Remarks on hepatic phlebotomy, and puncturing the liver's capsule, as curative procedures in hepatic disease.

  • Harley, George, 1829-1896.
Date:
[1886]
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on hepatic phlebotomy, and puncturing the liver's capsule, as curative procedures in hepatic disease. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ON PUNCTURING THE LIVER'S CAPSULE, AS A REMEDIAL MEASURE IN CASES of CHRONIC CONGESTIVE HYPERTROPHY. All familiar with the course of liver inflammations, are aware thattho first stage in the sequelae to a severe attack of hepatitis—no matter whether it be the direct result of intemperance, malaria, or chill—is a chronic, enlarged, hardened condition of the liver. While in dif- ferent cases the extent of the enlargement varies considerably, the amount of induration, as calculated by palpation, differs but little. The general symptoms arising from this condition of liver are more or less marked in direct proportion to the extent of the enlargement. When the increase in the size of the liver is slight, even although the induration be marked, the discomfort it occasions is, comparatively speaking, tiifling. Whereas, when the organ is considerably enlarged—say, more than eight inches—in the right nipple perpendicular line, the general symptoms become as well marked as the physical signs. The chief thing the patient complains of is, however, the local discomfort, pro- ceeding from the enlarged liver. Its pressure on the neighbouring organs producing feelings of heavy weight, and a dull pain all over the hypo- chondriac region, specially complained of when lying on the side— sometimes most when on the right, sometimes most when on the left side. The weight of the organ, too, when the patient is in an upright position, is frequently spoken of as being a great burden. Acute pain is rarely complained of ; but even the bodily distress the mere feel- ings of discomfort just alluded to occasion, are, in general, sufficient to make the sufferer seek medical advice. The action of the bowels is usually irregular (most often constipation is troublesome), and the kidneys act capriciously. The urine is usually of high specific gravity, and frequently deposits, after standing for twelve hours or more, both oxalates and urates. The complexion assumes a dingy hue, and the whites of the eyes become yellow. Although it is seldom that the discoloration either of skin or eyes is sufficient for the patient to be called jaundiced. Unfortunately for the credit of our craft, we can do but little for such cases. The symptoms not being acute, cupping or leeching is out of the question, while blistering, in the majority of instances, does more harm than good. The application of hot fomentations and the administration of saline purgatives are usually about the only things that afford relief. Even their action has the disadvantage of being slow, as well as but little effective. Not a pleasing matter for the specialist, who is, in general, expected to be able to suggest both a rapid and effective remedy for every case he is consul ted about. The im- potency of the usual routine-forms of treatment in these cases, led me to reflect on their pathology, in the hope that probably some more efficient form of treatment might suggest itself. The result of the re- flexion was that I came to the conclusion that, first, nearly all the pain, and a great deal of the discomfort, in cases of hepatic congestive hypertrophy is directly clue to the pressure to which tho but recently inflamed and still congested hopatic tissues are subjected, from their