Removal of part of the Liver. 407 



exceed an inch in length, and was completely choked up 

 by the liver. The man stated, that he had been stabbed in 

 the dark about 12 hours previously, and that the liver came 

 through the wound, as the spear was drawn out. It was added, 

 that there had been very copious haemorrhage, but the liver 

 itself was not wounded, and though the patient was in consi- 

 derable pain, the pulse was very little depressed. 



My friend, Dr. CM. Henderson, who was present, agreeing 

 that it would be impossible to return the protrusion without 

 enlarging the wound to the extent of several inches, it was re- 

 solved, rather than wait for the tedious process of sloughing, 

 to remove it by the knife. 



To prevent haemorrhage, a ligature was applied tightly 

 round the base of the protrusion, which was then cut off. 

 Nevertheless, two arterial twigs bled very freely, and it was 

 found necessary to take them up, and a double ligature was 

 also passed through the stump, and tied on either side, 

 when all bleeding ceased. No attempt was made to re- 

 turn the portion of liver which still filled up the wound, as 

 it was of course desirable to prevent all risk of blood or of 

 bile being extravasated into the cavity of the abdomen. For 

 a day or two the patient was rather low, and had slight 

 irritative fever, and the bowels remained costive. These 

 symptoms, however, yielded to a few doses of purgative 

 medicine, and in nine days the ligatures came away along 

 with a small slough of liver, the wound granulated and heal- 

 ed, and the man returned to his home in three weeks. 

 No bilious discharge occurred from the granulating surface 

 of liver. The portion of liver removed, after having lost its 

 blood, and being in spirits for some weeks, weighed \\ oz. 

 Its surface is uneven, though not torn, and it is probably a 

 portion of the edge of the right lobe, from near the notch 

 between it and the left. 



It is difficult to explain how so large a portion of liver 

 could have protruded through so small a wound, even if 



8 G 



