The diagnosis, pathology, and treatment of diseases of womem : including the diagnosis of pregnancy / by Graily Hewitt.

  • Hewitt, Graily, 1828-1893.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: The diagnosis, pathology, and treatment of diseases of womem : including the diagnosis of pregnancy / by Graily Hewitt. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    there could be no fluctuation. Fluctuation of this kind might be observed in that rare disease, fibro-cystic tumour of the uterus. It is hardly necessary to mention that we are presuming that all cases of ordinary, ascites, or of ascites combined with tumour, or of distended bladder, have been excluded from the question by following tlie instructions contained in the preceding chapters. The absence of fluctuation does not, however, indicate that the tumour is not ovarian. If we examine the uterus from the vagina digitally and by means of the sound, and clearly ascertain that the os is natural, that the cavity of the uterus has its normal length, the conclusion to which we may come as regards the diagnosis of the tumour before us is, that it cannot be a polypus of the uterus; but this is the extent of the knowledge afforded. Polypus of the uterus may be excluded in other ways from the consideration. Thus, the previous history in cases of polypus is usually one of occasional haemorrhages, profuse menstruation, leucorrhoea, &c. The tumour when due to such a cause is very hard, externally it has the shape of a pregnant uterus, it is rare that it exceeds in size the gravid uterus of six or seven months, and the presence of a tumour ivithin the uterus is generally plainly to be made out by a digital exami- nation from the vagina and by the use of the soimd. In some cases the polypus partially occupies the vagina. The diagnosis, so far as regards the exclusion of polypus of the uterus from the list above given, is generally easy. The diagnostic signs are in brief as follows: there is a hard, smooth, well-defined, abdominal tumour of slow growth, the uterus evidently enlarged from the vagina, its cavity greatly lengthened, a hard tumour is percep- tible within the uterus. But it is not so easy to distinguish fibroid tumours of the uterus of large size from others of the above tumours not uterine in origin, and there is in fact very considerable difficulty frequently encountered in making a diagnosis between them. It will now be pointed out how these difficulties may be best surmounted. It is useless to attempt to distinguish the ovarian tumours inter se until we have thus separated the uterine and ovarian tumours one from the other. They have the following characters in common :—the pelvic cavity may be found distended by a tumour firm to the touch in both cases. The abdominal tumour may be firm to the touch in both cases. It may be of slow growth in both cases. It may be rounded, smooth, and have a tolerably uniform surface, in both