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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the digestive tube ; from suppuration of the solid viscera opening into the peritoneum ; from ul- ceration of the bladder, or ovaries ; or from perforation of the diaphragm by purulent col- lections on its thoracic surface. There can be no doubt that ulcerative perforation of the in- testinal tunics often takes place, especially in typhoid fever, without an escape of the con- tents of the canal into the abdominal cavity, owing to adhesions being formed between the two surfaces of the peritoneum at a point cor- responding to the situation of the ulcer. Again, owing to inflammatory adhesion, and subse- quent ulceration of different portions of the intestinal tube, we sometimes find communica- tions thus formed, the foecal contents thus pass- ing across the serous membrane without enter- ing its cavity. We often meet with perforating ulcers of the digestive tube communicating with the solid viscera, as where the base of an ulcer of the colon is formed by the tissue of the kid- ney, and ulcers of the stomach resting on the spleen, or of the duodenum on the liver; in all these cases effusion into the abdominal canal is prevented—a cicatrix is formed, and the health of the individual preserved. In these cases circumscribed peritonitis only ensues, and they are generally the consequence of chronic dis- ease, so that time is afforded for the exudation and organization of lymph. This disease most frequently, however, oc- curs from a perforating ulcer of the lower por- tion of the ilium, consequent on acute disease. The following remarks of Louis are worthy of record : The patients who have been the vic- tims of this disease were young and vigorous, with the exception of the first, who was weak and of a lymphatic temperament; they had a good constitution, were rarely ill, not addicted to excess, and presenting a sanguine, a bilious, or a lymphatic sanguine temperament. Almost all had been but a short time in Paris. The causes of their disease were unknown. If we except a single case, it commenced as a slight, continued fever, and presented no severe symp- tom before the period of the perforation ; in but one patient was there a severe diarrhoea, which was, however, of but short continuance; in another it had been moderate ; still less in the subjects of the second and sixth cases, and not occurring in the remainder. Those with whom the diarrhoea was for a short time severe had slight pains in the epigastrium, and more severe pains in other portions of the abdomen, while in the remainder they were very slight, or not at all present before the period of perforation. Three of them believed themselves convales- cent, and were considered so for some days, when the symptoms of this lesion occurred. A fourth seemed to have been cured rapidly of a slight enteritis; so that not only in these four subjects nothing occurred which could lead to the anticipation of the disease under which they sank, but it would have been absurd, from the mildness of their symptoms, to have apprehend- ed any serious consequences ; and at this mo- ment we have before us the history of many patients who have died from an acute perfora- tion of the intestine, and who, with this ex- ception, presented no symptom which could distinguish them from analogous cases, where there was a rapid return to health. If the pe- riod of the formation of these ulcerations can- not be accurately determined, we shall scarce- ly be far from the truth in supposing that it coincides with the first symptoms of the dis- ease, from which it would result that the progress of these ulcerations has been very rapid, and that they have arrived at their last period in from twelve to twenty five days, rare- ly later. At a certain period of the disease, on ac- count of which the patients had entered the hospital, they experienced suddenly an exqui- site and tearing pain of the abdomen, rapidly followed by alteration of the features, nausea, and vomitings, &c. These symptoms continu- ed with greater or less violence from twenty to fifty-four hours, presenting remissions which were more or less well marked, and indicating a most intense peritonitis, produced by a vio- lent cause acting in a hidden manner, just as occurs when an irritating substance is applied to the surface of the peritoneum. It is by the reunion of these signs that the lesion that now occupies us has been recognized by M.M. Ler- minier, Chomel, and Martin Solon, under whose care the patients were. From these circumstances it appears that we may regard the following as characteristic signs of perfo- ration of the intestine : if in an acute disease, and in an unexpected manner, a violent pain of the abdomen suddenly supervenes, if this pain is ex- asperated by pressure accompanied by rapid alter- ation of the features, and more or less promptly followed by nausea and vomiting, we may believe and announce that there is a perforation of the in- testine. (Rcchcrches Anatomico-Pathologiques, Paris, 1826 )] 135. c. Certain causes occasion peritonitis through the organic and vital actions, and the circulating fluids, there being, however, a pie- disposition in the peritoneum, or some part of it, to become affected, or pre-existing circum- stances determining the inflammatory action to this membrane. Many of the causes just enu- merated may be merely determining influences in developing the morbid action in this situation, other causes affecting primarily the vital and circulating functions, and producing the inflam- matory diathesis or constitution. Of these lat- ter, the most frequent and influential are. ex- posure to cold, humidity, or both conjoined, and to currents of cold air ; sleeping on the ground or in the open air, or in damp beds or bed-clothes ; sitting in wet clothes ; the con- taminating or infecting influences of foul air, or of animal miasms upon injuries, wounds, &c, communicating either directly or indirectly with the peritoneum ; the suppression of accustom- ed discharges or evacuations, and of determina- tions of blood from more external parts ; the retropulsion of cutaneous eruptions, of rheu- matism, erysipelas, &c.; repeated attacks of ague, occasioning vascular determinations to the liver and spleen, and unusual stretching of the investing peritoneum, favouring the super- vention of inflammation of it; changes in the •state of the blood, as respects both quantity and quality; and the puerperal states, and the various circumstances attending them. (See Puerperal Diseases.) 136. X. Treatment.—Having described the several states of local and general morbid ac- tion characterizing this malady, their varying consequences, and their complications, each of

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