Surgical lectures and essays / by A. Marmaduke Sheild.

  • Sheild, A. Marmaduke (Arthur Marmaduke)
Date:
[1904?]
Catalogue details

Licence: In copyright

Credit: Surgical lectures and essays / by A. Marmaduke Sheild. Source: Wellcome Collection.

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    violent acute pain in the right iliac fossa. Likely enough this has followed some sudden exertion, as at golf or foot- ball. The pain may be so bad as to cause the patient to cry out. Moreover he will speedily vomit, the vomit being of a greenish colour; the temperature may be raised and the pulse very quick and hard. Tenderness in the iliac fossa will be so great that the patient will complain if you touch the part. The muscles are rigid and “ board- liked’ He will lie in bed with the this'll somewhat flexed. Severe pain may be experienced down the cutaneous nerves of the thigh and towards the end of the penis. As the case progresses you will find that a large inflammatory mass will form deep in the iliac fossa, its limits being in the position 1 will show you on the diagram on the board. This somewhat oval swelling will be hard and exquisitely tender, the abdominal walls being rigid and resistent. The patient meanwhile lias high fever, a red and dry tongue, while his pulse will continue rapid. He is very apt to vomit ahnost everything he takes, because the intestine about the ciecal region may be inflamed and paralysed and thus really obstructed from loss of contrac- tile function. The condition of the bowels varies. Very often if an enema is given a certain amount of fascal material or flatus may pass away, giving great temporary relief. Now as the case goes on, if you leave it alone and do not operate you will find that the skin over the iliac fossa will become of a dusky red colour; and, more- over—this is a very important matter,—it willbe ocdematous, so that if you place your finger over the red swelling and exert a little pressure you will find definite “ pitting.” It is one of the fatal mistakes of practice to take this redness and oedema as an indication of superficial erysipelas, and to make small incisions, leaving a foul abscess undetected underneath. If the patient should survive, the abscess may cure itself by bursting into the intestine. In the olden days, when these abscesses were hardly ever touched, or operated upon with great reluctance, bursting of the abscess into the intestine was one of the methods by which