On the pathology of shock : a dissertation for the degree of M.D., read December, 1879 / by C.W. Mansell-Moullin.

  • Moullin, Charles William Mansell, 1851-1940.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: On the pathology of shock : a dissertation for the degree of M.D., read December, 1879 / by C.W. Mansell-Moullin. 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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    Accordingly, on July 18th, about three hours after the patient’s lunch, a small incision was made through the skin over the main prominence of the tumour, a little below and to the right of the xiphoid cartilage, and a fine aspirator trocar and canula introduced, with the result of obtaining immediately about two drachms of a clear limpid fluid. When no more followed, it was con- jectured that some hydatid membrane had blocked up the canula ; so it was drawn out, and a larger one, per- haps the size of a small goose-quill, introduced through the same puncture, without the patient making the least complaint of pain or flinching to the smallest extent. But as the post-mortem examination showed, this one missed the cyst and entered the liver substance ; so that the two or three ounces of fluid that escaped through it consisted of nearly pure blood, which coagulated readily. While this was happening, and owing to the suction of the aspirator and the size of the canula, it required but a very short time, a sudden change was observed to pass over the patient’s face: the canula was instantly withdrawn; hut from one moment to another, without wrarning of any land, without a cry or struggle, all expression vanished from his countenance: a naturally bright complexion faded into a livid pallor ; his arms sank down by his side, and the pulse ceased, with the exception of a few faint beats, that seemed to coincide with a short and gasping attempt at respiration. So sudden and unexpected w'as the occur- rence, that, although the remedies ordinarily employed under similar circumstances were actually on the spot, none could be applied. At the post-mortem examination, performed twenty- four hours after death, the following notes wrere made :— Temperature cool, though it was the month of July; rigor mortis well marked; body not remarkably pale ; the superficial veins on hands and arms being even distended; no trace of any such blanching as w'ould have resulted from internal haemorrhage. Ou laying open the abdominal cavity, in which was a slight amount of ascitic fluid, just blood stained, the puncture made by the trocar wras seen on the convexity of the right lobe of the liver; and a probe, on being passed into it, wras found to enter a small cyst, covered by perhaps half an inch of normal liver tissue, lying by the side of one much larger, and full