A manual of medical diagnosis / by A.W. Barclay.

  • Barclay, A. W., 1817-1884.
Date:
1857
Catalogue details

Licence: Public Domain Mark

Credit: A manual of medical diagnosis / by A.W. Barclay. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    136/642 (page 112)
    Bions of tlie intestines are found binding them down in certain positions; nay, more, almost the whole of the bowels may be fixed ill their places, and the fluid poured out into one portion only of the cavity, where it is retained even more firmly than when contained in a cyst. In considering such cases, infonnation sufficient to put us on our guard against mistake may be derived from the early history of the case and the condition of the patient, with reference to the date of formation and the actual size of the sup- posed cyst. The pain of peritonitis, such as must have existed to cause the adhesions, and the whole character of the seizure can never be simulated by the pain occasionally attending the first appearance of ovarian dropsy. Neither does the same disturbance of the general health manifest itself when an ovarian cyst has become filled to the same extent for the first time, as must of necessity accompany ascites with adhesions so extensive. A mistake is most liable to be made when the patient asserts that swelling existed before the occurrence of pain, and other causes have led to derangement of health. Hydatid cysts are much less liable to be mistaken for ascites. They are discriminated by the history and mode of growth, their firm feeling and less distinct fluctuation, and often by their irre- gularity of outline ; but, more than this, ate they distinguished by the position of the fluid with reference to the intestine, as ascer- tained by percussion, not obeying the laws of gravitation. Hydro-metra is only liable to be confounded with the earlier stages of ovai-ian dropsy. A distended bladder cannot lead to any mistake, except by neglect of one of the essential inquiries— the condition of the urine, and extreme carelessness in investi- gating the case. Diagnosis is necessarily incomplete, except we can ascertain with more or less confidence the cause upon which ascites depends. This is most ajit to be over- looked when anasarca exists to such an extent, and its causes appear to be so definite, that the ascites is con- sidered as only one manifestation of general dropsy. Unquestionably its most common cause is obstruction of the portal circulation in disease of the liver, causing effusion of serum from the capillaries of the various venous branches which unite to form the vena portae. When this is produced by chronic inflammation and shrinking of the liver, inflammatory thickening of the peritoneum often goes along with it, and probably aids the effect by intei’fering with absoiqition. It is also believed that chronic peritonitis may thus, without