So long as the aetiology is unknown it is impossible to claim any treatment as a rational cure for
the disease, while the uniformly fatal issue up to
the present time proves that empiric treatment has
no permanent value.
All authorities agree that Iron alone is of no
use whatever, seldom showing any improvement even
From the use of Arsenic. alone or combined with
Iron, from Bone-marrow and from Oxygen considerable
benefit can always be obtained for a time, Koster
claims complete recovery from advanced Splenic Anaemia
in 3 months, from the administration of Arsenic and
Quinine with 4 litres of Oxygen daily in a case previously going down under Arsenic and Quinine alone.
Taylor, on the other hand, obtained only a temporary
improvement from Arsenic and Iodides with as much as
30 litres of Oxygen daily.
While Arsenic is antiseptic, it also, like Iron
and Bone-marrow, stimulates the growth of bone (the
chief blood-forming tissue) and, according to Bins is
a means of indirectly supplying oxygen to the tissues.
In severe cases a trial night he made of
injection of arsenic or quinine into the spleen.
Transfusion of blood has been used with apparent temporary benefit , but , promising as were the
early results, it has been, as far as I can gather,
finally abandoned as a mode of treatment in primary
Splenectomy has been tried in one or two
cases with transitory benefit. Banti, Wells, Taylor
& Gould have given their opinion in favour of this
radical treatment of the splenomegaly. The danger
of the operation is rapidly becoming less with improved technique, Spanton's mortality-tables showing
already no more than 37$f of deaths. In the improvement after splenectomy there-'is perhaps some slight
confirmation of the theory of microbic origin, from '
the fact that the main constitutional result of the
removal of this organ is an increase of the bactericidal action of the blood and consequently a greater
power of recovery from ineffective processes (Blunreich
& Jacoby). Besides we must allow that whatever the
nature of the cause of the disease of the spleen , so
long as no change can be traced outside of that organ.
removal of the spleen jna^mean remove 1 of the origo
In regard to the treatment of my patient
M, P. there are two details worthy of mention,
(1) The rise of Bourboule Water 3,3 an introduct¬
ion to the administration of Arsenic. It was taken
with ease and benefit when very small doses of Arsenic
in other forms were rejected. It is to be remambered
that, apart from the Arsenic it contains, Bourboule
Water is practically blood-serum.
(2) The very, large amount of Bone-marrow taken
| without disturbance of digestion. As much as 6 oz,
was taken daily for several weeka, twice as much as
the largest dose I have read of, (Fraser & Barr) .
It is of course true that the marrow usually administered
consists of nothing but fat (Stockman.) but even
fat is a stimulant to the blood-forming tissues (Passe
The treatment of Splenic Anaemia therefore
must be conducted on general principles.
1. We can conserve the patient's energies by
complete rest , better in. open air and sunshine when possible.
2. We can supply a light, nutritious, blood-forming
3. We can directly stimulate reformation of the
blood "by the use of the drugs already named.
4. And in the last resort (or better, perhaps,
at an early stage) splenectomy may be tried
with a fair prospect of considerable tempor¬
ary improvement and a chance , remote it must
be confessed, of permanent cure.