A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions ... a classification of diseases ... a copious bibliography, with references; and an appendix of approved formulae / ... By James Copland.
- James Copland
- Date:
- 1844-58
Licence: Public Domain Mark
Credit: A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions ... a classification of diseases ... a copious bibliography, with references; and an appendix of approved formulae / ... By James Copland. Source: Wellcome Collection.
Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.
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![ABDOMEN—Investigation of, in Disease. difference in its size. Thus, it is somewhat changed 1 in severe diseases of the respiratory passages, when the entrance of air into the lungs is obstructed ; the epigastrium and hypochondria being then pressed inwards and upwaids: whilst in some morbid states of the liver and gall-bladder, of the spleen, and of the ovaria, an unusual prominence in their respective regions is frequently observed. But the most remarkable changes in the form of the abdomen is met with when the size of the ca- vity is also altered. It is scarcely necessary to allude to examples; but, in all those diseases at- tended with enlargement or diminution of the bulk of this important part of the body, either in one of its regions, in several of them, or in all, inspection should always be performed : it gives greater pre- cision to manual examination ; enables us to com- pare the bulk of a region with the corresponding region on the other side, and with others in its vicinity ; and impresses upon the memory the changes which the part may experience during the progress of disease. It should, therefore, never be neglected in all the forms of abdominal dropsy ; in peritonitis, chronic or acute; in in- flammation of the stomach, liver, spleen, and bowels; in the different kinds of colic, in fevers, in uterine and ovarian diseases; in afiections of the kidneys and urinary organs ; in all disorders accompanied with obstruction to the excretions; and, in short, in all ciironic maladies. It ought never to be oveilooked in the diseases of infancy and childhood, of whatever nature they may be. 7. Besides, however, attending in those diseases to the form and size of the abdomen merely, the motions which it presents ought not to be neglected. When rightly interpreted, they often furnish im- portant diagnostic and therapeutic hints. But they require to be viewed in connection with the motions of the thorax, and state of the heart's ac- tion. In diaphragmitis, peritonitis, gastritis, enter- itis, and certain states of hepatitis, the motions of the abdomen are slight or obscure, whilst the ac- tions of the thorax are increased. On the other hand, in several severe diseases of the respiratory organs, p.irticularly in croup, laryngiti-!, bronchi- tis, several varieties of asthma, pleuritis, pneu- monia, Sic, tiie parietes of the chest are nearly motionless ; whilst the niovements of the abdomen, especially at the epigastrium, in croup and asthma, are remarkably increased, or laborious. The motions of the abdomen, also, are often not li- mited to those caused by respiration ; but in some cases, particularly in organic changesof the heart, pericardium, aovta, &c.,and even in certain nerv- ous di^orde^s implicating these organs, comprise those occasioned by the action of the heart, in- creased by the state of the large abdominal vessels, and by the emaciation or other morbid conditions of the patient. 8. II. IManual Examination of tiie abdo- men is one of the most important means of dia- gnosis we possess: but it furnishes information in proportion to the perfection of manner in which It is made. In this very retjuisile mode of inves- tigation, the temperature of the hand of the prac- titioner at ilietiiue of making it should be attended to, in the great majority of diseases; both ns a moderate warmth of the hand is necessary to the greatest delicacy atul accuracy of touch, and as its ap])tication to the surface of the abdomen will not in that state occasion any disturbance or con- traction of the muscular parietes. In entering upon tlie examination, care should be taken not to excite the alarm of the patient. The hand ought to be applied at first in the gentlest manner pos- sible. By observing this, three very important objects wdl be best obtained ; namely, a know- ledge of the form, of the temperature, and of the sensibility of the surface of the abdomen, 9. As much more information than this is required from manual examination, the patient should be directed to place himself in a favour- able position for a more general and complete investigation. He should be placed on his back, with the head and shoulders slightly and com- fortably elevated, and the thighs drawn nearly to a right angle with the trunk. If the bladder be full, it should be emptied. When proceeding to examine, the patient should be told to lelax all the muscles, particularly the abdominal muscles. Commencing, therefore, with the utmost gentle- ness, and passing the hand slightly over the ab- domen, we should slowly increase the pressure, with the view of ascertaining the following con- ditions : — 1st, Its temperature ; 2d, Its form and size ; 3d, Its sensibility ; 4th, Its degree of ten- sion and firmness ; 5th, The existence of enlarge- ments, tumours, &c. ; 6th, The presence of effused fluids; 7th, The probable existence of accumu- lated secretions and faecal matters ; 8tli, Hernial protrusions and displacements. On each of these I proceed to offer a few remarks. 10. 1st, The temperature o( the abdomen fur- nishes most important indications as to the nature of disease. It is generally always higher than natural in diseases of increased action ; and is also often higher when the patient is actually com- plaining of cold, particularly at the commence- ment of fevers. In many feveis and inflammations of the abdominal viscera, particularly those of a dangerous or malignant character, the increased temperature is accompanied with a peculiar acrid pungency to the sensation of the examiner; a phenomenon which indicates the utmost risk of rapidly supervening disorganisation. Diminished temperature of the abdomen is met with in the period of depression, or cold stage at the com- mencement of fevers, but very seldom at their termination, even in death, unless in the most malignant or liquescent forms. It is also met with after injuries of the abdomen, particularly blows on the epigastrium, in anasmia, chlorosis, and other disordeis of debility. 11. 2d, The form and si^ze of the abdomen nre frequently altered, as already noticed (§6, 7.); but, in order to ascertain the nature of the alter- ation, various means of investigation are generally required, particularly those >vhich remain to be considered. When proceeding- with the manual examination of the abdomen, it is necessary very gently to increase the pressure, and, when acute pain is not complained of, to make it in various directions, — laterally, downwards, upwards, and backwards to the spine, — so that if altered sensi- bility of any of the contained viscera exist, it may not escape detection, but be accurately ascer- tained and estimated ; and the examination should always be made with a careful observ.ntion of its effects upon the expression of the countenance of the patient. Jt will also often be reijuisiie to per- form the manual examination, now with the points of several hngers, now with the whole of one, or](https://iiif.wellcomecollection.org/image/b2119709x_0010.jp2/full/800%2C/0/default.jpg)
