Outlines of the diseases of women / by John Phillips.

  • Phillips, John
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    57/332 page 37
    in the peritoneal cavity to any large extent may be considered as probable. If, however, dulness is present m both flanks the Patient should be told to turn on to her side ; if the elevated flank £ive a resonant note on percussion, fluid in a free state and m some quantity is probably existent in the peritoneal cavity. It a dull note is still elicited on percussion, then the fluid is either encysted or possibly a renal tumour may be present The ascending, transverse, and descending colon usually give if fairly distended, a tympanitic note, and can easily be mapped out on the abdominal surface. .,,,.11 j 4.1. U) Palpation should be performed lightly with both hands, tne pulp of the extended fingers being always used in preference to their tips The reasons for this are twofold: much more sensi- tiveness is present in the pulps, and the pain given to the patient is less It is needless to say that the patients attention must be distracted as much as possible, and her alarm pacified during the performance of palpation. Opening the mouth wide, taking a deep inspiration, and expiring gently and slowly are two practical methods of reducing rigidity of the abdominal wall. Facts to be ascertained by Palpation—(a) The presence or not of pain, and whether it is surface or deeper tenderness. This is surrounded with great difficulties. In hysterical women the mere palpation of either iliac fossa will produce apparent symptoms of pain. If the operator's hands are cold, real surface pain is produced. . . (b) The presence of any swelling, its apparent site ot origin— that is to say, whether it arises in the hypogastric, iliac, or lumbar regions (c) The characters of the swelling; whether it is mobile or fixed smooth on its surface or nodular; its shape, whether round or oval; whether on light friction over the abdominal surface rhythmic contractions and relaxations are felt; if at intervals, irregular movements can be detected. These two latter are absolutely distinctive of pregnancy. It must be remembered that percussion and palpation, although described separately here, may be carried out together. (d) Separation of the recti: this may be congenital or be a result of abdominal section; in extreme cases the majority of the intestines protrude through the cleft, forming a large ventral hernia. This accident through the site of an operation wound is unfortunately not uncommon. The condition is diagnosed by placing the fingers between the cleft, with the woman in the semi-recumbent position, then telling her to try to sit up. Immediately the recti are put into action, and their inner edges come into close apposition, nipping the examining fingers. The
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