ng a patient in that hospital for some
weeks, he returned home much worse. In addition to the aggravation of
his other symptoms, there were present oedematous swelling of the
extremities, which were generally cold and benumbed, gnawing pain in the
right hypochondriac region, and almost total loss of appetite. On
examining the right hypochondrium, which he described as swollen, there
was evident indication of an enlarged liver, and he complained much of
shooting pain in that region during a paroxysm of cough. Hitherto the
functions of the stomach and bowels had remained unimpaired; but at this
period, (September 1833,) the former became irritated, and the latter
obstructed. Tonics and gentle purgatives were administered, and
continued for a considerable time. The urinary secretion was all along
scanty and high coloured; but, as the disease advanced, the quantity
became exceedingly small, (almost none was voided for days together,)
for which he was taking diuretics; and on examining it with the
application of heat, I repeatedly found it coagulable. General anasarca
was now rapidly increasing; and as the cellular effusion advanced, the
breathing became more laborious. I understand, that at the commencement
of this person's affection, the pulse was frequent, with some heat of
skin at night, but from the time he became my patient, there was a
tendency to languor in the circulation, and the _beat_ at the wrist, for
some months previous to his death, was almost imperceptible. With a view
to remove the enlargement of the liver, a slight mercurial course was
proposed; but owing to debility, indicated at its commencement, it was
discontinued, and no effect produced on the organ. All medical treatment
having been given up, except mere palliatives, such as blisters and
expectorants, this poor man lingered out a most miserable existence from
his pectoral symptoms, and particularly from palpitation of heart.
Expectoration continued the same, of tough, ropy mucus, small in
quantity, and got up with difficulty from the air-passages. In repeated
examinations with the stethoscope, there was considerable dulness over
the whole thoracic region, no bruit whatever could be discovered in the
left side of the chest, no cavernous indication, although that side of
the thorax was fully developed. The mucous rale was heard very strong in
the upper lobe of the right lung, and some little crepitation at the
inferior angle of the scapula on the same si