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10.2.24 Douglas Sign (Douglas Cry)
Douglas sign or cry was named by Henri Alphonse Albertin (1860–1939) after the
Douglas cul-de-sac or pouch, the anatomical structure initially described by James
Douglas (1675–1742). We were able to identify limited historical information on
Henri Albertin. He received his medical degree in 1887 based on the thesis titled
“Des injection intra-utérines au point de vue obstétrical sous la méthode antisep-
tique” (Intrauterine Injections from an Obstetric Point of View under the Antiseptic
Method) [126]. Albertin served as an intern at the Lyon Hospital, a surgeon at the
Charité Hospital, Lyon, and later as a prosecutor at the Faculty of Medicine, Lyon
[127]. He received the Legion of Honor in 1912 [128].
Albertin described a nding that he identied during laparotomy and digital rec-
tal examination in women:
Since that time, the notion of a cause and effect between touching Douglas pouch and the
characteristic inspiratory reex accompanied by the “oh” has become common in Lyon.
There is no surgeon or assistant who has not observed this nding if he remembers to per-
form this aspect on examination [129, p.479].
Albertin reported on how to perform and reproduce what he referred to as an inspi-
ratory reex at the pharyngo-laryngeal region:
To produce it, it is necessary to touch the cul-de-sac of Douglas, which causes traction on
the uterus similar to that occurring during a hysterectomy. Palpation causes straining of the
uterosacral ligaments, an inspiratory reex, and the cry. The reex can be reproduced rhyth-
mically by touching the uterus at regular intervals [129, p.480].
In a comment to this paper, Tixier noted this reex in men causes prostate-rectal
dilation. Thus, Douglas cry sign as described by Albertin refers to the painful
expression caused by palpation of the Douglas pouch in cases of peritonitis
(Table10.1).
10.2.25 Danforth Sign
William Clark Danforth (1878–1949) was born in Chicago, Illinois, USA, and
received his medical degree cum laude from Northwestern University in 1903, fol-
lowed by an internship at Cook County Hospital that same year [130, 131]. He
worked at the General Hospital, Vienna, from 1906 to 1907. Danforth was a private
practitioner in Evanston, Illinois, and was appointed chief of obstetrics and gynecol-
ogy at Evanston Hospital in 1908 [131].
He was president of the Chicago Gynecological Society in 1921, the Evanston
Branch of the Chicago Medical Society, the Chicago Gynecological Society, the
Institute of Medicine of Chicago, the American Gynecological Society, and a char-
ter member of the Central Association of Obstetricians and Gynecologist to name a
few [131, 132].
10.2 Eponymic Signs
332
As to his character as articulated by Grier:
He was by nature direct, analytical, and adamant in matters of principle. Yet, all who knew
him well will recall his keen sense of humor, his hearty laugh, and his seemingly limitless
repertoire of anecdotes. (…) He was a most generous contributor to many charitable causes
and was ever ready to give freely of his time to civic programs and to the care of the indigent
sick [131, p.139–140].
Danforth reported two cases of patients who presented with bilateral shoulder pain,
found during surgery to have an intra-abdominal hemorrhage secondary to a rup-
tured tubal pregnancy (Table10.1). He described the pathophysiology of this process:
In rupture of the pregnant tube, particularly if considerable intrabdominal hemorrhage
occurs, blood may enter the subphrenic space and cause traction upon the falciform liga-
ment in the same manner as it is produced by gas. This is especially apt to be so if the
bleeding is large in amount and if the rupture of the tube is followed by faintness. The
patient then is likely to lie at for a time and often the foot of the bed is elevated. This
allows the uid blood to run upward along the colon on both sides, particularly the right
side, and to nd its way into the subphrenic space [133, p.883–884].
Thus, the shoulder pain represents a referred pain from the third, fourth, and fth
cervical cord segments of the phrenic nerve.
10.2.26 D’Amato Sign
There is limited historical information on Hugo Julio D’Amato. He served as
Secretary General of the Ministry of the Interior National Department of Hygiene,
president of the editorial commission of the Boletín Sanitario (Health Bulletin), and
vice-president and ofcial delegate of the Argentina Republic at the rst Latin
American Congress of Hospitals [134–136].
D’Amato reported on 13 patients with infrahepatic adhesions and a positive
Novaro-Bermúdez sign. This paper titled “Consideration on a sign of adherence of
the infrahepatic area” was presented by Raul Novaro and Bermúdez Zolezzi at the
21st session of the Society of Internal Medicine and was based on nine cases
observed at the Institute of Professor Agote. As reported by D’Amato:
It is opportune to transcribe her the words with which the authors of the sign have so bril-
liantly described. “The procedure is simple. The rst investigation is performed with the
patient in the supine position. Palpate the duodenum and gallbladder area, applying direct
pressures toward the spine. Once the point of greatest pain is found, and with the ngers
remaining in this position, place the patient in the left lateral decubitus position with legs
exed. In the case of adhesions, gentle pressure causes intense unbearable pain. Pain is
absent even when rm pressure is applied with the patient placed in the right lateral decu-
bitus position. The sign is so prominent that there is no uncertainty about the pain provoked.
When referring to the explanation of the phenomenon, the authors said, “in the left lateral
decubitus, there is a tendency to separate the duodenum and the gallbladder from the lower
surface of the liver. The evidence for this nding is that frequently the patient cannot adopt
such a position due to immediate pain. With manual pressure, the organs separate immedi-
ately, causing intense pain due to the pulling. Contrary, in the opposite position (right lateral
decubitus), the named organs are in close contact and cannot be separated regardless of how
much pressure is applied.” [137, p.18].
10 Intra-Abdominal andDiaphragm Signs
333
Thus, D’Amato sign refers to palpatory pain in the infrahepatic region in the supine
and left lateral decubitus position in patients with intrabdominal adhesions (Table10.1).
10.2.27 Chapman Sign
Limited historical information is available on Charles Leopold Granville Chapman
(1871–1951). He was a medalist and prizemen for the Arthur Durham Third- and
Fourth-Year Prize for Dissection in 1896 and 1897 at Guy Hospital, London,
England [138, 139]. Chapman was a member of the Royal College of Surgeons of
England. At the time of the publication of his sign, he was a surgeon at the District
Hospital, Grimsby, England [140].
Chapman reported a method for identifying an acute abdomen which he called
the “Rising test.” The maneuver is performed as follows:
[t]he patient putting both hands down by the side of the thighs and then raising himself in
bed by means of the abdominal muscles. This produces pain immediately, and the patient
fails to raise himself or complains of pain in doing so. This test will prove positive when
there is little or no tenderness in the abdomen. In my hands it has frequently proved he pres-
ence of acute abdomen and is often the decisive factor in doing an immediate operation. The
test is a sign of an acute abdominal condition, not necessarily appendicitis, and applies
equally well in any acute abdomen [140, p.786].
Thus, Chapman sign refers to the inability of the patient to raise themself in the
supine position without using their hands in cases of acute peritonitis (Table10.1).
10.2.28 Blaxland Sign
Athelstan Jasper Blaxland (1880–1963) was born in London, England, and received
his bachelor of medicine and bachelor of science degrees from Westminster School
and University College Hospital in 1904 [141]. He was appointed house physician
under the aegis of Sidney Martin (1860–1924) at the University College Hospital;
to Sir Archibald Garrod (1857–1936) at the Hospital for Sick Children, Great
Ormond Street; and house surgeon to Gilbert Benjamin Mower White (1866–1952)
at the Great Northern Central Hospital, London. He served initially as a house sur-
geon rising to the rank of assistant surgeon at Norfolk and Norwich Hospital,
England, in 1909 [141, 142]. He became captain of the Second London Casualty
Clearing Station and surgeon in the Royal Army Medical Corps (RAMC) stationed
in France during World War I [141, 143]. On his return, he became a full surgeon in
1925 at Norfolk and Norwich Hospital [141, 142].
Blaxland was elected fellow of the Royal College of Surgeons (RCS), England,
and earned his master of science degree in 1908 [141, 144]. He was honorary secre-
tary to the Norfolk Branch of the British Medical Association from 1922 to 1928
and its president from 1930 to 1931, chairman of the Norwich Division from 1923
to 1924, vice-president of the Medical Defense Union, and chairman of the nursing
committee of the Norfolk and Norwich Hospitals [141, 142].
10.2 Eponymic Signs
334
As to a description of his character:
Jasper was a whimsical, lovable character who retained his impish sense of fun to the end.
(…) His provocative interventions in committee frequently aroused impatience-quickly to
be dissolved by an ingenuous aside [141, p.123].
Blaxland described a method for distinguishing an ovarian cyst from ascites:
To elicit the sign, the ngers of the two hands are pressed—one hand on either side of the
lower abdomen—rmly and steadily backwards towards the lumbar spine. In the case of an
ovarian cyst the pulsation of the abdominal aorta can be felt. Presumably the tension in the
cyst, caused by the pressure of the ngers, permits the transmission of the pulsation. This
sign can be accentuated—and also be made evident to onlookers—by inserting one end of
a at ruler (or a long pencil) under the ngers of one of the hands pressing on the abdomen.
The free end of the ruler will then show the pulsation magnied. I have never been able to
obtain this sign in a case of pure ascites [145, p.839].
Thus, Blaxland sign refers to pulsation of an ovarian cyst in the absence of ascites
(Table10.1).
10.2.29 Butler–Carlson Sign
10.2.29.1 Edmund Butler
Edmund Butler (1886–1952) was born in Davenport, Iowa, USA, and received his
medical degree from Cooper Medical College in 1911 [146]. He served as assistant
to Stanley Stillman (1861–1934) from 1911 to 1914. During World War I, he was a
lieutenant in the navy. He was appointed chief surgeon at San Francisco Emergency
Hospital in 1919 [146]. Butler was an associate professor at Stanford University and
a member of the American Medical Association, American College of Surgeons,
and San Francisco County Medical Society. He was a secretary of general surgery
at the 1922 meeting of the California State Surgical Society and president of the San
Francisco Surgical Society in 1943 [146–148].
10.2.29.2 Everett Carlson
Everett Carlson (1896–1983) received his medical degree from Stanford University
in 1924 and served as a house ofcer in surgery at the San Francisco County Hospital
and resident physician administrator of the Stanford University staff in 1926 [149,
150]. He was a fellow of the American College of Surgeons and vice-president of
the San Francisco Surgical Society in 1956 [151].
Butler and Carlson reported the case of a 24-year-old male with acute abdominal
and bilateral testicular pain occurring after sustaining a traumatic upper abdominal
contusion. On laparotomy, they found a rupture involving the posterior wall of the
third portion of the duodenum. They concluded that:
Early excruciating pain in the testicles following a severe trauma to the upper abdomen
indicates a retroperitoneal rupture of the duodenum with a spreading out of bile beneath the
10 Intra-Abdominal andDiaphragm Signs
335
peritoneum so as to irritate the testicular nerves, the sympathetic chain accompanying the
spermatic artery [152, p.118].
Thus, Butler–Carlson sign refers to intense testicular pain in retroperitoneal duode-
nal rupture (Table10.1).
10.2.30 Leotta Sign
Nicola Leotta (1878–1967) was born in Acireale, Sicily, Italy, and received his med-
ical degree from the University of Rome in 1901 [153, 154]. He was elected assis-
tant surgeon to the United Hospitals, Rome, in 1901 and at the University of Rome
Clinic, rising to the rank of assistant of the surgical clinic in 1907. He was a lecturer
in special surgical pathology in 1908 and a teaching surgeon from 1909 to
1928 [154].
Leotta was an assistant physician rst class to the Italian Red Cross in 1906 and
later the recipient of the bronze medal for his service assisting victims of earth-
quakes in Reggio Calabria in 1908 and Marsica in 1915 [154, 155]. During World
War I, he served as a medical captain organizing the surgical service of the Second
Army in 1916 and was promoted to lieutenant colonel in 1918 and later colonel
[154, 155]. He was appointed to Castrense University of San Giorgio di Nogaro in
1918, returning to the University of Rome after the war. He was appointed extraor-
dinary professor of special surgical pathology at the Institute of Clinical Surgery,
University of Palermo [154].
He assisted in the recruitment of the faculty of medicine; served as director of the
surgical clinic in 1925; full professor of the surgical clinic and operative medicine
in 1926; and rector from 1927 to 1929 at the University of Bari [154, 155]. Leotta
was appointed director of the University of Palermo Surgical Institute in 1929, dean
from 1932 to 1934, and rector magnico from 1939 to 1943 [154].
He was president of the Medical Academy of Palermo and Apulian Academy of
Sciences, secretary of the Italian Society of Surgery, and member of the Higher
Council for Public Education [154, 155]. Among his many awards and honors, he
was a recipient of the title of honorary professor of surgery from the University of
Argentina, Great Ofcer of the Crown of Italy, Knight of the Order of Saints
Maurice and Lazarus, Greater Ofcer of Merit of the Republic, and a Gold Medal
for his contributions to the school, culture, and art [154].
Leotta reported at the 38th Surgical Congress at Bari, Italy, a physical sign for
identifying the presence of adhesions arising from inammatory conditions involv-
ing the gallbladder, duodenum, stomach, and transverse colon. The sign cause pain,
elicited by applying indirect traction by longitudinally stretching the abdominal
wall in the right upper abdominal quadrant. He referred to this as a “stretching
maneuver” which involves:
1) To establish the existence of adhesions in the upper crossroads, i.e., between the colon at
the bottom and the liver and gallbladder at the tip; the maneuver of stretching at the bottom
10.2 Eponymic Signs
336
is applied, i.e., the ngers are placed in the right upper abdominal quadrant and pressed
downward. The traction pushing the colon downward will be painful if adhesion adheres to
the gallbladder or the liver. The pain increases if the patient forcibly exhales while the hand
is maintained in the lower traction position because the diaphragm rises, stretching the liver
and gallbladder upwards.
2) To establish the existence of adhesion between the ascending colon and parietal peri-
toneum, the maneuver involving stretching inside the right half of the abdomen is used.
Traction and pressure are applied with the hand in a transverse direction, starting from the
lateral abdomen, moving towards the midline, and from the midline outwards. This maneu-
ver stretches the adhesions, if they exist, in the ascending colon and the nearby parietal
peritoneum, causing more or less severe pain [156, p.119].
Thus, Leotta sign refers to the palpatory method for detecting adhesions between
the colon at the bottom, the liver and gallbladder tip, and ascending colon and pari-
etal peritoneum (Table10.1).
10.2.31 Lian–Odinet Sign
10.2.31.1 Camille Lian
Camille Lian (1882–1969) was born in Treigny (Yonne), France, studied medicine
in Paris, was an intern, and conducted research at Laennec Hospital and François
Franck’s Physiology Laboratory, graduating in 1909 based on a thesis on mitral
incompetence [157]. He was a battalion medical ofcer during World War I in 1914.
Lian served as a doctor of Hôpitaux de Paris (Paris Hospitals) in 1919, associate
professor of the Faculty of Medicine, Paris, in history of medicine in 1923, and
clinical professor of medicine in 1942 [157, 158]. During World War II, he served
as a medical ofcer in the army as head physician and cardiologist at Stanislas
Hospital, Nantes, France, in 1940 [159]. He was appointed physician to Tenon
Hospital, France, in 1926 and chair of La Pitié, France, until 1952 [157].
Among his many accolades and accomplishments, he was president of the French
Society of Cardiology from 1948 to 1950, founding president of the International
Cardiological Week of La Pitié, and a member of the National Academy of Medicine
of France, Spain, and Italy [158].
He was selected commander of the Legion of Honor, grand ofcer of the Order
of Research and invention and international Order of Public Welfare and Public
Health, Polonia Restituta; Knight of the Order of St. Sava, and Commander of Order
of the Flag [158, 159]. He received the Medal of Honor and War Cross for his work
during an epidemic during the war years [159]. He received the Golden Stethoscope
Award from the International Cardiology Foundation in 1965. He invented with
Minot a phonocardiograph which was instrumental in recording cardiac murmurs
and abnormal heart sounds [157].
10 Intra-Abdominal andDiaphragm Signs
337
As to his character as described by Bedford:
He was a prodigious worker, a prolic writer, and an active participant in scientic meet-
ings and congresses. As a teacher, he spoke clearly, and emphatically, and his lecture at the
Pitié on triple rhythm still ranks in my memory as a masterly exposition [157, p.789].
On a plaque afxed to the residence where he lived from 1926 to 1969 is inscribed:
In this house lived from 1926 until his death Professor Camille Lian (1882–1969), member
of the National Academy of Medicine who was the rst author of the clinical description of
myocardial infarction [160].
10.2.31.2 Jacques Odinet
There is limited historical information on Marie Jacques Odinet (1903–1998). He
was born in Paris, France, was an intern at the Hospitals of Paris, and defended his
thesis titled “Recherches anatomiques et physiologiques sur le thymus, leurs appli-
cations cliniques et thérapeutiques” (Anatomical and Physiological Research on the
Thymus, Their Clinical and Therapeutic Applications) in 1934. He was a hospital
doctor at Tenon Hospital, Paris [161].
Lian and Odinet reported a technique whereby percussion in patients with ascites
and hydatid cysts of the liver causes a distant auscultatory double sound (Table10.1).
Normally, percussion with a curved nger or hammer causes a single, brief, high-
pitch auscultatory noise which varies depending on the compliance and distention
of the abdominal wall:
However, in ascites, the acoustic sound is different. Instead of one unique noise, two dis-
tinct juxtaposed sounds are heard. The rst corresponds to the one heard in normal persons,
while the second one is more intense and longer, reecting the presence of peritoneal effu-
sion [162, p.1337]. (…) However, with minimal ascites, the double noise is not heard when
the patient is in the recumbent position. In this case, the double noise should be searched for
in the standing position. This last position is useful in that it provides decisive results.
Indeed, this sign signicantly increases the intensity of the sound in the standing position
because this position increases the contact between the surface of the ascites and abdominal
wall [162, p.1338].
Two symmetrical points at the iliac or anks are chosen to determine the distance
between the percussion and auscultatory sounds and conrm the diagnosis of
ascites.
10.2.32 Piteld Sign
Robert Lucas Piteld (1870–1942) was born in Germantown, Pennsylvania, USA,
received his medical degree from the University of Pennsylvania in 1892, and was
a resident at the Germantown Hospital from 1892 to 1893 [163, 164]. He was a
10.2 Eponymic Signs
338
special assistant to Joseph MacFarland, a researcher at the Henry K. Mulford
Company, a private pharmaceutical company, and appointed demonstrator of bacte-
ria at the Medico-Chirurgical College (merged with the University of Pennsylvania)
from 1902 to 1904 [163, 164]. He was appointed pathologist at the Widener
Memorial Hospital for Crippled Children in 1906 [165]. At the time of the third edi-
tion of his book titled A Compend on Bacteriology: Including Pathogenic Protozoa
in 1917, he was a pathologist at the Germantown Hospital, Philadelphia, and visit-
ing physician at St. Timothy’s Hospital beginning in 1908, and Chestnut Hill
Hospital, Philadelphia [163, 166].
Piteld described a method for detecting ascites:
It might well be called the diaphragm sign since this organ of respiration plays the most
important part in its mechanism. It consists rst in collecting the uid into as limited a space
as possible on the diaphragm by having the patient sit up in bed. The patient should now
lean forward a little. The back of thorax over the suspected areas is percussed with the n-
gertips of one hand, the other hand palpates the quadratus lumborum muscle on the same
side. This will cause the collected uid to vibrate, and the vibrations are felt by the palpat-
ing hand on the muscle [167, p.984].
This nding is based on the anatomical juxtaposition of the diaphragm and quadra-
tus lumborum muscle and its attachment to the twelfth ribs. Piteld postulated that
percussion of the chest in the presence of ascitic uid causes the chest to vibrate,
which is transmitted to the diaphragm and quadratus lumborum muscle and felt by
the palpating hand. Based on these principles, Piteld explained that this sign is
absent with deep inhalation and breath hold, pulmonary consolidation or neoplasm
in the lower lobe of the lung, and pulmonary adhesions attached to the diaphragm.
A false negative sign may be due to acute pneumonia [167, p.983–984].
Piteld also reported another method for detecting uid in the abdomen. In this
method, the patient is requested to:
[s]it upright in bed rather than to lie at on his back. The uid is thus gathered into one
place, and presses upon the entire circumference of the abdominal wall; the intestines are
oated up out of the way and cannot absorb the percussion impulses; and lastly, no third
hand is needed to compress the abdomen and the oating bowels as when the patient lies
supine. The height of the uid may be noted from time to time by this method by marking
the lowest place where the percussion impulse is felt [167, p.984].
Thus, Piteld sign refers to the ability to detect the height of the uid in the abdo-
men in the supine position (Table10.1).
10.2.33 Rob Sign
Charles Granville Rob (1913–2001) was born in Weybridge, England, and received
his medical degree from Cambridge University in 1937 [168]. While at Cambridge,
he joined the air squadron training as a pilot, obtaining a reserve commission in the
Royal Air Force [169, 170]. He was an intern in surgery at St. Thomas Hospital,
10 Intra-Abdominal andDiaphragm Signs
339
London, and a junior surgical resident at Royal Victoria Hospital, Montreal, during
World War II. Rob was appointed a fellow of the Royal College of Surgeons (FRCS)
in 1939, followed by a mastership of surgery in Cambridge [168–170]. He served as
resident assistant surgeon upon the acquisition of Hydestile Hospital by St. Thomas
Hospital [169].
Rob enlisted in the Royal Army Medical Corps and was a combat surgeon during
the war in 1942. He was the recipient of the Military Cross for bravery and service
and rose to the rank of lieutenant colonel [170]. He returned to St. Thomas Hospital
in 1946 and was appointed professor of surgery at Mary’s Hospital, London, in
1950 [168, 169].
He received an appointment at the University of Rochester Medical School in
1960, rising to the rank of professor and chair of the Department of Surgery until
1978 [168, 170]. Subsequent appointments include professor of surgery at East
Carolina University Medical School, Greenville, North Carolina, from 1978 to 1983
and nally as distinguished professor of surgery as a surgical professor and senior
adviser in the Department of Surgery at the Uniformed Services University of the
Health Sciences, Bethesda, Maryland in 1995 [168, 170].
He is best recognized for his pioneering work in vascular surgical repair of blood
vessels and performing a carotid endarterectomy [168, 170]. Rob was president of
the International Society for Cardiovascular Surgery and the North American
Chapter of the International Cardiovascular Society, as well as vice-president of the
American Surgical Association [168, 170]. He co-edited with Sir Edwin Rodney
Smith (1914–1988) the eight-volume set of Operative Surgery in 1956 [170].
Rob reported an auscultatory nding found in 250 patients with an acute abdomi-
nal emergency and 150 patients with an abdominal wound:
In this series intestinal peristalsis was abolished by the presence, in the peritoneal cavity, of
intestinal contents, pus, bile, hemorrhagic exudate from strangulated intestine, and exudate
from an acutely inamed pancreas. It was not abolished by the presence of blood or urine
in the peritoneal cavity [171, p.721].
Thus, Rob sign refers to the absence of intestinal peristalsis when intestinal con-
tents, pus, bile, hemorrhagic, and exudate occur intraperitoneally.
10.2.34 Robertson Sign
William Egbert Robertson (1869–1956) was born in Camden, New Jersey, USA,
and received his medical degree from the University of Pennsylvania in 1892 [172,
173]. After a brief internship at Episcopal Hospital in Philadelphia and Cooper
Hospital in Camden, New Jersey, he furthered his studies abroad, pursuing post-
graduate training in pathology in Heidelberg and Vienna. He returned to Philadelphia,
was appointed medicine instructor, and worked under the auspices of Milton
Howard Fussell (1855–1921) at the University of Pennsylvania outpatient clinic
[172, 173].
10.2 Eponymic Signs
340
He served as an instructor of bacteriology and microscopic pathology, with later
appointments as an instructor in physical diagnosis and medicine and assistant pro-
fessor of clinical medicine at the Medico-Chirurgical College and Hospital in
Philadelphia [172, 174]. He was a pathologist at Episcopal Hospital from 1897 to
1904, maintaining an appointment as a visiting physician until 1931 [172, 173].
Robertson was appointed professor and chair of the Department of Medicine at
Temple University and visiting physician at Samaritan Hospital, Philadelphia, from
1916 to 1933 [172]. He was a physician and chief of staff at Philadelphia General
Hospital; visiting physician at Garrison Hospital; chief of St. Luke’s and Children’s
Hospital Medical Center; and a consultant at Rush; Kensington Hospital for Women;
and Northeastern Hospital [172, 173].
He was a fellow of the College of Physicians of Pennsylvania in 1903 and took
an active role in the college’s library committee, serving as its chairman and mem-
ber of the council overseeing the work of the section of general medicine and medi-
cal history [173]. Robertson was appointed a fellow of the American College of
Physicians in 1920, was its president, and served on the board of directors and cen-
sors of the Philadelphia County Medical Society in 1937 [173].
As a description of his character by Kern:
His charm of personality, his grace of manner, his steadfastness of purpose, the deliberate
thoroughness with which he did things, his meticulous attention to detail. He was soft-
spoken and courteous, patient and forbearing, but let no one think that his mildness of man-
ner betokened any weakness of resolution or vacillation in action [172, p.57].
In co-authorship with his son Harold Frederick Robertson in their book Diagnostic
Signs, Reexes and Syndrome, they described a bedside maneuver for determining
a smaller quantity of ascitic uid:
When a patient is recumbent, and no uid exists in the abdominal cavity, one hand of the
examiner being placed under the ank of each side will elicit no tension or fullness, and
often a slight concavity, dependent upon the mount of adipose possessed by the patient.
When uid is present, however, the ank of each side presents a sensation of fullness, more
or less tension, and a quick upward thrust of the ngers by momentarily displacing uid
will result in a form of ballottement. In small effusions, when the patient is recumbent, the
vertebral column separates the uid which therefore tends to collect in the form of a pool in
the posterior portions of the abdomen, hence the possibility of this sign [175, p.286–287].
Thus, Robertson sign refers to ballottement at the anks when ascites is present
(Table10.1).
10.2.35 Way Sign
Stanley Albert Way (1913–1988) was born in Portsmouth, England, and qualied
from Middlesex Hospital in 1936 [176, 177]. He served as registrar at Princess
Mary Maternity Hospital and consultant in the Department of Gynecology at the
10 Intra-Abdominal andDiaphragm Signs