The surgical significance of abdominal pain / by James P. Warbasse.

  • Warbasse, James Peter, 1866-1957.
Date:
1912
Catalogue details

Licence: In copyright

Credit: The surgical significance of abdominal pain / by James P. Warbasse. 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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    of the appendix is usually at McBurney’s point. If we carefully palpate the region of the pain, we find the most exquisitely tender spo* somewhere in the neighborhood of McBurney’s point, and if we make a dot on each of these two points, McBurney’s point representing the base of the appendix, and the other point the point of greatest tender- ness, and connect them by a line, that line will represent pretty gen- erally the direction of the appendix. This is commonly a valuable thing to know before we open the abdomen. The differentiation of the pain of appendicitis from other pains, I may speak of briefly. In tuberculosis of the cecum the pain is a more constant pain without the colicky feature of the appendicitis. In cancer of the cecum there is apt to be a pain which is colicky in the beginning, representing the symptom of a moderate degree of obstruc- tion. The intestinal muscularis becoming hypertrophied forces the intestinal contents through the narrowed lumen giving rise to colicky pains. Later, there comes a time when the pain becomes that char- acteristic of acute intestinal obstruction. The pain of ureteral colic must also be differentiated. The pain of rheumatoid arthritis of the vertebral joints affects the nerves leaving the vertebrae. This condition may produce a hyper- sensitiveness of the abdominal wall which has not infrequently been confused with appendicitis. In all of these reflex pains, however, the rigidity, which is partly a voluntary rigidity, yields to continuous pressure. It is not spastic like that which characterizes the involun- tary protective rigidity. The pain of tabes dorsalis with abdominal crises must also be differentiated. In herpes zoster of the i.ith and 12th dorsal nerves and the 1st and 2nd lumbar nerves, there is a sharp boring pain with an exquisite sensitiveness of the abdominal wall, which must be differen- tiated from that of a lesion in an underlying organ; but here again continuous pressure causes the rigidity to yield. It has happened that the vesicles which appear in herpes zoster have been mistaken on the third or fourth day for vesicles due to applications to relieve pain. . In perityphlitis the pain is more of a steady discomfort without the colicky feature unless an appendicitis is superadded. Appendicular colic produces a pain quite characteristic without the distinct muscular protective rigidity. The rigidity, however, supervenes when infiltra- tion of the appendix or an inflammation or infective condition de- velops. Intestinal colic, acute enteritis, right pneumonia, abscess of the right ovary, all produce right sided pain which must be differen- tiated from that of appendicitis. In acute intestinal obstruction, the pain is a distinctly colicky pain. Here we have a distended viscus with its muscularis attempting to overcome an obstruction. This pain persists so long as the mus- cularis is attempting to overcome the obstructing condition. When sufficient absorption of toxins has taken place to paralyze the muscu- laris and to anesthetize to a degree the nerves of the bowel, the pain subsides, even though the bowel be greatly distended. Pain arising from the female generative organs I shall not take the time to speak o . The most striking pain from the urinary organs is that of ureteral calculus, which is violent with reflex pain in the groin, scrotumor labia, and the colicky reflexes which tend to cause vomiting. JLms pain continues to be excruciating so long as the stone is engaged in the part of the ureter covered by peritoneum. The pain suddenly