Volume 2

A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst. Source: Wellcome Collection.

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

    22/414
    Symptoms.—“ Tlie prodromal symptoms,” remarks Frericlis,* “ arc tho.se of catarrhal gastro-enteriti.s,” with the presence of a simple icterus M'liicli may la.st eight to fourteen day.s. A slight elevation of tempera- ture may precede by several days tlie development of cerebral symp- toms. Difficulty in speech, headache, di.sordei*s of the .senses followc<l by delirium, convulsions—ehola?mic eclampsia—and c-oma arc the more important symptoms of cerebral origin. The pulse is remarkably small and frecpient. The temperature is at fh-st elevated several degrees, but becomes subnormal i>rior to death. The urine is spariuglv seerek'd, highly colored by the bile-pigments, and contains albumen, tid)e-easts, Icuciu, and tyrosin. Urea, uric acid, and the urates arc dimiui.shed. This combination of symptoms points to the retention within the blood of the wa.ste products normally excreted by the liver ami kidneys. Ultimately, a condition of complete hepatic and renal insufficiency is establi-shcHl. DiAOXOsr.s.—The dull yelloAV color of the skin, the fever, and the cerebral symptoms are signs of chief diagnostic import. Physical exploration reveals tenderness on pressure and rapidly-diminishing area of hepatic dulness on percussion. Acute ])hosphorus-poisoning, a tox- a;mia closely resembling acute yellow atrophy of the liver, must be excluded. PiiOGXOsr.s.—It is doubtful whether an authentic case of this disease has ever terminated in recovery. Examples of cure in su])])o.‘<e<l ca.ses of acute yellow atrophy of the liver have been reported by 0])polzer, Lebert, and Harley. The accuracy of the diagnosis in the.se ea.scs may well be que.stioned, since the very c-onec'ption of the di.scase involves the idea of a latal termination. Tue.vtment.—Theraj)eutic mea'«ures mu.st be addres.s«l to ]iro]diy- laxis, since the c'ourse of the di.scase is rapid, commonly terminating within a few days. It is netes.sar\' to regsird simple icterus as a possi- ble ))rodrome of the malignant form of the disonler. Diabetes.—The mo.st superficial di.scu.>ssiou of the disorders of Jireg- nanev would be incomplete without brief mention of dialwtes. Unfor- tunately, the observation of the clinical course of this afficctiou during ge.rtation has up to the present thrown but little light upon the jiathol- ogv and treatment of the di.sea.'^e. Attention has already been called to the occurrence of physiological glycosuria during jiregnaney, the jiuer- perium, and lactation. Claude Bernard has shown that glucose appears in the ])lacentie of calves at an early ]x*riod, attains its maximum in the third or fourth month, and entirely disapjiears when the glycogenic function of the fetal liver is establi.shed. The relation between jihysio- logieal glveosuria and that morbid exaggeration of a normal j)roee.ss, diabetes mellitus, is very obscure. It is, however, a clinical fact that * Klinik der Leberkr., Bd. i. p. 206.