Diseases of the intestines and peritoneum / by Hermann Nothnagel ; edited, with additions by Humphrey D. Rolleston ; authorized translation from the German, under the editorial supervision of Alfred Stengel.

  • Nothnagel, Hermann, 1841-1905.
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the intestines and peritoneum / by Hermann Nothnagel ; edited, with additions by Humphrey D. Rolleston ; authorized translation from the German, under the editorial supervision of Alfred Stengel. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    on the lateral and lower aspects of the cecum after acute appendicitis, and the posterior surface of the retroverted uterus. As an illustration of this view of Gersuny's, and at the same time of the rapid development of adhesions, the following case of Moser's may be quoted : Laparotomy was performed on October 31 on a case of typhoid fever for suspected perforation. This was absent, the coils of intestine were all free, and there were no adhesions. At the postmortem (death occurred on November 4) there were found, in Douglas' pouch, quite scanty col- lections of clotted blood; there were adhesions over the whole of the intestines, for the greater portion over the ascending and transverse colon; over cecum and vermiform appendix the adhesions were so strong that these organs could only be dissected out with scissors. Five days previously there had been no sign of adhesions. The formation of adhesions after abdominal operations is of the greatest importance, particularly now when laparotomy is so frequently undertaken. These adhesions often help in bringing about the object for which the operation was undertaken, and may, indeed, be a neces- sary part of the curative process. In other cases, however, they form a troublesome sequel of the operation, and numerous attempts have, therefore, been made, both experimentally and by practical surgeons, to prevent the formation of post-operative adhesions. It is doubtful whether there is a rheumatic form of adhesive peritonitis ; at all events it has not yet been proved to exist. In some of the cases of the afiectiou it is quite impossible to deter- mine the etiology. Diffuse Adhesive and Indurative Peritonitis.—In tuber- culosis and carcinomatosis adhesions are often widely spread in the peri- toneal cavity, and may be so extensive as to lead to complete oblitera- tion of its cavity. In other forms of peritonitis this difPuse adhesive change is rare, but it may be found in tumors of the peritoneum and in traumatic peritonitis. This form of the disease may originate in two ways : in the first place, there may be diffuse dry peritonitis, either after the absorption of a fluid exudate or without any fluid exudate whatever; or, in the second place, the process may be dry and at first circum- scribed, and by degrees extend and involve large portions of the peri- toneum. Syphilis is a rare, but very interesting, etiologic factor in the pro- duction of this form of peritonitis ; in adults this aflFection is so rare that it is doubtful whether it ever occurs without general syphilitic disease of the abdominal viscera; in one case of Lancereaux's, which has been widely quoted, the whole anterior abdominal wall was adherent to coils of the intestine which were adherent to each other, so that the whole formed a tough white mass; but in this case nearly all the abdominal organs, particularly the liver, showed syphilitic changes. In a case re- ported by Krapezky in a man of sixty-one years there was peritonitis et mesenteritis multiplex circumscripta fibrosa, which finally proved fatal from intestinal obstruction; but the author's assumption that this was a case of syphilitic peritonitis seems to me very doubtful. It is true