colored fluid slowly dribbled away; one drachm of tincture of The fluid immediately after removal iodine was then injected. was covered by a thick scum of crystals of cholesterine; heated in a test tube it coagulated into a firm brown clot. Two days after the operation great swelling of the whole thyroid gland took place, accompanied by much pain in the neck and difficulty of deglutition; there was also general fever and expectoration of a large quantity of viscid mucus; 12 leeches were applied, and a dose of calomel given, followed by a cathartic draught; the pain, swelling, and febrile symptoms gradually subsided, and the tumour was felt to be quite solid and very tender. Ordered syrupi ferri iod : 5j twice a day. The tumour and the enlargement of the thyroid rapidly decreased, and he left hospital on the 29th August. The patient was a native of Hereford. ,
II.?CASE OF ACUTE COXALGIA OE BOTH HIPS ; ABSCESSES ; COMPLETE
RECOVERY.
Robert Galloway, European, a ship's steward, aged 31 years, was admitted on the 4th of August last with the following history. On the 22nd of June last, while sleeping in his cabin at night, exposed to a current of cold air, lie experienced a sudden pain of a lancinating character in his right hip-joint, and shooting down to the inside of the knee ; during the course of the following day the left hip became affected in a similar manner, and general fever set in. rIhe pain and fever increased so that he was unable to move without assistance ; he remained in this condition for some time, and a considerable swelling of both hips took place ; after this the pain became less severe, and the fever left him. Eight days before admission the swelling of the right hip was punctured, and a large quantity of matter let out. State on admission.?Patient much emaciated ; unable to move without assistance. Pulse soft and frequent; skin moist, rather chilly at times; slight febrile heat is observed in the afternoon. Bowels costive ; urine high colored and scanty; tongue coated. The right hip-joint slightly swelled; mark of a puncture over the tensor vaginae femoris muscle; the left hip much enlarged ; swelling pits on pressure; over the gluteal muscles there is distinct fluctuation; pain does not now extend down to the knee ; he is able to move both hip-joints, and declares that he has no pain in the right one. A puncture made over the gluteal muscles, and 8 ozs. of thick pus removed. Ordered chicken diet; port wine 6 ozs.; ol: jecoris 5j ; mist: quinse giss three times a day. 7th.?The puncture on the right side has opened again ; both now discharge a serous fluid mixed with flakes of pus ; a probe passes down close to the joint on the right side in front of it, on the left side behind it; patient cannot take the cod liver oil. Ordered ferri et quin : citrat: grs. v. in solution three times a day. 13tlx.?Serous fluid continues to flow in considerable quantity from the two openings ; appetite good. Bowels rather costive ; he sweats profusely at night and is restless ; pulse 84. Same treatment. Pil aloes c. myrrh grs. v. o. n. 16tli.?Can walk without assistance ; hardly any discharge from the punctures. On the 20th he had a sharp attack of diarrhoea, which was followed by very marked improvement in his general health and closure of both punctures. On the 27th he was discharged; able to walk; quite well. III.?CASE
Apostoli Flacca, European, aged 28, in India six months, admitted on the 7th of September last, when he stated that he had been ailing three months with pain in the right hypochondrium and epigastrium. The pain has been gradually increasing of late, and his health has been gradually failing; latterly he has been unable to work. He was formerly a seaman, but has lately been employed as a bargeman. "Within the last few days the abdomen has become enlarged, and he has passed hardly any ?urine; he is now unable to walk without assistance; there is ascites and tenderness on pressure over the abdomen; the upper boundary of the hepatic duluess is on a level with the nipple ; the lower cannot be made out; respiration on both sides of the chest is harsh ; no cough; pulse 108, feeble; skin dry; thirst; tongue dry, margins florid ; says he has not passed urine for 24 hours ; one ounce of high colored urine removed by catheter, not albuminous; after standing it deposited some granular matter, and a few pavement epithelial cells ; ordered calomel and jalap; dry cups to the loins. 8 tli.?Bowels had acted freely; one pint of urine passed; ordered tisane of muriate of ammonia. 10 th.?Febrile heat; bowels costive. Ext: colocynth grs. viii. llth.?No fever; pain in left chest; friction sounds at lower part of lung; urine scanty; pulse 108, feeble ; ordered sp: ainmon: was
CASES PROM THE EUROPEAN GENERAL HOSPITAL, BOMBAY. By "W.
DYMOCK,
Assist an t-S uhgeos, X
I?CYSTIC BRONCHOCELE ; INJECTION WITH TINCTURE OP IODINE; CCRE. A. K., a European, age 22, mate of a merchant vessel, was admitted into the hospital on the 4th August last with a swelling on the left side of his neck, which he first noticed six years ago ; ho stated that latterly it had been increasing in size; on examination it was found to be about the size of a large egg, and when the parts were quiescent, situated beneath the lower part of the sterno-mastoid muscle, and projecting on both sides of it; to the touch it was elastic, and moved up and down during deglutition, becoming much more prominent; its connection with the thyroid gland could be clearly mado out ; it was punctured with a small trocar, and about one ounce of a senna-
OP ABSCESS OF THE LIVER; ECHINOCOCCI; LUMBRICI IN THE INTESTINES.
THE INDIAN MEDICAL GAZETTE.
364
5j., aq: anisi oz. i, mist: acacue 511. To continue the tisane. 12th.?Bad night; much pain in left side ; pulse 120 ; respiration 36 ; lower part of left clest dull; size of abdomen rather less ; urine more in quantity, of ,the same character ; one stool, brown and dry. Continue. 13 th.?Less pain ; left chest dull up to first rib; heart displaced to the right; pulse 120; respiration 36 ; bowels act daily after a arom :
simple
enema.
14th to 18th.?No change beyond gradual decrease of the ascites. 19th.?The dropsy has sufficiently decreased to enable a more accurate examination of the viscera to be made. The left side of the chest is distended with fluid ; the heart displaced to the right of the median line ; the epigastrium filled by a distinct hard tumour ; ordered lint: iodi: to the left chest. Continue. 1\st.?Died at 11-30 a.m. Post-Mortem Examination
(four
Head.?Venous sinuses contained
hours after
death).
fluid blood ; cerebral substance ozs. side Body much wasted ; on of the chest was seen to be much distended with turbid serous fluid, in which numerous flakes of soft lymph and pus were floating ; the cavity of the pleura was thickly covered with a shreddy layer of soft lymph; the lung was found lying close to the spine and extremely compressed, but not otherwise diseased ; the pericardium contained fluid of the same description as that in the pleura, and was coated all over with the same kind of soft lymph ; the surface of the right ventricle of the heart was adherent to the pericardium by scft adhesions ; on tearing these, pus issued from an abscess in the left lobe of the liver ; ttie situation of the heart was quite to the right of the median line. The right lung, although compressed by the heart and upward displacement of the liver, was healthy ; it was ex-sanguine, and weighed 11 ozs. The heart and valves were healthy; weight 10 ozs. 2 drms.; a small clot in right cavities ; muscular tissue normal. The abdomen was slightly distended with clear, saffron-colored fluid; the transverse colon distended by flatus and displaced downwards. The left lobe of the liver (two-thirds of it) was converted into a large bag, full of thick whitish pus, and had contracted firm adhesion with the colon, stomach, and diaphragm, and through the latter with the pericardium and left pleura; in the walls of this abscess slight traces only of condensed liver tissues could here and there be detected. The abscess having been examined in situ, the right lobe of the liver, together with the remaining one-third of the left lobe, was removed and found to weigh 60 ozs. The portal and hepatic veins were much dilated; the gall ducts were pervious and of natural size ; they contained a very small quantity of citron-colored bile. The right lobe of the liver contained hundreds of minute abscesses, from a hazel-nut to a millet seed in size, and containing thick white pus; their boundaries were irregular, and consisted of hvpcrasmic hepatic tissue, in which the hepatic cells were compressed, but quite distinct; a great proportion of these abscesses were distributed in the course of the portal vessels, and were seen in several places distinctly compressing them ; the hepatic cells in the sound portions of the liver were of normal shape and size, the proportion of their fatty contents unusually small; several of the small abscesses were superficial, and caused hard prominences on the anterior surface of the liver, which, if felt through the abdominal walls, might have well been mistaken for the effects of cirrhosis. The remaining one-third of the left lobe presented evident marks of inflammation, the capsule of Glisson much thickened, as well as the coats of the hepatic vein, the tissues becoming more and more condensed as the wall of the abscess was approached; this was formed of a tough fibrous boundary of considerable strength and thickness; the vessels were pervious but were here plugged by a soft fibrinous clot; up to this point, the surface of the clot towards the vessel was convex and smooth; the distal extremity extended into the abscess. The Spigelian lobe was completely occupied by a nest of Echinoeocci enclosed in a thick white cyst which could be lifted put of the excavated lobe, leaving a hollow shell of hepatic tissue lined by a fine white membrane ; the thick cyst was composed of a pearly white substance, like coagulated albumen; inside it was a delicate membranous lining full of a clear serous fluid, and myriads of Echinococci attached to the membrane ; the gall bladder was contracted and irregularly constricted; it contained a small quantity of dark bile ; the kidneys were large and granular; the tubules loaded with abnormal epithelium; the spleen healthy ; no lesion of intestines, but conjested patches, with a strong bilious tinge, were seen in the ilium; several lumbrici were found.
large quantity of normal; weight of brain 43 opening the thoraz the left a
[December 1,
1866
Remarks. There are two special points of interest in this case : first, the nodulated condition of the surface of the gland, caused by the projection of the small abscesses, which, had there not been dropsy, might have been felt through the abdominal walls, and led to the diagnosis of cirrhosis; second, the question whether there was any connection between the presence of Echinococci in the liver and that of lumbrici in the intestine. The abscess I believe to have been caused by a nest of Echinococci in the left lobe, although I failed in detecting their remains in-the pus contained in it. 1 /
II.?CASE OF ACUTE COXALGIA OE BOTH HIPS ; ABSCESSES ; COMPLETE
RECOVERY.
Robert Galloway, European, a ship's steward, aged 31 years, was admitted on the 4th of August last with the following history. On the 22nd of June last, while sleeping in his cabin at night, exposed to a current of cold air, lie experienced a sudden pain of a lancinating character in his right hip-joint, and shooting down to the inside of the knee ; during the course of the following day the left hip became affected in a similar manner, and general fever set in. rIhe pain and fever increased so that he was unable to move without assistance ; he remained in this condition for some time, and a considerable swelling of both hips took place ; after this the pain became less severe, and the fever left him. Eight days before admission the swelling of the right hip was punctured, and a large quantity of matter let out. State on admission.?Patient much emaciated ; unable to move without assistance. Pulse soft and frequent; skin moist, rather chilly at times; slight febrile heat is observed in the afternoon. Bowels costive ; urine high colored and scanty; tongue coated. The right hip-joint slightly swelled; mark of a puncture over the tensor vaginae femoris muscle; the left hip much enlarged ; swelling pits on pressure; over the gluteal muscles there is distinct fluctuation; pain does not now extend down to the knee ; he is able to move both hip-joints, and declares that he has no pain in the right one. A puncture made over the gluteal muscles, and 8 ozs. of thick pus removed. Ordered chicken diet; port wine 6 ozs.; ol: jecoris 5j ; mist: quinse giss three times a day. 7th.?The puncture on the right side has opened again ; both now discharge a serous fluid mixed with flakes of pus ; a probe passes down close to the joint on the right side in front of it, on the left side behind it; patient cannot take the cod liver oil. Ordered ferri et quin : citrat: grs. v. in solution three times a day. 13tlx.?Serous fluid continues to flow in considerable quantity from the two openings ; appetite good. Bowels rather costive ; he sweats profusely at night and is restless ; pulse 84. Same treatment. Pil aloes c. myrrh grs. v. o. n. 16tli.?Can walk without assistance ; hardly any discharge from the punctures. On the 20th he had a sharp attack of diarrhoea, which was followed by very marked improvement in his general health and closure of both punctures. On the 27th he was discharged; able to walk; quite well. III.?CASE
Apostoli Flacca, European, aged 28, in India six months, admitted on the 7th of September last, when he stated that he had been ailing three months with pain in the right hypochondrium and epigastrium. The pain has been gradually increasing of late, and his health has been gradually failing; latterly he has been unable to work. He was formerly a seaman, but has lately been employed as a bargeman. "Within the last few days the abdomen has become enlarged, and he has passed hardly any ?urine; he is now unable to walk without assistance; there is ascites and tenderness on pressure over the abdomen; the upper boundary of the hepatic duluess is on a level with the nipple ; the lower cannot be made out; respiration on both sides of the chest is harsh ; no cough; pulse 108, feeble; skin dry; thirst; tongue dry, margins florid ; says he has not passed urine for 24 hours ; one ounce of high colored urine removed by catheter, not albuminous; after standing it deposited some granular matter, and a few pavement epithelial cells ; ordered calomel and jalap; dry cups to the loins. 8 tli.?Bowels had acted freely; one pint of urine passed; ordered tisane of muriate of ammonia. 10 th.?Febrile heat; bowels costive. Ext: colocynth grs. viii. llth.?No fever; pain in left chest; friction sounds at lower part of lung; urine scanty; pulse 108, feeble ; ordered sp: ainmon: was
CASES PROM THE EUROPEAN GENERAL HOSPITAL, BOMBAY. By "W.
DYMOCK,
Assist an t-S uhgeos, X
I?CYSTIC BRONCHOCELE ; INJECTION WITH TINCTURE OP IODINE; CCRE. A. K., a European, age 22, mate of a merchant vessel, was admitted into the hospital on the 4th August last with a swelling on the left side of his neck, which he first noticed six years ago ; ho stated that latterly it had been increasing in size; on examination it was found to be about the size of a large egg, and when the parts were quiescent, situated beneath the lower part of the sterno-mastoid muscle, and projecting on both sides of it; to the touch it was elastic, and moved up and down during deglutition, becoming much more prominent; its connection with the thyroid gland could be clearly mado out ; it was punctured with a small trocar, and about one ounce of a senna-
OP ABSCESS OF THE LIVER; ECHINOCOCCI; LUMBRICI IN THE INTESTINES.
THE INDIAN MEDICAL GAZETTE.
364
5j., aq: anisi oz. i, mist: acacue 511. To continue the tisane. 12th.?Bad night; much pain in left side ; pulse 120 ; respiration 36 ; lower part of left clest dull; size of abdomen rather less ; urine more in quantity, of ,the same character ; one stool, brown and dry. Continue. 13 th.?Less pain ; left chest dull up to first rib; heart displaced to the right; pulse 120; respiration 36 ; bowels act daily after a arom :
simple
enema.
14th to 18th.?No change beyond gradual decrease of the ascites. 19th.?The dropsy has sufficiently decreased to enable a more accurate examination of the viscera to be made. The left side of the chest is distended with fluid ; the heart displaced to the right of the median line ; the epigastrium filled by a distinct hard tumour ; ordered lint: iodi: to the left chest. Continue. 1\st.?Died at 11-30 a.m. Post-Mortem Examination
(four
Head.?Venous sinuses contained
hours after
death).
fluid blood ; cerebral substance ozs. side Body much wasted ; on of the chest was seen to be much distended with turbid serous fluid, in which numerous flakes of soft lymph and pus were floating ; the cavity of the pleura was thickly covered with a shreddy layer of soft lymph; the lung was found lying close to the spine and extremely compressed, but not otherwise diseased ; the pericardium contained fluid of the same description as that in the pleura, and was coated all over with the same kind of soft lymph ; the surface of the right ventricle of the heart was adherent to the pericardium by scft adhesions ; on tearing these, pus issued from an abscess in the left lobe of the liver ; ttie situation of the heart was quite to the right of the median line. The right lung, although compressed by the heart and upward displacement of the liver, was healthy ; it was ex-sanguine, and weighed 11 ozs. The heart and valves were healthy; weight 10 ozs. 2 drms.; a small clot in right cavities ; muscular tissue normal. The abdomen was slightly distended with clear, saffron-colored fluid; the transverse colon distended by flatus and displaced downwards. The left lobe of the liver (two-thirds of it) was converted into a large bag, full of thick whitish pus, and had contracted firm adhesion with the colon, stomach, and diaphragm, and through the latter with the pericardium and left pleura; in the walls of this abscess slight traces only of condensed liver tissues could here and there be detected. The abscess having been examined in situ, the right lobe of the liver, together with the remaining one-third of the left lobe, was removed and found to weigh 60 ozs. The portal and hepatic veins were much dilated; the gall ducts were pervious and of natural size ; they contained a very small quantity of citron-colored bile. The right lobe of the liver contained hundreds of minute abscesses, from a hazel-nut to a millet seed in size, and containing thick white pus; their boundaries were irregular, and consisted of hvpcrasmic hepatic tissue, in which the hepatic cells were compressed, but quite distinct; a great proportion of these abscesses were distributed in the course of the portal vessels, and were seen in several places distinctly compressing them ; the hepatic cells in the sound portions of the liver were of normal shape and size, the proportion of their fatty contents unusually small; several of the small abscesses were superficial, and caused hard prominences on the anterior surface of the liver, which, if felt through the abdominal walls, might have well been mistaken for the effects of cirrhosis. The remaining one-third of the left lobe presented evident marks of inflammation, the capsule of Glisson much thickened, as well as the coats of the hepatic vein, the tissues becoming more and more condensed as the wall of the abscess was approached; this was formed of a tough fibrous boundary of considerable strength and thickness; the vessels were pervious but were here plugged by a soft fibrinous clot; up to this point, the surface of the clot towards the vessel was convex and smooth; the distal extremity extended into the abscess. The Spigelian lobe was completely occupied by a nest of Echinoeocci enclosed in a thick white cyst which could be lifted put of the excavated lobe, leaving a hollow shell of hepatic tissue lined by a fine white membrane ; the thick cyst was composed of a pearly white substance, like coagulated albumen; inside it was a delicate membranous lining full of a clear serous fluid, and myriads of Echinococci attached to the membrane ; the gall bladder was contracted and irregularly constricted; it contained a small quantity of dark bile ; the kidneys were large and granular; the tubules loaded with abnormal epithelium; the spleen healthy ; no lesion of intestines, but conjested patches, with a strong bilious tinge, were seen in the ilium; several lumbrici were found.
large quantity of normal; weight of brain 43 opening the thoraz the left a
[December 1,
1866
Remarks. There are two special points of interest in this case : first, the nodulated condition of the surface of the gland, caused by the projection of the small abscesses, which, had there not been dropsy, might have been felt through the abdominal walls, and led to the diagnosis of cirrhosis; second, the question whether there was any connection between the presence of Echinococci in the liver and that of lumbrici in the intestine. The abscess I believe to have been caused by a nest of Echinococci in the left lobe, although I failed in detecting their remains in-the pus contained in it. 1 /
