Cirrhosis of the liver and icterus of four years' duration : with remarks on biliary cirrhosis / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Cirrhosis of the liver and icterus of four years' duration : with remarks on biliary cirrhosis / by F. Parkes Weber. 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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    Reprinted for the Autlior from the Rkitish Medica:. Jol'KN'al, April 2stli. 1896. CIRRHOSIS OP THE LIVER AND ICTERUS OF FOUR YEARS’ DURATION. WITH HKMAUKS ON BII.IAIIY CIRRHOSIS. By F. PARKES 'WEBER, :M.T)., Pliysieian to the German Hospital. The case may be shortly given as follows : Mrs. M. L., aged 55, suffered from jaundice for about the last four years of her life. There seems to be uo doubt that the jaundice had really lasted all this time, though the history regarding the symptoms at the commencement is defective. Apptirently thei-e had been no definite biliary colic, but pain in the left side. She had never had jaundice pre- viously. She had had no children and no miscaiTiages. There was no history of syphilis or alcoholism (?). A friend connected the onset with mental trouoles following her husband's death. I first saw her in November, 1894, at which time she had already been jaundiced for about three years; she was admitted from the out-patients at the German Hospital by Dr. J. P. Zum Busch, then senior resident medical officer, who having watched the case for two years, considered it to be one of hypertrophic cirrhosis, due to some obstruction in the bile ducts. At that time the jaundice was deep, and she had xanthelasma palpebrarum, and a diffuse xanthoma of the skin over large areas at both sides of the neck; the affected skin in the neck was not raised above the general level .whereas the affected portion of the eyelids was, as usual, somewhat raised above the skin around. The liver appeared to be hard, and uni- formly much enlarged, the dulness extending from the fifth rib to the umbilical level. The spleen was not felt distinctly. There was no ascites, but some oedema about the ankles was noticed. The patient had no pain excepting a little in her joints, but she was tormented by a pruritus very little affected by treatment. Over the base of the right lung there was slightly impaired resonance, with crepitation, duo to pressure from the liver (?). On one occasion there was slight epistaxis. She left the German Hospital on Januai-y loth, 1895, in much the same condition as she entered it, but was readmitted on November 19th, 1895, in a condition of general weakness and prostration. The itching had practically left her, but the skin seemed darker, as if more pigment had been deposited in it than when she was previously under observation. Some ascites was now obseiwed, and there was more oedema of the lower extremities. The liver could no longer bo distinctly palpated. The stools were colourless, often loose and accompanied by a little blood, probably of hsemorrhoidal origin. The urine was deeply bile-coloured, and besides giving the ordinaiyGmelin’s reaction with nitric acid, turned green immediately on the addition of acetic acid, 1 even in the cold, but wlien heated a much smaller quantity of acetic acid was required to 1 I do not know in what proportion of jaundice cases this reaction with acetic acid takes place so easily. I have only noticed it once to such a degree, and that was in a case of rapidly fatal acute yellow atrophy of the liver. With the permission of Sir Dyce Duckworth I published notes of the case in the Lancet (1892, vol. i, p. 630), but did not at the time consider the reaction of sufficient importance to mention. Bilious urine is known occasionally to turn green without the addition of ativ reagents.