A case of waxy and syphilitic disease of the liver with ascites : portion of a clinical lecture / by T. Grainger Stewart.

  • Stewart Thomas Grainger, Sir, 1837-1900.
Date:
[1874?]
Catalogue details

Licence: Public Domain Mark

Credit: A case of waxy and syphilitic disease of the liver with ascites : portion of a clinical lecture / by T. Grainger Stewart. Source: Wellcome Collection.

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

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    always present at the most dependent part; on palpation, the characteristic thrill indicating the presence of fluid is de- tected. The liver feels hard and smooth, and measures seven inches and three-quarters vertically in the mammillary line. Circulatory System: Apex-heat imperceptible; pulse 108, regular, very feeble; superficial veins of abdomen distended. Lymphatic System: Blood watery; tenderness on pressure over the spleen ; splenic dulness increased; cervical glands enlarged and indurated on the left side. Kespiratory System: Chest bulging laterally at the base ; voice nasal and indistinct; the system otherwise normal. Integumentary System: Skin dry; purpuric spot above the right ankle (there was recently a number of similar spots) ; nutrition bad. Urinary System : No lumbar nor vesical pain; urine averages from fifty to sixty ounces, of a straw colour, neutral re-action, specific gravity 1005, no albumen nor bile. Reproductive System: Catamenia, which were always irregular after the amputation, ceased upwards of fourteen months ago. Nervous System: Complaint of pain in the right, and to a smaller extent in the left hypochon- drium; hearing on the left side has been defective for some time ; speech slow ; memory weak. Locomotory System : The left leg has been amputated above the knee; other extremities much emaciated; sinuses over right shoulder and above both wrists. The diagnosis then made was—General scrofula, with consti- tutional syphilis ; waxy liver, with syphilitic bands of fibrous tissue passing through the organ, and pressing upon some branches of the portal system ; waxy intestines ; possibly waxy spleen and waxy kidneys in the early stage; a considerable amount of ascites. Let me now indicate to you briefly the grounds for this diag- nosis. The ascites was obvious; and as there was no general dropsy nor heart affection, it was equally apparent that some hepatic disease or obstruction of the portal circulation was its cause. The liver presented none of the characters of cirrhosis, nor did the history or constitution of the patient make it likely that this existed. On the other hand, the abundant evidence of long- standing general strumous and syphilitic disease, and the enlarge- ment and smoothness of the organ, made it clear that waxy degeneration was present. But this degeneration is not usually attended by ascites and there was no evidence of thrombosis of the portal vein, so that an explanation of the dropsical accumu- lation was still to be sought. I had occasionally, in dissecting the bodies of syphilitic waxy cases, observed that the syphilitic masses or the cicatricial bands of fibrous tissue pressed upon divisions of the portal vein within the liver, and thereby led to atrophy of districts of liver-substance, and I thought it possible that the abdominal symptoms in this case might be explained by