Excerpt from West London Medical Journal, 1905
(6) Constipation. - This can hardly be described as a symptom of the onset.
(7) Pulse. - This is nearly always increased in frequency, and is small in volume.
(8) Any immediate exciting cause must be enquired for, such as trauma. The strain of lifting a heavy weight or the ingestion of a large meal may precipitate, for instance, the rupture of a gastric ulcer.
(9) The aspect of the patient, even in the early stage, is of importance. He is usually decidedly anxious and distressed in appearance, and is commonly convinced that some serious catastrophe has occurred. In peritonitis the thighs are frequently flexed on the abdomen, so as to relax the abdominal wall.
Having elicited a full account of the mode, time, and circumstances of the onset of the illness, the previous history of the patient should be enquired into, and attention should be directed to the following points: -
(1) The presence or absence of previous similar attacks. Information of the greatest value is often forthcoming. Thus, the patient may have suffered from appendicitis; or a history of biliary colic and jaundice, or of long indigestion with vomiting and possibly h?matemesis, or of renal colic with h?maturia may be obtained; a history of hysteria or neurasthenia is of value. In this connection it must be noted that the knee jerks should be examined, as the gastric crises of locomotor ataxy may be so severe and attended with such abdominal pain that laparotomy has been performed for the want of this precaution.
(2) The previous condition of the bowels should be ascertained. A history of progressively increasing constipation, coupled often with loss of weight, may indicate malignant disease, which not infrequently culminates in complete occlusion of the bowel and the symptoms of acute abdominal disease.
(3) The existence of rupture should be enquired for, and, in the subsequent examination, the rings should always be examined, especially for the presence of small femoral herni? , which are rather apt to be overlooked.
(4) The menstrual function should be thought of. The importance of a full history of this function will be referred to later, when considering extra-uterine gestation.
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