Notes of a recent case of soft cancer of the liver, co-existent with hydatid : with observations as to the possible relation between the two diseases / by Thomas Shearman Ralph.

  • Ralph, T. S. (Thomas Shearman), 1813-1892.
Date:
[1878]
Catalogue details

Licence: Public Domain Mark

Credit: Notes of a recent case of soft cancer of the liver, co-existent with hydatid : with observations as to the possible relation between the two diseases / by Thomas Shearman Ralph. 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.

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    explored, and had yielded results which had not been recognized. Thus the case proceeded for a while, when about the 18th of September a third exploration was made, more to the right of the first, and below its level; by this, a very small quantity of blood-coloured fluid was obtained, which was withdrawn with difficulty by the aspirator. The result was not immediately ascer- tained, but several days after I found two hooklets of an echinococcus in a coagulum of blood, which was withdrawn from the tube. The other materials did not yield exactly the same result as the first and second explorations had done ; yet they were to my mind parasitic as to their character. Within forty- eight hours after the operation a great portion of the skin was affected with an irritable red rash, and from the point of the punctured spot the integuments became cedematous with blood- coloured serum, the swelling extending over the right side of the chest, up to the nipple and down as far as the groin; this passed away gradually after a week or so. The discovery of the hooklets thus obtained, giving satisfactory evidence of the parasitic nature of the disease, induced a proposal for a further operation, which was fully to set at rest the nature of the tumour below, or to promote its removal, for doubts were still held out against the hydatid view of the case, and at the same time the following expression was used, to the effect that if one was quite certain of the hooklets being obtained from the liver, we might dismiss the cancer view of the case. An exploratory incision made below the umbilicus led to the determination that no further attempt should be made, as the tumour appeared to be cancerous, but was not penetrated, nor was the peritoneum cut into. Death took place twenty-four hours after from exhaustion, which had been coming on during several days prior to this event. The sufferings of the patient were considerably alleviated by the frequent subcutaneous injection of morphia during the last four weeks of his life. I may here notice that food was constantly or rather daily rejected by the stomach, and as some suspicion arose that an opening into it might have taken place, the discharges were examined, but nothing satisfactory indicating or confirming such a view was afforded. Post mortem examination.—On laying open the chest and abdomen the heart and lungs were found healthy ; the diaphragm above the liver was pushed up as high as the space between the fourth and fifth ribs. The stomach was completely pushed over to the left side by the enormous size of the liver, which presented on its anterior surface two cancerous nodules and two large cerebiiform cancer-masses, extending from the edge of the liver down to half way between the umbilicus and the pubes; the small intestines were agglutinated at portions below and