Ovarian tumors : their pathology, diagnosis, and treatment, especially by ovariotomy / by E. Randolph Peaslee.

  • Edmund Randolph Peaslee
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: Ovarian tumors : their pathology, diagnosis, and treatment, especially by ovariotomy / by E. Randolph Peaslee. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    170/618 (page 132)
    Exception-.—One or both flanks may be clear in ascites, from gaseous distention of the colon; but the hydrostatic level of the fluid, in different positions, will, of course, be maintained. Or tbe intestine may be filled witb solid contents, and, therefore, dull, in case of an ovarian tumor. The value of percussion, in a diagnostic point of view, as applied over the lumbar regions in a case of supposed ovarian cyst, was pointed out by the editor of the London Medical Times and Gazette, several years ago ;1 though I have modified his view and given a different explanation of the cause of the clear sound. He had never known this sign to fail: If, in a case of ascites, he remarks, the distention is so great that the hydrostatic line of level in front is not changed by posture— and only in case of ovarian cysts so large as to simulate this extreme condition, ought any difficulty [in the diagnosis] to occur—the patient be made to sit up in bed, and the loins be percussed, it will be found that the note is the same (usually dull) on both sides. If an ovarian case, no matter how great the distention, be treated in the same way, one loin will be found to be clear, and the other quite dull. For, in ascites, the air-containing coils of the intestines float as far forward as their mesenteric attachments will permit, while, in the case of an ovarian cyst, they are pushed over to the healthy side. Only entire exclusion of air from the whole tract of intestines could diminish the trustworthiness of this sign. It also indicates with unfailing accuracy on which side the ovarian cyst, if it exist, has arisen. The exception given above should modify the strength of these remarks. Dr. W. L. Atlee first suggested that the pulsations of the aorta are not felt by placing the hand over the anterior of the abdomen in ascites, while they are transmitted to this surface through an ovarian tumor. 8. By the vaginal touch, fluctuation is detected in ascites at once; in large ovarian cysts it is less distinct, and sometimes cannot be reached at all. The rectal touch easily detects the fluctuation of ascites, and is more liable to feel that of ovarian dropsy. The uterus is often prolapsed somewhat in ascites; and very seldom in case of ovarian tumor without complication. 9. The uterine sound shows the uterus to be in its normal 1 June, 1858, p. 574.