A case of eosinophile ascites : with remarks / by H.D. Rolleston.

  • Rolleston, Humphry Davy, Sir, 1862-1944
Date:
[1920?]
Catalogue details

Licence: In copyright

Credit: A case of eosinophile ascites : with remarks / by H.D. Rolleston. Source: Wellcome Collection.

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    Reprinted from the British Medical Journal, January 31st, 191U. A CASE OF EOSINOPHILE ASCITES : WITH REMARKS. By H. D. ROLLESTON, M.D., F.R.C.P., SENIOR PHYSICIAN, ST. GEORGE’S HOSPITAL; PHYSICIAN, VICTORIA HOSPITAL FOR CHILDREN, CHELSEA. Eosinophile ascites has, so far as I can find out, hardly ever been recorded. This rather contrasts with the attention which has been devoted to the occurrence of eosinophile cells in the exudate of experimental acute peritonitis in its earliest stages, especially by Durham, Opie, Dudgeon and Ross. But the exudate of acute peri¬ tonitis in human beings rarely contains as much as 1 per cent, of eosinophile cells. In this case of eosinophile ascites acute peritonitis brought the eosinophile count down from 22 to 0.5 per cent. The explanation of a haemic eosinophilia of 12 per cent, is not obvious in the absence of animal parasites. Possibly it may be connected with the presence of carcinoma, for Weinberg and U. Mello8 found 3.33 per cent, of eosinopliiles in carcinoma of the colon, and 6.6 in carcinoma of the liver. History and Course. A male, aged 52, at the end of September, 1913, had colic and vomiting two days after eating some fish, followed gradually by jaundice and putty-like stools, and about the middle of October by transient pruritus. He was admitted to St. George’s Hos¬ pital on November 4th with considerable jaundice, some rather vague resistance in the right loin, an enlarged and tender liver, and tenderness near the umbilicus. The gall bladder and the spleen could not be felt. For a time there was some apparent improvement, but on November 21st ascites was obvious, and on December 3rd 7 pints of fluid were removed ; Dr. E. L. Hunt found that this contained red blood corpuscles, lymphocytes 46 per cent., endothelial cells 29, eosinopliiles 22, polymorpho- nuclears 2, mast cells 1. The Wassermann reaction in the ascitic fluid and in the blood was negative (Mr. H. W. Bayly). A differential count of the haemic leucocytes (total count 17,040) showed: Polymorphonuclears, 71 per cent.; lympho¬ cytes, 16.5; mononuclears, 0.5; eosinophiles, 12; mast cells, 0. Examination of the stools did not reveal the presence of any ova of worms. The urine constantly contained bile pigment, but not bile salts, and there was no sugar ; in the last week of life there was a trace of albumin on two occasions. Early in December the base of the right lung was found to be dull on percussion, breath sounds to be absent, and skiagraphy showed opacity. On December 12th the patient had severe abdominal pain, and the pulse rose to over 100. The pain gradually in¬ creased and necessitated the use of morphine. On December [49/14]