Hydatid disease of the liver : its diagnosis and treatment / by Mortimer Balding.

Date:
[1881?]
Catalogue details

Licence: Public Domain Mark

Credit: Hydatid disease of the liver : its diagnosis and treatment / by Mortimer Balding. 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.

    18/56 (page 18)
    Pulse 80. Temperature slightly raised. Auscultation and percussion show the thoracic organs to be fairly healthy. Lower ribs on the right side slightly everted, and hypochondriac region prominent. Hepatic dulness in the right nipple-line five and a half inches. Upper limit normal. Projecting from the lower surface of the liver, in the right epigastric and hypochondriac regions, can be felt a smooth elastic tumour, the size of a cocoa-nut; it is slightly tender, but gives no vibration. No jaundice. Bowels regular. Urine 1030, acid. No albumen. Jan. 9.—Is weaker, and has more pain in tumour, which is enlarging. No rigors. Sweats profusely at night. Temperature 990 in the morning, and 1030 in the evening. An exploratory trocar introduced into the tumour, which gave exit to pus. A large trocar was then introduced, and 30 ounces of brick-red pus let out. Cavity washed out with a solution of chloride of zinc, and canula retained in position. Wound dressed with carbolic oil. For some days after the operation the patient was much better, the night-sweats greatly decreased, and the temperature almost normal. After several days, the temperature again rising, the canula was withdrawn, and several ounces of dirty, but not offensive, pus escaped. A drainage- tube was now substituted for the canula, and the cavity washed out daily. Jan. 18.—The drainage-tube appears to give a better exit to the pus than the canula, and the patient expresses himself as better. Pulse and temperature lower, and he takes his food fairly well. Jan. 20.—Discharge slightly offensive for the first time. Jan. 22.—Appetite not so good. Night-sweats and diarrhoea. Jan. 24.—Discharge contains bile. Tube removed, and the wound kept open by lint. From this time the patient gradually lost ground; rigors and profuse night-sweats returned, accompanied by loss of appetite and troublesome diarrhoea. He died on Feb. 4. Post-mortem.—Extreme emaciation. On opening the thorax, the left lung was found to be adherent over a considerable extent, and there was a small quantity of fluid in the right pleura. Lungs other- wise healthy; walls of heart thin and flabby; liver extensively adherent to diaphragm and to abdominal wall for about two inches around the seat of puncture. The cavity, which was bounded by a well-marked wall of fibrous tissue, would not now contain more than 16 ounces. Scattered throughout the liver were several small