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
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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![be always that of the temporary level of the fluid. Change of position immediately alters the rela- tive positions of the dull and tympanitic regions. For example : in the case of a moderate accumu- lation of fluid, when the patient is in the erect position, the whole of the lower parts of the abdomen, viz. : the hypogastric, inguinal, and part, at least, of the epigastric, iliac, and inferior dorsal regions, will yield the dull sound ; but if the patient assumes the horizontal posture, all the anterior regions will resume the tympanitic re- sonance, while the dulness will be transferred to the whole of the lateral and dorsal regions. The degree of dulness of sound is found to be in- creased in proportion as the percussion is made low down in the regions containing the fluid. It was formerly stated that, if in cases of moderate effusion we press the plate forcibly upon the abdomen, we frequently reach a point where per- cussion elicits a dull sound, although it had elicited a clear sound from the same spot when the plate was only pressed gently upon the sur- face. The fact is explained by the pleximeter having in the former case reached the level of the fluid in the abdominal cavity, after displacing or compressing the hollow bowels which had been floating above it. These various results indica- tive of the presence of fluid are frequently obtain- ed when the quantity is so small as to be undis- coverable by fluctuation. As they are equally observed whether the effusion is the consequence of inflammation or simple dropsy, they will be found in most cases of peritonitis ; and, therefore, percussion will prove, not merely a diagnostic of this disease, but a valuable aid in discriminating it from enteritis, properly so called. In inflam- matory affections of the abdomen, it is necessary to be very gentle in our operations on account of the painful state of the parts ; and, in such cases, it may be further requisite to employ a broader plate, with the view of diffusing the pressure more equably over the tender parts.* In the encysted dropsy of the abdomen, the results of percussion are, in several respects, dif- ferent ; and the differences supply means for enabling us to distinguish the two affections. In the encysted dropsy the sound is much duller ; the fluid not being able to change its place, the sphere of dull sound is almost fixed; or if the whole cyst changes its place, which it sometimes does in different postures of the patient, the hydrostatic line of level is never formed as in the case of the loose effusion. In these cases, also, wc frequently find the tympanitic resonance beneath the cyst, which could not be the case in simple ascites ; and the line of demarcation be- tween the dull and sonorous regions is seldom quite straight, as in the last-named disease. It is hardly necessary to caution the reader that, in all these cases, no one should be so imprudent as * M. Tarral has recently described a now mode of detecting abdominal effusions, which he terms superficial fluctuation, (fluctuation peripherique). His description of it is ;is follows : Place both hands on the abdomen, two or three inches apart, and with the two fore-fingers parallel to each other ; then, while the hands are still in this position, give slight blows or shocks on the abdomi- nal parietPS with the fore-finger of the right-hand : this will produce an un lulatory motion in the effus which v ill be readily perceived by the fore-finger of the left-hand. The same result i< (.Maine], if the right- hand is quite raised, provided the blows are given ob- liquely as if brushing the surface.—Piorry, du Procide Operatoire, p. 137. Vol. I. —5 to trust to percussion alone in forming a diag- nosis. In all kinds of cysts, as well as in other tumours, developed among the floating viscera, palpation will be, at least, of equal value with percussion. There are, indeed, few cases, if any, in which the one should be employed exclusively of the other, in the investigation of abdominal diseases. In the case of solid tumours, as of cysts, when they approach the surface, and thereby displace the floating viscera, they yield the dull sound on percussion. When seated more profoundly, the dull sound is only obtained by depressing the abdominal parietes to the level of the solid mass. Percussion is sometimes productive of the best results in cases of indurations and tumours of the abdominal parietes, such as chronic abscess in the interstices of the muscles. In such cases it is sometimes difficult to decide, especially in fat persons, whether the tumour has its seat within the cavity ; and here we have found percussion afford great aid in removing the difficulty. When, the tumour is seated in the parietes, percussion, when applied with sufficient force, will elicit the clear sound, however solid the tumour may be, if it is not of much greater size than is usually the case in such instances. In a solid tumour, spring- ing from within the abdomen itself, and pressing against the parietes, the sound will be perfectly dead. T -,-, John t orbes. ABORTION, (abortus,) signifies the expul- * sion of the foetus from the uterus before its dif- ferent organs have been sufficiently developed to enable it to support an independent life. When the product of conception is expelled between this period and the full term of utero-gestation, the process is usually termed premature labour. Abortion is a frequent occurrence in the early months of pregnancy, particularly among women of the lower classes of society, who are exposed to much bodily fatigue and mental anxiety. [Dr. Collins, of Dublin, met with 293 prema- ture cases in 16,414; and Dr. Beatty, with 21 premature cases in 1200. Dr. Churchill records 65 cases of abortion in 1705 deliveries; Madame Lachapelle, 116 cases in 21,960; and M. Deubel, 35 in 420 ; making, in all, 530 premature cases in 41,699 deliveries, or 1 in 78 J. It has been sug- gested by Dr. Guy as probable, that the small proportion observed by Madame Lachapelle is owing to the fact, that the females, who came under her observation at La Maternite, were in the latter months of pregnancy, when abor- tions arc comparatively rare ; and the same ex- planation may apply to other cases.] It is most liable to occur in plethoric, irritable, and nervous subjects ; in women who are affected with con- stitutional diseases, more especially syphilis ; in those who have deformity of the bones of the pelvis, or some organic disease in the uterine organs. All the chronic diseases, therefore, to which the uterus and its appendages are liable, may be considered causes of abortion. The pro duction of polypi in the cavity of the uterus, or of fibro-cartilaginous tumours in its walls, and morbid adhesions of the uterus to the surround- in?; viscera, may all, by impeding the regular ment of the gravid uterus, give rise to premature expulsion of its contents. Other predisposing causes of abortion, though](https://iiif.wellcomecollection.org/image/b21116763_0029.jp2/full/800%2C/0/default.jpg)
