Clinical lectures on some obscure diseases of the abdomen, delivered at the London Hospital / by Samuel Fenwick.

  • Fenwick, Samuel, 1821-1902.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on some obscure diseases of the abdomen, delivered at the London Hospital / by Samuel Fenwick. Source: Wellcome Collection.

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    tissue of the pelvis, which had burst into the sigmoid flexure of the colon or the upper part of the rectum ; but no absorption of the decomposing materials had taken place, and consequently the only ill effects of the perfora- tion were those of the diarrhoea excited by the contact of the pus with the mucous membrane. I think then we are justified in concluding that there are two classes of cases j in one the decomposition set up by the entrance of feculent matter into the abscess induces local gangrene, and the symptoms of septic poisoning; in the other the bursting of the abscess may afford relief, but is also very apt to set up exhausting diarrhoea from the irritation produced on the mucous membrane of the intestine. In two out of thirteen cases of fgecal abscess arising from catarrhal ulceration the formation of the abscess was attended by repeated rigors, but pain in some part of the abdomen was the most common accompaniment, and lasted during the whole progress of the case. It was noted as a prominent symptom in nine out of thirteen, but was pro- bably present in all; in five it is stated to have been in the abdomen, in one in the hypochondrium, in one in the hypogastrium, and in one in each iliac region, and it was generally accompanied by tenderness on pressure. Frequent vomiting was mentioned in five cases, consti- pation in five, and severe diarrhoea in seven, but in some constipation had preceded the diarrhoea. There was marked tympanites in four; the tongue was noticed as brown and dry in one, as coated in one, and as dry, red, and fissured in two cases. Great exhaustion and emaciation seem to have been present m almost every case, and in two the skin was said to have been yellow, probably from jaundice resulting from pyaemia. In two of the cases of fgecal abscess that have come under my own notice, rapid loss of flesh and strength, a quick pulse, fever, a dry, cracked, or brown tongue have been the prominent symptoms, but the patient has not presented the pallor of the lips and skin that so generally accompanies malignant disease.