Volume 1
A dictionary of practical surgery: exhibiting the present state of the principles and practice of surgery ... comprehending also an account of the instruments, remedies and applications employed in surgery, and the etymology and signification of the principal terms / [Samuel Cooper].
- Samuel Cooper
- Date:
- 1822
Licence: Public Domain Mark
Credit: A dictionary of practical surgery: exhibiting the present state of the principles and practice of surgery ... comprehending also an account of the instruments, remedies and applications employed in surgery, and the etymology and signification of the principal terms / [Samuel Cooper]. Source: Wellcome Collection.
18/1246 (page 6)
![blood. . The spleen, pancreas, and liver were sound; but the gall-bladder was of prodigious size, and contained a very thick viscid bile. The arteria. coeliaca, arteria coronaria ventriculi, and the arteria mesenterica, were preternaturally di- lated, and full of dark coloured blood. He speaks of them, however, only as being in an enlarged, mot an aneurismal state. Dr. Albers thinks it highly probable that it was one of these vessels, by which the pulsations had been occasioned. Dr. Albers has also seen these abdominal pul- who was afterwards seized with apoplexy. He likewise met with a married woman, the mother of several children, in whom these throbbings took place invariably at the commencement of preg-. other usual effects, as stoppage of the menses, &e. After the third month, however, they used to cease altogether. a Many valuable practical observations on cases attended with hemorrhages from the intestinal canal, my limits here oblige me te pass over. According to Dr. Albers, hemorrhoidal patients, especially when put to inconvenience by com- pression of the tumors, often complain of throb- bings about the spleen, which are plain even to the hand. The same gentleman says, that he has often remarked these pulsations in hypochondriacal and hysterical patients, who were put to much distress by the occurrence, as they supposed their hearts were out of their right places. (J. F. Albers, uber Pulsationen im Unierleibe, 8vo. Bremen, 1803.) The differences pointed out by this able phy- sician, between these pulsations and those of in- ternal aneurism, will be presently noticed. Dr. Parry makes a few interesting remarks on such abdominal pulsations as excite apprehensions of aneurism. In any persons, not very fat and lying upon their backs, he says, the pulse of the aorta can easily be felt, if strong pressure be made a little to the left of the median line, about half way between the navel and scrobiculus cordis. In certain instances, the pulsation is painfully felt by the patient himself. In many cases of this kind, particularly in nervous individuals, the sense of pulsation is merely the effect of preternatural action of the heart. While, in other examples, it is the effect of the pressure of some hard substance upon the descending aorta, determining a dispro- portionate quantity of blood to the head, “ and giving to the hand placed on the abdomen, and sometimes even to the eye, the appearance of a beating so near the surface, as to lead inex- perienced observers to conclude, that the aorta is morbidly dilated.’’ According to Dr. Parry, ‘the most common eauses are collections of foeces in the colon, requiring repeated and active pur- gatives, which must bring away almost incredible discharges of stercoraceous matter before the aortal puisation subsides. (See Purry’s Elements of Pathology, &c. and the Medico-Chir. Journ. & Renew, Vol. 1, p. 157.) Another eause of a temporary appearance of pulsation or movement in the abdomen, not men- tioned by any of the preceding authors, is the power which some persons have of putting por- convulsive action, Ihave seen a large abscess of the loins, attended with distinct and forcible pulsations, corresponding to those of the aorta, According to Mr. Allan Burns, a beating is generally felt about the pit of the stémach, in the advanced stage of chronic inflammation: of the heart: in this case, when the pericardium is closely adherent to the latter organ, it is corru- gated at every contraction of the ventricles, and the diaphragm and liver are elevated, The ven- tricle, however, having completely emptied itself, is again distended, and, in proportion to the de- gree of dilatation, the liver:and diaphragm de- scend, whereby an impulse is communicated in the epigastric region. (On Diseases of the Heart, p. 263.) This valuable writer cites the remark of Morgagni (Epist. 17, art. 28), that sometimes in dilatation of the heart, this organ descends so far, as to push the diaphragm into the hypochon- drium, and pulsate in that situation, so that .the disease is mistaken for an aneurism of the cceliac artery.. In Mr. Burns’s work, a memorable case of this description is related. An erroneous judgment is the more likely to be formed in such examples, because the pulsations of the heart and tumor are not exactly simultaneous ; for, it is not the heart which is felt directly beating, but the liver, which, by the action of the heart, is thrown forwards. Hence, the palpable interval between the. stroke of the heart, and the movement of the liver. Preternatura] pulsation about the epigastrium is also stated by Mr. A, Burns, to be sometimes occasioned by encysted tumors, attached either to the lower surface of the diaphragm, or formed between the layers of the pericardium towards the diaphragm, as happened in an instance recorded by Lancisi. Another cause specified by Mr. A. Burns, is enlargement of the vena cava, or of the right auricle of the heart. Senac describes a case, in which the vena cava wasas large as the arm, and there had been a violent pulsation in the epigas- trium. . The next cause; enumerated by the same gentleman, is increased solidity of the lungs, more especially of their lower acute margins, where they overlap the pericardium. In this case, the pulsation is about the scrobiculus cordis. Mr: A. Burns likewise comprises several other causes of epigastric or abdominal pulsa- tions, already illustrated in the foregoing part of this article, indurations of the pancreas, scirrhus of the pylorus, tumors in the mesentery, or any solid increase of substance about the abdominal aorta, or its principal branches; and, lastly, it is called, a peculiar affection of the vascular system itself. The following observations, on the criter##be- tween various abdominal pulsations and those of aneurism, appear interesting. tape According to Dr. Albers, an internal aneurism originates gradually, and the pulsations increase in strength by degrees. Other abdominal pulsa- tions, on the contrary, begin suddenly, and are most violent in the beginning, abating after they have lasted some time. _ In an aneurism, the pulsation is synchronous with the stroke of the artery at the wrist; but this is not regularly the case with other pulsations. Should the patient be affected with melan- cholia, hypochondriasis, hysteria, or other nervous](https://iiif.wellcomecollection.org/image/b33285251_0001_0018.jp2/full/800%2C/0/default.jpg)
