. The diagnosis and treatment of diseases of women. 89), there ismarked tenderness on palpation of the bone and pain on movement of same. There 302 GYNECOLOGIC DIAGNOSIS may be deformity, indicating previous injury or inflammation. The marked ten-derness is limited to the region of the coccyx. There is no palpable lesion of thegenital organs to account for the symptoms. BACKACHE. Backache, either in the lumbar region or extending down over the sacrum, maybe caused by most any of the conditions mentioned under pain in the pelvis andlower abdomen. It is not necessary to repeat them here. In addi
. The diagnosis and treatment of diseases of women. 89), there ismarked tenderness on palpation of the bone and pain on movement of same. There 302 GYNECOLOGIC DIAGNOSIS may be deformity, indicating previous injury or inflammation. The marked ten-derness is limited to the region of the coccyx. There is no palpable lesion of thegenital organs to account for the symptoms. BACKACHE. Backache, either in the lumbar region or extending down over the sacrum, maybe caused by most any of the conditions mentioned under pain in the pelvis andlower abdomen. It is not necessary to repeat them here. In addition, backache may be caused by affections of the muscles, nerves, liga-ments or joints of this region, or by affections of the bones or spinal cord. REFLECTED PAINS. Reflected pains do not occupy as large a place in gynecologic symptomatologyas formerly. We have come to look upon these distant pains in gynecological casesas usually an indication of some intercurrent or complicating trouble at the site of I Diap-hraj^a. Fig. 448. Showing the usual cause Qf Reflex Pa>ins ii-> the various regions. (Dana—Text-book ofNervous Diseases.) SIGNIFICANCE OF DISTURBANCES OF FUNCTION 303 the pain or of an abnormal condition of the nervous system,rather than as a directreflex from the pelvic trouble. I think careful investigation will show this to bethe case in the great majority of instances of so-called reflex pains. In rare cases, however, the connection between the distant pain and the pelviclesion seems very close, as where, for example, a pain in the head or other situation ismade to disappear by correction of a retrodisplacement of the uterus, only to re-appear as soon as the uterus returns to its malposition. When reflected pains do occur they are likely to be found as indicated in Fig. 448. DISTURBANCES OF FUNCTION. The various disturbances of function (amenorrhoea, menorrhagia, irregular men-struation, dj^menorrhoea, dyspareunia, sterility) const
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