The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1).

Date:
1845
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Licence: Public Domain Mark

Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    the abdomen, with a firm but gentle pressure, and tapping smartly with the other hand directly op- posite to it on the other side. It fluid is present, the impulse will be transmitted through it to the other hand, producing a peculiar vibratory shock which cannot be mistaken, after having been ex- perienced a certain number of times. The import of this fluctuation as a sign of disease is well known : it is almost pathognomonic of ascites, or dropsy of the peritoneum. It is, however, also found in other diseases of the abdomen ; and is generally acknowledged to be of importance, both positively and negatively, in aiding their diagnosis. For the various diseases in which it is employed as a sign, we refer to the different articles of this work, in which these diseases are treated. And we would here observe once for all, that in drawing up the present paper we have always had in view the ampler diagnosis which will be found under the head of individual diseases; our object not being to establish the diagnosis of particular dis- eases, but to give the practitioner a general out- line of the methods of exploration which are more or less applicable to all the diseases of the abdomen. If this were the place for such disquisitions, it were easy to show, from the authority of the best practical authors of all ages, how very important a place in the diagnosis of diseases has been always assigned to the physical exploration of the abdo- men. In the early ages of physic, this practice was, from various circumstances, much more in use than afterwards. Subsequently to the discovery of the circulation of the blood, when so much reliance was placed on the indications of the pulse, and when men's minds were so much occupied by theoretical and metaphysical distinctions, the phy- sical investigation of diseases generally, and of those of the abdomen among the rest, fell into neglect. It has, however, during the last fifty years, and more especially during the present century, more than regained its pristine estimation with all well-informed physicians, and is at length secured from ^11 future decadence on the immov- able basis of organic pathology. With good reason, therefore, we may conclude this imperfect exposition of the method of palpation, as applied to diseases of the abdomen, in the words of Hip- pocrates and Baglivi. « Certain it is that he who examines the abdomen, as well as the pulse, is much less likely to be deceived than he who does not.* If physicians were always to examine the abdomen, upon first visiting the patient, more particularly in acute diseases, they would assuredly commit much fewer mistakes than they do at present, neglecting this method of exploration. The knowledge of the condition of the upper parts of the abdomen improves vastly both our treat- ment and our prognosis.j- III. Percussion. (From percussio—percutio —per and quatio.) This form of abdominal ex- ploration had been used as an occasional aid to diagnosis from very early times. The manoeuvre for detecting the fluctuation of liquids, mentioned * Deindequi manibuscontrectavit ventrem fac venas], minus falli potest, quam qui non contrectavit. Hippoc. Predict., lib ii., § v. t Si medici nu'stri temporis omnium .Tgrotorum hypo- chondria statim tractarent, in morbis potissimdm acutis, pauciorcs rerte committerent errores quam faciunt spreta hypochondriorum ohservatione. Qui bene noverit hypo- chondriorum statura in morbis, quam bene curare nove- rit, quam bene priu-agire ! Baglivi de Prax. Med,, lib. ii., cap. 9. Op. p. 39. under the last head, is a mode of percussion ; and the very name so long borne by one morbid con- dition of this cavity (tympanites, from rv^avov, a drum) is at once sufficient evidence of the prac- tice, and of its antiquity. It is only, however, of very recent date that any attempt has been made to establish a formal and elaborate system of dia- gnosis, applicable to diseases of the abdomen, by means of percussion. M. Piorry, a young Parisian physician, has the honour of having, if not in- vented, at least brought into a formal and matured shape, this new application of the discovery of Auenbrugger, and with practical results of greater precision and importance than could have been anticipated.^; In the article Auscultation a full account will be given of the principles upon which per- cussion, as a general means of diagnosis, is founded. At present, nothing more will be attempted than a mere practical exposition of the method as applied to the discrimination of abdominal dis- eases. We shall only so far anticipate the details of the article referred to as to state that there are two methods of eliciting sounds from the surface of the body by percussion, with the view of judg- ing of the physical condition of the parts beneath, — the one termed direct percussion, or, simply, percussion ,■ the other mediate percussion. The former is the proceeding proposed by the great discoverer of the method, Auenbrugger, and con- sists in simply striking the part in a particular manner, with the points of two or more ringers united ; the latter differs very little either in prin- ciple or practice, except that a thin plate of solid and elastic matter, as of wood or ivory, is inter- posed between the fingers and the surface of the body. In exploring the chest by means of per- cussion, the comparative solidity and elasticity of its walls, as well as the nature of its contents, render the interposition of a sonorous body be- tween the fingers and its surface less necessary, although it will be seen that this is uSeful even there ; but in the case of the abdomen such assist- ance is absolutely necessary to the production of sufficient sound to enable us to judge of the con- dition of the viscera within. In the following observations it will, therefore, be understood that mediate percussion is the method always spoken of. The small ivory plate on which the percus- sion is made has been termed, by its inventor M. Piorry, thepleximeter, or measurer of percussion. In exploring the abdomen by this method, we make use of various degrees of force in applying the plate to the surface, so as to depress this more or less, according to the objects we have in view. In many cases percussion on the plate pressed slightly on the surface, yields a very different sound from that elicited from it in the very same spot, when it is pressed deeply into the cavity of the abdomen. In the former case, the sound may be perfectly tympanitic, owing to the proximity to the surface of the intestines containing air; while in the latter it is often dull or dead, from the circumstance of the plate having been depressed below the level of the floating intestines into mediate contact with some solid or fluid body incapable of yielding similar sound.*. t The two following works, by M. Piorry, are well worthy the reader's attention:—. 1. De la Percussion Mediate. Paris, 1828. 2. Du Procede Operatoire a suivre dans l'Exploration des Organes par la Percussion Mediate. Paris 1830.