Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATION. 145
can be no uncommon thing here. In the July 30th, 8:30 a. m.—Hemorrhage from
last fifteen months I have seen twenty-five tlie bowels. Patient very weak. Bowel
cases of amcebiasis, with ten deaths. In movement less frequent during the last
only one other case was liver abscess sus- twelve hours,
pected. J*ily 31st.—Hemorrhagic bowel move-
Case.—Mr. P., admitted to the charity ment continues. Patient very weak. Death
ward of St. Peter's Hospital, July 22, 1909; at 5 p. m.
white, male, age 5.S, married, box-maker. Autopsy Notes.
Well-water, vegetables from home garden. July 31st, 9:00 p. m.
Family histor3', negative. Past history, Both lungs adherent over posterior part
typhoid, pleuris)', bowel, stomach and liver of upper lobes one and one-half inches betrouble
fifteen years ago. Passed a renal low apices, showing sclerosed tubercles,
calculus some years ago (says it is in his Xo caseation. Heart pale and right venbladder
yet). No urinary symptoms until tricle collapsed. Left ventricle somewhat
last week. Has had dysentery off and on hyperlrophied. Abdomen opened and omenfor
a great number of years. tum found covering the intestines. Omentum
Present Condition.— Patient comes in com- adherent over middle of ascending colon
plaining of bloody flux, from which he has under border of liver. Stomach sagged
suffered for three months. Is greatly pros- down toward pylorus; cardiac end distendtrated,
emaciated and anemic, has straining ed; pyloric end contracted. Stomach not
and tenesmus at stool, with gross blood and opened. Small intestine normal from pymucus
in the movements. Has protracted lorus to caecum.
attacks of hiccoughs, which have caused From caecum to anus the colon was
soreness of the abdominal muscles. Some everywhere very much thickened and intenderness
over the sigmoid but none over filtrated and extensively ulcerated. The
the liver. Sleeps well, good appetite.
Physical Examination.— Nothing elicited
ulcers were sometimes as large as a half
dollar. Extensive areas of capillary hemorexcept
increased liver dullness. This extended
two inches below the costal margin
rhage into the wall of the colon were pres-
ent. On the front side of the middle of the
and across to the left nipple line.
Laboratory Report.— Urine: Acid, sp. gr.
ascending colon was what seemed to be a
perforation with dense adhesions to right
10.20, no albumen, no sugar. Microscopi- kidney, omentum, liver and gall bladder.
cal: Blood and pus, probably from the This was under the edge of the enlarged
bladder. Blood: Haemoglobin 70. Differ- liver. Spleen and pancreas normal on gross
ential count, polynuclears 92, monononu- appearance. Kidneys, gall bladder, adrenculears
8, eosinophiles 0. Sputum: Thin, als, prostate and urinary bladder not exgray,
liquid, offensive, no amoeba present, amined. Bile readily squeezed into the innot
examined for T. B. Feces: Liquid testines.
with blood and mucus, linlamoeba Ilisto- Liver enlarged with large dark -bluish
litica present in considerable numbers. blotch covering left half of right lobe. Left
Patient ran no temperature, pulse 85 to lobe extended to left anterior axillary line.
95, respiration IS to 22.
Diagnosis,—The diagnosis of amoebic
dysentery with abscess of the liver was
Right lobe two and one-half inches below
the ribs with gall bladder to the umbilicus.
On section an abscess was found a little
made on the strength of the fecal picture, larger than a hen's egg, one inch above
on increased liver dullness with hiccoughs and one and one-half inches to the right of
controlled only by morphia, and on the ab- the point where the gall bladder emerges
sence of eosinophiles with 92 per cent, from under the liver. Abscess full of green
polynuclears. and white thick, viscid pus and mucus.
Notes.—July 22nd. Patient has prolonged This has not been examined for amoeba.
attacks of hiccoughs which can be relieved
•
only by morphia. The Apparent Divorce ol Modern Medi-
July 27th.— Has had hiccoughs off and cine and Surgery, and Some ol lis
on for the last few days. Colonic irriga- Consequences.
tions had to be abandoned because of the
weak condition of the patient. High enemas
in bed were tried but without effect as only
bv J. Allison Hodges, M. D., Richmond. Va., Phv-
-charge Hygeia Hospital.
a quart could be introduced. Kept pretty
steadily under morphia. Xo effect on the
The opinions expressed in the discussion
of this subject are offered neither in the
bowels, which moved from fifteen to twenty capacity, nor in the spirit of a teacher, or
times a day.
July 29th.— Patient rapidly growing
weaker. Anemas stopped. Lead and opium
a critic. They are the result of an experience,
embracing observation of many cases
from many capable physicians and surpills
substituted for morphia. geons, and are intended to be suggestive