What to observe at the bed-side and after death in medical cases.

  • London Medical Society of Observation
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: What to observe at the bed-side and after death in medical cases. 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.

    48/166 (page 24)
    § IV, D.] EXAMINATION OF THE LIVER, ETC. [PABT I. crepitation. gurgling. fluctuation- sound. tienia-sound, etc. fcetal move- ments, aortic impul- sive sound, murmur. frctal heart. 1‘hyticat exami- nation qf Liver, Gnli-bladder, and Ducts, Inspection— fulness, etc. colour of skin, cedcma. | Palpation— resistance. edge of liver. surface of liver. —Crepitation or grating: how developed? its position, connexion with tumour or not, deep or superficial?— Gurgling: its seat, audible on pressure or iudej>endcntly of it, with inspiratory acts; special characters, ac- companied by metallic tinkling.—Fluctuation-iovud: sjKmtaueous ; its seat, connexion with tuinoiur;—ob- served on succussion.—'rtenia-sound;—hydatic sound, suprficial or deep-seated?—Sound of foetal movetnenU. —Sounds of aorta: impulsive sound increased.— Murmur: arterial; its scat, connexion with tumour, extent, intensity, special characters; accompanying systole or diastole of vessel or both ? accompanied by shock or not ? influenced by pressure on cither side of stethoscoi)e ? effect of posture on its development;— venous murmur; its scat, extent, intensity, s[>ecial similitude;—continuous mumiur (audible at a distance from patient);—uterine murmur ; effect of posture ujion it; its seat, loudness, B[>ecial chanicter.—Foetal heart sounds : where best heard aud to what extent ? their frequency; readiness of i>erception ; effect of pos- ture on perception of them.—Sounds audible at a distance from patient. Physical examination of the Liver, Gall- bladder, and Ducts. 113. Inspection:—Fulness or bnlpng (specially affecting right hypochoudrium, cpipstriura, or upper part of abdomen);—state of depression below cartilages of false ribs;—visible downward extent of liver;—state of intercostal spaces on right side;—8j)ecial promi- nences (pointing) apparent, their seat and form;—vari- ation in fulness, etc., with varying states of stomach or after vomiting.—Colour of skin over liver or sijecial prominences ; oedema over liver. 11 1. Palpation:—Temperature over hepatic region. —Pesistance to pressure below false ribs on right side, as compared with left; dow nward extent of resistance;— contraction of right or left rectus muscle on pressure; of other muscles of the soft wall.—IVy# of liver (if palpable, after evacuation of bowels) : its position and direction; effects of standing or recumbent posture or of deep inspiration on its position ;—its characters, indurated, thin, thick, irrcgnlar, etc.;—interlobular notch; its dejjth, direction.—Surface of liver: smooth, nodulated;—character of elevations on surface, round,