Volume 1

A dictionary of medicine : including general pathology, general therapeutics, hygiene, and the diseases of women and children / by various writers ; edited by Richard Quain ; assisted by Frederick Thomas Roberts and J. Mitchell Bruce ; with an American appendix by Samuel Treat Armstrong.

  • Quain, Richard, 1816-1898.
Date:
1895, ©1894
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of medicine : including general pathology, general therapeutics, hygiene, and the diseases of women and children / by various writers ; edited by Richard Quain ; assisted by Frederick Thomas Roberts and J. Mitchell Bruce ; with an American appendix by Samuel Treat Armstrong. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    canal; (e) the inferior cava; (/) the psoas muscle; (g) the pelvis of the kidney; (h) the spinal canal; or (i) the ureter, biliary pas- sages, or oesophagus ; the order given repre- sents the relative frequency of the fatal result; or (2) by exhaustion or syncope. The dura- tion of hfe after the rupture of the aneurysm has ranged from a few minutes to several weeks. A consecutive false aneurysm, retro- peritoneal in site, is specially characterised by feeble pulsation of the tumour, and diminished or arrested circulation in the femoral artery of one or both sides. Treatment.—The curative treatment of abdominal aneurysm maybe considered under three heads—operative, postural and die- tetic, and medicinal. Operative treatment consists in pressure applied to the aorta on the proximal side of the sac, or simultaneously on its proximal and distal sides, by means of tourniquets, so as completely to stop the circulation. The bowels should be first well moved and freed from flatus ; and during the continuance of pressure the patient should be kept under the influence of chloroform or ether. As a rule, compression should not be employed above the level of the duodenum. Five cases, if not more, in which a cure was effected by these means have been reported. The object sought to be attained being that of effecting rapid coagulation in the sac, the period during which pressure needs to be continued in these cases varies from three quarters of an hour to ten hours and a half. Where space for the application of proximal pressure does not exist, distal pressure alone may be tried. Under all circumstances, pressure must be used with care, as inflam- mation of the peritoneum or of the bowels has been known to result from it. Galvano- puncture, and the introduction of iron wire into the aneurysmal sac (Moore's treatment), have also been employed. In a small pro- portion of cases the latter method has been attended with a favourable result. Bellingham introduced the plan of treat- ment by posture and restricted diet. Under this plan perfect repose of mind and body is, as far as practicable, to be maintained; the bowels being kept moderately free, and the dietary restricted to 10 oz. of solids and 6 oz. of liquids daily. According to the method of the late Mr. Tufnell, which is based upon the same principle, but is more rigid, the patient is strictly confined to the horizontal posture for a period varying from eight to thirteen weeks, as determined by the effect upon the aneu- rysm, movement in bed being effected with caution; whilst, by a special arrangement, the bowels and the bladder may be evacuated without disturbance of the body. For break- fast, 2 oz. of white bread and butter, with 2 oz. of cocoa or milk, are allowed;. for dinner, 3 oz. of meat, with 3 oz. of potatoes or bread, and 4 oz. of water or claret; and for supper, 2 oz. of bread and butter, and 2 oz. of milk or tea. The total amount in the twenty-four hours would be: solids 10 oz., liquids 8 oz. This system might be in some degree relaxed if the patient proved restive. Mild laxatives and opiates as required are the only medicines used. Ten cases of the successful treatment of aortic aneurysm by this method have been reported by Mr. Tufnell. Abdominal aneurysm was solidified in two instances, after treatment extending over thirty-seven and twenty-one days re- spectively. Of the various medicinal agents used with a view to favouring or effecting a deposit of laminated fibrin in the sac, acetate of lead, iodide of potassium, aconite, and ergotin (ad- ministered hypodermically), alone claim at- tention. Iodide of potassium may be given with advantage in doses of 10 to 20 grs. thrice daily, with a view to reducing vascular tension, and thereby relieving pain and pro- moting deposition in the sac, whilst perfect rest in the recumbent posture and a restricted dietary are observed. The latter are, how- ever, the more important factors in the treat- ment. Dr. G-. W. Balfour has reported several cases successfully treated by means of iodide of potassium ; and an example of a similar kind was subsequently published by Sir Dyce Duckworth. Dr. Grimshaw has recorded an example of cure mainly through the use of aconite. In all cases the allowance of liquids must be reduced to the lowest pos- sible standard, whilst excretion is promoted. Alcoholic stimulants may be given in small quantity and at long intervals, if the pulse exhibit debility and the patient complain of a sensation of sinking; otherwise they should be prohibited. The palliative treatment as applied to abdominal aneurysm will be found described in the article Aorta, Diseases of (Aneurysm). The application of a few leeches, followed by a warm poultice, is very efficacious in relieving pain. The hypodermic use of morphine is still more rapidly effective. Thomas Hayden. C. J. Nixon. ABDOMINAL TYPHUS. — A synonym for typhoid fever. See Typhoid Fever. ABDOMINAL WALLS, Diseases of.—But little more will be needed in this article than to give a brief outline of the nature of the affections to which the abdo- minal walls are liable, as most of these are but local forms of diseases which are fully described in other parts of this work. The parietal peritoneum will be excluded from consideration, as its morbid conditions are treated of separately. 1. Superficial Affections.—a. The skin covering the abdomen may be the seat of various eruptions. The rash of typhoid fever is chiefly observed over this region.