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Art. IV.-A Case of Chronic Enlargement of the Spleen,

with Remarks. By RICHARD R. DASHIELL, M. D., of Ten

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THE case which I am about to relate is one of not very unfrequent occurrence in this State. I allude to the chronic enlargement of the spleen, succeeding an attack of intermittent fever.

Elizabeth Harris, æt. 36, was subject to periodical attacks of ague and fever for fifteen years, and upon the cessation of this disease, about six years ago, she complained of pain in the left hypochondrium, which extended to her back; from which time the spleen increased in size until it has attained its present dimensions. She has been pregnant five times, and at the last accouchement gave birth to twins, from which time the pain in her left side increased. When I first saw her, she had that peculiar hue of skin which often follows tedious intermittents, and which those who have seen it will always recognise. This color is easily distinguished from the hue of slight jaundice—it is what is usually termed a claycolour. She had cough, general debility, loss of appetite, pain in the head and back, periodical blindness, vertigo, constipation, loss of sleep, sometimes for a week at a time; her catamenial discharge was irregular, being frequently merely a show, and then entirely suppressed. She had no fever; pulse was rather slow and regular; her belly enormously tumefied. Upon first inspection, I accused her of being pregnant, which imputation she resented warmly, as she had been separated from her husband for six years. On a more minute manipulation, I found that the abdominal tumefaction did not depend upon the presence of a fætus in utero, or of

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fluid in the peritoneum, but was produced by enlargement of the spleen, and was a case of what is vulgarly called 'Ague Cake.' The tumour was remarkable for its dimensions, occupying more than one-half of the abdominal cavity, and extending to the spine of the ilium. Judging from the impression it gave through the integuments, it must have been three or four inches thick. At one time she describes it as having been as large as “a clever sized watermelon.”

As there was tenderness upon pressure, I applied three cups over the splenic region, and recommended a light diet, in addition to which, I directed a blue pill every other night. The pills were continued until the tenderness was removed, when I inserted two setons, which produced rapid diminution of the enlargement, and a perfect cure, so far as the spleen was concerned.— With respect to tonics, I found them of great service. I used a decoction of the woods,' with supertartrate of iron. They no doubt gave vigor to the constitution, which had been impaired by long ill health, and tended to promote the absorption of the morbid products, on which the elargement chiefly depends.

In conclusion, I would offer the suggestion, whether the reason why enlargements of this viscus from sanguineous engorgement are not more frequently cured, is, that they are confounded with enlargements arising from inflammatory action, which have resisted all the means of treatment devised for their cure by the masters of the healing art.' The latter, or enlargements arising from inflammatory action, are generally hard to the touch, and are always more or less painful-on manipulation they present the feeling of induration, though sometimes only in spots, particularly in the inferior and left lateral portions, the right being free from any appreciable lesion. On the contrary, enlarge

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ments arising from sanguineous engorgement, have a soft, spongy, elastic feeling, during the absence of febrile excitement, whilst during the progress of the fever they impress us with the sense of distension, and not of hardness.

Chronic indurations of the spleen have resisted every plan of treatment. Iodine and mercury used in every form, have been alike unsuccessful. Temporary relief only has been afforded by cupping or leeching, low diet, change of residence, mineral water bathings, keeping the bowels free, and wearing the tartar emetic plaster over the left hypochondrium. On the other hand, chronic enlargements of the spleen are capable of reduction by adopting a hygienic course of living, by strengthening the system by the exhibition of tonics, by an alterative course of mercury, and finally, by the use of the seton. It is this condition of the spleen alone that yields to a judicious treatment, while all others remain the opprobria of our art.

July, 1840.

ART. V.- Observations on Milk-Sickness. By John Travis,

M. D., of Carroll County, Tennessee.

Whenever a new disease occurs among mankind or the inferior animals, and its remote cause cannot be clearly demonstrated, the floodgates of imagination are thrown open, from which thousands of conjectures flow, some of which are of the most absurd and ridiculous character. Such was the case on the appearance of Asiatic cholera. It is the duty of the physician to examine, to write and to think of diseases,

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in a rational manner. It ill comports with the character of medical science in this enlightened age, to trace the origin of diseases to the influence of the sun, the moon, and the stars. I have as much faith in the judicial astrology of the Romans, or Hesiod's theory of the origin of the world, as I have in such notions.

That milk-sickness exists in certain localities, I cannot for a moment entertain a doubt. It has made its appearance annually in Carroll county, and some of the adjacent ones, since the first settlement of the Western District of Tennessee. Many instances of death among horned cattle have occurred in this county, and dogs feeding upon their dead carcases have become diseased, and some have died. My own dogs have had the disease in such a manner as to render them unable to walk, by feeding on a dead cow. Several persons of this vicinity have had the disease, and some have died of it. They have had the whole train of symptoms described by Professor Yandell in his essay on milk-sickness, in the Transylvania Journal of Medicine, vol. 1, No. 3. I have invariably pursued the course of practice suggested in that essay, in the management of the cases that have come under my care.

The great concern of the physician is to obriate the constipation that exists, which is often of the most obstinate character, and with the removal of which the nausea, vomiting, and other distressing symptoms generally yield. Whether the relief from cathartics be owing to the removal of the poison of milk-sickness from the prima viæ, or to the restoration of the alvine secretions, is a matter not yet decided among practitioners, but of the efficacy of these remedies in the disease, no one who has had experience in it entertains a doubt. Vencsection in the early stage is useful, not only in calming the symptoms, but in promoting the operation of the cathartic. The gastric irritation continuing after the use of the lancet and purgatives, a large blister is applied to the epigastrium. Sinapisms to the extremities are beneficial in equalizing excitement, and affusions of cold water answer a similar purpose when much heat of the surface is present. In a word, the treatment does not differ materially from that pursued in bilious fever, except that constipation being a more prominent symptom will require more attention. That being obviated, the disease in most cases becomes sufficiently manageable.

It may not be uninteresting to state a remarkable fact which has occurred under my own observation ; it is, that my own cattle range with those of my neighbors, and have done so for five years, and none of them have ever had the disease, while many of theirs have died. I am strongly inclined to believe, that this exemption is owing to my giving my cattle salt every other day, during the spring, summer and autumnal months, whereas other cattle get salt perhaps once a month. From this fact it would appear, that the muriate of soda, (common salt,) acts as a prophylactic of the disease.

A range of hills of considerable elevation runs up from near my mills on Sandy river, westward, between which are fertile valleys. In these ravines cattle often range, and, it appears, also contract this disease. In these valleys abounds the Rhus radicans, upon which cattle sometimes feed. From certain experiments made, some years ago, by a gentleman near Cincinnati, there appears some reason to believe, that a small poison vine, a species of the Rhus, will cause milksickness. He had a number of cattle in a lot, in the winter sea. son, where the vine grew; he observed them to eat of the vine, contract the disease, and die. He removed the vines and put other cattle in the same lot, which escaped the dis

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