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April 11, 1891


JAMA. 1891;XVI(15):522-523. doi:10.1001/jama.1891.02410670018006

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Dr. H. Toulmin has described in the Johns Hopkins Hospital Bulletin a well-marked case of this disease, in which the microscopic blood-conditions were examined with more than usual minuteness. The patient was a colored waiter twenty-three years old. He gave a history of malarial infection, dating back about two years; and had been suffering from swelling of the abdomen and legs from six to nine months. Among other symptoms he had had were epistaxis, a slight diarrhœa and incontinence of urine; priapism, so often observed in leucocythemia, was denied as having existed. The splenic "lump in his stomach" was first noticed by the patient about nine months before, when it would seem to have attained it present enormous size quite rapidly. It was prominent in the left hypochondrium and epigastrium, and occasioned a girth of 36 inches at umbilicus. The lump was a firm, solid and movable mass, occupying the

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