A practical treatise on medical diagnosis for students and physicians / by John H. Musser.

  • Musser, John Herr, 1856-1912.
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on medical diagnosis for students and physicians / by John H. Musser. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    1120/1378 (page 1002)
    Peritonitis is simulated by a condition to which the name hysterical peritonitis has been applied. It occurs in hysterical subjects, and every feature of the true form is imitated. The mode of onset, the decubitus, the difficulty in micturition, and the local distention and tenderness of the abdomen are characteristic of both. In a few cases that I have seen the vomiting differed from that of true peritonitis, both in the mode of ejection and in the character of the fluid. It must not be forgotten that the temperature may even be elevated, and collapse may take place in the hysterica] form. In the cases that I have seen, the abdominal facies did not develop; on the contrary, the facies of hysteria, with the self-interest Bimanual palpation to determine if pus is localized in the retrocecal region. exhibited by the patient, and the precision with which symptoms were narrated, coupled with emotional or other manifestations of hysteria, sug- gested the true nature of the affection. The case is judged by the history of other manifestations of hysteria and the presence of permanent stig- mata of the disease; there is always a positive absence of cause and of disease in any of the abdominal viscera. Sometimes if the patient's attention is diverted, the tenderness on pressure may not be complained of. I am not familiar with the results of examination of the urine in this form of peritonitis; indican should not necessarily be increased, as it is found to be in acute suppurative peritonitis. Local Circumscribed Peritonitis. The causes of localized peritonitis are those of general peritonitis—extension of inflammation from, or per- foration of neighboring viscera. After perforation has taken place the process remains localized if the inflammation progresses rapidly enough J to bring about immediate isolation of the perforated area from the gen-