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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    the existence of such changes. As soon as it became apparent that the patient M^as gaining strength and the treatment prov- ing benelicial, I ventured to liope that although a considerable portion of the liver might become atrophied, yet compensatory hypertrophy of the other parts might take place, and tlie func- tions of the organ be re-established. This anticipation turned out, as we shall presently see, correct. The diagnosis of waxy degeneration of the intestines rested upon the previous history, the existence of waxy degeneration elsewhere, and the diarrhoea. As the intestinal symptoms did not prove very intractable, I now doubt whether the degenera- tion really afiected that part, perhaps the obstructed circulation may have liad a larger share in its production than I at first supposed. The symptoms which warranted the diagnosis of waxy kidney were the discharge, notwithstanding the ascites, of a large amount of pale and afterwards albuminous urine along with the evidences of wax ydisease elsewhere. The plan of treatment adopted was with a view to checking the diarrhoea, relieving the tympanites, increasing the flow of urine, and improving the strength of the patient. Pills contain- ing sulphate of copper and extract of opium were prescribed for the diarrhoea. The tympanites was relieved by assafcBtida. Acetate of potash was given as a diuretic, and small doses of the iodide of potassium were after a time combined with it. Un- irritating diet and Parrish's syrup of the phosphates were given to improve her general condition. On account of the patient's extreme debility, paracentesis abdominis was not performed when she was admitted, but on June 18 (a fortnight afterwards), 360 ounces of fluid were drawn off. The fluid had a specific gravity of 1015, and on standing, large masses of lymph coagulated. For some time about this period the temperature continued about 100°, as before the operation. A fortnight later the abdomen was again tapped to the extent of 350 ounces of fluid. The further history of the case is, that the patient required to be tapped at first every fortnight, and afterwards at longer intervals, and that from first to last the enormous quantity of 12,120 fluid ounces was removed. Notwithstanding this heavy drain on her system, the patient continued to gain strength and flesh, and the sinuses healed. After a short time almost the only medication employed was syrup of iodide of iron, along with liberal diet and a small quantity of wine. The urine was examined at short intervals, but no albumen was detected till November 26 (about six months after admis- sion), when there was a slight trace. The daily amount of urine increased to seventy ounces, and for some time was above 100 ounces. A trace of albumen was constantly present; but before