Historical notices on the occurance of inflammatory affections of the internal organs after external injuries and surgical operations / by William Thomson, M.D.

  • Thomson, William, 1802-1852.
Date:
1840
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Licence: Public Domain Mark

Credit: Historical notices on the occurance of inflammatory affections of the internal organs after external injuries and surgical operations / by William Thomson, M.D. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    by a direct concussion of the liver, either from the individual having fallen on the right hypochondrium, or from some hard substance having struck that part of his body ; 2d, that these abscesses occur- ring after wounds of the head are owing to a sympathetic irrita- tion which the liver receives from the inflammation established in the fibrous membranes of the cranium, or of the bones of the upper and lower extremities, particularly of those of the same side; and to the metastasis towards the same viscus of ichorous miasmata, or of a more or less subtle fluid; 3d, that it appears that the commu- nications of the morbific principles of the injured parts with the hepatic organ, take place most easily when they have not to cross the median line of the body, which means, I presume, that the inflammation of the liver is generally in the right or the left lobe, according as the injury is on the right or left side of the head. M. Larrey thinks that, in the cases mentioned by M. Richerand, where fracture of the cranium and laceration of the liver were simultaneously produced by a fall, they were the effects of separate injuries, and might have existed separately. He records an ex- ample of death being produced by laceration of the liver, in conse- quence of a fall on that region, without either the head or the integuments of the abdomen being injured; and he alleges, that, in many instances of violent falls followed more or less immediately by death, the cranium and membranes have been found severely injured without the liver having suffered. He relates three cases of severe falls, in all of which the head was injured; yet neither in two of the patients who died was there any appearance, nor in the third who survived was there any symptom, of the liver having suffered. M. Larrey has likewise related three cases of sabre wounds of the cranium received in duels, in none of which did the individuals fall on receiving the injury, yet they all died affected with abscess of the liver. The only other topic connected with the occurrence of abscesses of the liver subsequently to injuries of the head, to which we have to advert, is, the question how far this occurrence is attended by any symptoms calculated to warn the practitioner that it is in pro- Marchetti had observed the posterior and lateral part of the neck to become painful at the time he supposed the translation of pus to be going on. This symptom has received from other authors almost as little credit as the explanation by which it was accom- panied Other authors, says Mr. Cheston, » who have taken notice of this complicated disease, have never once mentioned this symptom, unless from Marchetti, which surely is too remarkable to be overlooked or forgotten. Mr. Cheston states, however, that it is not unusual for patients who have received any violence, by a fall or other accident, on their head, if not thereby rendered insen- sible to complain, soon after the injury, ofa pain in the top of their shoulder as well as above the scapula; this pain he attributes to the violent shock communicated immediately to the neck and parts ad- jacent.