CASES OF ABSCESS OF THE SPLEEN, WITH REMARKS ON THE PATHOLOGY OF THAT ORGAN
Authors: E. Lyon
Journal: BMJ (1853)

OURknowledge of the functions of the spleen, or of the purpose which this organ serves in the animal economy, is so extremely imperfect, and our diagnosis of its diseases consequently so uncertain, that it is desirable to record every fact which may contribute to throw a little light upon either: and it seems probable that through the patholoqy we shall find the most trustworthy way of ex- ploring the physiokoqy of this organ.With this view, I have thought it not unprofitable to draw attention to the subject, by shortly describing a case which appears to be of rare occurrence, and adding a notice of some similar cases, with a few remarks suggested by a consideration of the facts brought forward.I regret that my memoranda do not enable me to give a more complete history of the following case.CASE i.The subject was a married woman, aged 30, who was delivered of a first child, in April 1833, by a practitioner with whomI was not acquainted.On July 17th, I saw the patient for the first time.in conjunctioii with Mr. Jordan, and leamed the following particulars :-Since the birth of her child, she had never been well, having suffered much pain in the left side, aind havine seldom been able to quit her bed.There was felt at this time, below the ribs of the left.side, a tumour, having an obscure degree of fluctuation.There were fre- quent shiverings, occasional vomiting, rapid pulse, thirst, and cough.She was very helpless, lying best on her back, suffering dyspano when laid on either side, or when sitting up for any length of time.The countenance had a very peculiar expression-a kind of smile mingled with anxiety.'The complexion was of that appearance which Darwin likened to that of a full-grown silk-worm, and John Bell to modelled wax.Palliatives only were thought advisable under these circumstances; and I did not see the patient again till September 3rd, from which time till her death, on October 5th, she continued to decline.During the last eight days of her life, she had a discharge, per anum, of very offensive matter, mingled with small blood-coloured vesicles; and after the commencement of this discharge, the tumour in the side disappeared.Examination of the Body on October 10th, forty-four hours after death, by Mr. Jordan and myself When the abdomen was laid open, a superficial view of its contents presented no marks of inflammation.The stomach was situated low down; and, on a close examination, its large end was found to have contracted adhesions to the adjoining textures.The small intestine was removed, and nothing rematkable observed in it.The adhesions of the stomach being torn up, a large cavity was exposed, bounded by the -stomach, diaphragm, left kidney, and colon.There were no remains of the spleen, except its capsule, and two fungoid bodies, of the size of walnuts, lying over the kidney.The diaphragm was pushed far upwards, so as to diminish considerably the left cavity of the thorax.The sac contained a small quantity of turbid and very footid matter; it communicated with the descending colon by a circular aperture, with smooth edges, capable of admitting the tip of the forefinger.The liver was pale; the gall- bladder contained a small quantity of light-yellow bile.The substance of the lungs was healthy.The left lung was reduced in volume, occupying only the upper portion *of the chest.The vertebrm did not appear diseased.The obscurely fluctuating tumour, accompanied by hectic, * This paper was read before.the Medical Society of Manuichester several years gp; anjd is now communuicated, with soma additions, by Samuel Crompton, Esq. and preceded by acute pain, rendered the existence of an abscess almost certain; andthe situation of the tumour