Diseases of women, including their pathology, causation, symptoms, diagnosis and treatment : a manual for students and practitioners / by Arthur W. Edis.

  • Edis Arthur W. (Arthur Wellesley), 1840-1893.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of women, including their pathology, causation, symptoms, diagnosis and treatment : a manual for students and practitioners / by Arthur W. Edis. Source: Wellcome Collection.

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

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    althougli some little time Avill be lost, much will be gained from her method of telling it; and should she become somewhat discursive, the practitioner can readily bring her back to the more immediate symptoms by following up any clue that her narrative may have given him, or elucidating more fully any special points for investigation. Among hospital patients, more especially when we have those voluble Celts to deal with, who habitually complain de om.nihus rebus et qui- husdam aliis, it is often advisable to launch out in medias res, and ask boldly. What do you complain of? our subsequent plan of action being determined by the nature of the complaint; thus, if pain be the principal symptom, its seat, nature, constancy or i-ecurrence, dura- tion, &c. It is well to avoid putting leading qviestions, for the answers are often very misleading, the patient either not understanding the query, or thinking it right to say yes or no, depending upon the manner in . which the question is asked. A far better plan is to lead up to the point you are anxious to ascertain, without, however, suggesting an inference or allowing the patient to see the drift of your queries. In young and unmarried patients it is always better to ascertain the general condition of the prmcipal functions before proceeding to the discussion of the uterine symptoms, as the nervous, the circula- tory, the digestive, ascertaining the condition of the bowels, and then inquiring as regaixls the menstiual function, levicorrhoea, dys- menorrhoea, &c. The duration and frequency of the catamenial periods should always be noted, together with the fact of their being scanty or profuse, painful or natural. Much may be learnt by a careful study of the physiognomy. It is difficult to convey in words the significance of the vaiious shades of chloro-ansemia. It is an experience to be gained only by practice. The appearance of anfemia from incipient phthisis in the young differs mateiially from that of chlorosis, and tliis again from the semi- chlor-otic tinge due to haematocele, or the pallor arising from pelvic cellulitis, or the blanched aspect depending upon menorrhagia, or the cachexia from malignant disease of the uterus. And yet the grada- tions are so slight that it would need a thorough artist to depict them aright. Again, in ovarian tumoui-s the physiognomy is most characteristic. Functional disorders of the ovary stamp their im- press on the countenance as well as on the upper lip and other portions of the face not usually hidden by hirsute appendages. It is only after much experience that the young practitioner will be enabled to estimate at their proper value the so-called sul)iective symptoms, i.e. what the patient herself tells him : he will frequently find that the objective signs, i.e. the actual physical condition of the parts, are by no means in direct relation the one to the other, in fact they often vary inversely—the more the complaint the less the cause. Many young women refuse to acknowledge they are ill or suffering until the fact is so patent to their friends that it is useless any longer denying it; bashfulness and a dislike to be considered ill, or to adopt the requisite precautions, being their chief motives in maintaining silence. Whereas among older patents they are apt to exaggerate trifling ailments, and make mountains of molehills,