Abscess of Liver after Typhoid Fever
Authors: G. Chater
Journal: BMJ (1873)

In the autumn of I872, he consulted me about pains in the abdomen, flatulence, and dyspepsia; he became jaundiced, and it soon became evident that he was suffering from malignant disease of the liver.He lingered until December 25th of that year.As the man had lived two years and eight months with an artificial anus, I was anxious to see what clhanges time and the operation had effected.Strong opposition was made by the friends to a post morttem examination.However, the consent of a part of the family having been obtained, I made a hasty inspection witlh the 1kind assistance of Mr. Barr, house-surgeon of the Dispensary, and dtiring the temporary absence of the demurrers.POST MORTE-m EXAMWINATION, December 26th, twenty-six hours after dleath.-Thebody was emaciated ; the abdomen tumid.The peri- toneal sac containied some serous fluid.The omentum was adherent by about half its inifer-ior margin.The sigmoid flexure of the colon was enormously distencded, and its coats hypertrophied.It projected out in front of the other initestines, and extended to the right side.It was at least about four inches in diameter, and about two and a half feet long.It contained a large amount of semifluid clayey fteces.At about the junction of the colon with the rectum was the stricture.It ap- peared as if the gut had been tied with a string.There was some little external thickenin,g.The stricture allowed the index-finger to pass through it, so that another finger passed per aiiz?lmi could touch it.The artificial anus appeared granular and congested.There was no in- duration.Ther-e wras a limited fold of mucous membrane at the lower edge of the opening extending into the bowel; but the communication withl the sigmoid ilexur-e wvas as free as with the descending colon.The colon, witlh the exception of the sigmoid flexure, was contracted and almost empty.The rectum was contracted and empty.The liver was enlarged, bard, and congested.It was extensively infiltrated with cancer, whiclh also appeared in white patches on its surface.Cancer was not found in the otlher viscera.RENIARKS.-It is evident that the f.ces passed from the descending colon direct into the sigmoid flexure, and there lodged until their accumulation caused the bowel to contract, or a voluntary or semivolun- tary effort to be made for their expulsion.The large size of the sig- moid flexure would lead one to suppose that the bulk of the fieces were Tetained for somi-e time, and that the reservoir was niever entirely emptied.It seems stranige that the rectum should have been so com- pletely " blockaded" during life, that the stricture would allow nothing *to pass, and yet that after death the finger should pass easily.There must have been some muscular spasm.To all appearance, the man might have been aii useful member of society for many years, but for the unfortunate advent of malignant disease.* The result of discussions on my former paper.The manuscript, together with drawings and model of the proposed hospital, were placed in the Annual Museum of the British Mledical Association, Atlgust I873.t The estimate, per bed, in I871, was ,150.lt would now, most probably, be somewhat higher.