Pg. 345

¶ 1 Leave a comment on paragraph 1 0 THE PROVINCIAL PRACTICE OF MEDICINE AND SURGERY.

¶ 2 Leave a comment on paragraph 2 0 345

¶ 3 Leave a comment on paragraph 3 0 At the autopsy, in addition to large effusion into both pleural sacs, the following appearances in connexion with the abdominal disease were discovered. The tumour had entirely disappeared, and all that remained of the abscess cavity was a fistulous track about capable of admitting a finger. This track led from the external opening deeply among the indurated tissue which connected the left lobe of the liver with the diaphragm. At its termination, the upper surface of the liver had manifestly been partly destroyed, and traces of recent cicatrisation were evident. The extent of disease, however, did not appear to have been great; the neighbouring parts of the organ seemed healthy. The lining membrane of the extremity of the pouch was of the ordinary villous character of pus-secreting surfaces, and did not in any way resemble the cyst wall of an hydatid.

¶ 4 Leave a comment on paragraph 4 0 Remarks.—We must conclude, then, in the above case, that the abscess had formed, as the result of injury, between the -diaphragm and liver, involving the upper surface only of the latter. Notwithstanding the ultimate result, there was in the immediate results very strong evidence in favour of the plan of treatment adopted. At the time the abscess was opened the man would probably not have lived another week, had that measure not been adopted; and by its aid all but a recovery ensued. The disease which at last caused death had no direct connexion with the hepatic abscess, though it was no doubt one of those low and intractable forms of inflammation to which those who have long been confined to bed by exhausting affections become particularly liable.

¶ 5 Leave a comment on paragraph 5 0 The following three cases of abscess in the liver we shall -quote very briefly, as their detailed particulars have already appeared in our Hospital Reports :—

¶ 6 Leave a comment on paragraph 6 2 Case 17.—Abscess in the Liver.—Death from Rupture into the Pericardium.—A man, aged 48, who had long been under the care of Mr. Erichsen, in University College Hospital, with symptoms of encysted vesical calculus, and who was in very bad health, and had had jaundice, began to suffer from what was suspected to be a pleuritic pain in the right side. About a month after this, a fluctuating tumour, the size of a fist, bulged forward beneath the free margin of the ribs into the left hypochondrium. The swelling having much increased in size, Mr. Erichsen made an incision into it about three, weeks after its first appearance, and evacuated nearly half a pint of brownish and very fetid pus. In spite of the free use of stimulants, death occurred on the fourth day. At the post-mortem, an abscess capable of containing an infant’s head was found in the extremity of the left lobe of the liver. The abscess communicated externally, by the incision which had been made, and also with the pericardium, by means of a fistulous opening about capable of admitting a goose- quill. The heart was bathed in pus, and rough from deposits of lymph. The left pleura contained nearly seven pints of turbid serum. (See Medical Times and Gazette for Feb. 5, 1853, page 139.)

¶ 7 Leave a comment on paragraph 7 0 Case 18.—Chronic Abscess in the Liver.—Rupture into the Peritoneal Sac.—A man, aged 29, was admitted into St. Thomas’s Hospital, under the care of Dr. Leeson, on account of symptoms -of sub-acute peritonitis. He had previously been under care as an out-patient, suffering from pain in the epigastric and right hypochondriac regions, with much depression of spirits; His severe symptoms had commenced suddenly a few hours before admission. On examination, a. decided bulging was noticed in. the right hypochondriac region, where percussion also gave a dull note ; but no fluctuation could be detected. He remained under treatment for about a month before death took place, and suffered much from frequent vomiting, diarrhoea, etc., not, how- ever, without several intervals of apparent improvement. About a fortnight after his admission, an abscess formed and broke beneath the umbilicus, and it subsequently discharged profusely an offensive pus. At the post-mortem, an abscess was found in the upper part of the right lobe of the liver, which had opened into the peritoneal cavity. The. abdominal viscera were generally adherent to each other, and several large encysted cavities had been formed by their adhesions, which contained fetid pus. With the largest of these the external opening communicated. (See Medical Times and Gazette for Feb. 5, 1853, page 140.)

¶ 8 Leave a comment on paragraph 8 0 Case 19.—Case of Abscesses in the Liver.—Death from Peritonitis.—A sailor, aged forty, who had formerly voyaged in tropical climates, had for upwards of three months been an inmate of St. Thomas’s Hospital, under the care of Dr. Risdon Bennett, on account of empyema of the left side. Thoracentesis had been four times performed. His illness had been characterised throughout by restless anxiety of manner and depression of spirits. For two months before death, he had complained of pain in the left shoulder, and had been subject to frequent attacks of nausea and

¶ 9 Leave a comment on paragraph 9 0 sickness; and there had been also a troublesome diarrhoea. No tumour in the abdomen had been noticed, and the fulness in the right hypochondrium which was present, had been attributed to pushing down of the liver by the distended pleural sac. Death finally occurred, after about twenty-four hours’ illness, with symptoms of acute abdominal inflammation. At the autopsy, a quantity of sero-purulent fluid was found in the peritoneal sac. The transverse colon and the stomach both adhered to the liver; and, on tearing them away, the cavity of a large hepatic abscess was opened. Five distinct collections of pus were found in the liver, the largest of which might have contained a fist. The surrounding tissue was softened and broken down, and the pus had a most fetid smell. (See Medical Times and Gazette for Feb. 4, 1854, p. 109.)

¶ 10 Leave a comment on paragraph 10 0 THE PROVINCIAL

¶ 11 Leave a comment on paragraph 11 0 PRACTICE OF MEDICINE AND SURGERY.

¶ 12 Leave a comment on paragraph 12 0 LIVERPOOL ROYAL INFIRMARY.

¶ 13 Leave a comment on paragraph 13 0 CASES OF INJURY OF THE HEAD, [Under the care of Mr. HALTON.]

¶ 14 Leave a comment on paragraph 14 0 [Reported by Mr. A. T. H. WATERS, House-Surgeon to the Infirmary.]Injuries of the scalp and head are among the most frequent cases that come before the notice of the Hospital Surgeon in Liverpool; and although, from the nature of the parts injured, and their vicinity to important structures, there is great liability to extension of the original mischief, yet, when due care is taken in their treatment, the proportion of cases in which such extension occurs is small. That the bones of the cranium may be denuded of their periosteum to a considerable extent, without any loss of vitality, is frequently seen; and although a separation of the external nutrient membrane, may be, and sometimes is, followed by a corresponding separation of the internal membrane, attended with the formation of matter, from the interference in the nutrition which consequently occurs, yet such results form rather the exception than the rule. The following two cases, which occurred under the care of Mr. Halton, in the Infirmary, serve to illustrate some of the more formidable and fortunately more rare consequences which occasionally follow injuries of this kind.

¶ 15 Leave a comment on paragraph 15 1 John C., aged 45, a cab-driver, was admitted into the Infirmary on the 26th of December, 1853. While driving his cab, he had fallen from the box, being at the time in a fit of intoxication. He was insensible for a few minutes after the fall, but soon recovered, and was brought at once to the Hospital. On examination, it was found that he had received a severe wound of the scalp covering the left side of the forehead. The wound was filled with dirt, the edges were very ragged, and the bone was denuded in two places, one a little above the left eye, the other somewhat above and external to the first. The wound was cleaned, and water dressing applied. For a fortnight, no unfavourable symptom occurred: small portions of slough came away from the wound, healthy action had set in, and granulation was proceeding favourably. On the 9th of January—viz., fourteen days after the receipt of the injury—he complained of pain in the head, with slight general disturbance, for which a purgative was administered, and he was carefully watched. On the morning of the 11th, he was somewhat confused in his manner, and unable to answer questions rationally; he was capable of being roused, and would protrude his tongue when told to do so; his pulse was slow, and somewhat laboured. There was no heat of scalp nor flushing of the face, and the wound presented a healthy aspect. In the afternoon the above symptoms had increased; he was scarcely able to articulate, and his pulse was slow, laboured, and irregular. Blood was taken from the arm “ pleno rivo,” the finger being placed on the pulse, which rose and became regular during the operation. Sixteen ounces were taken away. He was then ordered two grains of calomel, with one-eighth of a grain of tartarised antimony, every four hours, and a blister to the nape of the neck.

¶ 16 Leave a comment on paragraph 16 1 Jan. 12.—-He is in much the same condition as yesterday as regards consciousness. He is unable to give an intelligible answer when spoken to, although he seems to understand what is said. Pulse 56, regular; bowels open; there is no puffiness of the scalp. The blood drawn yesterday exhibits a cupped and buffed appearance. In the afternoon he was again bled to sixteen ounces, the pulse rising from 56 to 76 during the operation.

¶ 17 Leave a comment on paragraph 17 0 13th.—He evinces more consciousness, and is able to speak