File:The diagnosis of diseases of women (1905) (14783356273).jpg

Identifier: diagnosisofdise00find (find matches)
Title: The diagnosis of diseases of women
Year: 1905 (1900s)
Authors: Findley Palmer. (from old catalog)
Subjects:
Publisher: Philadelphia and New York, Lea brothers & co.
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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lar structureto dense bands. They are most frequently found about the adnexaeand behind the uterus. Much less frequently they are found infront of the uterus, for the reason that the infection commonlytravels through the tubes to the peritoneum, and it is unusual forthe tubes to lie in front of the uterus. Gonorrhoea is the most common cause of adhesions, and next inpoint of frequency are the infections following labor and abortion.As a result of the adhesions the uterus and adnexa^ are more or less THE DIAGNOSIS OF PERITONITIS 477 fixed, and their position is altered by contraction of the adhesions.With the exception of prolapsus and inversion of the uterus, allsorts of malpositions are caused by adhesions about the uterus andits appendages. The clinical diagnosis rests upon the physical findings. In aconjoined examination the adhesions are recognized as cords andbands, rarely as a diffuse thickening surrounding the viscera of thepelvis and uniting their peritoneal surfaces. Fig. 191
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Peritoneal adhesions bind the uterus in retroposition. The abnormal fixity of the organs and their displacements aresuggestive of the presence of adhesions. Not infrequently suchfixity and displacements are recognized in an examination withoutanaesthesia, and it is presumed that adhesions exist, though they arenot demonstrated without the administration of an anaesthetic. Where displacements of the uterus and adnexce with restricted rangeof motion are associated with tenderness and an indefinite sense ofresistance at the side of or behind the uterus, an anaesthetic should 478 SPECIAL DIAGNOSIS he administered to determine the ^possible presence of adhesions andexudates. ^ Differential Diagnosis. It is at times extremely difficult to differ-entiate a pelvic peritonitis from a hypercesthesia peritonii found inwomen of nervous temperament. The general nervous state of the in-dividual, the absence of all causes of infection, and, finally, a conjoinedexamination under anaesthesia will serv

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