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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    versely ; (2) Bulging prominently in some eccentric direction, whilst the rest of the wall lies flat; or (3) Ballooned out in all directions, with, except in the most extreme cases, a little flattening at the highest point. The eccentric position of the swelling in the second condition, evidently not common to the entire wall, is characteristic of a tumour of some kind, and is seen in no other condition. The examiner's hands are now laid flat upon the surface, the examiner sitting or kneeling at the side of the bed, so that the elbows are on the same level as the wrists. All movements of his hands and fingers are made from the carpal, metacarpal, and phalangeal joints alone, and are as gentle as possible. The muscular abdominal wall must be treated as though it were some half-trained animal, which would become unmanageable at the first display of force. Any rough or sudden movement will be followed even in the quietest patient by an automatic tightening up of the muscular wall; still more will this be the case if the patient is nervous or anxious, as most of them are. With the hands applied in this way, the examiner rests absolutely still for a minute, and then imperceptibly begins to move them, pressing slightly to the ulnar and slowly back to the radial side—slowly pressing first one finger, then another against the skin. The abdominal wall at first feels as if it were made of elastic wood, then of thick felt, then of two or three folds of blanketing, then of two, then one fold, and, lastly, in some cases, as though only a sheet interposed between the searching fingers and the organs sought. In some cases the earlier sensations will seem to be omitted, being passed through quickly ; in some the later ; but they are all passed through in regular gradation and in the order given, if no sudden dig or too powerful pressure brings back one of the earlier states.