A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 6).

James Copland

Date:: 1834-59

Credit: A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 6). 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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indicate the affection of the stomach. If the peritoneal coat of this viscus is inflamed, the disease may be considered either as a form of gastritis, or as partial peritonitis, according to the views of the physician ; but this portion of the peritoneum is the most rarely affected, at least alone, and in this climate. Some aid may occasionally be afforded in this case, as well as in others, by auscultation; for, although the motions of the diaphragm are generally slight, yet sometimes an imperfect or obscure rub- bing sound is heard, with the respiratory move- ments, in the sthenic forms of peritonitis ; and when much affusion takes place, and percussion is tolerated, a dull sound is emitted where the affusion is considerable. These modes of ex- amination may assist in distinguishing peritoni- tis from the diseases just noticed, as well as from colic and some other maladies. [We believe that Dr. Beatty, of Dublin, first called the attention of the profession to this physical sign in peritonitis in the year 1834. (Dublin Jour. Med. 4 Chirurgical Science, Sept., 1834.) In Jan., 1832, says Dr. B., a wom- an, aged 30, was admitted into my ward for the diseases of females, in the City of Dublin Hospital, labouring under dropsy of the left ovarium. The tumour filled the abdomen from the pubis to the ensiform cartilage, and was remarkably hard and unyielding. A few days after admission, she was attacked with severe pain in the belly and febrile symptoms, which continued for a week, and required the abstrac- tion of blood, and other antiphlogistic treat- ment, before she was relieved; during which time a remarkable sensation was communi- cated to the hand when applied over the um- bilicus and its neighbourhood. The sensation was that of a grating or rubbing together of two uneven and rather dry surfaces, and was rendered most evident by ordering the patient to take a full inspiration, thereby causing the abdominal parietes to move more freely over the surface of the tumour. By the application of the stethescope, a loud and distinct ' frotte- ment' was audible, extending over a space of about five inches in diameter, with the umbili- cus for a centre. In a few days the pain and inflammatory symptoms subsided, under the treatment employed, and, with them, the sensa- tion just described, and the audible phenomena altogether disappeared.—hoc. cil. Sementini states, that in all cases of peri- tonitis, in whatever part of the abdominal cavity the inflammation is seated, there is pain in the pubes and upon the great trochanters; which, if not spontaneously felt, is always developed by pressure, and of which the severity is di- rectly proportionate to that of the peritonitis. This fact, if, indeed, it be such, may be ex- plained by the relation of the nerves of the parts, in which the pain is felt, to the peritone- um, and by its connexion with the fascia and muscles about them. In addition to its value in the diagnosis of even the most obscure and latent cases of peritonitis, in all of which, we are told, this sign is present in a degree propor- tioned to the severity of the disease, Dr. S. has found it of value as an indication of treat- ment, and has obtained great benefit from the application of leeches and blisters over the trochanters, instead of on the abdominal walls. —Annaii, Univ. di Med., Sept., 1840 ] 125. 4. Certain states of colic sometimes re- semble peritonitis, especially when the former is attended by much abdominal distention and pain ; for I have seen in some instances the tenderness on pressure so great, owing to the stretching of the peritoneal covering of the bowels by the flatus distending them, as to re- semble peritonitis. In these the absence of fever, the state of the pulse, the cool or natural temperature of the abdomen, and other con- comitant symptoms, will guide the physician. Still, the occasional supervention of peritonitis or enteritis in these cases should be kept in recollection. In the more common states of colic, when pressure is tolerated, or even gives ease, there can be no mistake as to the nature of the disorder. (See art. Colic) 126. c. A hysterical form of colic and a hys- terical state of neuralgia may somewhat resem- ble peritonitis, chiefly owing to the apparent tenderness of the abdomen, which, however, is tolerant of firm pressure unexpectedly made on it. In these cases the presence of other hys- terical symptoms, the borborygmi, and the flatu- lent state of the digestive canal; the situation of the pain, and its connexion with uterine ir- ritation, and occasionally with tenderness in some portion of the dorsal or lumbar spine; the absence of fever and of several other in- flammatory symptoms ; the states of the urine and of the catamenia, &c., will generally indi- cate the nature of the disorder. I have, how- ever, met with cases of hysterical colic, in con- nexion with dysmenorrhcea, where the extreme tenderness, the acute pain and tension in the lower regions of the abdomen, the retchings and vomiting, and the disturbance of the circu- lation induced a dread of inflammation of the portion of the peritoneum reflected over the uterine organs ; and, most probably, the con- gestion of these organs had so affected the peritoneal covering, either by stretching or in- jecting it, as to develope its sensibility, the re- moval of the congestion by the supervention of the discharge removing, also, the suffering with the cause. 127. In all cases, when the abdominal ten- derness of hysteria most closely simulates peri- tonitis, a remarkable incongruity of symptoms is observed. The states of the countenance, of the pulse, of the tongue, of the evacuations, and of respiration are inconsistent with peri- toneal inflammation. The breathing is hurried and laborious, and not suppressed, short, and shallow, as in peritonitis ; the pain and tender- ness shift, or suddenly appear and as suddenly depart; the catamenia are usually more or less disordered ; and leucorrhoea is often present. In the hysterical affection the state of the tem- per and of the moral feelings, and the frequent occurrence of other hysterical symptoms, often of themselves sufficiently characterize the dis- order. 128. d. Rheumatism rarely affects the ab- dominal muscles, but when it does it may be mistaken for peritonitis, owing to the intense pain felt on pressure and motion. Dr. Parr states that the pain in rheumatism of these muscles is felt chiefly at their origins and inser- tions, shooting to the false ribs and spine of the ilium. This, however, does not agree with my observation; for I have considered the sheaths and aponeurosis of the abdominal mus-

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