ENLISTED:12 07 1826 Dublin
TROOP NO:Feb 1827: Depot Troop
Jun 1827: Troop 1
1831: Troop 1
TROOP CAPTAIN:1831: Captain William Havelock
RANK:1827: Private
1831-1832: Private
EMBARKATIONS:16 02 1827 England
DISEMBARKATIONS:12 06 1827 Bombay India
DIED:27 07 1832 Kirkee India aged 26 years. See autopsy report below.
BURIED:27 07 1832 Kirkee India.
AUTOPSY REPORT: CASE, No. 2. - Abcesses in the Liver: diseased large intestines:
JOHN RYAN, Private, 4th Light Dragoons, AEt. 25. 5 years in India. Never had fever, hepatitis, or dysentery. Admitted into Hospital May 18th, 1832. Stated that for two or three days back he has had chills and heat, with catarrhal symptoms, no difficulty of breathing, pulse somewhat frequent; vesp[ers], pain of right shoulder.
- 20th, vesp[ers], first complained that pain of shoulder extended to right hypochondre, that he could not lie on left side nor move without pain.
- 21st, pain increased, principally the middle of upper false ribs. Vesp[ers], the pained spot somewhat anterior to the centre of the convexity of the middle false rib; skin hot; pulse 96.
- 22nd, easier. Vesp[ers], inclination to go to stool, nothing passed.
- 23rd, easy, can lie on either side.
- 24th, return of pain. Refers the pain to one spot, and says, it seems to shoot through the back.
- 25th, more pain in the night.
- 27th, countenance anxious.
- 28th, not quite free of pain.
- 29th, a pretty good night; pain not quite gone.
- 31st, side easy, dry skin.
- June 2nd, a good deal of pain to-day; describes it as a sensation as if something adhered to the side.
- 3rd, had a dracunculus extracted from the right foot.
- 8th, the pain of side continues at the old place, that at the edge of the ribs gone; describes the pain as more throbbing; irritability of pulse.
- 9th, vesp[ers], pain at the edge of false ribs severly felt on motion; sharpness of pain.
- 10th, vesp[ers], pain unrelieved, it extends from a little below the last false rib to the top of the os ileum, and anteriorly towards the umbilicus, but is relieved by grasping the side and pressing it.
- 12th, easy with a bandage.
- 13th, pain below the false ribs continues.
- 14th, easier; skin occasionally dry; countenance pallid; tongue clear. Has appetite.
- 23rd, occasional retching; side easy. Vesp[ers] has been coughing a good deal. No pain of chest on full inspiration.
- 25th, cough gone, countenance pallid. The edge of the liver distinctly felt, stretching across the epigastrium. No pain there.
- 25th, return of cough, sputa reddish brown; chest expands well. Frequent pulse; hot skin.
- 28th, sweated much in the night; cough troublesome; full inspiration causes some pain of right hypochondre.
- 30th, purged, evacuations slimy and light-coloured.
- July 1st, cough, sputa redder.
- 2nd, pain at the anterior part of right false ribs, and stretching back.
- 5th, sputa brick red. Vesp[ers], much purged, evacuations light-coloured, thin, slimy, with drops of reddish mucus; straining.
- 6th, cough and purging; states that when he lies on the left side he does not expectorate with the cough, but when on the back, the cough is more troublesome; expectoration copious.
- 10th, purging and cough.
- 16th, purging, cough, sweating at night; failure of appetite.
- 22nd, tenderness over right side of epigastrium; the edge of the liver can be felt low, and is the seat of pain. Emaciation.
- 26th, more purging, evacuation light yeasty. Sinking. Died early on the 27th July.
Treatment, V.S. leeches, blisters, tartar emetic ointment, mercurials, nitric acid, ipecacuanha and gentian. Ptyalism was never freely induced.
Inspection seven hours after death:
The liver much enlarged, on the right side, extended as low as the last false rib, and in its passage across the abdomen projected considerably beyond the cartilages. It was bound closely to the right side; a great portion of the right lobe adhered firmly to the colon: part of the thin edge of the right lobe were three distinct abscesses, their cysts lined by a membrane with irregular surface: that abscess which approached nearest to the surface occupied the right side of the lower portion of the right lobe, between it and the colon there was only a thin layer of the substance of the liver, which with the colon formed part of the wall; the two other abscesses approached near to the diaphragm. The lowest lobe of the right lung adhered firmly to the diaphragm, so much so, that in one part, in endeavouring to separate the adhesions, part of the upper wall of one of the abscesses came away. Here the wall might be said to be formed of the diaphragm, in such close adhesion with the upper surface of the liver, and lower surface of the lung, that there was no possibility of distinguishing the difference of structure. No communication with the lung discovered. Pus thick, consistent. The left lobe contained no abscess, it was much indurated, but not changed in colour.
The omentum vascular, extended into the cavity of the pelvis, and adhered slightly to some of the viscera. The coecum thickened adhered to the ililac fossa. The transverse colon had not lost its cells, it was somewhat changed in direction. The mucous lining of the ileum healthy, that of the coecum with its sub-cellular tissue much thickened, in parts cartilaginous, ulcers of considerable size, unattended with redness, preferring the thicker and more indurated parts; the bottom of some of them formed only by the peritoneum; throughout the colon there was thickening, probably in the intercellular tissue, not to so great an amount as in the coecum; no ulceration. The mucous coat pulpy, had an irregular, papillous* surface: it looked more like a coat of thick transparent mucus, in parts removed, than an organized membrane. The mucous tunic with its thickened cellular tissue could be easily raised from the muscular coat and peeled off in large portions. The muscular fibres healthy. Stomach healthy. The lower lobe of right lung somewhat gorged, and when cut into and pressed, gave out frothy yellow, thin, purulent-looking fluid, the bronchial lining slightly reddened. In other respects, with the exception of a calcareous concretion near the bronchus of right lung, they were healthy. With the exception of adhesions to the diaphragm, there were hardly any others. Heart healthy.
Remarks. It is not often that we meet with cases in which each successive morbid change has been so clearly pointed out by the symptoms. There was complaint of pain of right shoulder before there was any symptom referrible to the liver. I am not aware that this precedence of the pain of the shoulder is a common occurrence. Certainly the concidence of liver disease and pain of right shoulder is not so common as has been often supposed. From the pain, and the inability to lie on the left side, it is probable that the disease commenced in the peritoneal lining of the convexity of the liver. On the 23rd, amendment; 24th, the pain, shooting to the back, gave reason to believe that the inflammation had extended to the substance of the liver, and on the 8th June, there was reason to believe, that it was passing into supperation; June 9th, 10th, the adhesions of the omentum to the thin edge of the liver, and those of the liver to the colon, probably formed; and this is a reason for believing that the abscess towards the colon was the one which formed first. The pectoral symptoms on the 23rd probably pointed out that the abscesses towards the diaphragm were in progress. On the 25th these abscesses had increased, and pushed the edge of the liver beyond the cartilages of the ribs. The report of July 2nd, clearly implicates the diaphragm. On the 30 June, the dysenteric symptoms first appeared.
The implication of the gastro-intestinal mucous lining, is common at the termination of many chronic diseases. I shall not stop to inquire whether the ulcerations of the colon, in cases of abscess of the liver, are merely an illustration of that general fact, or whether there be not some more individual relation. There was no communication between the lungs and the abscess. There may have been a minute one, or the sputa may have proceeeded from the irritated bronchial lining. The report of July 6th seems however to countenance the first view. The lesion of the mucous lining of the colon was probably an advanced stage of that observed in No. 1 [See John Knapp]. The membrane was more pulpy, and in parts a portion of it had been removed, causing the uneven papillous surface. This is not a very uncommon appearance in the stomach. I have seen it in the Hospital of the 4th Light Dragoons, in a state of collapse and coma from intoxication. It is an appearance which has differently explained; by some, as softening of the tunic, the lower level of parts being caused by the removal in such sites as part of the mucous surface: by others, as a fuller development of the mucous follicles, which elevates the tunic into small papillae: the parts of lower level being the tunic not thus elevated. Both these views may be correct, ... In this case, the implication ot he sub-cellular tissue bore relation to the amount of disease of the mucous tunic.
* I have ventured to use the word `Papillous' in the sense that Louis and other French pathologists have used the word Mamelonée. I mean it to have reference only to one of the meanings of the root Papilla, viz. Nipples.
OTHER SOURCES: Transactions of the Medical and Physical Society of Calcutta, Vol. 7, 1835

4th Light Dragoons Index