A - Diseases
Classic Disease Descriptions
Through the exploration of classical books and writings of old-time clinicians, this growing database aims to provide categorized, detailed characterizations of diseases, including finely detailed signs and symptoms that will provide an accessible, dependable online presence for such information.
"It may be thought somewhat out of place to treat of some of these displacements here, as they are so intimately connected with pregnancy and parturition; but, as they do occur independently, it appeared to me preferable to travel out of the way in order to complete the subject, rather than give a partial view or omit it altogether. We shall first speak of anteversion of the uterus, or that displacement where the uterus occupies a transverse position in the pelvis, the fundus being towards the symphysis pubis.
This accident is extremely rare, it can only occur whilst the uterus is about the natural size, and in the cavity of the pelvis. There are other circumstances also which preserve the female from this displacement, and which will strike us at once, if we recall the relative position of the uterus in the pelvic cavity, . Situated near the level of the upper outlet, it rests anteriorly upon the bladder, and posteriorly is in contact with the rectum. Now the oblique position of the pelvis, when joined to the spinal column, would naturally favor the occurrence of anteversion, were it not that the presence of the bladder, so often distended, offers an obstacle to its descent anteriorly. So long as the bladder contains much urine, this accident may be considered as impossible. When it does take place, the fundus uteri is directly anteriorly to the inner surface of the symphysis pubis, pressing upon the neck of the bladder; whilst the cervix presses the rectum posteriorly, the uterus thus lying transversely across the pelvis, instead of being nearly perpendicular. Causes.
—For the production of anteversion, it is necessary that the fundus uteri should be rendered somewhat heavier than usual, compared with the inferior portion of the organ, or else that a decided tilting forward should be occasioned by a force external to the uterus. If the bladder be empty, and a sudden expulsive force exerted at the same time, the uterus may be tilted over anteriorly, especially if the ligaments have been relaxed by previous pregnancies. In accordance with this explanation, we shall find that it has occurred in the first two or three months of pregnancy (Chopart. Baudelocque.), but not after the uterus has increased much in size (Nauche). In some cases, it has been discovered that the first displacing power, resulted from an accumulation of feces in the rectum which pressed forward the fundus uteri.
In others, that an attack of chronic metritis had rendered the womb top heavy, or that the same effect was produced by a fibrous tumor (Nauche). A blow, a fall, a shaking in an uneasy carriage, obstinate diarrhea have all been enumerated as exciting causes (Nauche). Symptoms.—These are not very marked, except such as depend upon the mechanical disarrangement of parts. If great pressure be made upon the neck of the bladder or upon the urethra, retention of urine may result, but this is rare. The patient complains of some difficulty in passing urine, as well as in going to stool, but assistance is seldom required on this account (Capuron). Constipation is sometimes occasioned by the pressure upon the rectum. The patient feels a great and unusual weight in the pelvis, with a pain in the hypogastrium and at the perineum (Duges); and a sense of dragging from the loins (Naucke); all of which are greatly increased by standing or walking. Leucorrhoea sometimes occurs, and occasionally there is some irregularity in the menstrual evacuation (Nauche). If an internal examination be made, the pelvis will be found blocked up by a tolerably dense body—the uterus: the fundus will be found anteriorly, and the cervix posteriorly. If a sound be introduced into the bladder, it will impinge upon the displaced fundus, and this has given rise to a suspicion stone in the bladder (Levret). There is, however, no sound resulting from the contact, nor is the touch like that of stone. If the displacement be not remedied, the anterior wall of the uterus generally becomes the seat of engorgement and inflammation (Nauche). There is a slighter degree of displacement in the same direction which takes place sometimes in the later months of pregnancy, and is called anteflexion or anterior obliquity.
It occurs in first pregnancies, from the natural obliquity of the uterus, and also after many childbearings, from the relaxation of the abdominal parietes allowing the uterus to fall forward. The os uteri is situated near the promontory of the sacrum, and is sometimes difficult to find. This has led to the supposition of certain cases being examples of imperforate uterus. The symptoms, in some respects, resemble those already described (Nauche), but in themselves they are of little consequence; our main attention will be directed to the effect of this displacement in retarding labor, by “forcing down a segment of the os uteri between itself and the ossa pubis; this portion of the uterus usually becomes tumified and indisposed to dilate; and the action of the uterus grows irregular, spasmodic, and more acutely painful.”
Churchill, F. (1986). Chapter XX Displacements-1. Anteversion of the Uterus. In Outlines of the Principal Diseases of Females (pp. 262-265). Birmingham, Alabama: The Classics of Medicine Library.
Added by: Kate Holder, 6/14/2020
“In a large proportion of all cases of acute appendicitis the following symptoms are present: (1) Sudden pain in the abdomen, usually referred to the right iliac fossa; (2) fever, often of moderate grade; (3) gastro-intestinal disturbances—nausea, vomiting, and frequent constipation; (4) tenderness or pain on pressure in the appendix region.
A sudden, violent pain in the abdomen is […] the most constant, first, decided symptom of perforating inflammation of the appendix. […] In fully half of the cases it is localized in the right iliac fossa, but it may be central, diffuse, but usually in the right half of the abdomen. Even in the cases in which the pain is at first not in the appendix region, it is usually felt here within thirty-six or forty-eight hours. It may extend toward the perinaeum or testicle. […]
Some patients speak of it as a sharp, intense pain—serous-membrane pain; others as a dull ache—connective-tissue pain. […] Fever is always present in the early stage, even in the mildest forms, and is a most important feature. […] The fever may be moderate, from 100o to 102o; sometimes in children at the very outset the thermometer may register above 103.5o. […] Nausea and vomiting are symptoms which may be absent but which are commonly present in the acute perforative cases. […] Constipation is the rule, but the attack may set in with diarrhea, particularly in children. […]
McBurney has called attention to the value of a localized point of tenderness on deep pressure, which is situated at the intersection of a line drawn from the navel to the anterior superior spine of the ilium, with a second, vertically placed, corresponding to the outer edge of the right rectos muscle. Firm, deep, continuous pressure with one finger at this spot causes pain, often of the most exquisite character.”
Osler, W. (1909). The Principles and Practice of Medicine (7th ed.). London: Appleton and Co. Pg. 514-515
Added by: Erin Choi, 6/10/2020
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...