Essentials of pelvic diagnosis : with illustrative cases / by E. Stanmore Bishop ; and an appendix on examination of blood, etc. by Chas. H. Melland.

  • Bishop, E. Stanmore.
Date:
1903
Catalogue details

Licence: In copyright

Credit: Essentials of pelvic diagnosis : with illustrative cases / by E. Stanmore Bishop ; and an appendix on examination of blood, etc. by Chas. H. Melland. 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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    Thus, the cheesy sensation on curetting with a sharp curette, as pointed out by Sinclair,* is pathognomonic of carcinoma uteri, whilst pain is rarely complained of to any great extent until all chance of a successful hysterectomy has disappeared; and the sensation of surrounding infil- tration is one which should never appear, if we are to hope to radically cure the patient. The symptoms of intense pain and collapse, occurring in a perfectly healthy woman whose last period has been delayed or omitted, are very nearly pathognomonic signs of an ectopic preg- nancy, but as they also mark and signalize the occurrence of rupture, their usefulness is not of primary value. Many symptoms are common to a large number of patho- logical states ; their grouping is therefore of more importance than their mere occurrence. Their presence or absence serve to narrow the field of enquiry, and to point in the direction to be followed ; but they rarely point directly to the actual disease present. These have been utilized in the Lines of Diagnosis, where they will be found in italics, to mark the earlier and broader aspects of the case, and in the Diagnostic Tables to divide up the classes, groups, and sections; and they are of great importance, since without them the final differentiation loses all its value. It is perhaps necessary to emphasize the fact that the absence of a symptom or sign may be quite as important as its presence. It is of no use to mention the presence of a symptom in one disease, if the student has an uneasy suspicion that it may also be present in a dozen others, although its presence has not been emphasized. The first duty of a diagnostician, then, is to collect his facts. These are to be obtained from the account given ; from the family and personal history of the patient as far as it can be elicited ; and also by the use of the practitioner's sight, touch, smell, and hearing. Touch, sight, and -Prof. Sinclair. Bk/. Med. Jour., 1902, vol. ii, p. 3-7-