The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare.

  • Edward Martin
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    It would seem tliat, where the inflammation is from the first sufficiently violent to block the lymphatics, there is compara- tively, a moderate amount of septic absorption; where these ves- sels still preserve their physiological capabilities, and the amount of septic matter is so great that it overwhelms the emunctories, the t}^ical symptoms of intestinal septicaemia are developed. Diagnosis.—In typical cases the diagnosis is easy. Fever, vom- iting of bile, constipation, pain, tenderness, tympanitic distention, absence of abdominal breathing, and ra])id pulse, if present, so clearly characterize the nature of the complaint that a mistake is scarcely possible. Cramps from muscular spasm or possibly tempo- rary invagination, pain from gall-,stones or renal calculi, pressure, effects of abdominal tumors, pus formation in the abdominal walls, although presenting individually certain of the characteristic symp- toms of peritonitis, never present the complete picture of inflamma- tion of the serous membrane, and, moreover, present features, pecu- liar to themselves, which will usually render a diagnosis practicable. While the diagnosis cannot immediately be made in some cases, by waiting a few hours the presence or absence of peritonitis usually becomes clear. From obstruction, peritonitis is distinguished with some diffi- culty, since one condition usually complicates the other. Perito- nitis, with its rapid onset, absence of peristalsis, and excessive ten- derness, is to be contrasted with the violent peristalsis, the steady advance of symptoms, and the moderate tenderness of intestinal obstruction in its early stages. In many cases the dividing line cannot be drawn, and Le Fort, Kronlein, and Mikulicz have all operated for the relief of obstruction and found the patient suffer- ing from a perforative peritonitis. Rheumatism of the abdominal walls can be a cause of doubt only for a short time, and the rheumatic peritonitis usually shows its nature by sudden transference of symptoms to other parts of the body, and by prompt yielding to the effects of anti-rheumatic treatment. The scanty, high-colored urine is not in any way diagnostic, since all intra-abdominal affections accompanied by persistent vom- iting are characterized by similar alterations of this fluid.