Melanotic sarcoma of the common bile duct and the ampulla of Vater / by Francis J. Shepherd.

  • Shepherd, Francis J. (Francis John), 1851-1929.
Date:
1908
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Licence: In copyright

Credit: Melanotic sarcoma of the common bile duct and the ampulla of Vater / by Francis J. Shepherd. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    PREPRINTED FROM CU MELANOTIC SARCOMA XHE COMMON BILE DUCT AND T^MtfP&lXA OF VATER.* BY FRANCIS J. SHEPHERD, M.D., LL.D., F.R.C.S., EDIN.(HON.) The rarity and obscurity of this case constitutes my apology for reporting it. Mr. A. S., aged 44, bridge engineer, consulted Dr. A. E. Morphy, of Lachine, P. Q., in June, 1907, for severe itching all over the body, but especially about the chest and back. On examination a very faint tinge of yellow was observed in the skin and conjunctive. There was no digestive disturbance but dis- tinct loss of appetite. A few days later the jaundice deepened and the itchiness increased. There was no pain, but the patient complained of loss of strength, great lassitude and much depres- sion of spirits. There was also constipation. On physical exam- ination, when first seen by Dr. Morphy, no abnormal condition about the liver was discovered; everything seemed normal. About the middle of July a smooth, rounded, painless swell- ing was made out in the region of the gall-bladder. This was looked upon as a distended gall-bladder. All this time there was abundant bile in the urine and the stools were colorless and very fetid, except occasionally when they had a chocolate hue. Mr. S. was admitted under my care as a private patient in the Montreal General Hospital, July 26, 1907, the following being his history: A tall, spare man, of very fair complexion; had never been ill before in his life and had always been most athletic, being very fond of outdoor sports. He was in his usual health until May 15, 1907, when his feet began to itch at night. This itching spread all over his body and very soon (early in June) his con- junctive became yellowish in color and then his whole skin became jaundiced. The color deepened rapidly, and at the time this note was made his color was more yellow than it had pre- viously been, the itching was less troublesome but he complained * Read before the American Surgical Association, May 5, 1908. OF MONTREAL, Surgeon to the Montreal General Hospital.