Charles Hastings

WORCESTER GENERAL INFIRMARY. CASE OF SUPPURATIVE HEPATITIS.

CHAS. RUDMAN, aged 40 years, was admitted an in-patient, Nov. 3rd, 1855. He is a stonemason by trade, and has worked in diferent parts of England and Wales, but has never been abroad. Five years ago, while working at Bristol, a large stone fell on his right side, in the region of the liver; and he was treated for several weeks in the Bristol Infirmary. Before this his health had been very good; but he says he has never been the same man since, and has frequently been obliged to give up work for some days together, though he has never been under medical treatment. A month before his admission, he got wet and cold while at work near Worcester, followed by severe rigors and erysipelas of the face; this was relieved by the medical man to whom he applied. when symptoms of peritonitis supervened, and he was directed to go to the infirmary. On admission, he was found much emaciated, complaining of paiu and tenderness in the left hypogastric region, but of no great severity. The abdomen generally bore prusure without pain; but the liver was found to be gatly enlarged, and the countenance expressed distress. There was also considerable dyspnna. Ile said that he had formerly drunk freely, but lately had been very temperate in his habits. Calomel gr. i and opium gr. ss. were given thrice a day, and a blister applied to the seat of pain. Daily reports would be tedious, and I will only give the more important ones. On the 7th, it was noticed that the contenance was beconing sallow, the pain increasing in severity and extent; urme scanty, highL coloured, and depositing abundance of pink lithates. On the 1lth, jaundice was confirmed; he also had vomiting, a dry tongue, weak rapid pulse, rigors, and sweating. Effervescing salines were given, which slightly relieved some of these symptoms. On the 10th, the gums were decidedly affected by the mercury; but there was no corresponding relief. The liver now was found to extencd from the fourth rib to a level with the umbilicus; and a circumscribed swelling was found in the epigastric region, with an obscure feeling of deep fluctuation. There was general abdominal tenderness; and, on the following day, fluctuation was perceived in the pentoneal cavity. During the following week, the jaundice deepened in tint; the urine was scanty, and loaded with bile; feces of a slaty green colour. The fluctuation in the epigastric swelling became more distinct, but without any appearance of redness or pointing. There were no head symptoms, but the vomiting was incesant, and uncontrollable either by hydrocyanic acid, opium, creasote, or brandy. The surface became cold, pulse imperceptible, and he died on the 22nd of November. POST MORTEIX EXAMINATION, twenty-four hours after death. Body much emaciated. Some pints of clear brown serum escaped on opening the abdomen. Peritoneum thickened and injected; intestines covered with a thin layer of false membrane. The stomach and intestines were displaced downwards by the enormously enlarged liver, which had also pressed up the diaphragm to the level of the fourth rib. The liver was not adherent to the parietal peritoneum, except in a poinLt corresponding to the epigastric swelling observed during life, where there were slight recent adhesions, easily broken down. Here, in the left border of the right lobe, there was an abscess as large as an orange, with dense walls, containing pus of a pultaceous consistence. In the right lobe, there were, besides this, five other distinct abscesses, one of which contained fully a pint of fluid healthy-looking pus; the walls of these were firm, dense, and white, of three or four lines thickness, and were surrounded by portions of healthy liver. In the left lobe were four abocesses of about the size of an egg, together with innumerable smaller ones; these had walls of very slight consistency, and one of them especially, on the extreme left border, broke down in removing the liver, and contained red grumous pus: the whole of the left lobe was completely riddled with small abscesses, and its general structure soft and friable. The gall-bladder was distended with healthy bile, and the cystic duct closed by the pressure of an enlarged gland. The only other morbid appearance was adhesion of the right pleura.

Worcester Infirmary: A Fatal Case of Diabetes, with Remarks.

coiimmuniicated by professionial frienids, cases in which chronic, vesical, or renal disease has destroyed the patients at periods, after the operation, varyiing from a fewimonths to two, three, or four years. These facts, couipled with the reports of successful operations for lithotomy contained in this and precedinig numbers of our Journal, have suggested to us that surgical science would be much advaniced by distanit reports from the great provincial and metropolitani hospitals, drawn up in a tabular fornm, and referring to either operation. We are aware of the great difficulty of collecting the hiistory of patients for periods, after operations, varying from months to years; buit obstacles greater tlhan these have been surmounted by the perseverance of men zealous in the pursuit of medical knowledge. The subjoined would, perhaps, answer for the tabular report-EDS.]