY DEAR SIR, Seetapoor, 2d Sept. 1810. HAVE now the pleasure to send you the case I promised. When I began to draw it up, I thought it might be interesting. as I was not aware of that complaint attacking the natives, and as it has only lately been taken notice of. I have since observ ed, however, in the Edinburgh Medical and Surgical Journal, an extract of a letter from Madras, in which it is stated to be very common in that establishment. I myself have never seen it before; and I am very much in the habit of prescribing mercury. I send it to you, however, as it shows that a return of it may be expected on a second exhibition of the medicine. This circumstance makes me suspicious, that it does not arise from cold so much as from a peculiarity in the constitution. I think, also, that were it the effect of cold, we should meet with it much more frequently; and that the mercury, instead of ang menting it, would, as in other cases arising from cold, tend to remove it, by its being quickly thrown in. During the second attack, there were no catarrhal symptoms, nor affection of the eyes; but that but that may be accounted for by the attack being slight, in consequence of the mercury having been stopped so early. * Hippocrates gives a case of excessive pain in the spleen; in which, after bleed. ing and abstinence had been employed, the disease became worse; but was at last cured by drinking a particular kind of wine (övs Meras dextos), vinum bibit nigrum tenue, sanatus est. Epidemics, (Lib. vii. c. 57.) This black wine was probably of those mild kinds he speaks of in another place, which possessed a purgative cooling quality, dive, pahaxa pecharts.~(De Diæta, Lib. ü. c. 22. ed. Vanden Linden.) |