A case of waxy and syphilitic disease of the liver with ascites : portion of a clinical lecture / by T. Grainger Stewart.

  • Stewart Thomas Grainger, Sir, 1837-1900.
Date:
[1874?]
Catalogue details

Licence: Public Domain Mark

Credit: A case of waxy and syphilitic disease of the liver with ascites : portion of a clinical lecture / by T. Grainger Stewart. 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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    A CASE OF WAXY AND SYPHILITIC DISEASE OF THE LIVER WITH ASCITES. PORTION OP A CLINICAL LECTURE ByT. GRAINGER STEWART, M.D., P.R.C.P., Physician to the Royal Infirmary ; Lecturer on Clinical Medicine and on the Practice of Physic. (^Reprinted from the Medical Times and Gazette ofJanuari/ 31, 1874.) [In the course of a clinical lecture upon cases of Ascites, with special reference to the indications for and the mode of per- forming paracentesis abdominis, the following case, which has been under observation for the past eighteen months, was described]:— Margaret M., aged 28, dressmaker, single, born in Edin- burgh, recently residing at Philpstoun Mills, was admitted to Ward VIII. on June 1, 1872, complaining of swelling of abdo- men and extreme debility. History.—Ten years ago amputation through the left thigh was performed for disease of the knee-joint. Two years ago abscesses formed over the first left costal cartilage and over both shoulders, and at a later period above both wrists. Some of these healed after a considerable time, others continue to dis- charge thin watery pus. About six months ago the patient was under treatment for ulceration of the soft palate, with necrosis of the bones in the neighbourhood. Shortly after this she noticed that the abdomen was becoming distended, since which time it has gradually increased in size. About a fort- night ago diarrhoea set in. The motions were at first of a dark grey colour; now they are light-coloured and watery About the time the abscesses formed, the patient was in- sufficiently fed, and lived in a damp house; since then she has been under more favourable conditions. She has always been much confined to the house on account of her occupa- tion. Some of her maternal uncles and aunts were subject to abscesses. State on Admission.—General appearance: The patient is about the middle height, of dark complexion, pale, with dark rings round the eyes; is much emaciated, and seems to be in an almost moribund condition; temperature 100°. Alimentary System: Lips excoriated; teetli carious; gums anajmic; tongue red, flabby, dry, tremulous ; fauces and palate inflamed; there is a perforation of the soft palate of considerable size, in consequence of which fluids regurgitate through the nose ; thirst great; appetite almost gone; feeling of weight in the epigas- trium; flatulent eructations; occasional sickness, but rarely vomiting; bowels loose, the motions light-coloured and watery. Abdomen distended, measuring 38 inches above the umbi- licus; it is flattened above, and bulging laterally, its form altering on change of position; a dull note on percussion is