Volume 1

A clinical treatise on diseases of the liver / by Fried. Theod. Frerichs ; translated by Charles Murchison.

  • Frerichs, Friedrich Theodor, 1819-1885.
Date:
1860-1861
Catalogue details

Licence: Public Domain Mark

Credit: A clinical treatise on diseases of the liver / by Fried. Theod. Frerichs ; translated by Charles Murchison. Source: Wellcome Collection.

    180/440 (page 148)
    The patient used opium in large doses* to counteract tlie tor- menting loss of sleep and the diuresis; and to keep the bowels open the watery extract of aloes, . with steel, was prescribed; attention was paid to the diet, wliich consisted principally of animal food. This change in his diet, Vogel, who in other respects was a quiet and sensible man, found to be insupportable, and, consequently, on the 2nd day of April he demanded his discharge. The distention of the gaU-bkdder, the hard tumour close to the left of this organ, and the size of the hver remained the same as on admission. So soon as the 6th of April, the patient returned in a much altered condition. His features were pale and collapsed; frequent evacuations of the bowels, consisting of mucus, blood, and fibrinous flakes, and accompanied by troublesome tenesmus, had quite exhausted him; along with this, the pulse was 64 and weak, the extremities were cool, there was complete loss of appetite, an inclination to somnolence, and slow answers. From the 7th to the 8th of April, 2,500 cub. cent. (88 fluid ounces) of urine were passed, of which the heaviest had a specific gravity of 1008, and the lightest 1005. It had an acid reaction, and contained büe-pigment, but not a trace of sugar. The quantity of urine passed from the 8th to the 9th, amounted to 2000 cubic centimetres (70 fluid ounces); had a specific gravity of from 1008 to 1006, and Hkewise contained no sugar. An enema containing nitrate of silver and opium, and, internally, compound tincture of bark with ether, wine, soups, and other ana- leptics, failed in arresting the dysentery and exhaustion. Death ensued at one in the morning of April 9 th. Autopsy, 10 hours qßer death. The body was jaundice-coloured to a considerable degree; there was no oedema. The dura mater was yellow, the pia mater was moderately congested, as was also the brain substance, which was somewhat softened, especially in the fornix, the corpora quadrage- mina, the pons Varolii, and the roof of the fourth ventricle. In the substance of the pons Varolii numerous Uttle reddish-brown masses of pigment, the remains of capillary apoplexies, were found. The mucous membrane of the mouth and pharynx, and also of * Three grains of opium were insufficient to induce sleep.