장음표시 사용
121쪽
OBSERvATION delivere December 23. The case of this patient is ne mithis gar to hich Pam not altogethe without dissiculty an expecto have stillgi eater dissiculi in the conductis the cure, than in ascertaining the nature of the disse
The symptoms with hicli his patientis at present assec Red are se in num-ber and of thes the greates par areobvious to the senses. Here theirs and most important question hicli natural lypresent itself, respect the welling in his abdomen Froin the equabie nature filiis, me a conclude that it dependsupon an affection os ome of the abdomina viscera, and we an suspectis viscus with greater probabilit than ine liver. Itis,ellanown that affections of this viseCu are Ver commons and although, onsom occasions suci affections wil continue o life without inconvenience, et in other cases the are attended illi themost serious consequences.
122쪽
This affection of the liver, then, Lwould conside a the mos essentia par of urpatient' disse se an it ma even e a question, ho farcit is nota be considerelas the cause of al of them. The other complainis hicli a present distres himmost, re cough an dissiculi respiration Thes may either dependis a catarrha affection, o the ma originate non a diseas of the liver. It is here, however, tot observed that the coughwith whicli ou patient is assected is in in soni respects different rom that fchronica catarri, and rom it being, asis expresse in the histor of the case, a constant ichling cough, me a conclude, that it oes no depend n the stimulus fio a quantit os viscit mucus Forwhen that is the case the fit os coughingar no si frequent a thesare severe andit then very aret happens that a sit ofo coughin terminates ithout the X- pectoration o a considerable quantity fviscid mucus I must heres ore Wn,
thati conside it tot the mos probabie
123쪽
supposition that both the cough an difficulino respiration dependis the dis
cased state of the liver. On what principi swellinian tumour of the live inould produce the dissicultyo breathing, is ussicienti obviolas. Anenlargement of that viscus must necessarii prevent the re motionis the dia-phragio, particulari When theiod is in recumbent postur: and on the motiono the diaphragm there ante no dotabithat respiratio principali depentis Noris it ver dissicultio conceive ho it ouldgive ris to cough for, rom the very circumstance of preventing the free motionis the diaphragni, it mill necessarii acn asgivin irritation to the lungs. An in his
manne me can account for the frequencyof the cough,ithout expectoration.
t te ver eminent pracstitioner asdisposed to refer to the live the cause of many diseases and Dom those who have
been his patienis, nothiniis more commonthan to ear o liver-coughs, liver-consumptions and the like Although Pam
124쪽
by no means disposed to conside iis influence to e so extenuve a soni imagine, yet it ould e quali groundies toden that it ma osten e the cause fcliseases and when, as in the present case, me have even Dona the testimon of the senses, nextri certain evidence of iis heingdiseased, it naturali present itfel atteas a the mos probabie cause of the aD
Aster these remark o the symptomswith whicli ou patient is at present affect-ed, it nex deserves tot mentioned that, since his complaints egata, he has been affected withither symptonas, hicli, although hey be no constant, have been
observed to retur alio Ver long inter valc and we have ever reason to apprehend that he illo again subjecte tothem. What Pallude to is the blood disse charge both by vomitiniandi stool butparticulari in the alter of these Ways. With regarii to this circumstance alse, there is ground forioubi It cither may O may Ot e connected with the fixe l
125쪽
assection of his liver It is certain thattumour an scirrhosity of the live very frequently occur ithout an such I Pearance an it is quali certain thathlood may be disicharge froni the alimentar canal hen it is derive fromother ources Most commonly, suchblood disicharges happen rom the vesteis of the alimentar canal itself Bessides thesecircumstances, there is another particularwhicli here creates farther oubi Theswellinio in live is aid tot only of two ear duration, hile e re old that this biood disicharge has alien placeat intervat for a greate tength of time. When ali these circumstances are taentogether, I cannot venture to assert illi
126쪽
state, it is more reas nable o suspect it tobe the cause of the symptoms, than to ascribe them to any the cause even the existence of whicli is no certain. Blood froni the esset of the liver ill sin aready accessi into the alimentar canal and wheti it is derived rom his ource, thereis a greater chance of iis belli dis charged, both upward and downwariis, than roman other. Hi is,el known that a disse charge both pWard an downwariis, happens illi regard to the fluid se creted by the liver and is bilious vo
Respecting the cause first inducinithis affection, we are entiret in the dat h. urpatient
127쪽
patient himself oes no ascribe his complain to an particular occurrence Fromthis ource, heres ore, no light is thrownupon the natur of the diseasse, an any conjecture whicli cani forme froni thecircumstances of ur patient' employmen musti very uncertain. et whenwe reflect on his occupation inclis e thato a chairmata, e re naturali te toconclude that he has been exposed tover stron occasionat cause of diseasse. Perhaps there is no employment romwhicli there occurs exposure t greater vicis studes of heat an os old an ac-
cordingly although non are capable fundertakinithis busines but hos of thestoutest and stronges make, et thei livesare rechone very badines by those holiave attended to calculations of that hind.We ma presume, heres ore, that this had som mare in producing the present affectio, and it is no impossibi that tmay have been aidet also by the to frequentis os spiritu ous liquors for whileth circumstances of the professon which
128쪽
we have mentioned naturali lead to theus o spiriis, ram-drinhin is, at thesiam time, nown to e a very powerfulcause induciniaffections of the liver. But an supposition hich may be en-teriai ne respecting the origin of the disia easse, ill no ver litti influence urjudgment,ith regarii to the prognostis. In the present case, I must own I an form
plainis, indeed, are o at present very urgent; and the sympto whicli is monurgent, the cough, is in realit the most inconsiderable This may indeed distres ghim, buta o no consider ii as angerous an although it is no perhaps to beentiret removed, hile the cause of the complain continues, et it ma admit os considerable alleviation. The wellingwhicli is perceptibie in his abdomen, ill in ali probabili ty be more obstinate andit ma no meret resis ali ur attempisto removerit, ut may et terminate in suppuration the patient belli after ardscut oss by the tabes hepalisa es se no rea son
129쪽
son or imagining however, that the progress in the present dis eas willi rapid; and is ur patient chooses to gi velim self that hance hicli disserent medicines may afford, it,ill a leas fui nimis illi
an opportunit for the trial of these: et, I must wn thates have but litti expectationis hein able to remove the affec
illi the vie os combatin that disse eas of the liver, hicli I ake to e thegi ea cause of ur patient' present complaints two great objects are tot almedat the remova o obstruction in that viscus, and the restoration os due circulation through t. e dolo imagine that, even by obtaining these ends, the welling ouldie entiret remove es for the pro babilit is that, after the affection hasbeen o socion standing the solii paris are in s me degre increasse l. et Pthintithere is litile oub that the reater parcof the fwellini lepend on impacted fluids; and that by re circulation these, ouldbe remove l. A the fame time, by the re
130쪽
storation os re circulation, an farthe ' had consequences Ouidi a voide l. O at the remedies known by the generat ille o deobstruenis, non perhapsias been held longe in high estimation hanmercvry and we have the mos inconterlabie evidence of iis actinias a peculiarand et powerfui stimulus a particular paris, after iis introducthion into the genera masis o circulatin fluids It is nihelope o obtaining this effect that havehere piat this patient on theus of it, both externalty and internalty. The fit si I intendiso meret as a means os introdu- cing mercur into the system, hut in some degre asin topica application. It is illithis te thates have conjoine it illi a smal proportioni camplior and I hope that iis influence, hen rubbedipon the integuments may in part be extende to the viscera for I cannot hel thinking, thates have seen instances of benefit romit, here there,as equali litile connec