Lectures on the Principles of Surgical Diagnosis: Especially in Relation to Shock and Visceral Lesions
Authors: F. Le Gros Clark
Journal: BMJ (1869)

is the solitary occupant of the sac; and still more so in the not infre- L ECT URE S quent complication of the presence of a small recent initestinal protrusion behind an old and irreducible omental ruipture. ON THEThe symptoms which characterise internal strangulation and recent PRINCIPLES OF SURGICAL DIAGNOSIS hernia are very closely allied, and for the obvious reason that these con- ditions are in all essentials identical, differing only in the accidental cir- ESPECIALLY IN RELATION TO SHOCK AND cumstance of locality.Some of these symptomis are due to the com- VISCERAL LESIONS.pression to whiich the bowel is subjected, and these are the earlier and Delivered at the Royal College of Suergeonts of England.more acute; such as pain, whichi is bothi topical and imore or less general over thle abdomlen, and often assumes the chiaracter j'ust now referred to, By F.LE GROS CLARK, F. R.C. S.,of a sense of painful dragging and conistrictioni acr-oss the umbilical Hunterian Professor of Suirgery and Pathology in the College; Surgeon to region; rejection of the contents of the stomiachi, excited immediatelySt. Thomas's Hospital; and Examiner in Surgery at the anything is swallowed; tenderness in the swelling if externial, or at some University of London.~~particular spot if internial.Small recent hiernicw are most liable to stran- guilation; and in such cases the strangulation is usually most acute: but LECTURE TI.-LEsioNs OF ABDOMEN (CONTINUED).the topical signs are much modified in old ruptures; for the accustomed Intestjijal Obstruction frlzVrosCue.Ilra n xenldescent of a heinia renders it less susceptible of pan and may lead to StrangurolatoSioasesn-ntrnl ndExeralits being overlooked even when the genieral symptomns hiave declaredi Stranulatin: yS'ng5oms anzd Sig,ns.-GeneralObser-vations oCt themselves.Indeed, wh-en acute local indications ushier in stranlgulation hlerniial anid other Obstirnc/ions.-Fatality of 0Ojorations, for Ilernia, in an old hernia, the explanation is probably to be found in the acci- Si( tomaCh ue and Intc tinesC.ltioz oei, Boies in thze dental addition of a small knuckle of intestine to the ordinary omental Stomeich tzndIiitesliizes.~~~contents of the sac, -a form of ruptuire whiichi, as I have already re- LESIONS OF THE PELVIC V'ISCERA, marked, is frequent, especially where the omentum is adherent andlFracturies of thie Jhis/vs andt their-C'omJl,icationzs.-RP,,tulre of.Blader,e1; therefore irreducible. 1 would observe that this occuirrence may miisleadIs it alway pea?Eft:cisdrtossgetdteey Rt- the inexperienced operator ; for tlse intestinial addition is ofteni very ture or Lacer-ationi of Urethra C'auses and Sylmiptomis.-Tr-aumiatic small and entirely hidden, until sought for; anid its return, during or Lesions of Rectul.-S/hock in Pelvic In/urtiies, and in C'ertain Mforbidi immediately prior to an operation, accounts, as I believe, for the appa.Coniditionzs of the C ?e;us.-Recajpitulation.-Indications Premzonito;jy rent anomaly whiich I have met with, of symptoms of acute strangulation ofDissoluttioni or C0n17alescence.-C'onclutsiont.coincident with the presence of unconstricted omienitumi-only in a sac.MR.PESIDNTI AD GETLEME,-Itwouldbe dfficut tomeet At a later period the character of the vomit becomes altered, as the withi a more apt illustration of the remark with which I commenced Poin' fdprueo h elce sra eee rmtesoah tlls curs ofLectirs tan n te ubjct f itesina obtrutios.But this feature-fcecal dischiarge by the mioutith-chiaracterises a stage thiscouse fLeturs tan i th sujec of ntctiial ostrctins, distinct from that in wvhich the mechianical irritation of constriction isThe essential conditions under whichi sudsi obstruction from strangyula-the cause of sickness: the regurgitant v omit is the consequence, as tion occurs, whiether initernal or external, may be identical, yet one already explained, of obstructioni and accumulation in the intestine; andl class of cases is assigned to the physician anid the other to the surgeon.the rapid developmenit of this sign is, to a certain extenit a measure of But the diagnosis of these coniditions in the two classes is by no mi-eans the distance from the stomach of the seat of stranguilation.