The treatment of diseases of the digestive system / by Robert Saundby.

  • Robert Saundby
Date:
1914
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of diseases of the digestive system / by Robert Saundby. Source: Wellcome Collection.

    19/222 (page 5)
    raised so as to relax the abdominal muscles and make the patient more comfortable. After examining and noting the condition of the thoracic organs and the urine, we should inspect the interior of the mouth, note any defect in the teeth, the state of the gums, tongue, and lips. By inspection we ascertain the shape of the abdomen, whether convex or concave ; the width of the costal angle, a narrow angle constituting the habitus asthenicus of the Germans ; the presence of dilated veins, or the so-called “ caput medusae ”—the curious ring of dilated veins around the umbilicus often seen in cirrhosis of the liver ; we observe any want of symmetry, or the presence of a ventral or umbilical hernia, or visible coils of intestine ; and in some emaciated patients we may distinctly see the outline of the stomach, or recognise peristaltic waves passing across its surface. Sometimes we may find that the severe pain of which complaint has been made is due to nothing more serious than a crop of herpes zoster, although the severity of the suffering may have suggested renal or biliary colic, or even peritonitis. Having noted all that can be made out by this means we next palpate the abdomen. There is probably no means of examining the body more fruitful in giving accurate information, when used by a skilled observer ; it is, there¬ fore, important to cultivate the art and to pay attention to the rules for its application. The physician stands on that side of the patient which he desires to examine, facing towards the patient's head and on a level with or rather lower than the hip joint ; his near hand should be placed flat on the abdomen so as to bring the whole surface of the palm and the palmar aspect of the fingers in contact with the skin, preferably at first in the long axis of the body, and the patient must be asked to breathe deeply and slowly. As the muscles relax during expir-