Gynecological diagnosis . large suchdetermination is difficult of accomplishment. If the tumor Issmaller, so that there is space to mow it within the abdominalwalls, moving the tumor will be felt by the finger in the vagina <pull the uterus at the same time. By rectal palpation, after trac-tion on the cervix has been made by a double tenaculum, the pi 302 DIAGNOSIS OF DISEASES OF THE OVARIES cian may be able to distinguish the situation and characteristicsof the pedicle. (See Fig. 126, page 301.) Inspection.—Inspection of the abdomen of a woman having amoderately large ovarian tumor will sh
Gynecological diagnosis . large suchdetermination is difficult of accomplishment. If the tumor Issmaller, so that there is space to mow it within the abdominalwalls, moving the tumor will be felt by the finger in the vagina <pull the uterus at the same time. By rectal palpation, after trac-tion on the cervix has been made by a double tenaculum, the pi 302 DIAGNOSIS OF DISEASES OF THE OVARIES cian may be able to distinguish the situation and characteristicsof the pedicle. (See Fig. 126, page 301.) Inspection.—Inspection of the abdomen of a woman having amoderately large ovarian tumor will show the enlargement mostpronounced on the side from which the tumor has sprung. Thisis not the case with very large tumors. As a rule the enlargementis in the lower portion of the abdomen. B. C. Hirst ( Diseases ofWomen, Second Edition, p. 539) has seen three cases in whichan ovarian tumor was in the upper abdomen—twice due to tightlacing and once to the fact that the tumor was elevated in preg- Dull Tympanitic. Tympanitic Fig. 127.—Diagram of a Cross Section of the Body in the Case of an Ovarian Tumor. nancy, became adherent to the liver, and did not descend withinvolution of the uterus. When the tumor has been long existent we expect to find thefades ovarina and loss of flesh about the chest and ascites is present or the tumor is excessively large, there isno bulging in the flanks. Palpation.—Palpation usually shows a fluctuating tumor, moredistinctly felt on the affected side. The elasticity will depend onthe sort of tumor present, and on the tenseness of the cyst. Ifthe tumor is very tense it may feel like a solid mass. It is rarefor solid tissues to predominate in ovarian tumors. Nodules maybe felt and loculi of a multilocular tumor if the abdominal wallsare thin. If the walls are very tense or thick it is necessary often to LARGE OVARIAN TUMORS 303 administer an anesthetic before a satisfactory examination canbe made. The mobility of the tumor depe
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