EXAMINATION OF THE ABDOMEN - entering upon the consideration of the various organs contained in the abdomen, and their special maladies, it may be well to advert to a few general facts connected with the diagnosis of diseases of nutrition. Regarding the brain as the centre of innervation, the thorax as that of the circulation, the abdomen is especially the region in which the processes of assimilation and excretion are performed. It is not meant that this definition is absolutely accurate; but, as an approximation to the truth, it points out in what direction we are to look for the signs and symptoms of disease there, as connected with the ingestion of food, the preparation of proper elements for absorption, their transmission into the circulation, the rejection of useless materials, and the removal of waste or effete particles, as well as the neces sity for the perfect integrity of the organs by which these pro cesses are carried on. That the deviations from healthy action should manifest themselves in altered condition of blood, in im perfect nourishment of tissues, and in functional disturbance of distant organs, to which the blood is carried, can cause no sur prise ; and the difficulties of the diagnosis are only that while, on the one hand, the deteriorated condition of the blood may not be simply due to defective assimilation and excretion by abdominal viscera ; on the other, important changes in the circulation and innervation must react upon the abdominal organs, as it is by these two great physiological functions that their integrity and power are supplied and sustained.
With reference to history, we must admit that it is often not reliable, nor perhaps very material: no one entirely escapes occa sional derangement of stomach and bowels, and it is impossible to say where healthy reaction against improper food ceases, and unhealthy action begins; hence, in chronic diseases, there are always a number of antecedent phenomena, and it requires skill to select those which are really valuable as facts in the history, as well as greater impartiality than is possessed by most medical men, to avoid putting the necessary questions in such a form as to elicit the answers which we expect to receive, from the general tenor of the symptoms. In cases of acute disease there is less
difficulty in obtaining correct information regarding the sensa tions and experiences of the patient since the severe symptoms arose; but here again we are encountered by the difficulty that the sensations in the abdomen are, at no time, very defined, and that some prior illness, the historical evidence of which is very defective, may have very considerably altered the organic consti tution or functional power of the viscus.
The totality of the general symptoms marking inflammatory fever has the same value here as in other'acute attacks : some times we derive secondary aids to diagnosis from the skin having a feeling of remarkable dryness, the pulse being small and wiry, or intermitting, &c.: the tongue always presents an unnatural appearance in derangements of digestion, and the bowels are sel dom regular in their action, or the feces healthy in character ; besides this, we find changes in the appetite, in the character of the urine, &c. Each of these symptoms has, therefore, a twofold meaning; first, as it forms one of a group which proves whether the attack be acute and inflammatory, or chronic; second, as it stands for one of the signs of disorder in the particular organ : it is very important to bear in mind this double application, and to consider how far each is to be taken as evidence of the general condition which the whole group tends to prove, or derives its importance from mere local circumstances, e. g., how far a coated tongue is to be taken as evidence of inflammatory action or of disordered bowels.
With reference to the appearance of the patient : any degree of emaciation points out a possible defect in assimilation ; even if it amount to no more than that the usual degree of obesity ob served at advancing periods of life is absent, we may still be not far wrong in assuming that the individual is the subject of weak or faulty digestion; but extreme emaciation is a very constant consequence of severe abdominal disease. The aspect of the face and the color of the akin are each of them, again, valuable sources of information in specific forms of disease.