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 1 2 3 
 
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 NOTE BOOK 
 
 BY 
 
 WM. H. HINGSTOX, M.I)., D.C.L., L.R.C.S., Edin., 
 
 SURGEON TO HOTEL-DIEU, 
 
 PROKKSSOR OF OLINtOAL SURGERY MONTREAL SCHOOL OF MEDICINE ; 
 C0N8ULXIKO SURGKpN TO WOMAX'8 HOaPITAL, ETC., ETC. 
 
 MONTREAL: 
 DAWSON BROTHERS. 
 ^- * 1882. 
 
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NOTE BOOK 
 
 FOR CASKS OF 
 
 7 
 
 BY 
 
 WM. II. KINGSTON, M.D., D.C.L., L.E.CS, Emx., 
 
 SUUGEON TO HOTKL-DIEU, 
 
 PltOFESSOU OF CMNICAT, SUUCERV MOXTUKAI. SCHOOI. OF ^KUICINK J 
 CONSULTING SOKGKON TO WOMAN'S IIOSI'ITAL, ICTC, ETC. 
 
 ,1 
 I 
 
 MONTREAL: 
 DAWSON BROTHERS. 
 
 1882. 
 
 IS'.'-- 
 
 ..K- 
 
PREFACE, 
 
 This Note Book, though fuller than, will be found to resemble, 
 in many respects, that of Dr. Spencer Wells, to whom is 
 due the credit of having first recommended the use of a 
 separate pamphlet in each case. The order of arrangement in 
 Dr. Hodges' excellent Note Book has been followed. But I have 
 added, under the head of Diagnosis, chiefly, many important 
 questions not heretofore recorded, attention to which, will, it is 
 hoped, aid the practitioner to avoid error by suggesting to him 
 its possible sources. 
 
 37 Union Avenue, - 
 20th November. 
 
GENERAL CONDITION. 
 
 NUMUKU. 
 
 1. Date of Examination. 
 
 2. Name. 
 
 3. Address. 
 
 4. Age, Nationaut\', 
 
 5. Where Born ? 
 
 G. Where has she lived ? 
 
 7. Occupation. 
 
 8. Usual Medical Attendant. 
 
6 General Condition. 
 
 9. (a) Married ? (h) When married ? (c) Single ? 
 
 10. Has had how many Childuen? 
 
 11, Respective ages. 
 
 12. Any Difficult Labor ? 
 
 13. Abortions ? 
 
 14. How Induced ? 
 
 15. Widow. When did Husband die ? 
 
 (• (a) Active. 
 
 16. Habits. ] 
 
 i (b) Sedentary. 
 
 General Appearance, 
 
 17. Complexion. 
 
 1 8. Expression of face. 
 
General Condition. 
 
 19. Emaciation 
 
 ' . , "> ') (a) In bed. 
 
 Easiest. V 
 
 I ) (i) Out of bed. 
 
 20. Posture, y 
 
 I Least } («) I" bed. 
 j comfortable, j (i) Out of bed. 
 
 Eespiratoky Organs. 
 
 21, Breathing. 
 
 22. Cough. 
 
 23. Expectoration. 
 
 24. Percussion. 
 
 25. Auscultation. 
 
 CiRCUIATlON. 
 
 26. Pulse-llate and Character. 
 
8 General Conditioii. 
 
 27. Allowance for anxiety during examination ? 
 
 Heaut. 
 
 28. Percussion. 
 
 29. Auscultation. 
 
 Digestive Organs. 
 
 lAMC! ' 
 
 30. Tongue. 
 
 31. Appetite. 
 
 32. Thirst. Amount of fluid taken daily, 
 
 33. Temjierature of mouth. 
 
 34. Fhitulcuce. 
 
 35. Nausea. 
 
General Condition. 9 
 
 36. Action of 'oowels. 
 
 Nkuvous System. 
 
 37. Sleep. 
 
 38. Pain. 
 
 39. In Occipital Ptegion. 
 
 40. Hysteria. 
 
 41. Condition of mind. 
 
 UuiNAR\ Organs. 
 
 42. Frequency of urination. 
 
 43. Incontinence. 
 
 44. Dysuria. 
 
10 
 
 General Condition. 
 
 UlUNE. 
 
 45. Color. 
 
 4i). Odor. 
 
 47. Quantity in 24 hours. 
 
 48. Specific pravity. 
 
 49. Acid or alkaline. 
 
 50. Albumen. 
 
 51. Sugar. 
 
 52. Deposits. 
 
 Inorganic. 
 Organic. 
 Blood. 
 Pus. 
 
 Epithelium. 
 -^ Tube Casts. 
 
 Genital Organs. 
 
 53. When last menstruated. 
 
General Condition. 1 1 
 
 54. Age at which menses began. 
 
 55 Ase at which menses ceased. 
 
 6^'^ Any sudden suppression. 
 
 57. Normal in quality & quantity. 
 
 58. Excessive or deficient menstruation. 
 
 59. Painful menstruation. 
 
 60. Leucorrhoea or other discharges. 
 
 Skin. 
 
 61. Temperature. 
 
 62. Cutaneous exhalation. 
 
 63. Eruptions. 
 
1^ General Condition. 
 
 64. Ulcers. 
 
 65. (Kcleum. 
 
 ^^. Varicose veins. 
 
 67. Lymphatic Glands, Condition of 
 
 HISTOEY. 
 
 68. Hereditary influence. 
 
 69. Previous diseases. . 
 
 '0. Accidents. 
 
 71. Moral causes. 
 
 72. Discovery of tumor, time of. 
 
 73. Where did it begin ? 
 
IT'tfitovy. 13" 
 
 74. Eate of increase ; — rapid or slow, 
 
 75. Eegular or otherwise. 
 
 76. Diminution at any time. 
 
 77. Pain or tenderness at any time in Abdomen. 
 
 78. In Groin or pubie region. 
 
 79. Irritable Bladder. .. :^ • :', : 
 
 80. Maumiary pains. 
 
 81. Nausea. 
 
 82. Movements felt in tumor or in Abdomen. 
 
 83. Changes in position of tumor. 
 
 84. Febrile attacks. 
 
14 History. 
 
 ■> Through Uterus. 
 V'giria. 
 
 85. Di.scliarges. j^ Abdominal Wail. 
 I Bladder. 
 J Bowel. 
 
 86. Serious or ularming symptoms at anv time. 
 
 87. Strength, as indicated l)y ability to walk, etc. 
 
 Tkea-TMENt Heretofoue. 
 
 88. Medical. 
 
 89. Surgical. 
 
 90. Date of tappings. 
 
 91. Quantity of fluid removed. 
 
 92. Character of fluid. 
 
 93. Other operations. 
 
LOCAL EXAMINATION. 
 
 Inspection of Abdomen. 
 
 94. Enlaroement, general or partial ? 
 
 95. Symmetrical or irregular' 
 
 96. Umbilicus depressed or prominent.? 
 
 97. Any changes in appearance of skin .? 
 
 98. Linea al])a changed in color ? 
 
 99. Are Veins enlarged ? 
 
 Palpation of Abdomen. 
 
 100. Any tenderness on touch? 
 
16 
 
 Local Examinat'uni, 
 
 101. Has tuiiior definito outline.? 
 
 102, Is it Iiard, soft, or olastic ? 
 
 103. Do abdominal walls glido over it? 
 
 104. Are abdominal walls thin or thick ? 
 
 105. Is pulsation of Aorta felt ? 
 
 Percussion. 
 
 JSOtlNlKS AT L'MlilMOAL ItEOloX. 
 
 lOG. When lying on back 
 
 107. When lying on right side. 
 
 108. When lying on left side. 
 
 109. When sitting or standint^. 
 
J 
 
 Local Exami n atlon . 
 
 17 
 
 At Epigastric Region. 
 
 110. When lying on baclv. 
 
 111. When sitthig up, 
 
 At Lumbar Regions^ 
 
 112. Eight, 
 
 113. Left. 
 
 114. How affected by change of position. 
 
 At Hypogastric Region. 
 
 115. Dull or resonant. 
 
 B 
 
m 
 
 18 
 
 Loral Ex<unin(iti<m. 
 
 Percumion on tlie sevcixU partH of the tumor. 
 
 110. When lyiii<(. 
 
 117. When sitting or standin<r. 
 
 118. Torcussion Sounds between above lecm.n. 
 
 gions. 
 
 Fluctuation. 
 
 119. Distinct or obscure. 
 
 120. In all, or pai-t of tumor. 
 
 121. Limited, and in sections, or extensive. 
 
 Auscultation. 
 
 122. Gurgling of intestines. 
 
Load Kxmmnat ton. 
 
 1<1 
 
 123. Crepitus. 
 
 124. riiiccntal Souttle. 
 
 125, l^'ojUil Heart. 
 
 120. Aueiirisnial murumv, 
 
 Mammauy Glands. 
 
 127. Kulargeraent. 
 
 128. Sensibility. 
 
 129. Areola, 
 
 130. I'apillae. 
 
 131. Secretion. 
 
20 
 
 Local Examination. 
 
 
 ^V.. 
 
Local Examination. 
 
 21 
 
 Measurements, 
 132. Around body at umbilicus, . . 
 
 Inches. 
 
 t • t 
 
 133. Greatest circumference, above or below umbilicus . 
 
 134. From ensiform cartilage to umbilicus, 
 
 135. From symphysis pubis to umbilicus. 
 
 4< 
 
 • • • • 
 
 136. From right ant. sup. sp. pro. of ilium to umbilicus. " 
 
 137. From left ant. sup. sp, pro. of ilium to umbilicus. " 
 
2^ Local Examination. 
 
 Vagina. 
 
 138. Where can tiniiur be felt.? 
 
 139. Can fluctation be detected? 
 
 140. Va.rinal fulness. 
 
 141. Vaginal Hue 
 
 Utkkiis. 
 
 142. Position. 
 
 143. Deviutious. 
 
 144. Mobility. 
 
 145. Attachments to tumor. 
 
 ^ 
 
Local Examivation. 
 
 146. Coiulitiou of Os and Cevvix. 
 
 147. Ballottement. 
 
 148. Length of cavity. 
 
 Measured lys. if no reasonio suspect pregnancy. 
 
 Anus and Eeotum. 
 
 149. Himnovrhoids. 
 
 150. Can tnmor be felt ? 
 
 151. Can it be separated from parts behind? 
 
 152. Can tiuctuafon be detected? 
 
 23 
 
 ^ 
 
24 Local Examination — Diar/nosis. 
 
 EXAMINATION BY ASPfllATION OR TAPPING. 
 
 153. Quantity of fluid, if any, removed. 
 
 154. Color, density, tenacity, etc. 
 
 155. Specific gravity. 
 
 15G. Albumen. 
 
 157. Microscopical appotirances. 
 
 DIAGNOSIS. 
 
 158. Is the enlargement witliin the abdominal cavity ? 
 
 159. Is it solid or fluid ? 
 
 I 
 
LoGcd Examination— Diagnods. 25 
 
 160. Does it contain liquid or gas, or both ? 
 
 161. Is liquid thin or thick ? 
 
 162. Is there any pus 
 
 163. Tympanites. 
 
 164. Ascites. 
 
 165. Distention of urinary bladder. 
 
 166. Diseased condition of pelvic bones. 
 
 167. Pelvic or psoas .bscess ; or pelvic tumor. 
 
 I 
 168. Eetention of menses. I 
 
 169. Preguancy. 
 
3i0 Local Examination — Diagnosis. 
 
 170. Extra-uterine pregnancy, 
 
 171. Amniotic Dropsy. 
 
 172. Phantom Tumor. 
 
 173, Tumor or Abscess of liiver. 
 
 174 " " Spleen. 
 
 175. " " Kidney. 
 
 176. Floating Kidney. 
 
 177. Hydatids in Peritoneal Cavity^ 
 
 178. Limited Peritoneal accumulation. 
 
Local Examination — Diagnods. 27 
 
 179. Sub-peritoneal cysts. 
 
 180. Tumor, other than above, in Abdominal Cavity. 
 
 181. Development, distension or displacement of abdominal 
 viscera. 
 
 182. FcBcal impaction. 
 
 183. Tumor of Uterus (Fibroid, Fibrocystic or Malignant). 
 
 184. Cysts of Broad Ligament. 
 
 185. Tubal Dropsy. 
 
 186. Cystic disease in other parts of abdomen. 
 
 187. Tumor of Ovary. 
 
28 Local Examination — Diagnosis. 
 
 188. Cystic, Fibrous or Fib-ocystic. 
 
 189. Cancerous or tubercular degeneration of Ovary, 
 
 190. Dermoid Cysts of Ovary. 
 
 191. Is the cyst single, or are there lew or many cysts? 
 
 192. Is the pedicle long or short ? 
 
 193. Adhesions. 
 
 194. Eupture of cyst. 
 
 195. Hajmorrhage within cyst. 
 
 196, Inflammation of cyst. 
 
Local ExaTTiination — Prognosis. 29 
 
 f Acute. 
 19*?'. Peritonitis, -j 
 
 [^Chronic. 
 
 198. Name of this variety of Tumor, and of rgan involved. 
 
 PEOGNOSIS. 
 
 199. Probable duration of life if left alone. 
 
 200, Probability of recovery if operated, upon. 
 
80 PROGRESS SINCE FIRST EXAMINATION. 
 
Progress since First Examination. 
 
 31 
 
88 
 
 Progress. — Treatment. — OpercUion. 
 
 TKEATMENT RECOMMENDED. 
 
 OPERATION. 
 
 201. Date. 
 
 202. Where performed. 
 
 / 
 
 203. Assistants. 
 
Locai ExaimntitlouH. - Operation. 33 
 
 204. Visitors present. 
 
 205. Ana'sthotic. Administered by 
 
 206, Chief nurse's name. 
 
 207. Incision, situation. 
 
 208. <' length. 
 
 209. Ascitic fluid. 
 
 210. Adhesions, where. 
 
 211. Eemoval of Tumor or 
 
 212. Tapping. 
 
 213. Contents of cyst. 
 
34 Local Examinations. — Operation. 
 
 2 14. Physical character. 
 
 215. Chemical 
 
 216. Microscopical " 
 
 217. Hcen^orrhage. Quantity . 
 
 218. Chief source. 
 
 219. How arrested. 
 
 Pedicle: 
 
 220. Long or short. 
 
 221. Broad or narrow. 
 
 222. How secured. 
 
Local Examinations.. — Operation. 35 
 
 223. Opposite ovary, condition of 
 
 224. Uterus, condition of 
 
 225. Relation to tumor. 
 
 226, Wound, how closed. 
 
 227. Peculiarities of operation. 
 
 228. Description of tumor. 
 
 229. Quantity of fluid removed. 
 
 230. Weio'lit of cvst walls and solid matter. 
 
 231. Combined weight. 
 
 232. Condition found during operation compared with ire- 
 
 vious diagnosis. 
 
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