Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    55/332 (page 35)
    General questions should be directed to the digestive and other functions. Family history and history of previous illnesses should be inquired into. B. Present Condition.—Note the manner in which the patient walks into the room: whether erect or stooping, whether she is stout or thin, fresh-coloured or pale, and whether her face betokens presence of pain or not; and if any distinctive odour emanates from her person. Should suspicion be raised by her general appearance of the existence of fever, take her temperature with a thermometer. No accurate value can be paid to the pulse, which the excitement of the interview usually increases in rate. Our methods of exploration are four in number. I. Examination of the abdomen, more particularly directed to the hypogastrium and iliac fossse—per hypogastrium. II. Examination by the vagina—per vaginam. III. Examination by the rectum—per rectum. IV. Examination by the bladder. I. Examination of the Abdomen. First, the patient having all her clothes loosened, the stays undone, and nothing between the examiner's hand and the abdominal wall but the linen, should be placed on a couch on her back in a semi-recumbent position. Every effort should be directed to distract the patient's attention from the examination of the abdomen, which must now be carried out by means of inspection, percussion, superficial (or surface) and deep palpation, and auscultation. For convenience of recording the case the abdomen is divided into certain areas—hypogastric, iliac, umbilical, &c. (i) Inspection.—Is the abdomen really enlarged or not by a uterine or other swelling? Abnormal adipose tissue in the abdominal walls and distension from flatus give to the eye the idea of enlargement. The surface should be examined .for the presence or not of shining white lines; these are usually arranged in a circular manner around the umbilicus, and are most marked below its level where they become parallel to Poupart's ligament. They are due to over-stretching of the abdominal parietes, and hence pregnancy is the most common cause; but it must not be concluded from their presence that pregnancy has existed, as the over-distension from ovarian tumour, ascites, and excessive adipose deposit may similarly cause them. They are also seen on the breasts and thighs. Umbilicus: whether it is situated in the median line, and nearer the xiphoid cartilage or pubes, should be ascertained.