The practice of medicine and surgery : applied to the diseases and accidents incident to women / by W.H. Byford and Henry T. Byford.

  • Byford, W. H. (William Heath), 1817-1890.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: The practice of medicine and surgery : applied to the diseases and accidents incident to women / by W.H. Byford and Henry T. Byford. Source: Wellcome Collection.

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    although they may occur at any time during the active condition of the sexual functions, while the ovaria are subject to menstrual con- gestions and their effects. Quite a large number of cases make their first appearance in early menstrual life. In rare instances they are congenital and show themselves in infancy and childhood. Fibrous growths of the uterus are not likely to begin so soon. Their increase after being first observed is comparatively rapid, more so in the young than those somewhat advanced in age. They are not usually at- tended with pain in their own proper substance; this is not always true, for the congestion and hyperexcitement may be attended with pain and soreness. Functional disturbances in their early stages often occur in the pelvic viscera; first, on account of pressure, such as tenesmus, dysuria, dragging, or weight in the pelvis; and secondly, imperfect menstruation. Sometimes the menses are suppressed, scanty, and painful, but often no deviation is observed. The main thing in the history of the case, in this respect, is to remember that the symp- toms point in the beginning to trouble in the pelvis. It is generally, or at least sometimes, stated that the tumor rises from one iliac region and continues to occupy one side for some time. This, I think, is the exception to the rule, and, by Dr. Frederick Bird, is considered an evidence of adhesion. When large enough to overcome the sup- port of their peritoneal envelope, they fall into the cul-de-sac of Douglas, and, as they grow, come up in front of the promontory of the sacrum, until large enough to be felt above the pubis, having their point of support in the hollow of the sacrum, instead of one of the iliac fossee. The patient will usually speak of it as a lump, in- stead of saying that she is swollen, as in pregnancy. She has watched it coming up out of the pelvis, and not starting from above or from one side, and encroaching upon the abdomen from either of those directions. Physical Examination. The knowledge derived by physical examination is the most valu- able ; and while the modes of procedure are the same, and applicable to all stages of growth and enlargements of the tumor, we will be able better to describe and understand them, as made use of for one that has arisen from the pelvis, and more or less thoroughly filled the abdominal cavity,—a tumor that has become obvious, and from which our patient is solicitous of being relieved. The means afforded us for physical examination are: 1st, palpa- tion ; 2d, percussion; 3d, auscultation; 4th, vaginal and rectal digital examination; 5th, examination with the sound or .uterine probe. These may be used separately, or combined in any given case; some being more valuable in some cases, and others in different ones. Exploring needles, chemical tests, and the microscope may also be