CASE OF CHRONIC HYPERTROPHIC CIRRHOSIS OF THE LIVER; WITH REMARKS.

413 The thirty-six, who rapidly recovered from an attack of right viz, transient and recurrent jaundice, vomiting, &c. disease proved fatal in July, 1885, from chronic hypertrophic hemiplegia under the influence of iodide of potassium. In two cases the hemiplegia was associated with occa- cirrhosis and asthenia. The man had always been of sober sional epileptic attacks: one of these being a man (J. H-) habits, and there was nothing personal in his history differing in these parts, aged forty-eight, who has had right hemiplegia for some from what is found amongst the labourers of weather. to the such as vicissitudes a woman and the exposure other, (S. H- -) aged fiftyyears past; From a physiological point of view these cases are in8even, who had an attack of left hemiplegia, from which she recovered in the course of a few weeks, and in whom teresting. In common parlance, it was a case of premature break-down, and beyond the remedial power of medicine. The there was a strong history of alcoholism. Of the remaining five cases, one had been bedridden for patient inherited the seeds of the disease, to develop sooner or later, according to circumstances. He was unhealthy to some months with chronic rheumatic arthritis, while in the error the in blood and in the organs the other four there was a well-marked history of alcoholism. with, begin being Mary G-, aged seventy-one, of a marked rheumatic that deal with nutriment. Be that as it may, the same diathesis, was suddenly seized with paralysis and anesthesia constitutional dyscrasia that had caused a pleurisy to of the left arm; the left leg was cold and anseathetic, but degenerate into an empyema, with, subsequently, much not paralysed. Four days later the paralysis had much formation of fibroid tissue, when once the flood-gate of improved, and it continued to improve slowly until her impure blood had been opened, led to degeneration in other .death, which occurred twenty-five days after the seizure. parts. Why the liver should not have been the subject of At the necropsy the dura mater of the vault was found gin-drinkers’ cirrhosis I take to be in the difference of - thickened and adherent to the brain along the median the originating causes : in the one case, alcohol being more assure, but otherwise both brain and spinal cord appeared of an irritant, inflammatory changes with thickening of perfectly healthy. The heart was fatty, but otherwise the tissue resulting, and contraction; while in the other, added development of fibrous tissue, with increase of bulk. normal, the lungs oedematous, and the kidneys normal. The cases with a history of chronic alcoholism were as In the former case, one would expect the disease to be follows :more rapid and painful on account of the greater activity George T-, aged forty, had a sudden attack of right of the poison. Lung affections and short breathing are hemiplegia, from which he recovered in the course of a few common among those who have lived for some time in weeks. tropical climates, on their return to temperate parts. The Mary Ann W-, aged fifty-seven, had an attack of right liver is invariably affected. In these cases, not uncommonly, hemiplegia eighteen months ago, from which she has been from sudden chill, a fatal congestion or bronchitis results, and there being possibly pre-existing fibroid affection of for some few months convalescent. Robert C--, aged sixty, had an attack of right hemi- the lungs, may not that be a predisposing cause of the untoward event ? The rationale would be evident. Blood ,plegia, with rapid recovery. William W-, aged sixty-eight, had an attack of left dyscrasia, from the liver not performing its appropriate hemiplegia with amnesia four months ago, from which he functions of depuration, alteration, or otherwise, and thererecovered in about a month. A second attack occurred a fore the cellular structure of the lungs being supplied with month ago, this time on the right side, and again associated unsuitable nutriment, perverted growth would ensue. Thus with amnesia, from which he is now convalescent, the thevena porta brings blood to the liver, and it is altered there, and made fit for nourishment of tissues (altering venous amnesia, however, remaining. Also in the two cases mentioned above-namely, JesseY blood in other systems before it is arterialised). However, with associated heart disease, and Sarah H--with occasional when what is brought to the liver, or when the liver, from epileptic attacks-there was a well-marked history of chronic occult causes, in digestive or other parts (or in itself), causes a failure of proper nutrition, the tissues (lungs, kidneys, alcoholism. In none of these cases was there any facial palsy. Hence spleen, and elsewhere), instead of their normal constitution it would, I think, appear that, in these seven latter cases at being maintained, will consequently have substituted some least, the transient nature of the paralysis, its alternation other than their healthy formation, in excess or in defect, as from side to side, as illustrated in the case of Wm. W--, the case may be. Where so large and so important a viscus its frequent recurrence, as specially illustrated in JesseY as the liver exists, we cannot suppose but that its functions and again the results of the post-mortem examination of are of the utmost importance. The many morbid states it Ii Mary G-, are all of them suggestive of some temporary displays without immediate fatal interference or death ,pressure upon the cortex of the brain such as would be point otherwise; so, likewise, may it be said of every other occasioned by a slight and transient kindling of the chronic organ of the human body, from the brain to the smallest inflammation of the dura mater of the vertex, so common cell, which may remain unsound throughout life to a greater in the later stages of chronic alcoholism, and to a less extent or less extent. A great part of the way of diseases is as unknown. The want of access to medical libraries will, of chronic arthritic rheumatism.

CASE OF

in the remarks I have made, be my excuse for the total absence ’of reference to authorities on this subject. Blood dyscrasia is a wide field, and its connexion with morbid growth, fatty fibroid, and other degenerations requires

CHRONIC HYPERTROPHIC CIRRHOSIS OF investigation. THE LIVER; WITH REMARKS. BY ALEXANDER

YULE, M.D., C.M.ABER.

JoHy T-, aged sixty-three, a Sussex labourer, came under my observation in 1830 suffering from dyspeptic symptoms and difficulty of breathing. This would last for a few days, and his usually indifferent health followed. I examined his chest, and observed that at one time he had had empyema. There was a cicatrix under the left breast ; the lower half of the left side had fallen in, and the lung shrunk. This occurred many years before I first saw him. The want of breathing capacity and feeble action of the heart I attributed to the changes in the chest. I examined the heart frequently, and failed to find a murmur. There was at first a little swelling of the feet and lower part of the legs. The size of the abdomen varied according to the action of the bowels and kidneys, but at all times was much distended with serum. The liver was enlarged in every direction, and the urine albuminous. In 1883 and 1884 increasing anaemia and dropsy supervened, associated with which were symptoms referable to kidney, liver, and lungs-

A NOTE

ON "TROPICAL

BY GEORGE

ULCER."

RANKING, M.D. CANTAB.,

SURGEON, 5TH

BENGAL CAVALRY.

I HAVE adopted the above name for the form of ulcer which I am about to describe for two reasons: firstly, because it leaves open the question of causation; and, secondly, because, never having met with cases of ulceration exactly conforming to this type elsewhere, it has been my lot to see large numbers in tropical latitudes, under various names taken from the locality-e.g., "Delhi boil," The ulcer com"Meean Meer sore," "Scinde sore," &c. mences usually as a small circumscribed patch of inflamed skin. This is attended with pain of varying intensity, but generally only amounting to burning or itching sensations. The skin on palpation is found to be boggy, with a zone of cedema surrounding it. Very soon there appears a dark central spot, which ulcerates, leaving a small perforation, through which issues a larger or smaller amount of thin