On the production of gas-containing cavities in the internal organs of the body / by J.H. Bryant and W.C.C. Pakes.

  • Bryant, John Henry.
Date:
[1898?]
Catalogue details

Licence: Public Domain Mark

Credit: On the production of gas-containing cavities in the internal organs of the body / by J.H. Bryant and W.C.C. Pakes. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Case 13.—(Case 23, Welch and Flexnor’s paper). A man who died in the second week of typhoid fever. On the day before his death marked tym- panites was noticed. The autopsy was performed eight hours after death. There was no odour or discolouration indicating decomposition. There was no swelling of the body. There was some slight emphysematous crackling on the outer side of the forearm below the elbow, on the wrists, and along the outer side of the thigh. There was no gas in the heart, vessels, or any organ except the liver, which was large, pale, and everywhere perforated with small gas holes. The gall-bladder and bile-ducts contained gas. The walls of the gall-bladder and the surrounding connective tissue were emphysematous. Microscopical examination showed extensive necrosis of the liver. There was no perforation of the intestine. The presence of the bacillus aerogenes capsulatus was shown by microscopical examination, culture and inoculation. In this case it was thought that the gas-forming bacilli invaded the liver by means of the bde-ducts. Case 14.—(Adami’s case.) A. 0., set. 45, a lumberman. For six years he had suffered from dull aching pains in the loins. He was temperate, and had no other complaint. Four weeks prior to his admission, while drawing wood, he felt a soreness over his whole body. On the following day pain superseded the soreness, and it was so severe that he had to take to his bed. He suffered from chills, his urine became red coloured (bilirubin), and a week before his admission, on April the 9th, he became jaundiced. Condition on admission. He complained of extreme weakness, but was in no pain. Temperature 102°, pulse 120, respiration 28. The abdomen was pendulous, and it was tender, especially over a small area three inches to the left and five inches above the umbilicus, where an indistinct mass could be felt, which was dull on percussion. There was tenderness in the left groin. The urine contained albumen and bilirubin. The faeces were liquid, and contained blood and pus cells. Soon after admission he vomited coffee-ground material, and the vomiting continued until his death, which occurred five days after his admission. On the 14th he was in great pain, and was constantly coughing. The abdomen was enlarged and tympanitic, and the tympanitic note could bo obtained one and a half inches above the edge of the liver. The blood was examined and showed marked leucocytosis, the red corpuscles did not form rouleaux, and there was well-marked poikilocytosis. The necropsy was performed twenty-eight hours after death, the body having been in the cold chamber since death. Perforative appendicitis was found, with localised suppurative peritonitis, and supurative thrombosis of the branches of the superior mesenteric vein, which had spread along other branches and given rise to retroperitoneal abscess. When the abdomen was opened there was an abundant escape of gas. Bubbles of air or gas were noticed in the veins of several of the abdominal viscera. The liver and kidneys floated in water. The liver was not much above the normal size, and presented rounded edges. Its surface was smooth, with a dark slaty background, mottled over thickly with pale yellowish circular patches 2 to 5 m.m. across. On section, it was extremely emphysematous, and crackled on pressure, and when a lighted match was brought close to the cut surface, and pressure was exerted on the organ, the expelled gas caused a series of explosions. The cut surface had a reddish-brown colour on the