The clinique médicale; or, reports of medical cases / Condensed and translated, with observations ... from ... medical authors: by D. Spillan.

  • Andral, G. (Gabriel), 1797-1876
Date:
1836
Catalogue details

Licence: Public Domain Mark

Credit: The clinique médicale; or, reports of medical cases / Condensed and translated, with observations ... from ... medical authors: by D. Spillan. Source: Wellcome Collection.

    979/1050 (page 947)
    part ; some purging (five or six liquid stools in twenty-four hours). Appearance of the tongue natural. Appetite still preserved ; no fever; skin very dry ; re- spiration free ; auscultation and percussion indicate no morbid state of the tho- racic organs. What was the cause of the ascites in this case? No organic lesion, as far as we could ascertain, could explain it. All that we could learn was the existence of chronic inflammation of the lower part of the digestive tube. On the day after the patient’s admission, paracentesis was performed. A bucket of limpid serum was drawn from the abdomen. Desirous of arousing the action of the kidneys, in order to prevent the peritoneal collection from forming, M. Ler- minier prescribed the usual diuretic preparations, also frictions on the inside of the thighs with tincture of digitalis. For the twelve days following no change of any moment occurred in the state of the patient. M. Lerminier then prescribed a mixture, consisting of an ounce of castor oil, half an ounce of syrup of buckthorn, and two drachms of mint. Very copious serous stools were obtained, accom- panied with severe colieky pains. Twenty days after the paracentesis, the ascites was much greater than it was at the period when the operation was performed. The features were changed ; the prostration was extreme ; the tongue retained its moist state, and was not red. At the commencement of January it began to become brown in the centre, without being red at the edges ; the pulse conti- nally became weaker, and the patient died without a struggle. The extremities had never been infiltrated. Post mortem.—An enormous quantity of limpid serum escaped through the abdominal parietes when cut into. No flocculi were observed to float in it, and there was no indication in the abdomen of any previous or present inflammation of the peritoneum. We were struck with the feeling of density which the liver presented externally to the mere touch ; though its size was not at all increased, it was much heavier than usual. It had a uniform red colour ; it could not be torn without considerable difficulty ; and with respect to its colour, its smooth section, and the aggregate of its physical properties, one could not compare one of its slices to any thing better than to a slice of lean ham. The stomach was pale throughout its internal surface ; its mucous membrane was so soft and thin towards the great cul-de-sac, that in several points nothing was found but the submucous cellular tissue lined by a liquid and whitish pulp. The duodenum and rest of the small intestine presented no appreeiable lesion, except here and there some partial injections of the mucous membrane. The cæcum presented over its entire surface a brownish tint, and considerable development of its follicles. The mucous mem- brane of the colon was white throughout ; but in several points it was perceptibly softened. The brownish colour reappeared in the rectum. Nothing else was found worth noticing, except that the lateral ventricles were distended with a con- siderable quantity of serum. The heart and lungs were quite healthy. We find in this case an alteration in the texture of the liver different from any observed in the preceding cases. Its parenchyma was considerably indurated, and its density increased ; its colour was of a deeper red than that of the liver in its healthy state. To discover this affection we find no characteristic symptom ; but here a new morbid phenomenon presents itself, which we have not seen hitherto ; namely, ascites. As it was evidently independent of disease of the heart, and as there was nothing to indicate that there had been peritonitis in the case, one might suspect that it must depend on an affection of the liver ; but of this there was no certainty. The increased consistence of this organ probably opposed the free circulation of the venous blood within it. There was here then obstruction of the liver, a very vague term, very properly banished from scientific language, but one which nevertheless expresses a real fact. There was no derange- ment, at least perceptible to us, of the biliary secretion.