File:The diagnosis and treatment of diseases of women (1907) (14761463356).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

View Book Page: Book Viewer
About This Book: Catalog Entry
View All Images: All Images From Book
Click here to view book online to see this illustration in context in a browseable online version of this book.

Text Appearing Before Image:
unt of fluid is so greatthat it fills the peritoneal cavity and raises the abdominal wall above the intestines(higher than the mesentery will permit the intestines to float), giving dullnessabout the umbilicus as well as elsewhere. This does away with the coronaof resonance about the umbilicus, which is so characteristic a feature of ordinaryascites. Fig. 135 shows a patient sent to me with a supposed ovarian cyst. The general 160 GYNECOLOGIC DIAGNOSIS appearance was very much like that of a cyst distending the abdomen. Thearea about the umbiUcus was dull, excluding ordinary ascites. In percussing care-fully over the whole abdomen, however, I found an area of resonance in the leftupper abdomen. Fig. 191 shows the outline of this area when the patient waslying on her back. Fig. 192 shows the outline of the area of resonance when thepatient was standing. A comparison of these two areas (Fig. 193) showed thatthere was decided variation in the area of dullness with the change of position.
Text Appearing After Image:
Fig. 192. Extreme Ascites. Area of Dullness with patient Standing.Same patient as shown in Fig. 191. Notice the marked change in theresonant area. The upper limit of the dullness is now almost horizontal.The former marks have not been completely removed. without any important change in the general shape of the abdomen, 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 hemorrhagea

Note About Images