Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3074_Библиотеки_им_академика_М_И_Перельмана.pdf
177
5.6.7 Chase Sign
Ira Carleton Chase (1868–1933) was born in Oberlin, Ohio, USA, and received his
A.M. degree from Oberlin College, Ohio in 1898 [158, 159]. He was initially
appointed professor of physics and chemistry at the old Fort Worth University,
Texas, in 1893 and chair of chemistry and toxicology in 1894 [158, 159]. He later
pursued a medical career and received his medical degree from the NewYork and
Bellevue Hospital Medical College in 1899. After graduation, he worked in group
practice in Fort Worth, Texas, and was appointed professor of anatomy in the medi-
cal department in 1901 and chair in 1910 at Fort Worth University. He was dean of
the Fort Worth Medical College and associate professor of surgery in 1913
[158, 159].
Chase was associate editor of the Oberlin Review from 1890 to 1891, co-editor
of the Texas Medical Gazette, and rst editor-in-chief of the Texas State Journal of
Medicine from 1905 to 1910 [158]. He was active in the Texas Medical Association
serving as general secretary at Denison, Texas, from 1902 to 1903. He was also the
Texas delegate to the American Medical Association and served as a judicial council
member [158]. Chase was a fellow of the American College of Surgeons in 1915.
He authored the textbooks The Chemical Examination of Gastric Contents in 1891
and A Laboratory Manual of Medical Chemistry in 1897 [158, 159].
As to a description of his character:
C.S.Laymen who have come to know Doctor Chase of Fort Worth have been impressed not
only by his unusual abilities in his profession but equally well by his personal character his
elevated purpose, and all the qualities that make the physician a real leader in the slow
evolution of humanity to a higher and better civilization [160, p.144].
Chase described a palpatory method which he referred to as the “cecal distension
test” for diagnosing acute appendicitis (Table5.2):
The patient is best placed on a hard, low bed or table. The knee should be exed and two
pillows placed under the head and shoulders, giving a dorsal semirecumbent position, ren-
dering the abdomen accid for the most satisfactory abdominal compression. The surgeon
stands on the patient’s left, facing the feet. The palmar surfaces of the ngers on the right
hand are placed under the patient’s left inguinal region and the ngers of the left hand used
to reinforce the right. Deep pressure is then made backward, slowly drawing the ngers
deeply and forcibly upward under the left costal arch. This procedure is intended to com-
press the lower portion of the descending colon and force its gaseous content into the trans-
verse, and thence to the ascending colon. The pressure being maintained with the ngers of
the left hand, the right hand is then removed and placed over the upper portion of the
descending colon, or better and forcibly depressed. A gaseous compression wave will travel
across the transverse and down the ascending colon and on arriving at the cecum will pro-
duce cecal distention, yielding a typical sharp pain in the right iliac fossa, if inammation
of the cecum or appendix be present [161, p.610].
Chase postulated that the maneuver:
[i]f carefully carried out will demonstrate conclusively, I believe, the presence or absence
of active inammation in the cecum or appendix by the typical colicky pains usually fol-
lowing in the right iliac region [161, p.610].
5.6 Eponymous Sign
178
He found that the test was helpful in patients with rigidity or tenderness in the right
lower quadrant precluding direct palpation in this region. Chase acknowledged the
paper published by Rovsing, entitled “Indirektes Hervorrufen des typischen
Schmerzes an McBurney’s Punkt” (Indirect Production of Typical Pain at
McBurney’s Point) in Zentralblatt für Chirurgie on November 5, 1907, prior to
completion of this paper presented to the North Texas Medical Association in
December 1907 [161].
5.6.8 Bastedo Sign
Walter Arthur Bastedo (1873–1952) was born in Newmarket, Ontario, Canada, and
received his doctorate in pharmacy from the NewYork College of Pharmacy and
medical degree from Columbia University College of Physicians and Surgeon (cur-
rently Columbia University Vagelos College of Physicians and Surgeons), NewYork,
in 1899 [162, 163]. Throughout his career, he was afliated with St. Mary’s, St.
Vincent’s, and Staten Island (consulting physician), City Hospital (attending physi-
cian from 1913 to 1919), and St. Luke’s Hospital, NewYork [164, 165]. He was
appointed attending staff at St. Luke’s Hospital, ascending to the attending and con-
sultant physician rank from 1899 to 1927 [162, 165].
He was an instructor in pharmacology at Cornell University Medical School,
NewYork, from 1899 to 1901, an instructor in materia medica and pharmacology,
an assistant in applied therapeutics, an associate in pharmacology, and an assistant
professor of clinical medicine at Columbia University College of Physicians and
Surgeons [162, 163, 166]. At Columbia University’s Vanderbilt Clinic, he served as
chief of the clinic in gastroenterology from 1902 to 1908 [167].
Bastedo was a member of the NewYork Board of Health advisory council from
1911 to 1919. He was chairman of the section of pharmacy and therapeutics of the
American Medical Association from 1918 to 1919 and president and chairman of
the board of trustees on revisions to the United States Pharmacopoeia from 1919 to
1920 [161]. Bastedo served as councilor of the gastroenterologist association in
1919 and ofcer of the NewYork Association for Medical Education in 1921 [167–
169]. He received the honorary degree of Doctor of Science from Columbia
University in 1929 and an honorary degree of Master of Science from Philadelphia
College of Pharmacy and Science in 1934 [163].
Bastedo read before the Medical Society of the County of Richmond, Virginia, a
method of dilating the colon to differentiate chronic appendicitis from other causes
of right lower quadrant abdominal pain. The method involves insufating air into
the colon using an atomizer bulb and a soft rubber rectal tube. He reported in patients
with chronic appendicitis (Table5.2):
In the routine examination of digestive patients by colon dilation, I noted, some three years
ago, that acute pain or tenderness in the region of McBurney’s point on dilatation of the
colon regularly meant appendicitis. I have now many cases in which the nding has proven
5 Appendicitis: Somatic andVisceral Nerve Reexes Signs: Mechanisms…
179
by operation, and in every case operated upon in which the sign was positive a disease
appendix has been found. (…) In no operation cases with the sign negative was appendicitis
found [170, p.110].
In 37 patients undergoing laparotomy for abdominal pain, this sign was positive in
23 patients with chronic appendicitis [171, p. 398]. Hertz in his 1913 paper on
Bastedo sign reported:
In my own experience, I have only obtained a positive Bastedo’s sign in appendicitis, the
appendix having always been found diseased at the subsequent operation, with the possible
exception of one case, which is still too recent to form a judgment as to whether the removal
of an apparently normal appendix will cause the symptoms to disappear [172, p.187].
Although not a practical maneuver, Bastedo sign used a nonpalpatory technique to
introduce air into the proximal colonic segment. He did not describe the location of
the pain induced by this maneuver. Thus, it represented another method similar to
that proposed by Rovsing, Owen, and Chase, causing air to move into the ascending
colon and appendix. We are unaware of any study that evaluated the sensitivity or
specicity of this sign.
5.6.9 Caden Sign
Historical information about Eliot and Corscaden is found under the somatic seg-
mental nerve pathway signs section. The sign eponymously named for Caden
reported that the abdominal rigidity in appendicitis as distinguished from intussus-
ception “[i]is almost always most marked in the lower right quadrant, while in intus-
susception the symptom, if present, is generally more marked on one side or the
other of the umbilicus, while the intervening abdomen between this area and either
inguinal region is either less rigid or entirely free from any rigidity whatever” [40,
p.184]. We were unable to determine whether this pain represented a somatomotor
or visceromotor reex and thus included this in both sections.
5.6.10 Aaron Sign
Charles Dettie Aaron (1866–1951) was born in Lockport, New York, USA, and
received his medical degree in 1891 from the University of Buffalo, NewYork [173,
174]. He served as house surgeon at Harper Hospital, Detroit, Michigan, from 1891
to 1893 and as city physician in Detroit from 1893 to 1895 [173, 175]. He traveled
to Europe to further advance his medical training at the University of Berlin and the
Universities of Giessen, Vienna, Wurzburg, Heidelberg, Paris, and London from
1896 to 1902 [174, 175]. At the Detroit College of Medicine and Surgery (currently
Wayne State University School of Medicine), he served as a lecturer in materia
medica and therapeutics in 1898 and professor of gastroenterology and dietetics
5.6 Eponymous Sign
180
from 1905 to 1938. Among his many accolades, he was the recipient of the honorary
degree of Doctor of Science from the University of Heidelberg, Germany, in 1910
[173, 174]. He served as a member of the American College of Physicians council,
president of the Northern Tri-State Medical Association and Detroit Academy of
Medicine, and the rst vice-president of the American Therapeutic Society [174]. It
is important to recognize that Aaron was the primary founder of the American
Gastroenterological Association and served as its secretary-treasurer from 1897 to
1910 [175]. He authored two books, Diseases of the Stomach in 1911 and Diseases
of Digestive Organs in 1915 [176]. Aaron identied in patients with chronic appen-
dicitis (Table5.2):
Continuous rm pressure with the ends of the rst three ngers over McBurney’s point
induced a referred distress or pain in the epigastrium or precordial region. (…) Since then,
in many cases of chronic appendicitis with digestive symptoms, I have been able to induce
a referred pain or distress in the epigastrium, left hypochondrium, umbilical, left inguinal
or precordial region by a continuous rm pressure over the appendix [177, p.350].
Aaron postulated that chronic appendiceal inammation causes connective tissue
proliferation and scar formation that impinges on the surrounding nerve bers con-
taining afferent pathways to the superior mesenteric, gastric, and hepatic sympa-
thetic plexuses [177]. Chronic rm pressure in the right lower quadrant stimulates
these nerve endings resulting in reex activation of afferent nerve pathways and
visceral nerve reexes. This nding is plausible as viscerosensory midline abdomi-
nal pain may be present during recurrent acute episodes of chronic appendicitis. We
are unaware of any study that evaluated the sensitivity or specicity of this sign.
5.6.11 Bassler Sign
Anthony Bassler (1874–1959) received his medical degree from Bellevue Hospital
Medical College, NewYork, in 1889. Along with Dr. Lewis Brinton (1861–1929),
he was co-editor of the American Journal of Gastroenterology in 1911, which com-
bined with the journal, Proctologist and renamed the Proctologist and
Gastroenterologists journal in 1916. That same year, Bassler was appointed consult-
ing gastroenterologist at Christ’s Hospital in New Jersey and 2years later Professor
of Gastroenterology at Fordham University Medical School and New York
Polyclinic Medical School and Hospital [178, 179].
Bassler was one of the incorporators of the NewYork Society for the Advancement
of Gastroenterology in 1932, which changed its name to the National Society for the
Advancement of Gastroenterology in 1934, and nally, the American College of
Gastroenterology in 1943. He served as its president from 1936 to 1948 [180, 181].
He also served as the rst chairman of the section of gastroenterology of the
American Medical Association and was the American president of the International
Society of Gastroenterology and Hepatic Insufciency. He was a fellow of the
National Society for the Advancement of Gastroenterology and an honorary
5 Appendicitis: Somatic andVisceral Nerve Reexes Signs: Mechanisms…
181
member of the Belgian Gastroenterological Society [182]. Bassler was decorated
with the Legion of Honor of France and received an honorary Legum Doctor
(LL.D.) degree from Hahnemann Medical College in Philadelphia [182].
Several honorary tributes were published in the American Journal of
Gastroenterology commemorating Anthony Bassler. As articulated by Louis L
Perkel, MD, FACG:
Dr. Anthony Bassler will long be remembered as one of the pioneers in the establishment of
gastroenterology as a recognized specialty. Those of us who had the privilege of knowing
him since we began practicing our specialty will never forget his kindness and helpfulness.
He was truly an inspiration to his younger colleagues. His passing is not only a personal
blow to his myriad of friends, but also an irreparable loss to the College as well as to the
medical profession [183, p.761].
Bassler described in 1913 a maneuver for diagnosing chronic appendicitis:
[n]ote the position of the right edge of the rectus muscle on the umbilical-spine line main-
taining the site with the nger. Having the patient rise to a sitting position helps in palpating
the rectus edge. Standing at the right and facing the patient (for right-handed individuals)
the thumb is placed vertical on the abdomen, the tip of the thumb pointing to the ensiform,
when it is slowly pressed backward into the abdomen, not inward, outward, up or down.
When the thumb has been sunk about half-way down to the back of the abdominal cavity, it
is swung to the right of the patient at a right angle to the downward pressure line. This
pinches the appendix against the iliacus muscle and unyielding structures under and at the
side of it, and usually elicits pain or tenderness [184, p.207–208].
Bassler believed that this method of examining the appendix was helpful in cases
where percussion was ineffective in identifying the cecum. He did not describe the
location of the pain (Table 5.2). We are unaware of any study that evaluated the
sensitivity or specicity of this sign.
5.6.12 Reder Sign
Francis Reder (1864–1936) was born in New Athens, Illinois, USA, and received
his medical degree from St. Louis Medical College (Washington University Medical
School) in 1884 [185, 186]. He completed an internship at St. Louis City Hospital
and Female Hospitals and received further postgraduate medical training at the
German Hospital, NewYork, under the aegis of G.A.Gerster (1874–1974) [185].
Reder was appointed house surgeon at this hospital from 1886 to 1888 [186]. He
traveled abroad for additional studies and training at the universities of Berlin in
1888, Munich, Vienna, and Paris in 1891 and 1901 [185, 186].
Reder was president of the St. Louis Surgical Society in 1929 and a member of
several societies, including the American College of Surgeons and the St. Louis
Surgical Society [185]. He was elected an honorary member of the St. Louis Medical
Society in 1935 [185, 187]. Reder was a private practitioner and general surgeon for
the Burlington Railway System and chief of the clinic for diseases of the rectum at
Washington University, St. Louis, Missouri [186].
5.6 Eponymous Sign
182
As to insights into his character as articulated by Fred W.Bailey:
Honored at home and abroad, loved and respected by all who knew him, he possessed the
admirable attributes of professional dignity, ability and congenial personality. To him the
world was a stage, and his profession the plot, in which he labored daily, administering to
the needs of his fellow men [185, p.150].
Reder described a method for distinguishing chronic appendicitis with adhesions
from chronic appendicitis without adhesions:
The “point” in the rectum, however, has invariably given a positive reaction in the presence
of a chronically diseased appendix. The part of the rectum concerned in this examination is
the rst portion. It commences at the sacro-iliac synchondrosis, usually the left side, is
entirely covered with peritoneum and has a mesorectum, which gives that portion of the
bowel a certain amount of mobility. (…) Within the lumen of the bowel at the junction with
the sigmoid, about 31/2 or 4 inches above the margin of the anus, there exist aggregations
of circular bres that form a valve. This valve is constant, is known as the valve of O’Beirne,
and varies but little in its distinctive circular characteristics. It serves as a landmark, and is
an important factor in the examination [188, p.16].
During the examination, the patient is positioned supine with legs exed, and a
nger is inserted into the rectum until O’Beirne’s valve is reached. He identied a
point in the rst portion of the rectum as a method for diagnosing chronic appendi-
citis. The examination is performed as follows:
In making the examination to reach the “point” the patient is comfortably placed on the
examining table upon his back, with both legs exed. The index-nger, well lubricated, is
introduced into the rectum, and a search made for O’Beirne’s valve. It is absolutely neces-
sary that the valve be located. (…) The valve having been located, the nger is hooked into
it and gentle traction made upon the structure to test the mobility of that portion of the
rectum. The tip of the nger is allowed to rest within the lumen of the valve and the patient
asked if he experiences any pain. Should there be any pain, it is generally referred to the
sphincter area of the rectum. By allowing the nger to rest for a short time this pain will
subside. It is desirable that the patient be entirely free from pain while the examining nger
is in this position. After being assured of the total absence of pain by the patient, the tip of
the nger is gently pushed upward toward the right iliac fossa, when, in the event of an
appendix lesion, the nger will touch a point beyond the valve that will cause great pain. As
a control maneuver a similar “point” may be touched by sweeping the examining nger
toward the left inguinal fossa, usually with negative result [188, p.16–17].
Thus, Reder sign refers to the presence of appendiceal inammation detected
through palpation of O’Beirne valve on digital rectal examination (Table5.2). We
are unaware of any study which evaluated the sensitivity or specicity of this sign.
5.6.13 Owen Sign
Edmund Blackett Owen (1847–1915) was born in Finchingeld, England, received
his medical training at St. Mary’s Hospital, London, diploma for membership in the
Royal College of Surgeons in 1868, and fellowship in the Royal College of Surgeons
in 1872 [189]. He was appointed demonstrator of anatomy from 1868 until 1875
[189]. At St. Mary’s Hospital, Owen had multiple appointments, including as a
5 Appendicitis: Somatic andVisceral Nerve Reexes Signs: Mechanisms…
183
lecturer in anatomy from 1876 to 1888 and surgical lecturer until 1896. He also
served on staff, rst as an assistant surgeon in 1877, full surgeon in 1883, and con-
sulting Surgeon in 1898 at the Hospital for Sick Children, London. He was a sur-
geon to outpatients in 1871, full surgeon in 1882 until his retirement in 1902,
whereby he was named consulting surgeon [189].
Among his other appointments, in the Royal College of Surgeons, he served as a
member of the council from 1897 to 1913, vice-president for two terms (1905–1906
and 1906–1907), a member of the board of examiners in anatomy and physiology in
1883, fellowship board and examiner in anatomy for the second examination of the
conjoint board in 1884, and court of examiners from 1888 to 1899 [189, 190]. He
also served as an examiner in surgery at the Universities of Durham, London, and
Cambridge [189].
Owen was an active member of the British Medical Association, serving as sec-
retary in the section of surgery at the annual Liverpool meeting in 1883, vice-
president at the annual meeting in Cardiff, Wales, in 1885, vice-president of the
section of surgery, and president of the section of surgery at the annual meeting in
Swansea, Wales, in 1903 [189]. In 1900, he was appointed to the ofce of chairman
of the constitution committee, chairman of the colonial committee in 1902, and
chairman of the council from 1907 to 1910 [189, 190].
Among his many other accolades, he was honorary associate and Knight of the
Grace of the Order of St. John of Jerusalem, orator of the medical society in 1897,
and president of the Harveian Society, to name a few [189]. During World War I, he
served as surgeon-in-chief of the St. John Ambulance Brigade and British Red
Cross. Owen received the Cross of the Legion of Honor in 1903 for his services at
the French Hospital beginning in 1901 [191].
A description of his character as enumerated by Francis Richardson Cross:
In the passing of Edmund Owen, the profession of surgery has lost one of its leaders, respected
for his uprightness and high sense of duty, and honored for the active part he has taken in
medical ethics, and in the progress and improvement of surgical practice and in its teaching.
(…) Owen was always in good spirits, courteous, and amusing, but not at the expense of oth-
ers. I never remember him saying an unkind word of any colleague, and he showed no unfair
bias against the opinions he did not agree with. If he could not speak well or kindly of men or
matters, he did not discuss them. He was a hard worker. He wrote and spoke forcibly and well.
Perhaps by nature somewhat impulsive, he carefully considered his subject with ability,
shrewdness and common sense, and, having formed his opinion, he was fearless and honest
in expressing his views, which were usually sound and accurate [189, p.202–203].
Owen described a method for diagnosing acute appendicitis (Table5.2):
If in the case of appendicitis, when the colon contains much gas, rm pressure is made with
the hand over the descending colon, the gas is forcibly driven towards the caecum, and the
inamed tissues being disturbed, the patient may complain of pain in the right iliac fossa.
This would scarcely happen in the case of ovaritis or other pelvic diseases, so it may prove
useful as a diagnostic measure in obscure cases of appendicitis. Again, it may be that a
person with appendicitis tolerates a considerable amount of pressure with the hand over the
right iliac fossa, and if the steady pressure is maintained long enough to drive some of the
gas out of the blind end of the large intestine, and the hand is then suddenly taken off, the
quick return of gas into the caecum so disturbs the inamed appendix that the patient calls
out with pain [192, p.49–50].
5.6 Eponymous Sign
184
It should be recognized that Niels Thorkild Rovsing had previously described a
similar maneuver in 1907 [154], seven years before Owen. We are unaware of any
study that evaluated the sensitivity or specicity of this sign.
5.6.14 Wachenheim Sign
Frederick L. Wachenheim (1870–1913) was born in New York City, USA, and
received his medical degree from Columbia University College of Medicine and
Surgeons (currently Columbia University Vagelos College of Physicians and
Surgeons), NewYork City [193]. He served at Sydenham Hospital and the poly-
clinic at Mount Sinai Hospital and was chief of the clinic children’s department,
Mount Sinai Hospital Dispensary, NewYork [194, 195].
He was a member of the Academy of Medicine, the American Medical
Association, and the committee of the prevention of tuberculosis from the Charity
Organization Society of the City of NewYork [191, 192]. He authored The Climatic
Treatment of Children in 1907 [195].
Wachenheim described a method for diagnosing acute appendicitis in coopera-
tive children:
High palpation of the right iliac fossa, per rectum, elicits tenderness and pain in the
McBurney region when appendicitis is present, never under normal conditions. To deter-
mine this point to our satisfaction, it is necessary to observe certain precautions. In the rst
place, we must gain the condence of the little patient, assuring him that that the procedure
will not be distressing. Secondly, we must introduce the examining nger quite painlessly;
this can always be done if we exercise patience; the ordinary rectal examination is far too
often conducted brutally, causing the patient considerable pain and alarm. It is evident that
no clear statement can be obtained from a child whose sphincter has been violently dilated.
With free lubrication and slow dilatation, this procedure can be rendered absolutely pain-
less, even at the age of six or seven years. The valuable diagnostic point in the fact that the
patient complains of no discomfort, until the introduced nger reaches the right iliac fossa,
when the child complains of a sharp pain in the neighborhood of McBurney’s point. To
assure ourselves that the pain is in no relation to the mere rectal examination, we must ask
the child to point out the site of the pain; if due to a rough introduction of the nger, the
patient will invariably point to the anus, if appendicular, it will always be correctly local-
ized, provided the intelligence of the child is adequate, as I have usually found it to be after
the age of eight years, and often much earlier [196, p.198].
A similar maneuver was described by Reder [188], although Wachenheim did not
specically require digital palpation of O′ Beirne valve (Table5.2).
5.6.15 Blaisdell Sign
Silas Canada Blaisdell (1856–1929) was born in Winterport, Maine, USA, and
received his medical degree from New York University Medical College in 1882
[197, 198]. After graduation, he was a private practitioner in Brooklyn, NY, and
5 Appendicitis: Somatic andVisceral Nerve Reexes Signs: Mechanisms…
185
lecturer in applied and comparative anatomy at New York University Medical
College, a lecturer in regional anatomy in the dental school at the NewYork College
of Dentistry, and a surgeon-in-chief of Eastern District Hospital, Brooklyn, NY.He
was a member of the Kings County Medical Society, Brooklyn, NY, and Brooklyn
Medical and Surgical Society, to name a few [197, 198].
Blaisdell reported a test used in the diagnosis of appendicitis (Table5.2):
[t]he pain is increased when the patient is turned to the left and diminished when he is
turned back on his right side. The pain is not so intense when the patient is on his back as
on the left side. (…) In making the test the abdomen must not be allowed to touch the bed
thereby allowing the viscera no support when it pulls to the left and drags along the sensi-
tive appendix thereby causing additional pain [199, p.285–286].
He believes this nding had not been previously reported, although Berthomier
described a similar palpatory maneuver in 1906 [149]. This patient presumably had
mesenteric adenitis as the appendix is a xed (retroperitoneal) structure and does
not shift when the patient is moved to the left lateral decubitus position.
5.6.16 Baldwin Sign
James Fairchild Baldwin (1850–1936) was born in Orangeville, NewYork, USA,
and received his medical degree from Jefferson Medical College, Philadelphia,
Pennsylvania, in 1874 and Master of Arts degree from Oberlin College, Oberlin,
Ohio, in 1875 [200]. He was appointed professor of physiology and anatomy at the
Starling Medical College, Columbus, Ohio, from 1875 to 1882 [201–203]. Baldwin
was a founding member of the Columbus Medical College in 1876 (merged with
Starling Medical College in 1892). He was the rst editor-in-chief, along with John
Waterman Hamilton (1823–1898), from 1876 to 1894 and independently from 1894
to 1898 of the Ohio Medical Recorder (named Ohio Medical Journal in 1881 and
Columbus Medical Journal in 1882), which was supported by the Central Ohio
Medical Society [201–203].
Baldwin was also a founding member of the Ohio Medical University in 1892
(united with Starling Medical College to become Starling Ohio Medical College in
1907 and subsequently Ohio State University College of Medicine in 1914), where
he was professor of gynecology and chancellor from 1890 to 1899 [202–204]. He
served as president of the Central Ohio Medical Society in 1889 and was a member
of this society throughout his career [203–207]. He founded Grant Hospital in
Columbus, Ohio, in 1900 and served as chief of staff [202]. He was president of the
Ohio State Medical Association from 1919 to 1920 and the American Association
of Obstetricians, Gynecologists, and Abdominal Surgeons in 1923 [202].
Baldwin, in a discussion of a case of a patient with retrocecal appendicitis,
described the maneuver and mechanism involved in eliciting this test:
In the vast majority of cases, when you have such a condition, you can by pressure elicit
tenderness such as the doctor described; then tell the patient to keep the knee stiff and lift
5.6 Eponymous Sign
186
the right leg: as the psoas muscle contracts under your ngers, the tenderness become much
more marked, and the leg drop with an expression of pain from the patient. The appendix
rests on the psoas muscle, and when brought up under the ngers get pinched. I have made
the diagnosis in this way over and over again, and have never failed to nd a retrocecal
appendix [208, p.254].
Thus, extending the right thigh and knee onto the pelvis causes discomfort because
the psoas muscle and ngers compress the inamed retrocecal appendix (Table5.2).
Baldwin did not dene the location of the pain. This sign is similar to the one
reported by Meltzer in 1902 [131].
5.6.17 Rosenstein Sign
Paul Rosenstein (1875–1964) was born in Graudenz, German Empire (currently
Grudziadz, Poland) and received his doctorate in 1898 [209]. He served as a junior
physician at the Institute of Pathology in Königsberg, Prussia, and at the
Gynecological and Surgical Hospital in Berlin, Germany [209, 210]. At the
Hasenheide Hospital in Berlin, he served as director of the surgical department in
1909 and adjunct professor of urology and chair of the surgical department. He was
director of the surgical polyclinic of the Jewish Community Hospital, Berlin, in
1917 [209, 210]. Rosenstein served as president of the Berlin Urological Society
until 1933. During National Socialism, he and other Jewish physicians were forced
from their positions and banned from practicing medicine [209, 210].
Rosenstein described a maneuver as a method for differentiating acute or chronic
cecal or appendiceal pain from other causes of abdominal pain. The bedside test is
performed as follows:
The patient is placed on his/her left side with the anterior superior spines of the ilium per-
pendicular to the surface. Pressure is applied to the right side, three ngerbreadths inside
and slightly below the right anterior superior spine. If the cecum or appendix is inamed,
the patient experiences intense pain [211, p.644].
Rosenstein did not dene the location of the pain. Pyotr Porryevich Sitkovsky
(1922) reported in his paper titled, “About one of the clinical signs in inammation
of the appendix,” the same maneuver described by Rosenstein two years earlier
[212]. Rosenstein postulated that the inammatory hyperemia and increased cecal
or appendiceal volume exert increased traction and pressure on the mesentery as it
falls to the midline when the patient assumes the left lateral decubitus position. He
also recognized that the inammatory processes within the mesentery or mesente-
riolum might also contribute to the pain. Sitkovsky believed the pain was due to
increased mesenteric traction caused by the inamed appendix and activation of
interceptors within the mesentery [212] (Table5.2).
The nding by Rosenstein and Sitkovsky is presumably caused by shifting of the
mesentery, which allows unimpeded access to the inamed appendix when the
patient is placed in the left lateral decubitus position.
5 Appendicitis: Somatic andVisceral Nerve Reexes Signs: Mechanisms…