Volume 1

Diseases of the liver, gall-bladder and bile-ducts / by Humphry Davy Rolleston.

  • Humphry Rolleston
Date:
1912
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Diseases of the liver, gall-bladder and bile-ducts / by Humphry Davy Rolleston. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    48/660 (page 6)
    hepatic dulness below the costal arch is mainly due to cloudy swelling and congestion {vide p. 19). Foaming- Liver {Synonym: Emphysematous Liver).—The formation of gaseous cysts in the internal organs, formerly put down to putrefaction, was shewn by Welch and NuttalV in 1892, to be due to the Bacillus aerogenes caimilatus. The infection with this micro-organism is generally a secondary and terminal event; in other words, this bacillus follows in the wake of other pathogenetic bacteria and does not appear till the patient is moribund. To these general rules there are exceptions. Pure cultures of the Bacillus aerogenes capsulaius have been obtained by Pratt and Fulton, 2 and by Pakes and Bryant; ^ from a case of infective endo- carditis, Gwyn 4 repeatedly isolated the micro-organism from the blood during life. The micro-organism may be present and yet not give rise to any formation of gas (Gwyn, and Pratt and Fulton). ^TilDtrgh-^his- infection -may occur in the body jiuririg life, there is no'evidence thai.Jji_ev6r ]5raduc^rgasbefore-d-eath. The micro-organism may give rise to'necrosis of the cells of the liver and to purulent inflammation, as was shewn in Pratt's and Fulton's case of cholangitis with multiple abscesses in the liver. The Bacillus aerogenes capsulatus is anaerobic, and must be distin- guished from the bacillus of malignant oedema. It stains with Gram's method. It is very frequently present in the alimentary canal, and has been found to be widely distributed in nature. Other gas-producing bacteria must be taken into account; thus, the colon bacillus (Kanthack, Pakes and Bryant) and other members of the aerogenes group, such as B. mucosus capsulatus (W. T. Howard, Jr.^), have been described as giving rise to gaseous cysts. Welch, however, is rather sceptical about their claim to be regarded in this light. The liver is the organ most frequently affected. In 23 cases tabulated by Pakes and Bryant, this organ was affected in 15. Etiology.—B. aerogenes capsulatus is often found in association with other micro-organisms, which probably favour the development of B. aerogenes capsulatus by diminishing the bactericidal power of the blood, and also by reducing the resistance of the liver. J. H. Drysdale <^ found that hot weather is a factor in the production of foaming liver, but that this condition may occur in the absence of any of the ordinary signs of decomposition. It is found much more frequently when there has been recent loss of blood, which seems to favour the entrance of the micro- organisms into the blood or their development in it. Ulceration and injury of the intestines also favour the entrance of the micro-organisms, which are commonly present in the alimentary canal, into the tissues 1 Welch and Nuttall. Bull. Johns Hopkins Hasp., Bait., 1892, iii, 81. Pratt and Fulton. Boston Med. and Surg. Journ., 1900, cxlii, 599. 3 Pakes and Bryant. Guy's Hosp. Rep., 1900 (1897), liv, 283. * Gwyn. Bull. Johns Hojikins Hosp., 1899, x, 134. 5 Howard, W. T., Jr. Journ. Eo:j)er. Med., 1900-1, v, 189. ^ Private communication.