A manual of medical diagnosis / by A.W. Barclay.

  • Barclay, A. W., 1817-1884.
Date:
1857
Catalogue details

Licence: Public Domain Mark

Credit: A manual of medical diagnosis / by A.W. Barclay. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    570/642 (page 546)
    54G DISEASES OF THE OVARIES. on percussion occupies one side of the abdomen much more than the other; fluctuation extends upwards on that side, and can be readily traced so long as one hand does not pass far beyond the umbilicus,butbecomes at once obscure when it is placed towards the flank on the resonant side. When these two observations cor- respond, the evidence is more satisfactory than that derived from Sny other source : sometimes it is even more striking when the fluid is contained in several cysts, and the tumour is multilocular. In such cases fluctuation may be most clearly perceptible while the hands ai-e placed only a few inches apart, but becomes obscure as soon as the boundary between two cysts is passed; indeed the position of the septa, as they reach the surface of the abdomen, is sometimes dis- tinctly defined. Occasionally the enlarged ovary very early assumes a central position with reference to other viscera, pushing them aside into both lumbar regions pretty equally, and approaching the anterior wall of the abdomen in the hy]Dogastrium; and then the diagnosis requires more care. As the disease advances it gradually encroaches more and more on the whole cavity of the abdomen, and then we have recourse to other measures to ascertain that the fluid is cysted, and not free in the peritoneum. The principles have been already laid down (p. Ill) which ought to be present to the mind in every case that comes before us, and they are equally applicable to the most self-evident as to the most obscure. Bising out of the pelvis, as the diseased ovary does, it is very often possible to trace in the lumbar and iliac regions resonant bowel pushed aside, not floated upwards upon the surface of the fluid. Even when the greater part of the intestines have been forced into the thorax by the enlai’gement of the cyst the ribs do not spread out as when subjected to the ]u-essure of fluid lodged in the peiitoneum, and the abdomen has a globular form ; at the same time, the