A System of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman.

  • William Leishman
Date:
1875
Catalogue details

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.

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    employed for the detection of pus. Every clinical student is taught that fluctuation is the most reliable Bign of the presence of fluid within a cavity which it fills, and is instructed how to apply the test, the manip- ulation being somewhat varied according as the accumulation is large as in ascites, or small as in an ordinary superficial abscess., In this strict sense, however, fluctuation is very rarely available in the diag- nosis of pelvic abscess, for the obvious reason that while we require, to produce real fluctuation and at the same time to appreciate it. two hands,—as a rule, in the investigation of these tumors, one hand, or it may be one finger only, is available. The circumstances under which actual fluctuation is then discoverable are to be found in those c only in which the tumor has reached above the pelvic brim in the direc- tion of the iliac fossa or elsewhere, or when it is possible to produce the wave of fluctuation between the fingers and the vagina, and the other hand applied to the abdominal wall. The presence of fluid may, how- ever, often be recognized quite easily by the finger in the vagina ; but there are many cases in which to be certain requires a high degr the tactus eruditus. u This is, however, as Dr. Duncan observes, not feeling fluctuation. It is merely the educated finger picking up such sensations as to enable the mind to perceive a collection of fluid in a cyst or bag. The finger cannot both produce fluctuation and feel the shock of the wave. Treatment.—The management of pelvic cellulitis and pelvi-peritonitis depends, in the first place, and very obviously, upon the nature of the case. It will depend, moreover, upon whether the symptoms are acute or chronic ; whether the disease is progressive or stationary ; an I whether there is already evidence of the formation of an abscess. It is quite clear, therefore, that on many points, the ordinary principles of surgical treatment must be our guide : but, in so far as the treatment to be pursued is identical with what a moderate acquaintance with clinical surgery would indicate, we shall not follow the subject. There are, however, many special practical considerations, most of which e.\] eri- ich : but to one or two of these we may here briefly advert. Of the symptoms which call for prompt treatment, none ; more importance than local pain. If the seat of the pain reaches above the brim, nothing is more grateful to the feelings of the patient than the application to that region of poultices and fomentations, which may tinkled with laudanum, or otherwise modified to suit the exigen- cies ofthecase. When the tumor i- more truly pelvic, and can only be felt from the vagina, the vaginal douche sometimes gives temporary relief, and in other instances me Heated | ih as were rec >m- mendedbv Sir James Simpson, may be employed. Berauta strongly advocated the internal use ofconium, and it may even be necessary to use Bome of the preparations of opium. The sufferin i patient a ivate I by the pressure which the tumor i boring viscera, especially the bladder and the rectum, when the function- of these parts may lie seriously interfered with. The exact nature of this < will entirely depend upon the anatomical relations which the tumor bears to contiguous \ arts. When the pressure i- forward-, in the direc- 47
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