A practical sketch of the Asiatic cholera of 1848 : its rationale and (presumed) pathology / by S.F. Statham.

Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: A practical sketch of the Asiatic cholera of 1848 : its rationale and (presumed) pathology / by S.F. Statham. 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.

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    fluid is wanting; the gall-bladder is always full from secretion continuing, and is not empty probably from want of ordinary stimulus to excite its contraction; tbe minute structure of the liver is not congested, it is pale, it may be soft from serous effusion, but its capillaries are not loaded—hence, showing its state is that of con- gestion, not of determination; tbe size of the liver is not increased, showing that the state of the liver is merely due to passive accumu- lation of blood from venous obstruction beyond it, and that partial and temporary, and is not due to any increased or exaggerated action in the intimate structure of the liver. The pancreas is firm, perhaps darker from congestion, and its duct (sometimes) full. The spleen firm and small, showing there is merely some passive venous obstruction ; it is never pulpy or softened in the algide state, as in cases of fevei’, &c., where the blood is diseased ultimately, if not primarily; but, as we should expect, the spleen is thus altered after reaction sets in. The kidneys are merely congested in their large vessels, as the liver, with perhaps some serous oozing, and, it is said, frequently contain thick fluid in their pelves, as if secretion failed from want of material, not from want of power. The bladder is empty, con- tracting with the same stimulus that cramps the muscles and empties the rectum ; the gall-bladder is, we know, not under the dominion of the will, but its action, there is every reason to suppose, is closely connected with the presence of food; hence now it remains full. The peritoneum is merely a little dry, from the absence of fluid in the blood. The mesenteric veins, as the hepatic in the centre of the lobules of the liver, are passively filled with blood; the mesenteric glands are always more or less enlarged, not white, as in chronic cases, not dark, as in congestion, sufficiently extensive or continued, but pink and firm, the result of increased capillary action. The stomach generally contains some fluid which, still regurgitating, the dying person had not strength to vomit; its coats are not altered. (Here I must mention that, having no experience in trying the usual or altered strength of the mucous membranes of the intestines, I did not attempt to employ this test.) The small intestines contain the fluid, tinged with bile in the duodenum ; it appears to be the water and salts of the blood, and its deposit to be albumen of the serum with fibrin, and some mucus. If opened sufficiently early after death, I believe uniform bright injection will always be found, a proof of inflammation. Tbe glands, Peyer’s and the solitary, are always enlarged, proving previous increased capillary action ; this could not result from congestion; if life is protracted, the enlarged glands burst—and if solitary, disappear ; but if aggregated, a sirnul-