Royal Infirmary cliniques.

  • James, Alexander, 1850-1932.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Royal Infirmary cliniques. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    with coarse crepitation, was found at both bases, mostly over the left. Alimentary System.—Appetite and digestion fairly good; no thirst; bowels regular; tongue rather flabby and furred. On physical examination of the abdomen it was found to be enlarged, measuring at the level of the umbilicus 38 ins. By percussion in varying positions the presence of ascites was ascertained. The liver was found enlarged, its vertical dulness in the right nipple line amounting to 9| ins. The splenic dulness could not be precisely ascertained, owing to the dulness at the left base, but the organ did not appear to be enlarged. Nervous System and Integumentary System are practically normal, except that for some weeks his sleep has been some- what disturbed, and that oedema of the skin and subcutaneous tissue is markedly present. In this case the history of a severe wetting, the occurrence of rheumatic symptoms, and the supervention after some weeks of dropsy of legs, genitals, abdomen, lung bases, and face, with diminution in the quantity of the urine, and the presence in it of albumen and casts, pointed to an acute nephritis. But we had found also affecting the patient, emphysema, a greatly dilated and hypertrophied heart, with mitral, and probably also aortic valvular disease, and athero- matous arteries. All these latter symptoms might reasonably be ascribed to the single fact of his being a blacksmith of about 40 years of age. We remembered also that the emphysema and the cardiac and vascular conditions were certainly of some duration, and that although on inquiry we could not elicit evidence that symptoms showing weakened action of the heart had existed, we believed that there must have been some tendency to backward pressure, and that this in the case of the kidneys meant an increased liability to acute nephritic attacks. But the question occurred to us, Had there been previously