File:The diagnosis and treatment of diseases of women (1907) (14597945937).jpg

Identifier: diagnosistreatmecros (find matches)
Title: The diagnosis and treatment of diseases of women
Year: 1907 (1900s)
Authors: Crossen, Harry Sturgeon, 1869-
Subjects: Genital Diseases, Female Gynecology Gynecology Women Generative organs, Female
Publisher: St. Louis : Mosby
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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domen, a conditionthat could be caused only by free fluid in the peritoneal cavity. As the patientstood, there was distinct bulging of the umbilicus (Fig. 138) and distinct fluctua-tion through the thin umbilicus. There was present also edema of the abdominalwall. On vaginal examination, no tumor wasfelt in the pelvis. These signs wereconsidered sufficient to exclude ovarian cyst, and I sent the patient back to herphysician with a diagnosis of ascites. As there was no decided kidney diseaseor heart lesion, the marked ascites was supposed to be of hepatic origin, which CHANGEABLE OUTLINE OF DULLNESS 161 diagnosis was confirmed by the womens death from sudden gastric hemorrhageand by the partial post-mortem examination, the details of which were kindlygiven me by her physician. Figs. 136 and 137 show other cases in which the amount of ascitic fluid was sogreat that the abdominal wall was raised above the intestines, and the corona ofresonance about the umbilicus was consequently absent.
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Fig. 193. Extreme Ascites. Same patient as shown in Fig. 191. TheTwo Resonant Areas contrasted. The area enclosed by the sohd line isresonant when the patient is on her back, while all elsewhere is dull onpercussion. The area enclosed by the dotted line is resonant when thepatient stands, while all elsewhere is dull. The change of outline ofthe dullness on change of posture, is clearly marked. Again, ascites may be associated with an abdominal tumor, either as a complica-tion or from some intercurrent disease. In either case, the association of the twois indicated by the outline of the area of dullness with the patient in- differentpositions. Fig. 118 shows a patient presenting obesity and a fibroid tumor andmoderate ascites. The obesity was very apparent on inspection. On palpating, to 162 GYNECOLOGIC DIAGNOSIS determine if there were any further causes for the prominent abdomen, I foundthat there was a distinct mass extending upward from the pelvis into the centralabdomen. Nothing m

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