Medical diagnosis : a manual of clinical methods / John James Graham Brown.

  • Brown, J. J. Graham (John James Graham)
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Medical diagnosis : a manual of clinical methods / John James Graham Brown. Source: Wellcome Collection.

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

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    small intestine, appears in the centre of the abdomen, especially between the umbilicus and the pubes. The abdomen then presents what Wyllie calls the ladder-pattern, as in Fig. n. Where the obstruction is at the pylorus the stomach only is distended, and it may shew visible peristaltic movements, its contour standing out in relief during the rigid spasms into which it is thrown from time to time. Retraction of the abdominal walls is met with in cases of inanition from whatever cause (particularly in oesophageal obstruction), and in all wasting diseases. It is also seen in various diseases affecting the nerve centres (as, for example, in tubercular meningitis), and is then attributable to contraction of the intestines, determined by the irritation at the base of the brain. In such cases the bony walls become prominent; the vertebral column, with the pulsations of the aorta lying on its left side, may be seen, and the relaxed abdom- inal walls form pendulous folds. Local tumefaction may occur in connection with various abdom- inal organs as follows :— Stomach.—Dilatation of this viscus gives rise to an oval swelling occupying the epigastrium, and extending chiefly towards the left. The position of the greater curvature may be indicated by a diagonal furrow running from the right downwards, and to the left. The outline of the stomach is best appreciated when it is artificially distended, according to the method originally recommended by Frerichs. The patient is made to swallow successively a solution of tartaric acid, and one of bicarbonate of soda, of each salt as much as may be carried on the point of (4 7> Fig. ii.—Abdomen, laddr pattern (after Wyllie).e