Diseases of the ovaries : their diagnosis and treatment . nd to the amount of tympaniticdistension of the intestines. In itself, it offers no assistancein diagnosis, because a thin-walled ovarian cyst, filled withlimpid fluid, with a moderately tense and thin abdominal wall,would give a more quick and decided wave than a moderatequantity of ascitic fluid beneath an abdominal wall thickenedby fat or subcutaneous oedema. The characteristic peculiarityof the fluctuation in ascites is that it varies with the positionof the patient, and is only perceived in the parts where thefluid gravitates towar
Diseases of the ovaries : their diagnosis and treatment . nd to the amount of tympaniticdistension of the intestines. In itself, it offers no assistancein diagnosis, because a thin-walled ovarian cyst, filled withlimpid fluid, with a moderately tense and thin abdominal wall,would give a more quick and decided wave than a moderatequantity of ascitic fluid beneath an abdominal wall thickenedby fat or subcutaneous oedema. The characteristic peculiarityof the fluctuation in ascites is that it varies with the positionof the patient, and is only perceived in the parts where thefluid gravitates towards the abdominal wall; while in ovariandropsy its situation does not vary with position, but is per-ceived wherever fluid is to be discovered by III. Percussion. The two following diagrams represent the situation of clearand dull sounds obtained by percussion in typical cases ofascites and ovarian disease, the patient lying flat and evenlyon her back. The dark parts of the abdomen are dull, therest clear. In ascites, the stomach and intestines are above. and in front; the fluid behind and on either side. In ovariandropsy the fluid is in front, extending in different degrees toeither side, and pushing the stomach and intestines upwardsand backwards, just as a gravid uterus does. The figure tothe right of the page, indeed, would represent either a graviduterus near the full period of pregnancy, or an ovarian cyst ofabout the size of such a uterus, and situated centrally, as II. 130 FLUCTUATION IN OVAKIAN DISEASE. ovarian cysts often are at this, or a rather later, period of theirgrowth. But quite as frequently they tend towards one sideor the other, in such cases the diagnosis being, of course,easier. It is seldom that a patient with ascites lies so flat as not toraise the shoulders enough to throw a layer of fluid down-wards towards the pubes. Very often the dulness may extendas high as the umbilicus, and generally does so when theshoulders are much raised by pillows. This might
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Keywords: ., bookcentury1800, bookdecade1870, booksubjectgynecology, bookyear1
