and of the profession, the distinguished position of “head” of the surgical profession in Jamaica-did me the honour to approve fully af my views and treatment. He advocated, as the last resource, and as almost the only chance of saving the boy's life, a step which I had often before recommended in vain, viz., the boy's removal to a colder climate, if his strength would admit of it.

On the third of October I tapped him, and removed 10 quarts fluid. The boy bore the operation, which was performed with great rapidity, well. A flannel bandage, cut into tails at both ends, which were held on each side by assistants, and drawn tighter as the fluid escaped, kept up a steady and even pressure; and before many minutes had elapsed, the abdominal cavity, full before, even to bursting, had emptied itself almost entirely. A little champagne given; the lips of the puncture sealed up close with court plaster; a pillow of soft lint being then placed over all; the bandages drawn down, and carefully and evenly adjusted, and its ends sewn over each other (for a knot would have exerted injurious pressure, and have caused pain). All this being done, the boy fell asleep with a sigh of relief.

Bandaged as he now lay, the enormous size of the spleen was apparent, even to the eye. It projected as an enormous tumour, occupying the greater portion of the left side of the belly, pushing out the bandage before it; while the belly, on the opposite side, was sunken and flat.

The condition of the removed fluid was equally striking. It frothed up into a dense mass of foam, which did not subside. I had no means of ascertaining its specific gravity; but, when I add that, on a portion of it being boiled, it was found to contain almost one-third of solid albumen, it will be seen that its density was high.

I need not enter further into the treatment of the case than to say that the boy was up and about in a couple of days; that he had a good appetite; and that he continued to take his iron and quinine frequently, and a draught of nitre in some gin toddy at bed time. I persuaded his father to remove him, a week after, to the sea-side, where he could have warm sea-baths, and breathe an abundant supply of pure ocean air; while he would have, at the same time, the benefit of the combined skill of the medical men of Kingston.

Before he left my charge-and I saw him, for the last time, five days after he had been tapped-the fluid had again formed in the cavity of his abdomen, to the extent of, at least, four quarts; so

that the prognosis to be formed, in regard to his ultimate recovery, is not a very cheering one.

I shall now proceed to make some general remarks on this case, and

On the Spleen and its Functions.

In the foregoing case there has been always an extreme want of colouring matter in the general mass of the blood. The boy is white and chlorotic looking-like faded wax-and he has been so for the past nine years. Were it possible to examine his blood in the field of the microscope, it would be found to abound in white corpuscles, and to be greatly wanting in solid constituents. This is, in fact, a case of aggravated leucocythemia; and, perhaps, as pure a case of this affection as has ever been seen. During its whole progress, quinine, and the various preparations of iron, given in different forms, as they seemed to be required, and changed when the stomach appeared to prefer one preparation to anotherwhich have usually such an effect in improving the quality and colour of the blood, and enriching it with solid matter, had not, in this case, the full effect generally expected from their use. And why? Because the spleen was powerless and inactive; incapable, in fact, of doing its usual dnty, i.e., of maturing red corpuscles, and supplying them to the general mass of the blood.

I have never heard this boy complain of the pain usually felt by chlorotic people, in the region of the spleen; unless, indeed, when the organ was struck sharply by the point of the finger in making an examination. Granting that the function of the spleen is that of maturing red corpuscles, and of supplying them to the general mass of the blood, the organ, in this case, has not done its duty, although it has been aided and stimulated, in every possible way, by blood-enriching tonics frequently administered.

The fact of this child having lived and grown to be a big boy of twelve years of age-all the while looking pallid and waxy, and more especially so when the spleen, from miasmatic or other causes, appeared to become increased in volume; all this, most assuredly, tends to prove that the function of the spleen is essentially that of supplying colouring matter to the blood, and, through it, to the tissues generally.

In this case, the organ, from its enormous size and its extreme hardness and lobular condition, must have lost, almost entirely, and that years ago, its functional use in the animal economy. It VOL. XLIII., No. 85, N. s.

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does not supply blood rich in red corpuscles to the system, for the lips are, and have been for years, very pallid, without, apparently, a particle of colouring matter in the blood circulating through them; and the cutaneous surface, generally, has had, for the past nine years, a faded shining appearance.

Any scratch, too, or sore on the child's body would continue in an indolent, unhealthy state; and should granulations at last spring up under the blood-improving powers of iron and quinine, they would be pallid and flabby, showing very little determination to coalesce.

The theory that the spleen acts as a diverticulum for the superfluous blood of the system, and that this is its main use in the economy, receives a severe blow from facts observed in this case, Here we have an enormous, indurated, and lobulated organ, at all times with its capsular covering and processes so much distended, as to be incapable of further sudden distention, or slackening, and, consequently, incapable of receiving or retaining any sudden accession of blood introduced into the circulation, or thrown back upon the spleen itself during any temporary congestion of neighbouring organs and vessels.

The sudden enlargement of the spleen, observed after the process of digestion has advanced as far as the formation of chyle in the duodenum, appears to me to be dependent more on the blood of its own vein being sent back upon the spleen, by pressure of the duodenum and its contents upon it (the vein), than upon any sudden accession of blood to the system at the completion of the process of digestion.

I speak now of the healthy state; but, of course, in congestion of the liver or stomach, or in any arrest of the circulation through the portal vessels, the blood must be thrown back, and is thrown back-from the absence of valves to prevent it-upon the spleen, and then congestion of the latter organ occurs as a matter of consequence.

In this very case the enormous hardened mass into which the organ has been converted, I doubt not, maintains and enlarges its own proportions, and keeps itself full always to distention, by exerting, per se, continuous pressure on the vena portæ, thus driving back the blood directly on the spleen, through the splenic; while, at the same time, it keeps up a steady distention of the mesenteric veins; and, as a natural consequence, causes a constant inpouring of sero-albuminoid fluid from these vessels into the

abdominal cavity. As an additional proof of the truth of the foregoing statement, I would add, that for some time past, the surface of the belly has been covered with an extensive network of distended veins, which ramify in every direction, and clearly show by their numbers and distended condition, an obstruction to the flow of blood upwards through the portal vessels. This I consider to be the pathological explanation of the case, and to account fully for all the symptoms, and I have no doubt but that the profession will fully support me in taking this view of the matter.

In corresponding with Doctor Fiddes, of Kingston, who has now charge of this case, I have proposed that some mechanical apparatus should be made by which the spleen could be lifted from off the vessels behind, and injurious pressure on them thereby prevented. For instance, a bandage could be made, with a firm cup-like cavity, the convexity of which might be made to press on the tumour from behind, and thus to raise the spleen, and push it to the front. This suggestion is, at any rate, worthy of trial; and I make it, leaving to the profession to put it in practice in similar cases, according to circumstances, and to report on its value.

3.-Case of Spinal Meningitis, Treated by Quinine and Opium, with Mercurial Inunction; Recovery.

Mrs. E., a married lady, aged fifty, had been complaining, for some days, of a very severe pain in the back, increased, by motion, over the lower dorsal vertebræ. She had, about six months before, when on a visit in another part of the island, suffered from a prior attack, not by any means so severe, according to her husband's report, as the one I am about to describe, of spinal irritation.

Warned by previous experience, she immediately retired to bed, and took measures to clear out the bowels. I believe she took a full dose of calomel, with a grain of opium in it, and that she followed up this, the day after, with some senna-tea. At the same time she applied a good-sized blister, much too large, however, over the seat of pain. The prima via were, I believe, well cleared out, but with no relief to the pain in the back, which continued to be very severe, while the stomach was exceedingly irritable.

On the second night after the accession of pain she tossed about the bed, and had an uneasy troubled sleep, complaining, at times, of severe cramps in her legs and thighs, all shooting from the back. Friction was employed, but all to no purpose. At midnight, she cried out, "a fit-a fit!" and immediately she became violently

convulsed over the whole body, her trunk being bent forwards in a state of perfect opisthotonos. These convulsions recurred several times before morning, each fit being more severe than the other preceding it, until she became quite exhausted.

I saw her about seven o'clock, a.m., when the preceding history of symptoms was related to me. I found her in a comatose state, skin clammy, and frequent sub

with the pulse small and weak, sultus. The tongue appeared to have been a good deal lacerated, although every care was said to have been taken, and had been taken, to prevent it.

There was evidently no time to be lost if a recurrence of strong convulsions was to be prevented. I saw, however, that I had a good foundation to build on, in as much as the bowels had been well cleared out, and I had an open blister on the back for local applications. On looking at the latter, I was horrified that such an extensive surface had been blistered-and such a blister it was! I pause here to state, that I had no doubt but that the extreme irritation caused by this large raw surface materially affected the severity of the attack.

At least four grains of powdered opium were rubbed up with about a drachm-for there was no time to weigh one or other-of mild mercurial ointment; and this was quickly spread and applied to the raw blistered surface. Frictions to the legs, and warmth applied, by mustard cataplasms and blankets, to the legs and thighs, were also enjoined. In the meantime I had weighed and made up some powders, each containing two grains of quinine and one grain of opium. I directed that one of these should be given every hour during the day.

The result of the above treatment was that the muscular twitchings ceased entirely for many hours. In the evening, however, she again became restless-her muscles twitched, and convulsions were imminent. A fresh plaster of opium and mercurial ointment, with even a greater proportion of finely-powdered opium in it than before, was at once applied, and a large warm poultice was placed over all. Frictions again; and warmth applied to the limbs, while cold applications were kept to the head, all combined to ward off the attack.

Still she continued restless, and, although opium had been used so unsparingly during the day-locally applied and otherwise-I now gave her a full dose of thirty drops of Battley's sedative. Her skin then assumed a comfortable warmth, and she slept quietly throughout the night.