The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1).

Date:
1845
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Licence: Public Domain Mark

Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1). 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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    serous membranes. We have already observed that the secretion of puriform fluid is not an infre- quent termination of chronic pleurisy. The same thing happens in peritonitis, in fatal cases of which more or less sero-purulent effusion is found in the abdominal cavity. The consistence and quality of this fluid vary according to the duration of the disease ; and hence, from the character of the effusion alone, its duration may, in most instances, be inferred. In some instances, circumscribed cavities, containing puriform fluid, are found. These originate in cases of partial or circumscribed peritonitis, the boundary of the cavity being formed by the effusion of coagulable lymph, by which the convolutions of the intestines become agglutinated. In other cases, purulent effusion into the abdo- men has been the consequence of the bursting of an abscess in some of the abdominal viscera the liver, for instance—or of intestinal perforation. These intestinal perforations may occur in any portion of the alimentary canal, but most fre- quently take place in the small intestines, and are generally the consequence of follicular ulceration and progressive destruction of the muscular and peritoneal tunics. When the peritoneal coat gives way, the intestinal contents escape into the cavity of the belly, and rapid inflammation, followed by death, is the almost invariable result. In some cases, the adhesion of the bowel to some adjacent part has prevented the intestinal perforation. In a remarkable case of this kind, the abscess communicated with the caput coli, to which, and to the parietes of the abdomen, the omentum had contracted a very firm adhesion. In this manner a circumscribed cavity was formed, bounded by this portion of omentum, the posterior surface of the caput coli, and the portion of peri- toneum lining the parietes at the part. This cavity contained a small quantity of ill-conditioned pus, and three or four bodies which appeared to be the seeds of fruit covered by earthy incrustation. It communicated with the caput coli by a small irregular opening, the mucous membrane around which was thickened and vascular. (Abercrombie, p. 338.) 2. Abscess of the liver is not very common in temperate countries, but is a very frequent termi- nation of hepatitis in warm climates. The pus may be either infiltrated through the substance of the liver, or may be contained in a cyst, forming the encysted hepatic abscess. Abscesses of this organ vary in extent, being sometimes very small, in other cases of a large size, not less than three to four pounds of purulent matter having been found in a single abscess. (Abercrombie.) They differ, also, in number: there may be one abscess only, or there may be several, which are either perfectly distinct from each other, or communicate by fistulous openings. Hepatic abscess, when of small extent, may be absorbed ; more generally, however, adhesive in- flammation takes place between the walls of the abscess and some of the surrounding structures. In this way the pus may be evacuated externally through the parietes of the abdomen ; into the right pleural cavity ; through the diaphragm ; or, should adhesion have taken place between the liver, diaphragm, and parenchyma of the lungs, the contents of the abscess may be coughed up through an opening in the bronchi, and the patient may eventually recover. In other instances, the Vol I — 6 b • abscess forms adhesion to some contiguous portion of the alimentary canal, into which the pus is evacuated and discharged, either by vomiting, should the abscess adhere to the stomach, or by stool, if the adhesion takes place to the alimentary canal. In a case related by Malpighi, in which the abscess was situated near the gall-bladder, adhesion took place, and the contents were dis- charged through the biliary duct into the bowels. Andral alludes to a case in which an abscess of the liver communicated with the interior of the vena cava, and to another in which it opened into the pericardium. (Vol. ii. p. 598.) 3. The termination of inflammation of the spleen in abscess is uncommon ; indeed, idiopathic inflammation of this organ is a very rare disease. Purulent infiltration in the spleen, however, often takes place at the same time that pus is deposited in other parenchymatous structures. In these cases, it is probable that the pus is formed else- where, and only deposited in the spleen through the medium of the circulation. Andral mentions the case of a woman, in whom, on dissection, he found a number of small abscesses in the spleen, lungs, liver, and brain ; the uterus, however, was the organ in which the pus was originally formed ; for the symptoms of inflamma- tion of the uterus were those which appeared first; and in the substance of this organ there were several collections of purulent matter, while all the uterine veins were filled with pus. The pus, in abscess of the spleen, may be dif- fused through the parenchyma of the organ, or it may be confined in a cyst of variable extent. The structure surrounding the abscess is sometimes unchanged ; more generally, however, it is softened and considerably altered in its texture, so as to be pulpy and easily broken down. These abscesses often attain an extraordinary size. In a case recorded in the Memoirs of the Academy of Sciences, an abscess of the spleen contained thirty pounds of purulent matter. In another mention- ed in the same work, eight pounds of matter were drawn off by tapping. The patient died next day, and the spleen was found still to contain seven pounds of pus, the sac of the abscess being eigh- teen inches in length and twelve in diameter. Like abscesses of the liver, those of the spleen, by forming adhesion to some adjoining viscus, may burst into the cavity of the pleura, (Tweedie, Clinical Illustrations of Fever,) stomach, (Coze, Journ. de Med. torn. 82,) colon, (Jacquinelle, Journ. de Med. torn. 88) ; or, by the cyst of the abscess forming adhesion to the kidney, the pus may be discharged with the urine. The matter may be, also, extravasated into the cavity of the belly, in which case it proves rapidly fatal; or the abscess may form an external tumour in the left hypochondrium, and in this way the matter may be discharged externally, by an opening in the abdominal parietes. Among the lesions observed in the spleen in fatal cases of fever, abscess may be enumerated. Though rather uncommon, cases of this kind have been recorded. Mr. Wardrop states, in a note to Baillie's Morbid Anatomy, that in some of the British soldiers who suffered from the Wal- cheren fever, and who afterwards died in this country, the whole substance of the spleen was converted into a puriform fluid, contained in its proper capsule.