The diagnosis of early pregnancy : with report of one hundred cases and special reference to the sign of flexibility of the isthmus of the uterus / by Ellice McDonald.

  • McDonald, Ellice, 1876-1955.
Date:
1908
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Licence: In copyright

Credit: The diagnosis of early pregnancy : with report of one hundred cases and special reference to the sign of flexibility of the isthmus of the uterus / by Ellice McDonald. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ment was to the right in 26 per cent, and to the left in 21 per cent. When the uterus was symmetrically enlarged, it could not be judged whether the enlargement was anterior or posterior, save in one case where the enlargement is markedly posterior. Softening of the uterus is a sign which should be taken with that of symmetrical or asymmetrical enlargement. It occurred in this series in the same proportion of cases, i.e., 53 per cent, symmetrically, 21 per cent, on the left and 26 per cent, on the right side. This softening usually takes the character, as has been pointed out by Dickinson, Von Braun and Piskacek, of an elastic doughiness, often with firm, isolated points or buttons. The firm part of the uterus is unchanged and, from the soft part being larger and more easily palpated, gains the impression of an increase of density. Weissenberg,32 in his interesting study of the difference in consistency of the two halves of the uterus, noted the softness on one or other side and never symmetrically. In 108 exami- nations he found that the left half was softer in seventy-three cases (67.9 per cent.), while the right half was the softer in thirty-five cases (33 per cent.). The discrepancies between the percentages of the two sides were more marked in the earlier weeks when the left was much more frequently softer. The author of this paper, however, believes that the enlargement is not always to one side or the other, as Weissenberg has it, but that it is sometimes central, anterior or posterior, and is felt bimanually as a symmetrical enlargement. A very marked finding in the present study of 100 cases was the great increase of softness and vascularity in the uterus in proportion to the amount of enlargement which was noted in eight cases of retroflexion. The softening of the uterus and the amount of lividity of the cervix was greater in these cases of early pregnancy with retroflexion, than it was in proportion to their uterine enlargement, and than it was in comparison with the cases of early pregnancy with anteflexion with a history of the same duration. This increase in softening is supposed to be due to the increase in congestion caused by the retroposition. The enlargement and softness of the uterus often joined with a marked thinning of the uterine wall. This is not, however, the rule, although it is not uncommon. The consistency of the uterus should be judged during an interval of relaxation, when the softness and enlargement may be properly appreciated. If it is judged during a contraction,