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341
Royal Victoria Inrmary, Newcastle-upon-Tyne, in 1939 [176]. He also served as a
consultant for the Newcastle Regional Cancer Organization. After a brief appoint-
ment at Shotley Bridge General Hospital, he was appointed consultant to the Queen
Elizabeth Hospital, Gateshead, in 1947. He founded the oncology unit designed to
manage and conduct research on gynecological cancers [176, 177]. Way is perhaps
best recognized for his work on the study of the lymphatic drainage of the vulva,
which led to pioneering work on radical vulvectomy and lymph node dissection in
women with vulvar carcinoma.
Way was a Hunterian Professor of the Royal College of Surgeons from 1947 to
1948, Victor Bonney Prizeman and lecturer from 1964 to 1966, and with the
Royal College of Obstetricians and Gynecologists the Blair Bell Lectureship from
1947 to 1948 [176, 177]. He was elected fellow of the Royal College of
Obstetricians and Gynecologists in 1953 and appointed an honorary fellow of the
American Association of Gynecologists and Obstetricians and the International
Association of Cytology and a fellow of the Royal College of Surgeons (FRCS) in
1974 [176, 177].
Way in a consecutive series of 113 cases of tubal pregnancy reported on a fre-
quently overlooked symptom of shoulder tip pain (Table10.1):
To my mind this is one of the most important symptoms in ectopic gestation and for some
reason or other it has been completely neglected in gynecological textbooks. Its mechanism
is well understood, namely-irritation of the under surface of the diaphragm and the refer-
ence of pain through the phrenic nerve and its connections with the third, fourth and fth
cervical segments, these same segments supplying the skin over the tip of the acromion.
(…) [e]xcluding 15 of my cases in which there was no information it was found to be pres-
ent in 60% of ruptured ectopic gestations and in 41% of the whole series [178, p.551–552].
Way found a lack of correlation between the side of the ruptured ectopic pregnancy
and the involved shoulder. Of the 24 patients with shoulder pain, the pain was
referred to the right shoulder in 13 and the left shoulder in four. In seven cases, the
pain was present in both shoulders.
10.2.36 Dew Sign
Harold Robert Dew (1891–1962) was born in Reservoir, Victoria, Australia, and
received his medical degree from the University of Melbourne in 1914 [179–181].
He served during World War I as a temporary lieutenant in the Royal Army
Medical Corps (RAMC) in England in 1915 and with the eld ambulance in
France and Egypt [180, 182]. He commanded the cholera laboratory at the
Egyptian Stationary Hospital in Kantara in 1918 and received the accommodation
of the Epidemics Medal of Honor for his work from the French government in
1917 [181–183].
10.2 Eponymic Signs
342
Dew was elected Fellow of the Royal College of Surgeons (FRCS), England, in
1920 [180, 182]. He served as assistant director of the Walter and Eliza Hall Institute
of Medical Research and had joint appointments with the surgical staff as a clinical
assistant in 1922, becoming an honorary surgeon in 1923 at the Royal Melbourne
Hospital [179].
He was a founding fellow of the Royal Australasian College of Surgeons in 1928,
a professor of surgery and Bosch Chair at the University of Sydney, and a surgeon
at the Royal Prince Alfred Hospital from 1930 to 1956 [179–181, 183]. Dew served
as dean of the faculty of medicine at the University of Sydney from 1936 to 1938
and from 1940 to 1952 and president of the Royal Australasian College of Surgeons
from 1954 to 1955 [179, 181, 183]. He was a foundation member of the National
Health and Medical Research Council and was chair of the research advisor com-
mittee from 1946 to 1956 [180, 184].
His many honors included the Jacksonian Prize from the Royal College of
Surgeons in 1924, the David Syme Research Prize from Melbourne University in
1927, and Hunterian Professorship in 1930 and at the Royal College of Surgeons in
1953 [180, 183]. He is the recipient of an honorary doctorate degree from Cambridge
University and an honorary fellow at Edinburgh Royal College of Surgeons. Dew
was knighted in 1955 [182]. The Ormond College of Sir Harold Dew Medical
Scholarship is sponsored by the University of Melbourne, and the Sir Harold Dew
Prize at the University of Sydney was established in 1957 [185, 186].
As to a description of his character:
His sound clinical and operative work was based on an enviable familiarity with the funda-
mental preclinical aspects of surgery, and naturally this approach made him an excellent
expositor both to undergraduate and to colleagues. His complete sincerity and unselsh
devotion to surgery made him a wise adviser in both professional and educational manners
[185, p.1478].
Dew described a method for differentiating hydatid cysts in the right lung base and
those in a subdiaphragmatic location (Table10.1):
Hydatid cysts of the right lung must be distinguished from cysts of the superior quadrants.
Radiography shows elevation, xation, or distortion of the diaphragm, with or without
patches of calcication in the one, and a thoracic opacity in the other, and a thoracic opacity
in the other, although a co-existent pleural effusion may mask the real state of affairs. A
useful method is to compare the area of air entry and resonance at the right base in the sit-
ting and in the hands and knee positions [187, p.783].
In the case of a hydatid cyst located beneath the right cupola (subdiaphragmati-
cally), a resonance area moves caudally when the patient assumes the hand and knee
position [188].
10 Intra-Abdominal andDiaphragm Signs
343
Table 10.1 Intra-abdominal and diaphragm signs
Name Year Description of sign Signicance
Hippocratic facies [4] Fourth
century
BC
The eyes are sensitive to light, involuntarily tear, squint, or one eyelid is more closed than the
other. The conjunctiva is red and livid, has black veins, and is crusty. The eyes are restless,
protruding, or become very hollow. The countenance is squalid and dark, or the color of the
whole face is changed. All these are considered harmful and fatal symptoms. However, if the
eyelids are contracted, the lip and nose livid or pale, along with the other symptoms, one
knows that death is imminent
Peritonitis-agonal state
Stokes [10] 1842 Increased pulsation of the abdominal aorta Enteritis
Duchenne [17] 1873 At the beginning of inspiration, the epigastric and hypochondriac regions are depressed, and
the chest dilates. During expiration, these movements are reversed. When the diaphragm is
weak, this signs is seen only during forced respiration. During quiet breathing, abdominal
protrusion and chest expansion, and vice versa, occur in unison as during normal health.
When the diaphragm is paralyzed on one side, this signs is seen only on the paralyzed side.
Respiration is more rapid but is normal during rest
Diaphragmatic paralysis
Pfuhl-Jaffé [19, 21] 1877,
1881
During respiration, the pressure conditions in the thoracic cavity are exactly the opposite of
those in the abdominal cavity. If a manometer attached to a cannula is inserted into the
abscess, pressure uctuations occur during respiration. In the abdomen, inspiration produces
an increase and expiration a diminution of pressure. In the thorax, the reverse relationship
occurs
Subphrenic abscess
Federici [25] 1883 Transmission of heart sounds at a space bounded and enclosed by the diaphragm Peritonitis
Thomayer [30] 1884 In ascites, without peritonitis, a crescent-shaped mufed area is found during percussion. In
peritoneal tuberculosis and malignancy, the dimensions and localization of both the
tympanitic and the mufed areas are distinct. In all cases, the tympanitic intestinal sound was
predominantly found over the right side, and the dull liquid sound was over the left side of
the abdomen
Tuberculous and
malignant ascites
Clark [37] 1885 Sudden, severe pain is most commonly found in the lower abdomen and spreads rapidly. The
pulse is accelerated and becomes small. The bowel gas escapes into the peritoneal cavity and
is resonant to percussion over the lower part of the liver
Intestinal perforation
Fürbringer [41] 1889 On needle puncture, a serous exudate is found in an upper and a purulent exudate in a lower
intercostal space. Pus is aspirated after the needle has passed the diaphragm or when the
needle moves during respiration
Subphrenic abscess
(continued)
10.2 Eponymic Signs
344
Bolognini [45] 1895 The physician should quiet the patient to avoid abdominal muscle contraction. The patient is
supine with the thighs exed to relax the abdominal muscles. Place the hands on the
abdomen wall and, using the three middle ngers, alternate between the ngers of the hands,
applying light touch followed by increasing pressure. A tactile thrill is felt, giving the
impression that rubbing is occurring under the ngers, slightly produced by two rough
surfaces sliding over each other. The sensation is not uniform throughout the abdomen and is
only detectable in specic regions. Sometimes the rubbing is restricted to a specic point on
the abdomen. The rubbing may be present for only a brief period. It is not easy to reproduce
the phenomenon where it was previously found. For those performing this maneuver for the
rst time, it is recommended that only slight pressure be applied initially. By applying
increasing pressure, the sensation will disappear
Peritonitis
Cushing [51] 1898 Sudden acute onset of increased abdominal pain. Any complaint of pain of less abrupt onset
associated with tenderness should raise suspicion for a localized inammation of the
abdominal serosa with adhesive peritonitis
Peritonitis
Strauss [58] 1899 Carcinoma metastases occurring at Douglas pouch Peritoneal carcinomatosis
Landau [63] 1900 With the patient in a horizontal position, the ngers of the two palpating hands fail to meet
on the sides of the uterus. The slightly depressed uterus feels to the palpating ngers as if it
were lying on a cushion of air or water. If the patient is examined with the pelvis elevated
and the abdominal wall relaxed as much as possible by adduction of the thighs and exion of
the knees bimanual examination provides a different result. Now the ngers meet on the side
of the uterus so it can be grasped
Ascites
Lennander [67] 1902 The difference between the temperature in the rectum and the axilla, which normally is about
0.6°C, is greater in peritonitis
Peritonitis
Bryant [72] 1903 Blood effused into the right spermatic cord while the corresponding half of the scrotum is
ecchymosed
Abdominal aortic
aneurysm rupture
Morel [74] 1906 The patient is supine, and the bladder is catheterized and emptied. The injured person is told
to stand up immediately and remain upright for 2min. The patient is now placed in the
supine position, and the bladder is again catheterized. The bladder lls again with
intraperitoneal uid based on a quantity equal to the rst evacuation
Perforated bladder
Name Year Description of sign Signicance
Table 10.1
(continued)
10 Intra-Abdominal andDiaphragm Signs
345
(continued)
Kehr [80] 1907 Left shoulder pain in splenic injury Subdiaphragmatic
inammation
Barnard [95] 1907 The abdominal swelling formed by a subphrenic abscess does not descend on respiration,
because it is adherent. The part of the swelling formed by peritoneal adhesions is rigid,
tender, and dull on percussion. The part formed by pus in contact with the abdominal wall is
scarcely tender; it bulges, uctuates, and is dull on percussion
Subphrenic abscess
Blumer [101] 1909 On digital rectal examination, 2–4cm above the prostate gland, the nger is passed along the
anterior rectal wall and impinges on a cartilaginous shelf that projects into the rectal cavity.
In some cases, further palpation shows that the whole rectum is involved in an annular zone
of inltration more marked anteriorly and tapering off toward the posterior wall (a signet ring
stricture). In such cases, the inltration is no longer conned to Douglas’ pouch but involves
the submucosa of the rectum. The inltrated area is xed, shelf-like, or peg-like at its most
prominent portion, without ulceration of the overlying mucous membrane. The lack of
ulceration of the overlying mucosa and the peculiar shape distinguishes the rectal shelf from
a primary rectal neoplasm
Peritoneal carcinomatosis
or peritonitis
Brown [108] 1909 Two signs of intestinal perforation secondary to typhoid fever: Peritonitis
1. The “dipping-crackle” sound. The rst exam takes place a few minutes after the
perforation. On placing the bell of the stethoscope over the right iliac fossa and depressing
suddenly, a very ne crackle is heard, which sounded similar to a ne crepitant rale (as if two
sticky surfaces were drawn apart)
2. The patient is examined immediately, and a small area of tenderness is found low in the
right iliac fossa. The patient is then placed in the left decubitus position. Within 30min, the
area of tenderness moves about 2in. toward that side
Chilaiditi [111] 1910 The large bowel is located between the diaphragm and the liver. The type and severity of
displacement vary depending on the quantity and degree of distension of the interposed loop
of large bowel and laxity or elongation of the falciform ligaments of the liver or suspensory
ligament of the transverse colon
Interposition of the bowel
between the liver and
diaphragm
Oehlecker
a
[118] 1913 Right and left shoulder pain is due to inammatory processes and mechanical stimuli
involving the phrenic nerve endings of the diaphragm
Subdiaphragmatic
inammation
Claybrook [121] 1914 Transmission of heart and respiratory sounds over the abdomen and chest Peritonitis
10.2 Eponymic Signs
346
Drachter [122] 1914 Slightly raise one leg (the right one) with the patient lying on his back with the knee
extended and grasp the foot with the left hand. The sole of the right foot is hit lightly with the
right st
Peritonitis
Douglas (cry) [129] 1922 Palpating Douglas pouch causes traction on the uterus and causes the patient to express pain Peritonitis
Danforth [133] 1926 The patient lies at, and the foot of the bed is elevated, causing blood to run upward along
the colon, particularly the right side, and to the subphrenic space causing traction on the
falciform ligament
Subdiaphragmatic
inammation in ectopic
pregnancy
D’Amato [137] 1926 The patient is in the supine position. Palpate the duodenum and gallbladder area toward the
spine by applying direct pressure. Once the point of greatest pain is found, and with the
ngers remaining in this position, the patient is placed in the left decubitus position with the
legs exed. Gentle pressure causes intense unbearable pain. When the patient is placed in the
right decubitus position, there is no pain when rm pressure is applied
Adhesions
Chapman [140] 1927 The patient places his hand down at the side of the thighs and then raises himself in the bed
utilizing his abdominal muscles. Pain occurs immediately, causing the patient to be unable to
raise themselves
Peritonitis
Blaxland [145] 1930 The ngers of the two hands are pressed, one on either side of the lower abdomen, rmly and
steadily backward toward the lumbar spine. In patients with an ovarian cyst, the pulsation of
the abdominal aorta is 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 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
Ascites
Butler–Carlson [152] 1931 Early excruciating pain in the testicles following severe trauma to the upper abdomen
indicates a retroperitoneal rupture of the duodenum with bile throughout the peritoneum
irritating the testicular nerves, sympathetic chain, and spermatic artery
Peritonitis
Name Year Description of sign Signicance
Table 10.1
(continued)
10 Intra-Abdominal andDiaphragm Signs
347
Leotta [156] 1934 1. The maneuver involves stretching the abdomen to conrm the presence of adhesions
between the colon, liver, and gallbladder. The ngers are placed in the right upper abdominal
quadrant and pressed downward. This traction pushes the colon downward and is painful if
adhesions adhere 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
Adhesions
2. The maneuver of stretching inside the right half of the abdomen is applied to establish the
existence of adhesion between the ascending colon and parietal peritoneum. Traction and
pressure with the hand are applied in a transverse direction, starting from the lateral abdomen
and moving toward the midline and from the midline outwards. This maneuver causes pain by
stretching the adhesions, if they exist, in the ascending colon and the nearby parietal
peritoneum
Lian–Odinet [162] 1934 Depending on the compliance and distention of the abdominal wall, percussion with a curved
nger or hammer normally causes a single, brief, high-pitch noise to be auscultated. In
ascites, two distinct juxtaposed sounds are heard, with the rst corresponding to the one
heard in normal persons, while the second one is more intense and longer, reecting the
presence of peritoneal effusion. However, in patients with minimal ascites, the double noise
is heard in the standing, not supine position, because this position enhances the contact
between the surface of the ascites and the abdominal wall
Ascites
Piteld [167] 1936 Method 1 Ascites
The “diaphragm sign” consists in collecting uid into as limited a space as possible on the
diaphragm by having the patient sit in bed and leaning slightly forward. The posterior thorax
over the suspected areas is percussed using the ngertips of one hand, while the other hand
palpates the quadratus lumborum muscle on the same side. This causes the collected uid to
vibrate which is felt by the palpating hand on the muscle
Method 2
The patient sits upright in bed. The height of the uid is identied by marking the lowest
place where the percussion impulse is felt
Rob [171] 1947 Absent intestinal peristalsis is caused by intestinal contents, pus, bile, hemorrhagic exudate
from a strangulated intestine, and exudate from an acutely inamed pancreas, but not by
blood or urine in the peritoneal cavity
Abdominal trauma
(continued)
10.2 Eponymic Signs
348
Robertson [175] 1947 With ascites, the anks present a sensation of fullness and tension. With the patient
recumbent, a quick upward thrust of the ngers at the anks results in a form of ballottement
Ascites
Way [178] 1949 Irritation of the undersurface of the diaphragm causes pain over the tip of the acromion Subdiaphragmatic
Dew [187] 1961 If the hydatid cyst is located beneath the right cupola (subdiaphragmatically), an area of
resonance moves caudally when the patient assumes the hand and knee position compared to
the sitting position
Subdiaphragmatic cyst
a
Denotes an individual who supported anti-Semitism, racial acts, or committed crimes against humanity
Name Year Description of sign Signicance
Table 10.1
(continued)
10 Intra-Abdominal andDiaphragm Signs
349
10.3 Conclusion
A variety of signs were identied using the physical examination skills of observa-
tion, palpation, and percussion as a mechanism to identify conditions occurring
intra-abdominally. Some of these indirectly involved the diaphragms leading to sub-
diaphragmatic inammation, causing pain referred to the shoulder (Oehlecker,
Way). Eponymic signs of ascites described the various means to detect this condi-
tion and, in some cases, distinguish it from ovarian cysts (Blaxland). Douglas sign
or “cry” represents an interesting divergence from eponyms as it was described by
Henri Alphonse Albertin but in reference to the anatomical structure named by
James Douglas (1675–1742). These signs have not been studied; thus, their utility
in clinical practice remains unknown. They provide the learner with an appreciation
of the bedside examination as a method to diagnose disease.
References
1. Skinner HA. Diaphragm. In: The origin of medical terms. Baltimore, MD: Williams &
Wilkins; 1949. p. 118.
2. Beckett WA.A universal biography: including scriptural, classical and mythological mem-
oirs, together with accounts of many eminent living characters, vol. 2. London: Isaac, Tuckey,
and Co.; 1836. p. 636.
3. Skinner HA.Hippocrates. In: The origin of medical terms. Baltimore, MD: Williams &
Wilkins; 1949. p. 177.
4. Adams F.The genuine works of Hippocrates, vol. 1. London: Sydenham Society; 1849.
5. Stokes SW.William Stokes: his life and work. London: T.Fisher Unwin; 1898.
6. [No author]. Obituary: William Stokes. Lancet. 1878;1:108–9.
7. [No author]. Obituary: William Stokes. N Y Med J. 1878;27:330–1.
8. [No author]. Obituary: William Stokes. Med Times Gaz. 1878;1:51–2.
9. [No author]. Medical news: William Stokes MD, FRS.Edin Med J. 1878;22–23:764–5.
10. Stokes W, Bell J.Lectures on the theory and practice of physic, vol. 1. 2nd ed. Philadelphia,
PA: Barrington & Haswell; 1842.
11. Collins J.Duchenne of Boulogne: a biography and appreciation. Med Rec N Y. 1908;73:50–4.
12. Breighton P, Breighton G.Duchenne, Guillaume (1806–1875). In: The man behind the syn-
drome. Berlin: Springer; 1986. p. 44–5.
13. Keith A. Duchenne of Boulogne as orthopedist. In: Menders of the maimed. London:
H.Frowde; Hoddler & Stoughton; 1919. p. 91–105.
14. Brissaud E.L’Oeuvre scientique de Duchenne de Boulogne. Rev Sci. 1899;4:449–60.
15. Collective. Duchenne, Guillaume Benjamin Amand. In: The Encyclopaedia Britannica: a dic-
tionary of the arts, sciences, literature and general information, vol. 8. Cambridge: Cambridge
University Press; 1910. p. 629.
16. Mottet A.Duchenne (de Boulogne) et son œuvre. Rev Int Électrothérapie. 1896;6:257–70.
17. Duchenne GBA.Paralysis and contraction of the diaphragm. In: Poore GV, editor. Selections
from the clinical works of Dr. Duchenne (de Boulogne). London: The New Sydenham
Society; 1873. p. 325–33.
18. Pfuhl E.Wiki. https://second.wiki/wiki/eduard_pfuhl. Accessed 5 Oct 2022.
19. Pfuhl E.Ein oberhalb der Leber gelegenes peritonitisches Exsudat in die rechte Lunge perforirt
mit den Zeichen eines rechtsseitigen Pneumothorax. Berl klin Wochenschr. 1877;14:57–60.
References
350
20. Schomerus G. Jaffé Karl (1854–1917). In: Ein Ideal und sein Nutzen: Ärztliche Ethik in
England und Deutschland, 1902–1933. Frankfurt: Peter Lang; 2001. p. 184.
21. Jaffé K.Ueber subphrenische Abscesse nebst Bemerkungen über die Operation des Empyems.
Dtsch med Wochenschr. 1881;7:213–7.
22. [No author]. Obituary: Professor Cesare Federici. Lancet. 1892;1:1278.
23. [No author]. Morte di Socieo corr. Bull Sci Med. 1892;63:496–8.
24. Grocco P.Cesare Federici. In: Annuario per l’anno accademico. Firenze: R.Istituto di Studi
superiori pratici di perfezionamento in Firenze; 1893. p. 120–1.
25. Federici C. Istoria di una rara oppilazione dell’intestino. In: Revista Clinica. Bologna:
Francesco Vallardi; 1883. p. 84–93.
26. Thomayer J (23.3.1853–18.10.1927). Akademický bulletin. Ociální časopis Akademie
věd ČR. 2008. http://abicko.avcr.cz/archiv/2003/3/obsah/josef-thomayer-23.-3.-1853%2D
%2D18.-10.-1927-.html. Accessed 25 Oct 2022.
27. Thomayer J.Ps. R.E. Jamot (1853–1927), Mediziner und Schriftsteller. Österreichisches
Biographisches Lexikon. 2014. https://www.biographien.ac.at/oebl/oebl_T/Thomayer_
Josef_1853_1927.xml. Accessed 25 Oct 2022.
28. Mašek F.Prof. MU Dr. Josef Thomayer. Zdrav Prac. 1975;25:170–1.
29. Jedlička J. Profesor MU Dr. Josef Thomayer, klasik české lékařské vědy, národní kulturní
buditel, mecenáš a člověk. Cas Lék čes. 1972;111:551–6.
30. Thomayer J.Beitrag zur Diagnose der tuberkulösen und karzinomatösen Erkrankungen des
Bauchfells. Zeitschr klin Med. 1884;6:378–408.
31. [No author]. Obituary: Alonzo Clark, MD, LLD.Bost Med Sci J. 1887;117:296.
32. [No author]. Biography: Alonzo Clark, AM, MD, LLD.Gaillard Med J. 1887;45:379.
33. [No author]. Alonzo Clark, MD: a memorial read before the Academy of Medicine on January
5, 1888. Med Rec. 1888;33:122–4.
34. Echols M, Arbittier D.Alonzo Clark, MD.Medical Antiques. https://www.medicalantiques.
com/civilwar/Medical_Authors_Faculty/Clark_Alonzo.htm. Accessed 10 Sep 2022.
35. Special funds: Alonzo Clark scholarship fund. Catalogue, 1900–1901. Columbia University
in the City of New York. 1901. https://www.google.com/books/edition/Catalogue/0RsZA
AAAYAAJ?hl=en&gbpv=1&dq=Alonzo+Clark+1887&pg=PA54&printsec=frontcover.
Accessed 20 Oct 2022.
36. Elliot E.Memoir of Dr. Alonzo Clark, MD, LLD.N Y Acad Med. 1887;4:499–510.
37. Pepper W, Starr L.A system of practical medicine: General diseases (continued) and diseases
of the digestive system, vol. 2. Philadelphia, PA: Lea Brothers & Co.; 1885.
38. Stürzbecher M.Fürbringer, Paul. In: Neue Deutsche Biographie, Bd. 5. Berlin: Duncker und
Humboldt; 1961. p. 690–1.
39. Fürbringer P. Biographisches Lexikon hervorragender Ärzte. http://www.zeno.org/
Pagel-1901/A/F%C3%BCrbringer,+Paul. Accessed 22 Oct 2022.
40. [No author]. Veränderungen im Personalbestand der Akademie. Leopoldina. 1882;18:202.
41. Fürbringer P.Ueber Pyothorax subphrenicus. Berl klin Wochenschr. 1889;26:287–8.
42. [No author]. Prof. Dott. Pirro Bolognini. In: Annuario della R. Università degli studi di
Padova per l’anno accademico. Padova: Università di Padova; 1921. p. 209–10.
43. [No author]. Necrologio: Pirro Bolognini. L’università italiana rivista dell’istruzione supe-
riore. Bologna: Zamorani e Albertazzi; 1918. p. 48.
44. [No author]. Nuova sezione Polesana della ANMO.Rivista Ospedaliera Giornale. 1913;4:153.
45. Bolognini P.Di un segno precoce del morbillo. Pediatria. 1895;3–4:110–6.
46. Cannon WB.Obituary notices: Harvey (Williams) Cushing, 1869–1939. Biogr Mem Fellows
R Soc. 1941;3:277–90.
47. MacCallum WG. Biographical memoir of Harvey Cushing, 1869–1939. Nat Acad Sci.
1940;22:49–70.
48. Trail RR.Harvey Williams Cushing. London: Royal College of Physicians. https://history.
rcplondon.ac.uk/inspiringphysicians/harvey-williams-cushing. Accessed 30 Oct 2022.
49. [No author]. Editorials: Harvey Cushing. NEJM. 1939;221:623–5.
10 Intra-Abdominal andDiaphragm Signs