A treatise on the practice of medicine, for the use of students and practioners / By Roberts Bartholow.

  • Bartholow, Roberts, 1831-1904.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the practice of medicine, for the use of students and practioners / By Roberts Bartholow. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    Diagnosis.—It is often extremely difficult to distinguish typhlitis from perityphlitis or frora occlusion of the bowel by other kinds of obstruction. The points of difference between typhlitis and perity- phlitis can be better understood after the study of the latter, and are therefore reserved. Typhlitis in the mild form is distinguished from other affections of the bowel by the local pain and soreness, by the fullness without impaction ; in the severe form, the symptoms of ob- struction are the same as in other kinds of occlusion, but the local pain and the distinct enlargement of the bowel indicate the existence of an inflammation and fecal obstruction of the csecum. In these af- fections, the decubitus of the patient is an important aid to diagnosis. Chronic catarrh of the caecum is recognized by the locality of the dis- tress. As cancer of the csecum behaves in the same way in the early stage of its formation, there may be no means of differentiating ; but, in the progress of the case, the growth of a nodulated tumor, the pro- gressive increase in the pain and obstruction, and the develoi^ment of a cachexia, are sufficient to indicate the nature of the affection. Prognosis.—In the simple form the prognosis is favorable ; in the severe form it is grave, although recovery will ensue in a large pro- portion of the cases if the management is judicious. In the chronic form, when the connective tissue has become thickened, the prognosis as to cure is unfavorable. . Treatment.—In the treatment of acute typhlitis all active purga- tives must be avoided. If there is but little feverishness, and the local tenderness is slight, saline laxatives may be administered from the beginning, in small doses at short intervals, to induce liquefaction of the contents of the bowel. The hyperaemia is lessened by the same means. When free discharges are obtained in this way, the canal should be kept quiet with opium for a few days. The most efficient and, at the same time, safe laxative is sulphate of magnesia. It is a curious fact that this salt will be retained when other salines are re- jected by vomiting. Rochelle salts may be used as a substitute when Epsom salts is not suitable. Different management is required in cases of typhlitis with impaction and arrest of the intestinal movements. If there be fever and much tenderness, no attempt should be made to relieve the bowels by purgatives of any kind. It is in this condition of affairs that opium in some form, especially in the form of the hypo- dermatic injection of morphia, is so serviceable. The patient should be kept thoroughly under the influence of the narcotic. It is better to combine atropia with the morphia, for greater security and increased therapeutical power. No absolute rule for quantity can be laid down, but the decided effects of morphia, as shown in the state of the pupil, the pulse, the respirations, and the somnolence, should be steadily maintained. The fullest curative power of morphia is obtained from a quantity strictly within the limits of safety, and hence no risk need