Clinical lectures on some obscure diseases of the abdomen delivered at the London Hospital.

  • Samuel Fenwick
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on some obscure diseases of the abdomen delivered at the London Hospital. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    apparent. There is no tenderness on pressure. The utenis is normal, and no cause for intestinal obstruction can be discovered by vaginal exa- mination. The percussion note is very tympanitic in every part, but the left side is more prominent and more clearly tympanitic than the right. After drinking no gurgle can be detected in the stomach by auscultatory percussion. She states that she had always enjoyed good health until three months ago, when she was suddenly attacked with severe pain near the umbilicus, accompanied by diarrhoea. This attack lasted eight days, and ever since that time she has suffered from attacks of pain of the abdomen, which are increased by exercise as well as by food, and from occasional vomiting, which chiefly comes on in the evenings. December 24th.—The vomiting has ceased since her admission, but she still complains of pain at the umbilicus, coming on a short time after food. The bowels now act regularly with the aid of enemata. The movements of the intestines have become more visible and are very well marked. January 8th, 1875.—The pains are now much more severe than for- merly, and the whole of the front of the abdomen seems to be occupied by a mass of moving intestinal coils. She had vomited a large quantity oE pure bilious fluid mixed with mucus. Pulse 120, small and feeble. She died rather suddenly, without any alteration either in her sym- ptoms or in the physical signs. Post-mortem examination.—The small intestines were found to be enormously distended, especially the ileum ; they contained a dark- coloured fluid; their walls were much thickened, and numerous haemor- rhages were found in the submucous coat; the ileo-caecal valve was much contracted, but numerous small openings existed in its place between the small and larger intestines ; some solid faeces were in the ascending colon; the descending colon was much contracted. The other organs of the body were in a healthy state. Case 2.—Fanny F—, aged twenty-seven, admitted August 24th, 1877. She complains of severe pain of the abdomen, coming on in paroxysms, attended with occasional vomiting ; the pulse is 100; tongue furred ; appetite bad ; temperature ] 00°; the bowels have been confined for two weeks. The abdomen is much distended and tympanitic; no dulness can be discovered in any part, but there is increased tension and resistance to pressure in the right iliac region, although no tumour can be felt there. The motions of the intestines are visible over the whole abdomen ; they are constantly present, but seem to be most distinct in the umbilical region. Catamenia irregular. On examination by the rectum a round hard mass can be felt, apparently in Douglas's pouch, and the uterus seems to project forwards.