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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![17. 7th, Acciimulaiion of fmeal matlers in the bowels are not infrequently mistaken for Munours. These matters usually collect and harden in the caecum, or in some part of the colon. They seldom accumulate iu the small intestines, unless they consist of certain kinds of intestinal concretions (see the art.) ; which are with difficulty dis- tinguished from tumours seated in some one of the abdominal viscera. It is indispensably re- quisite to examine the abdomen carefully in all cases of habitual or occasional constipation, par- ticularly in the region of the caecum and course of the colon; as, when conducted with an expe- rienced tact and discrimination, these collections will generally be ascertained : and when the history of the case, and numerous contingent rational symptoms, are taken into account, little risk will be run of confounding them with morbid growths. The accumulation of secretions in the gall-bladder, and in the urinary bladder, are chiefly, particularly the latter, ascertained by manual examination. The diagnosis of those disorders is fully pointed out in another place. 18. 8lh, Protiusion of some part of the abdo- minal contents, giving rise to any either of the more common kinds of Hernia-, or of those which are unusual, should never be overlooked. Inguinal, femoral, and umbilical herniaj are so fre(|ueiit, and, when either incarcerated or strangulated, occasion so serious effects, that in all cases where severe symptoms are referred to any of (he viscera contained in the abdominal cavity, or in its vici- nity, or when the functions of the bowels are obstructed, this source of mischief should be par- ticularly inquired into. 19. 1 may observe generally, in respect of manual examination of the abdomen, that it fu>- nishes valuable means of diagnosis in very many diseases, particularly when estimated in due con- nection with those derived from other sources; but I should add, — what I shall often have to prove herealter, — that it does not always give us exactly the same kind of information that is slated in several, and even in some very recent, works. Thus it is said to be the most certain means of ascertaining the presence of enlarged mesenteric glands, and by actually feeling these glands en- larged, A'ow this is nut the case, and I slate it from an experience of many hundred cases : for there are comparatively but few instances in which these enlarged glands can be satisfactorily detected, by the most careful manual examination. Hut this mode of inve-^tigation furnishes certain indications of their presence of a different kind from that which writers have laid down. It may also be remarked, that a manual examination of the abdomen is generally much more successfully made in lean subjects, in females than in males, and in children than in adults; whilst in muscu- lar men, and in fat persons, it furnishes much less information, owing to the muscularity and thick- ness of ihe abdominal parieles. 20. HI, Peiicussion has been employed as a means of diagnosis in diseases of the abdomen, from a very early period of medical knowledge, but chiefly with a view of recoijnising tympanitic alFections, or unu-ual accumulations of air, and dropsical efl'u-ioiis ; and ii was not until very lately that altenlion was directed to it as a means of investigation in a very large proportion of other diseases of the ab lominal viscera. Percussion of the abdomen, as well as of the thorax, is either direct or mediate: the former is that which was first ably insisted on by Auenbrugger, and brought into notice by Cokvisart, chiefly in the investigation of thoracic diseases ; the latter, both in its application to abdominal and thoracic affec- tions, is the invention of JM. Piounv, who has paid great attention to its perfection, and has written ably on it as a means of diagnosis. 21. Direct percussion consists of simply striking the parts, somewhat smartly, with the points of two or more fingers united and brought to the same plane, and attending to tlie sounds elicited. Mediate percussion is performing the same with a thin plate of ivory, box wood, or any other hard elastic body, placed over the part to be thus examined, and striking upon it. The advantages derived from having such a body interpo-ed be- tween the surface and the fingers are, 1st, The part is protected in a great measure from the stroke, which, although slight, yet is frequently unpleasant to delicate and sensitive persons; 2d, It assists in the production of the sound for the obtaining which percussion is employed. (See art. Peucussiox.) The body on which the per- cussion is thus made usually consists of a small ivory plate of about 2^ or 3 inches in diameter ; M. PioiiRV calls it the plc.iimeter, or measure of percussion. In all cases in which we wish to examine the abdomen by percussion, it will be necessary to use the pleximeter. The information it conveys varies according to the state of the parts underneath. If we place it over the liver, percussion gives out a dull sound; from the cir- cumstance of a dense body lying beneath that part of the abdominal parietes: if it be moved in the course of the stomach and colon, a sound will be elicited clear in proportion to the quantity of air contained in these viscera. 22. During our investigation of the abdominal contents with the aid of mediate percussion, it will be necessary to attend to certain facts : — 1st, That the pleximeter will furnish, in the same person, a sound varying from dull to tympanitic as the parts over which it may be placed differ in density and the (juantity of air they may enclose; 2d, I'hat in situations of the abdomen where, owing to the quantity of air usually contained in the bowels, mediate percussion generally gives a tympanitic sound when the plate is placed lightly on the surface, it will give a much duller, or even a dead sound, when pressed inwards so as to displace the air from underneath it, and to approach nearer to some solid body, or to bring the parts nearer to that condition by the pressure ; 3d, That the stomach and whole tract of the in- testinal canal always contain a certain (piantity of air or gaseous fluid, particularly the large bowels ; and that they approach more nearly to the abdominal paiietes in pro|)ortion to their dis- tension, whether with air, or with fluid, or more or less solid contents ; and, 4tli, The quantity of air contained in the digestive tube, especially the stomach an'l large bowels, is great in pro])ortion to the deficiency of its vital energy, and the degree of inflammatory action affecting it. 23. These facts being attended to in our in- vestigations of abdominal diseases by means of percussion, mediate or diiect, the extent of the liver may be distinctly traced by its means ; and the d gree of inflation of the bowels, or stoniacii.](https://iiif.wellcomecollection.org/image/b2119709x_0012.jp2/full/800%2C/0/default.jpg)
