Splenic Neutropenia in Felty's Syndrome

Case Report A retired female clerk aged 68 was admitted to Mount Vernon Hospital on December 1, 1955. She had been feverish and vaguely ill since an attack of herpes zoster in May. Twenty years ago she had had recurrent iritis and pyelitis. For four years she had had epigastric and retrosternal pain after meals, on stooping, and when in bed; she had vomited blood and passed a melaena stool twice during the previous seven months. Rheumatoid arthritis began in 1948, starting in the hands and gradually involving most joints. It had been treated by heat, massage, and aspirin, and had caused few symptoms in recent years. It was not a serious trouble to her on admission. The only medicines she had taken were antacid tablets and soluble aspirin. Her mother had suffered from arthritis of the knees, ankles, and shoulders in her later years and died of pneumonia, aged 73. On examination the patient was obese and pale, with mild rheumatoid arthritis of the hands. The liver extended one fingerbreadth and the spleen three fingerbreadths below the