Dr. Harvey M. Goldstein*: A 38-year-old Negro man with a 20-year history of heavy alcohol ingestion was initially hospitalized on the Washington University Service at St. Louis City Hospital in January 1967 for evaluation of bilateral leg pain, numbness, and paresthesias. The liver was massively enlarged, and liver function tests were consistent with hepatocellular destruction. He responded to dietary and vitamin therapy and was finally discharged, with a return of liver function toward normal. One day prior to the present admission on May 27, 1967, he noted the onset of abdominal swelling, tightness, and vague upperabdominal pains. He denied nausea and vomiting, but in the two weeks prior to admission, he had four to five diarrheal stools per day and a 9.1-kg (20-lb) weight loss.
Physical examination revealed a young Negro male in no acute distress but with marked abdominal distention. Pulse rate was 100 beats per minute and regular;