Volume 1

A dictionary of practical surgery / [Samuel Cooper].

  • Samuel Cooper
Date:
1825
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.

    17/1282 (page 5)
    the abdominal parietes, he could feel a very strong pulsation, and, what is curious, could trace it not ouly along the track of the aorta, but in the course of the left iliac artery. The pulse at the wrist, which was small, frequent, and hard, did not correspond with the abdominal pulsations. For several days, the evacuations from the bowels had been as black as pitch. After the employ- ment of gentle purgatives, all the complaints quickly abated, though the throbbings were feebly perceptible for nine months afterwards. The next case, which Dr. Albers met with, is very interesting. A robust sailor, whose bowels were so constipated, that hardly the strongest purgative could affect them, was seized with con- stant pain in the left hypochondrium. With this complaint were soon joined great pain in the about in the belly from one side to the other, and thence extended up to the neck, followed by the vomiting of a greenish matter. At the same time, he felt in the left side a pulsation, which he took for that of the heart, and which continued the whole of hisillness. The pulse at the wrist was na- tural, and synchronous with that in the abdomen. In the beginning of the disorder, the patient was obliged to sit with his body very much inclined forward, as no other posture could be endured. Vor the first week, opening medicines afforded so much relief, that he was sometimes quite free from pain for six or eight hours. After a time, a round swelling formed in the left hypo- chondrium, reached to the navel, and attained with incredible quickness the size of a child’s head. Indeed, it could now be traced beyond the umbilicus to the right side. The motions were quite of a dark colour, or else red blood and a puriform matter were discharged. Sometimes the blood vwided was of a bright red colour, sometimes it was dark, coagulated, and mixed with bile. The patient was at length worn out with febrile sym- ptoms, and died. On opening the body, Dr. Albers found a swelling in the middle of the mesentery, the texture of which cannot be easily described, and the circumference of which was 16 French inches. The stomach was filled with co- agulated blood. The spleen, pancreas, and liver were sound; but the gall-bladder was of prodigi- ous size, and contained thick viscid bile. The arteria coeliaca, arteria coronaria ventriculi, and the arteria mesenterica, were preternaturally di- lated, and full of dark coloured blood. He speaks of them, however, only as being in an enlarged, not an aneurismal state. Dr. Albers thinks it highly probable, that it was one of these vessels, by which the pulsations had been occasioned. Dr. Albers has also seen these abdominal pul- sations in a paralytic female; and in a lunatic, who was afterwards seized with apoplexy. He likewise met with a married woman, the mother of several children, in whom these throbbings took place invariably at the commencement of preg- nancy, and were a surer sign of this state, than other common effects, as stoppage of the menses, &c. After the third month, however, they used to cease altogether. Many valuable practical observations on cases attended with hemorrhages from the intestinal eangl, my limits here oblige me to pass over. According to Dr. Albers, hemorrhoidal patients, especially when put to inconvenience by com- pression of the tumors, often complain of threb- bings about the spleen, which are plain even to the hand. (J. F. Albers, iiber Pulsationen im Unterleibe, 8vo. Bremen, 1803.) Dr. Parry makes a few interesting remarks on such abdominal pulsations as excite suspicion of aneurism. In any persons, not very fat and lying upon their backs, he says, the pulse of the aorta can easily be felt, if strong pressure be made a little to the left of the median line, about half way between the navel and scrobiculus cordis. In certain instances, the pulsation is painfully felt by the patient himself. In many cases of this kind, particularly in nervous individuals, the sense of pulsation is merely the effect of preternatural action of the heart. While, in other examples, it is the effect of the pressure of some hard substance upon the descending aorta, determining a dispro- portionate quantity of blood to the head, “ and giviog to the hand placed on the abdomen, and sometimes even to the eye, the appearance of a beating so near the surface, as to lead inex- perienced observers to conclude, that the aorta is morbidly dilated.” According to Dr. Parry, the most common causes are collections of foeces in the colon, requiring repeated and active pur- gatives, which must bring away almost incredible discharges of stercoraceous matter before the aortal pulsation subsides. (See Purry’s Elements of Pathology, §2. and the Medico- Chir. Journ. & Review, Vol. 1, p. 157.) Another cause of a temporary appearance of pulsation or movement in the abdomen, not men- tioned by any of the preceding authors, is the power which some persons have of putting por- tions of the recti muscles separately into strong convulsive action. I have seen a large abscess of the loins, attended with distinct and forcible pulsations, corresponding to those of the aorta. According to Mr. Allan Burns, a beating is generally felt about the pit of the stomach, in the advanced stage of chronic inflammation of the heart: in this case, when the pericardium is closely adherent to the latter organ, it is corru- gated at every contraction of the ventricles, and the diaphragm and liver are elevated. The ven- tricle, however, having completely emptied itself, is again distended, and, in proportion to the de- gree of dilatation, the liver and diaphragm de- scend, whereby an impulse is communicated in the epigastric region. (On Diseases of the Heart, p- 263.) This valuable writer cites the remark of Morgagni (Epist. 17, art. 28), that sometimes in dilatation of the heart, this organ descends so far as to push the diaphragm into the hypochon- drium, and pulsate in that situation, so that the disease is mistaken for an aneurism of the cceliac artery. In Mr. Burns’s work, a memorable case of this description is related. An erroneous judgment is the more likely to be formed in such examples, because the pulsations of the heart and tumor are not exactly simultaneous; for, it is not the heart which is felt directly beating, but the liver, which, by the action of the heart, is thrown forwards. Hence, the palpable interval between the stroke of the heart, and the movement of the liver. The following fact shows how circumspect a An anonymous writer informs us, that he attended a gentleman, in consultation with an eminent sur-