The practice of medicine / by Thomas Hawkes Tanner.

  • Thomas Hawkes Tanner
Date:
1872
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Licence: Public Domain Mark

Credit: The practice of medicine / by Thomas Hawkes Tanner. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    matters produced, may be very different in different cases—that the quan- tity of the acids formed may vary greatly—that their composition may be affected, taurocholic acid being produced instead of glycocholic acid (Kiihne)—that the quanthVv of blood corpuscles disintegrated by the presence of bile compounds in the blood varies—and that other chemical derangements may be caused, although the action of the liver cells is not suspended even for a very short time.* There are certain diseases of the liver—such as acute atrophy, imper- meability of the bile ducts, cirrhosis, fatty degeneration, &c.—which lead to complete disorganization of this gland, and therefore to an arrest of its functions. Under these circumstances symptoms of blood-poisoning- will arise, which very generally terminate fatally in a short time. Of course this toxaemia does not ensue in all cases, because sufficient healthy hepatic tissue may be left to do the necessary work. Abnormal conditions of the nervous system are the essential symptoms in cases of acholia. Usually there is, first, a stage of excitement, char- acterized by noisy delirium and convulsions; followed, secondly, by depression marked bj' somnolence and progressively increasing coma. Sometimes the first stage is absent, and the patients rapidly fall into a state of typhoid prostration, which passes into coma. Along with these S3anptoms we have hemorrhage from the mucous membrane of the stomach and intestines, petechia? with ecchymoses of the skin, and in a few cases, jaundice. The treatment must consist in the administration of active purgatives, particularly croton oil or podophyllin (F. 160, 168). Benzoic acid (F. 49), or the chloride of ammonium (F. 60), or the diluted nitro-hydro- chloric acid (F. 3*78), can be tried, if there should be time for either of them to act. By these agents life will perhaps be prolonged for a brief period. Beyond this the cases are hopeless. The term acholia [from 'A privative + %olr> = bile], signifying defi- ciency or absence of bile, has been here employed in the sense intended by Frerichs. Without, therefore, saying that this author's views are cor- rect, we may, with our present imperfect knowledge, assume them to be so. Hence acholia must not be confounded with jaundice or chohemia [from XoX-q + al,ua= blood], a morbid state in which bile exists in the blood owing to its reabsorption after having been formed by the liver. In the one case we have retained in the blood those substances by the metamorphosis of which bile is produced ; in the other, the blood contains the bile itself. The subject of jaundice has to be still further considered in the section on hepatic diseases. 9. PYiEMIA.—A very important morbid condition of the system, known frequently as ichorhsemia, or septicaemia, or pyaemia [ichorheemia, from '/^«j/>= sanies, or any thin acrid matter discharged from wounds-f ai/j.a = blood ; septicaemia, from Stjttcu = to putrefy; pyaemia, or pyohse- mia, from Uuuv = pus] ; is caused by the introduction of ichorous or * Kidney Diseases, Urinary Deposits, and Calculous Disorders. Third edition, p. 2.37. London, 1869.