On some affections of the liver and intestinal canal : with remarks on ague and its sequelae, scurvy, purpura, etc / by Stephen H. Ward.

Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: On some affections of the liver and intestinal canal : with remarks on ague and its sequelae, scurvy, purpura, etc / by Stephen H. Ward. 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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    drugs carry off tlie serum from the intestinal vessels, and directly tend to relieve and to prevent effusion into tlie peritoneum. When liydragogue cathartics fail to relieve the ascites, and this becomes so con- siderable as by npward pressure seriously to embarrass the breathing, nothing remains but to tap the abdomen. The effect of the operation is to give immediate rehef to the distressing symptoms ; but the patients are now in an advanced stage of the disease^ their strength and flesh seriously diminished and blood materially impoverished, and they often sink rapidly after the first or second tapping. It is, I know, opposed to the experience of most physicians to tap early, rather than to persevere in the use of hydra- gogues; but these drugs very often cause much irrita- tion and depression, impair the appetite and keep up an irritable state of bowels, and it is to me a question of moment whether an early tapping, of course when the abdomen is much distended, is not preferable. I have recently had under my care at the Seamen’s Hospital a man who had all the symptoms of advanced cirrhosis, who, before his admission, had been tapped six times, and who subsequently to his admission has been tapped* five times. After each operation, which was performed at intervals of from two to three weeks, he was much relieved, and being well supported by a flannel bandage was able to get about and make him- self useful. I tried compound jalap powder and elaterium in his case, and they relieved the dropsy, and enabled us to postpone the tapping, but made him feel ill and uncomfortable. The following cases will suffice in the way of illus- tration :
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