The diseases of children, medical and surgical / by Henry Ashby and G.A. Wright.

  • Henry Ashby
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The diseases of children, medical and surgical / by Henry Ashby and G.A. Wright. Source: Wellcome Collection.

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    monia with jaundice, but in all these the jaundice would as a rule follow and not precede the other symptoms. Morbid Anatomy.-Organs bile-stained; haemorrhages in various organs. Liver small, limp in texture, mostly bile-stained, some portions being greenish yellow, others orange-red, often bulging in some parts from shrinking in others. On section, there are usually areas of red or yellow colour in which the lobules are indistinct or entirely indistinguishable. , _ Treatment.—Unfortunately but little can be said under this head, as such cases have been invariably fatal. Cirrhosis of Iiiver Alcoholic—A typical hobnail liver due to alcoholism is necessarily rare during early life, as it is hardly likely that it will often happen that a child has many opportunities for indulging in alcoholic drinks to any excess. Cases of this sort have, however, been reported by Continental writers, and a few in this country and also in America. Dr. Wilks relates the case of a girl of 8 years who had taken daily for some time half a pint of gin ; she eventually suffered from ascites, and at the post-mortem a small hobnail liver was found. Cases of cirrhosis have been reported by Frerichs, Bamberger, Howard, and others, in which there was a history of alcoholism. Mitchell Clarke 1 reports two cases of cirrhosis of the liver in children, in which there was no history of syphilis, tubercle, or alcoholism. As the symptoms of alcoholic cirrhosis when it occurs in childhood are the same in children as in adults, no special description is needed here. Syphilitic Cirrhosis.—Syphilis is by far the commonest cause of inter- stitial hepatitis occurring during early life ; though in a large proportion of cases it is found in the post-mortem room in cases in which it was not diagnosed during life. In syphilitic infants who are born dead, or who die within a few months of birth, the liver is sometimes found to be en- larged and firmer than usual, the surface is perhaps smooth, but the liver cuts as if of leathery consistence, and the cut surface shows the acini to be less distinct than normal, and bands of fibroid tissue may be seen running through the liver substance. In some cases there are no very characteristic microscopic appearances, and it is only on microscopical exa- mination that interstitial hepatitis is made out. In a well-marked case the section shows an excessive amount of connective tissue along the course of the portal vessels, and numerous spindle cells and embryonic tissue. In more advanced cases islands of fatty liver cells may be seen surrounded by newly formed connective tissue. The above appearances are so characteristic of congenital syphilis, that they are diagnostic of syphilis when found post mortem, even in the absence of symptoms during life and other confirmatory evidence after death. Gubler has described another form of syphilitic liver, in which there are miliary gummata present in the liver mostly about the size of pins' heads, scattered through the substance or situated in groups, in combination with interstitial hepatitis. The small gummata consist of small round cells, and are mostly connected with the smaller branches of the portal vein or biliary capillaries (Birsch Hirschfeld). There is often also thickening 1 Brit. Med. Jour. June 30, 1894. N