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 / by Charles Murchison.

  • 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 / by Charles Murchison. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    III. Rickets, causing lateral distortion of the spine, and the deformity known as the ' pigeon breast,' may lead to appa- rent enlargement of the liver, owing to the organ being de- pressed and elongated in its vertical diameter from lateral compression. The resemblance to hepatic enlargement may be further increased by there being a disproportionate reces- sion of the ribs immediately above the liver, as the result of which there is an apparent bulging of the hepatic region. Hence, in lateral distortion of the spine and in the * pigeon breast,' care must be taken not to arrive at any hasty conclu- sion as to enlargement of the liver. IV. The 'practice of tight-lacing may cause displacements and malformations of the liver, which may simulate enlarge- ment, and give rise to difficulties in diagnosis. Tight-lacing may act on the liver in three ways, according to the situation, the tightness, and the duration of the constricting cause. a. The liver may be displaced upwards or downwards, according as the pressure is applied below or above the organ. The precise situation where the pressure is applied will vary with the prevailing fashion of dress; but most commonly in this country the displacement is downwards, and this may be to such an extent that the lower margin of the liver reaches the ilium, and the organ appears to fill up the whole of the right side and front of the abdomen (fig. 6). h. In consequence of lateral compression, the liver may be elongated in its vertical diameter, so that a larger portion of it is brought into apposition with the abdominal and thoracic walls. This is a very common result of tight-lacing (fig. 6). The narrower the lower portion of the chest, the greater will be the extent of liver opposed to the thoracic and abdominal walls. c. When the pressure is exerted by a tight cord, it may produce deep fissures in the substance of the liver, as the result of which portions of the organ may be more or less detached, and may be felt as movable tumours separated from the he- patic dulness by tympanitic portions of bowel. Apparent enlargements of the liver from tight-lacing are far more common than is generally believed. You cannot pay many visits to the post-mortem room without observing examples of this malformation, which accounts for not a few movable tumours in the abdomen that are a source of anxiety both to the j)atient and the medical attendant. Moreover,