Sarcoma and cirrhosis of the liver / by W.W. Ford.

  • Ford, William W. (William Webber), 1871-1941.
Date:
[between 1895 and 1910?]
Catalogue details

Licence: Public Domain Mark

Credit: Sarcoma and cirrhosis of the liver / by W.W. Ford. Source: Wellcome Collection.

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    same time. A swelling of the abdomen, which the patient said began several days before the paralysis, increased with great rapidity subse¬ quent to this seizure. Condition on Admission. Patient is a man aged about sixty-five years, whose speech is so thick and indistinct as to render answers to questions almost unintelligible. He is extremely drowsy, the skin is muddy, and there are a few stellate veins about the nose, cheeks and forehead ; subcutaneous fat moderate in extent, and muscles of fair size and firmness. The abdomen is greatly distended ; the surface is covered with scratch marks, showing a slight dilatation of the superficial veins. There is dulness in both flanks, which changes to resonance with the shifting of the patient’s body. The liver dulness extends from the fifth rib to the costal border, measuring three inches in nipple line; neither liver nor spleen is palpable. The heart sounds are distant and feeble, apex impulse not palpable; pulse small and feeble, 120 to the minute. There is slight cyanosis of finger nails. Complete left hemiplegia, the face being slightly drawn to the right side, the left labio-nasal fold shallower than the right. The left hand and arm and the left leg are quite powerless, the arm is held flexed across the chest; there is no rigidity of either extremity. The patellar reflexes are increased, the plantar present on the right side, absent on the left. The day after admission the patient’s condiiion became much worse. He developed great restlessness, and a dull, drowsy stupor; articulation was greatly impaired, and the pulse much diminished in strength and frequency ; temperature between 97° and 98°. The patient died about midnight of the second day. Diagnosis during Life. Cirrhosis of the liver and abdominal ascites, left-sided hemiplegia, and right-sided thrombosis of the cerebral vessels. The autopsy was performed the day following the death of the patient. Autopsy Notes. Body of a large, well-developed man of medium height; no jaundice; lips and mucous membranes pale; mouth and pharynx filled with clear watery fluid; marked lividity of dependent parts of the body, and complete rigor mortis in arms and legs; no petechia of skin ; external genitalia normal. Thorax: A few pleural adhesions at apex of right lung. Hypostatic congestion of both bases with slight acute inflammation of the walls of the larger bronchi. No areas of pneumonia or tuberculous consolida¬ tion. Pleural cavities free from fluid. Larynx: Congested and slightly cedematous. Thyroid : Normal. Heart: Not enlarged; no pericardial adhesions; a thick layer of pericardial fat. Mitral valves thickened ; aortic valves normal. Aorta not calcified. Heart muscle brownish. Abdomen contains 4000 c.c., pale-yellow ascitic fluid, not blood¬ stained. Mesentery and omentum filled with small nodules the size of a pea, white or reddish ; similar nodules scattered over peritoneal sur¬ face of abdominal muscles and of the diaphragm. The omentum was so filled with these nodules as to form a hard, stifl* ridge-like swelling, palpable just below the costal margin. Stomach and intestines normal ; rectum normal.