THE TREATMENT OF SPLENOMEGALY J BY INJECTIONS OF MILK

By C. L. PASRICHA, MAJOR, I.M.S.

and

G. S. CHOPRA, m.b., b.s.

(From the Department of Bacteriology, Calcutta School of Tropical Medicine)

Singh (1932) reported favourable results following the injection of milk intramuscularly in patients suffering from splenomegaly, more particularly when the enlargement of the spleen

April, 1938] TREATMENT OF SPLENOMEGALY : PASRICHA & CHOPRA 219

was malarial in origin. Enlarged spleens which reached nearly to the umbilicus disappeared under the costal margin after three or four or at the most five injections of milk. In 1934 this

method of non-specific therapy was started in

the out-patient department of the Carmichacl Hospital for Tropical Diseases. The patients selected for treatment were those with markedly enlarged spleens extending to the umbilicus or lower who gave no history of kala-azar and whose sera were negative both to Chopra's test and Napier's test for this disease. These Patients had been under observation prior to the beginning of milk injections for at least ?ree months, during which period the usual *?rms of medical treatment had been given Without producing any appreciable effect on the size of the spleen. All the cases were afebrile, blood smears showed no parasites and in the

majority there was a varying degree of anaemia. ln view of the pressure of routine work in an ?ut-patient department it was not possible to make complete investigations of each patient. Skimmed fresh milk was sterilized on three

consecutive days in required amounts in test- tubes. The milk was tinged lightly with phenol

Table I

The results of treatment of the whole series

wi.n',rnber treated Spleen mAent noted in Snlepn

n0 Palpable after treatment Slight ?.on?idei;ably reduced but still palpable &

tVi mini]tion in the size of the spleen but definite improvement in No anen?yi?1?toms-

in ?feciable difference in the size of the spleen and no improvement the symptoms.

By the intra- muscular route

70 50 or 71.4 per cent 10 or 14.3 ?

24 or 34.3 ?

16 or 22.8 ?

20 or 28.6 ?

By the intra- cutaneous route

30 16 or 53.3 per cent

4 or 13.3 ?

10 or 33.3 ?

2 or 6.6 ?

14 or 46.7 ?

in order to disguise from the patients

. nature of the material injected. It is

nnportant that fresh milk from a reliable

source be used as otherwise there is an enor-

mous multiplication of bacteria the products

of

which might lead to undesirable reactions. A

generous supply of Aolan was available through

the courtesy of the manufacturer's agents and

^ small series of patients was treated with 1

results were similar to both series but w

ien

'^cilities exist for sterilization, for reasons o

economy, milk is to be preferred. The results

Reported in this paper are those based

on the

leatment with milk alone.

Of the 100 patients treated 70. were given the

nnlk injections intramuscularly and 30 patients

intracutaneously. The dosage was (1) by the

mtramuscular route, preliminary dose of 4 c.cm.

giadually increased to 16 c.cm. at intervals o

five to seven days, and (2) by the intracutaneous

0.1 to 0.3 c.cm. with a maximum of

at any one site at intervals

of five to

seven days.

Careful records were made of the size of the

spleen, of the general symptoms and of any re- actions following the injections. During the course of treatment no other medication was

given. The patients selected were 94 male adults and

6 female adults of the labouring class. The treatment by the injection of milk was popular and no difficulty was experienced in securing regular attendance of the patients. In fact the

only difficulty was the extreme disappointment of those patients in whom there was no diminu- tion in the size of the spleen and no marked improvement in the symptoms. In the majority of the patients in whom satisfactory results were obtained marked improvement was noted

usually after the sixth or seventh injection. A

certain number of the patients in whom marked shrinkage of the spleen had occurred were

kept under observation for periods varying up to a year and no relapse was noted. The

patients who did not react to the first series of

ten injections failed to show any appreciable effect to further series of milk injections. The

results of the treatment are given below in

tabular form :?

It will be seen that the intramuscular route

appears to yield better results but if the figures for those in whom the spleen was considerably reduced are compared there is no appreciable difference in the results obtained by the two methods. In the series treated by the intra- muscular route the spleen was markedly reduced in 34 or 48.5 per cent of the patients treated and in patients treated by the intracutaneous route the spleen was reduced in 14 or 46.6 per cent. The results in table II show that better results

were obtained in the patients suffering with en- larged spleens reaching to about the level of the umbilicus than in the patients in whom the spleen was larger. Although the number of patients treated was not sufficiently large the

general impression that was formed during the course of this trial was that in patients in whom the spleen was not hard and not sclerosed the shrinkage of the spleen occurred quicker and was complete usually before the end of the series of the ten injections of milk.

220 THE INDIAN MEDICAL GAZETTE [April, 1938

Table II

The results of treatment according to the size of the spleen prior to treatment

Total number treated Improvement noted in

Spleen not palpable after treatment Spleen considerably reduced but still palpable ..

Slight diminution in the size of the spleen but definite improvement in the symptoms.

No appreciable difference in the size of the spleen and no improvement in the symptoms.

Spleen up to

umbilicus

68 55 or 80.7 per cent 12 or 17.6 ?

32 or 47.0 ?

11 or 16.1

13 or 19.3 ?

Spleen below umbilicus

32 11 or 38 per cent 2 or 7 ?

2 or 7 ?

7 or 24 ?

'

21 or 62 ?

Summary.?The results of the treatment of a series of one hundred patients suffering from

splenomegaly not of kala-azar origin with in-

jections of skimmed sterilized milk are recorded. The results show that there is a marked reduc- tion in the size of the spleen in approximately 50 per cent of the patients treated. From the data available the results after the

injection of the milk by the intramuscular route are better than the results after the intra- cutaneous route, probably because of the greater amount of foreign protein injected by the former route.

Reference

Singh, B. H. (1932). Milk Injections in Malarial

Spleens. Indian Med. Gaz., Vol. LXVII, p. 498.