A case of deep-seated tropical abscess of the liver treated by trans-thoracic hepatotomy : recovery / by Byrom Bramwell and Harold J. Stiles.

  • Bramwell, Byrom, Sir, 1847-1931.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: A case of deep-seated tropical abscess of the liver treated by trans-thoracic hepatotomy : recovery / by Byrom Bramwell and Harold J. Stiles. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    7/16 (page 7)
    night previously. I saw no reason to modify my previous conclusion that the cause of the febrile disturbance was in all probability suppurative hepatitis, and that the pus was probably deeply seated in the upper and back part of the right lobe. The very localised friction rub over the base of the right lung, which was the only physical sign indicative of disease, seemed to support this opinion, which was con- curred in by all the gentlemen who were present at the con- sultation, and was communicated to the patient’s relatives. The question of immediate exploratory puncture was again debated, and it was decided to wait for a few days longer with the object of seeing if any further symptoms or signs uidicative of the position of the supposed abscess would develop; and then, whether such development took place or not, that the operation of exploratory puncture should be performed. The Suegical Teeatment of the Case and Eemaeks BY Me. Stiles. i, ^ patient again. He had had a bad night in consequence of having been seized with a lancmating pain localised to the seventh interspace m the inid-axillary line. The evening temperature durine the previous week had risen to between 103° and 104° F and on one occasion reached 104’6°; there had been no distinct rigors, but the night sweats were more profuse. As the temperature had gradually been getting higher and the patient slowly but surely losing ground it was decided to explore the liver for pus, notwithstanding the absence of anv enlargement. A medium-sized trocar and cannula belongin’c' to the ordinary Potain’s aspirator was pushed into the liver mid-axillary line through the seventh intercostal space, this situation was selected, firstly, because from it the ISfruf “ost readilv t>®cause it was the seat of the sharp patient complained. Pus was reached after the trocar had penetrated for a distance of about two and a half inches from the surface, a slight resist- ance being encountered as the wall of the abicess wa>^ pierced. About a tablespoonful of brick-red pus, strongly igpstive o anchovy sauce, was removed and received into cannula could be pushed up to the hilt without meeting with any resistance