Nicholas Alders (1904 – 1995) was a Hungarian born, Austrian trained, English naturalised obstetrician, gynaecologist and surgeon.
Remembered for his description of Alders sign (1951) to differentiate the causes of abdominal pain in pregnancy and the puerperium
- Born on March 21, 1904 – Nikolaus Abelles in Budapest
- 1928 – Medical degree, Vienna
- 1930 – Specialist in obstetrics and gynaecology, Vienna
- 1938 – Forced to flee Vienna. A former house surgeon approached him and said “I am taking over your practice and flat, so you had better leave.” He protested, but the response “Have you ever heard of a concentration camp?” silenced him. He fled to England.
- 1941 – Requalified in medicine; surgeon in the Emergency Medical Service
- 1945 – Fellow of the Royal College of Surgeons, Edinburgh FRCSE
- 1947 – Naturalised in England as Nicholas Alders
- 1948 – Resident medical officer to the obstetrics and gynaecology department at the Royal Victoria Hospital, Bournemouth
- 1951 – Member of the Royal College of Obstetricians and Gynaecologists MRCOG
- 1954 – Consultant in obstetrics and gynaecology at the Royal Victoria Hospital, Bournemouth
- 1995 – ‘A few weeks before his death the Austrian government offered to restore his citizenship. He ignored the offer, being more than content to remain an Englishman with a foreign accent.’ Dr Ronald Fisher
- Died on August 30, 1995 in Bournemouth, Dorset, England
Alders sign (1951)
Alders sign to differentiate the causes of abdominal pain in pregnancy and the puerperium. In a gravid female with a palpable uterus and the patient in a supine position, the examiner locates the site of maximum pain on the abdominal wall. With fingers remaining at this site, turn the patient to the opposite side to a lateral decubitus position. If the pain lessens or disappears, then it is of uterine origin (e.g. leiomyoma, concealed haemorrhage). However, if the pain remains unaltered or fixed then it is deemed to be extrauterine in origin (e.g. appendicitis, ovarian torsion, diverticulitis, or gallbladder disease). Alders referred to this as the “sign of fixed or shifting tenderness”.
With the patient lying straight on her back, the examining fingers find the area of maximum tenderness to pressure on the abdominal wall. While the fingers remain in contact with that area without altering the intensity of pressure they are exerting to elicit pain, the patient is made to turn over on the opposite side so that the plane of the anterior abdominal wall is approximately vertical. The pain produced by the pressure of the fingers will be less or will have entirely disappeared if the lesion is uterine and has fallen away from the examining fingers “shifting tenderness”
…this sign can be of use only if the uterus is large enough to be palpable abdominally, and that it may be misleading in the rare case in which a uterine lesion has become fixed by adhesions to the anterior abdominal wall. In acute salpingitis, which does occur in pregnancy, the result of the test will depend on the presence or absence of perisalpingitic adhesionsAlders 1954: 1194-1195
Chen et al (n=14) reported that 36% of pregnant patients with appendicitis had a positive Alders sign. Tamir et al (n=85) only evaluated Alders sign in two of the 85 patients, and were therefore unable to evaluate its merit.
- Alders N. Portal pyaemia with recovery. Lancet. 1944; 243(6283): 151
- Alders N. Senile haematocolpos. Lancet. 1949; 254(6577): 513-514
- Alders N. Sign for Differentiating Uterine from Extrauterine Complications of Pregnancy and Puerperium. Br Med J. 1951; 2(4741): 1194-5. [Alders sign]
- Alders N. Scrotal gangrene in a newborn baby. Arch Dis Child. 1954; 29(144): 160-2.
- Alders N. The diagnosis of the acute abdomen in pregnancy. Med Illus. 1954 Aug;8(8):505-9.
Born: Nikolaus Abelles. Alias: Nikolaus Alders; Nicholas Alders.
- Nikolaus Alders. Date of Birth: 21/3/1904. Place of Birth: Budapest
- Naturalisation Certificate: Nikolaus Alders. From Austria. July 31, 1947
- List of ALIENS to whom Certificates of Naturalization have been granted by the Secretary of State. London Gazette September 19, 1947
- Obituary: Nicholas Alders. BMJ 1995; 311: 1294
- Bibliography. Alders, Nicholas. WorldCat Identities
- Horowitz MD et al. Acute appendicitis during pregnancy. Diagnosis and management. Arch Surg. 1985; 120(12): 1362-7.
- Tamir IL, Bongard FS, Klein SR. Acute appendicitis in the pregnant patient. Am J Surg. 1990; 160(6): 571-5; discussion 575-6.
- Chen CF, Tan KH, Shin FC, Chen HI. Acute appendicitis during pregnancy. J Med Sci. 1999; 19(9): 256-262
- DeSantis RA, Ernest G. Appendectomy during Pregnancy: A Survey of Two Army Medical Activities. Military Medicine 1999; 164(10): 671-674.
- Rastogi V et al. Abdominal Physical Signs and Medical Eponyms: Movements and Compression. Clin Med Res. 2018; 16(3-4): 76-82.
- Eponymythology: Appendicitis eponymous signs. LITFL
the person behind the name
Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |