Children in whom great enlargement of the spleen exists are very sub ject to gastrointestinal troubles, and in consequence of their weakness are frequent sufferers from every form of catarrhal derangement. In fact, they usually die from a severe diarrhoea or an attack of bronchitis or ca tarrhal pneumonia. If they escape these accidents recovery is not impossi ble. We sometimes find the spleen gradually diminish in size and eventu ally return to its normal dimensions.
A little boy, aged twelve months, with no teeth, was brought to me, as he was said to be weakly. The child had been reared by band, and was subject to attacks of sickness. A short time previously, during a visit to the seaside, he had been jaundiced. There was some slight enlargement of the ends of the bones and his fontanelle was large. The child could not stand, but liked to be danced about and played with. His complexion was excessively pale, with a faint olive cast. The abdomen was full, and the spleen, which. was large and hard, reached to the level of the navel. The child was put upon a nutritious diet, and was ordered cod-liver oil and plenty of fresh air. In five months' time he bad cut ten teeth, and although still pale, had a better complexion. Seven months afterwards (twelve from his first visit) he had sixteen teeth and could run about well. His spleen was now greatly reduced in size, being just perceptible below the ribs. His complexion was good and he seemed perfectly well.
In this case no special medication was attempted with the object of reducing the size of the spleen. The general weakly state was improved by fresh air and a suitable dietary, and cod-liver oil was given on account of the signs of incipient rickets. Moreover, further intestinal catarrhs were prevented by a carefully applied abdominal bandage. The hope that under these altered conditions the size of the spleen would diminish as the general health improved was perfectly justified by the event.
Diagnosis.—There is little difficulty about the diagnosis of these cases. The complexion of the child is very characteristic. Indeed, in a young child extreme anaemia should always direct attention to the spleen. When a hard lump is discovered in the left side of the abdomen, it is easy to ascertain if the swelling is due to splenic enlargement. The 'superficial position of the tumour ; its passing upwards beneath the ribs ; its less rounded inner edge, with a perceptible notch ; the free mobility of the mass, which can be pressed upwards by the fingers, and may be seen to move in correspondence with respiration, descending when a deep breath is drawn, and rising again with the diaphragm as the lungs contract—all these signs leave little doubt of the nature of the enlargement. That the tumefaction is a simple hypertrophy, and is not due to lymphadenoma or leucocythemia, is inferred from the absence of lymphatic enlargements in the former case, and in the latter from the small increase in number of the white corpuscles of the blood.
Prognosis.—The prospects of the child in simple hyperplasia of the spleen depend in a great measure upon the care bestowed upon him, and the watchfulness with which he is guarded from intercnrrent ailments. The prognosis is:therefore much more favourable in the case of children of well-to-do parents than in those belonging to the class by which our hos pitals are supplied. If the patient show marked signs of rickets or syphi lis, a cure can hardly be anticipated ; but if the signs of rickets are only moderately developed, or the syphilitic origin of the enlargement is merely a matter of suspicion, the child, under favourable conditions, has a fair chance of recovery. Any considerable excess of white corpuscles in the blood must greatly diminish our hopes of a successful termination to the case.
the treatment of cases of simple hypertrophy of the spleen we must not allow our attention to be directed too exclusively to the swollen organ, to the neglect of the general health. Much injury is often done in these cases by long courses of mercury or iodide of potas sium, and the energetic application of mercurial ointments to the left hypochondrium.
Our first care should be to attend to any gastrointestinal derangement which may be interfering with the patient's nutrition. Vomiting must be stopped, looseness of the bowels must be arrested, and the diet must be arranged so as to supply the most ample nourishment with the least tax the digestive powers. Most of the patients are weakly children under two years of age. They must therefore be dieted the prin ciples recommended m the chapter on Infantile Atrophy. Milk, yolk of egg, Mellin's food, Chapman's baked flour, broths, thin bread and butter, and, if the child is eighteen months old, raw or underdone mutton, pounded in a mortar and strained through a fine sieve, should be given. Watch fulness must be exercised that the size and frequency of the meals are duly proportioned to the digestive capabilities of the patient ; and in the case of milk, in particular, it is important, by careful inspection of the stools, to satisfy ourselves that curd is not passing away in large quantities by the bowels. If this be the case, milk should not be given pure as a drink, but be always mixed with barley-water or other thickening material, so as to aid its digestion by insuring a fine division of the curd. Three or four grains of pepsine, given just before the three principal meals, will be of great assistance in these cases.