T. Holmes
1864 The Lancet  
234 the aide, the tongue is cleaner, and his spirits have improved; 1 but with reference to the condition above described, and to his having had three attacks of hepatic congestion within twelve months, or latterly lost two stone weight, I consider that it would be very unsafe for Mr. Sto remain in Bengal through another rainy season, and do therefore recommend that he be allowed to proceed at once to Europe for a period of not less than fifteen months." Such was the correct statement of the
more » ... e presented to me by the patient, as drawn up by Dr. Hugh McPherson, of Calcutta, who saw the case but for a few days. During the passage home from that city, which occupied six weeks, Mr. Ssuffered greatly, especially in the transit through Egypt, but still more on getting into the easterly winds in the English Channel, which parched the surface of the body, and produced much increase of his hepatic sufferings, and general restlessness. On the 7th of July, 1864, I first visited this patient, and, after perusing the recorded case, I made a careful examination of the hepatic region and into the general condition of the health. The ltver was greatly enlarged in all directions, and the left lobe extended three inches into the epigastrium, but was not sensitive to pressure, neither was the liver so generally. But the fulness and uneasiness of the side were distressing, and the least movement of the trunk was performed with a painfully measured and cautious slowness; a similar restraint impeding the movements of the right arm. The breathing was frequent aud oppressed, and there was an occasional slight hacking cough. The general surface was cool, the feet and hands being cooler than the body, and tending to clamminess. The pulse was weak, and numbered 120 in the minute, increasing in frequency towards night. With great fortitude and endurance, the countenance was nevertheless anxious and distressed. There was a flat cedematous nipple between the eighth and ninth ribs, extremely painful to the most delicate touch; and here, if anywhere, I concluded that adhesion had taken place between the two peritoneal surfaces. Dr. John McPherson, just arrived from Calcutta, and who saw the patient, concurred with me in this view. July 13th.-In consultation with Dr. Cameron, of Nottingham-place (Dr. McPherson having left town), I passed an exploring trocar into the liver at the point indicated, and pus having flowed through the canula, I withdrew it, replacing it by a medium sized trocar, and leaving the canula fixed by
doi:10.1016/s0140-6736(02)68507-1 fatcat:6pcl5aslb5e5lmyo5gahyemdba