A System of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman.
- William Leishman
- Date:
- 1875
Licence: Public Domain Mark
Credit: A System of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
737/824 page 721
![XLV.] SYMPTOMS. 7-1 often of a bright-green color. The bowels are generally constipated. Diarrhoea is rare, except in fatal cases. The abdomen is distended with gas. The degree of distension is sometimes extreme, especially when death is about to occur, when it may materially impede respira- tion. The abdomen is generally tender. This tenderness usually begins in one or both iliac fossae, and extends upwards till nearly all the abdominal surface is involved. The patient rarely complains of much pain in the abdominal and pelvic cavities. When asked to take a deep breath, she usually mani- fests more or less uneasiness. The severity of the pain and the degree of tenderness bear no proportion whatever to the extent and intensity of the inflammation of the peritoneum. The most extensive and severe peritonitis may exist, and yet the patient manifest little or no uneasiness when the abdomen is firmly and even rudely manipulated. This has been repeatedly observed in fatal cases, in which the post-mortem examination revealed the existence of the most severe and extensive inflammation of the peritoneum. In other eases the pain may be severe, and the abdomen exquisitely sensitive to pressure. These symptoms are rare, however. It is very seldom that complaint is made of the weight of the bed-clothes, and the decubitis is nearly always on the back with the limbs fully extended. The pulse during the first twenty-four hours is full and round, but rather compressible. It is never small, hard, and corded, as it is in acute sthenic non-septic peritonitis. It quickly runs up to 120, L30, or 140 per minute, and we have seen it as high as 170 on the third day after confinement. In a tew days it becomes very frequent,weak, and compressible, as in all typhoid diseases. Throbbing of the carotid and the other large arteries which are superficial in their position, is a frequent symptom. The respirations are frequent, and the patients usually complain of pain in the abdomen and pelvis upon taking a full inspiration. In fatal cases, a> death approaches, breathing is often greatly interfered with, and rendered singultiform by the extreme tympany. In the majority of the eases the disease runs its course without any pulmonary complication, but acute pleurisy and pneumonia are not rare,and may set in at any time after the third or fourth day of the disease. The pleurisy i- generally bilateral. It is often latent, and hence the eru- dition of the lungs should always be carefully watched in this disease. In rare cases the symptoms of pleuritic inflammation may completely mask those <'f the peritonitis. The temperature ascen Is abruptly at the outset of this disease, and reaches 1! or 105 Pahr. in a few hours. This sudden elevation is fol- lowed in '»:k' i- two .lays by a decline in which the body heat approaches more or less nearly to the normal standard, but does not reaeh it. This decline occurs in both favorable and fatal cases. It does not afford the slightest ground for a favorable prognosis. In fatal eases there may be a regular and apparently a favorable decline of temperature for one, tWO, or three days before death. Unless this diminution of the body heat is associated with corresponding favorable changes in the pulse, respirations,and appearance of the patient, it indicates that the dis» 46](https://iiif.wellcomecollection.org/image/b21016112_0737.jp2/full/800%2C/0/default.jpg)
