Clinical lectures on diseases of the liver, jaundice and abdominal dropsy : including the Croonian Lectures on functional derangements of the liver delivered at the Royal College of Physicians in 1874.

  • Murchison, Charles, 1830-1879.
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on diseases of the liver, jaundice and abdominal dropsy : including the Croonian Lectures on functional derangements of the liver delivered at the Royal College of Physicians in 1874. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    2S He was in bed for five months, and during this time he had frequent vomiting and nine fits of convulsions, the movements being limited to leffc side of the body. Shortly after this his mother noticed that his right side had 'grown out,' and the swelling increasing she took him to the London Hospital, where he remained for four months, and where his general health underwent great improvement. His health continued good, and he was able to go about, but the swelling slowly increased, until about a week before admission, when, after getting thoroughly wet outside a cab, he was seized with severe pain in back, cough, and febrile symptoms. On admission, patient was anremic and emaciated, and complained of cough and shortness of breath, and of great pain and tenderness in lower part of spine. Pulse 108 ; respirations 48 and thoracic ; bron- chitic rales over whole of both lungs, with dulness and friction over lower fourth of left. Tongue clean ; appetite bad ; temperature 101 •4°. No anasarca; and urine contained no albumen. But the most re- markable feature about the boy was the enormous size of abdomen, which measured 33^ inches at umbilicus, the bulging being greatest in right flank. This enlargement was almost painless, and was evi- dently due to an encysted collection of thin fluid on right side, ex- tending from liver down into pelvis, and as far forwai'ds as middle line, but clearly shut off from general cavity of peritoneum, as the rest of abdomen was tymjianitic in whatever position patient lay. Hepatic dulness ascended to nipple in front, and to lower angle of scapula behind. After admission, tumour increased in size, and dyspnoea became so urgent that, on Dec. 23, it was resolved to tap cyst, which was ac- cordingly done by Mr. Hulke, midway between ribs and crest of ilium, and 170 ounces of fluid drawn off. The fluid which first came away was clear, but of a brownish colour ; its specific gravity was 1010, and it contained much chlorides, and about one-sixth of albumen. The last two pints contained much pus, forming on standing a creamy de- posit, of about one-half of the entire bulk. No portion of the fluid contained either echinococci or booklets. At first the operation was followed by great relief to dyspncx?a, and at no time afterwards had patient either rigors, profuse perspirations, pain in tumour, or albumen in' urine. The prostration, however, in- creased daily; tongue became dry ; temperature varied from 100° to 103-2° ; much restlessness with sleeplessness and occasional delirium ; and the signs of pleurisy at base of left lung noted before operation extended. He gradually sank, and died Jan. 2, 1808. Autopsy.—No signs of recent peritonitis, but on right side of ab- domcn, lying behind intestines, was a cyst, with thick fibrous walls, about size of an adult human head. It was firmly attached by fibrous adhesions to under surface of liver, to false ribs, and to abdominal wall. It extended downwards to brim of pelvis, and slightly beyond