Enteralgia and chronic peritonitis / by A. Jacobi.

  • Jacobi, A. (Abraham), 1830-1919.
Date:
[1889]
Catalogue details

Licence: Public Domain Mark

Credit: Enteralgia and chronic peritonitis / by A. Jacobi. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    i i ENTERAL(tIA AND (’irRONiC l'ERltOXITIS. 7 titis. There may be occasional vomitiny, particularly where there happens to be an intervening acute catarrh ; but there are other conditions—for instance, renal and biliary colic—which are more liable to exhibit that very symptom to an excessive degree. Indeed, it is so often absent in chronic peritonitis that its very absence, being a negative symptom, is not of much account. Even in many acute cases it is not met with. There is, for in- stance, none in twenty-five eases out of a hundred of septic peri- tonitis of the newly born. Constipation is frequent, diarrhoea not unusual. Horizontal posture is often quite uncomfortable; but a common colic depending on gas not absorbed or expelled in. duces the same posture (viz.: the knees drawn up) in most in- stances. However, when horizontal posture is shunned in chronic peritonitis, the patient is more apt to be quiet with raised knees than he who is suffering from flatulency; very few of this class will abstain from kicking and moving. The abdomen is apt to he tumid, but it must not be overlooked that general adi- posity is mostly developed on the abdomen ; that women who have had children are liable to have large and prominent abdomens; that that of the healthv baby is so large as to measure one-third of his whole length ; that a simple hysterical dilatation and infla- tion may simulate that which is produced by peritonitis; that with the former, there is sometimes an oedematous swelling of •both hypogastric regions, which complicates the diagnosis still more seriously, and that there may .occur a local dilatation of an intestine from habitual constipation only. The surface of the ab- domen exhibits nets of dilated, veins more frequently in peritonitis (and hepatic diseases) than in any other morbid condition. Now and then there is a friction sound or a slight crepitus on ausculta- tion; inspection may also reveal solitary convolutions which rise above the level : and palpation may lead to the discovery of exu- dations in various shapes and sizes, nodules, lumps, cakes, hard and soft, which are either organized material or glued intestines. Percussion may discover these solid masses, or fluid contents. Fluctuation will show ascites more readily than percussion, for the latter may fail in this, as there may be adhesions between the parietal peritoneum and intestine in the flanks. The gas contained in the adherent bowel will then yield the tympanitic percussion note, though the region may be filled with fluid: a