On the surgical aspect of hepatic abscess : being three lectures delivered at the Hospital for Consumption and Diseases of the Chest, Brompton / by Rickman J. Godlee.

  • Godlee, Rickman John, Sir, 1849-1925.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: On the surgical aspect of hepatic abscess : being three lectures delivered at the Hospital for Consumption and Diseases of the Chest, Brompton / by Rickman J. Godlee. 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.

    11/34 (page 7)
    of course well known that only a very small proportion of patients with dysentery ever develop liver abscess. I think it may be equally certainly stated that, if a patient with abscess of the liver be passing dysenteric stools, or much mucous discharge with the motions, the chance of his recovery, when the pus is evacuated, is very much diminished. I said that surgical treatment of a case of multiple abscess was very hopeless, and I will now give an example of a bad case of this kind to illustrate my meaning. Un- fortunately it is impossible to do much more than hazard a guess as to whether any particular case is single or multiple. Case v.—E. S., a Bohemian Jew, aged 36, had been resident in Kimberley for eight years, and had enjoyed good health ther«, without fever or dysentery; but he developed intermittent fever on his way home at Madeira, in July, 1883, and this continued for two weeks after his return to Germany. It was then absent for three months, but returned in April, 1884, accompanied by pain in the right lobe of the liver, and this continued with slight inter- missions till May 7th. The patient was attended by Dr. Dunbar Walker, of Notting Hill, and had seen SirWm. Gull and Sir Joseph Fayrer. By this time the liver reached down to the umbilicus, and an abscess was obviously pointing at the epigastrium. He was stout, flabby, of a muddy colour, with a foul tongue and a weak pulse, and a temperature varying from normal in the morning to 102° or 103° in the afternoon. I opened the abscess, after ascertaining the presence of adhesions, and evacuated about half a pint of disagreeably smelling yellow pus. There was a good deal of bleeding. The temperature was normal for all the next day—but on this day only; it afterwards began to rise in the afternoon, the patient always becoming much worse at this time of day; and by the 17th it had again a range of from normal to 103°. The pulse was weak and rapid, 110 to 150. The tongue coated and dry, though he continued to take milk. The bowels acted freely and the motions were plentifully bilious, but the abdomen was distended with gas. Thus, though the abscess behaved quite well, the discharge being sweet and small in amount, we felt sure he had another. Accordingly, on the 14th, a week after the first operation, at Sir Joseph Fayrer’s suggestion, I first punctured the liver just below the ribs, a little outside the first opening, and failing to find pus at three inches, I passed the needle through the seventh or eighth space at the lower part of the axilla and drew out three or four ounces of yellow pus, from a depth of four inches. The wound was then enlarged, and using the cannula as a guide, dressing- forceps and the finger were passed into the abscess. This caused terrific haemorrhage, and I was obliged (in the weak state of the patient) to plug the wound. Two days later I removed the plug and introduced a long tube, which appeared to drain the abscess satisfactorily for a time. But the general state showed no improve- ment, and ten days later a fine trocar was passed deeply through the lateral wound and evacuated a quantity of pus, probably a third abscess, though this is not quite certain. But none of these evacuations did the patient the slightest good, and on June 3rd, nearly five weeks after the first operation, he died, and though we could not obtain a post-mortem examination I have no doubt that his liver was riddled through with abscesses. Case vi.—I have had another case: An Indian officer, Major L., aged about 40, whom I saw with Sir Joseph Fayrer and Mr. Leedham, in which the evacuation of the abscess gave the patient no relief; but this case was complicated with diarrhoea, and the discharge from it was unusually profuse. He was very thin and emaciated at the time of the operation, March 16th, 1886, and he