The surgical treatment of intestinal perforation in typhoid fever / by Donald Armour.

  • Armour, Donald, 1869-1933.
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: The surgical treatment of intestinal perforation in typhoid fever / by Donald Armour. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tion, whether adhesions exist or not. And that general septic peritonitis in typhoid fever arising from threatened intestinal perforation from the necrosed and damaged areas of peritoneum over the base of ulcers is not a very uncommon occurrence has been shown by Gairdner.*® Are symptoms ever present then which may be called roaming symptoms—i.e., symptoms, the advent of which should put the physician on the alert and urge upon him the necessity of calling a surgical confrere in consultation? Shattuck from a review of his cases says : “ It is rational to conclude that the severe symptoms corresponding to the ordinary text-book picture of intestinal perforation in typhoid were, in the majority of cases, caused by the general septic peritonitis resulting from a perforation or a threatened per- foration, the occurrence of which was indicated more or less plainly by symptoms of less severity which antedated the severe or so-called diagnostic symptoms by a definite number of hours.” Only five of Shattuck’s cases, in which perfora- tion occurred, presented a sudden acute picture of grave abdominal infection rdthout any premonitory symptomg. In all the other cases distinct warning symptoms antedated equally distinct severe and diagnostic symptoms. Of Finney’s 112 cases, in only nine were the symptoms denoting perfora- tion not marked and of gradual onset. The symptoms most often complained of by the patient are various degrees of abdominal pain and tenderness, either localised or general. A point to be emphasised is that abdominal pain, especially if localised, is not a frequent complaint in mild or moderately severe cases of typhoid fever, unless it means localised or general peritoneal infection, and hence complaints of abdominal pain in such cases should be regarded as serious danger signals. A steadily rising leuco- cytosis, with localised muscular spasm and tenderness accompanying the pain, are signs of the utmost diagnostic importance. Vomiting is not always present. A rapid drop in temperature is not infrequent and Dieulafoy regards it as almost an infallible sign. On the other hand, many cases are accompanied by a rise in temperature. The pulse becomes small and rapid and stands out in sharp contrast to the drop in temperature if present. The respirations become rapid and shallow and chiefly of the costal type. Gairdner^' states that rigor as an initial symptom of perforation is 19 Glasgow Meflical Journal, vol. xlvH. 2® Bulletin de I’Academle de Medecine, October, 1896.
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