Suppurative pylephlebitis / by J.H. Bryant.

  • Bryant, John Henry.
Date:
[1898?]
Catalogue details

Licence: Public Domain Mark

Credit: Suppurative pylephlebitis / by J.H. Bryant. 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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    days, and the temperature rose to between 101° to 103° in the evenings, falling to 99° in the mornings. The pain was referred to the umbilicus, with some tenderness in the right groin. Her medical attendant (Dr. Marshall) diagnosed the case as one of enterica. After about ten days’ illness she began to have rigors and night sweating. About the eighteenth day hor night temperature was 106°, and the rigors were severe. Dr. Pitt was called into consultation, aud found signs of pleurisy, without effusion, in the right axilla, rigidity of the abdominal wall on the right side, and diagnosed vappendicitis, with possibly hepatic abscess or general pysemia. Condition on admission.—Temperature 103'4°, respiration 28, pulse 144. Patient was much wasted, with an “abdominal expression” on her face. The tenderness of the abdomen was not marked, owing to a recent injection of morphia, but there was rigidity on the right side, from the groin to a line just above the umbilicus, with some impaired percussion resonance over the rigid area. No tumour could be felt, and there was no rigidity in the right loin. A rub could be heard in the right axilla. The diarrhoea had commenced again. There was a large bed-sore over the sacrum. Mr. Symonds was called in, and operated at midnight. An incision was made in the right nipple line about opposite the umbilicus, and the liver and right kidney explored and found apparently healthy except that the edge of the liver reached an inch below the costal margin. The incision was con- tinued to the groin, and the ciecum and appendix explored. The appendix was found firmly adherent to the ccecum, and the adhesions bled freely on attempting to separate them. The appendix was removed and a small quantity of pus, not more than nixxx., found at its distal end. Iodoform was powdered on, and the wound packed with gauze. The patient bore the opera- tion, which lasted ninety minutes, well. She was given morphine, gr. J, hypodermically, and ordered hot water to drink. Nutrient enemata 4tis horis. Rectum to bo washed out with warm water twice in the twenty-four hours. On September the 49th and 20th she was taking fluid diet well, but pus was coming from the wound and patient wa3 clamorous for morphia. (No entries in report from September 21st to October 3rd.) On October 3rd a rib was resected and a quantity of foul pus removed from the right pleural cavity, a puncture having been made previously and pus found. A finger was inserted and a small cavity felt above the liver. This was washed out with weak boric acid lotion and tubes were inserted. Patient was collapsed after the operation and a hot enema was given. She died on October 5th, at 6.30 a.m. (The temperature varied between 99° and 100° in the mornings, and 101° to 102° in the evenings, rising on several occasions to 103° and once to 104°.) Autopsy (performed by Dr. Pitt), No. 380. 1895.—The body was wasted and profoundly anaemic and there was a bed-sore over sacrum. There was an empyema on the right side, extending from the third to the tenth rib, but limited to the region of the spine, and only three and a half inches across. This had not been reached by the axillary exploration. A portion of the ninth rib had been removed and there was an aperture in the diaphragm leading to an hepatic abscess. The posterior parts of both right lobes, especially the lower, were compressed. The lungs on the left side were mottled and there were a few ecchymoses on the posterior surface and two or three early patches of broncho-pneumonia.