Boston Medical and Surgical Journal
A case of this condition which came under my care led me to look into the subject, and to think that my results might prove of some interest, especially to physicians of this neighborhood, the great immunity of which from malarial influences renders affections of the spleen comparatively rare. July 26, 1877, I was called to a young man, a baker by trade. His family history was good, and he had never been laid up before by sickness, so far as he could remember. Was born in Boston, and had always
... ton, and had always lived here with the exception of two or three years (1873-75), which he passed near the eastern end of the Hoosac Tunnel, a region in which, I am informed, malaria is not unknown. He had never suffered from chills and fever, had never done any heavy lifting, or had any fall or injury of consequence. July 14th, went to bed and to sleep as usual, but was wakened during the night by severe pain in the left hypochondriac region, and then discovered for the first time that he had a tumor in his abdomen. He described the pain as having been very sharp, as having drawn him down on the left side, and as having been aggravated by deep inspiration or by flexing the left thigh on the body. By July 19th the pain left him, and he resumed work, but had a fresh access during the night of the 21st, and again during that of the 22d. A physician was then called in, who enjoined close confinement to bed. I found him in bed, without fever or any subjective symptom, but with a prominence of the left side of the abdomen dependent on a smooth, firm, clearly defined, and non-sensitive tumor, extending from half an inch to the left of the umbilicus and under the lowest ribs toward the lumbar region. Its lower border was on a level with the anterior superior spinous process of the ilium ; and the whole tumor could be pushed up several inches toward the region normally occupied by the spleen, but in other directions was only slightly movable. No notch could be felt. Placing the patient on the right side, with the left arm over the head, I found marked dullness on percussion over the tumor, and full resonance over the splenic region. No difference could be detected between the lumbar regions of the two sides in the back by palpation or percussion, either when the patient was in the erect posture or when he was lying on his belly. No enlargement of lymphatic glands, and no apparent anaemia. His bowels had acted freely and regularly of late, and I made the diagnosis of enlarged and floating spleen.