THE INSPECTION OF THE ABDOMEN.
inspection without the help of instruments concerns the gen eral appearance of the body: the size, weight, walk, configuration and inclination of the pelvis, curvature of the vertebral column, the size and surface of the abdomen, the inguinal region, the lower extremities, the development and coloration of the mammee, the nipples and the areolse. The external genital organs, the internal surfaces of the thighs, the lower third of the vagina when the vulva is open, may be inspected without the help of instruments, and inspection should always precede resort to the touch or to the speculum.
For purposes of careful inspection the different portions of the body are uncovered, in the order in which the examination is made; palpation may often, however, be made to follow inspection to advantage, as for instance where it is a .question of spinal deformity. According to cir cumstances inspection may be undertaken with the patient standing or lying, but in any event care should be taken to have the attitude a sym metrical one. The changes in the shape of the abdomen are often of the greatest possible value, since free fluid in the abdominal cavity will cause the abdomen to assume a different shape from what happens, for instance, in case of a cyst.
The chief value of inspection is for the detection of deformities of the bony skeleton, and above all abnormality in the abdomen. The size of the abdomen is to be noted, and as to whether the normal convexity is present or else a concavity, as in case of thin individuals, or as the result of certain disease, diarrhoea, for instance, or lead poisoning, or certain mental troubles, etc. The amount of increase or of decrease in size, the regular or irregular distension, the form of the abdomen, the site of the greatest convexity, the position of the umbilicus, in particular its retrac tion or projection, the quality of the abdominal walls, that is to say, their distensibility, etc., are further points to be noted. In excessive disten
sion of the abdomen, the skin is either smooth, white and shiny, or else streaked red or purple-red. In women who have borne children, or else have suffered from some cause of abdominal distension, there are present on the abdomen those reddish to whitish streaks, the lines; al bicantes, which are due to tears of the fibrils of the rete malpighii, and which are erroneously considered a sign of child-bearing. From the re searches of Credo, Casper, and C. Langer, it is evident that these stria) are not certain evidence of antecedent pregnancy, for out of 100 cases in ten none were present. These strite appear generally in the second half of pregnancy, often only after its termination, and they also result from any disease which is accompanied by distension of the abdomen. The same strife, although less frequently, are also found on the skin of the thighs, of the thorax, of the lower limbs, of the buttocks even, and they never disappear entirely, although after some years they become smaller and paler, so that it is often very difficult to detect them. It is justifiable and important to judge of the age of the strife from their appearance.
The further changes in the anterior abdominal wall to be noted are: Abnormal coloration, exanthematous eruptions, the. result, generally, of scratching or of the application of medicinal agents, abscesses, herniae, diastases, tumors, abnormal development of the blood-vessels (the eaput meduste), and the changes in the linea alba. Separation of the recti abdominis and their tendons are frequently seen, as also great forward projection in the lumbar region, and those changes in position which occur in the sternum and in the lower ribs, as the result of great ab dominal distension. Finally, by inspection are determined those move ments which are due to peristalsis or to the presence of a foetus, the pulsation of the abdominal aorta and the respiratory act.