Clinical lectures on diseases of the liver, jaundice and abdominal dropsy / by Charles Murchison ; edited by T. Lauder Brunton ; the section on tropical diseases by Joseph Fayrer.

  • Murchison, Charles, 1830-1879.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on diseases of the liver, jaundice and abdominal dropsy / by Charles Murchison ; edited by T. Lauder Brunton ; the section on tropical diseases by Joseph Fayrer. Source: Wellcome Collection.

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    tions are far from being necessarily associated with constipation. 1 The resemblance to hepatic disease in these cases may be further increased by the hardened scybala imparting to the tumour a 1 nodulated character like that of cancer, and by the development ,of such symptoms as jaundice, vomiting, and hiccup. The dia- gnosis of these cases from true enlargement of the liver must 1 rest mainly on— 1. The occurrence of spasmodic pains like those resulting ! from obstructed bowels, &c. 2. The disappearance of the tumour, and the amelioration < of the symptoms under such treatment as poultices and fomen- : tations, purgatives, enemata, and belladonna. Lastly:— VIII. Abnormal conditions of the abdominal parietes may 1 simulate enlargements of the liver. Fh-m contraction of the bellies of the recti muscles, owing * either to inflammation of the subjacent peritoneum or viscera, tor, hi cases of increased muscular irritability, to the mere (application of the hand, is apt to be mistaken for hepatic en- 1 largement, or tumour; and the difficulty is increased by the 1 circumstance that the upper division of the rectus is sometimes ] larger on one (usually the right) side than on the other. It is 1 distinguished by:— 1. The situation, size, and form of the apparent tumour 1 corresponding to one of the divisions of the rectus muscle. 2. The sound on percussion being usually more clear and • tympanitic than it would be over a solid tumour. 3. When the patient is made to sit up in bed, the swelling ■ contracts and becomes thicker. 4. When the patient is placed on his back, with his shoulders : raised and his thighs flexed on the abdomen, and his attention is engaged by conversation or by making him count, the tumour may disappear; and it will certainly do so if he be placed under the influence of chloroform. The diagnosis may also be considerably embarrassed by an inflammatory swelling in the abdominal parietes over the liver. This has often been mistaken for an abscess of the liver itself. Several remarkable instances of this sort have come under my notice, in which, for some days, the diagnosis has been very doubtful. The following characters usually suffice to distinguish this condition from hepatic disease :— 1. The margin of inflammation and of dulness on percussion