Nicholas Alders

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

Medical Eponyms
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 adhesions

Alders 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.

Major Publications


Born: Nikolaus Abelles. Alias: Nikolaus Alders; Nicholas Alders.



Eponymous term


BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, 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 |

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