The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1).
- Date:
- 1849-59
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![higher. The temperature of the hand itself is I also to be taken into account, and not merely its actual temperature, but its habitual temperature. Some persons have hands habitually cold, and others habitually warm ; and it is not likely that such persons will judge similarly of temperature, even when their hands chance to be equally warm at the period of experiment. It is still less likely that they will agree if their hands are of different temperature. In examining the temperature of the abdomen, or of any other part of the body, it will be most, safe to judge< rather of the relative than of the absolute degree of heat; and this will be best done by examining alternately other parts of the body presumed to be in a state of health.* The temperature of the abdominal surface is frequently an important sign of disease. If very elevated, it indicates inflammation of the subjacent parts, or, at least, that increased afflux of blood, which cannot be practically discriminated from the early stage of inflammation. If that singular, and, we believe, still unexplained pungency, which attends certain febrile and inflammatory affections, is present, the complication renders the sign still more significant of severe disease. In exploring the degree of sensibility, the pres- sure should, of course, in the first place, be made in the gentlest manner, and with the open hand. If the surface is impatient of the slightest touch, we may be assured that the cause of the tender- ness is in the parietes. If no superficial tender- ness exists, we proceed to examine the parts more freely by compressing the parietes more or less forcihly, and in different directions. Sometimes we find that a change in the direction of the pres- sure produces very different results in the same part. In peritonitis, for instance, direct downward pressure towards the spine is sometimes borne tolerably well, when pressure in a lateral direction, particularly such as forces the abdominal peritone- um to slide over the intestines, occasions extreme pain. In chronic diseases, much greater freedom may generally be used in our explorations ; and when considerable doubt exists respecting the nature of a disease, we should endeavour to bring every organ of the abdominal cavity within the sphere of our explorations. Some physicians, in exploring the abdomen, seem to consider it sufficient merely to pass the hand across it once or twice, using a very gentle pressure in the suspected places. Such a method is often more calculated to mislead than to instruct. It may, indeed, satisfy the patient that his case has met with due attention, while he has, at the same time, been treated with gentleness and delicacy ; but it cannot be satisfactory to the practitioner who knows the value of this mode of investigating dis- ease. But while we recommend the propriety of a free exploration, it is necessary to caution the young practitioner against adopting one of unne- cessary violence. Some physicians make use of so much pressure, or rather they apply it in so injudicious a manner, that they hardly ever fail to elicit from the patient the expression of pain in the suspected region. This is particularly the case when the pressure is made, with the very * Nothing run show the imperfection of mere sen- sation as a test of temperature, more strongly than the fact constantly observed, of patients am] their attendants reporting particular parts aapreternaturallyhot— burn- ing hut, —which arc found on trial, to be of the natural degree of warmth. points, or still more with the nails of the fingers or when the soft parts are compressed against such as are solid. No very general rules can be laid down in such cases. Experience of the natural sensibility of the parts to pressure, in health and disease, can alone give the true practical tact; but even experience, we find, may here, as in other circumstances, be over-mastered by the influence of theory and prejudice acting on a weak judgment or a warm imagination. In every case, while exploring the sensibility of the abdomen, it is im- portant to watch the expression of the patient's countenance; as this is often found to be a truer index of his sensations than his words are. If, in the course of our exploration, we discover any unusual swelling or indurated part, we must endeavour to ascertain its nature and various relations,— its exact site, size, form, consistence, connexions, and degree of sensibility; whether it contains a fluid or not, whether it is pulsatile or not, and whether it is fixed or movable. All these circumstances are of consequence. The situation, size, and form of the swelling will enable us to judge respecting the organ or part affected ; its consistence, degree of sensibility, &c. will help us to the knowledge of the nature of the tumour itself. In persons that are of a spare habit, and in whom the abdominal parietes are relaxed, and more particularly in women and children, whose muscles are naturally small and feeble, we are able to ascertain the condition of almost all the parts contained in the abdomen with considerable minuteness, and to an extent beyond what is commonly believed by practitioners. In many cases, for instance, it is easy to feel the mesenteric glands when enlarged, and even the kidneys. We must, however, be careful, in making these free examinations, not to mistake natural conditions of the parts for morbid deviations. Masses of in- durated faeces in the colon, and even the spinal column, have been mistaken for morbid growths. (Bianchi, Hist. Hspat. 325. Double, Semeiol. t. i. 383.) Errors of this kind may, in general, be avoided. The movableness of the fsecal masses ought to point out their nature ; and the extreme fixedness of the spine, as well as its form and direction, will hardly permit such a mistake to be committed by any one possessed of a common degree of anatomical knowledge. In examining the abdomen with the view of detecting fluids accumulated in its cavity, we, in some respect, reverse the preparatory steps recom- mended in searching for more solid matters. In exploring for fluids, we wish the abdominal parie- tes to be in a state of tension rather than relaxa- tion : and, with a view to obtain this result, if the patient is in bed, and cannot conveniently get up, we make him lie quite flat, with the head low and the legs extended ; or we even increase the ab- dominal tension still further by placing a pillow under the loins. It is, however, still better if the patient can be placed in the erect position ; as the abdominal walls are thereby rendered naturally tense, and the fluids are accumulated at the inferior and anterior parts of the cavity, in place of being intermixed with, and in some degree hidden by the intestines, as is partly the case when the patient is in the horizontal position. The litt.e manoeuvre for ascertaining the fluctuation of the fluid is universally known. It consists, simply, in placing the palm of one hand against one side of](https://iiif.wellcomecollection.org/image/b21116805_0027.jp2/full/800%2C/0/default.jpg)
