The clinique médicale; or, reports of medical cases / Condensed and translated, with observations ... from ... medical authors: by D. Spillan.

  • Andral, G. (Gabriel), 1797-1876
Date:
1836
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Licence: Public Domain Mark

Credit: The clinique médicale; or, reports of medical cases / Condensed and translated, with observations ... from ... medical authors: by D. Spillan. Source: Wellcome Collection.

    1032/1050 (page 1000)
    CHAPTER II. ACUTE PERITONITIS CURED. Case 8.-—Acute peritonitis, the first synniptoms of which showed themselves during the paroxysm of an intermittent of the tertian type. He had had already five paroxysms, which presented nothing unusual, and during the intermissions he was in good health, when at the commencement of the cold stage of the sixth paroxysm he felt acute pains in the abdomen, which were increased by pressure and by motion. These pains continued during the cold and hot stage, and disappeared according as the sw'eating stage set in. Till the return of the next paroxysm these pains did not reappear ; pressure on the abdomen did not excite them, but the patient was pale and more cast down than usual. The pain re- appeared with the cold stage of the seventh paroxysm, but disappeared with the sweat as at first. Till then the intermittent fever had been left to itself. After the seventh paroxysm we began to give the sulphate of quinine in ten-grain doses. At the usual time the shivering reappeared with the abdominal pain ; there w'ere also two attacks of bilious vomiting. After having lasted only an hour,it ceased ; but was not succeeded either by a hot stage similar to that of the preceding paroxysms, nor by sweat ; other symptoms much more alarming appeared ; the abdominal pain continued to be very acute ; the abdomen become tense ; bilious vomiting came on every half hour, small at first, but very distressing to the patient. The face became shrivelled and pale, and the pulse very frequent. On the next morning there was no doubt of the patient been attacked with peritonitis. Leeches were ordered, and as there was constipation castor oil also was given in small and re- peated doses. The leech bites continued to bleed all the day ; he had five or six bilious stools. The next day the abdominal pains wmre felt only on pressing or moving, but then they were very acute ; he could lie only on his back. Some nausea still, but no vomiting. Abdomen full and tense. Leeches applied every day for the three days following, and a blister to each leg. He wms now in the sixth day of his peritonitis, and the pain had been decreasing every day, as also the fre- quency of the pulse. The skin, which was till now dry, was covered with a pro- fuse sweat. On the 10th day he was convalescent. We may here observe the evident success of the treatment employed. For four days an almost constant bleeding was kept upon the abdominal parietes, and before this a general bleeding had been adopted. The castor oil seemed to be very serviceable, and lastly, the blisters applied to the lower extremities, at a time when the inflammatory symptoms were much less acute, effected a useful revulsion, and accelerated, no doubt, the complete resolution of the peritonitis. Irritants applied to the skin as revulsives have certainly been very much abused ; when employed too soon, or with persons of very irritable habit, or with very active sympathies, they have but too often aggravated the inflammation which they were intended to subdue. Instances of their danger occur in several parts of this work. But in many cases their great advantage cannot be called in question. It wdll be seen that in general blisters, applied to the lower extremities, at a distance from the seat of the disease, have appeared to succeed best. Thus in cases of pleuritis, pneumonia, and pericarditis, it is to different parts of the lower extremities] that we should apply revulsives, though there may be cases in w'hich their application to the chest itself be more useful. In cases of acute cerebral affection, the application of a revulsive to the nucha has scarcely ever appeared to be attended with advantage ; with respect to blisters to the cranium, they have always seemed to have an injurious influence. On one occasion in a