Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

206/440 (page 188)

constipation coexisted in no less thcan 51. Had tlio latter proportion been kept up, we should have had 63-3 instead of 30, so that, according to our present data, the coincidence of abdominal pain with constipation in typhus is to its occur- rence along with diarrhoea as three is to one. I might still further heighten the contrast, by deducting one who died of phthisis, in whom the abdominal pain did not supervene till after the fever had run its course, and in whom it was found on dissection to depend on very extensive tubercular suppuration and ulceration of the intestines; another in whom it supervened about the 20th day, along with a profuse dis- charge from a very large bedsore; and a third, in whom the evacuations, though frequent, were mixed throughout with scybala; but the difference is striking enough without any such refinement. I have marked a considerable number of the above as relieved by diarrhoea, a circumstance which naturally pro- vokes inquiry into the previous state of the bowels. I find, then, that of the 30 in whom pain and diarrhoea were con- temporaneous, 10 may be called cases of spontaneous diar- rhoea, 6. the purging was not, so far as I know, brought onby medicine; while in the remainder it may be ascribed to that cause. In 28 of those in whom diarrhoea, whether spontaneous or consecutive, was observed, the bowels were more or less obstinately constipated during the first stage of the fever; and in that number are included almost all those in whom diarrhoea gave relief to pain. And finally, of the 51 in whom constipation lasting throughout the disease was accompanied by pain (in many cases exceedingly acute) the operation of purgative medicine,—of casfcor-oil, turpentine, jalap, calomel, or the neutral salts, given according to the strength of the patients, and the indications presented in the course of the disease, was followed by decided and immediate relief in 20 cases. Dr. West mentions, that of 30 who had pain, 8 only had diarrhoea, while 15 were constipated; a result that fully bears out my statements. Abdominal pain and spontaneous diarrhoea were coincident in all of the nine patients labouring under typhoid fever to whom I have alluded. The shortest period of coexistence was four, the longest thirty-two, and the average is a littlo